Prevalence of high grade squamous intraepithelial lesions (HSIL) and invasive cervical cancer in patients with atypical squamous cells of undetermined significance (ASCUS) from cervical pap smears.

To determine the prevalence and factors associated with histologic diagnoses of High Grade Squamous Intraepithelial Lesions (HSIL) or invasive cervical cancer in women with a cytologic diagnosis of atypical squamous cells of undertermined significance (ASCUS), medical records of women with an ASCUS Pap smear from January 2003 to December 2006 were reviewed. Of 287 women with ASCUS Pap smears in whom data were available, 189 were annotated with "favoring a premalignant or malignant process", 74 with "favoring reactive", and 24 with "not otherwise specified". The prevalences of HSIL and invasive cervical cancer were 9.1% and 1.2%, respectively. Only subtypes of ASCUS were significantly associated with the detection of HSIL or invasive cancer, 12.7% with favoring premalignant or malignant process, 2.7% with favoring reactive, and 16.7% in with ASCUS-NOS (p=0.034).

Results of laparoscopic pelvic and/or para-aortic lymphadenectomy in gynecologic oncology patients in Bangkok Metropolitan Administration Medical College and Vajira Hospital.

OBJECTIVE: To determine the results of laparoscopic lymphadenectomy in gynecologic oncology patients. MATERIAL AND METHOD: Medical records of 31 gynecologic oncology patients who underwent laparoscopic lymphadenectomy between November 1, 2004 and February 28, 2007 were retrospectively reviewed. RESULTS: The median age of the study population was 47 years (range 24-77 years). Sixteen patients (51.6%) had endometrial cancer while 15 (48.4%) had ovarian malignancy, with median numbers of resected pelvic and paraaortic nodes of 12 (range 3-30 nodes) and 1 (range 1-3 nodes). The groups of lymphadenectomy only, lymphadenectomy with total laparoscopic hysterectomy, and lymphadenectomy with laparoscopic assisted vaginal hysterectomy had median blood losses of 100 ml (range 30-220 ml), 350 ml (range 100-800 ml), and 200 ml (range 150-400 ml) respectively. Accidental injuries of common iliac artery and large bowel occurred in two patients, all of whom were converted to a laparotomy for correcting the damaged sites. Overall, the median duration for postoperative recovery was three days (range 2-8 days). CONCLUSION: The results suggest that surgical staging for gynecologic malignancies can be adequately performed through laparoscopic surgery, with benefit in terms of early postoperative recovery.

Prevalence of high grade squamous intraepithelial lesion (HSIL) and invasive cervical cancer in patients with low grade squamous intraepithelial lesion (LSIL) at cervical pap smear.

OBJECTIVE: To assess the prevalence and factors associated with a histologic diagnosis of high grade squamous intraepithelial lesion (HSIL) and invasive cervical cancer in patients with low grade squamous intraepithelial lesion (LSIL) cervical pap smear findings. METHODS: Medical records (including cytology reports, colposcopic impression, and pathologic results from cervical biopsy, endocervical curetting, cervical conization or hysterectomy) of 226 women with LSIL from conventional cervical pap smears during January 2001 to December 2005, who subsequently underwent colposcopic evaluation at our institution, were reviewed. RESULTS: Mean age of the patients was 39.0 years. The incidences of LSIL, HSIL, microinvasive cervical cancer were 58.8%, 15.0%, 1.3% respectively. No associations were found between age, parity, contraception, anti-HIV or menstrual status and the detection of HSIL/invasive cervical cancer. CONCLUSION: Approximately 16.3 % of LSIL pap smear cases turn out to be HSIL or invasive cervical cancer from histologic diagnosis.

Tumor persistence in high grade squamous intraepithelial lesion patients with positive surgical margin post loop electrosurgical excision procedure.

OBJECTIVE: To determine the rates of persistent and recurrent tumors in patients with High Grade Squamous Intraepithelial Lesion (HSIL) who had positive surgical margin from Loop Electrosurgical Excision Procedure (LEEP). MATERIAL AND METHOD: Clinical and pathological data of all women who underwent LEEP procedures and revealed HSIL lesions with positive surgical margin between July 1997 and December 2004 were recorded. RESULTS: Histologic diagnoses of HSIL with positive surgical margin were found in 95 cases during the study period. Residual diseases were identified at ectocervical margins in 46 cases (48.4%), endocervical margin in 26 cases (27.4%), and both margins in 23 cases (24.2%). Subsequent hysterectomy was performed in 58 cases (61.0%). The remaining 37 cases (38.9%) underwent periodic follow-up with the median follow up period of 11 months (range, 1-74 months). Persistent diseases were identified in 18 of 58 hysterectomized cases but none in 37 follow-up cases. Recurrent disease was identified in only one case in the follow-up group. Overall the rates of persistent and recurrent disease were found in 18.9% and 1.1% respectively. CONCLUSION: In HSIL patients with positive surgical margin from LEEP the rate of persistent disease was 18.9%, while the rate of recurrence was 1.1%.