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Liu Y, Liao J, Yi X, Pan Z, Pan J, Sun C, Zhou H, Meng Y. Diagnostic value of colposcopy in patients with cytology-negative and HR-HPV-positive cervical lesions. Arch Gynecol Obstet 2022; 306:1161-1169. [PMID: 35320389 DOI: 10.1007/s00404-022-06415-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Accepted: 01/20/2022] [Indexed: 12/24/2022]
Abstract
PURPOSE High-risk human papillomavirus (HR-HPV)-positive but cytology-negative cervical cancer screening results are not uncommon. This study aimed to investigate colposcopy's accuracy and diagnostic value in patients with cytology-negative HR-HPV-positive screening results. METHODS This retrospective study included patients with HR-HPV-positive cytology-negative screening results who underwent electronic colposcopy with acetic acid and multi-point cervical biopsy, HPV typing (24 HPV subtypes), and quantitative HPV detection. RESULTS Among 229 patients, 130 had chronic cervicitis, and 99 had cervical lesions (CIN1, n = 37; CIN2/3, n = 55; invasive carcinoma, n = 7). Using colposcopy as a reference, the cervical cytology false-negative rate was 43.2% (99/229). Colposcopy was more accurate in patients with HR-HPV16/18 or high viral loads. Multivariable analyses showed HPV viral load and childbearing history were the independent factors affecting the accuracy of colposcopy (P < 0.05). CONCLUSION Colposcopy in HR-HPV-positive cytology-negative patients has a moderate diagnostic accuracy. The type of cervical transformation zone and HPV viral load are independent factors affecting the accuracy of colposcopy-based diagnosis.
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Affiliation(s)
- Yang Liu
- Department of Reproduction, The Second Affiliated Hospital of Kunming Medical University, Kunming, 650101, China
| | - Jing Liao
- Department of Gynecology, The Second Affiliated Hospital of Kunming Medical University, Kunming, 650101, China
| | - Xiaojia Yi
- Department of Pathology, The Second Affiliated Hospital of Kunming Medical University, Kunming, 650101, China
| | - Zhengmei Pan
- Department of Reproduction, The Second Affiliated Hospital of Kunming Medical University, Kunming, 650101, China
| | - Jing Pan
- Department of Gynecology, The Second Affiliated Hospital of Kunming Medical University, Kunming, 650101, China
| | - Chunyi Sun
- Department of Gynecology, The Second Affiliated Hospital of Kunming Medical University, Kunming, 650101, China
| | - Honglin Zhou
- Department of Gynecology, The Second Affiliated Hospital of Kunming Medical University, Kunming, 650101, China
| | - Yushi Meng
- Department of Reproduction, The Second Affiliated Hospital of Kunming Medical University, Kunming, 650101, China.
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Biggs KV, Soo Hoo S, Kodampur M. Mechanical dilatation of the stenosed cervix under local anesthesia: A prospective case series. J Obstet Gynaecol Res 2022; 48:956-965. [PMID: 35132727 PMCID: PMC9303640 DOI: 10.1111/jog.15179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Revised: 01/12/2022] [Accepted: 01/22/2022] [Indexed: 11/30/2022]
Abstract
AIM Cervical stenosis is traditionally managed by mechanical dilatation under general anesthesia (GA). We aimed to assess the safety, effectiveness, and patient acceptability of dilatation in the outpatient setting under local anesthesia (LA). METHODS Data were collected prospectively from all patients attending the outpatient department with cervical stenosis from March 20, 2015 to September 23, 2020. Mechanical dilatation of the cervix was performed using Hegar dilators under LA. Subsequent colposcopic assessment, cytology, histology, and management were recorded. RESULTS One hundred forty-nine cases were referred for cervical dilatation, 63 (43%) of which had complete stenosis. One hundred eighteen (79%) patients had previously undergone cervical procedures. Successful dilatation under LA was achieved in 119 (83%) patients; 5 (3%) declined (requesting GA), 6 (4%) did not tolerate speculum examination, and 19 (13%) had unsuccessful procedures. The median Hegar size used was 8 mm. Dilatation under LA was acceptable in 93% attempted procedures. Thirteen episodes of restenosis were recorded with no major adverse events. Younger age (p = 0.045) and severe (compared to complete) stenosis (p < 0.0001) were associated with procedure success, with improved results over time (p = 0.003). Successful dilatation permitted cervical assessment; eight patients required cervical excisions, two underwent hysterectomies, with one confirmed case of adenocarcinoma. CONCLUSION Rigid cervical dilatation in the outpatient setting provides effective, instantaneous treatment for women who have failed cytological or colposcopic assessment. For the vast majority of women, the procedure was well tolerated and preferred to using GA. However, given that 1 in 10 women experienced restenosis, patients should be counseled about the possibility of requiring further management.
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Affiliation(s)
| | - San Soo Hoo
- University Hospitals North Midlands NHS Trust
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Lee F, Desravines N, Recknagel J, Singleton M, Muñoz R, Rahangdale L. History of Surgical Treatment for Cervical Intraepithelial Neoplasia. J Gynecol Surg 2022. [DOI: 10.1089/gyn.2021.0138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Affiliation(s)
- Fan Lee
- Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Nerlyne Desravines
- Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Johnathon Recknagel
- Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Miller Singleton
- Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Rodrigo Muñoz
- Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Lisa Rahangdale
- Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
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Manga SM, Kincaid KD, Boitano TKL, Tita AT, Scarinci IC, Huh WK, Liang MI. Misoprostol and estradiol to enhance visualization of the transformation zone during cervical cancer screening: An integrative review. Eur J Obstet Gynecol Reprod Biol 2022; 269:16-23. [PMID: 34952401 PMCID: PMC10958763 DOI: 10.1016/j.ejogrb.2021.11.431] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 09/07/2021] [Accepted: 11/21/2021] [Indexed: 11/27/2022]
Abstract
The purpose of this integrative literature review was to appraise studies conducted worldwide using misoprostol and estradiol in converting Type 3 transformation zone (TZ) of the cervix into Types 1 or 2 and to assess which regimen could be more feasible in low-and-middle-income countries (LMICs). We reviewed the English language literature for peer-reviewed studies that evaluated strategies to convert Type 3 TZs to Types 1 or 2 for cervical cancer screening. Web of Science and PubMed searches were performed up to July 2020. Search terms included: "cervical colposcopy," "inadequate colposcopy", "cervical cancer screening", "transformation zone," "estrogen", "estradiol", and "misoprostol." Inclusion criteria were articles published in the English language, original research, and peer reviewed articles. A total of 127 articles were abstracted, 24 articles were reviewed, and 9 articles met all inclusion criteria. We found that intravaginal misoprostol, intravaginal estradiol, and oral estradiol can successfully convert Type 3 TZ to Types 1 or 2. A single dose of vaginal misoprostol had a similar maximum response rate (20-80%) to a multi-dose regimen over several days or weeks of both intravaginal estradiol (64-83%) and oral estradiol (50-70%). Misoprostol administration was associated with more side effects such as abdominal cramping and vaginal bleeding compared to estradiol, although these were generally mild. In conclusion, Oral estradiol, intravaginal estradiol, and intravaginal misoprostol can be used to convert Type 3 TZ to Types 1 or 2. Intravaginal misoprostol is well tolerated and more feasible in LMICs due to availability and shorter treatment schedule compared to oral or intravaginal estradiol.
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Affiliation(s)
- Simon M Manga
- Women's Health Program, Cameroon Baptist Convention Health Services, P.O. Box 1, Bamenda, Cameroon; Center for Women's Reproductive Health, Department of Obstetrics & Gynecology, University of Alabama at Birmingham, 176F Suite 10270, 619(TH) Street South, Birmingham, AL 35249-7333, USA.
| | - Kaitlyn D Kincaid
- Department of Obstetrics & Gynecology, University of Alabama at Birmingham, 176F Suite 10360, 1700 6(th) Avenue South, Birmingham, AL, USA
| | - Teresa K L Boitano
- Department of Obstetrics & Gynecology, University of Alabama at Birmingham, 176F Suite 10360, 1700 6(th) Avenue South, Birmingham, AL, USA
| | - Alan T Tita
- Center for Women's Reproductive Health, Department of Obstetrics & Gynecology, University of Alabama at Birmingham, 176F Suite 10270, 619(TH) Street South, Birmingham, AL 35249-7333, USA; Division of Maternal Fetal Medicine, Department of Obstetrics & Gynecology, University of Alabama at Birmingham, 176F Suite 10270, 1700 6(th) Avenue South, Birmingham, AL, USA
| | - Isabel C Scarinci
- Center for Women's Reproductive Health, Department of Obstetrics & Gynecology, University of Alabama at Birmingham, 176F Suite 10270, 619(TH) Street South, Birmingham, AL 35249-7333, USA; Division of Gynecologic Oncology, Department of Obstetrics & Gynecology, University of Alabama at Birmingham, 176F Suite 10250, 1700 6(th) Avenue South, Birmingham, AL, USA
| | - Warner K Huh
- Center for Women's Reproductive Health, Department of Obstetrics & Gynecology, University of Alabama at Birmingham, 176F Suite 10270, 619(TH) Street South, Birmingham, AL 35249-7333, USA; Division of Gynecologic Oncology, Department of Obstetrics & Gynecology, University of Alabama at Birmingham, 176F Suite 10250, 1700 6(th) Avenue South, Birmingham, AL, USA
| | - Margaret I Liang
- Center for Women's Reproductive Health, Department of Obstetrics & Gynecology, University of Alabama at Birmingham, 176F Suite 10270, 619(TH) Street South, Birmingham, AL 35249-7333, USA; Division of Gynecologic Oncology, Department of Obstetrics & Gynecology, University of Alabama at Birmingham, 176F Suite 10250, 1700 6(th) Avenue South, Birmingham, AL, USA
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Kent L, Mallen A, Hoffman M. Suspicion of Cervical or Uterine Pathology in Patients with a Distorted Cervix: Case Series. J Gynecol Surg 2020. [DOI: 10.1089/gyn.2020.0036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Laura Kent
- Department of Gynecologic Oncology, Moffitt Cancer Center, University of South Florida Morsani College of Medicine, Tampa, Florida, USA
| | - Adrianne Mallen
- Department of Gynecologic Oncology, Moffitt Cancer Center, University of South Florida Morsani College of Medicine, Tampa, Florida, USA
| | - Mitchel Hoffman
- Department of Gynecologic Oncology, Moffitt Cancer Center, University of South Florida Morsani College of Medicine, Tampa, Florida, USA
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Grubman J, Meinhardt SS, Nambiar A, Lea JS. Specimen Fragmentation and Loop Electrosurgical Excision Procedure and Cold Knife Cone Biopsy Outcomes. J Low Genit Tract Dis 2020; 24:27-33. [DOI: 10.1097/lgt.0000000000000509] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Chevreau J, Carcopino X, Foulon A, Preaubert L, Lanta-Delmas S, Sergent F, Gondry J. Risk factors for unsatisfactory colposcopy after large loop excision of the transformation zone: The results of a four-year multicenter prospective study. Eur J Obstet Gynecol Reprod Biol 2019; 240:156-160. [PMID: 31288186 DOI: 10.1016/j.ejogrb.2019.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2019] [Revised: 06/23/2019] [Accepted: 07/01/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVES Not being able to completely examine the cervical squamocolummar junction (SCJ) in colposcopy after large loop excision of the transformation zone (LLETZ) is an important issue regarding surveillance, as high-grade cervical intra-epithelial neoplasia recurrence risk is high. This study was conducted in order to identify risk factors for post-LLETZ unsatisfactory colposcopy. METHODS This prospective multicenter observational study was performed in nine French University hospitals, with inclusions running from December 2013 to December 2017. All patients scheduled for LLETZ were included and were divided into two groups after the two to four months post-procedure colposcopic examination: a satisfactory and an unsatisfactory post-LLETZ colposcopy group. RESULTS In total, 601 cases were analyzed and 71 post-LLETZ colposcopies (12%) were described as unsatisfactory (including 19 cervical stenosis). In a univariate analysis, we only observed a statistically significant increase of the following parameters in the unsatisfactory post-LLETZ group in comparison with the satisfactory post-LLETZ group: parity (2.11 [±1.55] and 1.49 [±1.24] respectively, p < .01), depth of the LLETZ specimen (10.9 mm [±3.37] and 9.76 [±3.79] respectively, p < .01), age (45.9 years [±11.7] and 37.9 [±9.42] respectively, p < .001) and an unsatisfactory pre-LLETZ colposcopy (43 satisfactory pre-LLETZ colposcopies [61%] and 456 [86%] respectively, p < .001). In a stepwise binary logistic regression analysis, only the two latter parameters were found to be independently associated with unsatisfactory post-LLETZ colposcopies. CONCLUSIONS Surgeons should consider other therapeutic strategies when contemplating iterative diagnosis-LLETZ in older women with initially invisible SCJ, as an appropriate post-LLETZ surveillance is at higher risk of being impossible to achieve.
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Affiliation(s)
- Julien Chevreau
- Department of Obstetrics and Gynecology, University Hospital of Amiens, CHU Amiens-Picardie, Avenue Laennec, Amiens Cedex 1, France.
| | - Xavier Carcopino
- Department of Obstetrics and Gynaecology, Hôpital Nord, APHM, Aix-Marseille University (AMU), Univ Avignon, CNRS, IRD, IMBE UMR, Marseille, France
| | - Arthur Foulon
- Department of Obstetrics and Gynecology, University Hospital of Amiens, CHU Amiens-Picardie, Avenue Laennec, Amiens Cedex 1, France
| | - Lise Preaubert
- Department of Obstetrics and Gynaecology, Hôpital Nord, APHM, Aix-Marseille University (AMU), Univ Avignon, CNRS, IRD, IMBE UMR, Marseille, France
| | - Ségolène Lanta-Delmas
- Department of Obstetrics and Gynecology, University Hospital of Amiens, CHU Amiens-Picardie, Avenue Laennec, Amiens Cedex 1, France
| | - Fabrice Sergent
- Department of Obstetrics and Gynecology, University Hospital of Amiens, CHU Amiens-Picardie, Avenue Laennec, Amiens Cedex 1, France
| | - Jean Gondry
- Department of Obstetrics and Gynecology, University Hospital of Amiens, CHU Amiens-Picardie, Avenue Laennec, Amiens Cedex 1, France
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Risk Factors of Post-Large Loop Excision of the Transformation Zone Recurrent High-Grade Cervical Intraepithelial Lesion: A Prospective Cohort Study. J Low Genit Tract Dis 2018; 23:18-23. [PMID: 30085949 DOI: 10.1097/lgt.0000000000000423] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of the study was to identify the risk factors of post-large loop excision of the transformation zone (LLETZ) recurrent disease and the impact of colposcopic guidance at the time of LLETZ on that risk. MATERIALS AND METHODS From December 2013 to July 2014, 204 patients who had undergone LLETZ for the treatment of high-grade intraepithelial lesion with fully visible cervical squamocolumnar junction were included. The use of colposcopy during each procedure was systematically documented. The dimensions and volume of LLETZ specimens were measured at the time of the procedure before formaldehyde fixation. All participants were invited for a follow-up. The primary endpoint was the diagnosis of post-LLETZ recurrent disease defined as the histologic diagnosis of a high-grade cervical intraepithelial lesion. RESULTS The median duration of post-LLETZ follow-up was 25.8 months. Recurrent disease was diagnosed in 8 (3.6%) patients. Older than 38 years (adjusted hazard ratio [aHR] = 11.9, 95% CI = 1.6-86.0), history of excisional therapy (aHR = 21.6, 95% CI = 3.5-135.3), and the absence of colposcopy for the guidance of LLETZ (aHR = 6.4, 95% CI = 1.1-37.7) were found to significantly increase the risk of post-LLETZ recurrent disease. The dimensions and volume of the specimen were not found to have any impact. Only positive endocervical margins were identified to significantly increase the risk of post-LLETZ recurrent disease (aHR = 14.4, 95% CI = 2.0-101.1). CONCLUSIONS Risk factors of post-LLETZ recurrent disease are older than 38 years, history of excisional therapy, positive endocervical margins, and lack of colposcopic guidance at the time of LLETZ.
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