To review the safety, efficacy, and clinical considerations of vaginal estrogen therapy for the treatment of genitourinary syndrome of menopause (GSM) in patients with a history of breast or gynecologic cancer. This is a narrative review of the current literature and clinical guidelines which evaluate vaginal estrogen use in cancer survivors, with a focus on the key outcomes of cancer recurrence and mortality as well as dosing considerations. Vaginal estrogen therapy is consistently associated with significant improvement in GSM symptoms and quality of life. There is minimal systemic absorption with low-dose formulations, with serum estradiol levels remaining within postmenopausal ranges. Large observational studies and meta-analyses show no increased risk of breast cancer recurrence or mortality among users, including those with estrogen receptor-positive disease and those on tamoxifen. Data on patients receiving aromatase inhibitors (AIs) are more limited. Current evidence supports the safety and efficacy of low-dose vaginal estrogen for GSM in most cancer survivors, with no clear increase in recurrence or mortality. Although nonhormonal therapies should be considered first-line, low-dose vaginal estrogen is an appropriate and effective option for patients with refractory symptoms along with shared decision making and multidisciplinary care. Further prospective studies are needed, especially in patients receiving AIs.

This study assessed the diagnostic accuracy and potential therapeutic value in performing targeted pelvic lymph node dissection (PLND) guided by magnetic resonance imaging (MRI)-ultrasonography (US) fusion combined with Indocyanine green (ICG) injection (tPLND-MUI). This study was retrospectively designed and included 72 patients who underwent robotic radical prostatectomy (RARP) combined with PLND. The inclusion criteria were: (1) prostate cancer with a Prostate Imaging Reporting and Data System version 2.1 (PI-RADS v2.1) category 4 or 5 lesion on MRI, (2) Patients who had clinical records of ICG fluorescence or surgical videos of PLND. The clinical impact of the tPLND-MUI was assessed based on its diagnostic accuracy for identifying nodal metastasis and its potential therapeutic value in achieving complete removal of metastatic lymph nodes. A backup PLND using the super-extended template (sePLND) was performed, and outcomes of tPLND-MUI, limited-PLND (limPLND), extended-PLND (ePLND), and standard-PLND (sPLND) were compared against sePLND. A total of 72 patients were incorporated into the final analysis. tPLND-MUI resulted in a median removal of 29 lymph nodes which were fewer than those of sePLND and ePLND. For detecting at least one lymph node metastasis, sensitivity reached 100% with both ePLND and tPLND-MUI, 95.2% with sPLND, and 71.4% with lim-PLND. The ratios of complete removal of lymph node metastases were 81.0% for ePLND, 66.7% for sPLND, 33.3% for limPLND, and 95.2% for tPLND-MUI. tPLND-MUI may demonstrate excellent therapeutic and diagnostic performance despite the removal of fewer lymph nodes and fewer dissecting regions. Further prospective research is needed to validate these findings.