Risk of HSIL (CIN 2-3) on colposcopic biopsy is minimal in postmenopausal women with LSIL on cytology and a negative HRHPV test

BackgroundCurrent cervical cancer screening guidelines recommend a 1-year follow-up period for patients with a postmenopausal low-grade squamous intraepithelial lesion (LSIL) who are test negative for high-risk human papillomavirus (HrHPV). The aim of this study was to assess whether such patients had an increased immediate risk of high-grade squamous intraepithelial lesion. MethodsWe assessed 54 HrHPV-negative women with postmenopausal LSIL in the Department of Obstetrics and Gynecology of our hospital between 2012 and 2013. All patients underwent liquid-based cytology and reflex HrHPV testing (for human papillomavirus [HPV] types 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 66, and 68). Colposcopic examination and guided biopsy were performed by the same gynecologist (MO). ResultsThe average age of the patients was 53.13.2 years. There were 33 patients (61%) with cervical intraepithelial neoplasia (CIN) grade 1 and 21 who were non-dysplastic. None of the patients was positive for CIN 2 or any other lesions. ConclusionsIf the HPV test is negative, repeat cytology after 12 months is recommended by the American Society for Colposcopy and Cervical Pathology for cases of HrHPV-negative postmenopausal LSIL. We recommend reflex HPV testing as the best choice for patients who test positive for postmenopausal LSIL by Pap smear, in line with the literature. Diagn. Cytopathol. 2016;44:969-974. (c) 2016 Wiley Periodicals, Inc

Cytohistological discrepancies of cervico-vaginal smears and HPV status

Objectives: Discrepancies between abnormal cervical cytology or high-risk human papillomavirus (HR-HPV) status (cytolo-gy negative/HPV positive) and subsequent histological findings are a common occurrence. After using co-testing, the dis­crepancies between the HR-HPV status and cervical cytology have become an issue. In this study, we aimed to determine the characteristics of women with a discrepancy between histology and cytology/HR-HPV status, in terms of diagnosis, review and identification. Material and methods: A total of 52 women, patients of the University Hospital between 2013–2015, with cytohistologi­cal or HR-HPV status discrepancy were recruited for the study and retrospectively analyzed. The cytological samples were liquid-based Pap smears, classified according to the 2001 Bethesda system. The HR-HPV status was identified using the Hybrid Capture 2 HR-HPV DNA assay. The histological samples were obtained by cervical biopsy as well as large loop exci­sion of the transformation zone (LLETZ). Results: A cytohistological discrepancy was demonstrated in patients with (-)cytology/HR-HPV(+), ASCUS, LSIL, ASC-H, HSIL, AGC-NOS: 17.3%, 23.07%, 26.9%, 9.5%, 17.3% and 5.7%, respectively. When the degree of atypia in cytology increases, the concurrency of cervical cytology with biopsy also increases. A positive HR-HPV co-test result (19/24, 79.1%) was observed in nearly all CIN2 ≥ (+) cases. Our study emphasizes the significance of HR-HPV testing to determine CIN2 ≥ (+) cases, even in the presence of a normal cytological result. Conclusions: In case of cytohistological or HR-HPV discrepancies, a careful review of the HR-HPV status and the degree of cytological atypia should be performed before further intervention

Comparison of risk of malignancy indices; RMI 1-4 in borderline ovarian tumor

Purpose: The aim of this study was to evaluate prognostic values of the risk of malignancy index (RMI)/1-4 in patients with borderline ovarian tumors (BOTs). Methods: The study consisted of 50 patients with BOT diagnosed and treated between 2005-2010 and 50 patients with benign adnexal massses between 2009-2010 as a control comparison group in the retropsective study. Preoperative serum CA125, U score, tumor size (S), and menopausal status were recorded. The RMI 1-3 was calculated according to the formula; UxMxCA125 and RMI 4 formulation was; UxMxCA125xS. S equaled 1 for tumor size = 7 cm. The RMI 1-4 indices were calculated for all patients together with the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and diagnostic accuracy (DA). The performances of RMI indices were evaluated by McNemar's test and determined the best score cutoff value by the receiver operating characteristic (ROC) curve. Results: The mean age, median value of CA 125, ultrasound score, menopausal status, median values of RMI 1-4 of BOTs were statistically higher than benign adnexal masses. The sensitivity of RMI 1-4 was 26, 36, 62, and 60% at cutoff 200 level, respectively. The areas under curve of RMI 1-4 were found to be 0.676, 0.665, 0.668 and 0.734, respectively. DA of RMI 1-4 was found to be 56, 59, 50, and 71, respectively. When RMI 1-4 indices were compared with each other RMI 4 was the best RMI for BOTs. Conclusion: RMI 4 was the best predictive RMI for preoperative discrimination of BOT at a cutoff level of 200

Suggested Office Hysteroscopy Holding Technique to Minimize Delicate Instrument Bending

OBJECTIVE: Office hysteroscopy is valuable in diagnosing and treating intrauterine pathologies. But the expensive instruments used for operative office hysteroscopy are delicate and prone to be damaged by bending. We are suggesting a method to increase the life time of the equipment and decrease the expenses. STUDY DESIGN: 43 patients undergoing office hysteroscopy for endometrial polyps and submucous myomas in Gülhane Military Medical Academy in January 2008 - April 2008 are included in this study and applied the new holding technique suggested by Dr. Emre Karaşahin. Departmentally available instruments are used. RESULTS: All the office procedures were successfully completed, without a single defect on the scissors and forcepses used for the operative office procedures. CONCLUSION: The technique explained in the text increases the life time of the equipment, and therefore decreases the costs of operations

Yarı dolu mesane ile yapılan vajinal histerektomi

Yarı dolu mesane ile yapılan vajinal histerektom

Misapplication of Acetic Acid During The Colposcopy: A Case Report

A vaginal mucosa chemical burn injury because of the misapplication of 98% acetic acid in colposcopic examination, which was treated with local oestrogen and antibiotics safely and efficiently is presented. A 28 years old G0 P0 patient had menorrhagia and Atypic Squamous Cell-High Grade (ASC-H) in her pap smear. During the pelvic examination, myoma uteri was diagnosed, and myomectomy with a colposcopic examination under general anestesia was planned. In the operation room, instead of 5% acetic acid, 98% acetic acid solution for colposcopic examination was misapplied under general anestesia. In a few minutes vaginal mucosa was erythematous and bullous because of corrosive vaginal burn injury. Vaginal mucosa was immediately irrigated with saline infusion and treated with local oestrogen and antibiotics. After two weeks, chronic erosive cervisitis was seen on the cervix and no visible sign of erythematous and bullous structure was apperent in the vagina. Full recovery took two weeks. Topical vaginal oestrogen is a safe, convenient and easy to apply treatment option for vaginal chemical burn injuries