Registry Study of the Working Group on Cervical Pathology and Colposcopy (AGCPC) on the Diagnostic Algorithm for the New Cervical Cancer Screening - Initial Data.

Introduction: For the first time since 1971, new regulations were introduced for cervical cancer screening as an organized cancer screening guideline (oKFE-RL) starting 1 January 2020. From the age of 20, a cytological smear test is performed annually, and from the age of 35, so-called co-testing (cytology and test for high-risk HPVs) is performed every three years. In case of abnormalities, the algorithm is used as the basis for investigation. According to this diagnostic algorithm, even so-called low-risk groups receive early colposcopic evaluation. This approach has been heavily debated and serves as the basis for this registry study. Methods: All patients who presented to the centers for a colposcopy as part of the diagnostic algorithm were included after signing an informed consent form. The following findings were obtained: Medical history, colposcopy, histology, and cytology findings, as well as possible therapies and their findings. The aim was to evaluate the frequency of the target lesions cervical intraepithelial neoplasia (CIN) 2+/CIN 3+ in the respective groups. Result: A total of 4763 patients were enrolled in the study from July 2020 to October 2022. As a referral diagnosis, HPV persistence (HPV: human papillomavirus) with group I was determined in 23.9% (1139), HPV persistence with group II-a in 2.1% (100), II-p (ASC-US) in 11.2% (535), and II-g (AGC endocervical NOS) in 1.3% (64). III-p (ASC-H) and III-g (AGC endocervical favor neoplastic) were found in 9.4% (447) and 2.2% (107), respectively, IIID1 (LSIL) in 19% (906), IIID2 (HSIL, moderate dysplasia) in 18.9% (898), IVa-p (HSIL, severe dysplasia) in 10.7% (508), IVa-g (AIS) in 0.7% (31), IVb-p (HSIL with features suspicious for invasion) and IVb-g (AIS with features suspicious for invasion) in 0.3% (15), 0.1% (6), and 7 with suspected invasion V-p (squamous cell carcinoma)/V-g (endocervical adenocarcinoma) (0.1%). In the IVa-p group (HSIL, severe dysplasia), 67.7% had CIN 2+ and 56.5% had CIN 3+, adenocarcinoma in situ (AIS), and adenocarcinoma. If the histology of the excised tissue specifically based on the colposcope findings was also evaluated, CIN 2+ was found in 79.7% of cases, and CIN 3+ in 67.3% of cases. In IIID2 (HSIL, moderate dysplasia), CIN 2+ was detected in 50.9%, and CIN 3+/AIS in 28.3%. After evaluating patients who underwent surgery immediately, this increased to 53.0% for CIN 2+ and 29.3% for CIN 3+/AIS. In IIID1 (LSIL), CIN 2+ was detected in 27.4% and CIN 3+/AIS in 11.7%, and in II-p (ASC-US), CIN 2+ was detected in 23.4% and CIN 3+ and AIS in 10.8%, and in II-g (AGC endocervical NOS), CIN 2+ was detected in 34.4% and CIN 3+ in 23.4%. In the HPV persistence/II-a and I group, 21% showed CIN 2+, and 12.1% showed CIN 3+ and AIS, and 13% showed CIN 2+ and 5.9% showed CIN 3+ and AIS. In patients who were HPV-negative and had further diagnostics performed on the basis of cytologic smear alone, 27.9% had CIN 2+, and 14.1% had CIN 3 and AIS. Discussion: In a synopsis of the present findings of our initial data of the registry study on the new cervical cancer screening, according to the organized early cancer screening guideline (oKFE-RL), we could show that the target lesion CIN 3+ and AIS is detected unexpectedly frequently in a not insignificant proportion, especially in the cytological low-risk group. Currently, we cannot answer whether this can reduce the incidence and mortality of cervical carcinoma, but this could be an initial indication of this and will be reviewed in further long-term evaluations.

Clinical experience with the ATS 3F stentless aortic bioprosthesis: five years' follow up.

BACKGROUND AND AIM OF THE STUDY: The ATS 3F aortic bioprosthesis is an equine pericardial stentless valve used for aortic valve replacement (AVR). The study aim was to determine the incidence of valve-related events during a five-year follow up period. METHODS: Between 2002 and 2003, a total of 35 patients (mean age 73 +/- 6 years; range 61-86 years) underwent AVR with the ATS 3F valve implanted in the subcoronary position, utilizing a single running suture technique. The mean valve size was 26.0 +/- 1.9 mm. Prior to surgery, all patients were in NYHA class III or IV. The hemodynamic performance of the valve was assessed after one, three, and five years by means of transthoracic echocardiography. Clinical outcome was evaluated by either physical examination or by telephone interviews with the primary care physicians. RESULTS: The total patient follow up was 123 patient-years. Four patients (11%) were lost to follow up. The overall survival was 86%, and none of the deaths was valve-related. Up to five years, no severe structural or non-structural valve dysfunction was identified in the followed patients. Freedom from severe adverse events (SAE) was 89%; the SAE included one permanent and three transient neuroembolic events, but echocardiographic examinations of these patients were unsuggestive for thrombotic depositions on the prosthetic valves. Freedom from endocarditis was 100%. Minimal paravalvular regurgitation was detected in four patients; this was of no clinical importance, and resulted in a 100% freedom from reoperation. The mean transvalvular pressure gradients were 12.9 +/- 6.3, 11.2 +/- 4.2, and 15.2 +/- 5.3 mmHg at one, three, and five years, respectively. The left ventricular mass and NHYA class were each improved significantly during the observation period. The left ventricular geometries showed also a trend towards improvement. CONCLUSION: The ATS 3F aortic valve prosthesis continues to perform with satisfactory hemodynamic results, comparable to those of other pericardial valves. With minimal SAE, the prosthesis demonstrated excellent intermediate-term clinical results and--to date--is proving to be durable.

Aortic valve replacement with new-generation stentless pericardial valves: short-term clinical and hemodynamic results.

BACKGROUND AND AIM OF THE STUDY: Aortic valve replacement (AVR) with stentless bioprostheses offers superior hemodynamics. In order to overcome the disadvantages of older, stentless valves, a new generation of pericardial stentless prostheses has been developed. Herein, the hemodynamic and clinical results of these substitutes have been evaluated. METHODS: Between March 2002 and May 2004, 85 patients (59 females, 26 males; mean age 73.6 +/- 6.1 years) who underwent AVR received either a bovine (Sorin Pericarbon Freedom; SPF; n = 50) or an equine (3F Aortic Bioprosthesis; 3F; n = 35) pericardial stentless valve. Patients were followed up prospectively at six months after surgery by clinical and echocardiographic examination. The mean follow up period was 5.6 +/- 0.8 months, and was 96.4% complete. RESULTS: Mortality was 2.4% at 30 days (two SPF patients; one died at reoperation for suspected valve thrombosis and one was a non-valve-related death) and 2.5% at follow up (two SPF patients; both nonvalve-related). Neither structural valve failure nor endocarditis were observed. Preoperatively, there were no differences in baseline data, functional status and hemodynamics between SPF and 3F patients. The aortic cross-clamp time was similar in both groups (51.7 +/- 11.2 min for SPF; 51.6 +/- 8.2 min for 3F). NYHA functional status improvement was similar in each group (1.8 +/- 0.5 for SPF; 1.7 +/- 0.6 for 3F). The mean transaortic pressure gradient (deltapmean) was reduced in all patients during follow up. With SPF, a lower deltapmean was found for smaller aortic roots (indexed annular diameter (IAD) < 14 mm/m2) as well as in larger (IAD > 14 mm/m2) aortic roots: 8.0 +/- 4.5 mmHg versus 13.2 +/- 7.2 mmHg (p < 0.05) and 6.8 +/- 3.0 mmHg versus 12.8 +/- 4.8 mmHg (p < 0.05), respectively. CONCLUSION: New-generation pericardial stentless aortic valves are very pliable, which facilitates their implantation. Clinical and hemodynamic results with these prostheses are promising. The SPF prosthesis demonstrates excellent performance, and may be superior when implanted in small aortic roots.