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Kuenkel E, Jaeger A, Bohlmann I, Bergauer F, Kuehler-Obbarius C, Prieske K, Maass-Poppenhusen K, Schmalfeldt B, Woelber L. The use of colposcopy for triage in HPV-positive women aged 65 years and older. Arch Gynecol Obstet 2024; 309:1561-1567. [PMID: 38081959 PMCID: PMC10894107 DOI: 10.1007/s00404-023-07281-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 10/22/2023] [Indexed: 02/25/2024]
Abstract
PURPOSE Persistent high-risk HPV infection is associated with an elevated risk for prevalent CIN II + despite normal cytology (NILM). Our study aims to evaluate the clinical relevance of a persistent high-risk HPV infection without cytologic changes in women aged ≥ 65 and to determine the role of colposcopy for triage in these cases. METHODS 211 patients aged ≥ 65 with persistent HPV infection and normal cytology (NILM) who presented for colposcopy at five certified centers between January 2021 and April 2022 were included in the study. Colposcopic findings, HPV subtypes, when available, histology and p16/Ki67 staining were assessed as well as individual risk factors such as smoking and previous HPV-related surgery. RESULTS 87.7% (185/211) of the included women had a type 3 transformation zone. In 83.4% (176/211), a biopsy was taken [thereof 163 endocervical curettages (ECC)]. In 35/211 women (16.6%), sampling was not possible during colposcopy due to an inaccessible cervix, pain during examination or obliteration of the cervical canal. Out of these, 6 women received a diagnostic excision. CIN II + was detected in 10.6% of all histologies (excisional or biopsy) (20/182). 50% of the women with a CIN II + where HPV 16 positive. Taking only the women diagnosed with CIN III or AIS into account, (n = 12) 75% were HPV 16 positive. Interestingly, 80% of the women with CIN II + had an abnormal cytology when repeatedly taken during colposcopy, vice versa an endocervical lesion was diagnosed in 53% of women with abnormal repeat cytology (27/51). CONCLUSION The prevalence of CIN II + in women is ≥ 65 with persistent hr HPV infection but NILM cytology is similar to that in younger women. However, more than 85% of the women have a type 3 transformation zone. Colposcopy is, therefore, not helpful to diagnose the women who need treatment in this age group.
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Affiliation(s)
- E Kuenkel
- Dysplasia Unit Women's Practice Heussweg, Frauenarztpraxis und Dysplasie-Einheit Heussweg, Heussweg 37, 20255, Hamburg, Germany.
| | - A Jaeger
- Department of Gynecology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
- Dysplasia Unit at Jerusalem Hospital, Moorkamp 2-6, 20357, Hamburg, Germany
| | - I Bohlmann
- Dysplasia Munich, Nymphenburger Str. 77, 80636, Munich, Germany
| | - F Bergauer
- Dysplasia Munich, Nymphenburger Str. 77, 80636, Munich, Germany
| | - C Kuehler-Obbarius
- Dysplasia Unit Women's Practice Heussweg, Frauenarztpraxis und Dysplasie-Einheit Heussweg, Heussweg 37, 20255, Hamburg, Germany
- Cytologylaboratory Dr. Med. Kühler-Obbarius, Fangdieckstr. 75a, 22547, Hamburg, Germany
| | - K Prieske
- Department of Gynecology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
- Dysplasia Unit at Jerusalem Hospital, Moorkamp 2-6, 20357, Hamburg, Germany
| | - K Maass-Poppenhusen
- Department of Gynecology, University Hospital Campus Kiel, Arnold Heller Str. 3, 24105, Kiel, Germany
| | - B Schmalfeldt
- Department of Gynecology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - L Woelber
- Department of Gynecology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
- Dysplasia Unit at Jerusalem Hospital, Moorkamp 2-6, 20357, Hamburg, Germany
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Della Corte L, Lavitola G, Bifulco G. How endocervicoscopy can impact obstetric outcomes in women undergoing LEEP for CIN2 + : a retrospective cohort analysis. Arch Gynecol Obstet 2023; 308:507-513. [PMID: 37264271 DOI: 10.1007/s00404-023-07087-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Accepted: 05/19/2023] [Indexed: 06/03/2023]
Abstract
PURPOSE To assess the impact of preoperative endocervicoscopy on obstetric outcomes and complications in women undergoing LEEP for CIN2 + . METHODS This was a retrospective cohort study carried out between October 2012 and April 2018. All women had undergone cervical length measurement at T0 (before LEEP), T1 (6 months after LEEP), and T2 (at 20 weeks of pregnancy) through transvaginal ultrasound examination after LEEP for CIN2 + . A total of 528 patients fulfilled our inclusion criteria and contributed to the final analysis: 288 had undergone endocervicoscopy before the excisional procedure (Group A), while the remaining 240 (Group B) did not. RESULTS Patients who did not undergo endocervicoscopy showed a greater amount of tissue excised at LEEP compared to those of Group A (6.7% vs 31.9% in Group A and B, p < 0.01, respectively). A statistically relevant difference was detected in the lesion margins involvement: negative in 93.8% in Group A compared to 65.6% in Group B. The cervicometry before the treatment resulted in similar between the two groups, while a statistically significant difference was noted after 6 months (37.5 ± 2.9 mm in Group A vs 35.1 ± 3.8 mm in Group B, p < 0.01) and at 20th week pregnancy (36.9 ± 5.3 mm in Group A vs 33.5 ± 5.6 mm in Group B, p < 0.01). The number of pregnancies after LEEP as well as the difference in the elapsed time (in months) did not result in a statistical significance between the two groups. The threatened preterm labor (TPL) and the threatened miscarriage showed a statistically significant difference in incidence between the two groups (4,2% and 4.2% in Group A vs 15.3% and 25% in Group B, p < 0.01, respectively). CONCLUSION Endocervicoscopy reduces the size of the LEEP sample and in particular its depth, saving healthy cervical tissue, and guarantees the total eradication of the lesion as the resection margins are negative in almost all cases, allowing for a reduction of the rate of TPL and threatened miscarriage in women with CIN2 + , especially with Type 2 or 3 cervical squamocolumnar junction (SCJ).
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Affiliation(s)
- Luigi Della Corte
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, 80131, Naples, Italy.
| | - Giada Lavitola
- Department of Public Health, University of Naples Federico II, 80131, Naples, Italy
| | - Giuseppe Bifulco
- Department of Public Health, University of Naples Federico II, 80131, Naples, Italy
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Li X, Liu L, He J, Yan J, Wang Y. Analysis of the effectiveness of the application of pelvic floor rehabilitation exercise and the factors influencing its self-efficacy in postoperative patients with cervical cancer. Front Oncol 2023; 13:1118794. [PMID: 37228499 PMCID: PMC10204585 DOI: 10.3389/fonc.2023.1118794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 04/18/2023] [Indexed: 05/27/2023] Open
Abstract
Objective To analyze the application effect of pelvic floor rehabilitation exercise in postoperative patients with cervical cancer and the factors influencing their self-efficacy. Methods 120 postoperative patients with cervical cancer from January 2019 to January 2022 from the Department of Rehabilitation, Aeronautical Industry Flying Hospital, Bayi Orthopaedic Hospital and Southwest Medical University Affiliated Hospital of Traditional Chinese Medicine, and the Department of Obstetrics and Gynecology, Chengdu Seventh People's Hospital, and the Department of Oncology, Sichuan Provincial People's Hospital were selected for the study. They were divided into routine group (n=44, applied routine care) and exercise group (n=76, applied routine care + pelvic floor rehabilitation exercise) according to the different perioperative care programs. The perioperative indicators, bladder function recovery rate and urinary retention incidence, urodynamic indicators, and pelvic floor distress inventory-short form 20 (PFDI-20) scores were compared between the 2 groups. The general data, PFDI-20 scores and broome pelvic muscle self-efficacy scale (BPMSES) scores of patients in the exercise group were investigated and analyzed individually to investigate the factors influencing the self-efficacy of patients with pelvic floor rehabilitation exercise after cervical cancer surgery. Results The time of first anal exhaust, urine tube retention and hospitalization after surgery were shorter in the exercise group than in the routine group (P<0.05). The bladder function grade I rate after surgery was more in the exercise group than in the routine group, and the urinary retention incidence was lower than that in the routine group (P<0.05). At 2 weeks after exercise, bladder compliance and bladder detrusor systolic pressure were higher in both groups than before exercise, and they were higher in the exercise group than in the routine group (P<0.05). There was no significant difference in urethral closure pressure within and between the two groups (P>0.05). At 3 months after surgery, the PFDI-20 scores were higher in both groups than before surgery, and the exercise group was lower than the routine group (P<0.05).The BPMSES score for the exercise group was (103.33 ± 9.16). Marital status, residence and PFDI-20 scores were influential factors in the self-efficacy level of patients undergoing pelvic floor rehabilitation exercise after cervical cancer surgery (P<0.05). Conclusion Implementing pelvic floor rehabilitation exercise for postoperative patients with cervical cancer can speed up the recovery of pelvic organ function and reduce the occurrence of postoperative urinary retention. Marital status, residence and PFDI-20 scores were influential factors in the self-efficacy level of patients undergoing pelvic floor rehabilitation exercise after cervical cancer surger, medical staff need to incorporate these clinical features to provide targeted nursing interventions to enhance patient compliance with training and improve postoperative survival quality.
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Affiliation(s)
- Xichun Li
- Department of Rehabilitation, Chengfei Hospital, Chengdu, China
| | - Ling Liu
- Department of Rehabilitation, Bayi Orthopaedic Hospital, Chengdu, China
| | - Jinhui He
- Department of Obstetrics and Gynecology, Chengdu Seventh People’s Hospital, Chengdu, China
| | - Jue Yan
- Department of Rehabilitation, Southwest Medical University Affiliated Hospital of Traditional Chinese Medicine, Luzhou, China
| | - Ying Wang
- Department of Oncology, Sichuan Provincial People’s Hospital, Chengdu, China
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Hanczuk T, Weiss M, Henes L, Engler T, Neis F, Henes M. Certification as dysplasia unit and its impact on large loop electrosurgical excision (LEEP). Arch Gynecol Obstet 2023; 307:1177-1184. [PMID: 36209297 PMCID: PMC10023626 DOI: 10.1007/s00404-022-06807-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 09/26/2022] [Indexed: 11/26/2022]
Abstract
PURPOSE This study evaluates the overall treatment indicators and outcomes of patients who underwent loop electrosurgical excision procedure (LEEP) at the Department of Women's Health Tübingen and the impact of certification as a dysplasia unit on treatment quality. METHODS Retrospective data analysis of 1596 patients from 2013 to 2018 who underwent LEEP excision at the Department of Women's Health Tübingen. Data of cytology, colposcopy, biopsy, LEEP histology, repeat LEEP histology and general characteristics were collected and analyzed descriptively. RESULTS 85.4% (1364) of patients had CIN 2 + and 14.6% (232) had CIN 1 or normal findings on LEEP histology. The proportion of CIN 2 + excisions increased significantly from 82.4% in 2013 to 89% in 2018. The concordance of HSIL biopsy and LEEP histology was 89.1% in 2013 and 92.6% in 2018. In 2018, more biopsies and colposcopies were performed before excision. Complete resection (R0) was achieved in 88.3% of all excisions. R0 rates in patients with CIN 3 increased in 2014-2017 compared to 2013, resulting in fewer Re-LEEP excisions and hysterectomies. CONCLUSION Certification as a dysplasia unit and the associated requirements have improved the diagnostic quality for patients with cervical dysplasia undergoing LEEP. This was demonstrated by several treatment indicators such as the number of colposcopies and biopsies and treatment outcomes such as an increased proportion of CIN 2 + excisions and R0 resections.
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Affiliation(s)
| | - Martin Weiss
- Department of Women's Health, University Hospital Tübingen, Calwerstraße 7, 72076, Tübingen, Germany
| | - Leon Henes
- Department of Women's Health, University Hospital Tübingen, Calwerstraße 7, 72076, Tübingen, Germany
| | - Tobias Engler
- Department of Women's Health, University Hospital Tübingen, Calwerstraße 7, 72076, Tübingen, Germany
| | - Felix Neis
- Department of Women's Health, University Hospital Tübingen, Calwerstraße 7, 72076, Tübingen, Germany
| | - Melanie Henes
- Department of Women's Health, University Hospital Tübingen, Calwerstraße 7, 72076, Tübingen, Germany.
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Wang L, Liu P, Duan H, Li P, Li W, Chen C. Evaluation of individualized para-tumor resection of cervical cancer patients based on three-dimensional reconstruction. Front Surg 2023; 10:1174490. [PMID: 37181590 PMCID: PMC10174429 DOI: 10.3389/fsurg.2023.1174490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 04/03/2023] [Indexed: 05/16/2023] Open
Abstract
Objective To discuss the possibility of individualizing the para-tumor resection range (PRR) in cervical cancer patients based on three-dimensional (3D) reconstruction. Methods We retrospectively included 374 cervical cancer patients who underwent abdominal radical hysterectomy. Preoperative computerized tomography (CT) or magnetic resonance imaging (MRI) data sets were collected to get 3D models. Postoperative specimens were measured to evaluate surgical scope. Oncological outcomes of patients with different depths of stromal invasion and PRR were compared. Results A PRR of 32.35 mm was found to be the cut-off point. For the 171 patients with stromal invasion <1/2 depth, patients with a PRR over 32.35 mm had a lower risk of death and higher 5-year overall survival (OS) than that in the ≤32.35 mm group (HR = 0.110, 95% CI: 0.012-0.988, P = 0.046; OS: 98.8% vs. 86.8%, P = 0.012). No significant differences were found in 5-year disease-free survival (DFS) between the two groups (92.2% vs. 84.4%, P = 0.115). For the 178 cases with stromal invasion ≥1/2 depth, no significant differences were found in 5-year OS and DFS between groups (≤32.35 mm group vs. >32.35 mm group, OS: 71.0% vs. 83.0%, P = 0.504; DFS: 65.7% vs. 80.4%, P = 0.305). Conclusion In patients with stromal invasion <1/2 depth, the PRR should reach 32.35 mm to get more survival benefit and in patients with stromal invasion ≥1/2 depth, the PRR should reach 32.35 mm at least to avoid worse prognosis. Cervical cancer patients with different depths of stromal invasion may receive tailoring resection of the cardinal ligament.
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Affiliation(s)
- Lu Wang
- Department of Obstetrics and Gynecology, Nanfang Hospital, Southern Medical University, Guangzhou, China
- Department of Obstetrics and Gynecology, The Second Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Ping Liu
- Department of Obstetrics and Gynecology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Hui Duan
- Department of Obstetrics and Gynecology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Pengfei Li
- Department of Obstetrics and Gynecology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Weili Li
- Department of Obstetrics and Gynecology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Chunlin Chen
- Department of Obstetrics and Gynecology, Nanfang Hospital, Southern Medical University, Guangzhou, China
- Correspondence: Chunlin Chen
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