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ObjectiveTo evaluate whether compliance with European Society of Gynaecological Oncology (ESGO) surgery quality indicators impacts disease-free survival in patients undergoing radical hysterectomy for cervical cancer.MethodsIn this retrospective cohort study, 15 ESGO quality indicators were assessed in the SUCCOR database (patients who underwent radical hysterectomy for International Federation of Gynecology and Obstetrics (FIGO) stage 2009 IB1, FIGO 2018 IB1, and IB2 cervical cancer between January 2013 and December 2014), and the final score ranged between 0 and 16 points. Centers with more than 13 points were classified as high-quality indicator compliance centers. We constructed a weighted cohort using inverse probability weighting to adjust for the variables. We compared disease-free survival and overall survival using Cox proportional hazards regression analysis in the weighted cohort.ResultsA total of 838 patients were included in the study. The mean number of quality indicators compliance in this cohort was 13.6 (SD 1.45). A total of 479 (57.2%) patients were operated on at high compliance centers and 359 (42.8%) patients at low compliance centers. High compliance centers performed more open surgeries (58.4% vs 36.7%, pConclusionsPatients with early cervical cancer who underwent radical hysterectomy in centers with high compliance with ESGO quality indicators had a lower risk of recurrence and death.

Objective To evaluate the incidence of underlying serious gynaecological pathology in women referred to colposcopy with post-coital bleeding. Main outcome measures. Incidence of precancer and cancer. Methods A retrospective cohort study of women referred to colposcopy at a London hospital from January 2008-March 2015. Inclusion criteria are women with post-coital bleeding and the following cervical cytology history: negative; inadequate; never had. Multinomial logistic regression was used to assess for significant risk factors for cervical dysplasia and cancer. Results Overall, 635 women with either negative cytology (n = 436/68.7%), no previous cytology (n = 175/27.6%), or inadequate cytology (n = 24/3.8%) were referred to colposcopy for post-coital bleeding. The median age is 35 years (S.D. = 9.7 years). In 256 (40.3%) women, no cause was detected, and 322 (50.7%) women had a benign cause. Overall, 42 (6.6%) women had low-grade dysplasia, and eleven women had high-grade dysplasia (1.7%). Four women (0.6%) had cervical cancer; clinically evident cancer on speculum examination (n = 3); micro-invasive cancer (n = 1). Current smokers were significantly more likely to have HPV atypia (p = 0.015) or cervical intraepithelial neoplasm grade 1 (CIN1) p = 0.003. Advancing age was a significant risk factor for cervical cancer (p = 0.037). Conclusion All women with post-coital bleeding need an urgent speculum examination to rule out frank cervical cancer. Although most women had a benign cause for post-coital bleeding, around 2% had a colposcopy-aided diagnosis of either cervical precancer or cancer; therefore, referral of symptomatic women deserves consideration. HPV testing may reduce referrals to colposcopy for post-coital bleeding due to non-significant pathology in the future.

Atypical endometrial hyperplasia shows a high propensity to progress to endometrioid adenocarcinoma. Hysteroscopic biopsy represents a valid method for detection of this pre-neoplastic disease. This study assesses the accuracy of histological diagnosis of endometrial atypia in hysteroscopy with blind biopsy, in postmenopausal women with an endometrial thickness (ET) greater than 5 mm. In order, to determine the relationship between ET and atypia more precisely, ET was subdivided in three categories of 5–7 mm, ≥7–9 mm and >9 mm. Ninety-nine postmenopausal patients, aged 51–79 years, with abnormal uterine bleeding and an endometrial thickness >5 mm in whom a diagnosis of endometrial hyperplasia, with or without atypia, was established with hysteroscopy with biopsy, underwent subsequent hysterectomy. Hysteroscopy and biopsy were carried out using a blind endometrial biopsy guided by hysteroscopic findings. The results of biopsies and hysterectomy histology, for the presence of atypia, were compared. Sensitivity and likelihood ratio of hysteroscopic biopsy, as a diagnostic tool for detecting atypia, were calculated. The sensitivity in detecting atypia was 93.3 % corresponding to a negative likelihood ratio equal to 0.06. Univariate analysis did not show a significant association between atypia, age and/or endometrial thickness. The high sensitivity of hysteroscopic biopsy, corresponding to a strong negative likelihood ratio, made it a valid diagnostic tool for detecting atypia in postmenopausal women with abnormal uterine bleeding, hyperplasia and endometrial thickness >5 mm. There was no association between atypia and increase of endometrial thickness from 5 to >9 mm.

Objective.This study assesses the role of preoperative serum CA125 levels in the planning treatment options for women diagnosed with uterine cancer.Material and Method.Ninety five consecutive patients diagnosed with uterine cancer during a four-year period were identified. Age ranged from 35 to 89 years with a mean age of 69 years. The preoperative CA125 levels were dichotomised at 28 U/mL (using ROC analysis to identify the best discriminating threshold for 5-year survival). This level was then correlated with preoperative prognostic indicators: patient age, tumour grade, and histopathological tumour cell type. Survival data was plotted using Kaplan-Meier curves and analysed using the log-rank test. Univariate and multivariate analysis were performed to identify the predictors of overall survival.Results.The mean age of patients was 69 years (range: 35–89). On univariate analysis, the use of preoperative CA125 levels of greater or less than 28 U/mL correlated significantly with age(P=0.01), the grade of disease(P=0.02)and unfavourable tissue type(P=0.03). This threshold CA125 level had a sensitivity of 75%, specificity of 76%, positive predictive value of 35% and negative predicative value of 96.25%, and a likelihood ratio of 3.12 for predicting nodal disease. Using a threshold of preoperative CA125 level of 28 U/mL (area under curve: 0.60) was also a significant predictor of 5-year survival (log-rank test,P=0.01). Using Cox multivariate survival analysis to identify predictive preoperative factors overall, unfavourable cell type was the strongest predictor of survival (Chi square = 36.5, df = 4, andP=0.001), followed by preoperative CA125 level (CA125 > 28 U/mL,P=0.011) and unfavourable preoperative grade (P=0.017). Amongst patients with a favourable histological tissue type (endometrioid), preoperative CA125 levels predicted overall survival (Chi square = 6.039, df = 2,P=0.02); however unfavourable preoperative grade did not (P=0.5). Overall, at five-year follow-up, while there were no deaths among the women with preoperative serum CA125 less than 12 U/mL, eleven of the twenty-three deaths (47.82%) in the study occurred in women with a preoperative CA125 more than 28 U/mL.Conclusions.A preoperative CA125 assay for women with uterine cancer is a relatively inexpensive, reproducible, and objective test which provides valuable information regarding the risk of metastatic disease and overall likelihood of long term survival. Patients with a low likelihood of metastatic/nodal disease (favourable tissue type and CA125 level