Folate receptor-mediated cervical staining as an adjunct to colposcopy which can improve the diagnostic accuracy of detecting high grade squamous intraepithelial lesions

Objectives: Cervical cancer is rated fourth in terms of incidence and cancer-related mortality in women. Cytology-basedscreening programs and colposcopy provided insufficient rates of detecting cervical intraepithelial neoplasia (CIN) promptingresearchers to develop new tools. The aim of this study was to evaluate whether folate receptor-mediated staining isuseful in detecting CIN2+ during gynecological examination with colposcopy.Material and methods: In total 96 women with abnormal cytology findings were enrolled. The study was conducted on thePolish population. The diagnostic process consisted of colposcopy, receptor-mediated diagnosis (FRD), and histopathologyexamination. All women were subjected to the same diagnostic procedure.Results: The patient mean age of 96 women was 38 ± 14.5 years. On colposcopy, high-grade lesions were detected in83 women. The FRD gave positive results in 63 women. Histopathology revealed 1 case of carcinoma plano epithelial akeratodes,21 cases of high-grade squamous intraepithelial lesions, 13 cases of low-grade squamous intraepithelial lesions. A totalof 61 cases presented no pathology. FRD as an adjunct to colposcopy gave the following test results in detecting CIN2+lesions: sensitivity — 94.29%, specificity — 46.67%, PPV — 50.77%, NPV — 93.33%, and accuracy — 64.21%. Using bothtechniques provided better results than using each of the tests alone.Conclusions: FRD is a promising test for the diagnosing CIN2+ cervical pathologies because it can increase the probabilityof detecting CIN2+ without any additional burden posed on patients. Further studies should be conducted on large andvarious populations to complement current evidence

Use of electrical impedance spectroscopy as an adjunct to colposcopy in a pathway of cervical intraepithelial neoplasia diagnostics

Objectives: Screening with cytology decreases cervical cancer burden, but new methods have emerged. We assessed the diagnostic value of electrical impedance spectroscopy (EIS) in the real-world gynecological setting. The study aimed to determine the diagnostic usefulness of EIS used as an adjunct to colposcopies in the diagnosis of high-grade squamous intraepithelial lesions in women with abnormal cytology findings. Material and methods: A cross-sectional, single center, observational study considered 143 women. All were subjected to a colposcopy and EIS with ZedScan. ZedScan-guided or colposcopically-guided biopsies were carried out. Results: Data from 118 women were analyzed. The average age of the included women was 38.29 } 12.52 years (range: 22–86 years). Overall, 27 had a diagnosis of CIN2+ and above on histopathological examination, 99 had low-grade colposcopy results, 18 had high-grade colposcopy results, and 80 had positive ZedScan examination. No adverse events related to the examination with ZedScan were observed. EIS used as an adjunct to colposcopies showed sensitivity of 96.30% (95% CI: 81.03–99.91) and specificity of 39.56% (95% CI: 29.46–50.36), and accuracy of 52.54% (95% CI: 43.15–61.81). The procedure allowed to detect 11 additional cases with positive histo-pathological result in comparison to colposcopies alone. Conclusions: Colposcopies performed with ZedScan as an adjunct were effective in detecting high-grade cervical lesions. Advantages of ZedScan include real-time result display, no additional diagnostic burden posed on the patient, and good safety profile. Studies on large patient cohorts are needed for further evaluations of this diagnostic procedure and factors which may affect its diagnostic accuracy

Possible deferral of diagnostic and therapeutic procedures for patients with abnormal screening tests results in cervical cancer secondary prevention in current SARS-CoV-2 pandemic Interim guidelines of the Polish Society of Gynecologists and Obstetricians and the Polish Society of Colposcopy and Cervical Pathophysiology

The Polish Society of Gynecologists and Obstetricians and Polish Society of Colposcopy and Cervical Pathophysiology Interim Guidelines goal at aiding gynecologists in providing a cervical cancer prevention care during the evolving SARS-CoV-2 pan-demic. Presented guidelines were developed on a review of limited data and updated when new relevant publications were revealed. Timing for deferrals of diagnostic-therapeutic procedures were mostly covered in the guidelines. Also, a support for the existing Polish recommendations on abnormal screening results in a subject of minor and major screening abnor-malities terminology were given. The guidelines are obligatory for the specified COVID-19 pandemic period only and they might be changed depending on the new available evidence

Morphology of the cesarean section scar in the non-pregnant uterus after one elective cesarean section

Objectives: A growing number of studies suggest that the incomplete healing of the CS scar in the uterus increase the risk of uterine dehiscence or rupture during subsequent pregnancies. Thus, the factors that affect wound healing should be evaluated. We aimed to determine whether the morphology of the CS scar in non-pregnant women after one elective CS was affected by the site of the uterine incision, uterine flexion, maternal age, and fetal birth weight. Material and methods: 208 non-pregnant women were invited for participation in the study, but only 101 of them met inclusion criteria. Standardized scar parameters (residual myometrial thickness (RMT), depth (D) and width (W) of the hypoechoic niche) were measured using ultrasonography at least 6 weeks after the CS. Results: Scar defect was detected in 26 of 101 subjects. Women without scar defect had significantly higher RMT values (1.87 vs. 0.87), lower newborn birth weight (3127 g vs. 3295 g), and higher scar location above the internal cervical os (62% vs. 16%), than those with scar defect. Maternal age was significantly correlated with D value (R = 0.40). Uterine retroflexion was significantly correlated with a larger D value (R = 0.63) and a larger D/RMT ratio (R = 0.24). Conclusions: In low-risk women who have undergone one elective CS, several risk factors are associated with development of the scar defect, but only scar location can be modified during surgery. Future research is needed to determine whether a relatively higher incision location in the uterus can ensure optimal healing of the CS scar

Diagnostyczna przydatność detekcji genu RHD w osoczu ciężarnych w profilaktyce konfliktu matczyno-płodowego na tle antygenu D z układu Rh

Objectives: The aim of the study was analytical validation of prenatal noninvasive fetal RHD detection in maternal plasma and the preliminary assessment of its clinical utility. Introduction of this noninvasive test into routine diagnostic use is important for more rational and safe immunoprophylaxis. Material and methods: RHD gene was detected using real-time PCR. Primers and probes complementary to sequence on exons 7 and 10 were chosen. Samples with RHD-negative results were examined with additional tests to confirm the proper isolation of cell-free fetal DNA (cffDNA). For male fetuses, the presence of fetal DNA was confirmed by detection of the male genetic marker (SRY gene) using Quantifiler DuoR kit. In the case of SRY-negative result we used mini SGM test, which is based on the detection of short-tandem repeat polymorphism differences between maternal and fetal DNA. Results: Diagnostic accuracy of RHD test was 96.82%, while diagnostic value of SRY determination was lower (87.50%). Mini SGM test was able to confirm the presence of fetal DNA in 77% of the cases. Conclusions: Effectiveness of the proposed procedure of prenatal noninvasive RHD determination and cffDNA confirmation is high, on condition proper control samples and suitable verifying tests are used.Cel pracy: Celem badań była walidacja oraz wstępna ocena przydatności testu do prenatalnego określania genu RHD pochodzenia płodowego w osoczu ciężarnej w rutynowej praktyce laboratoryjnej i klinicznej. Wprowadzenie do diagnostyki nieinwazyjnych badań prenatalnych ma na celu bardziej racjonalne i bezpieczne stosowanie immunoprofilaktyki. Materiał i metody: Badanie genu RHD w osoczu ciężarnych wykonano techniką real-time PCR z zastosowaniem starterow i sond specyficznych do sekwencji eksonow 7 i 10 genu RHD. Wyniki ujemne badania na obecność genu RHD weryfikowano dodatkowymi testami, ktore miały na celu potwierdzenie udanej izolacji i obecności DNA płodowego w probce. W pierwszej kolejności wykonywano oznaczenie markera płci męskiej (genu SRY), ktore potwierdzało obecność płodowego DNA w przypadku płodow płci męskiej. Badanie wykonywano testem QuantifilerR Duo. Probki z ujemnym wynikiem poddawano dalszej analizie poprzez oznaczanie polimorfizmow typu STR (ang. short tandem repeat) metodą mini SGM, rożnicując DNA pochodzenia matczynego i płodowego. Wyniki: Dokładność diagnostyczna testu do oznaczania genu RHD w osoczu wynosiła 96,82%. Wartość diagnostyczna oznaczania genu SRY była niższa i wynosiła 87,50%. Testem mini SGM udało się znaleźć marker rożnicujący w 77% przypadkow. Wnioski: Opracowany algorytm badania DNA płodowego metodami biologii molekularnej ma wysoką wartość diagnostyczną przy wykrywaniu genu RHD w osoczu i potwierdzaniu obecności DNA płodowego oraz umożliwia weryfikację wynikow ujemnych, pod warunkiem zastosowania właściwych badań kontrolnych

Comparison of the diagnostic value of histopathological examinations of miscarriage products after pharmacological induction of miscarriage and curettage

Objectives: For early miscarriage (pregnancy loss ≤ 12 weeks of gestation), two types of therapeutic treatment are offered (pharmacotherapy and curettage of the uterine cavity) depending on the presence and severity of clinical symptoms as well as patient choice. Our study aimed to assess the diagnostic value of the results of histopathological examinations of miscarriage products in relation to the administered treatments.  Material and methods: 850 medical records from patients diagnosed with missed miscarriage or empty gestational sac were analyzed retrospectively. Patients underwent surgical treatment or pharmacotherapy. Inefficacy of pharmacotherapy resulted in subsequent curettage. The results of histopathology were evaluated for their diagnostic value and classified: subgroup 1 — high value specimen (the studied specimen included fetal tissues, and villi), and subgroup 2 — no-diagnosis (the studied specimen included maternal tissues, autolyzed tissues, blood clots). Data were compared with chi-squared test. Differences was considered significant at p < 0.05.  Results: 1128 histopathological test results were analyzed; 569 (50.4%) were obtained during pharmacotherapy and 559 (49.6%) after curettage; out of the latter 497 after the initial pharmacotherapy and 62 after surgery. In the pharmacotherapy group, high value specimens comprised 231 cases (40.59%) while no diagnosis was obtained in 338 cases (59.4%). Considering specimens obtained in the course curettage, high value specimens were found in 364 cases (65.1%) while results that did not allow a diagnosis to be made were found in 195 cases (34.9%).  Conclusions: Tissue specimens of high diagnostic value are obtained significantly more often during surgical treatment of miscarriage than during pharmacotherapy

The Polish Society of Gynecologists and Obstetricians statement on surgery in gynecology during the COVID-19 pandemic

The publication presents recommendations on the performance of surgical procedures in gynecology during the COVID-19 pandemic. The recommendations were prepared by the Polish Society of Gynecologists and Obstetricians, based oncurrent knowledge of SARS CoV-2. These recommendations contain the latest guidelines of scientific societies related tothe subject of operational procedures