Accuracy of Cervical Pap Smear / 대한부인종양콜포스코피학회잡지

BACKGROUND: Carcinoma of the uterine cervix is a theoretically preventable disease because its precursor lesions can be detected by cervical Papanicolau smears and appropriately treated, Although cervical cytology screening programmes have resulted in the redution of cervical cancer incidence and mortality, Pap smear have been subjected to intense scrutiny and criticism in recent years. The focus of criticism has been the false-negative Pap smear, and the false-negative Pap smear is the major quality issue currently facing the physicians. To reduce the false-negative rate of Pap smear, it is essential to improve the accuracy of Pap smear. But false-negative rate of Pap smear has been reported variously. OBJECTIVE: This study was undertaken to evaluate accuracy of Pap smear by study false-negative and false-positive rate of Pap smear and to determine whether false-negative and false-positive rate had any correlations with clinical factors. STUDY DESIGN: The study population was comprised of 346 women, who were undertaken gynecologic operation at the Department of Obstetrics & Gynecology at Hanyang University hospital between March, 1997 and April, 1998. All patients were taken Pap smear before operation. In 93 women of these, preoperative diagnosis were cervical intraepithelial neoplasia and carcinoma in situ of uterine cervix, and in 253 women of these, preoperative diagnosis were benign disease as uterine myoma or adenomyosis, etc. All of their surgical specimen were examined. Pap smear, pathology, medical charts of all patients were reviewed retrospectively, and false-negative rate and false-positive rate were calculated. Clinical factors that associated with false-negative and false-positive rate were evaluated. Fishers exact test and Pearson chi-square test were used of statistical analysis, RESULTS: False-negative rate of Pap smear was 7.2%, false-positive rate was 4.6%, corresponding rate with histology was 88.2%. Sensitivity and specificity of PAP smear were 87.0% and 97.0% respctively. According to gross finding of uterine cervix, erosion was 46.6% in cervical intraepithelial neoplasia, 67.8% in carcinoma in situ, 66.6% in microinvasive carcinoma of uterine cervix and 55.3% of 103 erosion findings was cervical intraepithelial neoplasia, carcinoma in situ or microinvasive carcinoma. 23.1% of cervical lesion were normal gross finding. Menopause was associated with false-negative rate and previous vaginal infection history, previous cervical minor operation, delivery mode, contraception method, pelvic inflammatory disease history, vaginal bleeding at Pap smear and gross finding of cerbix were not associated. There were no clinical factors that were associated with false-positive rate. CONCLUSION: Compared with other reports, false-negative rate(7.2%) and false-positive rate(4.6%) of Pap smear was lower and corresponding rate(88.2%) was higher in Hanyand university hospital. Because of higher false-negative rate in menopausal women, it need more careful to take and interpretate Pap smear in these group.

Predictability of the Survival using Prognostic Index (PI) of Patients with Epithelial Ovarian Cancer / 대한부인종양콜포스코피학회잡지

OBJECTIVES: To predict of the survival of patients with epithelial ovarian cancer, multivariable analysis was done to identify variables with independent prognostic factors. Based on materials from 191 clinical trials performed by Department of Obstetrics and Gynecology, Hanyang University Hospital, we constructed a prognostic index (Pp with considerable predictive power for long-term survival of patients with epithelial ovatian cancer treated with cis-platin based combination chemotherapy, METHODS: On identifying variables with independent prognostic value, statistical analysis were performed with clinicopathologic variables including age, FIGO stage, histologic subtype, histologic grade, residual tumor, presence of ascites, pretreatment levels of hemoglobin, platelet, and tumor markers(CA 125, CA 19-9). We also analyzed biological variables using immunohistochemical staining for GST-pie (glutathione-s-transferase-pie), p-glycoprotein, and MT (metallothinein) as a drug resistance and uPA (urokinase type plasminogen activator), PAI-1 (plasminogen activator inhibitor-l), nm23 (nonmetastatic gene 23) as a tumor invasion and metastasis. In addition, univariable analysis was performed followed by multivariable analysis using Coxs proportional hazards model to identify variables predictive of poor prognosis. Prognostic index (PI) was calculated based on sum of individual beta-coefficient of the most important independent prognostic value. RESULTS: With univariable analysis, age, FIGO stage, histologic grade, histologic subtype, presence of ascites, residual tumor, initial value of CA 125, MT, uPA, and PAI-1 were found to predict of patients survival. In the multivariable analysis and proportional hazard model, the pretreatment characteristics needed for the calculation of the PI are the age, the site of metastases expressed as stage, the histologic subtype, the size of residual tumor, the histological grade, and the presence of ascites. In the subgroup comprising the 10% of the patients with the best prognosis, 5-year survival rate was 78.9%, whereas in the subgmup comprising the 10% with the poorest prognosis, 5-year survival rate was 7.1%, which illustrates the large variability of the prognosis among patients. CONCLUSIONS: The PI was found to retain its value after response was achieved. The information provided by the PI can be expected to be useful in treatment planning and the proper stratification of patients in clinical trials.

Prediction of the Diagnosis of Adnexal Masses According to the Ultrasonographic Morphologic Scoring System and Doppler Velocity Wave Form / 대한부인종양콜포스코피학회잡지

OBJECTS: The purpose of this study was to evaluate the relative usefulness of the morphologic scoring system and spectral doppler ultrasonographic analysis in differentiating between benign and malignant adnexal masses. METHODS: All patients scanned between July 1995 and June 1998 with sonographically identified and pathologically confirmed adnexal masses formed the study group. The adnexal masses were scored as benign or malignant on the basis of their sonographic appearance. Specific categories included inner wall structure, wall thickness, septal structure, and echogenicity. Women whose morphologic findings were suspicious for malignancy underwent doppler sonography. A threshold pulsatility index of 1.0 and resistance index of 0.4 were used to differentiate benign from malignant lesions. The findings were correlated with the presence of malignancy. RESULTS: Two hundred fifty one patients formed the study group; 215 patients were benign and 36 patients were malignant pathologically. Using the morphologic scoring system, 31 of the 36 malignant masses were classified as suggestive of malignant tumor, and 147 of the 215 benign masses were classified as not suggestive of malignant tumor (sensitivity, 86%; specificity, 68%; positive predictive value, 31%; negative predictive value, 97%). Doppler velocimetry was performed on a total of 62 patients, 19 patients with malignant tumors and 43 patients with benign tumors. A mean PI value of 0.85 and RI value of 0.52 for malignant tumors and mean PI value of 2.00 and RI value of 0.75 for benign tumors was shown. The PI value was significantly lower (p 0.001) in malignant than that of in benign masses, but RI value was not significant (p 0.184). The sensitivity and specificity in the detection of malignancy combined with doppler velocimetry was 86% and 67%, respectively. CONCLUSION: Doppler velocimetry studies did not add substantially to the prediction of malignancy using the morphologic scoring system.

Clinico-Pathologic Study on Borderline Epithelial Tumors of the Ovary / 대한부인종양콜포스코피학회잡지

Twenty six cases of borderline ovarian tumor(BOT) were treated between Jan. 1985 and Dec. 1997 at the Department of Obstetrics and Gynecology, Hanyang University. The clinical records were reviewed for all patients including histopathology, clinical features, and follow-up. The frequency of BOT was 12%(26/214) of epithelial ovarian malignancies, and patients with these tumors tend to present at a younger age(36 yrs) than those with invasive carcinomas. In terms of histologic type, mucinous type(21/26: 81%) were more prevalent than serous tumor(5/21: 19%) in this study. The positive rate of CA 125 was 20% in serous, and the positive rate of CA 19-9 was 24% in mucinous tumor. The size of mucinous was larger than that of serous tumors(17.1 cm vs 9,3 cm). Almost all of these tumor categorized as early stage(stage I: 96%), however, only one patient with serous tumor had advanced stage of disease(stage III: 4%), Therefore BOT tend to be diagnosed as earlier than invasive carcinoma. About 2/3 of patients were treated as conservative surgery(unilateral salpingooophorectomy or enuclation). Postoperative adjuvant chemotherapy was not given about half of cases(13/26). Median follow-up was 43 months and recurrent case was found only one in serous tumor, All patients in this study are still alive and free of disease except one, 5-year survival rate was 100%. But large number of study and long-term follow-up are needed to make a decision to treat and manage of BOT.