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Comparative Oncologic Outcomes in High-Risk Human Papillomavirus-Positive and -Negative Cervical Intraepithelial Neoplasia - Article abstract #950452

BACKGROUND Endometrial polyps are a common gynecological condition that often cause significant clinical symptoms. Hysteroscopic resection is considered the gold standard treatment; however, recurrence remains a notable risk even after surgery. The recurrence of endometrial polyps after surgery raises concerns for women, due to persistent symptoms and potential malignancy risk. Therefore, this study aims to identify factors influencing recurrence in reproductive-aged women undergoing hysteroscopic polyp resection. MATERIAL AND METHODS We conducted a retrospective analysis of 1021 reproductive-aged women who underwent hysteroscopic polypectomy for abnormal uterine bleeding between 2010 and 2024. Diagnoses were confirmed by histopathological examination. Multivariable logistic regression modeling was used to determine predictors of recurrence. RESULTS Endometrial polyp recurrence occurred in 8% of patients, with a median recurrence time of 42.5 months. Levonorgestrel-releasing intrauterine system (LNG-IUS) treatment significantly reduced recurrence (odds ratio [OR]=0.043, 95% CI=0.019-0.097, P<0.001). Risk factors for recurrence included adenomyosis (OR=10.297, 95% CI=5.251-20.188, P<0.001), polycystic ovarian syndrome (OR=8.990, 95% CI=2.855-28.312, P<0.001), body mass index ≥30 kg/m² (OR=8.698, 95% CI=4.521-16.736, P<0.001), tamoxifen use (OR=6.088, 95% CI: 1.936-19.140, P=0.002), and leiomyoma uteri (OR=4.012, 95% CI: 2.143-7.509, P<0.001). CONCLUSIONS Clinicians should inform patients at high risk, including those with adenomyosis, myoma uteri, polycystic ovarian syndrome, or tamoxifen use, about the increased risk of recurrence and should conduct regular follow-ups. LNG-IUS treatment can be considered for the prevention of recurrence and enhancement of management strategies.

Objective: Accurate preoperative differentiation between benign endometrial conditions and malignancies is essential for guiding therapeutic interventions. However, high-quality evidence regarding the diagnostic accuracy of endometrial sampling techniques remains insufficient. This study aimed to evaluate the diagnostic efficiency of hysteroscopically directed biopsy, Pipelle suction curettage, and dilatation and curettage (D&C) for detecting endometrial hyperplasia or carcinoma in premenopausal women and to identify associated risk factors. Methods: A retrospective single-center cohort analysis was conducted on 2054 premenopausal women. Demographic, clinical, and obstetric data, along with biopsy techniques and histopathological findings, were recorded. Diagnostic accuracy of biopsy methods was compared against definitive surgical pathology. Results: The prevalence of endometrial hyperplasia and carcinoma was 5.6% and 1.0%, respectively. Hysteroscopically directed biopsy demonstrated superior diagnostic accuracy (AUC 0.957) compared to D&C (AUC 0.909) and Pipelle suction curettage (AUC 0.858). Sensitivity was highest for hysteroscopically directed biopsy (91.3%), followed by D&C (82.0%) and Pipelle suction curettage (71.7%), while specificity remained excellent across all methods (p < 0.001). Elevated BMI increased the risk of hyperplasia or carcinoma by 1.05 times per unit increase (OR = 1.054, p = 0.005), while hypertension nearly doubled the risk (OR = 1.99, p = 0.009). Multiparity showed protective effects, reducing risk with each additional delivery (OR = 0.877, p = 0.029). Conclusions: Hysteroscopically directed biopsy provides superior diagnostic accuracy for detecting endometrial hyperplasia and carcinoma in premenopausal women. Hypertension and elevated BMI increase risk, while multiparity offers protective benefits.

Objective: We aimed to analyze the impact of stage shifts on disease-free survival and overall survival in patients with uterine carcinosarcoma stratified based on FIGO 2009 and 2023 staging systems. Materials and Methods: A total of forty-five patients diagnosed with uterine carcinosarcoma between 2010 and 2024 were included in the study. Patients were classified and analyzed according to both the 2009 and the revised 2023 FIGO staging systems to evaluate the impact of the updated staging criteria on oncologic outcomes. The median disease-free (DFS) and overall survival (OS) rates were calculated and compared when stage shifts occurred. Results: A total of 17 upstage shifts (37.7%) occurred between the 2009 and 2023 FIGO staging system. All patients with upstage shifts were stage I patients categorized according to the FIGO 2009 classification. Restaging from the FIGO 2009 to the FIGO 2023 criteria resulted in a reduction in the number of stage I cases and an increase in the number of stage II cases. The two main factors leading to upstage were serous histology and LVSI positivity. The 5-year DFS and OS rates for stage I disease were 80% and 75%, respectively, according to the 2009 FIGO staging system, whereas the 2023 FIGO staging system demonstrated significantly higher rates of 100% for both DFS and OS. In stage II patients, the 5-year DFS and OS rates were 33.5% and 33.7%, respectively, according to the 2009 FIGO staging system, while the 2023 FIGO staging system demonstrated higher rates of 58.8% for DFS and 65% for OS. Conclusions: The revised FIGO 2023 staging system has better performance in predicting disease prognosis than the previous version.

ÖZ Amaç: Adenomyozis ve leiomyoma uteri hastalarında semptomların ve ultrasonografi bulgularının doğru kombinasyonu sonucunda tanının doğru konulması tedaviye yön gösterecektir. Biz bu amaçla, çalışmamızda klinik semptomların ve Transvajinal Ultrasonografi (TVUSG) bulgularının, patoloji sonuçları ile karşılaştırılması amaçlanmıştır. Gereç ve Yöntemler: Akdeniz Üniversitesi Tıp Fakültesi Kadın Hastalıkları ve Doğum Kliniğinde, benign nedenlerle histerektomi operasyonu olan ve sitopatolojik inceleme sonucu, leiomyoma uteri ve/veya adenomyozis olarak rapor edilen olgular retrospektif olarak değerlendirilmiştir. Bulgular: İki yüz bir olgunun histerektomi materyalinin incelenmesinde; 94 olguda (%46,8) leiomyoma uteri, 33 olguda adenomyozis (%16,4), 37 olguda (%18,4) leiomyoma uteri+adenomyozis saptanmıştır. Parite sayısı (mean±Sd: 3,36±1,912 ve 2,07±1,065; p

Background: Sirtuins and FoxO1 are reported to be important in the pathophysiology of preeclampsia. This study aimed to investigate whether serum FoxO1 and SIRT2 concentrations differ between preeclampsia and normal pregnancy and also to compare these markers in early- and late-onset preeclampsia. Methods: This cross-sectional study was conducted on 27 women with early-onset preeclampsia, 27 women with late-onset preeclampsia, and 26 healthy normotensive pregnant controls. Maternal serum levels of FoxO1 and SIRT2 were measured with the use of an enzyme-linked immunosorbent assay kit. Results: The mean maternal serum FoxO1 levels were significantly lower both in early-onset (9.1 ± 3.8 vs. 29.1 ± 3.2, p < 0.001) and late-onset preeclampsia (2.6 ± 1.6 vs. 29.1 ± 3.2, p < 0.001) than the normotensive pregnancies. The mean maternal serum FoxO1 level of late-onset preeclampsia was significantly lower than the early-onset preeclampsia group (2.6 ± 1.6 vs. 9.1 ± 3.8, p < 0.001). The mean maternal serum SIRT2 levels were significantly lower both in early-onset (4.5 ± 2.1 vs. 6.3 ± 0.9, p < 0.001) and late-onset preeclampsia (2.1 ± 0.6 vs. 6.3 ± 0.9, p < 0.001) than the healthy pregnancies. Conclusions: FoxO1 and SIRT2 may be biomarkers for early detection of preeclampsia and potential therapeutic targets in the pathophysiology of preeclampsia.

Objectives: Considerable debate exists among guidelines regarding when cervical cancer screening can be safely stopped. The authors aimed to compare the efficiency of human papillomavirus (HPV) test, cytology, and previous screening history for the diagnosis of cervical intraepithelial neoplasia (CIN) 2+ lesions in women aged older than 65 years. Materials and Methods: This is a retrospective cohort study. Multiple logistic regressions were used to compare the efficiency of the HPV test, cytology, and previous screening history for the diagnosis of histologically proven CIN 2+ lesions. Results: A total of 5,427 women were included in the study. A total of 2,143 women were tested with HPV and 52 (2.4%) of them were HPV-positive. Abnormal cytology was detected in 359 (6.6%) women. Most of the women (70.4%) had inadequate screening in the previous 10 years. According to regression analysis, an HPV-positive test increases the risk of probability of CIN 2+ 136.111 times [95% CI for odds ratio (OR) = 41.212–449.538] compared with an HPV-negative test (p < .001). Abnormal cytology increases the probability of CIN 2+ 13.072 times (95% CI for OR = 3.878–44.062) compared with normal cytology (p < .001). Inadequate or positive previous screening increases the likelihood of CIN 2+ 9.705 times (95% CI for OR = 1.603–58.756) compared with adequate and negative previous screening (p = .013). Conclusions: Adequate previous screening is a valuable strategy, and abnormal cytology is an important screening test in women aged older than 65 years. However, the HPV test is the most determinant parameter for CIN 2+ risk in elderly women.

Objective: We aimed to investigate the effect of the SARS-CoV-2 pandemic on obstetric management and pregnancy complications in healthy pregnant women without SARS-CoV-2 infection. Methods: A total of 750 pregnant women who delivered singleton infants after 11 March 2020, the date when the World Health Organization (WHO) declared a pandemic, formed the study group, while 750 pregnant women who gave birth before this date formed the control group. The study included pregnant women who were found to have no infection clinically or by SARS-CoV-2 serology testing. The groups were compared in terms of demographic characteristics, type and duration of delivery, gestational age, indication for cesarean section, and pregnancy complications. Results: The median±IQR gestational age at delivery was 38±2 weeks in pregnant women who gave birth during the pandemic and 39±1 weeks in women who gave birth before the pandemic (p

Amaç: COVID-19 pandemisi, sağlık sorunlarına neden olduğu gibi toplumsal düzeyde alınan önlemler nedeniyle de olumsuz sosoyoekonomik sonuçlara, insanların günlük yaşamında da kısıtlamalara yol açmıştır. Amacımız, global ve ulusal olumsuz sonuçlara yol açan COVID-19 pandemisinde maternal anksiyete ve depresyonun prevelansının araştırılması, anksiyete ve depresyona etki eden faktörlerin belirlenmesidir. Gereçler ve yöntem: Temmuz-Kasım 2020 tarihlerinde kliniğimize kontrol amaçlı başvuran gebeler çalışma kapsamında değerlendirilmiştir. Çalışmaya dâhil edilen gebelerden pandemi döneminde davranışlarını ve demografik özelliklerini içeren sorulara yanıt vermeleri istenmiştir. Katılımcıların depresyon ve anksiyete seviyeleri, Beck depresyon ve Beck anksiyete ölçekleri ile araştırılmıştır. Anksiyete ve depresyona etki eden faktörler multipl lojistik regresyon analizi ile değerlendirilmiştir. Bulgular: 310 gebe çalışma kapsamında değerlendirildi. Katılımcıların medyan yaşı 29 (25.-75. Yüzdelik; 25-33) olarak bulundu. 198 (%63,9) olguda anksiyete tespit edilirken, 86 (%27,7 )olguda depresyon tespit edildi. COVID-19 pandemisinde anksiyete riskinin şehir merkezinde yaşama ile arttığı (OR: 10,269 95% CI: 5,676-18,580, P

Objectives: Low back pain during pregnancy is a common disorder with an obscure etiopathogenesis. This study sought to investigate the association of low back pain by assessing various epidemiologic and clinical risk factors including weight changes, the presence of striae gravidarum, and intraperitoneal adhesions. Material and methods: A total of 250 pregnant women between 37 and 40 gestational weeks who were scheduled for cesarean section were included in this multicenter prospective trial. Sociodemographic parameters and physical examination findings were noted and assessed as potential risk factors that may play a role in the development of low back pain. Results: The mean age of the study population was 29.98 ± 5.23 years and low back pain was identified in 120 (48%) patients. According to the logistic regression results, an increase in BMI (%) during pregnancy (odds ratio: 1.240; 95% CI: 1.061–1.448; p = 0.007) is correlated with the presence of low back pain. Separately, receiver operating characteristic curve analysis suggested that an increase in BMI (%) during pregnancy has a sensitivity of 77.5% and a specificity of 60% for the prediction of low back pain, and the cutoff point was found to be 15.5%. Conclusions: Our results imply that an increase in BMI (%) was correlated with low back pain during pregnancy. Weight gain should be personalized for each pregnancy and the increase in BMI (%) during gestation should be reduced. Measures should be taken to assure appropriate weight control to prevent low back pain during pregnancy. Objectives: Low back pain during pregnancy is a common disorder with an obscure etiopathogenesis. This study sought to investigate the association of low back pain by assessing various epidemiologic and clinical risk factors including weight changes, the presence of striae gravidarum, and intraperitoneal adhesions. Material and methods: A total of 250 pregnant women between 37 and 40 gestational weeks who were scheduled for cesarean section were included in this multicenter prospective trial. Sociodemographic parameters and physical examination findings were noted and assessed as potential risk factors that may play a role in the development of low back pain. Results: The mean age of the study population was 29.98 ± 5.23 years and low back pain was identified in 120 (48%) patients. According to the logistic regression results, an increase in BMI (%) during pregnancy (odds ratio: 1.240; 95% CI: 1.061–1.448; p = 0.007) is correlated with the presence of low back pain. Separately, receiver operating characteristic curve analysis suggested that an increase in BMI (%) during pregnancy has a sensitivity of 77.5% and a specificity of 60% for the prediction of low back pain, and the cutoff point was found to be 15.5%. Conclusions: Our results imply that an increase in BMI (%) was correlated with low back pain during pregnancy. Weight gain should be personalized for each pregnancy and the increase in BMI (%) during gestation should be reduced. Measures should be taken to assure appropriate weight control to prevent low back pain during pregnancy.