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OBJECTIVE: Vulvar cancer is a rare pathology affecting mainly elderly women. This study aims to evaluate the impact of age on tumor size in vulvar cancer. MATERIAL AND METHODS: This was a multicenter retrospective observational study carried out between January 1, 1998, and December 31, 2020, in patients operated on for vulvar cancer. Univariate analysis was performed according to patients' age ≥ or <65 years. Factors associated with tumor size found to be significant according to age were then included in a multiple linear regression model. RESULTS: Of the 382 patients included, there were 133 patients aged <65 years and 249 ≥ 65 years. Radical total vulvectomy surgeries were more frequently performed in women ≥65 years (n = 72 (28.9 %) versus n = 20 (15 %); p = 0.004). The median histological tumor size and interquartile range was 20 mm [13-29] in the <65 years and 30 mm [15-42] in patients ≥65 years (p = 0.001). Multiple linear regression showed that age ≥65 years had a regression coefficient of 7.15 95 % CI [2.32; 11.99] (p = 0.004), constituting a risk factor for larger histological tumour size. Patients aged ≥65 years old had a higher early complication rate (n = 150 (62 %) versus n = 56 (42.7 %), p = 0.001). They also had a greater risk of recurrence (HR = 1.89 (95%CI (1.24-2.89)), p = 0.003) with a worse overall survival (HR = 5.64 (95%CI (1.70-18.68)), p = 0.005). CONCLUSION: Age is a risk factor for larger tumor size, leading to more radical surgery and a greater risk of complications in already fragile patients, with a greater risk of recurrence and an impact on overall survival.
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OBJECTIVES: To revise the 1983 colposcopic terminology form the French Society of Colposcopy and cervicovaginal pathology (SFCPCV). METHODS: All the three following steps of colposcopic examination were considered for the description of various colposcopic features: inspection without coloration, followed by the application of acetic acid and iodine staining. This revised terminology now includes the different possible colposcopic aspects of the normal cervix, including the ectropion and the normal transformation zone. It also includes colposcopic appearance of abnormal glandular cervical epithelium and of vaginal epithelium. The revised nomenclature was reviewed by all the board of the SFCPCV and was finally approved during the 45th annual conference of the SFCPCV. RESULTS: Abnormal transformation zone grade (TAG) 1a and 1b have been brought together under the sole TAG1 designation. TAG2a and TAG2b now correspond to TAG2, whereas TAG2c corresponds to TAG3. Colposcopic report should mention the interpretability of the colposcopic examination, with the precise type of the squamocolumnar junction (1, 2 or 3), the colposcopic impression, the size of any TAG and finally mention whether one or multiple biopsies were taken and their precise location. Colposcopic impression must give priority to the most pejorative colposcopic aspect which takes precedence over others. CONCLUSION: When performing colposcopy, one should keep in mind that this examination only relies on the interpretation of various colposcopic signs and images with this not guaranteeing for diagnosis. Only histological analysis of a possible guided cervical biopsy provides for a precise diagnosis.
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Neoplasias del Cuello Uterino , Femenino , Embarazo , Humanos , Neoplasias del Cuello Uterino/diagnóstico , Neoplasias del Cuello Uterino/patología , Cuello del Útero/patología , Colposcopía/métodos , Biopsia/métodos , Ácido AcéticoRESUMEN
OBJECTIVES: To assess the probability of spontaneous regression of high grade cervical intraepithelial neoplasia (HGCIN) in women under 30 and the predictive factors for such evolution. METHODS: We conducted a bicentric retrospective study. A total of 98 patients under 30 and with untreated HGCIN were included from 01/01/2010 to 31/12/2019. For each patient, the initial clinical and colposcopic characteristics were systematically documented. In compliance with French guidelines, these patients were offered repeated 6-months colposcopic follow-up for 2years. The endpoint was the occurrence of spontaneous regression of the HGCIN defined by normalization of colposcopy, and/or a negative biopsy and/or a negative HPV test or histological regression to low grade CIN, or a colposcopy showing simple minor abnormalities requiring no biopsy. RESULTS: Spontaneous HGCIN regression was observed in 37/98 patients. The median follow-up was of 16 (10.5-24.3) months. Predictive factors for spontaneous regression were: minor initial cytological abnormalities (HR=3.4; 95% CI: 1.02-11.05) and grade 1 atypical transformation at initial colposcopy (TAG1) (HR=2.3; 95% CI: 1.1-4.7). CONCLUSION: Before 30, the probability of spontaneous regression of HGCIN exists but remains low. Predictive factors for such evolution are minor initial cytological abnormalities and TAG1 colposcopic impression.
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Displasia del Cuello del Útero , Neoplasias del Cuello Uterino , Cuello del Útero/patología , Colposcopía , Femenino , Humanos , Embarazo , Estudios Retrospectivos , Neoplasias del Cuello Uterino/patología , Displasia del Cuello del Útero/patologíaRESUMEN
INTRODUCTION: Node involvement is one of the main prognostic factors for cervical cancer. Para-aortic lymph node (PALN) assessment is crucial for treating advanced cervical cancer, to define irradiation fields. Objective of this study was to develop a score predicting para-aortic lymph node involvement in patients with advanced cervical cancer. PATIENTS AND METHOD: We performed a multicenter, retrospective, study on 9 French centers from 2000 to 2015, including patients with advanced squamous cell cervix carcinoma who had PALN status assessed by imaging and/or by surgery. Factors associated with a risk of PALN involvement were determined by univariate and multivariate analysis using a logistic regression model. A score was then developed and validated. RESULTS: A total of 1446 patients treated for cervical cancer were included. Of these, 498 had an advanced squamous cell cervical cancer. Ninety-one patients (18.3%) had positive PALN. After univariate and multivariate analysis, tumor size on pelvic MRI, initial SCC, and suspected pelvic node involvement on PET-CT were included in our score. This model allowed the population to be divided into 3 risk groups. Area under the ROC curve of the score was 0.81 (95%CI = 0.72-0.90). In the low-risk group, 9% (28/287) had PALN involvement, whereas in the high-risk group, 43% (22/51) had PALN involvement. CONCLUSION: We developed a simple score predicting PALN involvement in advanced cervical cancers. Three risk groups can be defined, and patients considered to be at low risk may avoid para-aortic staging as well as extensive field irradiation.
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Carcinoma de Células Escamosas/patología , Carcinoma de Células Escamosas/terapia , Metástasis Linfática , Neoplasias del Cuello Uterino/patología , Neoplasias del Cuello Uterino/terapia , Carcinoma de Células Escamosas/diagnóstico por imagen , Femenino , Francia , Humanos , Persona de Mediana Edad , Tomografía Computarizada por Tomografía de Emisión de Positrones , Valor Predictivo de las Pruebas , Pronóstico , Estudios Retrospectivos , Medición de Riesgo , Neoplasias del Cuello Uterino/diagnóstico por imagenRESUMEN
OBJECTIVE: To assess the diagnostic and prognostic characteristics of borderline ovarian tumours (BOTs) detected during pregnancy, and to establish an inventory of French practices. MATERIALS AND METHODS: A retrospective multi-centre case study of 14 patients treated for BOTs, diagnosed during pregnancy between 2005 and 2017, in five French pelvic cancerology expert centres, including data on clinical characteristics, histological tumour characteristics, surgical procedure, adjuvant treatments, follow-up and fertility. RESULTS: The mean age of patients was 29.3 [standard deviation (SD) 6.2] years. Most BOTs were diagnosed on ultrasonography in the first trimester (85.7 %), and most of these cases (78.5 %) also underwent magnetic resonance imaging to confirm the diagnosis (true positives 54.5 %). Most patients underwent surgery during pregnancy (57 %), with complete staging surgery in two cases (14.3 %). Laparoscopy was performed more frequently than other procedures (50 %), and unilateral adnexectomy was more common than cystectomy (57.5 %). Tumour size influenced the surgical approach significantly (mean size 7.5 cm for laparoscopy, 11.9 cm for laparoconversion, 14 cm for primary laparotomy; P = 0.08), but the type of resection did not. Most patients were initially diagnosed with International Federation of Gynecology and Obstetrics stage IA (92.8 %) tumours, but many were upstaged after complete restaging surgery (57.1 %). Most BOTs were serous (50 %), two cases had a micropapillary component (28.5 %), and one case had a micro-invasive implant. BOTs were bilateral in two cases (14.2 %). Mean follow-up was 31.4 (SD 14.8) months. Recurrent lesions occurred in two patients (14.2 %) and no deaths have been recorded to date among the study population. CONCLUSION: BOTs remain rare, but this study - despite its small sample size - supports the hypothesis that BOTs during pregnancy have potentially aggressive characteristics.
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Laparoscopía , Neoplasias Ováricas , Niño , Cistectomía , Femenino , Humanos , Estudios Multicéntricos como Asunto , Recurrencia Local de Neoplasia , Estadificación de Neoplasias , Neoplasias Ováricas/diagnóstico por imagen , Neoplasias Ováricas/cirugía , Embarazo , Estudios RetrospectivosRESUMEN
This European consensus statement on essential colposcopy provides standards for the general colposcopist seeing women referred for colposcopy with an abnormal cervical screening test (including cytology and HPV tests) or with a clinically suspicious cervix. The article gives guidance regarding the aims and conduct of colposcopy. Recommendations are provided on colposcopy technique, the management of common colposcopy issues, treatment and follow-up of after treatment of CIN or early stage cervical. Colposcopists should make an informed decision on the management of each individual that is referred and organize appropriate follow-up. Cervical cancer is still a major health issue and the quality of care can only improve if there is a structured guidance for women with an abnormal smear or suspicious cervix.
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Infecciones por Papillomavirus , Displasia del Cuello del Útero , Neoplasias del Cuello Uterino , Colposcopía , Consenso , Detección Precoz del Cáncer , Femenino , Humanos , Papillomaviridae , Infecciones por Papillomavirus/diagnóstico , Embarazo , Neoplasias del Cuello Uterino/diagnóstico , Frotis Vaginal , Displasia del Cuello del Útero/diagnósticoRESUMEN
OBJECTIVES: The aim was to review the clinical impact of lymph node ratio (LNR) of groin metastatic nodal disease in women with vulvar squamous cell carcinoma. MATERIAL AND METHODS: Cohort study of women with vulvar squamous cell carcinoma, managed between January 2005 and December 2015, in five institutions in France with prospectively maintained databases (French multicenter tertiary care centers). POPULATION: In total, 636 women managed for VSCC of whom 508 (79.9%) underwent surgical groin nodal staging. MAIN OUTCOME MEASURES: Comparison of overall and recurrence free survival between women according to LNR. RESULTS: In total, 176 women (34.6%) had at least one positive lymph node (LN). There was a significant differences for the 5-year overall survival and recurrence free survival rates between women with LNR>0.2 and women with LNR<0.2. CONCLUSION: LNR seems to be a significant prognostic factor in women with vulvar squamous cell carcinoma.
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Carcinoma de Células Escamosas , Ingle , Carcinoma de Células Escamosas/cirugía , Estudios de Cohortes , Femenino , Humanos , Escisión del Ganglio Linfático , Índice Ganglionar , Ganglios Linfáticos , Metástasis Linfática , PronósticoRESUMEN
INTRODUCTION: Recommendations for the management of patients with gynecological cancer during the COVID-19 pandemic period. MATERIAL AND METHOD: Recommendations based on the consensus conference model. RESULTS: In the case of a COVID-19 positive patient, surgical management should be postponed for at least 15 days. For cervical cancer, the place of surgery must be re-evaluated in relation to radiotherapy and Radio-Chemotherapy-Concomitant and the value of lymph node staging surgeries must be reviewed on a case-by-case basis. For advanced ovarian cancers, neo-adjuvant chemotherapy should be favored even if primary cytoreduction surgery could be envisaged. It is lawful not to offer hyperthermic intraperitoneal chemotherapy during a COVID-19 pandemic. In the case of patients who must undergo interval surgery, it is possible to continue the chemotherapy and to offer surgery after 6 cycles of chemotherapy. For early stage endometrial cancer, in case of low and intermediate preoperative ESMO risk, hysterectomy with bilateral annexectomy associated with a sentinel lymph node procedure should be favored. It is possible to consider postponing surgery for 1 to 2 months in low-risk endometrial cancers (FIGO Ia stage on MRI and grade 1-2 endometrioid cancer on endometrial biopsy). For high ESMO risk, it ispossible to favor the MSKCC algorithm (combining PET-CT and sentinel lymph node biopsy) in order to omit pelvic and lumbar-aortic lymphadenectomies. CONCLUSION: During COVID-19 pandemic, patients suffering from cancer should not lose life chance, while limiting the risks associated with the virus.
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Betacoronavirus , Infecciones por Coronavirus/complicaciones , Neoplasias de los Genitales Femeninos/cirugía , Procedimientos Quirúrgicos Ginecológicos , Neumonía Viral/complicaciones , COVID-19 , Infecciones por Coronavirus/transmisión , Procedimientos Quirúrgicos de Citorreducción , Femenino , Francia , Neoplasias de los Genitales Femeninos/complicaciones , Procedimientos Quirúrgicos Ginecológicos/efectos adversos , Humanos , Procedimientos Quirúrgicos Mínimamente Invasivos , Pandemias , Neumonía Viral/transmisión , Guías de Práctica Clínica como Asunto , SARS-CoV-2 , Sociedades MédicasRESUMEN
OBJECTIVE: In vulvar cancer, it is admitted that tumor-free margin distance is one of the most important element for locoregional control. It is currently recommended to surgically remove the tumor with at least an 8â¯mm tumor-free margin. The aim of this study was to evaluate the impact of tumor-free margin distance on recurrence and survival in vulvar cancer. MATERIAL AND METHODS: From 2005 to 2016, 112 patients surgically treated for a vulvar squamous cell cancer were included in a retrospective multicenter study. Overall, disease-free and metastasis-free survivals were analyzed according to tumor-free margin distance. RESULTS: Patients were divided into three groups: group 1 (margin <3â¯mm, nâ¯=â¯47); group 2 (margin ≥3â¯mm toâ¯<â¯8â¯mm, nâ¯=â¯48) and group 3 (margin ≥8â¯mm, nâ¯=â¯17). During the study, 26,8% patients developed recurrence (nâ¯=â¯30) after a median of 8 months (1-69). Analysis of 5-year overall survival, as well as disease-free and metastasis-free survivals, did not reveal a difference between groups. We performed a subgroup analysis in patients with a tumor-free margin <8â¯mm (group 1 and 2). It showed that histological lesions observed closest to the edge of the specimen were more often invasive or in situ carcinoma lesions in group 1 than in group 2, in which VIN lesions were mainly observed at this location. After re-excision, no patients in group 1 and 50% (nâ¯=â¯2) patients in group 2 developed recurrence. CONCLUSION: This study did not reveal a significant impact of tumor-free margin distance on recurrence and survival in vulvar cancer. Moreover, the benefit of re-excision seems stronger when tumor-free margins are positive or very close (<3â¯mm), cases in which invasive or in situ lesions are often present closest to the edge of the specimen.
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Carcinoma in Situ/cirugía , Carcinoma de Células Escamosas/cirugía , Márgenes de Escisión , Recurrencia Local de Neoplasia/epidemiología , Neoplasias de la Vulva/cirugía , Adulto , Anciano , Anciano de 80 o más Años , Carcinoma in Situ/patología , Carcinoma de Células Escamosas/epidemiología , Carcinoma de Células Escamosas/patología , Estudios de Cohortes , Supervivencia sin Enfermedad , Femenino , Francia/epidemiología , Humanos , Escisión del Ganglio Linfático , Persona de Mediana Edad , Estadificación de Neoplasias , Pronóstico , Estudios Retrospectivos , Biopsia del Ganglio Linfático Centinela , Tasa de Supervivencia , Carga Tumoral , Liquen Escleroso Vulvar/epidemiología , Neoplasias de la Vulva/epidemiología , Neoplasias de la Vulva/patologíaRESUMEN
BACKGROUND: We assessed the validity of Clearsight™ as a non-invasive cardiac output and stroke volume monitoring device, comparing it with transthoracic echocardiography measurements during the third trimester of pregnancy. METHODS: Measurements obtained from Clearsight™ were compared with those from echocardiography as the gold standard. The precision and accuracy of the Clearsight™ was measured using the Bland and Altman method. Clinical agreement with echocardiography was assessed using the agreement tolerability index. RESULTS: Measurements were recorded from 44 pregnant women with a median [IQR range] gestational age of 33 [30-37] weeks. We found that Clearsight™ measurements presented a systematic overestimation of cardiac output, with mean bias [CI 95%] of 2.7 [2.3-3.0] L/min, with limits of agreement of⯠-0.1 to 5.4â¯L/min. It overestimated stroke volume, with a bias of 29.5 [25.0-33.4] mL and a limit of agreement of -1.6 to 60.1â¯mL. In addition, the analysis of cardiac output showed a percentage of error of 41% and intra-class correlation [CI 95%] of 0.37 [0.17 to 0.53, Pâ¯<0.001]. For stroke volume, the percentage of error was 40% and intra-class correlation 0.16 [-0.1 to 0.34; P=0.27]. We found that agreement tolerability index scores were unacceptable. We evaluated the ability of the device to track changes in cardiac output by inducing a left lateral decubitus position, but the analysis was inconclusive. CONCLUSION: The agreement between Clearsight™ and the echocardiography measurements of cardiac output and stroke volume were not within an acceptable range in the third trimester of pregnancy.
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Gasto Cardíaco/fisiología , Monitorización Hemodinámica/instrumentación , Monitorización Hemodinámica/métodos , Monitoreo Fisiológico/instrumentación , Monitoreo Fisiológico/métodos , Volumen Sistólico/fisiología , Adulto , Femenino , Humanos , Embarazo , Tercer Trimestre del Embarazo , Estudios Prospectivos , Reproducibilidad de los ResultadosRESUMEN
OBJECTIVES: To evaluate the risk of severe perineal tear following instrumental vaginal delivery (IVD) performed with spatulas and vacuum extraction. Secondary objectives were to estimate the impact of episiotomy on this risk. METHODS: From December 2008 to October 2012, women who underwent spatulas or vacuum were prospectively included. Each spontaneous vaginal delivery (SVD) following each included IVD were included as control cases (1-1 ratio). Careful perineal examination was systematically performed. Severe perineal tear was defined by the occurrence of anal sphincter rupture with or without anal mucosa tear. RESULTS: A total of 761 patients were included in the current study: 248 (64%) spatulas, 137 (36%) vacuums and 381 (49%) SVDs. Severe perineal tear was diagnosed in 19 (2.5%) cases. Episiotomy had been performed in 276 (36.9%) patients. Only spatulas extraction was found to significantly increase the risk of severe perineal tear (AOR=7.66; 95% CI: 2.06-28; P=0.02). Although vacuum extraction seemed to increase this risk, it was not found to be significant (AOR=3.25; 95% CI: 0.65-16.24; P=0.15). No significant difference was observed between the risk of severe perineal tear following spatulas and vacuum (AOR=2.36; 95% CI: 0.63-8.82; P=0.202). Finally, neither foetal macrosomia, nor episiotomy, nor foetal extraction with the head in the deep pelvis, nor delivery at night had a significant impact on the probability of severe perineal tear. CONCLUSIONS: Spatulas extraction is an independent risk factor for severe perineal tear. The practice of episiotomy was not shown to have any significant impact on this risk.
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Forceps Obstétrico/efectos adversos , Perineo/lesiones , Extracción Obstétrica por Aspiración/efectos adversos , Adulto , Canal Anal/lesiones , Estudios de Casos y Controles , Estudios de Cohortes , Episiotomía/estadística & datos numéricos , Femenino , Humanos , Mucosa Intestinal/lesiones , Perineo/cirugía , Embarazo , RoturaRESUMEN
BACKGROUND: The aim of this prospective observational study was to assess the performance of ultrasonographic gastric antral area (GAA) to predict gastric fluid volumes of >0.4, >0.8 and >1.5 ml kg(-1), in fasted women in established labour. METHODS: A first ultrasound examination of the antrum was performed, in order to confirm gastric vacuity by using a qualitative score. Baselines GAA measurements were obtained in both supine and right lateral decubitus positions. Thereafter, parturients were allowed to drink clear fluids only. Measurement of GAA was repeated 15 min after last fluid intake, in both supine and right lateral positions. Receiver operating characteristics (ROC) curves were constructed to determine the accuracy of GAA to diagnose ingested volumes of >0.4, >0.8 and >1.5 ml kg(-1). RESULTS: Data from forty parturients were analysed. The areas under the ROC curves ranged from 80% to 86%. The cut-off value for antral area measured in supine position, to detect a volume >0.4 ml kg(-1), was 387 mm(2), with a sensitivity of 87%, a specificity of 70% and a negative predictive value of 85%. A cut-off value of 608 mm(2) predicted a fluid volume >1.5 ml kg(-1), with a specificity of 94%, a sensitivity of 75% and a negative predictive value of 92%. CONCLUSIONS: This study provides cut-off values for GAA that could be used in addition to the qualitative assessment of the antrum to define a full stomach in labouring patients.
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Antro Pilórico , Estómago , Femenino , Contenido Digestivo , Humanos , Embarazo , Estudios Prospectivos , UltrasonografíaRESUMEN
In intrauterine pregnancies of uncertain viability with a gestational sac without a yolk sac (with a mean of three orthogonal transvaginal ultrasound measurements <25mm), the suspected pregnancy loss should only be confirmed after a follow-up scan at least 14 days later shows no embryo with cardiac activity (Grade C). In intrauterine pregnancies of uncertain viability with an embryo <7mm on transvaginal ultrasound, the suspected pregnancy loss should only be confirmed after a follow-up scan at least 7 days later (Grade C). In pregnancies of unknown location after transvaginal ultrasound (i.e. not visible in the uterus), a threshold of at least 3510IU/l for the serum human chorionic gonadotrophin assay is recommended; above that level, a viable intrauterine pregnancy can be ruled out (Grade C). Postponing conception after an early miscarriage in women who want a new pregnancy is not recommended (Grade A). A work-up for women with recurrent pregnancy loss should include the following: diabetes (Grade A), antiphospholipid syndrome (Grade A), hypothyroidism with anti-thyroid peroxidase (anti-TPO) and anti-thyroglobulin (anti-Tg) antibodies (Grade A), vitamin deficiencies (B9, B12) (Grade C), hyperhomocysteinaemia (Grade C), hyperprolactinaemia (Grade B), diminished ovarian reserve (Grade C), and a uterine malformation or an acquired uterine abnormality amenable to surgical treatment (Grade C). The treatment options recommended for women with a missed early miscarriage are vacuum aspiration (Grade A) or misoprostol (Grade B); and the treatment options recommended for women with an incomplete early miscarriage are vacuum aspiration (Grade A) or expectant management (Grade A). In the absence of both chorioamnionitis and rupture of the membranes, women with a threatened late miscarriage and an open cervix, with or without protrusion of the amniotic sac into the vagina, should receive McDonald cerclage, tocolysis with indomethacin, and antibiotics (Grade C). Among women with a threatened late miscarriage and an isolated undilated shortened cervix (<25mm on ultrasound), cerclage is only indicated for those with a history of either late miscarriage or preterm delivery (Grade A). Among women with a threatened late miscarriage, an isolated undilated shortened cervix (<25mm on ultrasound) and no uterine contractions, daily treatment with vaginal progesterone up to 34 weeks of gestation is recommended (Grade A). Hysteroscopic section of the septum is recommended for women with a uterine septum and a history of late miscarriage (Grade C). Correction of acquired abnormalities of the uterine cavity (e.g. polyps, myomas, synechiae) is recommended after three early or late miscarriages (Grade C). Prophylactic cerclage is recommended for women with a history of three late miscarriages or preterm deliveries (Grade B). Low-dose aspirin and low-molecular-weight heparin at a preventive dose are recommended for women with obstetric antiphospholipid syndrome (Grade A). Glycaemic levels should be controlled before conception in women with diabetes (Grade A).
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Aborto Espontáneo/terapia , Aborto Espontáneo/diagnóstico , Aborto Espontáneo/etiología , Femenino , Humanos , EmbarazoRESUMEN
OBJECTIVE: To assess the consequences of loop electrosurgical excision procedure (LEEP) on the quality of sexual life. MATERIAL AND METHODS: A prospective observational study in two university hospital departments in Marseille, France, including women requiring a LEEP. Sexual quality of life was assessed before LEEP and three months after the procedure with a self-administered validated questionnaire: the Brief Index of Sexual Functioning for Women (BISF-W). RESULTS: Among the 100 women included, 69 filled both questionnaires. Among the 69 women whose outcomes were available, composite BISF-W score was significantly lower before LEEP than three months after LEEP (28.3±13 vs 30.1±13.2; P=0.01). The items scores concerning desire (D1) and orgasm (D5) were significantly improved after LEEP (4.3±2.3 vs 5±2.2 [P<0.001] and 4.3±2.5 vs 4.7±2.6 [P<0.001]). CONCLUSIONS: This study found an improved quality of sexual life after LEEP. These findings suggest that the psychological impact of HPV infection on sexual function is greater than the anatomical and functional impact of LEEP.
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Electrocoagulación , Electrocirugia , Sexualidad/fisiología , Displasia del Cuello del Útero/cirugía , Adulto , Electrocoagulación/efectos adversos , Electrocoagulación/instrumentación , Electrocoagulación/métodos , Electrocirugia/efectos adversos , Electrocirugia/instrumentación , Electrocirugia/métodos , Femenino , Francia , Humanos , Persona de Mediana Edad , Paridad , Embarazo , Calidad de Vida , Conducta Sexual/fisiología , Encuestas y CuestionariosRESUMEN
OBJECTIVE: To evaluate what is the proportion of surgery rooms from Marseilles' area that do perform excisional therapies for CIN without any use of colposcopic guidance. MATERIALS AND METHODS: From November 2012 to January 2013, a survey was conducted among all surgery rooms from Marseilles' area practicing excisional therapies for CIN. In addition, answers from gynecologists from Marseilles' area who participated to a national survey that evaluated practices of excisional therapies in France were specifically analyzed. RESULTS: Among the 55 surgery rooms from Marseilles' area practicing excisional therapies, 52 (94.1%) participated to the current survey. A colposcope was available in only 19 (36.5%) surgery rooms and was systematically used for the guidance of excisional therapies in only 4 (21%) of these surgery rooms. Finally, 36 (69.2%) surgery rooms answered performing excisional therapies without any use of colposcopic guidance. Colposcopy was occasionally and systematically used in 12 (23.1%) and 4 (7.7%) surgery rooms, respectively. Among the 116 gynecologists from Marseilles' area who answered to the national survey, 88 (75.9%) answered not using colposcopy when performing excision for CIN. Only 6% answered performing excision systematically under direct colposcopic vision and 18.1% occasionally. CONCLUSION: No colposcopic guidance is used when performing excision for CIN in the majority of surgery rooms from Marseilles' area.
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Procedimientos Quirúrgicos Ginecológicos/métodos , Auditoría Médica , Pautas de la Práctica en Medicina , Displasia del Cuello del Útero/cirugía , Neoplasias del Cuello Uterino/cirugía , Colposcopía , Femenino , Francia , Humanos , QuirófanosRESUMEN
OBJECTIVES: Evaluate how excisional therapies are performed in France and if colposcopy is used for the guidance of excision. MATERIALS AND METHODS: A national survey was performed among French gynecologists using an anonymous online questionnaire. RESULTS: A total of 555 (14.9%) gynecologists participated to the survey, only answers from the 396 (71.3%) who answered practicing excisional therapies for CIN were considered. LLETZ was the most common excisional technique employed (84.9%). Among respondents, 275 (69.3%) answered not using colposcopy at the time of excision, 67 (16.9%) answered performing excisions under naked eye vision immediately after they had performed a colposcopic examination and 52 (13.8%) under direct colposcopic vision. Although initial colposcopic training did not influence the probability to use colposcopy at the time of excision, the probability of performing excisions immediately after a colposcopic examination or under direct colposcopic vision was significantly increased by the monthly practice of 30 or more colposcopic examinations (AOR: 3.34; 95%CI: 1.54-7.26 and AOR: 2.16; 95%CI: 1.08-4.34, respectively) and by the monthly practice of 5 or more excisional therapies (AOR: 3.06; 95%CI: 1.42-6.56 and AOR: 3.03; 95%: 1.54-5.96, respectively). CONCLUSION: Only a minority of French gynecologists uses colposcopy for the guidance of excisional therapies for CIN. Such practice seems to be influenced by the number of colposcopic examinations and of excisions they perform in a month.
Asunto(s)
Pautas de la Práctica en Medicina/estadística & datos numéricos , Displasia del Cuello del Útero/cirugía , Neoplasias del Cuello Uterino/cirugía , Auditoría Clínica , Colposcopía/métodos , Colposcopía/estadística & datos numéricos , Conización/métodos , Conización/estadística & datos numéricos , Femenino , Francia/epidemiología , Humanos , Histerectomía/métodos , Histerectomía/estadística & datos numéricos , Masculino , Persona de Mediana Edad , Médicos/estadística & datos numéricos , Encuestas y Cuestionarios , Neoplasias del Cuello Uterino/epidemiología , Displasia del Cuello del Útero/epidemiologíaRESUMEN
OBJECTIVES: To assess the coverage of HPV vaccine among young women from Marseilles' area and factors influencing the probability of this vaccination. MATERIALS AND METHODS: An anonymous survey was conducted among 2124 high school and university students from Marseilles' area, France from December 2011 to May 2012. RESULTS: Mean age of participants was 20.4years (±SD: 3.3). Only 41.6% participants reported being vaccinated against HPV, of whom 768 (93.3) had completed the 3 injections scheme. Among non-vaccinated respondents, 33.6% acknowledged they would accept a catch-up vaccination. Factors influencing the probability of being vaccinated were young age (AOR: 0.728; 95% CI: 0.681-0.779; P<0.001), socioeconomic and/or education level of parents (AOR: 1.324; 95% CI: 1.006-1.742; P=0.045), information about vaccination (AOR: 24.279; 95% CI: 5.417-108.82; P<0.001) and having a general practitioner (GP) favourable to vaccination (AOR: 68.776; 95% CI: 34.511-137.061; P<0.001). Factors influencing the probability to accept a catch-up vaccination were age (AOR: 1.059; 95% CI: 1.001-1.120; P=0.046), socioeconomic and/or education level of parents (AOR: 1.637; 95% CI: 1.198-2.237; P=0.002) and having a GP favourable to vaccination (AOR: 4.381; 95% CI: 2.978-6.445; P<0.001). Only 35.5% of respondents were aware that screening remains necessary following HPV vaccination. CONCLUSION: The coverage of HPV vaccine among young women from Marseilles' area is insufficient. Factors influencing the probability of being vaccinated against HPV are age, socioeconomic and/or education level of parents and information regarding vaccination. GP plays a major role in the acceptance of HPV vaccine.
Asunto(s)
Infecciones por Papillomavirus/prevención & control , Vacunas contra Papillomavirus/uso terapéutico , Estudiantes/estadística & datos numéricos , Vacunación/estadística & datos numéricos , Adolescente , Femenino , Francia/epidemiología , Conocimientos, Actitudes y Práctica en Salud , Humanos , Aceptación de la Atención de Salud/estadística & datos numéricos , Instituciones Académicas/estadística & datos numéricos , Conducta Sexual/estadística & datos numéricos , Estudiantes/psicología , Encuestas y Cuestionarios , Universidades/estadística & datos numéricos , Neoplasias del Cuello Uterino/prevención & control , Adulto JovenRESUMEN
OBJECTIVES: To evaluate the practice of cytologic cervical cancer screening during the follow-up of pregnancy. MATERIALS AND METHODS: A retrospective cohort study was conducted from July to November 2013. During this period, 300 women attending to the obstetrical department of two universitary hospitals were randomly included immediately after their delivery. RESULTS: Among included women, 155 (51.7%) had a normal cervical cytology performed within the past 3 years. Overall, 75 (25%) women had a cervical cytology performed during their pregnancy. Although patients who did not have a cervical cytology performed within the past 3 years were significantly more likely to have a cervical cytology performed during the follow up of their pregnancy (AOR: 2.30; 95% CI: 1.03-5.26; P=0.049), only 39 (26.9%) of the 145 women who did not have a cervical cytology performed within the last 3 years had a catch up cytology performed. Age 25 or older had no significant influence on the probability that a cervical cytology had been performed during pregnancy (ORA: 1.11; 95% CI: 0.51-2.43; P=0.786). CONCLUSION: Although the follow-up of pregnancy allows for the catch up of non attendant women to cytologic cervical cancer screening, such catch up remains insufficient and most of cervical cytologies performed during pregnancy are done irrespectively of the current guidelines.