Background: Screening for cancer of the cervix at Kenyatta National Hospital (KNH), follows the recommended three-step strategy;Papanicolaou (Pap) smear, colposcopy/biopsy and loop electrosurgical excision procedure (...Background: Screening for cancer of the cervix at Kenyatta National Hospital (KNH), follows the recommended three-step strategy;Papanicolaou (Pap) smear, colposcopy/biopsy and loop electrosurgical excision procedure (LEEP)/biopsy. This approach poses the following challenges: multiple clinic visits, costly, time consuming, long turnaround time to treatment, non-compliance and loss-to-follow-up. Objective: To determine the agreement between histologies following colposcopy and LEEP amongst women in KNH as a forerunner for opportunity to shift from the three-step approach to the two-step “see and treat” (same-day colposcopy and LEEP) approach. Methods: This was a retrospective descriptive cohort of Women who underwent LEEP procedure between January 2008 and 31st December 2010 following the three-step approach at KNH, Kenya. Results: A total of 124 patients out of the 132 patients who underwent LEEP were included in the analysis. The 8 patients excluded had missing files. HIV infected, uninfected or unknown women are similar socio-demographically. The mean (SD) age for the HIV infected, uninfected and unknown is 37 (6), 33 (10) and 35 (9) years respectively. Colposcopic and LEEP biopsy histology within patients demonstrated a high weighted kappa statistics agreement of 84%. LEEP increased diagnosis of invasive cancer. Patients had a median (IQR) 5 (4 - 6) clinic visits from Pap smear to LEEP treatment. It took median (IQR) 55 (27 - 116) days between Pap smear to colposcopy result and 167 (101 - 276) days between Pap smear results to LEEP treatment. If a LEEP procedure were to be performed in this cohort of women on the same day of the colposcopy biopsy a median (IQR) 77 (55 - 137) days could have been saved. Conclusion: There is a high agreement between colposcopy and LEEP biopsies in our setting offering a window of opportunity to perform “See and Treat” same-day colposcopy and LEEP treatment procedure, skipping the colposcopy biopsy stage.展开更多
Background: Cervical Intraepithelial neoplasia treatments have become essential interventions to manage cervical lesions. Most recipients are women of reproductive age who, as reported in the literature, may be at ris...Background: Cervical Intraepithelial neoplasia treatments have become essential interventions to manage cervical lesions. Most recipients are women of reproductive age who, as reported in the literature, may be at risk of adverse pregnancy outcomes. This study investigated the risk of abortions, prematurity, stillbirths, and prolonged labor among reproductive-age women following Cryotherapy, Thermal ablation, and Loop Electrosurgical Excision Procedure treatments in Zambia. Methods: This cross-sectional study analyzed records of 8000 women aged 15 - 49 years at the Adult Infectious Disease Control Centre using records between January 2010 and December 2020. Women constituting the treatment group were all respondents treated by cryotherapy, thermal ablation, and LEEP, while the control group were VIA negative women. Women from both groups were invited to answer a phone survey. Data were analyzed using Stata version 16;descriptive analysis estimated the prevalence and obtained the frequency distribution of abortion, prematurity, prolonged labor and fresh stillbiths. Chi-square and Fisher’s exact test established the associations of CIN and APOs at 95% Confidence intervals. Univariate and multivariable binary logistic regression estimated the odds of adverse pregnancy outcomes across the three treatments. Results: Adverse pregnancy outcomes were more prevalent in the treatment group (39.2%) compared to the untreated group (16.9%). Across the two groups, normal outcomes were lower in the treated (42.3% vs 57.7%). The treated group accounted for the majority of abortions (74.5% vs 25.5%) and prolonged labor (72.5% vs 27.5%), while the untreated group accounted for higher proportions of stillbirths (66.7% vs 33.3%) and prematurity (53% vs 47%). Adverse pregnancy outcomes were five and two times more likely in women treated with thermal ablation (aOR = 5.05, 95% CI = 4.01 - 6.36, p Conclusion: Cervical treatment among Zambian women increases the risk of abortion and prolongs labor. Therefore, caution should be taken when administered to those of reproductive age. Vigilant monitoring should be maintained during pregnancy, delivery, and postpartum to improve maternal and neonatal health.展开更多
BACKGROUNDAlmost all cases of cervical cancer can be attributed to human papillomavirus(HPV) infection. The loop electrosurgical excision procedure (LEEP) is widelyused to treat HPV-mediated disease;thus, cervical can...BACKGROUNDAlmost all cases of cervical cancer can be attributed to human papillomavirus(HPV) infection. The loop electrosurgical excision procedure (LEEP) is widelyused to treat HPV-mediated disease;thus, cervical cancer is highly preventable.However, LEEP does not necessarily clear HPV rapidly and may affect theaccuracy of the results of ThinPrep cytology test (TCT) and cervical biopsy due tothe formation of cervical scars.CASE SUMMARYA 40-year-old woman underwent LEEP for cervical intraepithelial neoplasia grade1 approximately 10 years ago. Subsequent standard cervical cancer screeningsuggested persistent HPV-52 infection, but TCT results were negative. Cervicalbiopsy under colposcopy was performed thrice over a 10-year period, yieldingnegative pathology results. She developed abnormal vaginal bleeding after sexualactivity, persisting for approximately 1 year, and underwent hysteroscopy in ourhospital. Histopathologic evaluation confirmed adenocarcinoma in situ of theuterine cervix.CONCLUSIONPatients with long-term persistent, high-risk HPV infection and negative pathologyresults of cervical biopsy after LEEP are at risk of cervical cancer. Hysteroscopicresection of cervical canal tissue is recommended as a supplement tocervical biopsy because it helps define the lesion site and may yield a pathologicdiagnosis.展开更多
Background: Cervical Intraepithelial neoplasia treatments have become essential interventions to manage cervical lesions. Majority of the recipients of these treatments are women within the reproductive age group, who...Background: Cervical Intraepithelial neoplasia treatments have become essential interventions to manage cervical lesions. Majority of the recipients of these treatments are women within the reproductive age group, who according to literature may be at risk of adverse pregnancy outcomes. This pilot study is part of a study investigating adverse pregnancy outcomes among women who received Cryotherapy, Thermal ablation and Loop Electrosurgical Excision Procedure compared to the untreated women in Zambia. Materials and Methods: This descriptive study analyzed records of 886 (n = 443 treated and n = 443 untreated) women aged 15 - 49 years. The women were either screened with Visual Inspection with Acetic Acid or treated for Cervical Intraepithelial neoplasia at the Adult Infectious Disease Centre between January 2010 and December 2020. Women meeting the criteria were identified using the Visual Inspection with Acetic Acid screening records and telephone interviews to obtain the adverse pregnancy outcome experienced. Data were analysed using STATA version 16 to determine the prevalence and obtain frequency distribution of outcomes of interest. Univariate and multivariable binary logistic regression estimated odds of adverse pregnancy outcomes across the three treatments. Results: The respondents were aged 15 to 49 years. Adverse pregnancy outcomes were observed to be more prevalent in the treatment group (18.5%) compared to the untreated group (5.4%). Normal pregnancy outcomes were lower in the treated (46.3%;n = 443) than the untreated (53.7%;n = 443). The treated group accounted for the majority of abortions (85.2%), prolonged labour (85.7%) and low birth weight (80%), whereas, the untreated accounted for the majority of still births (72.7%). Women treated with cryotherapy (aOR = 2.43, 95% CI = 1.32 - 4.49, p = 0.004), thermal ablation (aOR = 6.37, 95% CI = 0.99 - 41.2, p = 0.052) and Loop Electrosurgical Excision Procedure (aOR = 9.67, 95% CI = 2.17 - 43.1, p = 0.003) had two-, six- and ten-times higher odds of adverse pregnancy outcomes respectively, relative to women who required no treatment. Conclusion: Adverse pregnancy outcomes are prevalent among women who have received treatment in Zambia. The findings indicate that treating Cervical Intraepithelial Neoplasia has been linked to higher chances of experiencing abortion, delivering low birth weight babies and enduring prolonged labor that may result in a caesarean section delivery. Cervical neoplasia treatments, particularly Loop Electrosurgical Excision Procedure, are associated with significantly increased odds of adverse pregnancy outcomes. It is essential to include information about prior Cervical Intraepithelial neoplasia treatment outcomes in obstetric care.展开更多
To the Editor:Cervical cancer is the fourth most common malignancy in women globally,with 84%of cases occurring in developing countries.[1]In China,it has the highest incidence among female reproductive system cancers...To the Editor:Cervical cancer is the fourth most common malignancy in women globally,with 84%of cases occurring in developing countries.[1]In China,it has the highest incidence among female reproductive system cancers.Cervical squamous intraepithelial lesion(SIL)is closely associated with cervical cancer.In 2014,the World Health Organization classified SIL into low-grade SIL(LSIL)and high-grade SIL(HSIL),with HSIL having cancerous potential.Most LSIL cases are self-limiting;however,HSIL can become cancerous,representing a precancerous lesion.[2]Therefore,the early detection and treatment of HSIL are crucial for the prevention of cervical cancer.HSIL treatment involves cervical conization(CC),and total hysterectomy(TH)may be necessary later depending on postoperative pathology and other factors such as the patient’s age,fertility requirements,and comorbidities.This study analyzed perioperative data of HSIL patients who underwent TH after loop electrosurgical excision procedure(LEEP)at the Affiliated Cancer Hospital of University of Electronic Science and Technology of China over the past 8 years,comparing the effects of performing TH within 3 days and within 4 weeks after surgery.Early TH addresses residual disease and prevents recurrence,whereas in TH performed after 4 weeks,patients are better recovered and the assessment of surgical margins and recurrence risks is clearer.展开更多
目的探讨抑癌基因(P16)、增殖细胞相关抗原(Ki-67)蛋白对宫颈环形电切术与抗HPV蛋白敷料治疗宫颈病变HPV感染预后不良发生情况的预测价值。方法选取2022年1月至2024年1月新乡医学院第一附属医院收治的宫颈病变HPV感染患者300例,均接受...目的探讨抑癌基因(P16)、增殖细胞相关抗原(Ki-67)蛋白对宫颈环形电切术与抗HPV蛋白敷料治疗宫颈病变HPV感染预后不良发生情况的预测价值。方法选取2022年1月至2024年1月新乡医学院第一附属医院收治的宫颈病变HPV感染患者300例,均接受宫颈环形电切术与抗HPV蛋白敷料治疗,治疗后随访12个月,根据预后情况的不同,分为预后良好组(n=249)和预后不良组(n=51)。分析治疗前后的P16、Ki-67蛋白表达水平差异,探讨治疗后60 d P16、Ki-67对预后不良发生情况的预测价值,logistic回归分析宫颈病变HPV感染患者发生预后不良的影响因素。结果术后60 d,300例患者的P16、Ki-67阳性率均低于入院时(χ^(2)分别为162.140、150.273,均P<0.05)。预后不良组术后60 d的P16、Ki-67阳性率高于预后良好组(χ^(2)分别为133.408、36.589,均P<0.05)。ROC曲线分析,P16、Ki-67联合预测宫颈病变伴HPV感染预后不良的效能AUC为0.843(95%CI:0.784~0.902)优于单一指标(P<0.05)。Logistic分析显示,P16、Ki-67阳性是宫颈病变伴HPV感染预后不良的危险因素(P<0.05)。结论宫颈环形电切术与抗HPV蛋白敷料联合治疗宫颈病变HPV感染能降低P16、Ki-67阳性率,P16、Ki-67阳性是宫颈病变伴HPV感染者预后不良的危险因素,两项指标联合预测能提高预后不良预测结果的准确度。展开更多
Endocervical curettage(ECC)is an optional practice during colposcopy,and the indication for endocervical curettage(ECC)is controversial between Europe and the USA.Here,we explored the value of ECC in a specific situat...Endocervical curettage(ECC)is an optional practice during colposcopy,and the indication for endocervical curettage(ECC)is controversial between Europe and the USA.Here,we explored the value of ECC in a specific situation.An elderly post-loop electrosurgical excision procedure woman,who had undergone a colposcopy 4 months before,went for her follow-up and abnormal cytology was found,and both the ECC and punch biopsy showed negative results.Then,a second ECC was performed,which led to the diagnosis of a high-grade squamous intraepithelial lesion.This case report shows that ECC is useful for diagnosing elderly women with Type 3 squamocolumnar junction.展开更多
文摘Background: Screening for cancer of the cervix at Kenyatta National Hospital (KNH), follows the recommended three-step strategy;Papanicolaou (Pap) smear, colposcopy/biopsy and loop electrosurgical excision procedure (LEEP)/biopsy. This approach poses the following challenges: multiple clinic visits, costly, time consuming, long turnaround time to treatment, non-compliance and loss-to-follow-up. Objective: To determine the agreement between histologies following colposcopy and LEEP amongst women in KNH as a forerunner for opportunity to shift from the three-step approach to the two-step “see and treat” (same-day colposcopy and LEEP) approach. Methods: This was a retrospective descriptive cohort of Women who underwent LEEP procedure between January 2008 and 31st December 2010 following the three-step approach at KNH, Kenya. Results: A total of 124 patients out of the 132 patients who underwent LEEP were included in the analysis. The 8 patients excluded had missing files. HIV infected, uninfected or unknown women are similar socio-demographically. The mean (SD) age for the HIV infected, uninfected and unknown is 37 (6), 33 (10) and 35 (9) years respectively. Colposcopic and LEEP biopsy histology within patients demonstrated a high weighted kappa statistics agreement of 84%. LEEP increased diagnosis of invasive cancer. Patients had a median (IQR) 5 (4 - 6) clinic visits from Pap smear to LEEP treatment. It took median (IQR) 55 (27 - 116) days between Pap smear to colposcopy result and 167 (101 - 276) days between Pap smear results to LEEP treatment. If a LEEP procedure were to be performed in this cohort of women on the same day of the colposcopy biopsy a median (IQR) 77 (55 - 137) days could have been saved. Conclusion: There is a high agreement between colposcopy and LEEP biopsies in our setting offering a window of opportunity to perform “See and Treat” same-day colposcopy and LEEP treatment procedure, skipping the colposcopy biopsy stage.
文摘Background: Cervical Intraepithelial neoplasia treatments have become essential interventions to manage cervical lesions. Most recipients are women of reproductive age who, as reported in the literature, may be at risk of adverse pregnancy outcomes. This study investigated the risk of abortions, prematurity, stillbirths, and prolonged labor among reproductive-age women following Cryotherapy, Thermal ablation, and Loop Electrosurgical Excision Procedure treatments in Zambia. Methods: This cross-sectional study analyzed records of 8000 women aged 15 - 49 years at the Adult Infectious Disease Control Centre using records between January 2010 and December 2020. Women constituting the treatment group were all respondents treated by cryotherapy, thermal ablation, and LEEP, while the control group were VIA negative women. Women from both groups were invited to answer a phone survey. Data were analyzed using Stata version 16;descriptive analysis estimated the prevalence and obtained the frequency distribution of abortion, prematurity, prolonged labor and fresh stillbiths. Chi-square and Fisher’s exact test established the associations of CIN and APOs at 95% Confidence intervals. Univariate and multivariable binary logistic regression estimated the odds of adverse pregnancy outcomes across the three treatments. Results: Adverse pregnancy outcomes were more prevalent in the treatment group (39.2%) compared to the untreated group (16.9%). Across the two groups, normal outcomes were lower in the treated (42.3% vs 57.7%). The treated group accounted for the majority of abortions (74.5% vs 25.5%) and prolonged labor (72.5% vs 27.5%), while the untreated group accounted for higher proportions of stillbirths (66.7% vs 33.3%) and prematurity (53% vs 47%). Adverse pregnancy outcomes were five and two times more likely in women treated with thermal ablation (aOR = 5.05, 95% CI = 4.01 - 6.36, p Conclusion: Cervical treatment among Zambian women increases the risk of abortion and prolongs labor. Therefore, caution should be taken when administered to those of reproductive age. Vigilant monitoring should be maintained during pregnancy, delivery, and postpartum to improve maternal and neonatal health.
基金2024 Natural Science Joint Foundation of Zhejiang Province,No.LBY24H040007.
文摘BACKGROUNDAlmost all cases of cervical cancer can be attributed to human papillomavirus(HPV) infection. The loop electrosurgical excision procedure (LEEP) is widelyused to treat HPV-mediated disease;thus, cervical cancer is highly preventable.However, LEEP does not necessarily clear HPV rapidly and may affect theaccuracy of the results of ThinPrep cytology test (TCT) and cervical biopsy due tothe formation of cervical scars.CASE SUMMARYA 40-year-old woman underwent LEEP for cervical intraepithelial neoplasia grade1 approximately 10 years ago. Subsequent standard cervical cancer screeningsuggested persistent HPV-52 infection, but TCT results were negative. Cervicalbiopsy under colposcopy was performed thrice over a 10-year period, yieldingnegative pathology results. She developed abnormal vaginal bleeding after sexualactivity, persisting for approximately 1 year, and underwent hysteroscopy in ourhospital. Histopathologic evaluation confirmed adenocarcinoma in situ of theuterine cervix.CONCLUSIONPatients with long-term persistent, high-risk HPV infection and negative pathologyresults of cervical biopsy after LEEP are at risk of cervical cancer. Hysteroscopicresection of cervical canal tissue is recommended as a supplement tocervical biopsy because it helps define the lesion site and may yield a pathologicdiagnosis.
文摘Background: Cervical Intraepithelial neoplasia treatments have become essential interventions to manage cervical lesions. Majority of the recipients of these treatments are women within the reproductive age group, who according to literature may be at risk of adverse pregnancy outcomes. This pilot study is part of a study investigating adverse pregnancy outcomes among women who received Cryotherapy, Thermal ablation and Loop Electrosurgical Excision Procedure compared to the untreated women in Zambia. Materials and Methods: This descriptive study analyzed records of 886 (n = 443 treated and n = 443 untreated) women aged 15 - 49 years. The women were either screened with Visual Inspection with Acetic Acid or treated for Cervical Intraepithelial neoplasia at the Adult Infectious Disease Centre between January 2010 and December 2020. Women meeting the criteria were identified using the Visual Inspection with Acetic Acid screening records and telephone interviews to obtain the adverse pregnancy outcome experienced. Data were analysed using STATA version 16 to determine the prevalence and obtain frequency distribution of outcomes of interest. Univariate and multivariable binary logistic regression estimated odds of adverse pregnancy outcomes across the three treatments. Results: The respondents were aged 15 to 49 years. Adverse pregnancy outcomes were observed to be more prevalent in the treatment group (18.5%) compared to the untreated group (5.4%). Normal pregnancy outcomes were lower in the treated (46.3%;n = 443) than the untreated (53.7%;n = 443). The treated group accounted for the majority of abortions (85.2%), prolonged labour (85.7%) and low birth weight (80%), whereas, the untreated accounted for the majority of still births (72.7%). Women treated with cryotherapy (aOR = 2.43, 95% CI = 1.32 - 4.49, p = 0.004), thermal ablation (aOR = 6.37, 95% CI = 0.99 - 41.2, p = 0.052) and Loop Electrosurgical Excision Procedure (aOR = 9.67, 95% CI = 2.17 - 43.1, p = 0.003) had two-, six- and ten-times higher odds of adverse pregnancy outcomes respectively, relative to women who required no treatment. Conclusion: Adverse pregnancy outcomes are prevalent among women who have received treatment in Zambia. The findings indicate that treating Cervical Intraepithelial Neoplasia has been linked to higher chances of experiencing abortion, delivering low birth weight babies and enduring prolonged labor that may result in a caesarean section delivery. Cervical neoplasia treatments, particularly Loop Electrosurgical Excision Procedure, are associated with significantly increased odds of adverse pregnancy outcomes. It is essential to include information about prior Cervical Intraepithelial neoplasia treatment outcomes in obstetric care.
基金supported by Sichuan Medical Research Projects(No.S21090).
文摘To the Editor:Cervical cancer is the fourth most common malignancy in women globally,with 84%of cases occurring in developing countries.[1]In China,it has the highest incidence among female reproductive system cancers.Cervical squamous intraepithelial lesion(SIL)is closely associated with cervical cancer.In 2014,the World Health Organization classified SIL into low-grade SIL(LSIL)and high-grade SIL(HSIL),with HSIL having cancerous potential.Most LSIL cases are self-limiting;however,HSIL can become cancerous,representing a precancerous lesion.[2]Therefore,the early detection and treatment of HSIL are crucial for the prevention of cervical cancer.HSIL treatment involves cervical conization(CC),and total hysterectomy(TH)may be necessary later depending on postoperative pathology and other factors such as the patient’s age,fertility requirements,and comorbidities.This study analyzed perioperative data of HSIL patients who underwent TH after loop electrosurgical excision procedure(LEEP)at the Affiliated Cancer Hospital of University of Electronic Science and Technology of China over the past 8 years,comparing the effects of performing TH within 3 days and within 4 weeks after surgery.Early TH addresses residual disease and prevents recurrence,whereas in TH performed after 4 weeks,patients are better recovered and the assessment of surgical margins and recurrence risks is clearer.
文摘目的探讨抑癌基因(P16)、增殖细胞相关抗原(Ki-67)蛋白对宫颈环形电切术与抗HPV蛋白敷料治疗宫颈病变HPV感染预后不良发生情况的预测价值。方法选取2022年1月至2024年1月新乡医学院第一附属医院收治的宫颈病变HPV感染患者300例,均接受宫颈环形电切术与抗HPV蛋白敷料治疗,治疗后随访12个月,根据预后情况的不同,分为预后良好组(n=249)和预后不良组(n=51)。分析治疗前后的P16、Ki-67蛋白表达水平差异,探讨治疗后60 d P16、Ki-67对预后不良发生情况的预测价值,logistic回归分析宫颈病变HPV感染患者发生预后不良的影响因素。结果术后60 d,300例患者的P16、Ki-67阳性率均低于入院时(χ^(2)分别为162.140、150.273,均P<0.05)。预后不良组术后60 d的P16、Ki-67阳性率高于预后良好组(χ^(2)分别为133.408、36.589,均P<0.05)。ROC曲线分析,P16、Ki-67联合预测宫颈病变伴HPV感染预后不良的效能AUC为0.843(95%CI:0.784~0.902)优于单一指标(P<0.05)。Logistic分析显示,P16、Ki-67阳性是宫颈病变伴HPV感染预后不良的危险因素(P<0.05)。结论宫颈环形电切术与抗HPV蛋白敷料联合治疗宫颈病变HPV感染能降低P16、Ki-67阳性率,P16、Ki-67阳性是宫颈病变伴HPV感染者预后不良的危险因素,两项指标联合预测能提高预后不良预测结果的准确度。
基金Shanghai Medical Center of Key Programs for Female Reproductive Diseases(No.2017ZZ01016).
文摘Endocervical curettage(ECC)is an optional practice during colposcopy,and the indication for endocervical curettage(ECC)is controversial between Europe and the USA.Here,we explored the value of ECC in a specific situation.An elderly post-loop electrosurgical excision procedure woman,who had undergone a colposcopy 4 months before,went for her follow-up and abnormal cytology was found,and both the ECC and punch biopsy showed negative results.Then,a second ECC was performed,which led to the diagnosis of a high-grade squamous intraepithelial lesion.This case report shows that ECC is useful for diagnosing elderly women with Type 3 squamocolumnar junction.
