Small lesion size measured by colposcopy may predict absence of cervical intraepithelial neoplasia in a large loop excision of the transformation zone specimen.

OBJECTIVE: To evaluate whether colposcopic measurement of the lesion size at diagnosis and/or human papillomavirus (HPV) genotyping can predict the absence of dysplasia in a large loop excision of the transformation zone (LLETZ) specimen in women treated for squamous intraepithelial lesions/cervical intraepithelial neoplasia (SIL/CIN). DESIGN: Prospective observational study. SETTING: Tertiary university hospital. POPULATION: A cohort of 116 women who underwent LLETZ because of biopsy-proven low-grade SIL/CIN that had persisted for 2 years, or because of a high-grade SIL/CIN diagnosed in the referral visit and squamocolumnar junction completely visible (types 1 or 2, according to the International Federation of Cervical Pathology and Colposcopy, IFCPC). METHODS: After LLETZ the women were classified by histology into the study group (absence of SIL/CIN in the surgical specimen, 28/116, 24.1%) and the control group (SIL/CIN in the LLETZ specimen, 88/116, 75.9%). MAIN OUTCOME MEASURES: The size of the lesion determined in the diagnostic colposcopy and the HPV genotype were evaluated in all women. RESULTS: The lesion size was significantly smaller in the study group (25.7 ± 37.8 versus 84.5 ± 81.7 mm2 ; P < 0.001). A lesion size of ≤12 mm2 and HPV types other than 16 or 18 were associated with an absence of SIL/CIN in the LLETZ specimen (P < 0.001 and P = 0.016, respectively). On multivariate analysis only a lesion size of ≤12 mm2 predicted the absence of SIL/CIN (odds ratio, OR 10.6; 95% confidence interval, 95% CI 3.6-30.6; P < 0.001). A lesion size of ≤12 mm2 had a specificity of 90.9% (95% CI 83.0-95.3%) and a negative predictive value of 86.0% (95% CI 77.5-91.6%) to predict the absence of SIL/CIN in the surgical specimen. CONCLUSIONS: Small lesion size in diagnostic colposcopy could predict the absence of SIL/CIN in the LLETZ specimen. Colposcopy measurement of lesion size prior to LLETZ may avoid unnecessary treatment. TWEETABLE ABSTRACT: Small lesion size in colposcopic evaluation might predict the absence of SIL/CIN in an LLETZ specimen.

Intraoperative post-conisation human papillomavirus testing for early detection of treatment failure in patients with cervical intraepithelial neoplasia: a pilot study.

OBJECTIVE: To evaluate the feasibility and utility of intraoperative post-conisation human papillomavirus (IOP-HPV) testing and cytology to detect treatment failure in patients with cervical intraepithelial neoplasia grades 2-3 (CIN2-3). DESIGN: Prospective observational pilot study. SETTING: Barcelona, Spain. POPULATION: A cohort of 132 women treated for CIN2-3 by loop electrosurgical conisation. METHODS: An endocervical sample was obtained intraoperatively with a cytobrush from the cervix remaining after the conisation. The material was kept in PreservCyt medium and processed for Hybrid Capture 2 and cytology. Patients were followed-up for 24 months. The performance of IOP-HPV testing and IOP cytology was compared with conventional indicators of recurrence (cone margin, endocervical curettage, and HPV testing and cytology at 6 months). MAIN OUTCOME MEASURE: Treatment failure (i.e. recurrent CIN2-3 during follow-up). RESULTS: Treatment failure was identified in 12 women (9.1%). IOP-HPV testing for sensitivity, specificity, and positive and negative predictive values for treatment failure were 91.7, 78.3, 62.2, and 96.0%, respectively, which are similar to the figures for conventional HPV testing at 6 months (91.7, 76.0, 64.0, and 95.1%, respectively), and are better than the values of other conventional predictive factors (cone margin, endocervical curettage, and cytology intraoperative at 6 months). IOP-HPV was strongly associated with treatment failure in the multivariate analysis (OR 15.40, 95% CI 1.58-150.42). CONCLUSION: IOP-HPV testing is feasible, and accurately predicts treatment failure in patients with CIN2-3. This new approach may allow an early identification of patients with treatment failure, thereby facilitating the scheduling of an attenuated follow-up for negative patients who are at very low risk of persistent disease.

Adenocarcinoma de cérvix diagnosticado por histeroscopia / Hysteroscopically-diagnosed cervical adenocarcinoma

Paciente menopáusica de 48 años que ingresa por sospecha de enfermedad inflamatoria pélvica. En la ecografía se observó endometrio engrosado. La citología fue negativa y la biopsia endometrial estableció el diagnóstico de endometritis sin signos de malignidad, con cultivo positivo para Streptococcus pneumoniae. Al mes se realizó una nueva citología que presentó células glandulares de probable origen endometrial, pero sin atipias, y una biopsia endometrial compatible con hiperplasia endometrial compleja. En la histeroscopia se observó una mucosa irregular con vascularización aumentada en el orificio cervical interno. La biopsia fue informada como adenocarcinoma de tipo endocervical, por lo que se realizó intervención de Schauta-Amreich y linfadenectomía pélvica. En la histeroscopia deben biopsiarse o extirparse todas las alteraciones que encontremos

We present the case of a 48-year-old woman who was admitted to hospital with suspected pelvic inflammatory disease. Ultrasound showed a thick endometrium. The results of Pap smear were negative and endometrial biopsy established a diagnosis of endometritis without malignant signs and positive Streptococcus pneumoniae culture. One month later, a further Pap smear revealed glandular cells of probable endometrial origin, but without any atypia, while endometrial biopsy showed findings compatible with complex endometrial hyperplasia. Hysteroscopy revealed an irregular surface with increased vascularization in the internal cervical orifice. Biopsy showed endocervical adenocarcinoma, and a Schauta-Amreich intervention with pelvic lymphadenectomy was performed. All alterations found on hysteroscopy should undergo biopsy or be removed

Pólipos endometriales: riesgo de malignización y correlación clínico-anatómica / Endometrial polyps: risk of malignant transformation and clinico-anatomic correlation

Objetivo: Conocer la incidencia de pólipos endometriales malignos en función del estado hormonal, la presencia o no de hemorragia uterina anormal (HUA), el uso de tamoxifeno (TMX) y de terapia hormonal sustitutiva (THS).Material y métodos: Se analizan 1.822 polipectomías histeroscópicas. Tomaban THS 85 pacientes y TMX, 150.Resultados: Los pólipos de pacientes premenopáusicas presentan más HUA que los de las posmenopáusicas. Se hallaron 16 pólipos histológicamente malignos (0,87 por ciento). De éstos, 14 se extirparon a pacientes posmenopáusicas, 11 de ellas presentaban HUA. Entre pacientes premenopáusicas se resecaron 2 pólipos malignos, uno de ellos era asintomático. No se detectaron pólipos malignos entre pacientes con THS. Se encontraron 4 pólipos malignos entre mujeres con tratamiento con TMX, 2 de ellos eran asintomáticos. Conclusiones: La resección sistemática de los pólipos endometriales permite detectar todos los pólipos malignos, incluso en los casos de pacientes asintomáticas y/o premenopáusicas (AU)