Objective To evaluate the efficacy of modified Swede Colposcopic Index (MSCI) to predict high-grade lesion and cancer of cervix (CIN2+, cervical intraepithelial neoplasia grade 2 or worse) in women with abnormal cervical cytology who underwent a colposcopy. Methods We conducted a retrospective study and MSCI using 5 features of cervical lesions evidenced from colposcopy: acetouptake, margin and surface, vessels, lesion size, and location of lesion. Each feature was scored from cervicograhpic findings which transformation zone was completely seen. Odds ratio of each feature was obtained by logistic regression analysis. Receiver operating characteristic curve was used to assess the efficacy of summation score to predict CIN2+. An appropriate cut-off point score was assigned. Results Two hundred and twenty women were included in the study. The assigned score for each factor in level 1 to 3 was 1, 2 and 3 points with a total score of 15 points. The most appropriate cut-off points score for MSCI to predict CIN2+ was 11 points. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy using MSCI were 82.2%, 96.2%, 96.0%, 85.0%, and 90.0% respectively. Conclusion MSCI showed a high efficacy for predicting CIN2+ in satisfactory colposcopy.

Objective: ESGO/ESTRO/ESP guidelines recommend that DNA mismatch repair (MMR) proteins or microsatellite instability tests should be performed in all cases of endometrial cancer. This study aims to clarify the relationship of MMR protein deficiency (dMMR) between early and advanced stages of endometrial cancer. Secondary objective is to identify dMMR affecting factors in endometrial cancer. Methods: This cross-sectional study was conducted on endometrial cancer patients who underwent surgery at HRH Princess Maha Chakri Sirindhorn Medical Center, Srinakharinwirot University, between May 2013 and April 2021. Patients with endometrial cancer whose tumor tissue was available for analysis were identified. The expression of MMR proteins was assessed by immunohistochemistry, including MLH1, MSH2, MSH6, and PMS2. Then, the pathological specimens were reviewed. Results: A total of 207 patients with endometrial cancer were assessed for data analysis. MMR deficiency was observed in 92 cases (44.4%). We found patients with dMMR in both the early and advanced stages of endometrial cancer-68/155 cases (43.9%) and 24/52 cases (46.2%), respectively (P = 0.774). Statistically significant differences were found only in myometrial invasion (adjusted prevalence odds ratio 2.35, 95% CI 1.21 to 4.57, P = 0.012). Conclusion: Our study showed no difference in tissue dMMR between early-and advanced-stage endometrial cancer. The dMMR was not associated with improved outcomes in patients with endometrial cancer. Even though ESGO/ESTRO/ESP guidelines recommend the performance of MMR IHC or MSI tests in all endometrial cancer cases, we can select the appropriate patients those categorized as "advanced stage" or "recurrent"-who may gain the most benefits from the immunotherapy modality of treatment.

Objective: To determine the appropriate cone depth for treating high grade precancerous lesions to achieve negative pathological margins of cones from LEEPs. Other factors associated with positive pathological margin were also investigated. Methods: A Retrospective study recruited 170 patients who received indications for LEEP during January 2015 to July 2020 were enrolled. The participants were operated by a single cut of LEEP and not had previously conization before. All patient data were collected into two groups, including negative and positive cone margin groups. Then, we used the cone depth by calculating from cone tissue after formalin fixation to eliminate shrinkage effect. The appropriate cut-off points for cone depth were calculated by ROC and analyzed factors that influence positive cone margin. Results: The depth of cone (mm ±SD) of negative margin group was 8.70 (±3.36) and 6.13 (±2.28) mm in positive margin group. The appropriate cut-off points for cone depth were calculated by ROC presented at resection depth of 7.21 mm, which displayed proper cone depth with a sensitivity of 63.53% and specificity of 71.76%. Elderly age (adjusted OR 1.061, 95%CI 1.008-1.117, p=0.002), number of quadrants of lesion involvement (adjusted OR 1.182, 95%CI 1.312-2.513, p=<0.001) and glandular involvement (adjusted OR 3.648, p=0.002) were the significant risk factors for positive margin. Conclusion: The appropriate cone depth for treating high grade precancerous lesions was at least 7.21 mm to achieve a negative cone margin from LEEP. The significant factors associated with positive cone margin include elderly age, more quadrants of lesion involvement and glandular involvement.