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Introduction: Cervical cytology has limited sensitivity to detect cervical pre-cancerous lesions. High-risk human papillomavirus (hr-HPV) DNA testing has high sensitivity but its specificity is limited. This study was done to assess the utility of p16INK4a/ki-67 dual stained cytology in improving the predictive value for high-grade cervical (CIN2+) lesions. Aim/Objective: To assess the significance of P16/Ki-67 immunocytochemistry in improving the predictive value for high-grade cervical intraepithelial (≥CIN 2+) lesions on Pap smear. Material and Methods: This was a prospective diagnostic study that included 93 patients with ASC-US/LSIL/ASC-H and HSIL on thin prep cervical smears and who also underwent hr-HPV DNA test and colposcopy-guided biopsy. Biopsy was the gold standard against which the performance of P16INK4a/Ki-67 and hr-HPV results were compared. Results: In women of all ages, sensitivity of (96.8%) hr-HPV test and p16/Ki-67 dual immunocytochemistry (≥1 positive cell) were similar and negative predictive value (NPV) was (97.1% vs. 97.9%) but the latter test showed better specificity (69.4% vs. 53.2%) and positive predictive value (PPV, 61.2% vs. 50.8%) for ≥CIN 2 lesions. A higher cut off of at least 10 positive cells gives a higher specificity and PPV, with slightly decreased sensitivity and NPV. Conclusion: Because high-risk HPV test has a high sensitivity and NPV, whereas P16/Ki-67 dual immunocytochemistry (≥10 positive cells) has a high specificity and PPV, the latter can be recommended as an ancillary test in hr-HPV-positive women to reduce the number of women going for colposcopy and biopsies.

Objectives1.To audit complications following ovarian cancer surgery (Clavien-Dindo classification) and their impact on oncologic outcome 2. To determine risk factors associated with postoperative complications.MethodsElectronic medical records of women who underwent surgery for epithelial ovarian cancer between January 2016 – December 2018 were audited. Design : Retrospective nested case control study. Cases: Patients with post-operative complications. Control: Those without complications. Setting: Department of gynaecologic oncology. Statistical analysis: SPSS v20 was used to analyse data. Chi square/Fischer test , ANOVA and multivariate regression were used to assess risk factors of complications.ResultsOver 36 months, 370 women underwent surgery .Fifty percent (188/370) underwent primary cytoreduction and 74% had advanced disease (273/370). Optimal cytoreduction was achieved in 84% (273/370). The post-operative complication rate was 35% (129/370) ,over a median period of 5 days (0 to 53) : 24 % (89/370) and 10% (37/370) had grade 1–2 complications and grade 3–4 complications respectively . The 30 day mortality was 0.8 % (3/370). Advanced disease (p=0.027) , high complexity of surgery (p=0.015), and intraoperative blood loss (p=0.001) were independently associated with increased rate of complications. The median time to recur was 17 months (12.6 to 21.3 months). Kaplan-Meir curve for survival showed a median recurrence free period of 20, 13 and 11 months respectively in the complication free, grade 1–2 and grade 3–4 complication group respectively, with a log rank value of 0.214.ConclusionsOvarian cancer surgery is associated with an acceptable complication rate and patients should be selected with discretion .

ObjectivesThis study aimed to assess sexual health and quality of life (QoL) in endometrial cancer survivors and the factors influencing these variables.MethodsA mixed method design comprising quantitative (cohort design) and qualitative (face-to-face interviews) aspects was chosen. A total of 132 patients who underwent surgery alone, surgery followed by adjuvant vaginal brachytherapy, or surgery followed by chemotherapy and radiation were included. Female Sexual Function Index (FSFI) and Functional Assessment of Cancer Therapy General (FACT-G) questionnaires were used to assess the participants’ sexual health and QoL at 6 months and 1 year post-treatment. Multivariate logistic regression models were used to analyze the factors associated with general and sexual well-being.ResultsAt 1 year, 89% of the participants still had low sexual function scores. Survivors over 50 years (OR 284.7, 95% CI 13 to 364, p<0.001) and educated below graduate level (OR 26.8, 95% CI 2 to 370, p=0.014) had low sexual function scores. Patients who had surgery alone had better QoL than those who received adjuvant radiation. Women who had surgery, chemotherapy, and radiation had the lowest QoL scores (OR 6.4, 95% CI 2.1 to 19.5, p=0.001). All scores improved with time.ConclusionsThis study demonstrated the high prevalence of low sexual function and poor QoL in endometrial cancer survivors. There was a communication gap between the women and their partners as well as their healthcare providers. This study highlights the need for discussion about the survivors’ sexual well-being and QoL.

Background Molecular subtyping of endometrial carcinomas (EC) has been shown to classify tumors into prognostically relevant groups. Characterizing EC with a limited number of markers viz., POLE mutations, p53 mutations, and MMR status, can provide valuable information. Design Paraffin sections of a cohort of 48 EC from a tertiary care center were characterized for the above-mentioned molecular markers and analyzed in the context of survival. Methods Formalin fixed paraffin embedded tissues from 48 EC were characterized for POLE mutations by Sanger sequencing (exons 9–14), for MMR (MLH1, MH2, MSH6) using immunohistochemistry (IHC) and copy number (high/low) using p53 IHC. Mutational status was integrated along with the clinicopathological details and survival analysis performed. Results Eleven (22.9%) patients were MMR deficient, 3 (6.3%) had POLE mutation, while 2 (4.1%) had both POLE and P53 mutations (regarded as multiple classifiers). Twelve (25%) patients were found to have P53 mutations, while the remaining 20 (41.7%) had no specific molecular profile (NSMP). Median follow-up duration was 43.5 (2–62) months with 8 recurrences and 9 deaths. Tumors with POLE mutation had the most favorable prognosis followed by the NSMP and the MMR mutated group while the P53 and multiple classifier groups had the worst prognosis in terms of OS (Log-rank p : 0.006) and PFS (Log-rank p : 0.001). Conclusion The integration of molecular-clinicopathologic data for endometrial cancer classification, through cost-effective, clinically applicable assays appears to be a highly objective tool that can be adopted even in resource-limited settings. It has the potential to cause a shift in the paradigm of EC pathology and management practice.

Introduction Carcinoma vulva is a rare gynaecological malignancy accounting for 5%, but is associated with significant surgical complication rate of 40%- 60%. The study introspects different complications encountered following vulval carcinoma surgeries. Methodology This is a retrospective study conducted in the Gynaecologic Oncology Department of a Tertiary Care Hospital in India, where electronic medical records of patients with vulval carcinoma who underwent surgery between 1 January 2016 and 31 October 2021 were reviewed and analysed. Results A total of 33 patients were identified during this period. The mean age was 60.1 (SD 11.7), and the median body mass index was 26.5(range 38). Most (21, 63%) of them belonged to FIGO I (surgical staging for vulval cancer 2009). Radical wide local excision was performed among 23 patients, and 10 underwent radical vulvectomy. Three of them underwent concomitant flap repair with V–Y flaps. Inguinofemoral dissection was performed among thirty patients. Squamous cell carcinoma was the most common histology. Thirteen patients received adjuvant treatment. The average time to adjuvant treatment was seven weeks. There were 16 (48%) observed complications, most commonly wound breakdown—inguinal wound (5, 15%) and vulval wound breakdown (6,18%). The wound breakdowns were managed conservatively with antibiotics and dressing. Lymphocyst aspiration was done among two patients and interventional lymphangio-embolization in one. One vulval wound breakdown underwent flap reconstruction. Conclusion The complication rate was 48% of whom most patients had minor complications (14/16: Clavein–Dindo grade 1 and grade II). The mainstay treatment for vulval carcinoma is surgery combined with inguinofemoral lymph node dissection with or without adjuvant radiation. Lymphadenectomy majorly contributes to post-operative morbidity. Proper selection of patients, multi-disciplinary discussion, and sentinel node mapping can minimize post-operative complications.

Purpose To study the pattern of serum CA19-9 in adnexal masses and its accuracy in diagnosing malignancy. Methods A cross-sectional study of 267 women with an adnexal mass, who underwent CA 19-9 testing prior to surgery. Descriptive statistics and diagnostic test characteristics were used. Results There were 115 benign, 13 borderline and 139 malignant cases. CA 19-9 was elevated in 68 patients (25.5%) when a cut-off of 33 IU/ml was considered. Among the benign, borderline and malignant tumours, 26, 38.5 and 23.7%, respectively, had elevated CA 19-9. Among patients with benign tumours, CA 19-9 was elevated in 48% of the dermoids, 29.6% of the mucinous tumours and 15.9% of the others. There were 131 epithelial (34 mucinous, 97 non-mucinous types), 18 non-epithelial tumours and three metastatic to the ovaries. CA19-9 was raised in 30 (26.1%) of benign, five (38.5%) borderline and 33 (23.7%) of malignant tumours. Elevated CA 19-9 was seen in 15 (34.1%) of the mucinous type, 32 (23.5%) of the non-mucinous type and 21 (27.3%) of the non-epithelial tumours. Conclusion CA 19-9 is most likely to be raised in ovarian mucinous tumours and dermoid cysts. It is not a good test for malignant ovarian tumours.

To analyse the compliance of surgical care provided to patients diagnosed with carcinoma endometrium, to the European Society of Gynaeacological Oncology (ESGO) quality indicators. This is a retrospective audit done in the Department of Gynaecologic Oncology. Electronic medical records of patients who underwent surgical management of carcinoma endometrium from January 2020 to December 2021 were assessed. A total of 163 patients had undergone primary surgery, and 2 patients had surgery for recurrence. The audit showed that the target for categories of general indicators and pre-operative work-up was met. There was lack in compliance to the intraoperative management, with only 34% among presumed early-stage disease undergoing successful MIS, 31% undergoing sentinel lymph node procedure and 53% among them being done using indocyanine green with 18% bilateral mapping rate. None of the patients had complete molecular classification. Compliance to adjuvant treatment provided was adequate. Minimal required elements in surgical reports were in 81% and pathological reports in 91% of patients falling short of the set target. The audit helped us identify the need to increase MIS and use and adapt sentinel lymph node procedure with ICG dye more aggressively. There also is a need for improvement in documentation of pertinent information on surgical and pathology reporting. Molecular classification should be routinely incorporated into the diagnostic algorithm to aid in adjuvant therapy.

Objectives To compare the prevalence and detection of human papilloma virus (HPV) DNA from urine and self-collected vaginal samples of women with cervical neoplasia. Methods In this cross-sectional study, approved by the institutional review board, 40 women attending the Gynaecologic Oncology clinic with an abnormal Pap smear or cervical biopsy were recruited for the study after obtaining informed consent. Women were asked to self-collect urine and vaginal samples. If positive for HPV DNA, genotyping was done either by CHUV assay or the linear array. The acceptability of the two self-collected methods was assessed by a questionnaire. Results HPV DNA was detected in 24 (60%) of the urine samples and in 33 (83%) of the vaginal samples. Excepting one vaginal sample where low risk type was only detected, all other vaginal samples and all positive urine samples had high-risk HPV. HPV 16 was the most common genotype isolated from urine and vaginal samples. Self-collection of vaginal samples was acceptable to most and, 60% preferred it over physician collection. Most (65%) women preferred collecting urine over vaginal self-sampling, the agreement between urine and vaginal samples was fair (PABAK = 0.350, p  = 0.062). For type specific HPV, there was moderate agreement for HPV 16 (PABAK = 0.650, p  = 0.355) and moderate agreement (PABAK = 0.450, p  = 0.007) for HPV 16/18/both. Conclusion The agreement between urine HPV and vaginal HPV for HPV 16 and 18 genotypes was moderate. Detection of high-risk HPV in urine is a promising alternative to detection from self-collected vaginal samples.