Deirdre A Lum

All Publications

• Evaluation of the routine use of pelvic MRI in women presenting with symptomatic uterine fibroids: When is pelvic MRI useful? JOURNAL OF MAGNETIC RESONANCE IMAGING Kim-Nhien Vu, Fast, A. M., Shaffer, R. K., Rosenberg, J., Dababou, S., Marrocchio, C., Vasanawala, S. S., Lum, D. A., Chen, B., Hovsepian, D. M., Ghanouni, P. 2019; 49 (7): E271–E281

  View details for DOI 10.1002/jmri.26620

  View details for Web of Science ID 000474612300028

• Detection of Circulating Tumor DNA in Patients With Uterine Leiomyomas. JCO precision oncology Przybyl, J., Spans, L., Lum, D. A., Zhu, S., Vennam, S., Forgó, E., Varma, S., Ganjoo, K., Hastie, T., Bowen, R., Debiec-Rychter, M., van de Rijn, M. 2019; 3

  Abstract

  The preoperative distinction between uterine leiomyoma (LM) and leiomyosarcoma (LMS) is difficult, which may result in dissemination of an unexpected malignancy during surgery for a presumed benign lesion. An assay based on circulating tumor DNA (ctDNA) could help in the preoperative distinction between LM and LMS. This study addresses the feasibility of applying the two most frequently used approaches for detection of ctDNA: profiling of copy number alterations (CNAs) and point mutations in the plasma of patients with LM.By shallow whole-genome sequencing, we prospectively examined whether LM-derived ctDNA could be detected in plasma specimens of 12 patients. Plasma levels of lactate dehydrogenase, a marker suggested for the distinction between LM and LMS by prior studies, were also determined. We also profiled 36 LM tumor specimens by exome sequencing to develop a panel for targeted detection of point mutations in ctDNA of patients with LM.We identified tumor-derived CNAs in the plasma DNA of 50% (six of 12) of patients with LM. The lactate dehydrogenase levels did not allow for an accurate distinction between patients with LM and patients with LMS. We identified only two recurrently mutated genes in LM tumors (MED12 and ACLY).Our results show that LMs do shed DNA into the circulation, which provides an opportunity for the development of ctDNA-based testing to distinguish LM from LMS. Although we could not design an LM-specific panel for ctDNA profiling, we propose that the detection of CNAs or point mutations in selected tumor suppressor genes in ctDNA may favor a diagnosis of LMS, since these genes are not affected in LM.

  View details for DOI 10.1200/po.18.00409

  View details for PubMedID 32232185

  View details for PubMedCentralID PMC7105159

• Rising From the Ashes: Minimally Invasive Surgery in the Wake of Power Morcellation. Obstetrics and gynecology Lum, D. 2019; 134 (2): 225–26

  View details for DOI 10.1097/AOG.0000000000003386

  View details for PubMedID 31348208

• Techniques in minimally invasive surgery for advanced endometriosis CURRENT OPINION IN OBSTETRICS & GYNECOLOGY King, C. R., Lum, D. 2016; 28 (4): 316-322

  Abstract

  Surgery can be an important treatment option for women with symptomatic endometriosis. This review summarizes the recommended preoperative work up and techniques in minimally invasive surgery for treatment of deeply infiltrating endometriosis (DIE) involving the obliterated posterior cul-de-sac, bowel, urinary tract, and extrapelvic locations.Surgical management of DIE can pose a challenge to the gynecologic surgeon given that an extensive dissection is usually necessary. Given the high risk of recurrence, it is vital that an adequate excision is performed. With improved imaging modalities, preoperative counseling and surgical planning can be optimized. It is essential to execute meticulous surgical technique and include a multidisciplinary surgical team when indicated for optimal results.Advanced laparoscopic skills are often necessary to completely excise DIE. A thorough preoperative work up is essential to provide correct patient counseling and incorporation of the preferred surgical team to decrease complications and optimize surgical outcomes. Surgical management of endometriosis is aimed at ameliorating symptoms and preventing recurrence.

  View details for DOI 10.1097/GCO.0000000000000291

  View details for Web of Science ID 000379586200015

  View details for PubMedID 27273310

• Impact of the 2014 Food and Drug Administration Warnings Against Power Morcellation JOURNAL OF MINIMALLY INVASIVE GYNECOLOGY Lum, D. A., Sokol, E. R., Berek, J. S., Schulkin, J., Chen, L., McElwain, C., Wright, J. D. 2016; 23 (4): 548-556

  Abstract

  To determine whether members of the AAGL Advancing Minimally Invasive Gynecologic Surgery Worldwide (AAGL) and members of the American College of Obstetricians and Gynecologists Collaborative Ambulatory Research Network (ACOG CARN) have changed their clinical practice based on the 2014 Food and Drug Administration (FDA) warnings against power morcellation.A survey study.Participants were invited to complete this online survey (Canadian Task Force classification II-2).AAGL and ACOG CARN members.An online anonymous survey with 24 questions regarding demographics and changes to clinical practice during minimally invasive myomectomies and hysterectomies based on the 2014 FDA warnings against power morcellation.A total of 615 AAGL members and 54 ACOG CARN members responded (response rates of 8.2% and 60%, respectively). Before the FDA warnings, 85.8% and 86.9%, respectively, were using power morcellation during myomectomies and hysterectomies. After the FDA warnings, 71.1% and 75.8% of respondents reported stopping the use of power morcellation during myomectomies and hysterectomies. The most common reasons cited for discontinuing the use of power morcellation or using it less often were hospital mandate (45.6%), the concern for legal consequences (16.1%), and the April 2014 FDA warning (13.9%). Nearly half of the respondents (45.6%) reported an increase in their rate of laparotomy. Most (80.3%) believed that the 2014 FDA warnings have not led to an improvement in patient outcomes and have led to harming patients (55.1%).AAGL and ACOG CARN respondents reported decreased use of power morcellation during minimally invasive gynecologic surgery after the 2014 FDA warnings, the most common reason cited being hospital mandate. Rates of laparotomy have increased. Most members surveyed believe that the FDA warnings have not improved patient outcomes.

  View details for DOI 10.1016/j.jmig.2016.01.019

  View details for PubMedID 26827905

• Are fibroid and bony pelvis characteristics associated with urinary and pelvic symptom severity? Shaffer, R. K., Dobberfuhl, A. D., Vu, K., Fast, A. M., Dababou, S., Marrocchio, C., Lum, D. A., Hovsepian, D. M., Ghanouni, P., Chen, B. MOSBY-ELSEVIER. 2019

  View details for DOI 10.1016/j.ajog.2019.01.230

  View details for Web of Science ID 000467043800011

• Are Fibroid and Bony Pelvis Characteristics Associated with Urinary and Pelvic Symptom Severity? American journal of obstetrics and gynecology Shaffer, R. K., Dobberfuhl, A. D., Vu, K., Fast, A. M., Dababou, S., Marrocchio, C., Lum, D. A., Hovsepian, D. M., Ghanouni, P., Chen, B. 2019

  Abstract

  BACKGROUND: Urinary and pelvic floor symptoms are often attributed to size and location of uterine fibroids. However, direct supporting evidence linking increased size to worsening symptoms is scant and limited to ultrasound evaluation of fibroids. Because management of fibroids is targeted towards symptomatic relief, identification of fibroid and pelvic characteristics associated with worse symptoms is vital to optimizing therapies and preventing needless interventions.OBJECTIVES: We examined the correlation between urinary, pelvic floor and fibroid symptoms, and fibroid size and location using precise uterine fibroid and bony pelvis characteristics obtained from magnetic resonance imaging (MRI).STUDY DESIGN: A retrospective review (2013-2017) of a multidisciplinary fibroid clinic identified 338 women examined via pelvic MRI, Pelvic Floor Distress Inventory questionnaire (PFDI; score 0-300), and a Uterine Fibroid Symptoms questionnaire (UFS; score 1-100). Multiple linear regression analysis was used to assess the influence of clinical factors and MRI findings on scaled PFDI and UFS scores. Data were analyzed in STATA.RESULTS: Our cohort of 338 women had a median PFDI of 72.7 (IQR 41-112.3). Increased PFDI score was associated with clinical factors of higher BMI (p<0.001), non-commercial insurance (p<0.001), increased parity (p=0.001) and history of incontinence surgery (p=0.003). Uterine volume, dominant fibroid volume, dimension and location, and fibroid location relative to the bony pelvis structure did not reach significance when compared with pelvic floor symptom severity. The mean UFS score was 52.0 (SD 23.5). Increased UFS score was associated with dominant submucosal fibroid (p=0.011) as well as BMI (p<0.0016), and a clinical history of anemia (p<0.001) or any hormonal treatment for fibroids (p=0.009).CONCLUSION: Contrary to common belief, in this cohort of women presenting for fibroid care, size and position of fibroids or uterus were not associated with pelvic floor symptom severity. Whereas, bleeding symptom severity was associated with dominant submucosal fibroid and prior hormonal treatment. Careful attention to clinical factors such as BMI and medical history is recommended when evaluating pelvic floor symptoms in women with uterine fibroids.

  View details for PubMedID 30711512

• Evaluation of the routine use of pelvic MRI in women presenting with symptomatic uterine fibroids: When is pelvic MRI useful? Journal of magnetic resonance imaging : JMRI Vu, K., Fast, A. M., Shaffer, R. K., Rosenberg, J., Dababou, S., Marrocchio, C., Vasanawala, S. S., Lum, D. A., Chen, B., Hovsepian, D. M., Ghanouni, P. 2019

  Abstract

  BACKGROUND: Pelvic ultrasound (US) diagnosis of uterine fibroids may overlook coexisting gynecological conditions that contribute to women's symptoms.PURPOSE: To determine the added value of pelvic MRI for women diagnosed with symptomatic fibroids by US, and to identify clinical factors associated with additional MRI findings.STUDY TYPE: Retrospective observational study.POPULATION: In all, 367 consecutive women with fibroids diagnosed by US and referred to our multidisciplinary fibroid center between 2013-2017.FIELD STRENGTH/SEQUENCE: All patients had both pelvic US and MRI prior to their consultations. MRIs were performed at 1.5 T or 3 T and included multiplanar T2 -weighted sequences, and precontrast and postcontrast T1 -weighted imaging.ASSESSMENT: Demographics, symptoms, uterine fibroid symptom severity scores, and health-related quality of life scores, as well as imaging findings were evaluated.STATISTICAL TESTS: Patients were separated into two subgroups according to whether MRI provided additional findings to the initial US. Univariate and multivariate regression analyses were performed.RESULTS: Pelvic MRI provided additional information in 162 patients (44%; 95% confidence interval [CI] 39-49%). The most common significant findings were adenomyosis (22%), endometriosis (17%), and partially endocavitary fibroids (15%). Women with pelvic pain, health-related quality of life scores less than 30 out of 100, or multiple fibroids visualized on US had greater odds of additional MRI findings (odds ratio [OR] 1.68, 2.26, 1.63; P = 0.02, 0.004, 0.03, respectively), while nulliparous women had reduced odds (OR 0.55, P = 0.01). Patients with additional MRI findings were treated less often with uterine fibroid embolization (14% vs. 36%, P < 0.001) or MR-guided focused US (1% vs. 5%, P = 0.04), and more often with medical management (17% vs. 8%, P = 0.01).DATA CONCLUSION: Pelvic MRI revealed additional findings in more than 40% of women presenting with symptoms initially ascribed to fibroids by US. Further evaluation using MRI is particularly useful for parous women with pelvic pain, poor quality of life scores, and/or multiple fibroids.LEVEL OF EVIDENCE: 4 Technical Efficacy: Stage 3 J. Magn. Reson. Imaging 2019.

  View details for PubMedID 30614145

• Minimally Invasive Surgery for Uterine Fibroids with Contained Tissue Extraction CURRENT WOMENS HEALTH REVIEWS Brown, D. N., Lum, D. 2018; 14 (1): 42–47

  View details for DOI 10.2174/1573404813666170412114155

  View details for Web of Science ID 000425041700008

• Utility of MRI in deeply infiltrating endometriosis Lum, D. MOSBY-ELSEVIER. 2016: S513

  View details for DOI 10.1016/j.ajog.2016.01.131

  View details for Web of Science ID 000372080500119

• Impact of the 2014 FDA Warnings Against Laparoscopic Power Morcellation. Journal of minimally invasive gynecology Lum, D., Berek, J. S., Sheikhi, F., Sokol, E. R. 2015; 22 (6S): S77-?

  View details for DOI 10.1016/j.jmig.2015.08.207

  View details for PubMedID 27679337

• Conservative Laparoscopy for the Obliterated Posterior Cul-De-Sac. Journal of minimally invasive gynecology Lum, D. 2015; 22 (6S): S128-?

  View details for DOI 10.1016/j.jmig.2015.08.394

  View details for PubMedID 27678690

• Obesity and older age as protective factors for vaginal cuff dehiscence following total hysterectomy GYNECOLOGICAL SURGERY Donnellan, N. M., Mansuria, S., Aguwa, N., Lum, D., Meyn, L., Lee, T. 2015; 12 (2): 89–93

  View details for DOI 10.1007/s10397-015-0882-8

  View details for Web of Science ID 000213193000002

• Obesity and older age as protective factors for vaginal cuff dehiscence following total hysterectomy. Gynecological surgery Donnellan, N. M., Mansuria, S., Aguwa, N., Lum, D., Meyn, L., Lee, T. 2015; 12 (2): 89-93

  Abstract

  Studies have shown an increased risk of vaginal cuff dehiscence following total laparoscopic hysterectomy (TLH). Patient variables associated with dehiscence have not been well described. This study aims to identify factors associated with dehiscence following varying routes of total hysterectomy. This is a retrospective, matched, case-control study of women who underwent a total hysterectomy at a large, urban, university-based teaching hospital from January 2000 to December 2011. Women who underwent a total hysterectomy and had a dehiscence (n = 31) were matched by surgical mode to the next five total hysterectomies (n = 155). Summary statistics and conditional logistic regression were performed to compare cases to controls. Obese women (BMI ≥ 30) were 70 % less likely than normal weight women (BMI < 25) to experience a dehiscence (p = 0.02). When stratified by hysterectomy route, obese women were 86 % less likely to have a dehiscence following robotic-assisted total hysterectomy (RAH) and TLH than normal weight women (p = 0.04). Further, increasing age was protective of dehiscence in this subgroup of women (p = 0.02). Older age and obesity were associated with a decreased risk of dehiscence following RAH and TLH but not following other routes. Increased risk of dehiscence following TLH observed in previous studies may be partially due to patient characteristics.

  View details for PubMedID 25960707

• Brush Cytology of the Fallopian Tube and Implications in Ovarian Cancer Screening JOURNAL OF MINIMALLY INVASIVE GYNECOLOGY Lum, D., Guido, R., Rodriguez, E., Lee, T., Mansuria, S., D'Ambrosio, L., Austin, R. M. 2014; 21 (5): 851-856

  Abstract

  To determine whether fallopian tube epithelial cells adequate for cytopathology can be obtained via a minimally invasive approach using brush cytology.Prospective feasibility study (Canadian Task Force classification II-1).Tertiary-care university-based teaching hospital.Ten patients who underwent laparoscopic hysterectomy, with or without adnexal surgery, because of benign indications.Attempted hysteroscopic and laparoscopic brush cytologic sampling of the fallopian tubes.ThinPrep slides and cell blocks were prepared and analyzed. P53 and KI-67 immunostaining was performed on cell block specimens if adequate cellularity was present. The first 5 patients underwent attempted hysteroscopic sampling of the fallopian tube, with successful collection only in 1 patient. The protocol was then modified to enable sampling of the fallopian tube laparoscopically as well as hysteroscopically. In the other 5 patients sampling of the fallopian tubes was successful laparoscopically, including successful sampling hysteroscopically in 1 patient. The brush biopsy catheter could not be passed through the entire length of the fallopian tube in either the hysteroscopic or laparoscopic approach. All cytologic findings were interpreted as benign, although findings of nuclear overlapping, crowding, and small nucleoli were initially considered benign atypia. Immunohistochemistry for P53 and KI-67 yielded uniformly negative findings.To our knowledge, this is the first study to describe endoscopic brush cytology of the fallopian tubes with correlated cytologic narrative. In the future, cytologic sampling of the fallopian tube may have implications for an ovarian cancer screening test.

  View details for DOI 10.1016/j.jmig.2014.03.017

  View details for Web of Science ID 000342117800023

• Utilization of and charges for robotic versus laparoscopic versus open surgery for endometrial cancer JOURNAL OF SURGICAL ONCOLOGY Yu, X., Lum, D., Kiet, T. K., Fuh, K. C., Orr, J., Brooks, R. A., Ueda, S. M., Chen, L., Kapp, D. S., Chan, J. K. 2013; 107 (6): 653-658

  Abstract

  To analyze the utilization and hospital charges associated with robotic (RS) versus laparoscopic (LS) versus open surgery (OS) in endometrial cancer patients.Hospital discharge data were extracted from Florida Agency for Health Care Administration between October 2008 and December 2009.Of 2,247 patients (median age: 64 years), 29% had RS, 10% had LS, and 61% had OS. The mean length of hospital stay was 1.6, 1.8, and 3.9 days for RS, LS, and OS, respectively (P < 0.001). The median hospital charge was $51,569, $37,202, and $36,492, for RS, LS, and OS (P < 0.001), with operating room charges ($22,600, $13,684, and $11,272) accounting for the major difference. Robotic surgery utilization increased by 11% (23-34%) over time.In this statewide analysis of endometrial cancer patients, the utilization of robotic surgery increased and is associated with higher hospital charges compared to laparoscopic and open procedures.

  View details for DOI 10.1002/jso.23275

  View details for Web of Science ID 000317939400017

  View details for PubMedID 23129514

• Laparoscopic management of rectus sheath hematomas. Journal of the Society of Laparoendoscopic Surgeons Chamsy, D., Lum, D., Mansuria, S. 2013
• Cytologic Findings in Experimental in vivo Fallopian Tube Brush Specimens ACTA CYTOLOGICA Rodriguez, E. F., Lum, D., Guido, R., Austin, R. M. 2013; 57 (6): 611-618

  Abstract

  The fallopian tube is now recognized as a primary source of precursor neoplastic lesions for pelvic serous adenocarcinomas. Cytologic features of fallopian tube brushings from low-risk patients have not been well described.We describe the cytomorphology of tubal epithelium from prospectively collected experimental in vivo brushings from normal fallopian tubes of 7 low-risk patients. Liquid-based cytology slides and cell blocks were prepared and reviewed on all specimens.Fifteen brush cytology specimens were obtained, ten by laparoscopy, four by hysteroscopy and one following hysterectomy and bilateral salpingo-oophorectomy on an ex vivo specimen. Variable cytologic features were documented for background, cellularity, cellular architecture, cilia, nuclear overlap, mitoses, nuclear pleomorphism, nuclear membrane changes and nucleoli. Negative P53 and Ki-67 stain results were documented in available cell blocks. Histopathologic salpingectomy findings and clinical follow-up were benign.Moderate nuclear pleomorphism and nuclear overlap, prominent single and multiple nucleoli and background granular debris were common challenging cytologic findings in fallopian tube brushings from low-risk patients. With experience, cellular changes can be recognized as benign. Recognition of the range of normal fallopian tube cytology should help to minimize false-positive interpretations of cytology specimens obtained in association with risk-reducing salpingo-oophorectomies.

  View details for DOI 10.1159/000353825

  View details for Web of Science ID 000327925900013

  View details for PubMedID 24107657

• Cytologic findings in experimental in vivo fallopian tube brush specimens Acta Cytologica Rodriguez, E., Lum, D., Guido, R., Austin, R. M. 2013
• Total laparoscopic hysterectomy Female Pelvic Medicine and Reconstructive Surgery Lum, D., Lee, T. McGraw Hill Publishers. 2012