WEDNESDAY, SEPTEMBER 6 59
FC3.22.09
DIAGNOSTIC WORK-UP AND THERAPEUTIC MODALITIES FOR
PERSISTENT DYSFUNCTIONAL UTERINE BLEEDING (DUB)
M. M. Fathalla, H. Abdel-Aleem, I. El-Nashar, A. El-Samman,
Dept. OBIGYN, Faculty of Medicine, Assiut University, Assiut, Egypt.
Objectives: To evaluate a diagnostic work-up for DUB consisting of
D&C biopsy, diagnostic hysteroscopy, ultrasound examination, Doppler
and screening for thyroid, liver and blood diseases. Secondly, to
compare between the results of hysterectomy versus endometrial
ablation.
Study Methods: 82 patients with DUB who failed to respond
satisfactorly for a reasonable trial of medical, hormonal treatments and
several D&Q were evaluated using the items of the diagnostic work-
up. Treatment options (hysterectomy versus endometrial ablation) were
compared using computer package software (SPSS).
Results: Uterine polypi were diagnosed definitely by ultrasound only in
28.5% suspected in 5% and false negative results in 21.5% of cases.
Doppler indices were lower in cases with hyperplasia than proliferative
endometrium. Positive findings on hysteroscopy were found in 31 cases
(polyps in 41.9%, submucous fibroids 29% and polypoidal endometrium
in 12.9%). Thyroid disorders were found in 30 cases (3.6%) and blood
diseases in 3 (3.6%). 38 cases were treated with hysterectomy and 38
with electrosurgical ablation. Intraoperative and postoperative morbidity
are higher in the hysterectomy group. Postoperative hospital stay and
pain are less in the ablation group.
Conclusions: D&C has a false negative rate of 37.8%, hysteroscopic
examination proved to be an excellent method for detection of
intracavitary lesions. Transvaginal sonography is a single non-invasive
method of detection of gross uterine and ovarian abnormalities but has a
limited value in the diagnosis of small polypi. When the Doppler indices
were higher (285) the presence of simple hyperplasia was ~10% and
there were no organic lesions. Hysterectomy is an ultimate choice for
treatment of bleeding problems with an excellent satisfaction rate
(>90%). However, it is associated with relatively high morbidity and is
considered an overtreatment for benign conditions. Endometrial ablation
is an attractive, alternative line of treatment with less morbidity and
reasonable satisfaction rate of 80%.
FC3.23 LOWER GENITAL TRACT: INTRAEPITHELIAL
NEOPLASM
FC3.23.01
AVALIATION OF THE CERVICAL AND VAGINAL
INTRAEPITHELIAL NEOPLASIAS FOUND IN 3105
COLPOSCOPIES REALIZED IN CLASSES A AND B WOMEN
SK Aluerovitch, D. Alperovitch, Paul& Association of Medicine, SBo
Paula, Brazil.
Objective: The objective in this work is the study of frequency of CIN
and VAIN in 3.105 colposcopies realized in classes A and B women in
Saint Paul City.
Study Methods: The diagnosis was done by histopathological
examination obtained by directed biopsies.
Results: We found 06 cases of CIN (3 CIN I) and 03 cases of VAIN (2
VAIN I).
Conclusions: We concluded that in class A and B women the frequency
of CIN and VAIN occur in 0.19% and 0.09%, and the use of colposcopy
is important in cervical cancer prevention.
FC3.23.02
RISK FACTORS FOR HIGH RISK HPV TYPES AMONG 18-35
AGED WOMEN
R. Nadisauskiene, M. Kliucinskas, T. Spukaite, Z. Padaiga, Dept.
OBIGYN, Kaunas University of Medicine, Kaunas, Lithuania.
Objectives: The aim of the study was to evaluate risk factors for the
patients with high malignancy risk HPV types between 18-35 year old
women.
Study Method: 475 women participated in the cross sectional study.
Non-anonymous questionnaire with structured and open questions was
used, gynecological examination, Pap smear, Schiler test were done;
HPV was detected by Hybrid Capture testing.
Results: High malignancy risk HPV types were found in 29% of cases.
After logistic regression analysis we found out that significant risk
factors for high malignancy risk HPV types was sexual debut ~18 years
OR 2.07 CI (1.35-3.17); > 1 partner/year OR 2.17 CI (1.42-3.34);
smoking OR 2.73 CI (1.64-4.55); important risk factors were other STDs
e.g. syphilis OR 1.89 CI (0.46-7.89).
Conclusions: Risk factors for high malignancy risk HPV types are
similar to the risk factors for other STDs.
FC3.23.03
THE ROLE OF HUMAN PAPILLOMAVIRUS TESTING IN
CERVICAL SCREENING.
Paraskevaidis E’, Koliopoulos G’, Paschopoulos M’, Kontostolis E’,
Zikopoulos K’, Pappa L’, Malamou-Mitsi M’, Kalantaridou SN’,
Georgiou 13, Kitchener HC“, Lolis DE’.
‘Gynecologic Oncology Unit, Department of Obstetrics and
Gynecology; ‘Department of Cytopathology; and 3Laboratory of
Molecular Biology, Department of Obstetrics and Gynecology,
University of Ioannina School of Medicine, University Hospital,
Panepistimiou Avenue, 45500, Ioannina, Greece, “Department of
Obstetrics and Gynecology and Reproductive Health Care, St Mary’s
Hospital, Manchester, UK
Objective: To investigate whether human papillomavirus (HPV) testing
should be performed as a screening test along with Papanicolaou (pap)
smear for the detection of cervical intraepithelial neoplasia (GIN) lesions
not detected by pap smear.
Study Methods: HPV typing by using semi-quantitative PCRiELISA
(subtypes 16118 and 31133) was performed in 1000 women who were
self-referred for routine Pap-smear. Women were further referred for
colposcopy following a smear indicating squamous intraepithelial
lesions (SIL) or positive HPV testing. Large loop excision of the
transformation zone (LLETZ) was performed in all the women with
cytologic and colposcopic findings of SIL. Shallow loop excision of the
transformation zone was performed in women with positive HPV testing
and colposcopic impression of SIL.
Results: Pap smear examination was suggestive of HPV infection in
22.3% of the women, CINl in 2.1%, and CIN213 in 1.8%. LLETZ was
performed in 64 cases. Histologic evaluation revealed HPV infection in
3 cases (5%), CINl in 34 (53%), and CIN213 in 27 (42%). Positive HPV
typing was found in 46 (6%) of the remaining 738 women. Shallow loop
excision of the transformation zone was performed in 11 of the above 46
women due to colposcopic impression of SIL. Histologic examination
revealed HPV infection in 6 cases (55%), CINl in 4 (36%), and CIN213
in 1 (9%). Overall, pap test detected 94% of the cases with CIN (61 out
of 66) whereas HPV typing detected 6% (5 out of 66).
Conclusions: In a screening program, pap test detected 94% of women
with CIN. HPV typing resulted in the identification of 6% of women
with CIN which would have been missed by standard cytologic
screening. Randomized trials are required to determine the role of HPV
testing in cervical screening.
FC3.23.04
PAPANICOLAOU TEST RESULTS AND COLPOSCOPY FINDINGS
IN WOMEN WITH BACTERIAL VAGINOSIS
->
.I. Sisovic’ A. Georgijevi?, S. Djukic-Ivancevic’, M. Bujko3 ’
‘Gynecology Department of Outpatient Clinic Vozdovac, Belgrade,
Yugoslavia
‘Institute of Microbiology and Immunology, School of Medicine,
University of Belgrade, Yugoslavia
31nstitute of Public Health, School of Medicine, University of
Montenegro, Podgorica, Yugoslavia
Objectives: The aim of the study was to investigate what are
Papanicolaou test results and colposcopy findings in women with
bacterial vaginosis (BV).
Study methods: Ninety-six women of reproductive age were examined
in the Gynecology Department of one Belgrade Outpatient Clinic. The
pregnant women were excluded. Each woman was examined
gynecologically and with the colposcope, and for every woman the
Papanicolaou test was done and also microbiological analysis of her
vaginal secretion. Diagnosis of BV was made by Nugent criteria. Using
Nugent scoring system women were divided into three groups: women
with BV, women with intermedial vaginal flora and women without BV.