Marta Preston

Risk of High-Grade Cervical Dysplasia in Older Patients With a Positive Human Papilloma Virus Cervical Screening Test

Introduction The Australian National Cervical Screening Program has mandated management algorithms that are uniform across all age groups, but evidence is emerging that perhaps the risk of high-grade squamous intraepithelial lesion (HSIL) may decrease in the postmenopausal period. Objective The aim of the study is to identify if patients ≥50 years of age referred to a tertiary colposcopy service have a different risk of HSIL or greater (+). Materials and Methods This is a retrospective cohort study of 3239 referrals to a hospital colposcopy clinic with a positive human papillomavirus (HPV) cervical screening test between December 2017 and May 2023. Patients were included if they were aged 25–74 years, had a cervix, and completed an outpatient colposcopic assessment. Medical records were analyzed to determine the incidence of HSIL+ for each age group and compared them using χ2 and multivariable regression. Results The overall incidence of invasive carcinoma was 0.93% and HSIL/adenocarcinoma-in-situ was 20.38%. Patients ≥50 years of age were less likely to have HSIL or greater diagnosed than those <30 (p < .0001) or those 30–49 (p < .0001), even after considering referral HPV subtype and reflex cytology (OR = 0.45, 95% CI = 0.34–0.59). The risk of invasive carcinoma in those aged ≥50 was no different than those aged 30–49 (p = .982). Conclusions We observed a lower incidence of HSIL or greater with increasing age even after considering referral HPV subtype and reflex cytology. As further data emerges regarding the risk of high-grade disease in those ≥50 years of age, refinement of the risk-based screening algorithm to account for advanced age may be required.

Sentinel lymph node detection with indocyanine green and patent blue dye in cervical cancer: A single‐centre feasibility study

BackgroundSentinel lymph node (SLN) dissection has been established as standard of care in many tumours. Its use in early cervical cancer is an area of increasing interest and some studies suggest a high detection rate.AimTo explore feasibility of SLN dissection and establish the patient detection rate in women with early cervical cancer.Materials and MethodsAll patients with early cervical cancer, International Federation of Gynaecology and Obstetrics (FIGO) 2018 Stage 1, of any histology who underwent SLN dissection from January 2017 to March 2023 were included. Patients were eligible if they had pelvic confined disease; no suspicious lymph nodes on pre‐operative imaging or intra‐operatively; tumours <4 cm at the time of surgery and no contra‐indications to surgery. Patients were excluded if there was a known allergy to dye or less than six months follow‐up data.ResultsSixty‐two patients were included in the study and 53% had FIGO stage 1b1 disease. The overall bilateral SLN detection rate was 89%, and the side‐specific rate was 94%. Where indocyanine green (ICG) was used alone, the bilateral detection rate was 87% and the side‐specific rate was 93%. Where ICG was used with patent blue dye (PTB) the bilateral detection rate was 92% and the side‐specific rate was 96%. Where PTB was used alone the bilateral detection rate was 85% and the side‐specific rate was 92%. The node positive rate was 6% (7/124) which included isolated tumour cells in four patients.ConclusionSLN dissection with ICG or PTB is feasible in early‐stage cervical cancer.