scholarly journals Risk Factors of Residual Lesions in Cervical High-Grade Intraepithelial Lesion After LEEP in Perimenopausal and Postmenopausal Women

2021 ◽  
Author(s):  
Zhuyun Ding ◽  
Lijuan Xu ◽  
Luting Chen ◽  
Haili Chai ◽  
Yan Jin ◽  
...  
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Postmenopausal Women ◽  
Margin Status ◽  
High Grade ◽  
Residual Rate ◽  
Significant Difference ◽  
Intraepithelial Lesion ◽  
Residual Lesions ◽  
P16 Expression

Abstract Purpose To investigate the risk factors of residual lesions in cervical high-grade squamous intraepithelial lesion (HSIL) after loop electrosurgical excision procedure (LEEP). Methods A total of 88 patients, including 38 perimenopausal patients and 50 postmenopausal patients, who were diagnosed with cervical HSIL after LEEP in Shanghai Jiaotong University affiliated Songjiang Hospital from May 2016 to May 2021 and then underwent hysterectomy within 3 months were collected. The patients' age, hrHPV typing, liquid-based thin-layer cytology (TCT), cervical biopsy P16 expression under colposcopy, endocervical curettage(ECC) during LEEP , margin status of LEEP and whole uterine pathology were reviewed and the risk factors of residual lesions after LEEP in HSIL patients were analyzed statistically with t test,χ2 test or logistic regression analysis. Results Among the 88 patients, there was no statistical difference in the residual rate between perimenopausal and postmenopausal women (P > 0.05). There were no statistically significant differences in age, hrHPV typing, TCT, P16 expression, and LEEP margin between with and without residue group (P >0.05), but there was statistically significant difference in ECC (P < 0.01). In perimenopausal group, there were no statistically significant differences in all the factors (P >0.05) except ECC (P < 0.01) between with and without residue group. While in postmenopausal group, all the factors were not statistically different(P >0.05) except margin status (P < 0.01).After multivariate, positive endocervical curettage was a risk factor of the residual lesionsin perimenopausal group after LEEP ( P < 0.01), and positive LEEP margin was one for postmenopausal patients (P < 0.05). Conclusions Positive ECC is a risk factor of residual lesions in perimenopausal women with HSIL after LEEP. Positive LEEP margin was a risk factor for the residual lesions in postmenopausal patients.

Necessity for subsequent surgery in women of child-bearing age with positive margins after cold knife conization: A retrospective cohort study

2021 ◽  
Author(s):  
Xinmei Wang ◽  
Juan Xu ◽  
Yang Gao ◽  
Pengpeng Qu
Keyword(s):  
Risk Factors ◽  
High Risk ◽  
High Grade ◽  
Transformation Zone ◽  
Positive Margins ◽  
Child Bearing ◽  
Significant Difference ◽  
Cold Knife ◽  
Cold Knife Conization ◽  
Residual Lesions

Abstract Background: Risk factors for positive margins and residual lesions after cold knife conization (CKC) for high-grade cervical intraepithelial neoplasias (CIN) were assessed in women of child-bearing age. A design for postoperative management and avoiding these situations is offered.Methods: This was a retrospective study on 1,309 premenopausal women with high-grade CIN (including CIN3 and CIN2) based on a cervical biopsy under colposcopy used to diagnose a positive or negative margin. Age, gravidity, parity, HPV species, cytology, transformation zone type, results of endocervical curettage (ECC), quadrant involvement, glandular involvement, and CIN grade were analyzed. Among those with positive margins, 245 underwent surgery within three months, including CKC, a loop electrosurgical excision procedure, and total hysterectomy. Residual lesions were also assessed.Results: There was no significant difference in age, gravidity, parity, glandular involvement, and CIN grade between the two groups (P>0.3). There was a significant difference in HPV species, cytology, ECC results, and quadrant involvement (P<0.002). Multivariate analysis showed a major cytology abnormality, high-risk HPV infection, type III transformation zone, positive ECC result, and multiple quadrant involvement were independent risk factors for positive margins and residual lesions (P<0.02). Age >35 years was also a risk factor (P<0.03).Conclusion: High-risk women should be treated appropriately considering fertility. Patients with positive margins should be managed uniquely. Surgery for women without fertility may be appropriate. Close follow-up is necessary for women who have fertility requirements or are unwilling to undergo subsequent surgery if they have no risk factors, especially for women <35 years.

scholarly journals Necessity for subsequent surgery in women of child-bearing age with positive margins after conization

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Xinmei Wang ◽  
Juan Xu ◽  
Yang Gao ◽  
Pengpeng Qu
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
High Risk ◽  
Infection Type ◽  
Hpv Infection ◽  
Transformation Zone ◽  
Positive Margins ◽  
Child Bearing ◽  
Significant Difference ◽  
Residual Lesions

Abstract Background 20–25% of women with high-grade cervical intraepithelial neoplasias (HSIL) have residual lesions after conization. The state of the margin is generally considered to be a risk factor for recurrence or persistent lesions. Predictors of positive margins and residual lesions need to be identified. A design for postoperative management and avoidance of overtreatment needs to be provided, especially for women of child-bearing age. Methods This study was a retrospective analysis of 1309 women of child-bearing age with HSIL, who underwent cold knife conization (CKC). Age, gravidity, parity, human papillomavirus (HPV) species, cytology, transformation zone type, results of endocervical curettage (ECC), quadrant involvement, glandular involvement, and Cervical Intraepithelial Neoplasia (CIN) grade were analyzed. Among those with positive margins, 245 patients underwent secondary surgery within three months, including CKC, a loop electrosurgical excision procedure, and total hysterectomy. Risk factors for positive margins and residual lesions were assessed. Results There was no significant difference in age, gravidity, parity, glandular involvement, and CIN grade between the two groups (P > 0.3). There was a significant difference in HPV species, cytology, ECC results, and quadrant involvement (P < 0.002). Multivariate analysis showed a major cytology abnormality, high-risk HPV infection, type III transformation zone, positive ECC result, and multiple quadrant involvement were independent risk factors for positive margins and residual lesions (P < 0.02). Age > 35 years was also a risk factor for residual lesions (P < 0.03). Conclusion High-risk women should be treated appropriately considering fertility. Patients with positive margins should be managed uniquely. Surgery for women without fertility may be appropriate. Close follow-up is necessary for women who have fertility requirements or are unwilling to undergo subsequent surgery if they have no risk factors, especially women < 35 years.

scholarly journals Postoperative Pneumocephalus on Computed Tomography Might Predict Post-Corpus Callosotomy Chemical Meningitis

2021 ◽  
Vol 11 (5) ◽  
pp. 638
Author(s):  
Ayataka Fujimoto ◽  
Keisuke Hatano ◽  
Toshiki Nozaki ◽  
Keishiro Sato ◽  
Hideo Enoki ◽  
...  
Keyword(s):  
Risk Factors ◽  
Computed Tomography ◽  
Risk Factor ◽  
Intractable Epilepsy ◽  
Epileptic Seizures ◽  
Computed Tomography Scan ◽  
Corpus Callosotomy ◽  
Significant Difference ◽  
Chemical Meningitis ◽  
Tomography Scan

Background: A corpus callosotomy (CC) is a procedure in which the corpus callosum, the largest collection of commissural fibers in the brain, is disconnected to treat epileptic seizures. The occurrence of chemical meningitis has been reported in association with this procedure. We hypothesized that intraventricular pneumocephalus after CC surgery represents a risk factor for postoperative chemical meningitis. The purpose of this study was to analyze the potential risk factors for postoperative chemical meningitis in patients with medically intractable epilepsy who underwent a CC. Methods: Among the patients who underwent an anterior/total CC for medically intractable epilepsy between January 2009 and March 2021, participants were comprised of those who underwent a computed tomography scan on postoperative day 0. We statistically compared the groups with (c-Group) or without chemical meningitis (nc-Group) to determine the risk factors. Results: Of the 80 patients who underwent a CC, 65 patients (25 females and 40 males) met the inclusion criteria. Their age at the time of their CC procedure was 0–57 years. The c-Group (17%) was comprised of seven females and four males (age at the time of their CC procedure, 1–43 years), and the nc-Group (83%) was comprised of 18 females and 36 males (age at the time of their CC procedure, 0–57 years). Mann–Whitney U-tests (p = 0.002) and univariate logistic regression analysis (p = 0.001) showed a significant difference in pneumocephalus between the groups. Conclusion: Postoperative pneumocephalus identified on a computed tomography scan is a risk factor for post-CC chemical meningitis.

Interobserver Variability in Subclassification of Squamous Intraepithelial Lesions

1999 ◽  
Vol 123 (11) ◽  
pp. 1079-1084 ◽  
Author(s):  
Sherry L. Woodhouse ◽  
Janet F. Stastny ◽  
Patricia E. Styer ◽  
Mary Kennedy ◽  
Amy H. Praestgaard ◽  
...  
Keyword(s):  
Interlaboratory Comparison ◽  
Interobserver Variability ◽  
High Grade ◽  
Test Results ◽  
Squamous Intraepithelial Lesions ◽  
Papanicolaou Test ◽  
Management Guidelines ◽  
Significant Difference ◽  
Intraepithelial Lesion ◽  
Intraepithelial Lesions

Abstract Objective.—To determine whether, on a national cytology proficiency test, a competent cytologist can consistently distinguish grades of squamous intraepithelial lesions. Design.—Results for low- and high-grade squamous intraepithelial lesion referenced slides from the College of American Pathologists Interlaboratory Comparison Program in Cervicovaginal Cytology for 1996 and 1997 were analyzed including educational, nongraded vs graded validated slides. Results.—The discrepant rate between low- and high- grade lesions ranged from 9.8% to 15% for cytotechnologist, pathologist, laboratory, and all responses. There was a statistically significant difference in performance on graded, validated slides vs educational slides with better performance on validated slides. Conclusion.—This significant interobserver variability in subclassification of squamous lesions should be considered in management guidelines for abnormal Papanicolaou test results and implementation of national cytology proficiency testing.

scholarly journals Low-Grade Squamous Intraepithelial Lesion or High-Grade Squamous Intraepithelial Lesion? Concordance Between the Interpretation of Low-Grade Squamous Intraepithelial Lesion and High-Grade Squamous Intraepithelial Lesion in Papanicolaou Tests: Results From the College of American Pathologists PAP Education Program

2018 ◽  
Vol 143 (1) ◽  
pp. 81-85 ◽  
Author(s):  
Barbara A. Crothers ◽  
Mohiedean Ghofrani ◽  
Chengquan Zhao ◽  
Leslie G. Dodd ◽  
Kelly Goodrich ◽  
...  
Keyword(s):  
Education Program ◽  
Repeated Measures ◽  
False Negative ◽  
Misclassification Rate ◽  
Low Grade ◽  
High Grade ◽  
Squamous Intraepithelial Lesion ◽  
Significant Difference ◽  
Intraepithelial Lesion ◽  
Diagnostic Concordance

Context.— Obtaining diagnostic concordance for squamous intraepithelial lesions in cytology can be challenging. Objective.— To determine diagnostic concordance for biopsy-proven low-grade squamous intraepithelial lesion (LSIL) and high-grade squamous intraepithelial lesion (HSIL) Papanicolaou test slides in the College of American Pathologists PAP Education program. Design.— We analyzed 121 059 responses from 4251 LSIL and HSIL slides for the interval 2004 to 2013 using a nonlinear mixed-model fit for reference diagnosis, preparation type, and participant type. We evaluated interactions between the reference diagnosis and the other 2 factors in addition to a repeated-measures component to adjust for slide-specific performance. Results.— There was a statistically significant difference between misclassification of LSIL (2.4%; 1384 of 57 664) and HSIL (4.4%; 2762 of 63 395). There was no performance difference between pathologists and cytotechnologists for LSIL, but cytotechnologists had a significantly higher HSIL misclassification rate than pathologists (5.5%; 1437 of 27 534 versus 4.0%; 1032 of 25 630; P = .01), and both were more likely to misrepresent HSIL as LSIL (P &lt; .001) than the reverse. ThinPrep LSIL slides were more likely to be misclassified as HSIL (2.4%; 920 of 38 582) than SurePath LSIL slides (1.5%; 198 of 13 196), but conventional slides were the most likely to be misclassified in both categories (4.5%; 266 of 5886 for LSIL, and 6.5%; 573 of 8825 for HSIL). Conclusions.— More participants undercalled HSIL as LSIL (false-negative) than overcalled LSIL as HSIL (false-positive) in the PAP Education program, with conventional slides more likely to be misclassified than ThinPrep or SurePath slides. Pathologists and cytotechnologists classify LSIL equally well, but cytotechnologists are significantly more likely to undercall HSIL as LSIL than are pathologists.

Outcomes for and Risk Factors Associated With Vancomycin-ResistantEnterococcus faecalisand Vancomycin-ResistantEnterococcus faeciumBacteremia in Cancer Patients

2007 ◽  
Vol 28 (9) ◽  
pp. 1054-1059 ◽  
Author(s):  
G. Ghanem ◽  
R. Hachem ◽  
Y. Jiang ◽  
R. F. Chemaly ◽  
I. Raad
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Mortality Rate ◽  
Cancer Patients ◽  
Independent Risk Factor ◽  
Response To Therapy ◽  
Aminoglycoside Therapy ◽  
Significant Difference ◽  
Vancomycin Resistant ◽  
And Control

Objective.Vancomycin-resistant enterococci (VRE) are a major cause of nosocomial infection. We sought to compare vancomycin-resistant (VR)Enterococcus faecalisbacteremia and VREnterococcus faeciumbacteremia in cancer patients with respect to risk factors, clinical presentation, microbiological characteristics, antimicrobial therapy, and outcomes.Methods.We identified 210 cancer patients with VRE bacteremia who had been treated between January 1996 and December 2004; 16 of these 210 had VRE. faecalisbacteremia and were matched with 32 patients with VRE. faeciumbacteremia and 32 control patients. A retrospective review of medical records was conducted.Results.Logistic regression analysis showed that, compared with VRE. faecalisbacteremia, VRE. faeciumbacteremia was associated with a worse clinical response to therapy (odds ratio [OR], 0.3 [95% confidence interval (CI), 0.07-0.98];P= .046) and a higher overall mortality rate (OR, 8.3 [95% CI, 1.9-35.3];P= .004), but the VRE-related mortality rate did not show a statistically significant difference (OR, 6.8 [95% CI, 0.7-61.8];P= .09). Compared with control patients, patients with VRE. faecalisbacteremia were more likely to have received an aminoglycoside in the 30 days before the onset of bacteremia (OR, 5.8 [95% CI, 1.2-27.6];P= .03), whereas patients with VRE. faeciumbacteremia were more likely to have received a carbapenem in the 30 days before the onset of bacteremia (OR, 11.7 [95% CI, 3.6-38.6];P<.001). In a multivariate model that compared patients with VRE. faeciumbacteremia and control patients, predictors of mortality included acute renal failure on presentation (OR, 15.1 [95% CI, 2.3-99.2];P= .004) and VRE. faeciumbacteremia (OR, 11 [95% CI, 2.7-45.1];P<.001). No difference in outcomes was found between patients with VRE. faecalisbacteremia and control patients.Conclusions.VRE. faeciumbacteremia in cancer patients was associated with a poorer outcome than was VRE. faecalisbacteremia. Recent receipt of carbapenem therapy was an independent risk factor for VRE. faeciumbacteremia, and recent receipt of aminoglycoside therapy was independent risk factor forE. faecalisbacteremia.

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