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Simple Summary: Patients with early-stage cervical cancer treated by minimally invasive surgery show shorter progression-free and overall survival compared to open surgery. This study integrated minimally invasive and open surgery survival data with surgery costs and utilities and conducted a cost-effectiveness analysis, using a Markovian decision analysis model, to compare the two surgical approaches. Our results show that open radical hysterectomy is not only oncologically superior but also more cost-effective. Until new data regarding the safety of minimally invasive surgery and surgery costs are presented, open radical hysterectomy should be the preferred approach from both the oncological and financial standpoint. We aimed to investigate the cost-effectiveness of open surgery, compared to minimally invasive radical hysterectomy for early-stage cervical cancer, using updated survival data. Costs and utilities of each surgical approach were compared using a Markovian decision analysis model. Survival data stratified by surgical approach and surgery costs were received from recently published data. Average costs were discounted at 3%. The value of health benefits for each strategy was calculated using quality-adjusted life years (QALYs). Incremental cost-effectiveness ratio, calculated using the formula (average cost minimal invasive surgery—average cost open surgery)/(average QALY minimal invasive surgery—average QALY open surgery), was used for cost-effectiveness analysis. One-way sensitivity analysis was conducted for all variables. Open radical hysterectomy was found to be cost-saving compared to minimally invasive surgery with an incremental cost-effectiveness ratio of USD −66 and USD −373 for laparoscopic and robotic surgery, respectively. The most influential parameters in the model were surgery costs, followed by the disutility involved with open surgery. Until further data are generated regarding the survival of patients with early-stage cervical cancer treated by minimally invasive surgery, at current pricing, open radical hysterectomy is cost-saving compared to minimally invasive radical hysterectomy, both laparoscopic and robotic. [ABSTRACT FROM AUTHOR]

Objective: To propose a treatment algorithm, after the LACC trial, of laparoscopic sentinel lymph node biopsy with frozen section, followed by immediate open radical hysterectomy in node‐negative cases, for early stage cervical cancer. Methods: We retrospectively collected all cases of cervical cancer that were surgically treated between 2019–2020. In all cases, surgery began with laparoscopic sentinel lymph node biopsy ± ovarian transposition. Node‐negative cases continued with open radical hysterectomy. In node‐positive cases, surgery was discontinued, sparing the patient a laparotomy incision. Results: Nine patients with cervical cancer were referred for surgery. Laparoscopic bilateral lymph node identification was achieved in all. In two cases, sentinel lymph nodes were positive for metastatic cancer and surgery was discontinued. For the other seven, node‐negative patients, open radical hysterectomy was completed. Four patients had laparoscopic ovarian transposition. There were no cases where nodes were negative on frozen section but positive on final pathology. Conclusion: Laparoscopic sentinel lymph node biopsy before open radical hysterectomy may spare a considerable number of laparotomies on the one hand and bi‐modal treatment with surgery and radiation on the other, for node‐positive patients. The oncological safety of this approach is yet to be determined. Laparoscopic sentinel lymph node biopsy before open radical hysterectomy is feasible and could prevent a considerable number of unnecessary laparotomies. [ABSTRACT FROM AUTHOR]

Objective: To describe trends and ethnic differences in incidence of gynecologic cancer in Israel.Methods: In the present retrospective epidemiologic study, age-standardized rates (ASRs) rates of gynecologic malignancies that occurred between January 1, 1993, and December 31, 2013, were extracted from the Israeli National Cancer Registry. The annual percent change (APC) was calculated separately for Jewish and Arab patients for ovarian, endometrial, and cervical cancers.Results: Among Jewish patients, the ASR of ovarian cancer decreased (APC -2.27%, 95% confidence interval [CI], -2.7 to -1.84; P<0.001), the ASR of endometrial cancer increased (APC 1.50%, 95% CI 0.87-2.14; P<0.001), and the ASR of cervical cancer did not change (P=0.737). Among Arab patients, the ASRs of ovarian and cervical cancer did not change (P=0.181 and P=0.575, respectively), and the ASR of endometrial cancer increased (APC 1.98%, 95% CI 0.15-3.85; P=0.021).Conclusions: Between 1993 and 2013, the incidence of gynecologic malignancies showed different trends among Jewish and Arab populations. Endometrial cancer increased among both populations and ovarian cancer decreased among Jewish patients. ASR of cervical cancer was low and stable among both Jewish and Arab groups. These trends could reflect differences in lifestyle and exposure to risk factors associated with each malignancy. [ABSTRACT FROM AUTHOR]

Objective: To investigate the performance of human papilloma virus (HPV) typing as a triage tool in the management of patients with postcoital bleeding (PCB). Methods: All patients referred for colposcopy at a cervical pathology clinic of a nationwide health insurance organization, due to PCB and had a preceding high-risk HPV (hrHPV) test between 2018 and 2020, were retrospectively located. Demographic and pathologic data were collected from electronic medical files. Sensitivity, specificity, and negative and positive predictive value of hrHPV test according to final pathology were calculated. Results: Three hundred ninety patients referred for colposcopy due to PCB with a preceding hrHPV test were located. HrHPV-positive patients were significantly younger (33.7 ± 10 vs. 37.2 ± 9, p < 0.006) with a higher proportion of nulliparous, nonmarried, and smokers compared with hrHPV-negative patients (75% vs. 47%, p < 0.001; 75.4% vs. 45.1%, p < 0.001; and 24.6% vs. 12.8%, p < 0.028, respectively). No case of high-grade cervical intraepithelial neoplasia (CIN2/3) was identified among hrHPV-negative patients. The sensitivity and NPV of the hrHPV test for high-grade cervical lesions were both 100%, decreasing to 36% and 95%, respectively, for any cervical dysplasia (CIN1/CIN2/CIN3). Adding cytology to HPV typing had a negligible effect on test performance. At univariate analysis, age, HPV vaccine status, nulliparity, and positive HPV typing were independently associated with cervical dysplasia. At multivariate analysis, only positive HPV typing remained significantly associated with cervical dysplasia (hazard ratio 2.75, confidence interval 1.1–6.5, p = 0.023). Conclusion: A negative HPV test even in the presence of PCB may rule out cervical dysplasia with extremely high accuracy and may save unnecessary colposcopies. [ABSTRACT FROM AUTHOR]