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Armstrong GM, Ragupathy K. Test of cure and beyond: superiority of thermal ablation over LLETZ in the treatment of high-grade CIN. Arch Gynecol Obstet 2022; 306:1815-1820. [PMID: 35107616 PMCID: PMC9519675 DOI: 10.1007/s00404-022-06409-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 01/12/2022] [Indexed: 11/26/2022]
Abstract
Purpose Among the treatment modalities for high-grade cervical intraepithelial neoplasia (CIN), large-loop excision of the transformation zone (LLETZ) is the commonest offered in the UK, whereas thermal ablation (TA) has not been common in several decades, despite several notable advantages. TA and LLETZ are both routinely undertaken in our colposcopy unit, and extensive follow-up data have been used to interrogate outcomes between the two modalities and determine whether one modality may be preferred over the other. Methods Up to 8 years of follow-up data (cytology and histology) were collected for patients who have undergone LLETZ or TA and failed post-treatment test of cure (ToC). These data were analysed and used to plot Kaplan–Meier survival curves, in order to compare outcomes: negative cytology, dyskaryosis, low- and high-grade CIN and invasive squamous cell carcinoma. Results i) Very few women treated with TA developed recurrent high-grade CIN in the follow-up period; (ii) LLETZ-treated women had a significantly higher rate of recurrence than those treated by TA; (iii) women who failed both virology and cytology components of post-treatment ToC had higher recurrence than those who failed only one, and the rate of recurrence was highest in those treated by LLETZ (> 65%). Conclusion TA is an effective treatment of high-grade CIN, with a high chance of achieving double-negative ToC and low recurrence relative to LLETZ. We recommend the wider adoption of TA, so that young women of reproductive age have a choice of treatment with no reported adverse effects on pregnancy outcomes.
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Affiliation(s)
| | - K Ragupathy
- Obstetrics and Gynaecology Department, NHS Tayside, Ninewells Hospital, Dundee, UK
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2
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Ragupathy K, Jayasinghe T, McMullen W. Thermal Ablation of High-Grade Premalignant Disease of the Cervix-Standing the Test of Time: A Retrospective Study. J Low Genit Tract Dis 2022; 26:27-31. [PMID: 34928251 DOI: 10.1097/lgt.0000000000000638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Analyze long-term (20 years) cytology and histology outcomes after treatment of high-grade cervical intraepithelial neoplasia (HGCIN) with thermal ablation (TA). METHODS All women having TA for HGCIN between January 1996 and December 1998 (36 months; N = 885) were identified; data were collected on age of patients, symptoms, colposcopy findings, and biopsy reports. Local and national (cytology and colposcopy) databases and colposcopy records were used to collect long-term follow-up data. Probability of CIN recurrence was assessed using Kaplan-Meier "survival" curve. RESULTS Follow-up data (available for 796) was collected in 2018 capturing 20 years of follow-up data. Two hundred eighty-one women were treated for CIN 2 and 515 women for CIN 3. Seven hundred ninety-one of 796 (>99%) were treated at first visit. Two hundred sixty two of 796 (33%) had evidence of crypt involvement on pretreatment biopsy. Probability of having consistently normal cytological follow-up was 92%, 89%, 86%, and 83% at 5, 10, 15, and 20 years, respectively. Cumulative probability of having recurrent HGCIN was 0.5% at 5 years, 1% at 10 years, 1.9% at 15 years, and 3% at 18 years. There was 1 invasive squamous cell cancer at 11 years after treatment. CONCLUSIONS Thermal ablation is a safe and effective treatment for HGCIN, which is now shown to have stood the test of time. We advise more widespread adoption in the United Kingdom and globally so long as agreed criteria are met.
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Affiliation(s)
- Kalpana Ragupathy
- Gynaecology Department, NHS Tayside, Ninewells Hospital, Dundee, United Kingdom
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3
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Mueller JL, Morhard R, DeSoto M, Chelales E, Yang J, Nief C, Crouch B, Everitt J, Previs R, Katz D, Ramanujam N. Optimizing ethyl cellulose-ethanol delivery towards enabling ablation of cervical dysplasia. Sci Rep 2021; 11:16869. [PMID: 34413378 PMCID: PMC8376953 DOI: 10.1038/s41598-021-96223-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 08/05/2021] [Indexed: 11/08/2022] Open
Abstract
In low-income countries, up to 80% of women diagnosed with cervical dysplasia do not return for follow-up care, primarily due to treatment being inaccessible. Here, we describe development of a low-cost, portable treatment suitable for such settings. It is based on injection of ethyl cellulose (EC)-ethanol to ablate the transformation zone around the os, the site most impacted by dysplasia. EC is a polymer that sequesters the ethanol within a prescribed volume when injected into tissue, and this is modulated by the injected volume and delivery parameters (needle gauge, bevel orientation, insertion rate, depth, and infusion rate). Salient injection-based delivery parameters were varied in excised swine cervices. The resulting injection distribution volume was imaged with a wide-field fluorescence imaging device or computed tomography. A 27G needle and insertion rate of 10 mm/s achieved the desired insertion depth in tissue. Orienting the needle bevel towards the outer edge of the cervix and keeping infusion volumes ≤ 500 µL minimized leakage into off-target tissue. These results guided development of a custom hand-held injector, which was used to locate and ablate the upper quadrant of a swine cervix in vivo with no adverse events or changes in host temperature or heart rate. After 24 h, a distinct region of necrosis was detected that covered a majority (> 75%) of the upper quadrant of the cervix, indicating four injections could effectively cover the full cervix. The work here informs follow up large animal in vivo studies, e.g. in swine, to further assess safety and efficacy of EC-ethanol ablation in the cervix.
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Affiliation(s)
- Jenna L Mueller
- Department of Bioengineering, University of Maryland, 3102 A. James Clark Hall, 8278 Paint Branch Drive, College Park, MD, 20742, USA.
- Marlene and Stewart Greenebaum Cancer Center, University of Maryland School of Medicine, Baltimore, MD, USA.
| | - Robert Morhard
- Department of Biomedical Engineering, Duke University, Durham, NC, USA
| | - Michael DeSoto
- Department of Biomedical Engineering, Duke University, Durham, NC, USA
| | - Erika Chelales
- Department of Biomedical Engineering, Duke University, Durham, NC, USA
| | - Jeffrey Yang
- Department of Bioengineering, University of Maryland, 3102 A. James Clark Hall, 8278 Paint Branch Drive, College Park, MD, 20742, USA
| | - Corrine Nief
- Department of Biomedical Engineering, Duke University, Durham, NC, USA
| | - Brian Crouch
- Department of Biomedical Engineering, Duke University, Durham, NC, USA
| | - Jeffrey Everitt
- Department of Pathology, Duke University School of Medicine, Durham, NC, USA
| | - Rebecca Previs
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Duke University Medical Center, Durham, NC, USA
| | - David Katz
- Department of Biomedical Engineering, Duke University, Durham, NC, USA
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Duke University Medical Center, Durham, NC, USA
| | - Nimmi Ramanujam
- Department of Biomedical Engineering, Duke University, Durham, NC, USA
- Duke Global Health Institute, Duke University, Durham, NC, USA
- Department of Pharmacology and Cancer Biology, Duke University, Durham, NC, USA
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4
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Fokom Domgue J, Futuh B, Ngalla C, Kakute P, Manjuh F, Manga S, Nulah K, Welty E, Schmeler K, Welty T. Feasibility of a community‐based cervical cancer screening with “test and treat” strategy using self‐sample for an HPV test: Experience from rural Cameroon, Africa. Int J Cancer 2019; 147:128-138. [PMID: 31633801 DOI: 10.1002/ijc.32746] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Revised: 09/16/2019] [Accepted: 10/02/2019] [Indexed: 12/24/2022]
Affiliation(s)
- Joel Fokom Domgue
- Department of Gynecologic Oncology and Reproductive MedicineThe University of Texas MD Anderson Cancer Center Houston TX
- Department of Obstetrics and GynecologyFaculty of Medicine and Biomedical Sciences, University of Yaoundé Yaoundé Cameroon
| | - Beatrice Futuh
- Cameroon Baptist Convention Health Services Bamenda North West Region Cameroon
| | - Calvin Ngalla
- Cameroon Baptist Convention Health Services Bamenda North West Region Cameroon
| | - Peter Kakute
- Cameroon Baptist Convention Health Services Bamenda North West Region Cameroon
| | - Florence Manjuh
- Cameroon Baptist Convention Health Services Bamenda North West Region Cameroon
| | - Simon Manga
- Cameroon Baptist Convention Health Services Bamenda North West Region Cameroon
| | - Kathleen Nulah
- Cameroon Baptist Convention Health Services Bamenda North West Region Cameroon
| | - Edith Welty
- Cameroon Baptist Convention Health Services Bamenda North West Region Cameroon
| | - Kathleen Schmeler
- Department of Gynecologic Oncology and Reproductive MedicineThe University of Texas MD Anderson Cancer Center Houston TX
| | - Thomas Welty
- Cameroon Baptist Convention Health Services Bamenda North West Region Cameroon
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Chin-Hong PV, Reid GE. Human papillomavirus infection in solid organ transplant recipients: Guidelines from the American Society of Transplantation Infectious Diseases Community of Practice. Clin Transplant 2019; 33:e13590. [PMID: 31077438 DOI: 10.1111/ctr.13590] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2019] [Accepted: 05/06/2019] [Indexed: 02/06/2023]
Abstract
These guidelines from the American Society of Transplantation Infectious Diseases Community of Practice update the epidemiology and management of human papillomavirus (HPV) infections in organ transplant recipients. HPV is one of the most common sexually transmitted infections and is associated with cancers of the anogenital region. Increasing evidence suggests an association with head and neck cancers as well. Solid organ transplant recipients have a higher risk of HPV infection than the general population. Infection manifests as premalignant lesions, warts, or cancer of the cervix, penis, vulva, scrotum, and anal canal. Most are asymptomatic initially, so diagnosis can be difficult without screening. A vaccine is available though not effective in preventing all cancer-causing strains. Organ transplant recipients should be screened for HPV-associated cancers and appropriate therapy initiated in a timely manner. Further studies are warranted to delineate the most effective screening methods and therapeutic modalities, including whether changes in immunosuppression are effective in attenuating disease.
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Affiliation(s)
- Peter V Chin-Hong
- Division of Infectious Diseases, University of California at San Francisco, San Francisco, California
| | - Gail E Reid
- Division of Infectious Diseases, Loyola University Medical Center, Maywood, Illinois
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6
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Abstract
Human papillomavirus (HPV) is a common infection in kidney transplant recipients. HPV causes cervical, anal, vulvar, vaginal, penile and head and neck cancers. Kidney transplant recipients have a disproportionate burden of disease given prolonged immunosuppression. Given the long pre-invasive state of precancer lesions such as cervical intraepithelial neoplasia (CIN) and anal intraepithelial neoplasia (AIN) most HPV-cancers are preventable with screening and targeted treatment of disease. Pre-transplant vaccination of age-eligible kidney transplant recipients is otherwise ideal.
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Affiliation(s)
- Peter V Chin-Hong
- Division of Infectious Diseases, Department of Medicine, University of California, San Francisco, San Francisco, CA.
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7
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Maza M, Schocken CM, Bergman KL, Randall TC, Cremer ML. Cervical Precancer Treatment in Low- and Middle-Income Countries: A Technology Overview. J Glob Oncol 2017; 3:400-408. [PMID: 28831448 PMCID: PMC5560450 DOI: 10.1200/jgo.2016.003731] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Cervical cancer is the fourth leading cause of cancer-related death in women worldwide, with 90% of cases occurring in low- and middle-income countries (LMICs). There has been a global effort to increase access to affordable screening in these settings; however, a corresponding increase in availability of effective and inexpensive treatment modalities for ablating or excising precancerous lesions is also needed to decrease mortality. This article reviews the current landscape of available and developing technologies for treatment of cervical precancer in LMICs. At present, the standard treatment of most precancerous lesions in LMICs is gas-based cryotherapy. This low-cost, effective technology is an expedient treatment in many areas; however, obtaining and transporting gas is often difficult, and unwieldy gas tanks are not conducive to mobile health campaigns. There are several promising ablative technologies in development that are gasless or require less gas than conventional cryotherapy. Although further evaluation of the efficacy and cost-effectiveness is needed, several of these technologies are safe and can now be implemented in LMICs. Nonsurgical therapies, such as therapeutic vaccines, antivirals, and topical applications, are also promising, but most remain in early-stage trials. The establishment of evidence-based standardized protocols for available treatments and the development and introduction of novel technologies are necessary steps in overcoming barriers to treatment in LMICs and decreasing the global burden of cervical cancer. Guidance from WHO on emerging treatment technologies is also needed.
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Affiliation(s)
- Mauricio Maza
- Mauricio Maza, Katherine L. Bergman, and Miriam L. Cremer, Basic Health International, New York, NY; Celina M. Schocken, Pink Ribbon Red Ribbon, Washington, DC; Thomas C. Randall, National Cancer Institute, Massachusetts General Hospital, Boston, MA; and Miriam L. Cremer, Cleveland Clinic, Cleveland, OH
| | - Celina M. Schocken
- Mauricio Maza, Katherine L. Bergman, and Miriam L. Cremer, Basic Health International, New York, NY; Celina M. Schocken, Pink Ribbon Red Ribbon, Washington, DC; Thomas C. Randall, National Cancer Institute, Massachusetts General Hospital, Boston, MA; and Miriam L. Cremer, Cleveland Clinic, Cleveland, OH
| | - Katherine L. Bergman
- Mauricio Maza, Katherine L. Bergman, and Miriam L. Cremer, Basic Health International, New York, NY; Celina M. Schocken, Pink Ribbon Red Ribbon, Washington, DC; Thomas C. Randall, National Cancer Institute, Massachusetts General Hospital, Boston, MA; and Miriam L. Cremer, Cleveland Clinic, Cleveland, OH
| | - Thomas C. Randall
- Mauricio Maza, Katherine L. Bergman, and Miriam L. Cremer, Basic Health International, New York, NY; Celina M. Schocken, Pink Ribbon Red Ribbon, Washington, DC; Thomas C. Randall, National Cancer Institute, Massachusetts General Hospital, Boston, MA; and Miriam L. Cremer, Cleveland Clinic, Cleveland, OH
| | - Miriam L. Cremer
- Mauricio Maza, Katherine L. Bergman, and Miriam L. Cremer, Basic Health International, New York, NY; Celina M. Schocken, Pink Ribbon Red Ribbon, Washington, DC; Thomas C. Randall, National Cancer Institute, Massachusetts General Hospital, Boston, MA; and Miriam L. Cremer, Cleveland Clinic, Cleveland, OH
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8
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Kunckler M, Schumacher F, Kenfack B, Catarino R, Viviano M, Tincho E, Tebeu PM, Temogne L, Vassilakos P, Petignat P. Cervical cancer screening in a low-resource setting: a pilot study on an HPV-based screen-and-treat approach. Cancer Med 2017; 6:1752-1761. [PMID: 28580596 PMCID: PMC5504339 DOI: 10.1002/cam4.1089] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Revised: 03/30/2017] [Accepted: 03/31/2017] [Indexed: 01/24/2023] Open
Abstract
Cervical cancer (CC) is the leading cause of cancer‐related death among women in sub‐Saharan Africa, primarily because of limited access to effective screening and preventive treatment. Our aim was to assess the feasibility of a human papillomavirus (HPV)‐based CC screen‐and‐treat approach in a low‐resource context. We recruited 1012 women aged 30–49 years through a CC screening campaign conducted in the District Hospital of Dschang, Cameroon. Participants performed HPV self‐sampling, which was tested for high‐risk HPV (HR‐HPV) DNA using the point‐of‐care Xpert HPV assay. All HPV‐positive women were invited for visual inspection with acetic acid and Lugol's iodine (VIA/VILI) to exclude CC or enable triage. A cervical sample for histological analysis was also collected. Women positive for HPV 16/18/45 and for other HR‐HPV with pathological VIA/VILI were selected to undergo treatment with thermocoagulation. The HPV prevalence in the study population was 18.5% (n = 187); of these cases, 20 (10.6%), 42 (22.3%) and 140 (74.9%) were positive for HPV16, HPV18/45 and other HR‐HPV types, respectively. Overall, 107/185 (57.8%) VIA/VILI examinations were classified as pathological and 78 (42.2%) as normal. Women positive for HPV16/18/45 were 4.2 times more likely to harbor cervical intraepithelial neoplasia grade 2 or worse (CIN2+) than those with other HPV types. The specificity of HPV 16/18/45 genotypes for detection of high‐grade lesions among HR‐HPV positive women was higher than that of VIA/VILI in all age groups. The sensitivity and specificity of VIA/VILI in detecting CIN2+ among HPV positive women were 80% and 44%, respectively. Overall, 110/121 screen‐positive women (90.9%) were eligible for, and were treated with, thermocoagulation. An HPV‐based screen‐and‐treat approach is feasible in a low‐resource context and may contribute to improving the effectiveness of CC prevention programs. Immediate thermocoagulation treatment for women who are HPV16‐ and/or HPV18/45‐positive is a practical approach for the treatment of CIN2+. The combination of HPV‐testing and VIA/VILI for CC screening might reduce overtreatment.
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Affiliation(s)
- Margot Kunckler
- Gynecology Division, Department of Obstetrics and Gynecology, University Hospitals of Geneva, Geneva, Switzerland
| | - Fanny Schumacher
- Gynecology Division, Department of Obstetrics and Gynecology, University Hospitals of Geneva, Geneva, Switzerland
| | - Bruno Kenfack
- Department of Biomedical Sciences, University of Dschang, Dschang District Hospital, Dschang, Cameroon
| | - Rosa Catarino
- Gynecology Division, Department of Obstetrics and Gynecology, University Hospitals of Geneva, Geneva, Switzerland
| | - Manuela Viviano
- Gynecology Division, Department of Obstetrics and Gynecology, University Hospitals of Geneva, Geneva, Switzerland
| | - Eveline Tincho
- Faculty of Medicine and Biomedical Sciences, Centre Hospitalier Universitaire (CHUY), Yaoundé, Cameroon
| | - Pierre-Marie Tebeu
- Faculty of Medicine and Biomedical Sciences, Centre Hospitalier Universitaire (CHUY), Yaoundé, Cameroon
| | - Liliane Temogne
- Faculty of Medicine and Biomedical Sciences, Centre Hospitalier Universitaire (CHUY), Yaoundé, Cameroon
| | - Pierre Vassilakos
- Geneva Foundation for Medical Education and Research, Geneva, Switzerland
| | - Patrick Petignat
- Gynecology Division, Department of Obstetrics and Gynecology, University Hospitals of Geneva, Geneva, Switzerland
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9
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Viviano M, Kenfack B, Catarino R, Tincho E, Temogne L, Benski AC, Tebeu PM, Meyer-Hamme U, Vassilakos P, Petignat P. Feasibility of thermocoagulation in a screen-and-treat approach for the treatment of cervical precancerous lesions in sub-Saharan Africa. BMC WOMENS HEALTH 2017; 17:2. [PMID: 28061842 PMCID: PMC5219781 DOI: 10.1186/s12905-016-0355-x] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Accepted: 12/08/2016] [Indexed: 12/28/2022]
Abstract
BACKGROUND The use of thermocoagulation for the treatment of cervical precancerous lesions has recently generated a great deal of interest. Our aim was to determine the feasibility of this outpatient procedure in the context of a cervical cancer (CC) screen-and-treat campaign in sub-Saharan Africa. METHODS Between July and December 2015, women living in the area of Dschang (Cameroon) aged between 30 and 49 years, were enrolled in a CC screening study. HPV self-sampling was performed as a primary screening test and women who were either "HPV 16/18/45-positive" or "positive to other HPV types and to VIA" were considered screen-positive, thus requiring further management. The primary outcome was the percentage of screen-positive patients who met the criteria to undergo thermocoagulation. The secondary outcome was the assessment of the procedure's side effects immediately after treatment and at the 1-month follow-up visit. RESULTS A total of 1012 women were recruited in the study period. Among 121 screen-positive women, 110 of them (90.9%) were eligible to be treated with thermocoagulation. No patients discontinued treatment because of pain or other side effects. The mean ± SD (Standard Deviation) score measured on the 10-point Visual Analogue Scale (VAS) was 3.0 ± 1.6. Women having less than 2 children were more likely to report a higher pain score than those with more than two (4.2 ± 2.0 versus 2.9 ± 1.5, respectively; p value = 0.016). A total of 109/110 (99.1%) patients came to the 1-month follow-up visit. Vaginal discharge was reported in 108/109 (99.1%) patients throughout the month following treatment. Three patients (2.8%) developed vaginal infection requiring local antibiotics. No hospitalizations were required. CONCLUSION The majority of screen-positive women met the criteria and could be treated by thermocoagulation. The procedure was associated to minor side effects and is overall feasible in the context of a CC screen-and-treat campaign in sub-Saharan Africa. TRIAL REGISTRATION The trial was retrospectively registered on November 11, 2015 with the identifier: ISRCTN99459678 .
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Affiliation(s)
- Manuela Viviano
- Division of Gynaecology, Department of Gynaecology and Obstetrics, Geneva University Hospitals, Geneva, Switzerland. .,Division of Gynecology, Geneva University Hospitals, Boulevard de la Cluse 30, 1205, Geneva, Switzerland.
| | - Bruno Kenfack
- Department of Biomedical Sciences, University of Dschang, Dschang, Cameroon
| | - Rosa Catarino
- Division of Gynaecology, Department of Gynaecology and Obstetrics, Geneva University Hospitals, Geneva, Switzerland
| | - Eveline Tincho
- Department of Biomedical Sciences, University of Dschang, Dschang, Cameroon
| | - Liliane Temogne
- Department of Biomedical Sciences, University of Dschang, Dschang, Cameroon
| | - Anne-Caroline Benski
- Division of Gynaecology, Department of Gynaecology and Obstetrics, Geneva University Hospitals, Geneva, Switzerland.,Saint Damien Medical Centre, Ambanja, Madagascar
| | - Pierre-Marie Tebeu
- Department of Gynecology and Obstetrics, University Centre Hospital, Yaoundé, Cameroon
| | - Ulrike Meyer-Hamme
- Division of Gynaecology, Department of Gynaecology and Obstetrics, Geneva University Hospitals, Geneva, Switzerland
| | - Pierre Vassilakos
- Geneva Foundation for Medical Education and Research, Geneva, Switzerland
| | - Patrick Petignat
- Division of Gynaecology, Department of Gynaecology and Obstetrics, Geneva University Hospitals, Geneva, Switzerland
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10
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Oga EA, Brown JP, Brown C, Dareng E, Adekanmbi V, Odutola M, Olaniyan O, Offiong R, Obende K, Adewole AS, Peter A, Dakum P, Adebamowo C. Recurrence of cervical intraepithelial lesions after thermo-coagulation in HIV-positive and HIV-negative Nigerian women. BMC WOMENS HEALTH 2016; 16:25. [PMID: 27169666 PMCID: PMC4864941 DOI: 10.1186/s12905-016-0304-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/04/2015] [Accepted: 05/04/2016] [Indexed: 01/30/2023]
Abstract
BACKGROUND The burden of cervical cancer remains huge globally, more so in sub-Saharan Africa. Effectiveness of screening, rates of recurrence following treatment and factors driving these in Africans have not been sufficiently studied. The purpose of this study therefore was to investigate factors associated with recurrence of cervical intraepithelial lesions following thermo-coagulation in HIV-positive and HIV-negative Nigerian women using Visual Inspection with Acetic Acid (VIA) or Lugol's Iodine (VILI) for diagnosis. METHODS A retrospective cohort study was conducted, recruiting participants from the cervical cancer "see and treat" program of IHVN. Data from 6 sites collected over a 4-year period was used. Inclusion criteria were: age ≥18 years, baseline HIV status known, VIA or VILI positive and thermo-coagulation done. Logistic regression was performed to examine the proportion of women with recurrence and to examine factors associated with recurrence. RESULTS Out of 177 women included in study, 67.8 % (120/177) were HIV-positive and 32.2 % (57/177) were HIV-negative. Recurrence occurred in 16.4 % (29/177) of participants; this was 18.3 % (22/120) in HIV-positive women compared to 12.3 % (7/57) in HIV-negative women but this difference was not statistically significant (p-value 0.31). Women aged ≥30 years were much less likely to develop recurrence, adjusted OR = 0.34 (95 % CI = 0.13, 0.92). Among HIV-positive women, CD4 count <200cells/mm(3) was associated with recurrence, adjusted OR = 5.47 (95 % CI = 1.24, 24.18). CONCLUSION Recurrence of VIA or VILI positive lesions after thermo-coagulation occurs in a significant proportion of women. HIV-positive women with low CD4 counts are at increased risk of recurrent lesions and may be related to immunosuppression.
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Affiliation(s)
- Emmanuel A Oga
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD, 21201, USA. .,Institute of Human Virology Nigeria (IHVN), Abuja, Nigeria.
| | - Jessica P Brown
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD, 21201, USA
| | - Clayton Brown
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD, 21201, USA
| | - Eileen Dareng
- Institute of Human Virology Nigeria (IHVN), Abuja, Nigeria.,Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | | | | | | | | | | | | | | | - Patrick Dakum
- Institute of Human Virology Nigeria (IHVN), Abuja, Nigeria
| | - Clement Adebamowo
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD, 21201, USA.,Institute of Human Virology Nigeria (IHVN), Abuja, Nigeria.,University of Maryland Marlene and Stewart Greenebaum Cancer Center, Baltimore, MD, USA.,Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, USA
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11
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Dolman L, Sauvaget C, Muwonge R, Sankaranarayanan R. Meta-analysis of the efficacy of cold coagulation as a treatment method for cervical intraepithelial neoplasia: a systematic review. BJOG 2014; 121:929-42. [PMID: 24597779 DOI: 10.1111/1471-0528.12655] [Citation(s) in RCA: 86] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/01/2013] [Indexed: 11/30/2022]
Abstract
BACKGROUND Cold coagulation is an ablative method for treatment of cervical intraepithelial neoplasia (CIN). Despite reports of efficacy against all grades of CIN (CIN1-3), cold coagulation has been infrequently used since the 1980s, and was absent from the recent Cochrane review on CIN treatment. OBJECTIVES To provide a systematic review of cold coagulation efficacy and acceptability for CIN treatment through meta-analysis of clinical reports and a randomised control trial. SEARCH STRATEGY A literature search in PubMed, Web of Science, EMBASE, and regional databases yielded 388 papers. Title, abstract and/or reference list review identified 22 papers describing cold coagulation treatment of CIN, with 13 providing adequate data for inclusion in the meta-analysis. SELECTION CRITERIA Publications or conference abstracts describing original data (number of women treated, followed up and cured, provider type, cure definition) were retained. No language or publication date limitations were imposed. DATA COLLECTION AND ANALYSIS Data extracted from 13 studies were pooled, and statistical analyses of proportion cured were conducted with data stratified by lesion grade and study region. MAIN RESULTS Among 4569 CIN patients treated with cold coagulation, summary proportion cured of 96% [95% confidence interval (CI) 92-99%] and 95% (92-98%) were obtained for CIN1 and CIN2-3 disease, respectively. Side-effects and adverse effects were infrequent, and fertility was not impaired. CONCLUSIONS Cold coagulation CIN cure rates were comparable to those of other excisional and ablative methods. Cold coagulation is indicated for all grades of CIN, is safe, quick and acceptable, and may be of particular relevance for use in resource-limited settings.
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Affiliation(s)
- L Dolman
- Department of Human Genetics, McGill University, Montreal, QC, Canada
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12
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Chin-Hong PV, Kwak EJ. Human papillomavirus in solid organ transplantation. Am J Transplant 2013; 13 Suppl 4:189-200. [PMID: 23465011 DOI: 10.1111/ajt.12142] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Affiliation(s)
- P V Chin-Hong
- Division of Infectious Diseases, University of California at San Francisco, San Francisco, CA, USA.
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Allam M, Paterson A, Thomson A, Ray B, Rajagopalan C, Sarkar G. Large loop excision and cold coagulation for management of cervical intraepithelial neoplasia. Int J Gynaecol Obstet 2004; 88:38-43. [PMID: 15617703 DOI: 10.1016/j.ijgo.2004.09.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2004] [Revised: 09/16/2004] [Accepted: 09/22/2004] [Indexed: 10/26/2022]
Abstract
OBJECTIVES To evaluate the efficacy of large loop excision of the transformation zone (LLETZ) combined with a single application of the cone probe of a Semm Cold Coagulator as a new treatment for women with cervical intraepithelial neoplasia (CIN). METHODS Retrospective case-record review of 666 women treated with large loop excision and cold coagulation (LLECC) from 1992 to 2000. RESULTS Of the women who had high-grade CIN at their initial consultation, 4.2% had abnormal cytologic results 6 months after treatment and 0.6% had abnormal cytologic results at 12 months. Of the women who had low-grade CIN at initial presentation, 3.8% had abnormal cytologic results 6 months after treatment and none (0%) at 12 months. Furthermore, there were no reported cases of cervical cancer in this cohort of women during the follow-up period. Short-term bleeding complications (within 24 h of the procedure) occurred in 1% of the women assessed. CONCLUSIONS Large loop excision combined with cold coagulation is a new and effective treatment for CIN. Randomized controlled trials are required to confirm these findings and determine the long-term safety of the technique.
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Affiliation(s)
- M Allam
- Department of Obstetrics and Gynaecology, Royal Alexandra Hospital, Corsebar Road, Paisley, PA2 9PN, UK
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