Prevalence of high-grade cervical lesion in women with LSIL and HSIL cytology and prevalence of invasive cancer in women cytologically positive for malignancy.

AIM: To determine the prevalence of high-grade cervical lesion (CIN 2 or worse, CIN 2+) and the prevalence of invasive cancers in women with LSIL, HSIL and positive for malignancy on cytology, respectively. METHODS: A retrospective study of patients undergoing colposcopy in Rajavithi hospital between 2003-2004 was performed. The final diagnosis was based on colposcopy and histology. RESULTS: Among 250 women with LSIL and 152 women with HSIL, 28 (11.2%) and 112 (75.7%), respectively, had histology-confirmed high-grade cervical lesions. Invasive cancer was diagnosed in 12 (7.9%) of women with HSIL but in none of the LSIL cases. Among 19 women with positive smears for malignancy, only 7 ( 36.8 %) had histology-confirmed invasive cancer. CONCLUSION: The present study confirms that women with HSIL have high prevalence of high-grade cervical lesions and malignancy. Women with LSIL may be managed less aggressively because of the negligible risk of more advanced lesions. Smears positive for malignancy are inconsistent predictors of invasive cancer.

Treatment failure following large loop excision of the transformation zone for the treatment of cervical intraepithelial neoplasia at Rajavithi Hospital.

OBJECTIVE: To evaluate the treatment failure rate of large loop excision of the transformation zone (LLETZ) in the treatment of cervical intraepithelial neoplasia (CIN) and the risk of persistence or recurrence depending on the clinicopathologic factors. MATERIAL AND METHOD: Retrospective case-record review of 250 women who had a final diagnosis of CIN and underwent LLETZ in Rajavithi Hospitalfrom June 1st, 1998 to December 31st, 2003. Computerized files of these patients were then reviewed for clinicopathological follow-up results. RESULTS: Success rate of 86.8% was obtained. The incidence of treatment failure was 13.2%. The clinicopathologic factor associated with the persistence or recurrence was the presence of CIN at the margin of excision. Of 69 cases with incomplete excision (positive margin), treatment failure developed in 29.0%, compared to 5.2% in patients with complete excision (negative margins) (p < 0.001). Using multivariate analysis, incomplete excision and endocervical margin involvement of specimen were independent risk factors for the treatment failure of CIN. CONCLUSION: LLETZ is an effective treatment for CIN. Treatment failure rate is low. Positive surgical margin is a predictor of persistence or recurrence after LLETZ. Incomplete excision and endocervical margin involvement of specimen are significant independent risk factors.

Screening of cervical neoplasia by using pap smear with speculoscopy compared with pap smear alone.

OBJECTIVE: The objective was to compare the sensitivity and specificity of Pap smear plus speculoscopy with Pap smear alone. MATERIAL AND METHOD: The study was conducted in the Gynecology Clinic, Rajavithi hospital, Thailand between February 1st and July 31st 2003. Women who made a request for cervical screening underwent a Pap smear, speculoscopy and colposcopy. Colposcopically directed biopsies were obtained from women who had a positive colposcopy. Analytical methods were applied. RESULTS: Of 257 women recruited to the study, Pap smear plus speculoscopy could increase sensitivity from 6.67% with Pap smear alone and to 33.33% when Pap smear plus speculoscopy is used. The false negative rate was reduced from 93.33% with Pap alone and to 66.67% with Pap smear plus speculoscopy. In using Pap smear alone compared with combination of two tests, the specificity decreased from 97.52% to 77.68% and false positive rate increased from 2.48% to 22.31%, respectively. CONCLUSION: Adding speculoscopy to the Pap smear is able to significantly increase the sensitivity of the cervical screening. It also reduces the 'false negative" result. However, as expected, the specificity slightly decreases, due to the false positive from speculoscopy itself. One solution is to defer colposcopy for 6 months and to perform colposcopy only if either Pap smear or speculoscopy is positive.