Cervical carcinogenesis, bacterial vaginosis, HPV-mRNA test and relapse of CIN2+ after loop electrosurgical excision procedure (LEEP)

OBJECTIVE: The aim of the study was to evaluate the relationship between bacterial vaginosis (BV) and relapse of cervical intraepithelial neoplasia grade 2 or more (CIN2+) after Loop electrosurgical excision procedure (LEEP). PATIENTS AND METHODS: One hundred four patients who underwent LEEP for CIN2+ were followed up every six months for three years. Fifty-three were negative for BV and fifty-one were positive. Each clinical control included Pap test, colposcopy, Amsel criteria test, HPV-DNA, and HPV-mRNA test. RESULTS: Patients’ age, presence of BV, positivity to HPV-DNA and HPV-mRNA tests were analyzed. The average age of patients was 42.5 ± 8.92 years (median: 42.5; range from 27 to 58 years). The minimum follow-up was 6 months and maximum 36 months (average: 22.8 ± 4.53; median: 24). The 10% of the patients with HPV-mRNA test negative had relapsed, compared to 45% of patients with HPV-mRNA test positive. Among the 53 patients without BV the 20% had relapsed compared with 23% of 51 patients with diagnosis of BV. CONCLUSIONS: There is no evidence for higher percentage of relapse in patients with BV, submitted to excisional procedure for CIN2+ associated to HPV-m-RNA test positivity. There is only a correlation among BV and relapse of CIN2+ lesions after LEEP

Diagnostic accuracy of sonohysterography vs hysteroscopy in benign uterine endocavitary findings

OBJECTIVE: To compare diagnostic accuracy of sonohysterography vs hysteroscopy in patients with benign uterine endocavitary findings. PATIENTS AND METHODS: This retrospective study evaluated 202 patients submitted to sonohysterography after transvaginal ultrasound examination suspicious for uterine endocavitary findings. Cytological sample was taken and analyzed from the fluid used to distend the uterine cavity. Of 202 patients enrolled for this study, 86 patients underwent gynaecological surgery, of whom 77 were treated with operative hysteroscopy and 9 with other gynaecological surgical techniques. Statistical analysis was performed to evaluate diagnostic agreement between sonohysterography vs hysteroscopy and cytology vs histology. RESULTS: Diagnostic concordance between sonohysterography and hysteroscopy was significant (k value 0.87). The correlation between cytological and histological findings had a moderate level of concordance (k value 0.49).CONCLUSIONS: Sonohysterography provides a diagnostic accuracy as well as hysteroscopy, therefore, it could be considered an alternative procedure in the diagnosis of benign uterine endocavitary findings

Reliability of oupatient endometrial brush cytology vs biopsy in postmenopausal symptomatic women

Objective To compare outpatient endometrial sampling cytology with conventional biopsy in postmenopausal women with abnormal uterine bleeding and/or abnormal endometrial thickness at ultrasound Method Between December 2003 and December 2009 a group of 1 056 postmenopausal women was referred to the Department of Gynecological Sciences Perinatology an Child Health 11 Faculty of Medicine University of Rome S Andrea Hospital Four hundred and eighty two patients (45 6%) had abnormal uterine bleeding and 602 (57 0%) showed an endometrial thickness > 5 mm at ultrasound Patients on hormonal therapy (n = 194) including hormonal replacement therapy (HRT) or tamoxifen (TMX) were enrolled in the study Endometrial cytologic sampling was per formed using a brush device (EBC) while endometrial histological sampling was retrieved using a Novak curette Histologic evaluation showed a) malignant neoplasia b) atypical hyperplasia c) benign pathology d) normal or atrophic endometrium The following points were investigated a) failure in performing a procedure for cervical stenosis or pelvic pain b) nondiagnostic specimens c) diagnostic accuracy Results Evidence in score pain differences between brush and curette endometrial samples were observed 50% of patients undergoing brush cytology had lower pain scores (chi square = 288 33 p = 001) whereas 60% of patients undergoing endometrial biopsy had higher pain scores (chi square = 264 84 p = 001) The failure rate in performing procedures was 8 0% vs 4 1% and the results were statistically significant on the McNemar test respectively p = 01 and p = 001 A nondiagnostic specimen was obtained in 3 9% of cases by EBC and 103% of cases by the Novak curette (p = 001) Cytological evaluation had a sensitivity of 100% specificity of 99% positive and negative predictive value of 97% and 100% for diagnosing malignant neoplasia Cytology had high diagnostic accuracy for atypical hyperplasia sensitivity 100% specificity 99% positive and negative predictive value 83% and 100% respectively Conclusions EBC is a reliable well tolerated outpatient diagnostic tool for endometrial sampling in detecting early stage cancer in postmenopausal patients at high risk for endometrial cance

Follow-up in a long-term randomized trial with neoadjuvant chemotherapy for squamous cell cervical carcinoma

Objective To assess the role of neoadjuvant chemotherapy to achieve radical surgery in a lamer number of patients with locally advanced/or bulky Stage 1B cervical carcinoma We conducted a trial to determine whether neoadjuvant chemotherapy would improve disease-free survival and overall survival in Stage IB-III cervical cancer Design Prospective randomized clinical study with long-term follow-up Setting Department of Gynecology. Pernatology and Child Health. II Faculty University of Rome "La Saptenza" Methods 288 patients with squamous cell carcinoma of the uterine cervix. FIGO Stage IB-IIIB were randomized to one of the following treatments three courses of neoadjuvant chemotherapy with cisplatin. vinerstine. bleomycin (NACT arm. n = 159). conventional surgery or exclusive radiotherapy (CONV arm. n = 129) There was no difference in as:e. FIGO stage, tumor size and lymph node involvement between the two groups (p = its) Two hundred and thirty-four patients in Stage IB-IIb (n = 129 NACT arm and n = 105 CONV arm) and 24 patients in Stan Ill (NACT arm) who proved to be chemosensitive underwent radical hysterectomy Six Stage III patients. non responders to chemotherapy. and 24 patients, Stage III of the CONV arm, underwent radiotherapy Follow-up extended for seven years. Results The study was performed on disease-free survival related to several prognostic factors age. FIGO stage, tumor size, grading, parametrial involvement, lymph node status and surgical margins Recurrence of disease occurred in 49 (32.1%) patients of the NACT arm (n = 153) and in 39 (37 1%) patients of the CONV arm (n = 105) Statistically significant differences in the recurrence of the disease were related to FIGO stage (p < 003). grading (p < 05), paremetrial involvement (p < 002) lymph node status (p < .0001) and tumor size (p < .002) No statistical significance was related to age and surgical margins (p = its) Disease-free and overall survival in the two groups were, respectively, 65 4% vs 53 5% (p = ns) and 704% 65 9% (p = ns

Gynecologic sarcoma: A clinico-pathological review

Most of the cases showing good prognosis in literature are probably intermediate tumors between benign and malignant of undetermined malignant potential (UMP) and other tumors with intermediate features which are currently not considered among sarcomas. Misdiagnosis of a malignant lesion as a benign one has a tragic outcome for the patient. Best therapic choice for sarcomas remains surgery, while chemotherapy (CTX) and radiation therapy (RT) could be used in adjuvant settings. A major effort should be played in the understanding of biological features and behavior of the disease to address a better clinical practice. Uterine sarcomas are rare gynecological tumors; their incidence has been increasing during the last few years

Occurrence of malignancy in endometrial polyps during postmenopause

Objective.: To evaluate the occurrence of endometrial polyp malignancy in pre- and postmenopausal women with or without symptoms. Materials and Methods: A retrospective study was performed on 351 patients with endometrial polyps diagnosed by hysteroscopy. Results: Histological findings of biopsies obtained by operative hysteroscopy confirmed the presence of a simple endometrial polyp in 179 cases, polyps with typical simple hyperplasia in 42 cases, polyps with typical complex hyperplasia in 24 cases. polyps with atypical complex hyperplasia in three cases; carcinomatous polyps in seven cases; atrophic polyps in 17 cases; functional polyps in 56 cases; and inadequate sample in 23 cases. All seven patients with adenocarcinoma were symptomatic; six out of seven patients with adenocarcinoma were in postmenopause and one was in premenopause. The association between menopausal status and symptoms, and the presence of a malignant lesion was statistically significant (p < 0.001). Conclusions: This: study revealed that prevalence of endometrial polyp malignant transformation was <= 2.84% in postmenopausal and symptomatic patients

Breast density changes associated with hormone replacement therapy in postmenopausal women. Effects on the specificity and sensitivity of mammographic screening

Postmenopausal HRT use is associated with an increase of mammographic density and reduction of sensitivity and specificity of mammography results and an increase of false-positive and false-negative outcomes. The increased density does not allow a good evaluation of the exam. Mammographic density is an independent risk factor for breast cancer, but the link between changes in breast density and difference in breast cancer risk, remain uncertain. On the other hand, today specific guidelines and protocols to optimize the screening of neoplastic breast pathology in HRT users do not exist and it is unknown if short-term suspension of therapy improves mammographic sensitivity. More information is required to define this important risk factor

Transcervical hysteroscopic myomectomy: long-term effects on abnormal uterine bleeding.

To evaluate the effectiveness of hysteroscopic myomectomy in the treatment of symptomatic submucous leiomyomas and long-term outcomes. A total of 107 patients with abnormal uterine bleeding (n = 84) and/or infertility (n = 23) were submitted to hysteroscopic resection. Main outcome measures: control of menorrhagia and reproductive outcome. Abnormal uterine bleeding was controlled in 68 out of 84 patients with one procedure; 15 needed a second procedure for incomplete resection. Five patients had menorrhagic pathology relapse. Among 23 patients with associated infertility pregnancy was achieved in eight cases, seven went to term and one miscarried; one patient needed a second procedure. The mean follow-up was 36 months (24-60). Three patients were lost at follow-up. Transcervical hysteroscopic resection of submucous myomas is effective for control of abnormal uterine bleeding. Further studies are needed to define the value of such procedure in the treatment of infertility. Short and long-term results are strictly correlated to the possibility of obtaining a complete resection, which is conditioned by degree (0, 1, 2) and number of myomas