Perapong Inthasorn

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.

Prevalence of Abnormal Anal Cytology in Women with Abnormal Cervical Cytology

The aim of this study was to evaluate the prevalence of abnormal anal cytology in women presenting with abnormal cervical cytology (intraepithelial lesion or cervical cancer) at the largest tertiary university hospital in Thailand. A cross-sectional prospective study design was used. Anal cytology was performed on 145 women with abnormal cervical cytology between June 2014-Octoble 2014. If abnormal anal cytology was detected, anoscopy was performed with biopsy in any suspicious area of precancerous change. Prevalence of abnormal anal cytology was 5.5% (8 patients). Of 8 patients, six patients presented with low-grade squamous intraepithelial lesion, one patient with high-grade squamous intraepithelial lesion, and one with atypical squamous cell cannot exclude high-grade squamous intraepithelial lesion. Abnormal anoscopic impression was found in 3 cases, as follow: The first case showed faint acetowhite lesion and anoscopic impression was low grade squamous intraepithelial lesion; the second case was reported as human papillomavirus (HPV) change by anoscopic impression; and the third case showed dense acetowhite lesion with multiple punctation and pathologic examination showed anal intraepithelial neoplasm III (AIN3). The last patient underwent wide local excision of AIN3 with split-thickness skin graft reconstruction. Final pathology confirmed AIN3 with free resection margin. Prevalence of abnormal anal cytology was 5.5%  in patients with abnormal cervical cytology. The prevalence might be support anal cytology screening in this group of patients.