Komsun Suwannarurk

Ovarian Tumors during Pregnancy and Adverse Pregnancy Outcome: A Retrospective Analysis

To determine the prevalence of ovarian tumor in pregnancy. A retrospective descriptive study was conducted using electronic data from Obstetrics and Gynecology Department at Bhumibol Adulyadej Hospital (BAH), Royal Thai Air Force, Thailand recorded between January 2012 and December 2022. The participants were patients diagnosed with ovarian tumors during pregnancy (OTP) within the study period. Demographic characteristics, histopathological findings, ultrasonography results and pregnancy outcomes were recorded. A total of 190 OTP cases were identified among 41,842 pregnant women. One hundred twenty-six OTP cases underwent surgery during pregnancy. The mean age of the participants was 29.6 years. The prevalence of ovarian tumors was 4.5(190/41,842) in 1000 pregnancies. Malignant ovarian tumors accounted for 0.14% (2/126). Histopathological analysis revealed that germ cell ovarian tumors and common epithelial ovarian tumors were found in 50.79% (64/126) and 49.2% (62/126) of cases, respectively. Most germ cell ovarian tumors were mature cystic teratomas, which were found in 98% (63/64) of cases. One-third (32/126) of the OTP cases underwent surgery during the second and early third trimesters. Fetal loss following surgery occurred in 18.75% (6/32) of cases. Adnexectomy performed with cesarean delivery and after vaginal delivery occurred in 93 and 1 cases, respectively. Symptomatic OTP leading to emergency surgery was observed in 6.84% (13/190) of cases. The prevalence of OTP was 4.5 per 1,000 pregnant women. Fetal loss during surgery in pregnancy occurred in 18.75%. Mature cystic teratoma was the common histopathological finding.

The Impact of Waiting Time-to-Surgery on Survival in Endometrial Cancer Patients

Endometrial cancer (EC) is the most common gynecological cancer in developed countries and a standard treatment of surgery should be performed as expediently as possible. Delay time to surgery and survival was debated. The aim of this investigation was to evaluate the effect of time-interval between diagnosis and surgery (TDS) in EC patients with regards to prognosis and mortality rates. This retrospective study was conducted between January 2009 and May 2021 at Bhumibol Adulyadej Hospital, Thailand. Subjects were EC cases who underwent primary surgery during the study period. Cases with partial treatment were disqualified from the study. Subjects who underwent surgery before and after 6 weeks were classified as early and delayed surgery groups. Baseline and clinical characteristics were collected and analyzed. During the study period, 419 EC cases were recruited. The mean age of participants was 56.8 years. Two-thirds (338/491) of subjects were menopausal. Endometrioid histology (406/491) was the most common histology subtype. Five years disease free survival (DFS) of early and delayed surgery groups were comparable at a percentage of 82.5 and 83.0, respectively. Among advanced stage and non-endometrioid EC cases, the delayed surgery group had significantly shorter DFS than the early group. Advanced stage, high grade and positive lympho-vascular space invasion (LVSI) were independent factors for poor DFS. Predictive factors for mortality were advanced stage and tumor recurrence. The TDS was not a prognostic factor for disease recurrence or overall mortality. Time to surgery equal to or more than 6 weeks gave worse prognosis for DFS among advanced stage or non-endometrioid histology EC.

Knowledge and Attitudes of Pregnant Women toward Cervical Cancer Screening during Pregnancy

To assess the knowledge and attitudes towards cervical cancer screening (CCS) during pregnancy among pregnant women. This prospective cohort study was conducted at the antenatal clinic of Thammasat University Hospital, Pathum Thani, Thailand from February to September 2024. Participants were pregnant women aged 18 to 45 years old who attended their first antenatal visit at a gestational age of less than 20 weeks. After counseling, written informed consent was signed after well understood of the study. A self-administered questionnaire consisting of knowledge about cervical cancer, attitudes towards screening and interest in undergoing screening during pregnancy was used. A total of 384 participants were recruited. The average maternal age was 30 years. Two-thirds (254/384) of the participants had at least a bachelor's degree, and over half (197/384) had a high salary. Only 42.7 (164/384) percent had previously undergone CCS with 70 (115/164) percent screened in the past 3 years. Knowledge scores averaged 8.9 out of 15 with many participants unaware of key facts, including the use of the Pap smear for screening. Although most participants (85.2-97.4%) had a positive attitude towards CCS during pregnancy, only 57(219/384) percent were interested in undergoing CCS during pregnancy. Factors such as prior screening and knowledge level were significant determinants of interest in CCS. Pregnant women had moderate knowledge and a good attitude towards cervical cancer and CCS. Less than half of pregnant women uninterested in CCS during pregnancy with the reason of prior CCS before pregnancy and inconvenience.

Experience of Cervical Cytology and High-Risk HPV Testing (Physician vs Self-Collected) for Primary Cervical Cancer Screening in an Urban Hospital of Thailand

To explore the experience of conventional Pap smear (CPS), physician-collected HPV (pHPV) and self-collected HPV test (sHPV) for cervical cancer (CC) screening in the general population in the north-eastern region of Thailand. A retrospective study was conducted among women who visited the gynecology and colposcopy clinic in Kuchinarai Crown Prince Hospital for CC screening between January 2020 and December 2023. Participants received counselling before choosing between CPS, pHPV, and sHPV testing. Data reviewed from medical records included age, parity, CC screening results, colposcopy results, and treatment. A total of 5,984 women were enrolled in the study. There were 1,727, 2,962 and 1,295 cases in the CPS, pHPV, and sHPV, respectively. The average age of participants was 40.6, 49.5 and 47.6 years old in the CPS, pHPV, and sHPV, respectively. Percentage of multiparous participants were 86.3, 94.4 and 93.8 in CPS, pHPV and sHPV, respectively. Positive test results from the CPS, pHPV, and sHPV were 1.4, 5.7, and 6.8 percent, respectively with statistical significance. Return to colposcopy of CPS (62.5%) was highest and followed by pHPV (35.3%) and sHPV (18.2%) groups with statistical significance. Detection rate of CIN2+/CIN 3+ were 0.1/0.1, 0.5/0.4 and 0.2/0.2 percent from CPS, sHPV, and sHPV groups, respectively with statistical significance. Primary HPV and CPS testing had comparable reliability and acceptability for CC screening among Thai women. High missing rate for reflexed cytology or colposcopy of sHPV was a major issue.

Sexual Dysfunction in Patient’s Diagnosed with Cervical Cancer in Comparison to the Healthy Female Population

Aim of the study was to evaluate and compare the prevalence female sexual dysfunction (FSD) in cervical cancer (CC) survivors to a healthy female population. This observational prospective trial was conducted at Thammasat University Hospital, Thailand, between April 2023 and February 2024. Participants were CC survival who attended an outpatient cancer clinic. Subject with age between 30 and 60 years old and engaged in sexual intercourse at least once within the last 4 weeks were recruited. The control group was women who attended outpatient gynecologic clinic for routine pelvic examination with no serious medical diseases and no malignancy. The female sexual function index (FSFI) was applied to all the participants during the survey. Other demographic data of the participants were collected. A total of 116 cases were enrolled in the study. Participants were equally divided into the study and control groups. The mean age and BMI of participants were 49.4 years and 24.7 kg/m², respectively without statistical significance. The FSD's prevalence of the CC survival was significantly higher than control group (34.5 and 10.4 percent, respectively). CC survivors reported significantly poorer outcomes in the domains of lubrication, sexual satisfaction, and pain compared to the control group. The prevalence rates of CC survival and control group was 34.5 and 10.4 percent, respectively. Three out of six FSFI domains namely lubrication, satisfaction, and pain showed more problematic for CC survivors compared to control group.

Inflammatory Markers in Prior Loop Electrosurgical Excision Procedure (LEEP) as a Prognosis Factor in the Recurrence of Cervical Intraepithelial Neoplasia

To investigate the relationship between preoperative inflammatory markers and recurrence of CIN after loop electrosurgical excision procedure (LEEP). A retrospective historical cohort study was conducted at gynecologic oncology unit, Bhumibol Adulyadej Hospital, Royal Thai Air Force, Thailand. Data was collected from medical records of CIN cases from year 2016 to 2021. Inclusion criteria were subjects who were diagnosed of CIN and underwent LEEP with pathologic confirmation and followed up for two years (at 6 months, 1 year, and 2 years). Preoperative complete blood count (CBC) was obtained within one month for calculation as systemic inflammatory values. One hundred and ten cases of CIN were enrolled. Mean age of participants was 48.1 years old. Three-fourths (83/110) of the participants had histological confirmation as CIN2/3. Sixteen (18/110) and twenty (22/110) percentage of cases had recurrence of disease at 1 and 2 years, respectively. Monocytes /lymphocytes ratio (MLR) and systemic inflammation response index (SIRI) could predict recurrence of CIN within 2 years. MLR more than 0.16 and SIRI more than 0.57 gave the sensitivity and negative predictive value (NPV) at percentage of 77.3/ 81.8 and 91.8/ 90.2, respectively. Combination of MLR and SIRI had sensitivity and NPV at 90.5 and 95.4 percent, respectively. MLR and SIRI could not predict marginal involvement, glandular involvement, and LEEP confirmed CIN 2/3. Pretreatment MLR and SIRI were statistically significant in predicting the recurrence in CIN after post LEEP procedure within 2 years follow up.

Prediction Score of Cervical Intraepithelial Neoplasia Grade II or Higher (CIN2+) in Patients with Low-Grade Cytology (ASC-US, LSIL) and HPV- Negative or Non-type 16/18 High-Risk HPV-Positive Results

The aim of this study was to identify and quantify the risk factors with the greatest impact on the development of CIN2+ in patients with low-grade cytology and either HPV-negative or high-risk HPV-positive (non-16/18) results. The secondary aim was to develop and validate a multiparameter, risk-based prediction system. This retrospective cohort study was conducted in the Department of Obstetrics and Gynecology at Thammasat University Hospital between January 2021 and December 2024. Women who underwent cervical cancer screening and had a report of low-grade cytological abnormalities (ASC-US or LSIL), with either non-16/18 high-risk HPV infection or a negative HPV test, were included. A total of 480 participants were included. The mean age of participants was 40.7 years. The prevalence of CIN2+ was 15.6% (75/480). The predictive model was developed by incorporating six factors: having three or more deliveries, six or more lifetime sexual partners, smoking, no cervical screening within five years, lack of HPV vaccination, and high-risk HPV positivity (non-16/18). Subjects with a score of 5 or more out of 14 points were classified as high-risk and recommended to undergo colposcopy within four weeks. The model demonstrated a sensitivity of 97.3% and a negative predictive value (NPV) of 98.6%. The risk factors for CIN2+ included having three or more deliveries, six or more lifetime sexual partners, smoking, no cervical screening within the past five years, lack of HPV vaccination, and high-risk HPV positivity (non-16/18). The predictive model demonstrated a sensitivity of 97.3% and a negative predictive value (NPV) of 98.6%.