Self- and physician-collected high-risk human papillomavirus (HPV) testing to detect high-grade cervical lesions among Thai women.

OBJECTIVE: We compared the performance of high-risk human papillomavirus (HPV) messenger RNA testing of physician- and self-collected specimens for detecting histological grade 2 or higher cervical intraepithelial neoplasia (CIN) among women who visited a colposcopy clinic in Thailand. METHODS: From January 2022 to April 2022, 500 women participated in this cross-sectional multicenter study; 494 had complete data and valid specimen results. The participants were women who attended any one of the 10 participating institutes' colposcopy clinics due to abnormal cytology, positive high-risk HPV testing, or for follow-up. Participants used a self-sampling Aptima Multitest Swab specimen collection kit to self-collect vaginal samples before physicians biopsied the cervix during the colposcopic examination. The self- and physician-collected specimens were tested for high-risk HPV messenger RNA using Aptima nucleic acid amplification assays. Cervical tissues were collected during colposcopic-directed biopsy from the most severe lesion or a random biopsy and endocervical curettage specimen if no lesion was detected. RESULTS: We detected high-risk HPV messenger RNA in 75.4% of self-collected specimens and 70.6% of physician-collected specimens. The prevalence of histological grade 2 or higher CIN from cervical histology was 25.1% (n=124). For self-collected specimens, the sensitivity and specificity of high-risk HPV messenger RNA for grade 2 or higher CIN were 87.0% (95% CI 79.7% to 92.4%; n=108) and 28.5% (95% CI 24.0% to 33.4%). For physician-collected specimens, the sensitivity and specificity of high-risk HPV messenger RNA for grade 2 or higher CIN were 90.2% (95% CI 83.6% to 94.9%; n=112) and 36.1% (95% CI 31.2% to 41.3%). CONCLUSIONS: Self-collected specimens for high-risk HPV messenger RNA testing demonstrated good sensitivity and negative predictive value for detecting grade 2 or higher CIN in Thai women attending the participating institutes' colposcopy clinics. Self-collected samples performed similarly to physician-collected ones.

Urologic injuries during gynecologic surgery, a 10-year review.

AIMS: The study was conducted to evaluate the incidence of urologic injuries during gynecologic surgery, study the management and outcome of such injuries, and identify risk factors that may be associated with urologic injuries. METHODS: A case-control study was conducted in patients who underwent gynecologic surgery from 2005 to 2014 in the university hospital. The study cases referred to patients who had urologic injury during gynecologic surgery and the control cases referred to patients who had gynecologic surgery matching the same period, type of procedure, and etiological disease leading to surgery. The medical records were reviewed and analyzed. Odds ratios (ORs) and 95% confidence intervals (CI) were used to identify risk factors associated with urologic injury. RESULTS: During the study period, there were 86 cases of urologic injuries from a total of 28 819 cases. The overall 10-year incidence was 0.30%. The incidence of bladder injury was 0.18%, (0.083% for ureteric and 0.014% for combined ureter and bladder injury). Among 80 cases with complete data, 52 (65%) had bladder injury and 48 (92.3%) were recognized the time of surgery and underwent primary repair with successful outcome, whereas 18 (75%) of 24 ureteric injury were detected intraoperatively. Previous pelvic surgery and the presence of adhesion were significant risk factors of urologic injury with OR 3.436, 95% CI 2.037-5.796 and OR 2.185, 95% CI 1.319-3.621, respectively. CONCLUSION: Urinary bladder injury was the most common urinary tract injury during gynecologic surgery. Previous pelvic surgery and the presence of adhesion were significant risk factors.