Microinvasive Cervical Carcinoma Research Articles

Addressing cervical cancer prevention in Bhutan: A study on the use of loop electrosurgical excision procedures at the primary health care level

AbstractBackgroundCervical cancer is the top and fourth leading cause of death among women in Bhutan and worldwide, respectively. The cervical cancer elimination flagship program initiated by the Ministry of Health aims to achieve the 90–70–90 goals by 2030. To achieve this, detection and treatment of pre‐cancerous lesions of the cervix through colposcopy and loop electrosurgical excision procedure (LEEP) are being carried out through the outreach health camps.MethodsThis descriptive study aimed to assess the safety and tolerability of LEEP under local anesthesia and assess the margin status of high‐grade lesion (HGL). We analyzed 193 records of clients who underwent LEEP at Wangdue Phodrang Hospital from 26 September to 5 October 2022. The sociodemographic profile, intraoperative pain, complications, and histopathological reports were described using structured pro forma.ResultsThe mean age of clients was 40.9 ± 8.5 years (range 25–66 years). There were 3.1% who had intraoperative and 2.6% who had postoperative bleeding. There were 18.6% who had foul‐smelling vaginal discharge, and 8.3% had moderate‐to‐severe intraoperative pain. Histopathological assessment revealed 29.5% with chronic cervicitis, 34.2% with HGL, and 1.6% with microinvasive cervical carcinoma. The margin positivity for HGL was 36.4%.ConclusionGiven the safety profile of LEEP under local anesthesia in our setting, the scope of providing a complete cervical cancer screening and treatment package at the primary health care level looks promising. Based on the higher rate of overtreatment and margin positivity, we recommend the practical implementation of standard colposcopy guidelines.

Clinical Epidemiology of Microinvasive Cervical Carcinoma in an Italian Population Targeted by a Screening Programme.

Simple SummaryAccording to this population-based study, 3750 patients living in the Emilia-Romagna Region (northern Italy) were registered with cervical carcinoma between 1995–2016, including 2942 eligible patients. The likelihood of stage IA cervical carcinoma (n = 876, 29.8%) did not change over time, decreased with increasing patient age, and was lower for patients with adenocarcinoma and grade 3–4 disease. Three hundred and fifty (40.0%) patients had a conservative treatment, 317 (36.2%) had hysterectomy, 197 (22.5%) had hysterectomy with lymph node dissection (LND), and 12 (1.4%) had a conservative treatment with LND. The proportion of hysterectomy decreased from 70.6% in 1995–1999 to 46.9% in 2011–2016. The likelihood of hysterectomy increased above the age of 40. Among screening-aged (25–64 years) patients, the likelihood of hysterectomy did not differ between screen-detected and non-screen-detected ones. Hysterectomy was increasingly combined with LND. High tumour grade was the strongest determinant of LND during hysterectomy.(1) Background: This population-based study aimed at identifying the factors associated with the likelihood of detection of stage IA cervical carcinoma—versus the detection of stage IB through IV cervical carcinoma—and the patterns of surgical treatment. (2) Methods: Between 1995–2016, 3750 patients living in the Emilia-Romagna Region (northern Italy) were registered with cervical carcinoma, including 2942 eligible patients (median age, 53). Multivariate analysis was performed using binary logistic regression models. (3) Results: The likelihood of stage IA cervical carcinoma (n = 876, 29.8%) did not change over time, decreased with increasing patient age, and was lower for patients with adenocarcinoma and grade 3–4 disease. Three hundred and fifty (40.0%) patients had a conservative treatment, 317 (36.2%) had hysterectomy, 197 (22.5%) had hysterectomy with lymph node dissection (LND), and 12 (1.4%) had a conservative treatment with LND. The proportion of hysterectomy decreased from 70.6% in 1995–1999 to 46.9% in 2011–2016. The likelihood of hysterectomy increased above the age of 40. Among screening-aged (25–64 years) patients, the likelihood of hysterectomy did not differ between screen-detected and non-screen-detected ones. Hysterectomy was increasingly combined with LND. High tumour grade was the strongest determinant of LND during hysterectomy. (4) Conclusions: This study provided a multifaceted overview of stage IA cervical carcinoma over the last decades.

Letter to the editor: the value of microendoscopy in the diagnosis of cervical precancerous lesions and cervical microinvasive carcinoma

Letter to the editor: the value of microendoscopy in the diagnosis of cervical precancerous lesions and cervical microinvasive carcinoma

The value of microendoscopy in the diagnosis of cervical precancerous lesions and cervical microinvasive carcinoma

Cervical cancer is still one of the main causes of death in females. Conventional diagnostic tools such as colposcopy are still unsatisfactory, so accurate diagnostic tools for cervical diseases are needed. Therefore, the purpose of this study was to perform a clinical study to evaluate the value of microendoscopic imaging systems in the diagnosis of cervical precancerous lesions and cervical microinvasive carcinoma (MIC). Totally 106 patients ranging in age from 23 to 67years were recruited. All patients had abnormal thin-layer cytology (TCT) results (≥ low-grade squamous intraepithelial lesions) and high-risk human papillomavirus (HPV) positivity. Each patient was first subjected to ordinary colposcopy, followed by microendoscopy and biopsy. All results of the colposcopy and microendoscopy images were compared to the histopathological diagnosis. Characteristics of pathological blood vessels were easily distinguished by microendoscopy compared with ordinary colposcopy. The diagnostic agreement rate of microendoscopy with the pathological diagnosis was higher (95.3%) than that of ordinary colposcopy (37.7%) (weighted kappa = 0.863, P < .01). When diagnosing HSIL and more advanced disease, the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of the microendoscopic diagnosis were significantly higher than those of ordinary colposcopy (97.6 and 38.1%), (95.5 and 63.6%), (98.8 and 80.0%), (91.3 and 21.2%) and (97.7 and 43.4%), respectively. This study shows that microendoscopy has important value in the diagnosis of cervical lesions which can provide real-time diagnosis in vivo without staining, particularly for lesions that are not sensitive to acetic acid staining.

Analysis of the risk factors of residual lesions after conization and prognosis of multifocal micro-invasive squamous cell cervical carcinoma treated with different types of surgery.

The aim of the present study was to evaluate the residual lesions after conization and the clinical outcome of patients with multifocal micro-invasive squamous cell cervical carcinomas (MMSCCs) treated with different surgical strategies. A retrospective study was carried out in 98 patients with MMSCCs diagnosed by conization and treated between January 2010 and December 2016 in 2 institutions. The patients underwent further different surgeries as therapeutic conization, extrafascial hysterectomy (ES), modified radical hysterectomy (MRH), radical hysterectomy (RH) with or without pelvic lymph node dissection (PLND) and regular follow-up. The clinicopathological characteristics of all of the patients were recorded. The risk factors of residual lesions and that of the recurrence were also analyzed in the present study. The logistic regression analysis revealed that cone margins (P=0.001) were correlated with residual disease after conization whereas parameters including age, gravidity, parity, menopause, stage, LVSI and the number of lesions were not predictors of residual lesions. The cone margin status also indicated the incidence of residual disease as follows: The risk of residual disease was lower with a negative margin when compared with the margin with micro-invasive carcinoma [MIC; odds ratio (OR)=0.064, P=0.012] and was lower in margin with a high-grade intraepithelial lesion than the margin with MIC (OR=0.297, P=0.287). The Cox regression analysis revealed that there were no significant correlations between the following surgery scales and postoperative recurrences, nor were any significant correlations found between the recurrences and the gravidity and parity, postmenopausal state, stage, residual disease after conization, margin status, LVSI and number of lesions (P>0.05). Positive cone margin was the only predictive factor for residual disease in patients with MMSCCs. There were no significant correlations between the surgical scales and postoperative recurrences. This result may be due to the excellent prognosis of MICs despite multiple lesions, regardless the treatment.

Superficial cervical scar endometriosis following cone biopsy

Background: Cervical cone biopsy is a common simple surgical procedure for cervical intraepithelial neoplasia and cervical microinvasive carcinoma, with post-surgical bleeding being a common complication. ----Case Report: A 30-year-old woman with a history of cone biopsy two years prior complained of cyclic genital bleeding during the luteal phase of menstruation for more than a year. She was diagnosed with cervical scar endometriosis after cone biopsy. Electric ablation suppressed her long-term atypical genital bleeding, which caused her discomfort. Conclusion: The authors treated a rare case of uterine cervical endometriosis after cone biopsy. We should consider ectopic scar endometriosis during the differential diagnosis of atypical bleeding in women who have had a cone biopsy.

16P - Analysis of immune checkpoint- and apoptosis-related lymphocyte markers expression and its association with the prevalence of regulatory lymphocyte populations in the establishment of microinvasive cervical carcinoma

16P - Analysis of immune checkpoint- and apoptosis-related lymphocyte markers expression and its association with the prevalence of regulatory lymphocyte populations in the establishment of microinvasive cervical carcinoma

Study on clinical management of HPV(+)/Pap(-) during cervical cancer screening

Objective: To study the clinical management way for HPV(+)/papanicolaou (Pap)(-) during cervical cancer screening. Methods: To analyze retrospectively the data from the patients who had loop electrical excision procedure (LEEP) for biopsy confirmed cervical intraepithelial neoplasia (CIN) Ⅱ in Peking University People's Hospital from Jan. 2010 to Dec. 2014. Results: (1) For biopsy confirmed CIN Ⅱ, HPV positive rate was 98.5% (135/137), Pap test positive [≥atypical squamous cell of undetermined significance (ASCUS)] rate was 69.3% (95/137), there was significant difference between them (χ(2)=43.32, P<0.01). (2) For the 42 patients with HPV(+)/Pap(-), whose cytology slides were reviewed again. Among them, the interpretations of there were 16 cases confirmed as the same before, while 26 cases were changed to abnormal (≥ASCUS). Cytology be misdiagnosed was 19.0% (26/137) at the first review. Among the 26 cases, 13 (50.0%) cases were missed for the little amount of abnormal cells, 8 (30.8%) cases for mild atypical morphology changed; the other 5 (19.2%) cases missed for stain problems. (3) For the cervical LEEP samples, 37 cases of the pathology diagnosis were upgrade to CIN Ⅲ(+), among them, 2 cases of microinvasive cervical carcinoma, 1 case of invasive cancer, 34 cases of CIN Ⅲ; 37 cases were CINⅠ or no lesion found; 63 cases were still CIN Ⅱ. Four to six months later after LEEP, the cytology abnormal rate was 11.7% (16/137), and the HR-HPV positive rate was 34.3% (47/137). Conclusions: Compared with cytology alone, cytology combined with HPV testing increase the sensitivity of cervical high grade lesion. For the cases of HPV(+)/Pap(-) cases, the cytology slides should be reviewed. The quality control of cervical exfoliate sample collection and interpretation should be strengthened. LEEP procedure is not only a treatment method, but also it could provide samples to confirm the diagnosis.

Previous cervical cytology and high-risk human papillomavirus testing in a cohort of patients with invasive cervical carcinoma in Shandong Province, China.

BackgroundCurrently, available data regarding previous cervical cytology and high-risk human papillomavirus (hrHPV) test results to detect invasive cervical cancer are limited and controversial in China. Therefore, this retrospective study in a population of Chinese women with invasive cervical carcinoma aimed to gain further insight into the roles of cytology and hrHPV testing in cervical cancer screening.MethodsA total of 1214 cases with a histological diagnosis of invasive cervical cancer were retrieved from the Pathology Database of Jinan KingMed Diagnostics (JKD) over a 5-year period. Previous cytology and hrHPV test results of 469 patients carried out within the year before cancer diagnosis were documented.ResultsA higher percentage of patients who had undergone prior screening had micro-invasive cervical carcinoma than patients who had no prior screening (25.4% vs. 12.1%, P < 0.001). Of the 469 patients with available prior screening results, 170 had cytology alone, 161 had hrHPV testing alone, and 138 had both cytology and hrHPV testing. There was a significantly lower percentage of hrHPV-positive cases with adenocarcinoma than with squamous cell carcinoma (77.8% vs. 96.4%, P = 0.001). The hrHPV test showed a significantly higher sensitivity than cytology alone (94.4% vs. 85.3%, P = 0.006). The overall sensitivity of the combination of cytology and hrHPV testing (98.6%) was much higher than that of cytology alone (P < 0.001) but only marginally higher than that of hrHPV testing alone (P = 0.058).ConclusionsThe results revealed that prior cervical screening can detect a significantly larger number of micro-invasive cervical cancers. The hrHPV test can provide a more sensitive and efficient strategy than cytology alone. As the addition of cytology to hrHPV testing can only marginally increase the efficiency of the hrHPV test, hrHPV testing should be used as the primary screening approach, especially in the low-resource settings of China.

Surgical treatment of microinvasive cervical cancer: analysis of pathologic features with implications on radicality.

To evaluate pathologic features with implications on surgical radicality in women treated with radical hysterectomy and pelvic lymphadenectomy for cervical cancer stage IA1 with lymph vascular space invasion (LVSI) and stage IA2 by correlating findings in conization and hysterectomy specimens. Women with cervical cancer stage IA1 with LVSI and stage IA2 diagnosed by loop electrosurgical excisional procedure or cold knife conization were treated with radical hysterectomy and pelvic lymphadenectomy from January 1999 to December 2011 in 2 institutions. Fifty patients were enrolled: 40 with stage IA2 and 10 with stage IA1 with LVSI. Median age was 43 (30-67) years. All patients underwent cervical conization for diagnosis (45 loop electrosurgical excisional procedure, 5 cold knife). Lymph vascular space invasion was detected in 15 patients (30%). Two patients had positive pelvic nodes. No parametrial involvement was detected in the entire cohort. Positive margins were present in 35 patients, and residual disease was detected in 22 patients (44%). Positive margins predicted residual disease at radical hysterectomy (P = 0.02). Medium follow-up time was 51 months. One patient developed a pelvic recurrence, and there were no disease-related deaths. Patients with positive margins in cone biopsy specimens have an increased risk of residual disease at radical hysterectomy and require careful evaluation before conservative surgery. Pelvic lymph node evaluation is essential because lymph node metastasis may occur even in early stages. The lack of parametrial invasion in this study reinforces the knowledge that the select group of patients with microinvasive cervical carcinoma stages IA1 LVSI and stage IA2 have a very low risk of parametrial infiltration. Less radical surgery can be carefully considered for these patients.

Performance of HPV DNA testing in the follow-up after treatment of high-grade cervical lesions, adenocarcinoma in situ (AIS) and microinvasive carcinoma.

BackgroundOver the last two decades it has become clear that distinct types of human papillomavirus (HPV), the so-called high-risk types (hrHPV), are the major cause of cervical cancer. The hrHPV-DNA testing has shown excellent performance in several clinical applications from screening to the follow-up of conservatively treated patients.MethodsWe conducted a systematic review of the recent literature on the performance of HPV DNA testing in follow-up after treatment of high-grade cervical lesions, adenocarcinoma in situ, and microinvasive carcinoma compared to Pap smear cytology.ResultsObservational studies have demonstrated that the high risk hrHPV-DNA test is significantly more sensitive (95%) compared to follow-up cytology(70%) in detecting post-treatment squamous intraepithelial high-grade lesions. Moreover, in patients treated conservatively for cervical adenocarcinoma in situ, the hrHPV-DNA test is the most significant independent predictor of recurrent disease or progression to invasive cancer, and the combination of viral DNA testing and cytology reaches 90% sensitivity in detecting persistent lesions at the first follow-up visit and 100% at the second follow-up visit. The cause of microinvasive squamous cervical carcinoma is increasingly treated with conservative therapies in order to preserve fertility, and an effective strategy allowing early detection of residual or progressive disease has become more and more important in post-treatment follow-up. Primary results seem to indicate that the median time for viral clearance is relatively longer compared with patients treated for CIN and suggest a prolonged surveillance for these patients. However, the potential clinical value of HPV-DNA testing in this clinical setting needs to be confirmed by further observations.ConclusionsThe excellent sensitivity, negative predictive value, and optimal reproducibility of the hrHPV DNA testing, currently is considered a powerful tool in the clinicians’ hands to better manage post-treatment follow-up either in cervical squamous lesion or in situ adenocarcinoma.

Laparoscopia quirúrgica en cáncer de cuello uterino, en el Hospital IV Huancayo EsSalud

Introducción: El cáncer de cérvix es la causa más frecuente de muerte en la sierra central peruana. El tratamiento quirúrgico (histerectomía total laparoscópica e histerectomía radical más linfadenectomía pélvica laparoscópica) es el recurso terapéutico mayormente curativo en los estadios iníciales (Ia1, Ia2 y Ib1). Hace un año en el Servicio de Ginecología del Hospital IV Huancayo iniciamos el tratamiento quirúrgico laparoscópico en estos estadios. Objetivos: Revisar los resultados de histerectomía laparoscópica en cáncer microinvasivo de cuello uterino. Diseño: Estudio retrospectivo. Institución: Servicio de Ginecología, Hospital IV Huancayo, EsSalud, Junín, Perú. Pacientes: Doce mujeres sometidas a histerectomía laparoscópica por carcinoma microinvasivo de cérvix. Intervenciones: En seis mujeres con diagnóstico preoperatorio de cáncer de cérvix por conización cervical y estadio clínico Ia1 se les realizó histerectomía laparoscópica, con un tiempo operatorio de 59,16 minutos y tiempo de estancia hospitalaria de 4,1 días. A otras seis mujeres con estadio clínico Ia2-Ib1 se les realizó histerectomía radical más linfadenectomía pélvica laparoscópica, con un tiempo operatorio de 3 horas 58 minutos y tiempo de estancia hospitalaria de 10,1 días. Principales medidas de resultados: Curación clínica. Resultados: Todos los diagnósticos fueron confirmados con la pieza operatoria, y todas las pacientes estaban teóricamente curadas (márgenes libres, ganglios negativos); una paciente presentó complicaciones, requiriendo estancia prolongada (8,3%). Conclusiones: La histerectomía total laparoscópica y la histerectomía radical más linfadenectomía pélvica laparoscópica pueden ser realizadas de manera más rápida y radical con respecto a la histerectomía convencional por laparotomía. Ambas son intervenciones factibles y seguras, que pueden garantizar la curación en el carcinoma microinvasivo de cuello uterino.

Microinvasive cervical squamous cell carcinoma in Slovenia during the period 2001-2007.

BackgroundMicroinvasive squamous cell carcinoma (MISCC) comprises a significant portion of all cervical cancers in Slovenia. Criteria of carcinomatous invasion are well described in the literature, however histopathological assessment of MISCC is difficult, because morphological characteristics can overlap with cervical intraepithelial neoplasia grade 3 (CIN 3) and other pathological changes. The aim of our study was to evaluate the reliability of the histopathological diagnosis of MISCC in Slovenia during the period from 2001 to 2007.Materials and methods.Data on patients with a histopathological diagnosis of cervical MISCC (FIGO stage IA) in the period of 2001 to 2007 were obtained from the Cancer Registry of Slovenia. Histological slides were obtained from the majority of pathology laboratories in Slovenia. We received 250 cases (69% of all MISCC) for the review; 30 control cases with CIN 3 and invasive squamous cell carcinoma FIGO stage IB were intermixed. The slides were coded and reviewed.ResultsAmong 250 cases originally diagnosed as MISCC, there was an agreement with MISCC diagnosis in 184 (73.6%) cases (of these 179/184 (97.3%) cases were FIGO stage IA1 and 5/184 (2.7%) cases were FIGO stage IA2). Among 179 FIGO stage IA1 cases 117 (65.4%) showed only early stromal invasion.ConclusionsThe retrospective review of cases diagnosed as MISCC during the period 2001–2007 in Slovenia showed a considerable number of overdiagnosed cases. Amongst cases with MISCC confirmed on review, there was a significant proportion with early stromal invasion (depth of invasion less than 1 mm).

Laser polarization-variable autofluorescence of the network of optically anisotropic biological tissues: Diagnostics and differentiation of early stages of cancer ofcervix uteri

This research presents the results of investigation of laser polarization fluorescence of biological layers (histological sections, cytological smears) in the task of diagnostics and differentiation of early stages of cancer: Dysplasia — cervical microinvasive carcinoma of cervix uteri. The analytical conditions of polarization-optimal probing of biological layers were determined basing on the model of linear birefringence and dichroism of birefringent (fibrillar, porphyrin) networks. The technique of polarization-variable laser autofluorescence was developed and experimentally tested. The objective criteria (statistical moments) of differentiation of histological sections autofluorescent images of endometrium biopsy and cytological smears of it mucous coat were defined. The operational characteristics (sensitivity, specificity, accuracy) of this technique were determined concerning the positions of probative medicine, and clinical efficiency.

Can Body Mass Index Influence the Outcome of a Laparoscopic Hysterectomy?

Objective: The purpose of this study was to evaluate differences in outcomes on the basis of body mass index (BMI) in patients undergoing laparoscopic hysterectomy. Design: The study was a retrospective analysis. Methods: All cases of laparoscopic hysterectomy performed from May 2008 to May 2012 for benign, microinvasive cervical, early endometrial, and occult ovarian carcinoma were reviewed. There were 347 patients analyzed by BMI. As proposed by the World Health Organization classification system of obesity, patients were categorized by BMI. Ideal BMI was defined as being between 18.5 and 24.9 kg/m2, overweight was defined as having a BMI between 25 and 29.9 mg/m2, and obesity was defined as having a BMI ≥30 kg/m2. Laparoscopic surgery was completed successfully in 338 patients, and 9 patients had their surgery converted to laparotomy for findings at the surgery, not for complications relating to the surgery, and, therefore, were excluded from the analysis. Results: Mean age was 51.1 years in the ideal group, 50.45 in the overweight group, and 55.49 in the obese group. The patients' ages ranged in all the samples between 31 and 94 years (p<0.003). Mean operating time was 105.5 minutes, mean blood loss was 252 mL, and mean length of hospital stay was 2.4 days. There was not a significant difference among the three groups. Total major complication rate was 3.7% and early postoperative complication rate was 5. There was not a significant difference among the three groups. Urologic injury was present in 0.6% of all patients. Conclusions: Laparoscopic hysterectomy is feasible and safe, resulting in short hospital stay, minimal blood loss, and minimal operating time for patients in all BMI groups. The laparoscopic approach may extend the benefits of minimally invasive hysterectomy to the very obese, for whom abdominal surgery poses serious risk. (J GYNECOL SURG 30:74)

Clinical management of cervical intraepithelial neoplasia in pregnant and postpartum women

To evaluate the clinical management of cervical intraepithelial neoplasia (CIN) and cervical microinvasive squamous cell carcinoma in pregnant and postpartum women. This prospective study enrolled 27,230 pregnant women undergoing routine gestational examinations between August 1, 2007 and July 31, 2010 in the Beijing Obstetrics and Gynecology Hospital, Capital Medical University. Colposcopy and cervical biopsy were performed for patients with abnormal Thin Prep® Papanicolaou test (TCT) results. Periodic colposcopy was performed every 8-12 weeks and cervical biopsy was performed if progression was suspected. Cervical cold knife conization was recommended to patients diagnosed with CINIII or microinvasive cervical carcinoma 6-12 weeks after delivery. A total of 2,260 patients had abnormal TCT results (8.12 %). Colposcopy and cervical biopsy were performed for 369 patients. Fifteen patients had microinvasive squamous cell carcinoma, 116 patients had cervicitis, and the number of CIN patients with histological grades I, II, and III were 124, 49, and 65, respectively. Tumor progression during pregnancy was found in 253 patients (CINI or above). Prognosis varied depending on the highest grade of pathological diagnosis results during pregnancy or initial pathological diagnosis results performed 6-12 weeks after delivery by cervical biopsy under colposcopy. Treatment and follow-up were carried out according to diagnoses, state of progression, and reversion (if any). These findings underline a need for cervical lesion screening for all women during pregnancy, and colposcopy should be performed for pregnant women who have abnormal TCT results. Appropriate treatment and follow-up were recommended according to different diagnosis of CIN.

Should high‐risk adolescents have Papanicolaou tests?

The current American College of Obstetricians and Gynecologists guidelines state that cervical cancer screening should begin at age 21 years, regardless of sexual or obstetric history. However, previous studies have demonstrated that there is a small but significant subset of high-risk adolescents with extensive sexual and obstetric history who harbor a significant squamous cervical lesion. The objective of the current study was to use histologic and demographic data from adolescents (aged <21 years) who received Papanicolaou (Pap) tests to determine whether they benefited from early cervical cancer screening. Adolescent girls who had Pap tests between 2000 and 2010 were included in the study. Demographic data, including obstetric history, number of sexual partners, age of first coitus, age at first pregnancy, menarche, smoking history, and Chlamydia and syphilis infection, were analyzed for associations with levels of cervical dysplasia. Of 56,785 adolescent Pap tests, 277 (0.5%) were diagnosed as high-grade squamous HSIL, and 56 of those Pap tests (20%) were from patients who had grade 3 cervical intraepithelial neoplasia (CIN-3) on subsequent biopsy and/or excision. One patient had microinvasive cervical carcinoma identified on loop electrosurgical excision procedure at age 27 years after an HSIL Pap test. Increased parity was associated significantly with higher rates of CIN-3. The study findings indicated that current American College of Obstetricians and Gynecologists guidelines to begin Pap testing at age 21 years are appropriate for the majority of adolescents, because the rate of HSIL is very low, and the risk for invasive carcinoma is minimal. Although higher parity was associated with a significantly increased grade of CIN, the conclusions are questionable because of the significant amount of missing demographic data points. That being said, this study should lead to other similar studies to determine any association of higher grade CIN with adolescent sexual and obstetric history.

The appropriate cone depth to avoid endocervical margin involvement is dependent on age and disease severity

To analyse factors associated with endocervical cone margin involvement and suggest appropriate cone depth for the conization procedure. Retrospective cohort study. Gynecological oncology center. One thousand two hundred and twenty women undergoing conization for cervical intraepithelial neoplasia (CIN) II or III or stage IA1 microinvasive cervical carcinoma. The following factors were analysed: age, parity, gravida, conization type, margin status, disease severity and specimen depth. Receiver operating characteristic curve analyses were used to determine the best cut-off points to define appropriate cone depth. Cone depth to avoid endecervical margin involvement. Ninety-one women had endocervical margin involvement (7.5%). This was positively associated with disease severity and age and inversely related to cone depth. In women under 50 years of age, the cut-off value was achieved at 1.8 cm cone depth, with high sensitivity and relatively low specificity [area under the curve (AUC) 0.64, sensitivity 0.86, specificity 0.27, p= 0.005]. For a subset of CIN II patients aged ≤50 years, the cut-off value was 1.2 cm (AUC 0.75, sensitivity 0.90, specificity 0.47, p= 0.008). In women <40 years of age, the cut-off value was 1.8 cm (AUC 0.60, sensitivity 0.88, specificity 0.25, p= 0.036). In a subset of CIN II, the cut-off value was 0.9 cm (AUC 0.87, sensitivity 0.83, specificity 0.69, p= 0.002). Age, disease severity and cone depth are predictive factors for endocervical margin involvement. In women of reproductive age, the appropriate cone depth to avoid endocervical margin involvement can be changed depending on age and disease severity.

Cervical microinvasive squamous carcinoma during pregnancy: observation and outcome of pregnancy with planned delayed treatment

To evaluate the maternal and fetal outcomes of planned delay in treatment for cervical microinvasive squamous cancer during pregnancy. A prospective study of pregnant women was done from August 1, 2007 to May 31, 2010. Pregnant women who had not been carried out cervical cytological screening within one year were got thin-prep cytology test (TCT) screening at their initial prenatal visit. Patients with abnormal cytological results were performed colposcopic examination and directed biopsy. Women with cervical microinvasive cancer were followed up every 8 to 12 weeks. If lesion progression were suspected, compared with previous image, repeated biopsy directed by colposcopy should be performed. Once worsening invasive cancer was confirmed, the pregnancy should be terminated timely. All patients should be reevaluated 6 to 12 weeks postpartum with repeated colposcopic examination and biopsy. All mothers were performed cold knife conization (CKC) at 6 to 12 weeks postpartum. We totally diagnosed 17 cases cervical microinvasive squamous carcinoma during pregnancy. The positive rate is 6.2/10 000 (17/27 230). After informed consent, 15 pregnant women decided to delay treatment until fetal maturation. The mean gestational age of initial diagnosis was (19.3 ± 5.9) weeks. The women were followed up 2 to 4 times during pregnancy. Only 1 patient was verified lesion progression by directed biopsy at 34 weeks and delivered by cesarean section. The progression rate during pregnancy was 1/15. The mean delivered time was (37.1 ± 1.8) weeks (ranged from 34 to 40 weeks). The mean diagnosis-to-delivery interval was (18.4 ± 5.2) weeks. All patients were delivered by cesarean section and all newborns had good outcomes. Finally we confirmed 1 case with cervical cancer stage Ia2, 11 cases with stage Ia1, 3 cases with cervical intraepithelial neoplasia (CIN) III by pathological diagnosis after CKC during 6 to 12 weeks postpartum. All cases were disease free after follow-up ranged from 22 to 48 months. It is necessary to perform TCT screening for pregnant women who have not been carried out cervical cytology screening within 1 year. If cervical microinvasive squamous cancer were suspected during pregnancy, in order to achieve fetal maturity it is acceptable for the women who desired pregnancy to delay treatment under closely monitoring until postpartum.

Atypical squamous cells of undetermined significance in postmenopausal women: a comparative retrospective analysis

ObjectivesTo determine the outcomes of women with a diagnosis of atypical squamous cells of undetermined significance (ASCUS) with respect to menopausal status. Study designBetween October 2006 and March 2010, the data of 214 postmenopausal women with ASCUS results on Pap smear were evaluated. Sociodemographic data and histopathological results were compared with those of 1018 premenopausal women with ASCUS cytology. ResultsAt the final diagnosis, most histological findings were normal in pre- and postmenopausal women with ASCUS cytology (70% and 70.1%, respectively). In the premenopausal group, 23.1% of the women had cervical intra-epithelial neoplasia (CIN) 1 lesions and 6.7% had CIN 2/3 lesions. Similarly, CIN 1 and CIN 2/3 lesions were detected in 23.4% and 6.1% of postmenopausal women, respectively. No significant difference in the final diagnosis was found between the two groups (p=0.88). Two premenopausal women (0.2%) and one postmenopausal woman (0.5%) had micro-invasive cervical carcinoma. There were no cases of invasive carcinoma in either group. ConclusionsAccording to this study, the rates of pre-invasive and micro-invasive cervical carcinoma were similar in pre- and postmenopausal women with ASCUS cytology.