Conventional cytology scheme: adherence and associated factors.

OBJECTIVES: This study analyzed adherence rates to conventional cytology and associated factors in a cohort of women at a health service provider institution in Medellin, Colombia. STUDY DESIGN: Observational cohort study with repeated measures. METHODS: Clinical and sociodemographic data were obtained from databases for screenings between January 2018 and December 2022. Adherence, defined as undergoing 1, 2, or 3 cytology tests according to national guidelines, was the outcome. Statistical analysis involved a Poisson model with robust errors to identify factors associated with adherence. RESULTS: In total, 26,445 women were included, with a median age of 25 years (IQR: 22-27). Adherence rate was 20.4%. Having just high school education (RR = 0.51; 95% CI: 0.49-0.55), a history of pregnancy (RR = 0.63; 95% CI: 0.54-0.75), and a history of sexually transmitted infections (RR = 0.88; 95% CI: 0.78-0.99) decreased adherence. Conversely, the human papillomavirus (HPV) vaccination history increased adherence (RR = 2.11; 95% CI: 1.60-2.80). CONCLUSION: It is vital to monitor cytology programs to improve demand-induced and spontaneous consultations. Diligent follow-up, focusing on patients with factors linked to low adherence, along with appointment reminders, can enhance adherence to the screening protocol.

Comparing visual inspection with acetic acid, with and without Lugol's Iodine for triage of HPV self-sample positive women in Ethiopia: a randomized controlled trial.

BACKGROUND: Most women who are high-risk human papilloma virus (hrHPV) positive in a cervical cancer screening test will spontaneously heal from their infection. Visual inspection with acetic acid (VIA) is recommended by the World Health Organization as a triage test for cervical screening, however its accuracy as a triage test has been questioned. In this study, we aimed to examine the sensitivity and specificity of VIA with and without Lugol's iodine as a triage test to detect cervical intraepithelial neoplasia (CIN2+) among women who tested positive for hrHPV after self-sampling. METHOD: This two-armed randomized controlled trial (RCT) took place in Adama, Ethiopia. The women who tested positive for vaginal hrHPV (Anyplex ΙΙ, Seegene) after self-sampling were randomized to VIA with or without iodine and appointed to a midwife-led clinic. The result of the triage test was categorized as positive, negative, suspicion of cancer or inconclusive, and treated accordingly. Cervical biopsies were collected from women who were hrHPV positive to serve as a gold standard. RESULTS: 22.4% (197/878) of women tested hrHPV positive. Sensitivity and specificity for VIA to detect CIN2+was 25.0% (95% CI 0.6 to 80.0) and 82.7% (95% CI 69.7 to 91.8), respectively. For VIA with iodine, the sensitivity was 50.0% (95% CI 0.7 to 93.2) and the specificity 86.3% (95% CI 71.4 to 93.0). The difference between the two methods was not statistically significant, p=0.5. The odds of detecting CIN2+ was 5.4 times higher if positive for VIA with iodine compared with a negative result. For VIA without iodine, the odds of detecting CIN2+ was 1.6 compared with a negative result. The odds of detecting CIN2+ was 6.4 times higher if the women were HIV positive than for those who were HIV negative. CONCLUSION: VIA with iodine improved detection of CIN2+ in women who were hrHPV DNA positive but was not significantly better than VIA alone. TRIAL REGISTRATION NUMBER: NCT05125380.

Prediction model for spontaneous preterm birth less than 32 weeks of gestation in low-risk women with mid-trimester short cervical length: a retrospective cohort study.

BACKGROUND: A short cervix in mid-trimester pregnancy is a risk factor for spontaneous preterm birth. However, there is currently a lack of predictive models and classification systems for predicting spontaneous preterm birth in these patients, especially those without additional risk factors for spontaneous preterm birth. METHODS: A retrospective observational cohort study of low-risk singleton pregnant women with a short cervix (≤ 25 mm) measured by transvaginal ultrasonography between 22 and 24 weeks was conducted. A multivariate logistic regression model for spontaneous preterm birth < 32 weeks in low-risk pregnant women with a short cervix was constructed. Moreover, we developed a nomogram to visualize the prediction model and stratified patients into three risk groups (low-, intermediate-, and high-risk groups) based on the total score obtained from the nomogram model. RESULTS: Between 2020 and 2022, 213 low-risk women with a short cervix in mid-trimester pregnancy were enrolled in the study. Univariate logistic analysis revealed that a high body mass index, a history of three or more miscarriages, multiparity, a short cervical length, leukocytosis, and an elevated C-reactive protein level were associated with spontaneous preterm birth < 32 weeks, but multivariate analysis revealed that multiparity (OR, 3.31; 95% CI, 1.13-9.68), leukocytosis (OR, 3.96; 95% CI, 1.24-12.61) and a short cervical length (OR, 0.88; 95% CI, 0.82-0.94) were independent predictors of sPTB < 32 weeks. The model incorporating these three predictors displayed good discrimination and calibration, and the area under the ROC curve of this model was as high as 0.815 (95% CI, 0.700-0.931). Patients were stratified into low- (195 patients), intermediate- (14 patients) and high-risk (4 patients) groups according to the model, corresponding to patients with scores ≤ 120, 121-146, and > 146, respectively. The predicted probabilities of spontaneous preterm birth < 32 weeks for these groups were 6.38, 40.62, and 71.88%, respectively. CONCLUSIONS: A noninvasive and efficient model to predict the occurrence of spontaneous preterm birth < 32 weeks in low-risk singleton pregnant women with a short cervix and a classification system were constructed in this study and can provide insight into the optimal management strategy for patients with different risk stratifications according to the score chart.

S100 and CD34 positive spindle cell tumors of the uterine cervix with EGFR mutation: a hitherto unrecognized neoplasm phenotypically and epigenetically overlapping with "NTRK-rearranged spindle cell neoplasms" of the uterus.

NTRK-rearranged spindle cell neoplasm represents an emerging entity included in the latest 5th edition of WHO classification of both soft tissue and female genital tumors. By immunohistochemistry, they are commonly positive for CD34, S100 protein, and CD30 and typically harbor fusions of kinase genes such as NTRK1/2/3, RET, and BRAF. In the gynecological tract, they typically affect the uterine cervix or uterine body. Most of the reported cases had fibrosarcoma-like morphology, occasionally showing perivascular and stromal hyalinization with only a few cases showing a less cellular spindle cell proliferation. Except for one case with RET fusion, all other gynecological cases harbored exclusively NTRK1/2/3 fusions. Besides kinase gene fusions, the analogous tumors in soft tissues may also harbor activating EGFR or BRAF point mutations, but no such case has been described in the uterus. Herein we are reporting two cases from the uterine cervix showing morphology and molecular features previously unreported at this anatomic site. The patients were 46 and 34 years old and clinically presented with unremarkable cervical polyps each measuring 8 mm in diameter. Histologically, both cases had a rounded polypoid outline and were composed of hypocellular proliferation of bland spindle cells lacking mitotic activity and growing in a fibrotic stroma which was punctuated by prominent small vessels with thick hyalinized walls. Immunohistochemically, both showed a diffuse expression of CD34, CD30, and S100 protein, whereas SOX10 was negative. Both cases harbored exon 20 EGFR mutation and did not reveal any fusions or significant copy number changes. The patient in case 1 was treated by hysterectomy with salpingectomy with no other residual tumor detected, and she was alive and well 27 months after the diagnosis. The patient in case 2 had no other known tumors at the time of diagnosis, but no follow-up is available. We believe the reported cases represent a hitherto unrecognized variant of "NTRK-rearranged spindle cell neoplasms" of the uterine cervix with novel EGFR mutations.

Relationship between endometriosis and uterine cervical elasticity assessed using ultrasound strain elastography.

PURPOSE: Internal cervical os (ICO) stiffness is related to menstrual pain, a key symptom of endometriosis. The study evaluated whether women with endometriosis have a stiffer ICO than unaffected women. METHODS: A retrospective cross-sectional analysis was conducted using prospectively collected data from women with and without endometriosis, spanning from June 2020 to September 2022. Endometriosis was diagnosed through clinical and ultrasound evaluations, with histological confirmation in a subset of participants. Strain elastography (SE) was employed to measure tissue elasticity in four cervical regions of interest: the ICO and the anterior, posterior, and middle cervical compartments (ACC, PCC, and MCC, respectively). Tissue elasticity was quantified using a color-based scoring system ranging from 0.1 (blue, indicating less elasticity) to 3.0 (red, indicating greater elasticity). RESULTS: Overall, 287 women were included, with 157 diagnosed with endometriosis and 130 controls. On SE, women with endometriosis exhibited a lower color score (mean±standard deviation), indicating lower elasticity, for the ICO (0.56±0.28 vs. 0.70±0.26, P=0.001) and PCC (0.69±0.30 vs. 0.80±0.27, P=0.002). Additionally, they had a lower ICO/MCC ratio (0.45±0.28 vs. 0.60±0.32, P=0.001) and ICO/ACC ratio (0.68±0.42 vs. 0.85±0.39, P=0.001). Multiple logistic regression analysis revealed that endometriosis was associated with the ICO color score (odds ratio, 0.053; 95% confidence interval, 0.014 to 0.202; R2=0.358; P=0.001), even after adjusting for confounding factors like the presence of myomas (P=0.040) and the use of hormonal therapy (P=0.001). The results were corroborated in women with histologically confirmed endometriosis (n=71). CONCLUSION: The findings suggest a potential relationship between a stiffer ICO and endometriosis.

Prognostic Importance of 18F-FDG Positron Emission Tomography in Uterine Cervical Cancer.

Objectives: The aim of this study was to evaluate the prognostic value of 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) in the uterine cervix cancer patients. Methods: Thirty-two women (mean age: 52.7±12.6) who underwent 18F-FDG PET/CT for staging of uterine cervix cancer were retrospectively recruited for the study. Maximum standardized uptake value (SUVmax), SUVmean, metabolic tumor volume (MTV), and total lesion glycolysis (TLG) for primary tumors, lymph nodes, and distant metastases were calculated from 18F-FDG PET/CT images using the 40% threshold. Patients were divided into groups according to the presence of pelvic and para-aortic lymph node involvement on 18F-FDG PET/CT images. Life tables and Kaplan-Meier analyses were performed to compare the mean survival times of the different groups. Results: Primary tumor of 27 (84%) patients were 18F-FDG avid. The median SUVmax, SUVmean, MTV, and TLG of the primary tumors were 12.4, 6.1, 13.2 cm3 and 87.8 g/mL x cm3 respectively. Pathological uptake was detected in pelvic 14 (44%) patients and in paraaortic lymph nodes in 3 (10%) para-aortic lymph nodes. The median whole-body MTV and TLG were 21.7 cm3 and 91.1 g/mL x cm3. Disease progression was detected in 7 (22%) patients within a median follow-up period of 20.9 (minimum-maximum: 3-82) months. The only significant PET parameter to predict progression-free survival was SUVmax in the primary tumor (p=0.038). During follow-up period 8 patients died. SUVmax (p=0.007), MTV (p=0.036), TLG (p=0.001) of primary tumor, presence of pathological uptake on pelvic or paraaortic lymph nodes (p=0.015), whole-body MTV (p=0.047) and whole-body TLG (p=0.001) were found statistically significant PET parameters to predict overall survival. Conclusion: Metabolic parameters of primary tumors derived from 18F-FDG PET/CT images have prognostic importance for patients with uterine cervical carcinoma. In patients with metastatic disease, higher whole-body MTV and TLG are also associated with poor prognosis.

The effectiveness of vaginal progesterone to prevent preterm birth in singleton pregnant women with a short cervix at 18-32 weeks gestation.

Short cervix is a risk factor for preterm birth. Currently, both international and domestic studies about progesterone's effectiveness are limited to pregnant women at 18-24 weeks gestation. However, multiple studies indicated that cervical length was associated with preterm birth even before 32 weeks of gestation. Therefore, this study expanded the gestational week range to investigate whether progesterone can reduce the rate of preterm birth in singleton pregnant women with a short cervix at 18-32 weeks gestation.Pregnant women who underwent prenatal examination at Peking University First Hospital from January 2016 to August 2020 were prospectively followed. A total of 132 asymptomatic singleton pregnant women at 18-32 weeks gestation with a cervical length <25 mm were ultimately enrolled. According to the method of treatment, the participants were divided into progesterone group (80 patients) and control group (52 patients). The rate of preterm birth (PTB) at different stages was compared between two groups.(1) There was no significant difference in the total preterm birth rate (18.8% vs. 21.2%, RR 0.886[0.442-1.777], p = 0.734). (2) Stratified analysis found that, for pregnant women at <24 weeks gestation, there was a significant difference in the rate of PTB at <32 weeks (2.8% vs. 33.3%, p = 0.021). For women at 24-28weeks gestation, significant difference was not found in the rate of PTB at <37 weeks gestation (25% vs. 42.9%, RR = 0.583[0.186-1.831], p = 0.682), neither for women at after 28 weeks(12.5% vs. 11.1%,1.12[0.27-4.59], p = 1). (3) Vaginal progesterone was not associated with low birth weight (13.8% vs. 19.2%, p = 0.4), or preterm birth-related complications such as respiratory distress syndrome (3.8% vs. 7.7%, p = 0.555), aspiration pneumonia (22.5% vs. 19.2%, p = 0.653) and sepsis (2.5% vs. 7.7%, p = 0.331).For pregnant women with a short cervix at 18-24 weeks gestation, the rate of preterm birth before 32 weeks could be significantly reduced. For women with a short cervix at 24-28 weeks gestation, the rate of preterm birth could be reduced, while there was no significant effect for pregnant women. Further studies with a larger sample size and randomized controlled researches are needed.

A new screening of preterm birth in gestation with short cervix after pessary plus progesterone.

Objective: This study aims to create a new screening for preterm birth < 34 weeks after gestation with a cervical length (CL) ≤ 30 mm, based on clinical, demographic, and sonographic characteristics. Methods: This is a post hoc analysis of a randomized clinical trial (RCT), which included pregnancies, in middle-gestation, screened with transvaginal ultrasound. After observing inclusion criteria, the patient was invited to compare pessary plus progesterone (PP) versus progesterone only (P) (1:1). The objective was to determine which variables were associated with severe preterm birth using logistic regression (LR). The area under the curve (AUC), sensitivity, specificity, and positive predictive value (PPV) and negative predictive value (NPV) were calculated for both groups after applying LR, with a false positive rate (FPR) set at 10%. Results: The RCT included 936 patients, 475 in PP and 461 in P. The LR selected: ethnics white, absence of previous curettage, previous preterm birth, singleton gestation, precocious identification of short cervix, CL < 14.7 mm, CL in curve > 21.0 mm. The AUC (CI95%), sensitivity, specificity, PPV, and PNV, with 10% of FPR, were respectively 0.978 (0.961-0.995), 83.4%, 98.1%, 83.4% and 98.1% for PP < 34 weeks; and 0.765 (0.665-0.864), 38.7%, 92.1%, 26.1% and 95.4%, for P < 28 weeks. Conclusion: Logistic regression can be effective to screen preterm birth < 34 weeks in patients in the PP Group and all pregnancies with CL ≤ 30 mm.

Breast cancer with cervix, lung and neck metastases: a case report and literature review.

Background: Breast cancer has the potential to metastasize to various sites; however, cases of metastasis to the cervix are rare. Here, we present clinical and pathological data from a rare case of primary breast cancer metastasis to the cervix, including imaging characteristics and clinical progression. Case Description: A 68-year-old female patient self-detected nodules in her right breast. B-ultrasound examination revealed multiple nodules in the right breast, classified as Breast Imaging Reporting and Data System (BI-RADS) 4c. Radical treatment for right breast cancer was commenced. Histopathologic diagnosis revealed invasive ductal breast carcinoma of no specific type, with intraductal carcinoma in the right breast. Immunohistochemical analysis indicated that the tumor was androgen receptor (AR)-diffuse strong positive, estrogen receptor (ER)-negative, progesterone receptor (PR)-negative, with human epidermal receptor-2 (HER2, c-erbB-2) overexpression, and Ki-67 proliferation index 60%. The tumor was positive for GATA binding protein 3 (GATA-3) and fluorescence in situ hybridization (FISH) analysis revealed HER2 gene amplification. Chemotherapy was discontinued after completing three cycles. Three years after stopping chemotherapy, she experienced lower abdominal, pain with cervical bleeding, and underwent aspiration biopsy. Immunohistochemical results indicated: AR-diffuse strong positive, ER-negative, PR-negative, c-erbB-2-negative, and Ki-67 30%, with gross cystic disease fluid protein-15 (GCDFP-15) and GATA-3 both diffuse strong positive. Lung mass detection prompted lung puncture and biopsy, with immunohistochemical results: ER-negative, PR-negative, c-erbB-2-positive, Ki-67 30%, with GCDFP-15-diffuse positive, and GATA-3-diffuse positive. No HER2 gene amplification was detected by FISH. She was diagnosed with ductal breast carcinoma metastasized to the uterus and lung, based on morphological, immunohistochemical, and clinical findings. Eight months later, she developed a neck mass, and mass puncture and biopsy confirmed metastatic breast cancer [immunohistochemical results: ER-negative, PR-negative, c-erbB-2-positive, Ki-67 30%, trichorhinophalangeal syndrome type 1 (TRPS1)-positive, and GATA-3-positive]. The primary tumor was ER-negative, PR-negative, with HER2 amplification. Later, cervical, pulmonary, and neck metastases were ER-negative, PR-negative, and HER2 negative. The patient remains alive; last follow-up was February 15, 2024, 50 months after radical treatment for breast cancer. Conclusions: We report a relatively rare case of primary breast cancer metastasis to three metastatic sites: cervix, lung, and neck. To our best knowledge, this is the first report of primary breast cancer metastasis to three sites including the cervix.

The top hat procedure does not impact the management of women treated by LEEP in cervical cancer screening.

Objective: To describe Top-hat results and their association with margin status and disease relapse in a referral facility in Brazil. Methods: A retrospective study of 440 women submitted to LEEP to treat HSIL, in which 80 cases were complemented immediately by the top hat procedure (Top-hat Group - TH). TH Group was compared to women not submitted to Top-hat (NTH). The sample by convenience included all women that underwent LEEP from January 2017 to July 2020. The main outcome was the histological result. Other variables were margins, age, transformation zone (TZ), depth, and relapse. The analysis used the Chi-square test and logistic regression. Results: The TH Group was predominantly 40 and older (NTH 23.1% vs. TH 65.0%, p<0.001). No difference was found in having CIN2/CIN3 as the final diagnosis (NTH 17.0% vs. TH 21.3%, p=0.362), or in the prevalence of relapse (NTH 12.0% vs. TH 9.0%, p=0.482). Of the 80 patients submitted to top hat, the histological result was CIN2/CIN3 in eight. A negative top hat result was related to a negative endocervical margin of 83.3%. A CIN2/CIN3 Top-hat result was related to CIN2/CIN3 margin in 62.5% (p=0.009). The chance of obtaining a top hat negative result was 22.4 times higher (2.4-211.0) when the endocervical margin was negative and 14.5 times higher (1.5-140.7) when the ectocervical margin was negative. Conclusion: The top hat procedure did not alter the final diagnosis of LEEP. No impact on relapse was observed. The procedure should be avoided in women of reproductive age.

Influence of COVID-19 on the clinical characteristics of patients with uterine cervical cancer in Japan: A single-center retrospective study.

AIM: This study investigated the impact of coronavirus disease 2019 (COVID-19) on the clinical characteristics and interregional movement of patients with uterine cervical cancer. METHODS: This study included 1189 patients who underwent treatment for cervical cancer, including cervical intraepithelial neoplasm and adenocarcinoma in situ, at our hospital in Tokyo, Japan, in 2017-2018 and in 2021, before and after the pandemic, respectively. The patients' clinical information was compared during both periods. The clinical stage was unified using the International Federation of Gynecology and Obstetrics (FIGO) 2008 staging. RESULTS: The number of patients treated for cervical cancer was 355, 420, and 414 in 2017, 2018, and 2021, respectively. The percentage of invasive carcinomas significantly increased from 158 (44.5%) and 196 (46.7%) to 219 (52.9%) (p = 0.049). In all periods, no significant differences were observed in median age, histological type, and treatment. The proportions of FIGO Stage IA1 were significantly elevated from 3.9% and 3.8% to 11.4% (p < 0.001). The percentage of patients from prefectures other than Tokyo significantly increased from 34.9% to 40.8% (p = 0.049). Furthermore, the proportion of patients with invasive carcinoma in private clinics increased from 28.0% to 37.9% (p = 0.014). CONCLUSIONS: The number of patients with invasive carcinoma and the percentage of patients with invasive carcinoma referred from private clinics increased, indicating that the COVID-19 pandemic influenced patients to delay consultations. Furthermore, the surge in patients from other prefectures indicates that medical resources were more limited in rural areas, another impact of COVID-19.

Squamous cell carcinoma of the cervix associated with choriocarcinomatous differentiation: a case report and review of the literature.

The morphology of the choriocarcinomatous variant of cervical squamous cell carcinoma (SCC) suggests an undifferentiated aggressive biological behaviour and a poor outcome, for which standard treatment has not been established. In addition, cases are rarely reported, with only five cases of patients with cervical carcinoma with choriocarcinoma reported previously in the literature. This current case report describes in detail a patient who was diagnosed with cervical SCC mixed with choriocarcinomatous differentiation. The case report includes details of the diagnosis, pathology, short tandem repeat genotyping, treatment and follow-up of this patient. As there is no standard treatment for this variant, the patient underwent surgery followed by radiotherapy. Unfortunately, 4 months after therapy discontinuation, radiological evaluation and laboratory tests documented a recurrence of the disease and the patient died. This report also systematically reviews the literature on cervical cancer associated with choriocarcinomatous differentiation and the five previous cases. It provides the most up-to-date summary of this disease, including its clinical manifestations, histopathology, diagnosis, treatment and prognosis.

Cisplatin-Containing Combinations Associate with Survival in Women from Appalachian Kentucky with Metastatic, Persistent, or Recurrent Uterine Cervix Cancer.

Background: Prior preclinical studies showed promising antitumor activity and an acceptable safety profile associated with radiopharmaceuticals for patients with metastatic, persistent, or recurrent uterine cervix cancers. Whether the addition of a radiopharmaceutical to chemotherapy would significantly increase progression-free survival in such patients is untested. Our retrospective study sought to associate the line of treatment and progression-free survival as benchmarks for next-generation radiopharmaceutical development. Methods: We grouped metastatic, persistent, or recurrent uterine cervix cancer patients not amenable to curable surgery or radiotherapy between 2002 and 2023 by the line of doublet, triplet, and quadruplet chemotherapy or another intervention. After the first-line treatment, patients were monitored for radiographic progression every three months for up to three years. The primary endpoints were the first and any second or third progression-free survival intervals. Results: A total of 127 patients contributed demographic, tumor, line of treatment, and outcome data with a median follow-up of 18 months (25-75% interquartile range: 9 to 37 months). After the first-line treatment, 113 patients had local or distant progression or died from any cause, most often death from the disease (67%). Median progression-free survivals were 5.5 months (95% confidence interval: 4.8-6.0 months), 5.3 months (95% confidence interval: 4.5-6.3 months), and 3.0 months (95% confidence interval: 2.1-3.7 months) for the first-, second-, and third-line treatments, respectively. For a first-line cisplatin-containing regimen, the median progression-free survival was 6.5 months (95% confidence interval: 5.5-7.7 months). Conclusions: This study highlights the limited efficacy of current treatments for metastatic, persistent, or recurrent uterine cancer patients. A five-month progression-free survival might serve as a benchmark for the development of novel therapies in clinical efficacy trials, such as radiopharmaceuticals.

An unusual pattern of endometrial involvement: superficial spreading squamous cell carcinoma of the cervix.

Background: Cervical squamous cell carcinoma (SCC) is the most common type of cervical carcinoma. Usually, the cancer metastasizes through lymphatic or hematogenous dissemination. However, it is uncommon for a superficial spreading of cervical cancer to reach the endometrium, fallopian tubes, and the ovaries. Objectives: In the present study, we report 15 cases of superficial spreading SCC and discuss the possible mechanism involved. Methods: We collected 15 samples diagnosed by histopathology after surgery. Immunostaining, which included P16, P63, CD138, CD34, D2-40, and Ki-67, were performed for all samples. Results: All patients were postmenopausal or perimenopausal women. The commonest clinical presentation was vaginal bleeding in 66.67%. All patients were infected with HPV 16. The endometrium was replaced by high-grade squamous intraepithelial lesion (HSIL), which involved the endometrial gland, even squeezing into the myometrium and forming SCC. Bilateral fallopian tubes and ovaries involvement was in 1/15. A total of 10/15 (66.67%) of the women had disease of stage 1B or less. All SCCs were moderately or poorly differentiated. Immunohistochemistry revealed that the tumor cells were positive for P63 and P16, with a high Ki-67 labeling index. There was CD138 positive expression in varying degrees, which was strongly and diffusely expressed in 6/15 (40.00%). Conclusion: Superficial spread of cervical cancer towards the endometrium is a rare but cognizable phenomenon, and a guideline for the management of these cases has not been established. Our present findings suggest that multiple factors may interact with each other simultaneously, contributing to this rare disease.

Acceptability and validity of HPV self-sampling for cervical cancer screening among women living in different ecological settings in India.

India records one fifth of global cervical cancer burden. Unlike human papillomavirus (HPV) self-sampling, other screening methods may cause discomfort and embarrassment. This study aimed to investigate attitudes, acceptability, barriers, predictors, effective modality of instructions, and validity of HPV self-sampling among Indian women residing in varied settings and different literacy levels. This is community-based interventional study among Indian women 30-55 years, residing in urban slums (500), urban non-slums (500), and rural (600) settings with varied washroom facilities and privacy, to collect self-samples. Each group was subdivided into two arms; in one women received education with pamphlets and other with health education program (HEP). Study involved enlisting eligibles, obtaining informed consents and conducting personal interviews to collect baseline data. Self-samplers were distributed with instructions (pictorial pamphlets in one group and HEP in other) regarding usage, storage and return. Willingness to use self-samplers, refusals, experiences, and so forth were captured. Post-intervention knowledge, attitudes, practices was recorded. HPV reports were distributed. Women with positive result on either test were offered further management. Acceptance rate of self-sampling was 99.2%, 97%, and 98.8% and HPV positivity was 7%, 7.8%, and 8.5%, respectively among urban non-slum, urban slum and rural women. Agreement rate between health personnel collected and self-collected samples was 96.5% in pamphlet and 93.2% in HEP arm. Major barriers of self-sampling were lack of confidence about performing self-test correctly, fear that test would be painful and anxiety about test results. HPV self-sampling has good acceptability among Indian women and good agreement with health personnel collected samples.

Application of hysteroscopy in the treatment of Mullerian adenosarcoma of the cervix in an adolescent girl with 7 years of follow-up.

BACKGROUND: Mullerian adenosarcoma of the cervix is a rare biphasic tumor composed of a benign epithelial component and a malignant stromal component. Here, we report a rare case of Mullerian adenosarcoma of the cervix in an adolescent girl treated with hysteroscopic resection. CASE PRESENTATION: A 16-year-old girl presented to the Affiliated Hospital of North Sichuan Medical College in April 2017 with a one-year history of a painless vaginal mass. 10 hours prior to presentation, she had experienced rapid enlargement of the vaginal mass and mild vaginal bleeding. 16 hours after hospitalization, a mass measuring 14 × 10 × 4 cm was spontaneously expelled from the vagina. Histopathological examination of the mass confirmed a diagnosis of Mullerian adenosarcoma. On May 10, 2017, the patient underwent hysteroscopic resection of a cervical lesion and partial cervical resection. After nearly 7 years of follow-up, the tumor has not recurred. CONCLUSIONS: Mullerian adenosarcoma of the cervix is difficult to diagnose in adolescents. For young women affected by low-risk early-stage Mullerian adenosarcoma of the cervix, fertility preserving treatment using hysteroscopic resection with robust follow-up is a reasonable management option.

Rate of preterm delivery and latency period in asymptomatic patients undergoing cerclage for very short cervix ≤10.0 mm.

AIM: To estimate the rate of preterm delivery (PTD) and mean latency period to delivery in asymptomatic women with no history of preterm delivery and cervical length (CL) ≤10.0 mm undergoing or not cerclage and who were not treated with vaginal progesterone. METHODS: Retrospective analysis of asymptomatic patients with singleton pregnancies and no history of preterm delivery, with an incidental finding of a CL ≤10.0 mm measured with transvaginal ultrasound during the mid-trimester scan, 56 of them (63.6%) underwent cerclage placement and 32 (36.4%) did not, none of them received vaginal progesterone. Those with evidence of advanced dilation, prolapsing, membranes, ruptured membranes, or positive signs of infection were not candidates for cerclage placement were excluded from the analysis. Differences in the prevalence of preterm birth, mean gestational age at delivery, and mean latency from very short cervix identification to delivery between the two groups were calculated. Associations between cerclage and preterm delivery adjusted for maternal characteristics and fetal weight, were estimated. RESULTS: Median (range) gestational age at time of CL measurement in the cerclage group was (weeks/days) 20w6d (17w5d-23w3d) vs. 21w5d (17w6d-23w6d) in the no-cerclage group (p=0.02). No differences in CL were observed between those who had a cerclage (5.9 mm (SD 3.1 mm)) vs. those who did not (6.5 mm (SD 3.2 mm); p=0.4). The prevalence of preterm delivery (PTD) in women with cerclage vs. women without cerclage was: PTD <37 weeks 31/56 (55.3%) vs. 28/32 (87.5%); adjusted (a) OR 0.17 (95% CI; 0.05-0.62 p=0.008); PTD ≤34 weeks 27/56 (48.2%) vs. 24/32 (75.0%); aOR 0.16 (95% CI 0.05-0.55; p=0.02); PTD ≤28 weeks 19/56 (33.9%) vs. 22/32 (68.7%); aOR 0.15 (95% CI 0.05-0.51; p=0.002). The mean (range) gestational age at delivery was 32w6d (19w1d-40w1d) for the cerclage group, and 28w1d (20w1d-40w2d) for the no-cerclage group (p =0.001). The median (range) latency from the time of CL measurement to delivery in the cerclage group was 84 (8-144) vs. 43 (1-146) days in the no-cerclage group (p=0.003). CONCLUSION: Among low-risk asymptomatic women with a very short cervix (≤10.0 mm) in the midtrimester scan, those treated with cerclage have increased latency to delivery and lower prevalence of preterm birth as compared to expectant management.

[High-grade lesions probability in ASCUS HPV positive patient according to HPV type]. / Probabilité diagnostique d'une lésion de haut grade chez les patientes ASCUS HPV positif en fonction du typage HPV.

OBJECTIVES: The aim of our study was to assess the proportion of high-grade histological lesions, according to HPV type, in patients referred for colposcopy involving a positive HPV-HR test and ASC-US cytology. METHODS: This is a retrospective descriptive study of asymptomatic patients aged 25 to 65 with a positive HPV-HR test and ASC-US cytology. Data were collected at the Nord Franche-Comté Hospital from September 2019 to February 2022. The primary outcome was the proportion of high-grade histological lesions in patients with ASC-US cytology combined to HPV 16 or 18 (associated or not with other HPV type), compared with HPV no 16 no 18. RESULTS: Among the 298 patients included, 67% were HPV no 16 no 18, 22% HPV 16 associated or not with others and 11% HPV 18 associated or not with others. We found significantly fewer high-grade lesions in patients with ASC-US cytology and HPV no 16 no 18 than in patients with HPV 16 or 18 (8.5% versus 22.7%, P<0.01). In patients presenting an ASC-US cytology with HPV no 16, no 18: 53% of the biopsies found no histological lesion compared with 30% for the other HPVs (P<0.01). CONCLUSIONS: We have highlighted the reality of colposcopists: a high ratio of normal coloscopy associated with normal or low-grade biopsies, in patients with a positive HPV-HR test no 16, no 18 and ASC-US cytology.

Self-Screening for Cervical Cancer Offered through a Digital Platform in a Region of British Columbia with Lower Screening Rates.

Cervical cancer is highly preventable through vaccination, early detection, and treatment, yet is the fourth most common cancer globally. HPV testing is superior to cytology for the detection of cervical pre-cancer, and jurisdictions around the world are implementing HPV primary screening, which offers the opportunity for self-screening, an important self-care intervention. Digital health solutions are also increasingly important components of self-care. In this study, we assessed the acceptability and completion of self-screening for cervical cancer offered through a digital platform within a low screening uptake region of British Columbia. The primary objective of this study was to evaluate the acceptability of self-screening for cervical cancer offered through a digital platform as measured by return rates of self-screening kits. Patients due or overdue for cervix screening were invited to participate. Eligible participants registered online to receive a self-screening kit, which included a device for vaginal self-screening, instructions, and a return envelope, sent to their home. After self-screening using the vaginal device, HPV testing was conducted. HPV-negative participants were returned to routine screening, and HPV-positive participants were recommended for cytology or colposcopy. Attendance rates at follow-up were evaluated. Participants were invited to complete an acceptability survey. From April 2019 to December 2023, 283 participants were sent kits, with 207 kits returned for a completion rate of 73%. Of valid samples (n = 202), 15 were HPV positive, and 93% attended follow-up care. Most respondents found the CervixCheck website easy to use, informative, and secure and were satisfied with receiving their results online. CervixCheck had a high completion rate among participants who were sent a self-screening kit. High compliance with recommended follow-up and high acceptability of self-screening for cervical cancer was observed. Most participants indicated they would self-screen again in the future. Innovative approaches to cervical screening, including self-screening and the use of digital health interventions, are ways to enhance equity and improve uptake of cervical screening.

Digital and analog techniques for cemento-enamel junction reconstruction: A case study.

BACKGROUND: Non-carious cervical lesions (NCCLs) refer to the loss of dental hard tissue in the cervical region due to physical and/or chemical factors, often associated with the disappearance of the cemento-enamel junction (CEJ), posing challenges in both diagnosis and treatment of gingival recessions (GR). This case study introduces two protocols for multidisciplinary CEJ reconstruction prior to the root coverage therapy (RCT). METHODS: Two patients with GR and NCCLs were treated using two CEJ reconstruction techniques: both, analogically and digitally guided. For each case, the position of the therapeutic CEJ was predetermined using a combination of the methods described by Zucchelli and Cairo. Then, an analog or digital diagnostic wax-up was performed accordingly. In the analogically guided technique, a transparent silicone guide matrix was used to transfer information from the dental wax-up. In contrast, the digitally guided technique employed a rigid, translucent resin prosthetic guide matrix that was designed and printed. Restorations were fabricated using direct composite resin and RCT was performed 1 week later in both techniques. RESULTS: At 6 months, both cases demonstrated complete root coverage and effective healing of the soft tissues surrounding the restorations. CONCLUSIONS: Dimensional changes in materials and precise guide adjustment in the analog technique are operator-dependent and can affect the outcomes. Digital procedures, though effective, are costly and may limit their use. The usage of these two CEJ reconstruction techniques enhances communication within the multidisciplinary team and ensures optimal aesthetic outcomes and precise placement of the gingival margin. KEY POINTS: There are no established clinical protocols described in the literature for reconstructing the cemento-enamel junction (CEJ) once the position of a therapeutic CEJ has been predetermined and prior root coverage therapy (RCT). Performing a diagnostic wax-up (analogically or digitally) to reconstruct the therapeutic CEJ is crucial and facilitates the creation of a prosthetic guide that accurately reproduces the defined CEJ position. The reconstruction of the CEJ may improve the prognosis of RCT. PLAIN LANGUAGE SUMMARY: This study looked at a dental issue called non-carious cervical lesions, which happens when the hard tissue near the gum line of a tooth wears away, making it harder to treat gum recession. Two different approaches were tested to rebuild the lost tissue in the gum area before performing a procedure to cover the exposed roots. One approach used traditional methods with physical guides to help place the new tissue, while the other used advanced digital techniques to create a precise guide using 3D printing. After 6 months, both methods successfully covered the exposed roots and helped the gums heal properly. However, the traditional method's results can vary depending on the dentist's skill, while the digital method, although more accurate, can be expensive. Using these methods can improve teamwork among dental specialists and lead to better-looking results by ensuring the gum line is placed exactly where it should be.