Is large loop excision of the transformation zone depth a risk factor for affected endocervical margins?

OBJECTIVE: The aim of the study was to determine if the depth of large loop excision of the transformation zone (LLETZ) is a risk factor for presenting affected endocervical margins. METHODS: A cross-sectional retrospective study was performed on 353 patients that underwent LLETZ after presenting cervical biopsies with CIN grade 2 and grade 3 or persistent CIN grade 1 at Hospital Universitario Santa Lucía, Cartagena, Spain, from November 2011 to December 2016. Automatized measurement of the LLETZ depth was performed in microns and added to cervical canal extensions when these were performed. Other variables studied in positive endocervical margins were age (under or over 35 years), premenopause/postmenopause, number of affected quadrants, CIN grading, the presence of HPV 16 before LLETZ, parity (nulliparous vs multiparous) and the location where the LLETZ was performed (operating room vs consultation room). RESULTS: Our multivariant analysis showed that LLETZ depth ≤ 10 mm did not increase the risk in affected endocervical margins (P = 0.366) and no statistically significant difference between the two groups (affected and nonaffected margins) was found. CIN grading and parity did prove a statistically significant association (P = 0.039 and P = 0.011, respectively). Age, menopause, number of affected quadrants, HPV 16 and the location did not show statistical association with positive endocervix margins. CONCLUSIONS: LLETZ depth equal to or lower than 10 mm was not proven to be a risk factor to have affected endocervical margins after the treatment. Therefore, higher LLETZ depth would not be justified to ensure oncological results.

Prevalence of human papillomavirus in the saliva of sexually active women with cervical intraepithelial neoplasias

BACKGROUND: The main objective of this study was to estimate the prevalence of human papillomavirus-DNA (HPV-DNA) in the saliva of sexually active women with HPV-related cervical intraepithelial neoplasias (CIN) and compare the findings with a healthy control group. The secondary objectives were: 1) to determine the concordance between genital and oral HPV types in sexually active women with HPV-related CIN; 2) to analyze whether sexual habits influence the presence of HPV-related CIN; 3) to determine whether sexual habits influence the presence of oral HPV. MATERIAL AND METHODS: Saliva samples were collected from 100 sexually active women, 50 with HPV-related CIN and 50 healthy subjects presenting normal cytology. PCR assay was used to detect HPV-DNA. RESULTS: The prevalence of oral HPV infection in saliva samples was 14% in women with HPV-related CIN, while in the healthy group it was 12%, without statistically significant difference (p = 0.766). As for the concordance between genital and oral HPV types in women with HPV-related CIN, concordance was only observed for HPV-16, whereby among 22 women with genital HPV-16, only one (4.54%) also presented oral HPV-16. Regarding the possible influence of sexual habits on the presence of cervical pathology and presence of oral HPV, it was found that marital status, age at first intercourse, number of lifetime sexual partners, and condom use are related with the presence of cervical pathology (p < 0.001; p = 0.017; p = 0.002; and p < 0.001, respectively); condom use was also found to be related to the presence of oral HPV (p < 0.001). CONCLUSIONS: The prevalence of HPV-DNA in the saliva of sexually active women with HPV-related CIN is similar to healthy women. The concordance between genital and oral HPV types is low. Both the presence of cervical pathology and the presence of oral HPV are related to sexual habits. Wider sample size is required to confirm this results

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Does the trend toward less deep excisions in LLETZ to minimize obstetric risk lead to less favorable oncological outcomes?

OBJECTIVE: To analyze the relationship between large loop excision of the transformation zone (LLETZ) depth and the persistence of disease and human papillomavirus (HPV) infection in patients with cervical intraepithelial neoplasia grades 2 and 3. METHODS: A cross-sectional observational retrospective study included women with cervical intraepithelial neoplasia grades 2 and 3 who underwent LLETZ at Hospital Universitario Santa Lucía, Cartagena, Spain, from November 1, 2011, to December 31, 2016. Follow-up of cytology and HPV detection were performed at 6 and 12-18 months after surgery. RESULTS: In this study of 256 women, multivariate analysis revealed that conization depth of 10 mm or less did not indicate an increase of persistence/recurrence of pathological cytology at 6 months (P=0.094) and after 12-18 months (P=0.234), or infection by HPV at 6 months (P=0.675) and 12-18 months (P=0.938) after LLETZ. The affected endocervical margin at 6 months is the sole independent risk factor for persistence, both in the lesion (P=0.003) and HPV (P=0.004). CONCLUSION: Conization depth lower than 10 mm at LLETZ did not increase disease persistence or infection by HPV in an 18 month monitoring period. Therefore, higher depth conizations would not be justified to ensure favorable oncological results.

Evaluation of machine learning methods with Fourier Transform features for classifying ovarian tumors based on ultrasound images.

INTRODUCTION: Ovarian tumors are the most common diagnostic challenge for gynecologists and ultrasound examination has become the main technique for assessment of ovarian pathology and for preoperative distinction between malignant and benign ovarian tumors. However, ultrasonography is highly examiner-dependent and there may be an important variability between two different specialists when examining the same case. The objective of this work is the evaluation of different well-known Machine Learning (ML) systems to perform the automatic categorization of ovarian tumors from ultrasound images. METHODS: We have used a real patient database whose input features have been extracted from 348 images, from the IOTA tumor images database, holding together with the class labels of the images. For each patient case and ultrasound image, its input features have been previously extracted using Fourier descriptors computed on the Region Of Interest (ROI). Then, four ML techniques are considered for performing the classification stage: K-Nearest Neighbors (KNN), Linear Discriminant (LD), Support Vector Machine (SVM) and Extreme Learning Machine (ELM). RESULTS: According to our obtained results, the KNN classifier provides inaccurate predictions (less than 60% of accuracy) independently of the size of the local approximation, whereas the classifiers based on LD, SVM and ELM are robust in this biomedical classification (more than 85% of accuracy). CONCLUSIONS: ML methods can be efficiently used for developing the classification stage in computer-aided diagnosis systems of ovarian tumor from ultrasound images. These approaches are able to provide automatic classification with a high rate of accuracy. Future work should aim at enhancing the classifier design using ensemble techniques. Another ongoing work is to exploit different kind of features extracted from ultrasound images.

Cutaneous endometriosis: Presentation of 33 cases and literature review.

OBJECTIVE: Cutaneous endometriosis is a rare condition that usually affects the abdominal wall in women with a history of open abdominal surgery. It has a characteristic clinical picture of a mass and pain associated with menstruation. The diagnosis is difficult on being an uncommon and little known condition. Once there is suspicion, a correct anamnesis and examination is usually sufficient. The treatment is normally surgery. STUDY DESIGN: The study included all women identified with a diagnosis of cutaneous endometriosis over a period of 20 years. The variables collected and analysed included, age, surgical history, gynaecology history, symptoms, time period between surgery and consultation, specialist consulted, location, size, tests performed, treatment, and recurrence. RESULTS: A total of 33 women were identified, with a mean age of 35.4 ±â€¯2.33 years. A surgical history was found in 31 (93%) of 33 women. The main symptom was abdominal mass (96%), followed by period pain (51%), and non-period pain (42%). The initial diagnosis was correct in 15 (45%) of 33 women, and after performing further tests it was correct in 23 (69%) of 33 women. The main additional test was fine needle aspiration (FNA) in 24 (72%) of 33 patients. Surgery was performed on 30 (90%) of 33 women, with 8 (24%) women requiring a prosthesis. There was a recurrence of cutaneous endometriosis in 3 (9%) women. CONCLUSION: Although it is a rare disease, its association with gynaecological surgery, and in particular caesarean section, means that there should be more awareness of this condition. Its diagnosis may be complicated due to lack of knowledge, when a proper examination and anamnesis can give us the key.

Fetal MRI as Complementary Study of Congenital Cystic Adenomatoid Malformation During Pregnancy: A Single Case Report.

Fetal lung masses are rare findings in prenatal ultrasound scanning in general population, of which congenital cystic adenomatoid malformation is the most commonly diagnosed type. This paper reports a single case of congenital cystic adenomatoid malformation detected at our hospital and the subsequent clinical follow-up using ultrasound scanning and fetal magnetic resonance imaging.

Síndrome de varicela congénita / Congenital varicella syndrome

Se estima que la transmisión vertical del virus de la varicela ocurre entre un 8 y un 25% de los casos. De estos, solo en un 1-2% de las ocasiones se producirá el síndrome de varicela congénita (SVC), sobre todo si la infección ocurre entre las semanas 12-20 de gestación. La detección del DNA del virus en líquido amniótico, junto con la presencia de marcadores ecográficos de afectación fetal, hacen el diagnóstico altamente probable. Presentamos el caso de una tercigesta que en la semana 14.ª de gestación contrajo varicela, ocurriendo afectación fetal (calcificaciones hepáticas y miocárdicas en ecografía) y muerte del neonato al mes de vida. Actualmente, la inmunización pasiva representa la única estrategia activa para prevenir las graves consecuencias del SVC si una gestante no inmune se expone al VVZ antes de la semana 20 de gestación, ya que, tanto el uso de antivirales como profilaxis o como tratamiento como el uso de inmunoglobulina anti VVZ tras un contacto, no han mostrado resultados concluyentes. Por todo esto, consideramos capital la correcta información a los padres y el adecuado control de este tipo de gestaciones (AU)

Vertical transmission of the varicella virus is estimated to occur in 8% to 25% of cases. Among these, congenital varicella syndrome develops in only 1% or 2% of transmissions, especially if the infection occurs between weeks 12 and 20 of pregnancy. The detection of DNA from the virus in the amniotic fluid, combined with the presence of ultrasonographic markers of fetal involvement, leads to a highly likely diagnosis. We present the case of a gravida 3 who contracted varicella at week 14 of gestation, with fetal involvement (hepatic and myocardial calcifications detected on ultrasonography) and newborn death at 1 month of life. Currently, passive immunization is the only active strategy to prevent the serious consequences of congenital varicella syndrome if a non-immune pregnant woman is exposed to the varicella zoster virus before week 20 of pregnancy, since neither the use of antiviral prophylaxis or treatment, nor the use of anti-varicella zoster virus immunoglobulin have been proved to give significant results. Thus, it is of the utmost importance to provide information to parents and adequate management of this type of pregnancy (AU)