Publications by authors named "Ruaidhri McVey"

8 Publications

  • Page 1 of 1

Endometrial Mesonephric-like Adenocarcinoma Presenting as an Ocular Lesion: A Case Report.

Int J Gynecol Pathol 2021 May 3. Epub 2021 May 3.

Department of Pathology, St. Vincent's University Hospital (S.A.L.N., A.D., S.K., D.G.) UCD School of Medicine and Medical Specialties (S.K., R.M.V., J.C., D.G.) Departments of Gynecological Oncology (R.M.V.) Oncology (J.C.), St. Vincent's University Hospital.

Endometrial mesonephric-like carcinoma (ML-CA) is a recently recognized subtype of aggressive endometrial adenocarcinoma that is morphologically and immunophenotypically similar to mesonephric carcinoma but not typically associated with mesonephric remnants. Here, we report a case of 58-yr-old female who had a past medical history of fibroids and of irregular menstrual bleeding for ~20 yr who presented with visual disturbance. On further investigation, she was found to have a large choroidal peri-papillary tumor of the right eye. A presumptive diagnosis of choroidal melanoma was made. Right eye enucleation was performed, and microscopy revealed moderately differentiated metastatic adenocarcinoma. Further work up was advised. A uterine mass was identified on imaging followed by endometrial biopsy that showed a morphologically and immunohistochemically similar tumor to that in the eye. A hysterectomy was carried out and a malignant neoplasm with varying morphologic patterns including gland formation, solid sheets of tumor cells, cribriform, glomeruloid, spindled and papillary areas was seen. The immunohistochemical profile showed diffuse strong positivity for AE1/AE3, TTF1, P16, and vimentin. CD56, GATA3, Napsin A, and CD10 were focally positive. The neoplastic cells were negative for the following markers ER, PR, WT1, calretinin, and synaptophysin. PDL-1 was negative and mismatch repair protein was proficient. An identical KRAS mutation was detected in both the uterine corpus and ocular tumors. The findings are in keeping with a uterine mesonephric-like adenocarcinoma with an ocular metastasis. An Oncomine Focus-Mutation profile, Thermo-Fisher Scientific Inc., a 60 gene oncologic panel, performed on the ocular tumor, revealed no further mutations.
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http://dx.doi.org/10.1097/PGP.0000000000000781DOI Listing
May 2021

Maternal morbidity in placenta accreta spectrum following introduction of a multi-disciplinary service compared to standard care: an Irish perspective.

Ir J Med Sci 2021 Jan 15. Epub 2021 Jan 15.

National Maternity Hospital, Holles Street, Dublin 2, Ireland.

Aim: The purpose of this study is to compare maternal outcomes in patients with placenta accreta spectrum (PAS) when managed as part of a multi-disciplinary team (MDT) compared to standard care.

Methods: Patients in the standard care group were retrospectively identified from pathology records, with patients in the MDT group prospectively collected on an electronic database. Data on maternal demographics, delivery, estimated blood loss (EBL), transfusion requirements, and morbidity were recorded.

Results: Sixty patients were diagnosed with PAS between 2006 and 2019, of whom 32 were part of the standard care group and 28 in the MDT group. Compared to standard care, MDT care was associated with an increase in antenatal diagnosis from 56.3 to 92.9% (p < 0.0001), a significant reduction in EBL (4150 mL (800-19500) vs 1975 (495-8500), p < 0.0001), and transfusion requirements (median 7 (0-30) units of RCC vs 1 (0-13), p < 0.0001).

Conclusion: PAS is associated with significant maternal morbidity and warrants management in an MDT setting with specialist input, which is associated with improved outcomes.
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http://dx.doi.org/10.1007/s11845-020-02473-3DOI Listing
January 2021

A meta-analysis of morbidity and mortality in primary cytoreductive surgery compared to neoadjuvant chemotherapy in advanced ovarian malignancy.

Gynecol Oncol 2019 09 23;154(3):622-630. Epub 2019 Jul 23.

Ireland East Hospital Gynaeoncology Group, Mater Misericordiae University, Dublin 7, Ireland; Ireland East Hospital Gynaeoncology Group, St Vincent's University Hospital, Dublin 4, Ireland; UCD School of Medicine, Mater Misericordiae University Hospital, Dublin 2, Ireland. Electronic address:

Aim The aim of this meta-analysis is to review the morbidity and mortality associated with primary cytoreductive surgery (PCS) compared to neoadjuvant chemotherapy and interval cytoreductive surgery (NACT + ICS) for advanced ovarian cancer.

Methods: A literature search was performed for publications reporting morbidity and mortality in patients undergoing PCS compared to NACT + ICS. Databases searched were Cochrane, Medline, Pubmed, Pubmed Central, clinicaltrials.gov and Embase. Two independent reviewers applied inclusion and exclusion criteria to select included papers, with differences agreed by consensus. A total of 1341 citations were reviewed; 17 studies comprising 3759 patients were selected for the analysis. The literature search was performed using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Results were reported as mean differences or pooled odds ratios (OR) with 95% confidence intervals (95% CI).

Results: Patients in the PCS group were significantly more likely to have a Clavien-Dindo grade ≥ 3 morbidity with an overall rate of 21.2% compared to 8.8% (95%CI 1.9-4.0, p < 0.0001) and were more likely to die within 30 days of surgery (OR 6.1, 95% CI 2.1-17.6, p = 0.0008). Patients who underwent NACT + ICS had significantly shorter procedural times (MD -35 min, p = 0.01), lost less blood intraoperatively (MD-382 ml, p < 0.001) and had an average admission 5.0 days shorter (MD -5.0 days, 95% CI -8.1 to -1.9 days, p = 0.002) than those undergoing PCS. While NACT was associated with significantly increased optimal and complete cytoreduction rates (OR 1.9, 95% CI 1.3-2.9, p = 0.001, and OR 2.2, 95% CI 1.5-3.3, p = 0.0001 respectively), this did not confer any additional survival benefit (OR 1.0, p = 0.76).

Conclusion: NACT is associated with less morbidity and mortality and improved complete cytoreduction compared to PCS, with no survival benefit. Hence NACT is an acceptable alternative in selected patients in particular with medical co-morbidities or a high tumour burden.
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http://dx.doi.org/10.1016/j.ygyno.2019.07.011DOI Listing
September 2019

Association of Implementing a Multidisciplinary Team Approach in the Management of Morbidly Adherent Placenta With Maternal Morbidity and Mortality.

Obstet Gynecol 2018 11;132(5):1167-1176

National Maternity Hospital, Mater Misericordiae University Hospital, and UCD School of Medicine, National Maternity Hospital, Dublin, Ireland.

Objective: To compare maternal outcomes in patients with morbidly adherent placenta managed in a multidisciplinary team setting compared with standard care.

Data Sources: A literature search was performed for publications reporting multidisciplinary pathways in the management of cesarean delivery for patients with morbidly adherent placenta. EMBASE, MEDLINE, PubMed, PubMed Central, ClinicalTrials.gov, and Cochrane databases were searched.

Methods Of Study Selection: Databases were searched for studies reporting maternal morbidity of patients with morbidly adherent placenta managed by a multidisciplinary team in a specialist center compared with standard care. Two independent reviewers applied inclusion and exclusion criteria to select included articles, with differences agreed by consensus. A total of 252 citations were reviewed; six studies comprising 461 patients were selected for the analysis.

Tabulation, Integration, And Results: Literature search was performed using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Results were reported as mean differences or pooled odds ratios (ORs) with 95% CIs. Estimated blood loss was significantly reduced in the multidisciplinary team group (mean difference -1.1 L, 95% CI -1.9 to -0.4, P=.004) and these patients had lower transfusion requirements (mean difference -2.7 units, 95% CI -4.1 to -1.2, P=.040). Those treated in a standard care setting were more likely to develop complications (OR 2.5, 95% CI 1.5-4.0, P<.001); however, there was no difference in length of stay between the two groups.

Conclusion: This meta-analysis highlights the improved maternal outcomes in patients with morbidly adherent placenta when managed by a multidisciplinary team in a specialist center. High-risk complex cases warrant expert management in centralized units.
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http://dx.doi.org/10.1097/AOG.0000000000002865DOI Listing
November 2018

Baseline Laparoscopic Skill May Predict Baseline Robotic Skill and Early Robotic Surgery Learning Curve.

J Endourol 2016 05 23;30(5):588-92. Epub 2016 Mar 23.

2 Department of Urology, St. Michael's Hospital , Toronto, Canada .

Introduction: Robotic surgery is associated with a learning curve unique to each trainee. Knowledge about a trainee's baseline skill and learning curve would facilitate the development of a more individualized training curriculum. The aim of our study was to determine whether baseline laparoscopic skill is predictive of one's baseline robotic skill and short-term learning curve.

Methods: Trainees from four different surgical specialties were included in the study. Each trainee participated in a 4-week, simulation-based robotic surgery basic skills training course. Precourse, baseline laparoscopic and robotic skills were assessed using validated test tasks; a basic peg transfer (PT) and an advanced intracorporeal suturing and knot tying (ISKT) task. Trainee robotic skill was assessed again 1 week postcourse. Each task performance was video recorded and scored by two blinded expert surgeons.

Results: A total of 32 trainees were included; 14 urology, 7 gynecology, 8 thoracic Sx, 3 general Sx. Most (91%) were senior residents or clinical fellows and 50% had no prior robotic experience. There were no differences in baseline laparoscopic and robotic skill related to reported prior robotic experience. Between specialties, no differences were seen on baseline laparoscopic skill and only small differences were seen on baseline robotic skill. Both baseline Lap PT (p = 0.01) and Lap ISKT (p = 0.01) performances correlated with baseline robotic ISKT performance, but not robotic PT scores. Only baseline Lap ISKT performance correlated with postcourse robotic PT (p = 0.01) and ISKT (p < 0.01) performance. Baseline robotic ISKT scores, but not PT scores, correlated with postcourse robotic performance (p = 0.02 for PT, p < 0.01 for ISKT).

Conclusions: In this study, a trainee's baseline laparoscopic skill correlated with certain baseline robotic skills. Better baseline performance on an advanced, but not basic, laparoscopic and robotic skill task may correlate with a shorter learning curve for basic robotic skills. Further exploration of this finding may yield better training curricula.
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http://dx.doi.org/10.1089/end.2015.0774DOI Listing
May 2016

Determining the role of a national objective assessment of surgical skills in gynecological oncology: an e-Delphi methodology.

Int J Gynecol Cancer 2014 Jul;24(6):1098-104

*Division of Gynaecologic Oncology, Sunnybrook Hospital and Health Sciences Center, Toronto, Ontario, Canada; †Department of Medical Informatics, The Royal College of Surgeons in Ireland, Dublin, Ireland; and ‡Division of General Surgery, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada.

Objective: The aim of this study is to determine a national consensus on the role of an objective assessment of technical surgical skills in gynecological oncology (GO).

Methods: After approval was obtained from Society of Gynecologic Oncology of Canada, A panel of 20 GO leaders was assembled, representing all GO fellowship programs, and was asked to participate in an anonymous group and respond to an online 49-item questionnaire using a modified Delphi methodology.

Results: Ninety-five percent (n = 19) of those invited to participate did so. Seventeen of the panelists (89.5%) believed there was no sufficiently standardized technical skills assessment for GO fellows, whereas 18 responders (95%) believed that fellows should be objectively assessed on more than 1 occasion during their training. Consensus was predefined as Cronbach α greater than 0.8. The panel agreed on what procedures should be objectively assessed with a Cronbach α of 0.967. An overall Cronbach α of 0.993 was achieved after a single Delphi round.

Conclusions: We achieved consensus on the possible components and logistics of a skills assessment process among a group of highly experienced GO trainers in Canada. This study provides the basis for further investigation and debate on the potential value, necessity, and feasibility of an assessment of advanced surgical and nonsurgical skills of GO trainees.
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http://dx.doi.org/10.1097/IGC.0000000000000157DOI Listing
July 2014

The fallopian tube as the origin of high grade serous ovarian cancer: review of a paradigm shift.

J Obstet Gynaecol Can 2014 Feb;36(2):133-140

Division of Gynaecologic Oncology, Princess Margaret Hospital, Department of Obstetrics and Gynaecology, University of Toronto, Toronto ON.

Research published over the past 10 years has suggested that most "ovarian cancer," and specifically the high-grade serous carcinoma (HGSC) subtype of ovarian cancer, actually originates in the fallopian tube. In this review, we examine the evidence supporting the tubal origin hypothesis for HGSC, and discuss the clinical implications of our improved understanding of the pathogenesis of ovarian cancer. We searched Medline R and Medline in-process and non-indexed citations from inception to December 15, 2012, to identify all English or French language articles discussing the origins of HGSC. Articles and findings were summarized descriptively. A step-wise transformation from normal epithelium to a lesion with the ability to invade and metastasize has been demonstrated within the fallopian tube. Intraepithelial or early invasive carcinoma of the fallopian tube is frequently identified in BRCA mutation carriers who undergo prophylactic risk-reducing salpingo-oophorectomy. In both BRCA mutation carriers and women from the general population, pre-invasive changes within the fimbriated end of the fallopian tube appear in association with early HGSC. Molecular and genetic studies, as well as in vitro and animal models, have also supported a tubal origin for HGSC. Whether the removal of fallopian tubes (salpingectomy) at the time of pelvic surgery for other reasons will lead to reductions in mortality from ovarian cancer is currently unknown, but it is an important area for future clinical research.
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http://dx.doi.org/10.1016/S1701-2163(15)30659-9DOI Listing
February 2014

Toward a wiki guide for obstetrics and gynecology trainees in Ireland.

Int J Gynaecol Obstet 2013 Mar 7;120(3):301-6. Epub 2013 Jan 7.

Department of Obstetrics and Gynecology, Sunnybrook Hospital, Toronto, Canada.

Background: The present paper describes the implementation of a novel, web-based, comprehensive national information hub for trainees in obstetrics and gynecology in Ireland. This was a unique development in the context of an entire medical specialty and was aligned with the communication strategy of the governing professional body. To date, trainee doctors working in Ireland undergo an incoherent and inconsistent new-staff induction and handover. In the healthcare setting, staff integration can have a major impact on the quality of patient care.

Methods: A free wiki software platform (PBworks) was used for the website, and freely available software (Google Analytics) was used to determine user interaction and level of engagement.

Results: In the first year, 442 user visits were recorded. The average duration of site visits was 4 minutes 39 seconds, which compared favorably with the 4-minute duration for visits to Wikipedia.

Conclusion: The project was successful as a proof concept and in practice. Other medical faculties have expressed an interest in adopting the concept and developing it for their trainees. The concept is widely applicable to other countries, with the negligible cost relevant to resource-poor areas.
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http://dx.doi.org/10.1016/j.ijgo.2012.10.017DOI Listing
March 2013