1. Colposcopy & Research

2.  Arch Gynecol Obstet. 2015 May 26. [Epub ahead of print] Arch Gynecol Obstet.  Risk factors for treatment failure following cold coagulation cervical treatment for CIN pathology: a cohort-based study.  Papoutsis D 1, Underwood M, Parry-Smith W, Panikkar J. Papoutsis DUnderwood MParry-Smith WPanikkar J  1 Department of Obstetrics and Gynaecology, Shrewsbury and Telford Hospitals NHS Trust, Apley Castle, Grainger Drive, Telford, TF16TF, UK, dimitrios.papoutsis@nhs.net.  Abstract  PURPOSE:  To determine any risk factors for cytology recurrence in women after cold coagulation ablative treatment for cervical intraepithelial neoplasia (CIN).  METHODS:  This was a retrospective observational study of a cohort of women having had cold coagulation between 2001 and 2011 in the colposcopy unit of an NHS hospital. We retrospectively collected data from our colposcopy unit database. Women with previous cervical treatment were excluded.  RESULTS:  559 eligible women were identified with a mean age of 28.7 ± 6.2 years. Nulliparous women were 66.3 % with smokers involving 35.3 %. Referral cytology, pretreatment cervical punch biopsies and colposcopy were high grade in 51.9, 71.9 and 45.8 % of women. Endocervical crypt involvement (ECI) on pretreatment cervical punch biopsy involved 9.7 % of women. Mean follow-up was 3.1 ± 2.4 years. Overall cytology recurrence (mild/moderate/severe dyskaryosis) at 6 and 12 months follow-up was 7.4 and 5 %. High-grade cytology recurrence (moderate/severe dyskaryosis) involved 2.7 % of women over the entire follow-up period. Multiple regression analysis showed that ECI on pretreatment cervical punch biopsy was a risk factor for high-grade cytology recurrence (HR 3.72; 95 %CI 1.18-11.71; p = 0.024). There were no risk factors identified for overall cytology recurrence. However, when cytology tests with borderline nuclear changes at follow-up were pooled with mild/moderate/severe dyskaryosis cytology tests, then parity ≥2 was a risk factor for abnormal cytology (HR 1.71; 95 %CI 1.08-2.69; p = 0.022).  CONCLUSIONS:  Endocervical crypt involvement on pretreatment cervical punch biopsy and multiparity ≥2 are risk factors that increase the likelihood of abnormal cytology following cold coagulation. These two risk factors should be taken in consideration when performing cold coagulation cervical treatment for CIN pathology. Risk factors for treatment failure following cold coagulation cervical treatment for CIN pathology: a cohort-based study.

3.  J Low Genit Tract Dis. 2015 Aug 6. [Epub ahead of print] J Low Genit Tract Dis.  Papoutsis D 1, Panikkar J, Underwood M, Blundell S, Sahu B, Blackmore J, Reed N. Papoutsis DPanikkar JUnderwood MBlundell SSahu BBlackmore JReed N  1 1Department of Obstetrics and Gynaecology, Shrewsbury and Telford Hospitals NHS Trust, Telford, UK, and 2Cytology Department, Royal Shrewsbury Hospital, Shrewsbury, Shropshire, UK.  Abstract  OBJECTIVE:  The primary objective was to determine whether endocervical crypt involvement (ECI) by cervical intraepithelial neoplasia (CIN) on the excised cervical tissue after large loop excision of the transformation zone (LLETZ) represents a predictor of cytology recurrence. Secondary objective was to identify the ability of a pretreatment cervical punch biopsy to predict cytology recurrence.  MATERIALS AND METHODS:  This was a case series study conducted in an NHS hospital. Women with LLETZ treatment performed over a 2-year period (2010- 2011) were identified through our colposcopy database. Women with previous cervical treatment, cervical cancer on cone histopathology, or missing follow-up data were excluded.  RESULTS:  A group of 526 eligible women was identified over the study period. Crypt involvement was not a predictor of recurrence in the total sample. However, in the subgroup of women with CIN2-3 on pretreatment punch biopsy and with ECI on cone specimen in comparison to those without ECI, we identified an increased risk for overall cytology recurrence (HR, 3.1; 95% CI, 1.04-9.28; P = 0.043) and a trend for increased risk of high-grade cytology recurrence (HR, 4.62; 95% CI, 0.84-25.28; P = 0.07). A pretreatment punch biopsy showing crypt involvement by CIN2-3 was indicative of women at risk for abnormal cytology after excision. In women with CIN2-3 on pretreatment punch biopsy and ECI on excised tissue, the high-grade cytology recurrence was significantly reduced if more than 1.9 cm of cervix was removed.  CONCLUSIONS:  It seems that the presence of crypt involvement on the excised cervix in the subgroup of women with CIN2-3 on pretreatment punch biopsy is predictive of cytology recurrence. Endocervical Crypt Involvement by CIN2-3 as a Predictor of Cytology Recurrence After Excisional Cervical Treatment.

4.  Cytopathology. 2015 Jun;26(3):188-93. doi: 10.1111/cyt.12178. Epub 2014 Aug 13. Cytopathology.  Parry-Smith W 1, Thorpe D 1, Ogboro-Okor L 1, Underwood M 2, Ismaili E 1, Kodampur M 1, Todd R 1, Douce G 1, Redman CW 1. Parry-Smith WThorpe DOgboro-Okor LUnderwood MIsmaili EKodampur MTodd RDouce GRedman CW  1 University Hospital of North Staffordshire, Staffordshire, UK.  2 Royal Shrewsbury Hospital, Shropshire, UK.  Abstract  OBJECTIVES:  Vaginal vault cytology sampling following hysterectomy is recommended for specific indications in national guidelines. However, clinical governance issues surround compliance with guidance. Our first study objective was to quantify how many patients undergoing hysterectomy at the University Hospital of North Staffordshire (UHNS) had vault cytology advice in their histology report and, if indicated, whether it was arranged. The second was to devise a vault cytology protocol based on local experience and national guidance.  METHODS:  The local cancer registry was searched. Clinical, clerical and histological data for all patients undergoing hysterectomy were collected.  RESULTS:  In total, 271 patients were identified from both the gynae-oncology and benign gynaecology teams. Of these, 24% (65/271) were gynae-oncology patients with a mean age of 69 years. The benign gynaecology team had 76% (206/271) of patients with a mean age of 55 years. Subsequently, 94% (256/271) had cytology follow-up advice in their histopathology report. Ultimately, from both cohorts, 39% (18/46) had follow-up cytology performed when indicated.  CONCLUSION:  A high proportion of cases complied with national guidance. However, a disappointingly high number did not have vault cytology sampling when this was indicated. This is probably a result of the complex guidance that is misunderstood in both primary and secondary care. Vault follow-up of patients after hysterectomy rests with the team performing the surgery. Vault cytology, if indicated, should be performed in secondary care and follow-up should be planned. The protocol set out in this article should be followed to avoid unnecessary clinical governance failings. Cytological follow-up after hysterectomy: is vaginal vault cytology sampling a clinical governance problem?

5.  W. Parry-Smith1, M. Underwood2, D. Papoutsis2, S. De Bellis Ayres2, L. Bangs1,  S. Goodall2  1. University Hospital of North Staffordshire, Stoke-on-Trent, UK  2. Shrewsbury and Telford NHS Trust, Women and Children Division, Shropshire, England, UK  Objectives: The aim of this retrospective audit was to establish cure rates and preterm delivery rates (PTD) following thermo-coagulation (thermo) treatment for CIN.  Methods: Retrospective data collection of patients undergoing thermo at the Shrewsbury and Telford Hospitals during 2000-2012. Pre-treatment cytology and histology were collected with subsequent follow-up cytology for 558 patients. Data on additional treatments following the Thermo was also collected. Cure rate was taken as no dyskaryosis on cytology at 6-12 months post treatment. The PTD rate was defined as spontaneous deliveries <37/40.  Results: Pre-treatment histology confirmed CIN2+ in 71% (398/558). The cure rate at 6-12 months was 95.7% (534/558), with only four (0.7%) having high-grade dyskaryosis. Excisional treatment was required in 3.58% (20/558) of patients, of which 55% (11/20) had CIN2+ and one had a 1b1 squamous cervical cancer, however this patient was treated outside of our protocol. Following thermo 136 deliveries occurred of which 10 (7.35%) were spontaneous prior to 37/40 (range 27+0 - 36+6).  Conclusion: The safety and efficacy of thermo have been demonstrated in our data. There are concerns about the lack of robust data surrounding the use of cryotherapy for the treatment of high grade disease. Consideration should be given for a more widespread use of thermo as part of the management of CIN, in combination with visual inspection of the cervix with acetic acid (VIA) in low resource settings. OBSTETRIC OUTCOMES AND CIN CURE RATES FOLLOWING THERMO- COAGULATION (COLD COAGULATION) IN A UK SETTING. CAN WE APPLY THIS TO THE MANAGEMENT OF CIN USING VISUAL INSPECTION WITH ACETIC ACID (VIA) AND TREATMENT IN LOW RESOURCE SETTINGS?

6.  Journal of Lower Genital Tract Disease:  January 2015 - Volume 19 - Issue 1 - p 17–21 January 2015 - Volume 19 - Issue 1 - p 17–21  doi: 10.1097/LGT.0000000000000031  Original Articles: Cervix and HPV Clinical Research  Parry-Smith, William MB, BS 1 ; Underwood, Martyn MB, ChB 1 ; De Bellis-Ayres, Sabrina MBChB, BMedSc, MPH 2 ; Bangs, Laura MB, ChB 1 ; Redman, Charles W.E. MD 3 ; Panikkar, Jane MB, ChB 1  Abstract  Objective: To establish the cure rate at 1 year of patients who have undergone cold coagulation for the treatment of cervical intraepithelial neoplasia (CIN).  Design: Retrospective review of data for all patients at Shrewsbury and Telford NHS Trust who had undergone cold coagulation as part of their treatment for CIN between 2001 and 2011. Follow-up data up to December 2012 were analyzed.  Setting: Colposcopy Department, Shrewsbury and Telford NHS Trust, United Kingdom.  Population: Women undergoing cold coagulation for the treatment of CIN between 2001 and 2011, with cytologic follow-up until December 2012.  Methods: Patients were identified using a local colposcopy database. Data were obtained via the local histopathology reporting systems. Statistical analyses were performed using Stata/IC 10.1 software.  Main Outcome Measures: Post treatment cytology and whether subsequent treatment was required, with histology results.  Results: Data on 557 patients were collected and analyzed. Pre–cold coagulation treatment histologic findings were CIN 1 in 156 patients (28.01%), CIN 2 in 260 patients (46.68%), and CIN 3 in 141 patients (25.31%). The median length of time between cold coagulation treatment and first follow-up smear, used to calculate cure rates at around 1 year, was 406 days (interquartile range 123 days, range 169–3,116 days). The cure rate after cold coagulation was 95.7% at around 1 year.  Conclusions: Cold coagulation has a cure rate comparable to that of excisional treatments such as large loop excision of the transformation zone and should be considered more widely in patients undergoing primary treatment for CIN, where there is no suspicion of invasive disease on history, examination and cytologic results. Success Rate of Cold Coagulation for the Treatment of Cervical Intraepithelial Neoplasia: A Retrospective Analysis of a Series of Cases