Is The “See and Treat” Approach Appropriate for Management of Women with Abnormal Cervical Cytology in Thailand?

At present, the “see and treat” approach for women with abnormal cervical cytology is widely accepted. It has been proven to be more cost-effectiveness than conventional management, making it particularly attractive for many regions in Thailand where resources are limited and poor patients’ compliance is expected. However, the main disadvantage of the “see and treat” approach is the risk of overtreatment. National Health Service (NHS) guidelines recommend that the overtreatment rate in the “see and treat” approach must be less than 10%. The overtreatment rate appears to be acceptable if the “see and treat” approach is carried out in women with high-grade squamous intraepithelial lesion (HSIL) cytology or in women with lesser grades of smear abnormality whose colposcopic findings suggest high-grade disease

Abnormal Hysterosalpingographic Findings in Infertile Women

Objectives:To determine the rate and patterns of hysterosalpingography (HSG) abnormality among infertile women at Srinagarind Hospital, Khon Kean University, Thailand.Materials and Methods:The study patients were identified through the reports of the Infertile Clinic. In our hospital, HSG was routinely performed in all women undergoing an evaluation of infertility problems. Medical records were extracted for baseline characteristics, types of infertility, and details of HSG findings. A 95% confidence interval (CI) was calculated to demonstrate the precision of data. Logistic regression model was used to determine an independent impact of the type of infertility on abnormal HSG findings.results:Overall, 589 women were reviewed. The mean ± SD age was 32.9±5.0 years. Secondary infertility was noted in 163 (27.7%) women. Abnormal HSG was noted in 227 (38.5%, 95% CI, 34.6%-42.6%) women. The most common abnormal HSG findings were tubal occlusion and hydrosalpinx. When adjusted with patients’ age, women with secondary infertility carried a higher risk of having abnormal HSG finding compared to those with primary infertility (an adjusted odds ratio, 2.44; 95% CI, 1.68-3.54). Conclusion:Rate of abnormal HSG findings among infertile women in our setting was approximately 40%. Type of infertility was independently associated with abnormal HSG findings

Adenocarcinoma in situ of the uterine cervix

Adenocarcinoma in situ (AIS) of the uterine cervix has been acknowledged as a precursor lesion of invasive adenocarcinoma. AIS is histologically characterized by the presence of endocervical gland lined by atypical endocervical epithelium resembling the cells of adenocarcinoma but has no evidences of stromal invasion. AIS occurs within the endocervical clefts, it is difficult to screen cytologically. Incorporating high-risk HPV-DNA testing into cytologic screening could better identify AIS lesion. For definitive diagnosis of AIS, cervical conization either with knife, electrical loop, or laser is required to ensure the exclusion of coexisting invasive adenocarcinoma. Hysterectomy remains the most preferred method of definite treatment. Conservative management by conization alone is only acceptable for whom preservation of fertility is an issue. The occurrences of recurrent or persistent disease for women treated for AIS are mostly noted during the first 3 years of follow-up emphasizing the necessity of extensive surveillance in this period

Evaluation of Completeness of Operative Records in Women Undergoing Gynecologic Surgery at Chiang Mai University Hospital

Objective: To evaluate the completeness of operative records at the general gynecologic surgery unit using the Good Surgical Practice (GSP) 2008 guidelines as a gold standard.Materials and methods: The operative records of women undergoing gynecologic operation at Chiang Mai University Hospital between January and July 2009 were reviewed. According to GSP 2008, the operative record should include all of the following data: (1) date and time of operation; (2) types of surgery ; (3) name of the operating surgeon and assistant; (4) operative procedure carried out; (5) incision; (6) operative diagnosis; (7) operative findings; (8) operative complications; (9) any extra procedure performed and its reason; (10) details of tissue removed, added or altered; (11) identification of any prosthesis used including serial numbers of such materials; (12) details of closure technique; (13) postoperative care instruction and (14) a signatureResults: During the study period, the medical records of 232 women who underwent gynecologic surgery were reviewed to determine the quality of the operative record. Postoperative care instruction was completely recorded in all operative notes (100%). Only 2 of the 14 items failed above 10% including details of incision (10.3%) and details of closure technique (12.9%). The signature was absent in 13 operative notes (5.6%).Conclusion: The evaluation results of operative records as per GSP 2008 guidelines in this study appear to be favorable. The details of incision and closure technique should be improved and periodic audit is required to assure that these standards are maintained

HPV and cervical cancer related knowledge, awareness and testing behaviors in a community sample of female sex workers in China

BACKGROUND: Limited data suggested that the prevalence of Human Papillomavirus (HPV) among female sex workers (FSW) is much higher than in the general female population. The current study aimed to examine the HPV and cervical cancer related awareness, knowledge, and behaviors among FSW in China. METHODS: A total of 360 FSW recruited from entertainment establishments in Beijing completed a self-administered survey including demographics, HPV related knowledge, and health-seeking and cervical cancer preventive behaviors. RESULTS: Approximately 70.8% of the participants ever heard of cervical cancer, and as few as 22.1% and 13.3% ever heard of HPV and HPV vaccine, respectively. The mean score on a 7-item knowledge scale was 2.2 (SD = 2.4). Less than 10% of FSW perceived any risk of cervical cancer, and only 15.3% ever had a Pap smear. About 40.8% of FSW would accept HPV vaccine if it is free, and 21.8% would accept it even with a charge. Multivariate regression suggested that women with better knowledge of cervical cancer were more likely to have a Pap smear (aOR = 1.35); women who had tested for HIV were 11 times more likely to have a Pap smear, and women who had worked longer in commercial sex (aOR = 1.01) and had regular health check-ups (aOR = 1.95) were more likely to accept HPV vaccine. CONCLUSIONS: Our study underscores the needs for effective cervical cancer prevention programs for FSW in China and other resource-limited countries. We specifically call for cervical cancer and HPV knowledge and awareness programs and regular screening as well as HPV risk-reduction programs for these vulnerable women