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Ooi S, Eskaroos MA, Pather S, Carter J, Saidi S. Patient expectations and experiences with loop electrosurgical excision procedure in inpatient and outpatient settings. Aust N Z J Obstet Gynaecol 2022; 62:720-724. [PMID: 35762277 DOI: 10.1111/ajo.13556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 05/12/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Loop electrosurgical excision procedure (LEEP) for high-grade squamous intraepithelial lesion is performed in both an inpatient setting under general anaesthesia and an outpatient setting under local anaesthesia. Efficacy and safety are comparable and outpatient LEEP may save time and cost in the Australian setting. AIMS We aim to compare patient satisfaction with inpatient LEEP compared to outpatient LEEP for Australian best practice. MATERIALS AND METHODS This was a prospective quantitative and qualitative cohort study. An online questionnaire was sent to patients undergoing inpatient and outpatient LEEP to assess satisfaction with the procedure. Further histopathological and demographic data were also collected from the medical records. Groups were compared using Fischer's exact test and pain scores were compared using non-parametric tests. RESULTS Ninety-three outpatients and 52 inpatients responded to the survey. No difference was found between groups with regard to rate of positive histopathological margins or number of passes required. Outpatients found the procedure to be more convenient than inpatients (P = 0.007), and experienced more pain during the procedure than the inpatient group (P < 0.001). There was no significant difference in pain scores following the procedure or post-procedure anxiety. CONCLUSIONS Outpatient LEEP is an acceptable and well-tolerated procedure, comparable to inpatient LEEP. Regardless of the option chosen, patients are highly likely to be satisfied with their choice. Increased efforts should be made to reduce pre-procedural anxiety, which may in turn reduce expectations and experiences of pain.
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Affiliation(s)
- Sara Ooi
- Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | | | - Selvan Pather
- University of Sydney, Sydney, New South Wales, Australia.,Chris O'Brien Lifehouse, Sydney, New South Wales, Australia
| | - Jonathan Carter
- University of Sydney, Sydney, New South Wales, Australia.,Chris O'Brien Lifehouse, Sydney, New South Wales, Australia
| | - Samir Saidi
- University of Sydney, Sydney, New South Wales, Australia.,Chris O'Brien Lifehouse, Sydney, New South Wales, Australia
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2
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Henkle TR, Lam B, Kung YJ, Lin J, Tseng SH, Ferrall L, Xing D, Hung CF, Wu TC. Development of a Novel Mouse Model of Spontaneous High-Risk HPVE6/E7-Expressing Carcinoma in the Cervicovaginal Tract. Cancer Res 2021; 81:4560-4569. [PMID: 34215618 DOI: 10.1158/0008-5472.can-21-0399] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 05/05/2021] [Accepted: 06/29/2021] [Indexed: 01/05/2023]
Abstract
Current preclinical models for cervical cancer lack important clinical and pathologic features. To improve upon these models, we aimed to develop a novel, spontaneous HPV16-expressing carcinoma model that captures major aspects of HPV-associated cancer in the female genital tract. This novel preclinical model features (i) expression of HPV oncogenes E6 and E7 in the tumors in female reproductive tract of mice, (ii) spontaneous progression through high-grade squamous intraepithelial lesion (HSIL) to carcinoma, and (iii) flexibility to model cancers from different high-risk HPV genotypes. This was accomplished by injecting plasmids expressing HPV16 E6/E7-luciferase, AKT, c-myc, and Sleeping Beauty transposase into the cervicovaginal tract of C57BL/6 mice followed by electroporation. Cell lines derived from these tumors expressed HPV16 E6/E7 oncogenes, formed tumors in immunocompetent mice, and displayed carcinoma morphology. In all, this novel HPV-associated cervicogenital carcinoma model and HPV16E6/E7-expressing tumor cell line improves upon current HPV16-E6/E7-expressing tumor models. These tumor models may serve as important preclinical models for the development of therapeutic HPV vaccines or novel therapeutic interventions against HPV E6/E7-expressing tumors. SIGNIFICANCE: This study describes the development of a clinically relevant mouse model of cervicovaginal carcinoma that progresses from high-grade lesions and recapitulates key features of human HPV+ cervical cancer.
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Affiliation(s)
- Talia R Henkle
- Department of Pathology, The Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - Brandon Lam
- Department of Pathology, The Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - Yu Jui Kung
- Department of Pathology, The Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - John Lin
- Department of Pathology, The Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - Ssu-Hsueh Tseng
- Department of Pathology, The Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - Louise Ferrall
- Department of Pathology, The Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - Deyin Xing
- Department of Pathology, The Johns Hopkins Medical Institutions, Baltimore, Maryland.,Department of Oncology, The Johns Hopkins Medical Institutions, Baltimore, Maryland.,Department of Obstetrics and Gynecology, The Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - Chien-Fu Hung
- Department of Pathology, The Johns Hopkins Medical Institutions, Baltimore, Maryland. .,Department of Oncology, The Johns Hopkins Medical Institutions, Baltimore, Maryland.,Department of Obstetrics and Gynecology, The Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - T-C Wu
- Department of Pathology, The Johns Hopkins Medical Institutions, Baltimore, Maryland. .,Department of Oncology, The Johns Hopkins Medical Institutions, Baltimore, Maryland.,Department of Obstetrics and Gynecology, The Johns Hopkins Medical Institutions, Baltimore, Maryland.,Department of Molecular Microbiology & Immunology, The Johns Hopkins Medical Institutions, Baltimore, Maryland
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Bhuyan PK, Dallas M, Kraynyak K, Herring T, Morrow M, Boyer J, Duff S, Kim J, Weiner DB. Durability of response to VGX-3100 treatment of HPV16/18 positive cervical HSIL. Hum Vaccin Immunother 2020; 17:1288-1293. [PMID: 33175656 PMCID: PMC8078703 DOI: 10.1080/21645515.2020.1823778] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
VGX-3100 is an investigational DNA-based immunotherapy being developed as an alternative to surgery and ablation for cervical High-Grade Squamous Intraepithelial Lesion (HSIL) with the aim of preserving reproductive health while treating precancerous disease. Response durability up to 1.5 y following dosing is now reported. Histologic regression and HPV16 and/or HPV 18 (HPV16/18) clearance were previously demonstrated in a randomized, placebo-controlled, double-blind trial and reported for 6 months after the last dose of VGX-3100 or placebo. The presence of HPV16/18, Pap smear diagnoses, and immunogenicity longer-term responses were assessed at 18 months after the last dose. 91% (32/35) VGX-3100-treated women, whose cervical HSIL regressed and avoided excision at 6 months following study treatment completion, had no detectable HPV16/18 at 18 months following treatment completion. These results were comparable to those for women who received placebo and then later underwent surgery. For VGX-3100 recipients who regressed at 6 months following study treatment completion and avoided excision during the trial, Pap testing showed no HSIL recurrence at 18 months following VGX-3100 treatment. VGX-3100-induced cellular immune responses specific for HPV 16/18 E6/E7 remained higher than for placebo control recipients at 18 months. In women with cervical HSIL who responded to VGX-3100 and were able to avoid surgery, clinical outcomes were comparable to the placebo control group which underwent conventional surgical treatment. These findings extend the understanding of the durability of the treatment effect of VGX-3100 up to 1.5 y and support that VGX-3100 could be used as an alternative to surgery.
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Affiliation(s)
| | | | - Kim Kraynyak
- Inovio Pharmaceuticals, Inc., Plymouth Meeting, PA, USA
| | | | | | - Jean Boyer
- Inovio Pharmaceuticals, Inc., Plymouth Meeting, PA, USA
| | - Susan Duff
- Inovio Pharmaceuticals, Inc., Plymouth Meeting, PA, USA
| | - Joseph Kim
- Inovio Pharmaceuticals, Inc., Plymouth Meeting, PA, USA
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4
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Giannella L, D'Ippolito G. Cervical ripening balloon: An off-label but effective use to manage massive hemorrhage during outpatient cervical conization. Int J Gynaecol Obstet 2019; 147:126-127. [PMID: 31301236 DOI: 10.1002/ijgo.12910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Revised: 06/15/2019] [Accepted: 07/11/2019] [Indexed: 11/06/2022]
Abstract
A double‐balloon catheter may be very helpful in managing a major hemorrhage following outpatient conization.
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Affiliation(s)
- Luca Giannella
- AUSL-IRCCS of Reggio Emilia, Obstetrics and Gynecology Unit, Cesare Magati Hospital, Scandiano, Italy
| | - Giovanni D'Ippolito
- AUSL-IRCCS of Reggio Emilia, Obstetrics and Gynecology Unit, Cesare Magati Hospital, Scandiano, Italy
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Munro A, Powell RG, A Cohen P, Bowen S, Spilsbury K, O'Leary P, Semmens JB, Codde J, Williams V, Steel N, Leung Y. Spontaneous regression of CIN2 in women aged 18-24 years: a retrospective study of a state-wide population in Western Australia. Acta Obstet Gynecol Scand 2016; 95:291-8. [PMID: 26660398 DOI: 10.1111/aogs.12835] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Accepted: 11/21/2015] [Indexed: 12/01/2022]
Abstract
INTRODUCTION CIN2 has a high rate of spontaneous regression in young women and may be managed conservatively in appropriately selected patients. This study aimed to investigate health outcomes in women aged 18-24 years with biopsy-confirmed CIN2. MATERIAL AND METHODS A retrospective cohort study of Western Australian women aged 18-24 years diagnosed with CIN2 on cervical biopsy from 1 January 2001 to 31 December 2010. Women who had not received treatment at ≥4 months following CIN2 diagnosis were classified as managed 'conservatively'. Subsequent cervical cytology and/or biopsy test results were used to report lesion regression (absence of dysplasia or an epithelial lesion of lower grade than CIN2) and disease persistence (CIN2, CIN3 or ACIS). RESULTS Follow-up data were available for 2417 women of whom 924 (38.2%) were 'conservatively' managed. In all, 152 (16.4%) conservatively managed women had a lesion more severe than CIN2 detected within 24 months of initial diagnosis, of which 144 were CIN3 and eight were ACIS. There was no statistically significant association between rates of regression and patient age, Socio-economic Indexes for Areas or Accessibility/Remoteness Index of Australia indices. The 2-year regression rate for CIN2 was estimated to be 59.5% (95%CI 0.5-0.6) in this cohort of women. CONCLUSION In conservatively managed young women with CIN2 there was a high rate of spontaneous disease regression. Thus, excisional or ablative treatments may be avoided in selected patients who receive appropriate counseling and who are able to comply with more intensive and prolonged follow-up requirements.
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Affiliation(s)
- Aime Munro
- Institute of Health Research, University of Notre Dame Australia, Fremantle, WA, Australia.,St John of God Hospital Bendat Family Comprehensive Cancer Centre, Subiaco, WA, Australia.,Centre for Population Health Research, Curtin University, Bentley, WA, Australia
| | - Rhys G Powell
- Centre for Population Health Research, Curtin University, Bentley, WA, Australia.,School of Medicine, University of Notre Dame Australia, Fremantle, WA, Australia
| | - Paul A Cohen
- Institute of Health Research, University of Notre Dame Australia, Fremantle, WA, Australia.,St John of God Hospital Bendat Family Comprehensive Cancer Centre, Subiaco, WA, Australia.,School of Women's and Infants' Health Research, University of Western Australia, Crawley, WA, Australia
| | - Shirley Bowen
- School of Medicine, University of Notre Dame Australia, Fremantle, WA, Australia
| | - Katrina Spilsbury
- Centre for Population Health Research, Curtin University, Bentley, WA, Australia
| | - Peter O'Leary
- Faculty of Health Science, Curtin University, Bentley, WA, Australia
| | - James B Semmens
- Centre for Population Health Research, Curtin University, Bentley, WA, Australia
| | - Jim Codde
- Institute of Health Research, University of Notre Dame Australia, Fremantle, WA, Australia
| | - Vincent Williams
- School of Biomedical Sciences, Curtin University, Bentley, WA, Australia
| | - Nerida Steel
- WA Cervical Cancer Prevention Program, Perth, WA
| | - Yee Leung
- School of Women's and Infants' Health Research, University of Western Australia, Crawley, WA, Australia
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Diagnosis and Management of Precancerous Cervical Lesions. CURRENT OBSTETRICS AND GYNECOLOGY REPORTS 2014. [DOI: 10.1007/s13669-014-0083-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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