Prediction model for residual high-grade cervical intraepithelial lesions.

BACKGROUND: The aim of the study was to evaluate risk factors associated with high-grade cervical intraepithelial lesions (HSIL) in patients undergoing a second cervical excision procedure due to positive surgical margins and to create a prediction model for residual disease. METHODS: This study included patients with HSIL positive surgical margins following loop electrosurgical excision procedures (LEEP) between March 2015 and August 2019. HSIL in the second cervical excision pathology in these patients was accepted as residual disease. For residual disease prediction, a multivariate logistic regression and stepwise elimination analysis of 14 variables including demographic characteristics, clinical characteristics, pathology results and HPV genotypes of the patients was performed. RESULTS: Second cervical excision procedures were performed in 290 patients 85(29.4%) of these patients had CIN 2 (cervical intraepithelial neoplasia) and 205 (70.6%) had CIN 3. In the second excision procedure, 166 patients (57.2%) had ≤CIN 1, 124 patients (42.8%) had ≥CIN2. The prediction model of residual disease includes only 3 variables out of the 14 different clinical characteristics (AUC=0.605 [0.539-0.671]). These variables are gravida (adjusted OR: 1.15 [0.97-1.38], P=0.107), CIN2-3 presence in the endocervical canal in the first LEEP specimen (adjusted OR: 1.52 [0.94-2.47], P=0.091) and the presence of HR-HPV except 16/18 lesions (adjusted OR: 0.64 [0.38-1.06], P=0.083). CONCLUSIONS: A prediction model was designed with our data, from variables reported to be risk factors for residual disease in previous studies. While this model was statistically significant, it was poor at distinguishing residual disease. A prediction model can be designed to guide clinicians with future studies.

Targeted fetal cell-free DNA screening for aneuploidies in 4,594 pregnancies: Single center study.

BACKGROUND: Next-generation sequencing (NGS) and discovery of fetal cell-free DNA (cfDNA) in the maternal circulation render possible prenatal screening for trisomy 21 (Down syndrome), trisomy 18, trisomy 13, and sex chromosome aneuploidies. The approach is called "fetal cfDNA screening" and in contrast to noninvasive conventional serum screening, it provides the identification of 98%-99% of fetuses with Down syndrome. METHODS: Retrospective analysis of targeted noninvasive prenatal testing (NIPT) (Clarigo Test) pregnancies with moderate risk, which we have reported between 2016 and 2018 years is presented. Two separate laboratory workflows and NGS platforms are used for the same targeted NIPT analysis. RESULTS: In total, 4,594 pregnant women were investigated. Initial 3,594 cases are studied by MiSeq platform, the last 1,000 cases by NextSeq. Failure rate for MiSeq platform is 10.9% and for NextSeq is 8.7%. Automatically reported cases constitute 75% of the MiSeq group and 87% of the NextSeq group. CONCLUSIONS: Targeted NIPT results suggest that MiSeq platform could be used for NIPT which would be an essential option particularly for laboratories with low sample flow. And, the NextSeq platform has easier wet lab process and also increased success rate in automatic reporting which is suitable for centers with high number of NIPT cases.