Victoria L Parker

Predictors for negative large loop excision of the transformation zone (LLETZ) in a primary HPV screened population

To assess rates of histologically negative large loop excisions of the transformation zone (LLETZ) and potential predictive factors within a single UK Colposcopy Unit. Retrospective cohort study. Jessop Wing Colposcopy Unit, Sheffield, U.K. Patients coded upon the Colposcopy database as having undergone a LLETZ procedure. Univariate (Chi squared, t-test) and multivariate logistic regression analysis. Histological negative LLETZ sample. 2,969 patients underwent a LLETZ procedure; 291 (10 %) procedures resulted in a negative LLETZ. Older age group (p < 0.0001), referral with negative cytology high risk human papillomavirus (hrHPV) detected (p < 0.0001), unsatisfactory colposcopy (p < 0.0001), repeat LLETZ (p < 0.0001), and biopsy and treat procedures (p = 0.0005) were found significant predictors of negative LLETZ. Patients with negative LLETZ were significantly less likely to have had a 'select & treat' procedure (p < 0.0001). Due to the increased sensitivity of HPV testing in combination with cytology for the detection of high-grade disease, it is more likely a negative LLETZ will occur following positive biopsy. This may be due to the detection of small volume high-grade disease removed by the punch biopsy alone, spontaneous regression of disease, or resolution due to localised immune responses and healing. As increasing age and unsatisfactory colposcopy are significant risk factors for obtaining a negative LLETZ, the authors recommend further studies are conducted in this more challenging referral population.

Atypical placental site nodules: A retrospective case series

Abstract Introduction Atypical placental site nodule (APSN) is a rare diagnosis, representing remnants of a previous pregnancy and extravillous trophoblast tissue. These lesions are potential precursor lesions to rare forms of Gestational trophoblastic neoplasia (GTN). Recent data suggest up to a 15% risk of malignancy occurring either concurrently or manifesting within a few months of diagnosis. These patients are often young with future fertility considerations. Prognosis, treatment, and clinical follow‐up of APSN cases currently remain a matter of debate. This study aimed to address and explore some of these issues. Material and Methods Retrospective case series analysis was performed between 1st January 2000 and 31st December 2023 at the Sheffield Trophoblastic Disease Centre, Sheffield, UK. Patients on conservative management were asked at routine follow‐up telephone consultations if they would consider a completion hysterectomy in light of the risk of progression to GTN. Results Twenty‐two cases of APSN were registered, of which 10 (45%) received surgical management. Two (20%) cases were incidentally diagnosed following total abdominal hysterectomy (TAH) for other indications and eight (80%) had a TAH within twelve months of their initial diagnosis as part of primary management. None had histological evidence of GTN. Of the twelve (55%) patients initially opting primarily for conservative management, three (25%) decided to have a TAH performed based on the current evidence for risk of malignant transformation, eight (67%) indicated they would have a TAH based on advice from the center, and one (8%) was uncertain. No patients were diagnosed with GTN. Conclusions In this study, we found no evidence of malignant transformation in our patients, which conflicts with other published data conferring an 11%–14% risk of malignant transformation. An international consensus opinion needs to be reached within the Gestational trophoblastic community regarding the optimal advice, management, and follow‐up regimens for patients diagnosed with APSN.