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Objective: To evaluate the Turkey's nationwide HPV DNA screening program on the basis of first 4 million screened women., Methods: Women over age 30 were invited for screening via HPV DNA and conventional cytology. Single visit screen strategy was used to collect for both screening and triage (extended genotyping and conventional pap-smear)., Results: A total of 4,099,230 patients had attended to HPV DNA cancer screening. 4.39% were found to be HPV DNA positive. The most common HPV type was 16, followed by 51, 31, 52, 56 and 18 at all age intervals and geographic regions. Cytology results were reported as "normal" in (69.2%), "inadequate sampling" in (16.6%) and as "abnormal (≥ASC-US)" in the remaining. Current Turkish screening with HPV DNA (referral to colposcopy with HPV 16 or 18 or any smear abnormality ≥ASC-US) gives overall PPV of 24.3% for ≥CIN2. Only Pap-Smear triage revealed PPV of 26.4% for ≥ASC-US thresholds. Comparison of different triage methods for ≥CIN2+ according to different HPV genotype revealed a PPV of 32,6% for HPV 16; 15,3% for HPV 18. This figure was 34.4%, 19.3%, 15.3% and 14.0% for HPV 33, 31, 45 and 35; respectively., Conclusion: This study involves the largest series in the world summarizing a real-world experience with primary HPV DNA screening and triage with a single visit. The results show the feasibility and applicability of such screening method in developing countries with acceptable colposcopy referral rates. Among triage tests, only pap-smear seems to be effective without a need for extended genotyping., Competing Interests: Declaration of competing interest The authors declare that they have no conflict of interest., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Objective: To analyze the clinicopathological correlations of metastatic lymph node (LN) numbers in patients with epithelial ovarian carcinoma., Method: A total of 328 patients with epithelial ovarian carcinoma diagnosed and treated at Hacettepe University Hospital during 1982-2005 were retrospectively reviewed. Patients' age, number of resected lymph nodes, clinical disease stage, preoperative Ca-125 levels, peritoneal cytology, presence of ascites, tumor histology, tumor grade, maximal tumor diameter, cytoreductive success, overall and disease-free survivals were compared with respect to the number of metastatic lymph nodes (< 4 vs. > or = 4)., Results: The mean number of resected lymph nodes was 24.5 and mean number of metastatic lymph nodes was 6.2. About 47.3% (n=155) of the patients had < 4 metastatic lymph nodes and the remaining 52.7% of patients (n=173) had > or = 4 metastatic lymph nodes. Univariate comparison of the two groups relived preoperative Ca-125 values, peritoneal cytology and clinical disease stage to be significantly different among the two groups. However, multivariate analysis revealed a high Ca-125 level (> or = 500 IU/l) to be unique factor significantly different among the groups. Survival analysis also could not find a significant difference with respect to overall and disease-free survival among the groups., Conclusion: The number of metastatic lymph nodes increases as the preoperative Ca-125 values increase. Other patient characteristics do not have a significant effect on the number of metastatic lymph nodes. Metastatic LN number does not have a prognostic significance in terms of either the overall or the disease-free survival. Prospective series are needed for a definitive conclusion.

Objective(s): To evaluate the relationship between preoperative platelet counts and prognostic factors extensively, among endometrial cancer patients, especially with respect to cervical involvement., Methods: One-hundred fifty-five patients with endometrial carcinoma, who underwent surgery as the initial treatment consisting peritoneal cytology, total abdominal hysterectomy, bilateral salpingo-oophorectomy, systematic pelvic-paraaortic lymphadenectomy, and omentectomy were retrospectively analyzed., Results: There were no differences with respect to age, histological type (endometrioid vs. non-endometrioid), depth of myometrial invasion, peritoneal cytology, LVSI, and lymphatic metastasis. However, advanced stage (stages III and IV), poorly differentiated tumor grade (grade 3), the presence of cervical and adnexal involvements were associated with significantly higher median preoperative platelet counts. Accepting 325.000/microl platelet count as a threshold value, multivariate analysis revealed cervical involvement (P=0.008; OR=1.84, 95% CI:1.17-2.89) and presence of high grade histology (P=0.014; OR=2.23, 95% CI:1.18-4.23, for grade 3 disease) to be significantly associated with higher platelet count. At a cut-off value of 326.000/microl, 42.3% sensitivity and 82.8% specificity for the prediction of cervical involvement was observed under receiver operator characteristic curve method., Conclusion(s): Higher preoperative platelet counts, even in conditions with normal range (150.000-400.000/microl), may reflect poor prognostic factors such as cervical involvement and high grade among patients with endometrial carcinoma. Also, the higher platelet count should be taken into consideration for the necessity of radical hysterectomy.

Objective: The purpose of this study was to evaluate the role of CYP1A1*3 gene polymorphism in the development of cervical cancer by comparing patients having cervical intraepithelial neoplasia (CIN) or invasive cervical cancer with control subjects., Methods: CYP1A1*3 polymorphism was analyzed using an allele-specific PCR-based method., Results: In the group of patients with CIN, the frequency of the Ile/Val and of any Val alleles was significantly higher than in the healthy control subjects (OR: 4.51; 95%CI = 2.42-8.43, and OR: 3.71; 95%CI = 2.03-6.78). In the CIN1 group, patients with Ile/Val and any Val genotypes were found to be significantly higher (OR: 10.53; 95%CI = 3.78-29.33 and OR: 8.38; 95%CI = 3.04-23.08). In the CIN2 group, patients with Ile/Val and any Val revealed a 4.06- and 3.23-fold higher risk than those with Ile/Ile (95%CI = 1.54-10.74 and 1.24-8.45). However, the variance in the group of patients with CIN3 did not reach statistical significance. Patients with cervical cancer were analyzed with respect to the histological diagnoses. In the adenocancer group, the estimated ORs with respect to the control subjects were 11.29 for Ile/Val (95%CI = 3.35-38.07) and 8.98 for any Val groups (95%CI = 2.69-30.01), with a statistical significance. Among the squamous cell cancer patients, Ile/Val and any Val were significantly higher than in controls (OR: 5.76; 95%CI = 3.13-10.59 and OR: 5.20; 95%CI = 2.91-9.28). Although Val/Val genotype did not reach a significant value, it was near significance with an OR of 3.03 (95%CI = 0.95-9.68)., Conclusion: These results suggest that CYP1A1*3 gene polymorphism is linked to a propensity for cervical carcinogenesis and further series are needed to detect the exact role of this unique variation.

Background: Primary lymphoma arising from the female genital tract has been rarely encountered. Primary cervical lymphoma is even rarer in gynecologic oncology practice and accounts for approximately only 1% of extranodal lymphomas. In this article, two cases of cervical lymphoma are presented with a review of the available literature., Case Histories: A 51-year-old woman presented with abnormal vaginal discharge. On pelvic examination, cervix was apparently normal; however, a solid and mobile pelvic mass was palpated. Pap smear was reported as HSIL at another institution. Radiological evaluation revealed a cervical mass with a 3 cm diameter. Histopathological evaluation of LEEP material was reported as diffuse large B cell lymphoma. We performed abdominal hysterectomy plus bilateral salphingo-oopherectomy and the patient was treated with adjuvant 6 cycles of CHOP chemotherapy. A second case was a 49-year-old postmenopausal woman who had undergone a routine gynecologic follow-up examination without any complaint at another institution. Routine cytological smear revealed HSIL. Punch biopsy under colposcopic examination presented no remarkable pathology except for a benign inflammation. Due to discordance between cytology and histology, LEEP was performed under colposcopic examination, which revealed follicular lymphoma grade III. This patient was treated with 6 cycles CHOP chemotherapy without any surgery., Conclusion: Primary cervical lymphoma is a rare disorder. Although most reported cases in the literature have a normal Pap smear, some may represent with co-existent cytological abnormalities. Therefore, cervical lymphomas should be kept in mind in patients with cytological abnormalities.

Objective: The purpose of this study was to evaluate the prognostic factors, and the patterns of lymphatic metastasis in EOC patients who were treated with systematic pelvic and paraaortic lymphatic dissection., Methods: A total of 420 EOC patients was retrospectively evaluated. Clinical factors available were evaluated for a possible significance in terms of lymphatic metastasis and paraaortic involvement., Results: Two-hundred and three patients were found to have lymphatic metastasis. In multivariable analysis, stage (P < 0.001), histology (P < 0.01 for serous; P = 0.02 for mixed, and P = 0.04, for Brenner), and Ca-125 level higher than 500 U/ml (P = 0.04) were found to be significantly related with the lymphatic involvement. Age and grade were significant factors for paraaortic metastasis both in univariable and multivariable analysis (P = 0.003 and P = 0.02, respectively). Most of the patients with unilateral tumors had contralateral pelvic and/or paraaortic metastasis. There were eleven patients with lymphatic metastasis in stage I-II disease, and five had paraaortic metastasis while an additional five patients had contralateral pelvic nodal metastasis. However, there was no lymphatic involvement in Stage IA, Grade I-II disease (0/63). Survival analysis revealed no significant difference by the number of metastatic lymph nodes., Conclusion: In multivariable analysis, lymphatic involvement was predicted independently by stage, histology, and Ca-125 level. In apparently stage I-II disease, a considerable part of patients were upstaged due to lymphatic involvement. Although routine systematic lymphadenectomy is suggested for patients with early stage disease, further series are needed for a definite regimen in patients with stage IA G1-2 disease since we did not detect any lymphatic involvement in this unique group.

Objectives: The aim of this study was to evaluate the survival estimates, treatment outcomes, prognostic factors, and recurrence patterns of patients with surgical stage II endometrial cancer., Methods: Forty-eight stage II endometrial cancer patients treated between 1982 and 2000 were included. All the patients were subjected to the initial surgical staging procedure consisting of peritoneal cytology, infracolic omentectomy, abdominal hysterectomy (radical or simple), bilateral salpingo-oophorectomy, and complete pelvic-paraaortic lymphadenectomy. Of these 48 patients, 21 (44%) were treated with radical hysterectomy (RH) without adjuvant therapy. The remaining 27 (56%) patients were treated with simple hysterectomy plus adjuvant radiotherapy. With respect to the prognostic factors, no statistically significant difference was found between these two groups. The median follow-up period was 5 years (range, 2-9)., Results: The mean age at the time of diagnosis was 55.8 years (range, 34-75). The 5-year disease-free and overall survival (OS) rates of entire group were 83% and 86%, respectively. These figures for 27 (56%) patients treated with simple hysterectomy plus radiation were 81% and 83%, respectively. For 21 (44%) patients who were treated with radical hysterectomy without adjuvant therapy, the 5-year disease-free and overall survival rates were 85% and 90%, respectively. When these two groups were compared, survival rates were not significantly different from each other (P = 0.60 for disease-free survival and P = 0.46 for overall survival). In multivariate analysis, only the high grade predicted poor survival significantly (P = 0.04). Eight patients (17%) had recurrence: two local, five distant, and one both local and distant. Initial therapeutic approach was not related with the subsequent site of relapse. Two patients with only local failure were successively treated, but all the six patients who had distant component of relapse died within the same year. Surgical morbidity was seen in six (12.5%) patients. No surgical mortality was seen, and no patient developed a major complication directly related to the radical hysterectomy or lymphadenectomy., Conclusions: Without adjuvant radiotherapy, initial surgical staging procedure consisting radical hysterectomy and complete pelvic-paraaortic lymphadenectomy achieved excellent survival and minimal morbidity in stage II endometrial cancer. Distant failure was the main problem.

Objective: The aim of this study was to examine the effects of therapeutic modalities on survival of stage I endometrial cancer and also to evaluate the surgical morbidity and the prognostic importance of surgicopathological variables., Methods: A hundred and ninety-six stage I endometrial cancer patients treated at Hacettepe University Hospital between 1982 and 1997 were included. After initial diagnosis all patients underwent surgical procedures including peritoneal cytology, infracolic omentectomy, total abdominal hysterectomy, bilateral salphingoopherectomy, and complete pelvic-paraaortic lymphadenectomy. The mean age at initial diagnosis was 56 years (SD = 9.9 years) and the patients were followed 3-18 years (median, 8 years). All patients had endometrioid carcinoma. Stage IC and/or grade 3 tumors were considered high-risk factors and by this definition 147 (75%) patients were low risk and 49 (25%) patients were high risk. Forty-nine percent of high-risk patients received adjuvant radiotherapy compared with 3.5% of patients in the low-risk group., Results: The 10-year disease-free and overall survival rates of the entire group were 97 and 98%, respectively. Ten-year overall survival rate for the low-risk group was 100% compared with 94% for patients with high-risk features (P = 0.002). The 10-year disease-free survival rate in the high-risk group was 96% for 24 patients who received adjuvant radiotherapy versus 92% for 25 patients who did not receive adjuvant therapy (P = 0.53). Only high grade was a significant predictor of poor survival (P = 0.0004). Overall surgical morbidity rate was 8.1% without mortality related to surgery., Conclusions: Surgical staging achieved excellent survival for stage I endometrial cancer patients without incurring untoward morbidity and mortality. No survival advantage of adjuvant radiotherapy was detected even for high-risk patients, so we suggest the use of radiotherapy may be reserved for relapse.