Nida Jareemit

Yield of endocervical curettage in detecting cervical intraepithelial neoplasia grade 2 or higher during colposcopy: A prospective, cross‐sectional study

AbstractObjectiveThis study assessed the prevalence and factors associated with detecting cervical intraepithelial neoplasia grade 2 or higher (CIN2+) via endocervical curettage (ECC) during colposcopy.MethodsBetween December 2020 and September 2023, a prospective, cross‐sectional study involving women with abnormal cervical cancer screening results who underwent colposcopy was conducted. ECC was performed via a Kevorkian endocervical curette following colposcopy‐directed biopsy. The exclusion criteria were glandular cytology abnormalities, pregnancy, post‐hysterectomy status, and cervical cancer.ResultsThe study included 569 women, with a mean age of 41.6 ± 11.7 years. Among the participants, 78.9% presented with low‐grade cytology, whereas 21.1% presented with high‐grade cytology. All of the patients underwent ECC, with 0.4% (two patients) yielding inadequate samples. ECC detected CIN2+ lesions in 11.6% of the patients (95% confidence interval [CI], 9–14.3). Univariable analysis revealed that age, menopausal status, history of CIN2+, high‐grade cytology, and high‐grade colposcopy impression were significant factors for CIN2+ detection by ECC. Multivariable analysis confirmed high‐grade cytology as the sole independent factor (adjusted odds ratio [OR], 13.81 [95% CI, 4.60–41.42], P < 0.001). ECC added a diagnostic yield of 2.9% (95% CI, 1.5–4.3) for detecting CIN2+ lesions missed by colposcopy‐directed biopsy. Multivariable analysis demonstrated an independent association between human papillomavirus 16 (HPV‐16) infection and the additional diagnostic benefit of ECC, with an adjusted odds ratio (OR) of 6.26 (95% CI, 1.49–26.23, P = 0.012).ConclusionThis study highlights the critical role of ECC in detecting CIN2+ lesions, particularly in patients with high‐grade cytology or HPV‐16 positivity.

Risk of CIN2+ in women aged >60 years with abnormal cervical cancer screening: a multicenter retrospective cohort study from the Thai Gynecologic Cancer Society research group

To study patterns of abnormal cervical cancer screening in women aged >60 years and explore the risk and predictors of cervical intraepithelial neoplasia grade 2 or worse (CIN2+). This retrospective cohort study examined 1,596 women aged >60 years with abnormal cervical cancer screening results from eight Thai cancer centers. Those who underwent hysterectomy were excluded. Patient characteristics, previous and current cervical cancer screening results, and histopathology data were collected and analyzed. Mean age was 68.2±7.2 years. The abnormal screening results were normal cytology with positive high-risk human papillomavirus (0.9%), atypical squamous cells of undetermined significance (37.7%), low-grade squamous intraepithelial lesion (12%), atypical squamous cell cannot exclude high-grade lesion (11.7%), high-grade squamous intraepithelial lesion (12.7%), atypical glandular cell (20.1%), squamous cell carcinoma (4.3%), and adenocarcinoma (0.7%). Risk of CIN2+ in women with abnormal screening was 17.9% (95% confidence interval [CI]=16.1-19.8); among those with available histopathology, the risk was 28.8% (95% CI=26.1-31.7). Univariable logistic regression showed that age >70 years, sexual activity within 1 year, previous abnormal/no screening, previous CIN2+ pathology, presence of symptoms, and high-grade cytology were significant predictors of CIN2+. In the multivariable analysis, lack of previous screening (adjusted odds ratio=4.05; 95% CI=1.91-8.60; p60 years should be individualized based on their risk factors, particularly for those who have never been screened.

Comparison of surgical and oncologic outcomes in patients with clear cell ovarian carcinoma associated with and without endometriosis

To compare clinical characteristics, surgical and oncologic outcomes of clear cell ovarian cancer among patients with cancer arising from endometriosis, cancer coexisting with endometriosis, and cancer without endometriosis. A retrospective chart review of patients diagnosed with clear cell ovarian cancer during January 1998-March 2013 was performed. All histopathology specimens were reviewed by a gynecologic pathologist and classified into one of the three following endometriosis status groups: arising group, coexisting group, or without group. The primary outcome was disease-specific survival (DSS). The secondary outcomes were progression-free survival, surgical morbidities, response rate, recurrence rate, and cancer-specific death. Finally, 249 patients were included. There were 82, 96, and 71 patients in the arising, coexisting, and without groups, respectively. Regarding baseline characteristics among groups, the without group was significantly older and had more advanced diseases. There was a significant difference in progression-free survival between the arising group and the without group (p = 0.003). Five-year progression-free survival rates were 62.8% in the arising group, 50.2% in the coexisting group, and 38.3% in the without group. DSS was not significantly different among groups. Multivariate analysis revealed ovarian surface invasion (HR = 2.76) and pelvic lymphadenectomy (HR = 0.39) to be independent prognostic factors for progression-free survival, whereas no remission after primary treatment (HR = 8.03) and pelvic lymphadenectomy (HR = 0.21) were prognostic factors for DSS. Intraoperative blood loss and residual tumor were significantly higher in the without group. Endometriosis status was found not to significantly influence surgical and oncologic outcomes in patients with clear cell ovarian cancer.

A comparison of high‐risk human papillomavirus DNA detection between urine and cervical sample testing in women with abnormal Pap smears

AbstractAimsTo compare the clinical performance of high‐risk human papillomavirus (hrHPV) DNA detection between urine and cervical samples collected from the same patient for the detection of CIN2+ lesions (high‐grade squamous intraepithelial lesions or cervical cancer lesions). The secondary objectives were to evaluate agreement among hrHPV genotypes and to compare patient satisfaction between urine and cervical sample collection.MethodsThis prospective cross‐sectional study enrolled 96 women with abnormal cervical cytology who attended the colposcopy clinic at Siriraj Hospital (Bangkok, Thailand) between July 2016 and January 2017. Self‐collected random‐voiding and first stream urine samples were collected into a universal sterile urine container and immediately mixing with preservative before the pelvic examination. Cervical tissue sampling was performed according to standard treatment guidelines. Both specimens were sent for extraction and detection of hrHPV by Anyplex II HPV high‐risk testing. Study patients were surveyed to compare patient satisfaction between urine and cervical sample collection.ResultsCarcinogenic hrHPV positive rate was 73% in urine samples and 81% in cervical samples. The sensitivity for HPV in the detection CIN2+ was high in both the urine and cervical groups at 86.2% and 94.8%, respectively. Agreement between the urine and cervical groups for HPV 16 or 18 detection was high, with kappa values of 0.86 for subtypes 16/18. Urine specimen collection had significantly higher satisfaction and acceptability than cervical specimen collection.ConclusionUrine hrHPV testing by real‐time polymerase chain reaction demonstrated high sensitivity and accuracy for the detection of CIN2+ lesions, with very good agreement when compared with cervical sample testing.

High-risk human papillomavirus genotyping in women with atypical squamous cells of undetermined significance

AbstractWe conducted a prospective study to evaluate the prevalence of high-risk human papillomavirus (hr-HPV) positivity in women with atypical squamous cells of undetermined significance (ASC-US). Additionally, we assessed the association of hr-HPV positivity with the pathology of high-grade squamous intraepithelial lesions or worse (HSIL+) and the risk of subsequent detection of squamous intraepithelial lesions. A total of 376 women were included, with 242 (64.4%) exhibiting hr-HPV positivity. The predominant HPV genotypes were 16, 52 and 58. Factors associated with the immediate detection of HSIL+ pathology included a colposcopic impression of high-grade lesions, hr-HPV positivity, HPV 16 positivity, HPV 18 positivity, HPV 58 positivity, age less than 40 years, and biopsy of two or more pieces. However, only the first three factors were statistically significant in multivariate analysis. Among the 291 women who continued surveillance for 6 months or more, the median follow-up period was 41.8 months (interquartile range [IQR] 26.5–54.0). The prevalence of subsequent HSIL in women with hr-HPV positivity versus negativity was 3.6% versus 0.98%, respectively. The median time to the subsequent detection of SIL was 28.7 months (IQR 14.9–41.7). In conclusion, women with ASC-US in our study had a high proportion of hr-HPV positivity. Type-specific HPV testing could play a pivotal role in the development of specific management protocols for women with ASC-US.Clinical trial registration: https://thaiclinicaltrials.org, TCTR20161017002.

Significance of Genotype‐Specific High‐Risk Human Papillomavirus Testing in Cervical Cancer Screening: A Hospital‐Based Study

ABSTRACTThis study explored histopathological outcomes among women who tested positive for high‐risk human papillomavirus (hrHPV), examined the significance of extended HPV genotyping, and identified predictors of cervical intraepithelial neoplasia grade 2 or worse (CIN2+). This retrospective review assessed medical records of women who screened positive for hrHPV between January 1, 2020, and December 31, 2023. Genotyping results, diagnostic procedures, and histopathological findings were collected. Data were analyzed using SPSS, with p <  0.05 considered statistically significant. Among 1981 women, the median age was 40 years (IQR 32.0‒49.0), and the median parity was 1 (IQR 0‒2). Overall, 1223 women (61.7%) had prior screening, 1215 women (61.3%) had previous cytology, and 107 women (5.4%) had prior hrHPV testing. Single‐genotype infection occurred in 1408 women (74.7%), with HPV52, HPV16, and HPV58 identified in 23.7%, 15.6%, and 15.4% of cases, respectively. CIN2+ was detected in 152 women (7.7%), including 130 with CIN2/CIN3/AIS and 22 with cancer. Detection of HPV16 significantly increased the risk of CIN2+ (odds ratio [OR] 4.534, 95% CI: 3.197‒6.430), as did multiparity (OR 1.497, 95% CI: 1.070‒2.094). The immediate risk of CIN2+ for HPV31, HPV39, HPV56, HPV66, and HPV68 was below 4%. Among hrHPV‐positive women, 7.7% had CIN2+. Extended hrHPV genotyping may refine risk stratification by highlighting HPV16 and multiparity as significant predictors of CIN2+ lesions.