Accuracy of HPV Testing of Vaginal Smear Obtained With a Novel Self-sampling Device

Abstract

For women with menorrhagia, hysteroscopic resection of endometrial tissue, combined with myomectomy and polypectomy when indicated, offers an alternative to hysterectomy. Favorable short-term results have been documented, but the long-term outcome may be less impressive. This study examined long-term outcomes in 279 women with menorrhagia, seen consecutively in the years 1990-1999, who underwent hysteroscopic endometrial resection with or without myomectomy. Follow-up data were available for 259 women, 93% of those operated on, after a mean postoperative interval of 6 years. More than one-third of the women received hormonal therapy for endometrial suppression preoperatively.Operative complications occurred in 15 women, about 6% of the total group. Eight women with postoperative endometritis responded well to antibiotic therapy. Endometrial abnormalities were identified in 41% of cases. Onefourth of women had hysteroscopic resection of fibroids as well, and 9% had polypectomy. Late complications were recorded in nearly 8% of women who were followed up. A large majority of the 18 patients with hematometra had undergone tubal ligation. More than one-third of women had one or more gynecological procedures during follow-up, and 61 of them underwent hysterectomy. Indications for hysterectomy included, in order of declining frequency, myomas, adenomyosis, persistent menorrhagia or endometrial hyperplasia, and perioperative or postoperative complications. More than 80% of hysterectomies were done within 5 years after hysteroscopic surgery. On multivariate analysis, both past tubal ligation and a uterine cavity measuring 9 cm or more in length were associated with an increased risk of hysterectomy. Half of the women who did not require hysterectomy were amenorrheic on long-term follow-up, and none had more than slight menstrual bleeding.These findings show that hysteroscopic resection of endometrium and fibroids provide lasting benefit to women with menorrhagia and is a suitable alternative to hysterectomy. This approach may prove effective for women who have not been satisfied by use of a levonorgestrel-releasing intrauterine system GYNECOLOGY ABSTRACT Human papilloma virus (HPV) is a key factor in the development of cervical carcinoma. High-risk types of this virus are found in nearly all squamous-cell cervical cancers. HPV infection precedes cervical intraepithelial neoplasia (CIN), and is viewed as the most important factor in both premalignant cell changes and invasive cancer. HPV testing is highly sensitive for CIN lesions. The Pap smear is less sensitive but more specific. Many of the approximately 500 women in Sweden who are found each year to have cervical cancer have chosen not to be screened. A self-sampling device (SSD) for collecting vaginal smears now is available.This study compared the results of three sampling methods in 43 women who previously had abnormal cervical cytology. The women collected vaginal samples by inserting the SSD into the bottom of the vagina and rotating it one turn. The upper part of...

HPV self-sampling or the Pap-smear: A randomized study among cervical screening nonattenders from lower socioeconomic groups in France

“…This was much higher than the rates observed in our first trial (6.6%), but was similar to the rates previously seen in under‐privileged women living in Marseille (14%) (Piana et al ., unpublished data) and Mexico (15%) . However, this is lower than the rate found in Swedish women aged 35–50 years (26%) and in Italian women aged 35–64 years (21.8%) . These differences do not seem to be related to age, but probably to the level of risk associated with the specific populations screened.…”

Vaginal self-sampling without preservative for human papillomavirus testing shows good sensitivity

“…Almost half of the cervical cancer cases in Sweden develop in women who do not attend organized screening, or in women who have passed the organized screening program age. 2 About one third of the new cases occur in the screened population. They are usually less advanced or micro-invasive and are mainly curable by surgery.…”

Comparison of the accuracy of Hybrid Capture II and polymerase chain reaction in detecting clinically important cervical dysplasia: a systematic review and meta‐analysis

“…We then excluded 175 citations by applying the inclusion criteria to the titles and abstracts and retrieved 95 full‐text articles for further review. The review process yielded 28 articles that met all inclusion criteria . In addition, we added one manuscript from our own group (Luu et al, submitted), which is currently under review (Fig.…”

“…A total of 22,417 women were described, with four articles contributing fewer than 100 participants and 10 articles (Luu et al, submitted), more than 500 participants. The article by Schiffman et al.…”

“…Over half of the articles ( k = 16) reported results from Europe, with the remainder from Asia‐Pacific ( k = 5) , North America ( k = 6) (Luu et al, submitted) , and South America ( k = 2) . Just under half ( k = 14) reported studies were conducted in screening settings; 10 were in a follow‐up/diagnostic setting and the remainder ( k = 5) (Luu et al, submitted) were in both screening and follow‐up/diagnostic settings. Most ( k = 23) used a cross‐sectional study design ; four, a cohort study design (Luu et al, submitted) and two, a randomized controlled trial design .…”