Status of human papillomavirus infection after loop electrosurgical excision procedure at the National Referral Hospital, Bhutan, 2022-2023: A retrospective study.

Previous studies have suggested that human papillomavirus (HPV) and HPV-related disease may be associated with increased risk of adverse pregnancy outcomes, e.g., hypertensive disorders of pregnancy, small for gestational age (SGA), and gestational diabetes mellitus (GDM). As active surveillance for cervical intraepithelial neoplasia grade 2 (CIN2) leaves the lesion and underlying infection untreated, we aimed to investigate whether the risk of adverse pregnancy outcomes differs between women who undergo active surveillance for CIN2 compared to women having an immediate large loop excision of the transformation zone (LLETZ). We conducted a nationwide register-based cohort study in Denmark. Individual-level data was collected from Danish healthcare registers. We included women aged 18-40 with a first-time diagnosis of CIN2 between January 1, 1998, and December 31, 2018, and a subsequent singleton birth. We estimated the risk of hypertensive disorder of pregnancy, SGA, and/or GDM in a subsequent pregnancy. We calculated crude and adjusted relative risks (aRR) adjusting for potential confounders using modified Poisson regression. We included 10 537 women with CIN2 and a subsequent singleton birth; 4430 women (42%) underwent active surveillance, and 6107 women (58%) had a LLETZ. We identified 548 (5.2%) cases of hypertensive disorders of pregnancy, 379 cases of SGA (3.6%), and 315 cases of GDM (3.0%). For all three outcomes, the adjusted relative risk was comparable between active surveillance and immediate LLETZ (aRR 1.08 (95% CI 0.91-1.29), aRR 0.94 (95% CI 0.74-1.19), aRR 0.92 (95% CI 0.73-1.16), respectively). Stratified analyses revealed insignificant differences in the risk of hypertensive disorders of pregnancy, SGA, and GDM. No association was found between CIN2 management and risks of hypertensive disorders, SGA, or GDM in later pregnancy. These findings suggest that untreated HPV-related lesions do not increase adverse pregnancy risks and may help reassure women during clinical counseling about future pregnancies after CIN2 treatment.

This study investigates obstetrics and gynecology (OB/GYN) residents' attitudes and practices towards human papillomavirus (HPV) prevention. OB/GYN residents nationwide received an online survey. One hundred sixty-one residents (89.4% females) participated. About 90.0% received the HPV vaccine, mostly before age 26. About 95.1% completed the series. Mean age and sex were significantly associated with vaccination status ( p < .001). Perceived occupational risk of HPV exposure was considered low in 52.2%, high in 45.3%, and absent in 2.5%. During loop electrosurgical excision procedures (LEEP), 27.92% reported always wearing an N95 mask, while 22.73% never do. Reassuringly, most OB/GYN residents are vaccinated against HPV. However, further improvement of protection against HPV (both vaccination and use of personal protective equipment) is recommended, as only 27.9% report always wearing an N95 mask during LEEP.

To identify predictive factors of the absence of high-grade intraepithelial lesion on large loop excision of the transformation zone specimen of patients with a previous histological diagnosis of high-grade intraepithelial lesion. We conducted a multicenter retrospective study in nine hospitals. All patients treated by large loop excision of the transformation zone following histological diagnosis of high-grade intraepithelial lesion between 2015 and 2021 were included. All patients had initial diagnosis of high-grade intraepithelial lesion performed on cervical biopsy and/or endocervical curettage. Clinical, cytological, colposcopic, and high-grade intraepithelial lesion data were extracted from medical files. The primary endpoint was the absence of high-grade intraepithelial lesion on the specimen, defined either by the identification of a low-grade intraepithelial lesion only or by the absence of any intraepithelial lesion. A total of 2037 patients were included. The absence of high-grade intraepithelial lesion was identified in 191 (9.4%) patients. Three predictive factors of high-grade intraepithelial lesion absence on large loop excision of the transformation zone specimen were identified: a small abnormal transformation zone defined by cervical involvement less than or equal to one quadrant (aOR: 2.01; 95%CI: 1.47-2.75; p < 0.001), a colposcopic impression of normal cervix or minor changes (aOR: 1.73; 95%CI: 1.24-2.42; p = 0.001), and normal or low-grade or ASC-US cytology (aOR: 1.37; 95%CI: 1.00-1.87; p = 0.049). Predictive factors of high-grade intraepithelial lesion absence on large loop excision of the transformation zone specimen of patients with a histological diagnosis of high-grade intraepithelial lesion are a small abnormal transformation zone, a colposcopic impression of normal cervix or minor changes, and normal, low-grade or ASC-US cytology. Practitioners should take these three elements into account when considering large loop excision of the transformation zone treatment in women with a proven diagnosis of high-grade intraepithelial lesion.

The objective of this study was to identify risk factors for recurrent cervical high-grade squamous intraepithelial lesions (HSIL/CIN2-3) following loop electrosurgical excision procedure (LEEP), with a particular focus on evaluating the protective effect of human papillomavirus (HPV) vaccination, including effective timing of administration, against disease recurrence. This retrospective study analyzed 343 patients with colposcopy-directed biopsy-confirmed cervical HSIL who underwent LEEP, including 127 vaccinated and 216 unvaccinated individuals. Multivariate logistic regression analysis was employed to identify risk factors associated with HSIL recurrence. Receiver operating characteristic (ROC) curve analysis was used to determine the optimal cutoff timing of HPV vaccination for preventing post-LEEP HSIL recurrence. Among the 343 patients, the post-LEEP HSIL recurrence rate was 9.0%. Multivariate logistic analysis identified CIN3 (OR = 2.956, 95% CI 1.046–8.352, P = .041), glandular involvement (OR = 3.517, 95% CI 1.165–10.621, P = .026), positive margins (OR = 2.496, 95% CI 1.100–5.667, P = .029), and persistent HPV infection (OR = 6.253, 95% CI 2.043–19.135, P = .001) as independent risk factors for HSIL recurrence. HPV vaccination was associated with a lower risk of HSIL recurrence (OR = 0.249, 95% CI 0.082–0.760, P = .015). ROC analysis indicated that administration of the HPV vaccine within 6 months post-LEEP was the optimal cutoff time for preventing recurrence (AUC = 0.851, P = .017). Vaccination either before LEEP or within this 6-month postoperative period significantly reduced the risk of HSIL recurrence (P = .034). CIN3, gland involvement, positive margins, and persistent HPV infection increase the risk of cervical HSIL recurrence after LEEP. HPV vaccination, when administered either before or within 6 months after LEEP, is associated with a lower risk of cervical HSIL recurrence.

To evaluate the 5-year efficacy of thermal ablation (TA) for cervical intraepithelial neoplasia (CIN) and high-risk HPV (hrHPV) clearance in Chinese women. A total of 17,202 women aged 20-65 years were recruited to screening cohorts in 2017-2018 from 3 rural counties in Shanxi and Inner Mongolia and an urban area in Shenzhen with follow-up evaluations until 2022. The hrHPV-positive women with ablation-eligible lesions on colposcopy underwent biopsy and TA (n = 228) in one visit. A loop electrosurgical excision procedure (LEEP) or cold knife conization (CKC) was recommended for ineligible women with high-grade CIN on histology (n = 106 and 41, respectively), while untreated hrHPV-positive women served as controls. Treated women had annual hrHPV testing and cytology. Untreated women had annual hrHPV testing. Positive cases were referred for colposcopy, with biopsy performed when indicated. Cure rates and hrHPV clearance rates were analyzed using Kaplan-Meier and competing risk models with sub-distribution hazard ratios (SHRs) assessing treatment effects. The 5-year cure rate for CIN1 regressing to normal was 79.0% after TA treatment and the 5-year cure rate for CIN2 regressing to CIN1/normal was 87.9%, comparable to LEEP (90.3%) and CKC (94.4%) for CIN2 (P = 0.54). The TA cure (66.0%) was significantly lower for CIN3 than LEEP and CKC (97.0% and 94.1%; P = 0.006). TA achieved 98.0% 5-year hrHPV clearance in CIN1/normal cases, which was higher than untreated women (87.7%; SHR = 0.81, 95% CI = 0.73-0.90), particularly for HPV16 (SHR = 0.67), HPV31 (SHR = 0.56), and HPV33 (SHR = 0.65). The 5-year hrHPV clearance after TA was comparable to LEEP and CKC for CIN2/3. TA provides durable efficacy for CIN1 and CIN2 and promotes hrHPV clearance, reducing progression risk. It could complement excisional treatments for CIN2 and enhance treatment accessibility in low-resource settings.

To evaluate the predictive value of preoperative hematological parameters for determining lesion grade and recurrence risk in patients diagnosed with cervical intraepithelial neoplasia (CIN) by biopsy. This retrospective study included 700 women who underwent a loop electrosurgical excision procedure (LEEP) following colposcopy at a tertiary referral center. Preoperative complete blood counts obtained within one week before surgery were used to calculate the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), monocyte-to-lymphocyte ratio (MLR), systemic immune-inflammation index (SII), and systemic inflammation response index (SIRI). These indices were compared according to LEEP histopathology and evaluated for recurrence over a two-year follow-up period. No significant differences were observed in hematologic parameters (NLR, PLR, MLR, SII, SIRI) between low- and high-grade lesions (all p > 0.05). Similarly, among patients with biopsy-proven CIN2, preoperative indices did not differ across final LEEP results. During a 24-month follow-up, histologic recurrence occurred in 6.7% of patients. Recurrence was associated with HPV persistence (p < 0.001), whereas the univariable association with lower MLR values (p = 0.049) did not remain significant after multivariable adjustment. In multivariable analysis, only persistent HPV infection remained an independent predictor of recurrence (OR = 2.98, p = 0.014). ROC analysis showed weak and clinically limited discriminative power for MLR (AUC = 0.61). Preoperative hematologic parameters showed no clinically meaningful predictive value for lesion severity or recurrence and should not be used for clinical risk stratification.

Cold knife conization (CKC) and the loop electrosurgical excision procedure (LEEP) are standard treatments for cervical intraepithelial neoplasia and carcinoma in situ. However, the comparative long-term effectiveness of these procedures in promoting human papillomavirus (HPV) clearance and preventing recurrent cervical lesions remains uncertain. To compare the long-term incidence of HPV clearance and recurrence of cervical lesions after CKC or LEEP. This cohort study comprised 2 cohorts: a nationwide cohort from Sweden (cohort 1) and a multicenter hospital-based cohort from Fujian Province, China (cohort 2). The study dates were January 1, 1997, to December 31, 2013, for cohort 1 and from October 1, 2013, to October 1, 2022, for cohort 2. A target trial emulation framework was applied to evaluate the effectiveness of CKC vs LEEP, using inverse probability of censoring weighting to balance baseline covariates and address censoring. Women with cervical intraepithelial neoplasia or carcinoma in situ were included. Data were analyzed from October 1, 2024, to August 31, 2025. Cold knife conization or the loop electrosurgical excision procedure. The primary outcome was recurrence of cervical lesions. Secondary outcomes included HPV clearance at 3, 6, and 12 months (cohort 2). Weighted Cox models with hazard ratios (HRs) and 95% CIs were used to compare the recurrence of cervical lesions between CKC and LEEP, adjusting for clinical and demographic factors. The total sample size was 77 001 women who underwent cervical conization in Sweden between 1997 and 2013. In cohort 1, after 22 years of follow-up, 16 017 of 75 497 (21.2%) women who underwent LEEP had recurrence, and 319 of 1504 (21.2%) women who underwent CKC had recurrence. In cohort 2, 65 of 3710 (1.8%) women who were treated with LEEP had recurrent cervical lesions compared with 11 (0.8%) recurrent cervical lesions among the 1340 women who were treated with CKC after 9 years of follow-up. In the hypothetical target trial, women who underwent CKC had a significantly lower risk of recurrence compared with those who underwent LEEP, with HR of 0.67 (95% CI, 0.65-0.68) in cohort 1 and 0.41 (95% CI, 0.21-0.79) in cohort 2. In addition, the HPV clearance rate after CKC was higher than that of LEEP at 3, 6, and 12 months in cohort 2. These findings suggest that among women with cervical intraepithelial neoplasia or carcinoma in situ, CKC was associated with a lower risk of recurrent cervical lesions and higher HPV clearance rates compared with LEEP.

Background/Objectives: Large loop excision of the transformation zone (LLETZ) is used as a standard treatment for cervical dysplasia. Although obesity is associated with reduced cervical screening participation and may complicate gynecologic procedures, evidence on the impact of body mass index (BMI) on LLETZ outcomes remains limited. This study aimed to evaluate the association between BMI and clinical outcomes after LLETZ, with a particular focus on margin status. Methods: This retrospective single-center cohort study included 1397 patients who underwent LLETZ for cervical dysplasia between January 2010 and December 2024 at the Medical University of Vienna. Patients were categorized as normal-weight (BMI < 25 kg/m2) or overweight/obese (BMI ≥ 25 kg/m2). The primary outcome was margin status. Secondary outcomes included postoperative bleeding, lesion localization, histological findings, HPV status, cone depth, and surgeon status. Results: Overall, 949 patients had a BMI < 25 kg/m2 and 448 had a BMI ≥ 25 kg/m2. Negative margins were achieved in 984 patients (70.4%), with no significant difference between BMI groups. Postoperative bleeding occurred in 53 patients (3.8%) and was significantly less frequent in patients with BMI ≥ 25 kg/m2. Each 5-unit increase in BMI was associated with a 38% reduction in the odds of postoperative bleeding. BMI was not significantly associated with HPV status or histological findings. Conclusions: BMI was not associated with overall margin status after LLETZ, suggesting that overweight and obesity do not adversely affect short-term surgical outcomes in general. Further prospective studies are needed to evaluate long-term outcomes.

Preoperative LVSI assessment in early-stage cervical cancer: Can it reliably guide lymph node management?

The oncologic safety of fertility-sparing surgery in young women with early-stage cervical cancer is largely based on retrospective data from small series, highlighting the need for larger studies to validate its safety. We performed a nation-wide retrospective matched cohort study of all patients age 18-45 years with Fédération Internationale de Gynécologie et d'Obstétrique (FIGO) 2018 stage IA1 to IB2 cervical cancer who underwent fertility-sparing surgery (FSS; cone biopsy, large loop excision of the transformation zone, or [radical] trachelectomy) between 2000 and 2022 in the Netherlands (fertility-sparing group). These patients were matched 1:2 with women who had a (radical) hysterectomy for early-stage cervical cancer (hysterectomy group). Patients were matched for pretreatment FIGO 2018 stage, histology, and lymph vascular space invasion. We compared data on recurrence-free survival, disease-free survival, and overall survival (OS) between the fertility-sparing group and the hysterectomy-group. In total, 1,446 patients were included: 482 treated with FSS and 964 with a (radical) hysterectomy; 57.5% had stage 1A1 or 1A2, and 42.5% had IB1 or IB2 cervical cancer. The median follow-up was 8.9 years (IQR, 4.4-13.7). During the study period, 4.8% of patients developed a recurrence: 7.1% in the fertility-sparing group and 3.6% in the hysterectomy group (hazard ratio [HR], 2.21 [95% CI, 1.38 to 3.56]).The OS in both groups did not differ (HR, 1.06 [95% CI, 0.62 to 1.80]). Women treated with FSS had a significantly higher recurrence rate than patients who had the uterus completely removed. However, since the increased recurrence rate did not affect OS, fertility-sparing surgery appears to be a potentially safe treatment option.

ABSTRACTObjectiveTo investigate factors contributing to discrepancies between colposcopic‐directed biopsy (CDB) and conization in patients with cytology‐positive cervical lesions to reduce missed diagnoses of cervical cancer and unnecessary conizations.MethodsA retrospective analysis was conducted, including 1407 patients with positive ThinPrep cytologic test (TCT) results who underwent both CDB and cervical conization (loop electrosurgical excision procedure and cold knife conization), selected from a cohort of 200,814 screened individuals (January 2020–April 2025). The histopathological diagnosis of specimens obtained from cervical conization served as the gold standard, and Firth‐corrected logistic regression models were utilized to evaluate pathological discrepancies and their influencing factors.ResultsMcNemar's test revealed a significant discrepancy between the diagnosis of HSIL+ by CDB and post‐conization (p < 0.01). The overall concordance rate between colposcopic biopsy and post‐conization diagnoses was 42.7% (601/1407), with a Cohen's kappa coefficient of 0.336, indicating slight agreement. Univariate logistic regression analysis demonstrated that diagnostic downgrading in cone specimens was significantly associated with several factors: age, cytology results, glandular involvement, the time interval between biopsy and conization, and transformation zone (TZ) type. Specifically, downgrading was more likely in patients < 35 years of age, with TCT results showing ASC‐US, LSIL, or ASC‐H, no evidence of glandular involvement, a biopsy‐to‐conization interval < 90 days, and TZ 1. Multivariate logistic regression analysis further identified the colposcopic impression of chronic cervicitis, TCT results of ASC‐US or LSIL, CDB results of chronic cervicitis, LSIL, and no glandular involvement as significant factors associated with downgraded conization diagnoses.ConclusionSignificant pathological discrepancies exist between CDB and conization, and clinicians should consider these factors to create more precise and individualized treatment strategies.

Potential use of HOTAIR and MALAT1 as prognostic biomarkers for cervical cancer: An application to the NHS.

Background: Immunosuppressed women are at increased risk of residual or recurrent high-grade cervical intraepithelial neoplasia (CIN 2-3) after excisional treatment, yet long-term comparative data remain limited. Previous studies are often small and heterogeneous, and they rarely compare outcomes directly with immunocompetent populations. This study evaluated the long-term incidence, timing and associated factors of CIN 2-3 recurrence after large loop excision of the transformation zone (LLETZ), stratified by immune status. Methods: We conducted a retrospective cohort study including 283 women treated with LLETZ for CIN 2-3 between 1996 and 2016 at Bellvitge University Hospital in Barcelona, Spain. Of these, 41 were immunosuppressed and 242 immunocompetent. Clinical, histopathological, virological, and immunological variables were extracted from hospital and pathology registries. Kaplan-Meier estimates and Cox proportional hazards models adjusted for immunosuppression status were used to evaluate time-to-recurrence and factors associated with recurrence. Results: At 36 months post-treatment, the probability of residual/recurrent CIN 2-3 was 44% in immunosuppressed women versus 5% in immunocompetent women (HR = 10.42, 95% CI 4.70-23.08, p < 0.001). Recurrence appeared earlier in immunosuppressed women (median 7 vs. 13 months). Persistent high-risk HPV infection at first follow-up (HR = 23.6, 95% CI 5.44-102, p < 0.001) and positive surgical margins (HR = 3.88, 95% CI 1.45-10.3, p = 0.007) were among the factors most strongly associated with recurrence, and advanced immunodeficiency (CD4+ < 200 cells/mm3 or detectable HIV viral load) was associated with earlier recurrences, though this association was not maintained after accounting for immunosuppression status in Cox models. Conclusions: Immunosuppressed women are at significantly higher and earlier risk of residual/recurrent CIN 2-3 after LLETZ. These findings support a risk-adapted, multidisciplinary follow-up integrating gynecologic, infectious disease, and immunologic care. Tailored surveillance and perioperative HPV vaccination may enhance secondary prevention in this high-risk population.

Background: Human papillomavirus (HPV)-related diseases remain a major global health problem, with cervical intraepithelial neoplasia (CIN) representing a key precursor to cervical cancer. Identification of high-risk HPV genotypes is essential for early diagnosis and appropriate management. This study aimed to evaluate the usefulness of in situ hybridization (ISH) for detecting HPV DNA in formalin-fixed, paraffin-embedded (FFPE) cervical tissue and to compare automated signal detection with manual histopathological assessment. Methods: This prospective, non-randomized study included 83 women undergoing diagnostic procedures for abnormal cytology or confirmed CIN between 2022 and 2023. Tissue specimens obtained during a loop electrosurgical excision procedure (LEEP) were examined using two ISH probes: ISH II for low-risk HPV types 6 and 11, and ISH III for high-risk HPV genotypes. Staining patterns and distributions were evaluated and correlated with molecular HPV testing and histopathological outcomes. Results: ISH II distribution was significantly associated with the presence of HPV type 6 or 11 (p < 0.001), although stain structure itself was not. ISH III stain structure was significantly associated with high-risk HPV genotypes (p = 0.020). A positive ISH II result predicted low-risk HPV infection with a sensitivity of 62.5% and specificity of 64.0%, while ISH III predicted high-risk HPV infection with a sensitivity of 86.36% but lower specificity (23.53%). Overall diagnostic accuracy was 63.86% for ISH II and 73.49% for ISH III. Conclusions: ISH proved to be a reproducible method for detecting HPV in archived cervical tissue, enabling assessment even years after specimen collection. Although PCR-based methods remain more widely used due to higher sensitivity and less invasive sampling, ISH provides valuable morphological context and may serve as a complementary diagnostic tool, particularly when only archival tissue is available.

IntroductionCervical cancer remains a major health concern in low-resource settings, with Cambodian women experiencing some of the highest rates due to limited screening access. 15% of all Cambodian women work in the garment industry; very few of which have ever been screened for cervical cancer. Achieving the WHO’s 90–70–90 cervical cancer elimination target will require new service-delivery models capable of reaching large numbers of women in high-risk or underserved populations.MethodsA cross-sectional feasibility study was conducted, screening 2690 female garment workers aged 25–49 across nine factories in Cambodia. Mobile clinics were set up in factories to facilitate the screening and treatment process. Participants self-collected swabs for human papillomavirus (HPV) testing and results were communicated directly to participants via text message. Women with positive results were scheduled for digital colposcopy and concurrent treatment with thermal ablation or large loop excision of the transformation zone.ResultsOf the 2690 workers screened, 341 (12.7%) tested positive for HPV, of whom 314 (92%) underwent colposcopy and 311 had biopsies. Only seven of the 2690 self-swab specimens were found to be inadequate (ie, insufficient DNA) for testing (0.26%). There were 17 cases of CIN2+ lesions (cervical intraepithelial neoplasia), including one adenocarcinoma.ConclusionsThis study demonstrates that implementing HPV-based cervical cancer screening with mobile clinics in garment factories is feasible and highly accepted among workers. Such programmes not only enhance early detection and treatment of cervical lesions but also improve workforce stability and could serve as a model for other industrial sectors in low-resource settings. This screening model, which facilitates large numbers of women to be efficiently screened with self-swab HPV testing, may help Cambodia progress toward achieving the WHO’s 70% screening target. Integration of workplace-based models with national referral systems for more advanced treatment (when necessary) may reduce loss-to-follow-up and strengthen continuity of care.

The purpose of this study was to compare the efficacy of cold-knife conization (CKC) and loop electrosurgical excision procedure (LEEP) in treating cervical adenocarcinoma in situ (AIS) and identify relevant risk factors within a recent cohort from a tertiary hospital in China. We conducted a retrospective chart review of patients who underwent a conization procedure with a preoperative or postoperative diagnosis of AIS of the cervix from January 2021 to July 2024. Clinicopathological data and follow-up results were collected, with recurrence-free survival (RFS) as the primary endpoint. Among the 251 patients included, 161 (64.14%) underwent LEEP and 90 (35.86%) underwent CKC as primary treatment. Overall, 29.9% (75/251) underwent eventual hysterectomy. Median follow-up was 36 months. The positive margin rate was lower in the CKC group than in the LEEP group (16.7% vs. 31.7%, P < 0.001). Multivariate analysis showed that LEEP (aOR 2.28, 95% CI 1.13-4.58, P = 0.021), TZ type 2 or 3 (aOR 2.00, 95% CI 1.12-3.58, P = 0.019), and AIS with concurrent HSIL (aOR 2.07, 95% CI 1.13-3.78, P = 0.018) were independently associated with positive margins. Greater cone depth was associated with lower risk (per 1mm increase: aOR 0.73, 95% CI 0.55-0.97, P = 0.031) when conization type was excluded due to collinearity. Among patients who underwent hysterectomy, positive conization margin was the only predictor of residual disease (aOR 9.12, 95% CI 1.07-77.8, P = 0.043). Kaplan-Meier analysis showed a significant difference in RFS among the three groups (P = 0.018), but pairwise comparison did not reveal a significant difference between the LEEP and CKC groups (P = 0.109). In this retrospective cohort, CKC achieved lower positive margin rates than LEEP for AIS. However, short-term RFS did not differ significantly between the two techniques, suggesting that margin status alone may not fully predict oncologic outcomes. Positive margin was a predictor of residual disease at hysterectomy, but this finding requires validation. For fertility-seeking patients, CKC is preferred to optimize margins, though LEEP may be acceptable when CKC is not feasible.

Background and Objectives: To evaluate ocular findings in women with cervical HPV positivity undergoing loop electrosurgical excision procedure (LEEP) for cervical dysplasia and to assess conjunctival/eyelid papilloma and other ocular findings in this cohort. Materials and Methods: This single-center, prospective, cross-sectional observational study was conducted at a tertiary referral hospital between September 2021 and October 2023. Women in whom LEEP was planned because of cervical dysplasia were eligible for inclusion. Patients who consented to ophthalmologic evaluation underwent preoperative eye examination and were included in the study. For the final analysis, women with cervical HPV negativity were excluded. Demographic characteristics, cervical HPV status and subtype, colposcopic biopsy histopathology, final LEEP histopathology, and ophthalmologic findings were recorded prospectively. Ocular findings were classified as normal ocular findings, conjunctival/eyelid papilloma, or other ocular findings. Results: A total of 75 women were included in the final analysis. Normal ocular findings were observed in 66 women (88.0%), conjunctival/eyelid papilloma lesions were identified in 3/75 (4.0%), and other ocular findings were identified in six (8.0%). There were no significant differences among the ocular finding groups in age, gravida, or parity. Alcohol use differed across ocular finding groups (p = 0.039), although this finding was based on only three patients in the papilloma group and should be regarded as exploratory. Ocular findings were associated with colposcopic biopsy histopathology (p = 0.016) but not with final LEEP histopathology. In exploratory adjusted analyses, no independent predictor of conjunctival/eyelid papilloma or any other ocular pathology was identified. Conclusions: In this cohort, the majority of patients had normal ocular findings, and conjunctival/eyelid papilloma lesions were identified in only three patients. The observed ocular findings did not support a clinically meaningful cervical–ocular association in this cohort. Further studies with ocular tissue-based HPV testing are needed to investigate whether HPV is present in ocular lesions and whether these findings correspond to cervical HPV results.

To evaluate the diagnostic performance of systematic multiple biopsies in individuals with a transformation zone type 3 (TZ3) at colposcopy and to assess the influence of referral status and the use of dynamic spectral imaging (DSI) colposcopy on the detection of CIN2+ lesions. In this multicentre cross-sectional study, a total of 189 individuals referred with abnormal cytology and/or hrHPV positivity with a TZ3 at colposcopy were included at three colposcopy clinics in the Central Denmark Region. Data were obtained from questionnaires, electronic medical records and the Danish National Pathology Registry. All participants underwent colposcopy with four cervical biopsies. Histological outcomes were based on the combined results of all four biopsies and, when available, compared with the corresponding large loop excision of the transformation zone (LLETZ) specimens. One centre employed DSI colposcopy, while two centres used conventional colposcopy. Main outcome measures were CIN2+ detection rate and sensitivity of individual and combined biopsies, assessed overall and stratified by referral status and colposcopy method. The overall CIN2+ detection rate was 16.9%. The detection rate increased with each additional biopsy, with the highest sensitivity observed at the fourth biopsy (71.4%). The detection rate was significantly higher among individuals referred with high-grade abnormalities (42.6%) compared with low-grade referrals (6.4%) (p < 0.001). The use of DSI colposcope did not significantly improve biopsy sensitivity. Concordance between biopsy and LLETZ histology was 85.3%. Systematic multiple biopsies improve CIN2+ detection in women with TZ3 but may lead to overtreatment in those referred with low-grade abnormalities. Despite this approach, the true CIN2+ detection rate may still be underestimated.

Emerging evidence demonstrates the benefit of adjuvant HPV vaccination at the time of loop electrosurgical excision procedure (LEEP) in reducing cervical intraepithelial neoplasia 2+ (CIN2+) recurrence. Our primary objective aimed to increase the HPV vaccination rate by 15% over 6 months among a high-risk patient population seen in colposcopy. A secondary objective surveyed patient barriers to vaccination. This interrupted time series quality improvement study followed 127 immunocompetent patients aged 24-45 undergoing their first LEEP for high-grade cervical dysplasia from January to June 2023 in a quaternary colposcopy clinic. Interventions included nurse-led education and providing Gardasil-9 prescriptions to unvaccinated patients. The primary outcome was the total vaccination rate at 6 months. Weekly rates of prescription and patient brochure distribution, and the proportion of newly vaccinated patients by follow-up, were tracked as process measures to inform Plan-Do-Study-Act cycles. Balancing measures included cost and vaccine reactions. Data was analyzed with descriptive statistics, Mann-Whitney tests, and statistical process control (p) charts. Among eligible patients, 73/127 (56.6%) were unvaccinated at the time of LEEP. Among patients seen in follow-up, 47.9% (n = 34/71) started the vaccine series. The proportion of patients who pursued vaccination by their 6-month follow-up appointment increased from 42.5% (n = 54/127) to 69.3% (n = 88/127), a 26.8% absolute increase. Among the still unvaccinated cohort seen in follow-up (n = 37/71; 52.1%), the most common barriers were cost (n = 12/37; 32.4%) and time restraints (n = 9/37; 23.3%). Collaborative interventions to identify and counsel unvaccinated patients undergoing their first LEEP increases HPV vaccination rates, presenting an effective opportunity to engage patients in cervical cancer prevention.