Prevalence of precancerous gynecological lesions and gynecological cancer in patients undergoing vaginal hysterectomy for pelvic organ prolapse.

OBJECTIVES: This retrospective cohort study aimed to determine the prevalence of precancerous or malignant lesions of the cervix and/or endometrium among patients who underwent vaginal hysterectomy. MATERIALS AND METHODS: Medical record of patients who had been diagnosed with pelvic organ prolapse (POP) and undergone vaginal hysterectomy from January 2009 to September 2018 in tertiary hospital was reviewed. The exclusion criteria included individuals who had previously received a diagnosis of gynecologic precancerous lesions or cancer, had abnormal preoperative findings, presented abnormal cervical cancer screening test results or abnormal results from preoperative endometrial biopsy, and had incomplete operative notes or pathological results. RESULTS: The electronic medical records of 530 patients were reviewed and included in the analysis. Nine of the 530 patients (1.7%) had precancerous or malignant lesions of the cervix and/or endometrium. The prevalence of atypical endometrial hyperplasia and endometrial carcinoma were 0.19% and 0.57%, respectively. All of the patients with endometrial cancer subsequently underwent complete surgical staging. Precancerous cervical lesions were found in five patients (0.95%): CIN II 0.38% and CIN III 0.57%. No cases of cervical cancer were identified. CONCLUSIONS: It is possible to detect a minor prevalence of precancerous and malignant lesions following post-operative procedures in POP. The assessment of the elderly through the use of risk-based evaluation merits attention for the purpose of early identification. This study offers valuable insights that can be utilized in preoperative counseling and enhancing the preoperative evaluation process.

Perspective and conception of Thai gynecologic oncologists in palliative care.

BACKGROUND: Palliative care evidently increases the quality of life among the patients with advanced cancer. However, there are very few studies on the aspects of the physicians' ideas, conceptions, or the effects of their ideas in palliative care quality, especially in Asian countries. This study aimed to evaluate the conception and perspective on palliative care in Thai gynecologic oncologists. METHODS: The online survey was distributed to all certificated Thai gynecologic oncologists. The survey could be accessed via working email address, hyperlink, or QR code during May 2020 and January 2021. A 5-point Likert scale captured the perspectives and concepts of palliative care. The association between respondents' characteristics and their choices of content in palliative care, together with their decision making in specified clinical scenarios was analyzed. RESULTS: A total of 207 completed surveys from 320 Thai gynecologic oncologists were received (64.69% participation rate). They prospected a willingness to give the advices to both patients and their families (85.50%), and strongly agreed to introduce palliative care in any stage of cancer at the time of diagnosis (75.80%). The numbers of their palliative cases per year were 5-20 (57.97%) and the palliative care teams were available in their hospitals. They decided to offer early palliative care and do-not-resuscitate, especially for the elders, or patients with advance stages, or recurrent disease. We found that gynecologic oncologists who previously experienced a palliative care training did not show any difference in decision making in specified clinical scenarios, compared with who did not. CONCLUSIONS: Thai gynecologic oncologists responded to the conceptions and perspectives in palliative care. Their concepts of early and willingness to offer a palliative care especially in the elders, advanced stage, or recurrent patients were proven, regardless of the experience in palliative care training.

Serum CA19-9, CA-125 and CEA as tumor markers for mucinous ovarian tumors.

AIM: To analyze the use of serum cancer antigen 19-9 (CA19-9), cancer antigen 125 (CA-125) and carcinoembryogenic antigen (CEA) in predicting the malignant potential of mucinous ovarian tumor, and to assess the clinical factors associated with these tumors. METHODS: This retrospective study collected the data from 314 patients who were diagnosed with mucinous ovarian tumor. These patients had preoperative serum CA19-9, CA-125, CEA available and underwent surgery at Ramathibodi Hospital between January 2010 and December 2016. The diagnostic performance of CA19-9, CA-125 and CEA was analyzed using the receiver operator characteristic curve. The associations between clinicopathological factors and serum CA19-9, CA-125 and CEA level were also analyzed. RESULTS: A total of 314 patients were recruited in this study. They consisted of 221 patients with benign mucinous ovarian tumor (70.38%), 65 patients with borderline mucinous ovarian tumor (20.70%) and 28 patients with mucinous ovarian carcinoma (8.92%). Multivariate analysis revealed that the tumor size, elevated serum CA19-9, CA-125 and CEA influenced the tumor pathology. The mucinous ovarian tumor with large tumor size, elevated serum CA19-9, CA-125 and CEA more than the cut off values showed a positive correlation with the risk ratio of 1.60 (95% CI = 1.13-2.28; P = 0.005), 1.74 (95% CI = 1.22-2.47; P = 0.002), 1.90 (95% CI = 1.34-2.70; P < 0.001), 1.58 (95% CI = 1.10-2.29; P = 0.020), respectively. CA-125 provided the highest diagnostic performance, with an area under receiver operator characteristic curve of 0.745, to differentiate between borderline, malignant or benign mucinous ovarian tumor. CONCLUSION: Preoperative elevation of the serum CA19-9, CA-125, CEA and tumor size are useful predictors to differentiate between benign, borderline and malignant mucinous ovarian tumor. The best predictor is CA-125, followed by CA19-9 and CEA.

Limited Impact of Music Therapy on Patient Anxiety with the Large Loop Excision of Transformation Zone Procedure - a Randomized Controlled Trial.

BACKGROUND: Many studies have pointed to strategies to cope with patient anxiety in colposcopy. Evidence shows that patients experienced considerable distress with the large loop excision of transformation zone (LLETZ) procedure and suitable interventions should be introduced to reduce anxiety. This study aimed to investigate the effects of music therapy in patients undergoing LLETZ. MATERIALS AND METHODS: A randomized controlled trial was conducted with patients undergoing LLETZ performed under local anesthesia in an out patient setting at Ramathibodi Hospital, Bangkok, Thailand, from February 2015 to January 2016. After informed consent and demographic data were obtained, we assessed the anxiety level using State Anxiety Inventory pre and post procedures. Music group patients listened to classical songs through headphones, while the control group received the standard care. Pain score was evaluated with a visual analog scale (VAS). Statistical analysis was conducted using Pearson Chi-square, Fisher's Exact test and T-Test and p-values less than 0.05 were considered statistically significant. RESULTS: A total of 73 patients were enrolled and randomized, resulting in 36 women in the music group and 37 women in the non-music control group. The preoperative mean anxiety score was higher in the music group (46.8 VS 45.8 points). The postoperative mean anxiety scores in the music and the non-music groups were 38.7 and 41.3 points, respectively. VAS was lower in music group (2.55 VS 3.33). The percent change of anxiety was greater in the music group, although there was no significant difference between two groups. CONCLUSIONS: Music therapy did not significantly reduce anxiety in patients undergoing the LLETZ procedure. However, different interventions should be developed to ease the patients' apprehension during this procedure.

Vaginal Stump Characteristics after Total Abdominal Hysterectomy Using Electrosurgery versus Scalpel or Scissors for Vaginal Incision: A Randomized Controlled Trial.

Objective: To compare the vaginal stump characteristics following total abdominal hysterectomy between two vaginal incision techniques, electrosurgery versus scalpel or scissors. Material and Method: A randomized single-blind controlled trial was performed in 80 patients scheduled to undergo total abdominal hysterectomy for benign conditions. Either sharp instrument (scalpel or scissors) or electrosurgery was used for vaginal incision following standard surgical technique for total abdominal hysterectomy. The main outcome measures were the vaginal stump characteristics determined by the degree of vaginal mucosal approximation and the presence of vaginal granulation at 6-week postoperatively. Results: Six weeks after surgery, the number of patients with incomplete mucosal approximation following electrosurgical technique was 11 (27.5%), as compared to 8 (20%) (p = 0.43) in the scalpel/scissors technique group. The incidences of vaginal granulation in the scalpel/scissors group and electrosurgical group were 10% and 22.5%, respectively. Conclusion: The vaginal stump characteristics at six weeks following total abdominal hysterectomy between two vaginal incision techniques were not statistically significantly different.

The Level of Squamous Cell Carcinoma Antigen and Lymph Node Metastasis in Locally Advanced Cervical Cancer.

BACKGROUND: This study aimed to determine the utility and a cut-off level of serum squamous cell carcinoma antigen (SCC-Ag) to predict lymph node metastasis in locally advanced cervical cancer cases. We also investigated the correlation between SCC-Ag level and lymph node status. MATERIALS AND METHODS: From June 2009 to June 2014, 232 patients with cervical cancer stage IB2-IVA, who were treated at Ramathibodi Hospital, were recruited. Receiver operating characteristic (ROC) curves were used to identify the best cut-off point of SCC-Ag level to predict lymph node metastasis. Quantile regression was performed to evaluate the correlation between SCC-Ag levels and pelvic lymph node metastasis, paraaortic lymph node metastasis, and parametrial involvement as well as tumor size. RESULTS: Pelvic lymph node metastasis and paraaortic lymph node metastasis were diagnosed in 46.6% and 20.1% of the patients, respectively. The median SCC-Ag level was 6 ng/mL (range, 0.5 to 464.6 ng/ mL). The areas under ROC curves between SCC-Ag level and pelvic lymph node metastasis, paraaotic lymph node metastasis, parametrial involvements were low. SCC-Ag level was significantly correlated with paraaortic lymph node status (p=0.045) but not with pelvic lymph node status and parametrial involvement. SCC-Ag level was also related to the tumor diameter (p<0.05). CONCLUSIONS: SCC-Ag level is not a good predictor for pelvic and paraaortic lymph node metastasis. However, it is still beneficial to assess the tumor burden of squamous cell carcinoma of the cervix.

The location of needle insertion effect on maternal pain in amniocentesis.

OBJECTIVE: The purpose of this study was to determine whether maternal pain in amniocentesis was associated with the location of needle insertion and other identifiable clinical correlates. MATERIAL AND METHOD: This prospective study of mid-trimester amniocentesis was conducted between October 2005 and December 2005. Women were asked to complete a visual analog scale (VAS) after the amniocentesis. The distance from uterine fundus to symphysis pubis and from the location of needle insertion to symphysis pubis were measured and calculated to divide the insertion into two groups: upper third and middle third. The effect of previous amniocentesis, previous abdominal surgery, needle insertion through placenta and operators' experience was determined. The t-test was used for analysis; a probability value of < 0.05 was considered significant. RESULTS: Seventy-two women were participated in the study. The mean VAS was 2.7 +/- 2.1. The perception of pain was significantly less in patients with the upper-third insertion as compared with the middle third insertion (VAS 2.2 vs 3.9, p = 0.002). Previous amniocentesis, previous abdominal surgery, needle insertion through placenta and operators' experience had no impact on pain intensity. CONCLUSION: The pain from amniocentesis was significantly less in the patients with the needle insertion in the upper third of the uterus.