Study on Preoperative Neutrophil/Lymphocyte (NLR) and Platelet/Lymphocyte Ratio (PLR) as a Predictive Factor in Endometrial Cancer.

OBJECTIVE: To evaluate predictive factors between serum inflammatory markers and malignancy potential of endometrium. METHODS: This retrospective study was conducted at the gynecological oncology unit, department of obstetrics and gynecology, at the faculty of medicine of Thammasat University. The study period was from 2017 to 2020. Endometrial cancer and benign gynecologic disease cases who underwent hysterectomy (with or without adnexectomy) during the study period were recruited. Demographic characteristics, histopathology reports and serum markers were also collected. RESULTS: The study included a study group of 49 participants with endometrial cancer and a control group consisting of 119 cases of benign uterine disease. The study group had statistically significantly higher mean ages, proportional menopausal status and instances of underlying diseases when compared with the control group. Neutrophil/Lymphocyte ratios (NLR) and Platelet/Lymphocyte ratios (PLR) could not meaningfully predict the malignant potential of endometrium in hysterectomy specimens. NLR and PLR were statistically associated with depth of myometrial invasion (MI) in endometrial cancer cases. NLR equal to or greater than 1.93 predicted MI more than half thickness with sensitivity, specificity, accuracy, positive (PPV) and negative predictive value (NPV) at a percentage of 83.3, 52.8, 37.0, 90.5 and 60.4, respectively. PLR equal to or greater than 134.95 predicted MI of greater than fifty percent thickness with sensitivity, specificity, accuracy, PPV and NPV at 75.0, 55.6, 36.0, 87.0 and 60.4 percent, respectively. CONCLUSION: NLR and PLR have positive associations with myometrial invasion of endometrial cancer.

Diagnostic value of endocervical curettage for detecting dysplastic lesions in women with atypical squamous cells of undetermined significance (ASC-US) and low grade squamous intraepithelial lesion (LSIL) Papanicolaou smears.

BACKGROUND: To determine the frequency of dysplastic lesions in the endocervical curettage (ECC) specimens of women with ASC-US and LSIL Pap and to evaluate the possible factors associated with high grade dysplasia in those ECC specimens. MATERIALS AND METHODS: Two hundred and sixty patients with ASC-US and LSIL cytologic smears who underwent an ECC at the time of colposcopic examination during January 2010 and December 2012 were reviewed. Demographic and clinicopathologic data were collected. Multivariate analysis using binary logistic regression was used to identify factors that might be associated with high grade endocervical dysplasia. RESULTS: The frequency of endocervical dysplasia was 7.7% (20 out of 260 patients). Cervical intraepithelial neoplasia (CIN) 1 and CIN 2-3 lesions in the endocervical canal were observed in 12 and 8 patients, respectively. No microinvasive or invasive cervical cancers were identified. There was no difference in the frequency of high grade endocervical dysplasia between the patients with satisfactory and unsatisfactory colposcopic examinations (1.4% vs 5.1%, respectively, p=0.087). A multivariate logistic regression analysis demonstrated a significant association between high grade CIN on ectocervical biopsy as well as LSIL cytologic smears and high grade dysplasia in endocervical canal (OR=0.046, 95%CI=0.007-0.288; p=0.001 and OR=0.154, 95%CI=0.025-0.942; p=0.043, respectively). CONCLUSIONS: The frequency of high grade endocervical dysplasia in women with ASC-US and LSIL cytologic smears was low. Therefore, routine performance of ECC in those women is debatable. High grade ectocervical dysplasia and LSIL cytologic smears may be used as predictors for high grade dysplasia in endocervical canal and ECC in these patients is reasonable.

Cytohistologic discrepancy of high-grade squamous intraepithelial lesions in Papanicolaou smears.

OBJECTIVES: To evaluate the frequency of cytohistologic discrepancy of high-grade squamous intraepithelial lesions (HSILs) in Pap smears and associated factors. METHODS: Medical records of 223 women with HSIL Pap smears who were treated at Thammasat University Hospital were reviewed. Data on age, parity, menopausal status, contraceptive use and colposcopic directed biopsy and loop electrosurgical excision procedure (LEEP) pathology results were recorded. RESULTS: Mean (SD) age of patients was 38.0 (9.4) years. The majority were premenopausal (86.5%) and multiparous (83.9%). Cytohistologic discrepancy between the Pap test and colposcopic-directed biopsy histology was 45.7% and that between the Pap test and LEEP histology was 29.5%. Fifty-four (24.2%) women had no high-grade CIN on both colposcopic directed biopsy and LEEP. Nulliparity, postmenopausal status and having no oral contraceptive pills use were factors associated with cytohistologic discrepancy. CONCLUSION: The exact cytohistologic discrepancy rate was relatively high (24.2%). Factors associated with cytohistologic discrepancy were nulliparity and postmenopausal status and having no oral contraceptive pill use.

Risk factors for high-grade cervical intraepithelial neoplasia in patients with atypical squamous cells of undetermined significance (ASC-US) Papanicolaou smears.

OBJECTIVE: To determine risk factors of high-grade cervical intraepithelial neoplasia (CIN 2-3) among women with atypical squamous cells of undetermined significance (ASC-US) Papanicolaou (Pap) smears. METHODS: Two-hundred and sixty-six women with ASC-US Pap tests who underwent a colposcopy with histologic study were enrolled between August 2008 and June 2010. Patient data including age, education, income, parity, current pills used, number of vaginal deliveries, number of sexual partners, age at first sexual intercourse, history of sexually transmitted diseases, history of pelvic inflammatory disease and smoking habits were obtained. Logistic regression analysis was used to evaluate factors associated with CIN 2-3. RESULTS: CIN was diagnosed in 134 of 266 women (50.4%). Ninty-seven of these (72.4%) had CIN 1 and 37 (27.6%) had CIN 2-3. Frequency of the latter was lower in women who had at least bachelor's degree graduation as compared to those having less than primary school graduation (odds ratio (OR) 0.085, 95% confidence interval (CI) 0.013-0.557). In addition, those with a higher income (5,000-20,000 baht per month) had less frequent CIN 2-3 (OR 0.378, 95% CI 0.147-0.970), whereas women who had 3 or more sexual partners were more likely to develop CIN 2-3 (OR 3.181, 95% CI 1.316-7.687). CONCLUSIONS: Women with ASC-US Pap smears who had 3 or more sexual partners, low education and low income were at an increased risk of CIN 2-3. Therefore, this group of patients deserve a high priority for immediate colposcopy in order for early detection of high-grade CIN.

Effect of intramuscular diclofenac after explore laparotomy for gynecologic surgery: a randomized double-blinded placebo controlled trial.

BACKGROUND: Several adjuvant analgesic agents proposed to treat the postoperative pain while reducing the doses of opioid and its derivatives. Non-steroidal anti-inflammatory drugs (NSAIDs) are widely used in several operative procedures. The present study aimed to demonstrate the morphine-sparing effects of single-dose intramuscular diclofenac sodium in explore laparotomy gynecologic surgery. MATERIAL AND METHOD: Forty-six patients were randomly assigned to receive 75-mg of diclofenac sodium or normal saline with intramuscular morphine during immediate postoperative period. Additional morphine for pain control was given by patient-controlled analgesia. 24-hour morphine consumption, pain score, adverse effects and satisfaction of the patients were recorded. RESULTS: Median morphine consumption among groups was significant difference between placebo and diclofenac group (32 and 19 mg) (p = 0.041). Greater difference was shown in patients who underwent total abdominal hysterectomy (p = 0.009). Catagorical pain score at 6-hour postoperatively was significant lower in diclofenac group (p = 0.006). No significant difference was found between groups in visual analogue pain score, patients' satisfaction, presence of bleeding or nausea and vomiting. CONCLUSION: The present study demonstrated that single dose of diclofenac sodium has morphine-sparing effects and can be safely used in explore laparotomy gynecologic surgery without significant adverse effects.

Cervical cytologic abnormalities of cervical intraepithelial neoplasia 1 treated with cryotherapy and expectant management during the first year follow-up period.

AIM: To determine the frequency of cervical cytologic abnormalities in patients who were diagnosed as having CIN 1 and had undergone either cryotherapy or expectant management. METHODS: A retrospective medical record review of 87 patients with colposcopic cervical biopsy-proven CIN 1, was undertaken including age, parity, menstruation status, cervical cytology reports, colposcopic findings, and cervical cytologic follow-up reports. There were 38 patients (43.7%) treated with cryotherapy and the remainder underwent expectant management. RESULTS: Mean (SD) age of patients treated with cryotherapy was less than that of the patients who had expectant management (36.2 (9.4) vs 41.1 (9.4) years, respectively, p= 0.02). There were no differences in the frequencies of cervical cytologic abnormalities between the groups at 6- and 12-month-follow-up visits (cryotherapy group vs expectant group: 18.4% vs 18.4% at 6-months and 19.2% vs 16.1% at 12 months). CONCLUSION: Cryotherapy and expectant management with cytologic surveillance had comparable frequencies of cytologic abnormalities during a 12-month follow-up period. Expectant management requires adherence to follow up and high quality cytology and colposcopy testing. Therefore, it should be reserved for these settings. Cryotherapy may be more reasonable in women who are likely to be lost to follow up and high quality cytology cannot be guaranteed.