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Introduction: Tubal dysfunction is a leading factor in female infertility. Laparoscopy dye is the gold standard to detect tubal patency (laparoscopic chromohydrotubation, LSC-CHT), but hysterosalpingography (HSG) and hystero-contrast-sonography (HyCoSy) are also widely applied. Using office hysteroscopy guided selective chromopertubation (OHSC-SPT) we aimed to develop a less invasive effective and reproducible method, which can be performed in an outpatient setting without anesthesia.Material and Methods: 23 infertile patients (mean age: 32,77 ? 3,42) were examined before planned laparoscopy. A 2.7 mm optic was used, with a 5.5 mm sheath (EMD Endoscopy Technologies). A 1.7 mm diameter flexible plastic catheter (Cavafix, B-Braun) was introduced through an inbuilt channel of the sheath. Normal saline was used for the distension. The hysteroscope was introduced without grasping or dilatation of the cervix. A diagnostic hysteroscopy is performed first, then the catheter is inserted through the working channel and the tip of it is placed into the tubal orifice, through which methylene blue dye is injected slowly. In the absence of tubal occlusion the blue dye does not appear in the uterine cavity and normal color of the endometrium is seen. With damaged tubal patency the distension media of the uterine cavity turns blue, according to the backflow of the methylene blue. Laparoscopic standard tubal CHT was then performed by an operator uninformed about the OHSC-SPT results and the result were then compared.Results: Both tubes of the 23 patient were examined (N = 46). In 43 cases (93.5%) either there was an agreement with the laparoscopic findings or (5 cases, 11.6%) in spite of presence of the dye in the abdominal cavity, patency couldn't be proved properly at the time of laparoscopy. Three tubes (3 out of 41, 7,3%) were found patent with laparoscopy and were found occluded according to the OHSC-SPT. All of these false positive cases occurred at the beginning of the learning curve.Conclusion: The novel method of OHSC-SPT is an effective, highly minimal invasive method to investigate the tubal patency, which can be performed in an office setting without anesthesia. The OHSC-SPT negative/LSC-CHT positive cases suggest especially high sensitivity for tubal patency, but this finding requires further confirmation

We have investigated the expression of the aspartic proteinase cathepsin E and HLA-DR and the presence of HPV16 in normal squamous epithelium (n = 8) and low-grade (n = 21) and high-grade (n = 14) intraepithelial squamous lesions of the uterine cervix. Immunohistochemistry of cervical biopsies revealed that up-regulation of cathepsin E expression was related to increasing severity of the cervical intraepithelial neoplasia (CIN). Up-regulation of protein was associated with increased message as assessed by in situ hybridization. Langerhans cells and the majority of koilocytes did not express detectable cathepsin E levels. Although there was also an up-regulation of HLA-DR expression by cervical keratinocytes in cervical intraepithelial neoplasia lesions, as determined by immunohistochemistry, no significant correlation was found between HLA-DR and cathepsin E expression in these lesions; neither was expression of cathepsin E correlated to the presence of HPV16, detected by polymerase chain reaction. The expression of cathepsin E, an aspartic proteinase that is reported to play a role in antigen processing for presentation by class II major histocompatibility complex molecules, is associated with cellular dedifferentiation in cervical intraepithelial neoplasia.

The incidence of endometrial cancer is rising. Measures to identify women at risk and to detect endometrial cancer earlier are required to reduce the morbidity triggered by the aggressive treatment required for advanced endometrial cancer. We developed the WID-EC (Women's cancer risk IDentification-Endometrial Cancer) test, which is based on DNA methylation at 500 CpG sites, in a discovery set of cervical liquid-based cytology samples from 1,086 women with and without an endometrial cancer (217 cancer cases and 869 healthy controls) with a worse prognosis (grade 3 or ≥stage IB). We validated the WID-EC test in an independent external validation set of 64 endometrial cancer cases and 225 controls. We further validated the test in 150 healthy women (prospective set) who provided a cervical sample as part of the routine Swedish cervical screening programme, 54 of whom developed endometrial cancer within three years of sample collection. The WID-EC test identified women with endometrial cancer with a receiver operator characteristic area under the curve (AUC) of 0.92 (95% CI: 0.88-0.97) in the external set and of 0.82 (95% CI: 0.74-0.89) in the prospective validation set. Using an optimal cutoff, cancer cases were detected with a sensitivity of 86% and a specificity of 90% in the external validation set, and a sensitivity and specificity of 52% and 98% respectively in the prospective validation set. The WID-EC test can identify women with or at risk of endometrial cancer. This article is protected by copyright. All rights reserved.