Serkan Akis

The persistence of HPV type‐specific infections in patients following colposcopic examination: An observational study

AbstractAimHigh‐risk HPV infection is a necessary but not sufficient factor for the development of precancerous lesions and cervical cancer. Beyond mere HPV positivity, the persistence of infection over time plays a crucial role. This study aims to evaluate the clearance and persistence rates of HPV 16 and 18 genotypes.MethodsThe cervical cytology results were reported using the 2014 Bethesda System classification. The cervical cytology samples were analyzed using the Roche Cobas® 4800 HPV tests. Patients with any HPV genotype other than 16 or 18, those with missing data, those who were lost to follow‐up, those who underwent excisional procedures or hysterectomy, and those with high‐grade cervical dysplasia were excluded from this study.ResultsAmong 191 patients (mean age: 41.2 ± 0.6 years, 16.8% postmenopausal), the mean follow‐up was 21.6 ± 0.7 months. No significant differences were found between the clearance and persistence groups in age, follow‐up duration, cervical biopsy, or endocervical curettage results. However, HPV 16 had a higher persistence rate (28.2%), and abnormal cytology was more frequent in the persistence group (p = 0.038).ConclusionsAround 25% of patients had persistent HPV infection. Close monitoring is essential for those with CIN 1 on initial colposcopy, as they may have a higher risk of progressing to high‐grade dysplasia compared to those without dysplasia.

Tumor diameter as a predictor of lymph node involvement in endometrioid type endometrial adenocarcinomas

AbstractAimTo analyze the risk factors of lymph node involvement in pure endometrioid type endometrial cancer and assess factors that necessitate lymphadenectomy.MethodsPatients who had been operated on due to endometrial cancer and whose final pathology was reported as pure endometrioid carcinoma between January 2014 and January 2020 were assessed. Hysterectomy, bilateral salpingo‐oophorectomy, and systematic lymphadenectomy were performed in all patients. All specimens were reported by expert gynecopathologists.ResultsThe lymph node positivity rate was 14.4%. When the study population was classified according to the Mayo risk criteria; lymph node involvement in the low‐risk and high‐risk groups was 9.1% and 14.8%, respectively and there was no statistically difference (p > 0.05). The median of tumor size and the rate of deep myometrial invasion, lymphovascular space invasion, adnexal involvement, FIGO grade 3 tumor were found significantly higher in the positive lymph node group in univariate analysis. In the receiver operating characteristic curve analysis, the cut‐off value of the tumor diameter was determined as 47.5 mm (sensitivity 85%, specificity 62%). Every 10 mm increase in tumor diameter increased the risk of lymph node involvement 10 times.ConclusionThis study defined that the tumor diameter is an independent predictor for lymphatic dissemination. In the future, it could be shown that even with new modeling based on tumor diameter, lymphadenectomy or adjuvant radiotherapy requirements would be reevaluated.

The meaning of high‐risk HPV other than type 16/18 in women with negative cytology: Is it really safe to wait for 1 year?

AbstractBackgroundHuman papillomavirus (HPV) is a primary risk factor for cervical cancer. HPV 16 and 18 are the two most carcinogenic genotypes and have been reported in the majority of cervical cancer. High‐risk HPVs (hrHPVs) other than HPV 16/18 cause approximately a quarter of cervical cancers. We aimed to present the colposcopy‐guided biopsy results of non‐16/18 hrHPV‐infected women with negative cytology.MethodsThis is a retrospective cohort study conducted on 752 patients between the ages of 30‐65 years with non‐16/18 hrHPV and negative cytology undergoing colposcopy‐guided biopsy at a tertiary gynecological cancer center between January‐2016 and January‐2019.ResultsThe mean age of the women was 42.35±9.41 years. Cervical intraepithelial neoplasia (CIN) 2+ lesion was detected in 49 (6.5%) women with negative cytology. The rate of CIN 2+ lesions in women with abnormal cytology was 12.8%. Patients with abnormal cytology had about 2.1 and 2.4 times increased the odds of CIN 2+ lesion in cervical biopsy and endocervical curettage specimens, respectively. CIN 3+ lesion was detected in 20 (2.7%) women with negative cytology. One (0.1%) of the patients with HPV 39 and negative cytology had invasive cervical cancer. The two most common HPV subtypes were HPV 31 and HPV 51.ConclusionsThe risk of cervical preinvasive lesions still can be detected and cannot be completely eliminated among hrHPV other than 16/18‐infected women with negative cytology. Based on the results of this study, referral of non‐16/18 hrHPV‐infected women with negative cytology to colposcopy is supported as a credible and feasible strategy.

Effect of Human Papillomavirus Subtype on the Rate of Positive Surgical Margin After Cervical Conization

Objective. Human papillomavirus (HPV) infection is a risk factor for cervical carcinoma. Over 100 types of HPV have been identified. The excisional procedures are recommended for women with high-grade cervical intraepithelial neoplasia. Surgical margin status is an important predictor of the risk of relapse. The aim of the current study was to evaluate whether HPV genotype is a predictive factor of positive surgical margin after cervical cone excision. Materials and Methods. The records of 448 HPV-infected patients who underwent loop electrosurgical excision or cold knife conization at a tertiary gynecological cancer center were retrospectively reviewed. The patients were divided into 6 groups according to HPV positivity: HPV 16 only, HPV 18 only, HPV 16/18, other high-risk HPV (hrHPV), HPV 16/hrHPV, and HPV 18/hrHPV. Results. There was no significant difference between the HPV groups in terms of age, parity, menopausal status, endocervical canal involvement, conization method, and the rates of positive margin ( P = .15, P = .49, P = .07, P = .20, P = .24, P = .39, respectively). Conclusion. The results show that HPV subtypes might not be associated with endocervical canal involvement and the rates of positive margin. In addition, margin status was not related to the conization method and the number of excised cervical tissue.

Is Endocervical Glandular Involvement Related to The Depth of Cone Biopsy?

Introduction. This study aimed to determine whether endocervical glandular involvement by squamous intraepithelial lesion would differ with respect to the depth of the excised specimen and analyze the related factors that may define endocervical glandular involvement among cases treated with cone biopsy. Methods. Between April 2016 and December 2018, women who underwent colposcopy and excisional procedures in the department of gynecologic oncology were retrospectively investigated. Patients with multiple specimens, or whose specimen depths were not measured, and a negative/unknown HPV status were excluded from the study. Also, patients with no dysplasia or microinvasive/invasive cancer in the final pathology report and those who had not undergone endocervical curettage during colposcopy were excluded. HPV genotypes, degree of dysplasia, surgical margin status, and specimen depth were documented from medical records. Further, the association of these factors with endocervical glandular involvement was evaluated. Results: A total of 321 patients who fulfilled the criteria were included in the study, with a mean age of 41.9 years. In total, 101 patients (31.5%) had endocervical glandular involvement. The mean excised specimen depth was 17.04 mm; 17.9 and 16.7 mm for the positive and negative glandular involvement groups, respectively ( p = .13). The mean ages were 42.7 and 41.6 years for these groups, respectively ( p = .32). There was no association between the HPV genotypes and glandular involvement. Conclusions: Endocervical glandular involvement is not associated with the depth of the excised specimen. A deeper cone biopsy may not necessarily enable a more effective treatment of the disease.