Depot medroxyprogesterone acetate and endometrial cancer: A multicenter case-control study

OBJECTIVE

To assess the associations between depot medroxyprogesterone acetate (DMPA) and endometrial cancer.

METHODS

This multicenter case-control study was conducted among tertiary hospitals in Thailand. Patients were women with endometrial cancer. Controls were women admitted for other conditions, matched for age within 5 years of the patients' age. The controls had to have no abnormal vaginal bleeding, history of hysterectomy, or cancers of the other organs. A standardized questionnaire was used to gather information. Conditional logistic regression was applied to calculate adjusted odds ratio (aORs) and 95% confidence intervals (CIs).

RESULTS

During 2015 to 2021, 378 patients and 1134 controls were included. Ever use of DMPA was associated with a 70% decreased overall risk of endometrial cancer (aOR, 0.30 [95% CI, 0.21-0.42]). Endometrial cancer risk declined by 3% (aOR, 0.97 [95% CI, 0.96-0.98]) for every 3 months of DMPA use. The magnitude of the decline in endometrial cancer risk did not vary appreciably by cancer subtypes (aOR, 0.26 [95% CI, 0.17-0.41] and 0.38 [95% CI, 0.22-0.65] for low-grade and high-grade tumors, respectively).

CONCLUSIONS

Depot medroxyprogesterone acetate use was inversely associated with endometrial cancer risk in a duration-dependent manner. This association was independent of cancer subtype.

Self- and physician-collected high-risk human papillomavirus (HPV) testing to detect high-grade cervical lesions among Thai women

OBJECTIVE

We compared the performance of high-risk human papillomavirus (HPV) messenger RNA testing of physician- and self-collected specimens for detecting histological grade 2 or higher cervical intraepithelial neoplasia (CIN) among women who visited a colposcopy clinic in Thailand.

METHODS

From January 2022 to April 2022, 500 women participated in this cross-sectional multicenter study; 494 had complete data and valid specimen results. The participants were women who attended any one of the 10 participating institutes' colposcopy clinics due to abnormal cytology, positive high-risk HPV testing, or for follow-up. Participants used a self-sampling Aptima Multitest Swab specimen collection kit to self-collect vaginal samples before physicians biopsied the cervix during the colposcopic examination. The self- and physician-collected specimens were tested for high-risk HPV messenger RNA using Aptima nucleic acid amplification assays. Cervical tissues were collected during colposcopic-directed biopsy from the most severe lesion or a random biopsy and endocervical curettage specimen if no lesion was detected.

RESULTS

We detected high-risk HPV messenger RNA in 75.4% of self-collected specimens and 70.6% of physician-collected specimens. The prevalence of histological grade 2 or higher CIN from cervical histology was 25.1% (n=124). For self-collected specimens, the sensitivity and specificity of high-risk HPV messenger RNA for grade 2 or higher CIN were 87.0% (95% CI 79.7% to 92.4%; n=108) and 28.5% (95% CI 24.0% to 33.4%). For physician-collected specimens, the sensitivity and specificity of high-risk HPV messenger RNA for grade 2 or higher CIN were 90.2% (95% CI 83.6% to 94.9%; n=112) and 36.1% (95% CI 31.2% to 41.3%).

CONCLUSIONS

Self-collected specimens for high-risk HPV messenger RNA testing demonstrated good sensitivity and negative predictive value for detecting grade 2 or higher CIN in Thai women attending the participating institutes' colposcopy clinics. Self-collected samples performed similarly to physician-collected ones.

Diagnostic Accuracy and Optimal Cutoff Value of Serum HE4 to Predict Ovarian Cancer in Thai Women with Pelvic Masses

BACKGROUND

Serum human epididymis protein 4 (HE4) is highly expressed in women with ovarian cancers (OCs), but data about its clinical application of HE4 for Thai women is limited.

OBJECTIVE

To evaluate the diagnostic accuracy and optimal cutoff for HE4 in distinguishing benign lesions, borderline ovarian tumor (BOTs), and OCs compared with CA125 in Thai women at Rajavithi Hospital.

MATERIAL AND METHOD

The cross-sectional study was conducted in Thai women aged older than 18 years old with pelvic masses whom underwent elective surgery at Rajavithi Hospital between 2012 and 2013. Preoperative serum HE4 and CA125 levels were measured and pathologic specimens were reviewed.

RESULTS

Of the 518 participants evaluated, 316 had benign lesions, 43 had BOTs, and 159 had OCs. Between non-cancers and OCs, area under receiver operating characteristic curve (ROC-AUC) for HE4 hardly differed from CA125 (0.85 vs. 0.83, p = 0.402) but was significantly lower in postmenopausal women (0.79 vs. 0.86, p = 0.049). The optimal cutoff value of HE4 was 72 pM/L for all menopausal status. Lower HE4 was seen in 30.8% of mucinous carcinoma and 31.7% of clear cell carcinoma. The HE4 ROC-AUC was significantly higher than CA125 ROC-AUC in distinguishing benign diseases and BOTs (0.71 vs. 0.53, p<0.001), HE4 in 70% of BOTs was 51 to 95 pM/L.

CONCLUSION

Although the 72 pM/L cutoff for HE4 was appropriate in distinguishing between non-cancers and OCs for both pre- and postmenopausal women, the limitation for postmenopausal women, mucinous carcinomas, and clear cell carcinomas require to be complemented with CA125.

Appropriate interval for repeat excision in women undergoing prior loop electrosurgical excision procedure for cervical neoplasia

The objective of the present study was to evaluate the impact of intervals on complications and pathological examination in women undergoing a repeat loop electrosurgical excision procedure (LEEP) for cervical neoplasia. During October 2004 and January 2007, 78 women who had undergone repeat LEEP at Chiang Mai University Hospital, were prospectively evaluated. The mean age was 47.5 years (range; 27-69 years). The mean duration of uncomplicated vaginal bleeding was 4.4 days (range; 1-20 days). The occurrence of persistent vaginal bleeding was noted in 9 women. Among 78 women, 2 (2.56%) and 7 (8.97%) experienced intraoperative and postoperative hemorrhage, respectively. Six (7.69%) had postoperative infection. These complications were not significantly different from those observed in women undergoing first LEEP in the same period (P=0.56). There was no significant difference in the incidence of perioperative complications and the incidence of non-evaluable cone margins among women who undergoing repeat LEEP within 4-6 weeks, between 6-8 weeks, and more than 8 weeks after first LEEP. In conclusion, repeat LEEP could be safely performed 4-12 weeks after the first procedure without any impact on pathological specimen examination.

Benefit of electrocardiography during front-line combination paclitaxel and carboplatin chemotherapy for epithelial ovarian cancer

OBJECTIVE

To evaluate the patterns of electrocardiography (ECG), cardiac risk factors and its clinical consequence in women with epithelial ovarian cancer (EOC) who received paclitaxel and carboplatin (PC) as front line chemotherapy.

MATERIAL AND METHOD

The medical records and electrocardiographic data of women with EOC who received paclitaxel (175 mg/min2) and carboplatin (AUC=5) every 3 weeks at Chiang Mai University Hospital between January 2000 and December 2004 were reviewed for cardiac risk factors and clinical consequence.

RESULTS

Among 79 women receiving PC for EOC, 43 (54.4%) had cardiac risk factors. Seventy (88.6%) women had normal ECG, the remaining nine had sinus tachycardia (5), bundle branch block (2), mild T inversion (1), and Wolff-Parkinson-White syndrome (1) before the first course of chemotherapy. Among 70 women with normal initial ECG 8 (11.4%) had sinus tachycardia, one (1.4%) had early depolarization, two (2.9%) had sinus bradycardia and three (4.3%) had sinus arrhythmia in subsequent ECG All these cardiac disturbances were asymptomatic and needed no intervention, indicating grade I toxicity. The odds ratio of developing abnormal ECG in women with cardiac risk factor was 1.24 (95% CI = 0.33 to 4.64, p = 0.77). Among nine patients with abnormal ECG before the first course of PC, six (66.7%) had subsequent abnormal ECG but all were asymptomatic and no worsening of abnormal ECG pattern was noted.

CONCLUSION

Although paclitaxel and carboplatin chemotherapy could induce abnormal ECG in women with either normal or abnormal prior ECG, its consequence was of no clinical significance. Therefore, the benefit of ECG before each treatment course was theoretically limited.