Journal of the Turkish German Gynecological Association最新文献

Objective: To evaluate the results of loop electrosurgical excisional procedures (LEEP) with colposcopic biopsy results of patients who presented to our hospital for vaginal smears.

Material and methods: The LEEP reports of patients who presented to our gynecology clinic between January 2015 and December 2020 were retrospectively evaluated. The data were obtained from electronic patient records and the department of medical pathology archives.

Results: A total of 579 patients were evaluated with a mean age of 38.05±6.17 years. Colposcopy-guided biopsy was not taken from 102 patients. The results of the remaining 477 (82.4%) patients were: no dysplasia (n=12; 2.1%), Cervical intraepithelial neoplasia-I (CIN-I) (n=99; 17.1%), CIN-II (n=111; 19.2%), CIN-III (n=248; 42.8%), and cancer (n=7; 1.2%). Completed excision was performed in 87.0% of the patients using LEEP, the lesion was positive at the surgical margins in 10.9%, and the lesion could not be completely excised in 2.1%. The complication rate after LEEP was 3.1% including pelvic pain (n=5; 0.9%) and bleeding (n=13; 2%). The histopathologic results of LEEP were: benign (n=50; 8.6%), CIN-I (n=110; 19.0%), CIN-II (n=89; 15.4%), CIN-III (n=280; 48.4%), cancer (n=7; 1.2%), and metaplasia (n=37; 6.4%). The concordance between colposcopic biopsy and LEEP results was 85.9% for CIN-I, 71.2% for CIN-II, 98.4% for CIN-III, and 85.7% for cancer diagnoses.

Conclusion: LEEP is a simple minimally invasive method used in the treatment of CIN, with low persistence, recurrence, and complication rates and increased human papillomavirus clearance in most patients. Our results support the consistency of cervical colposcopic biopsy and LEEP results.

Objective: The aim of this study was to evaluate the use of delta neutrophil index (DNI) in predicting endometriosis.

Material and methods: A retrospective, case-control study was performed in a tertiary care center. DNI, red cell distribution width (RDW), and other blood parameters obtained from complete blood counts of 267 patients, consisting of 122 (45.7%) endometriosis patients with proven pathology reports of stages 3-4, and a control group of 145 women who underwent laparoscopy for simple ovarian cyst and/or diagnostic purposes and had normal histopathology, were compared. Receiver operating characteristic and logistic regression analyses were performed.

Results: DNI and RDW were significantly higher in endometriosis patients than in the control group (p=0.034 and p=0.003, respectively). Other parameters obtained from complete blood counts (leukocyte, neutrophil, lymphocyte, monocytes, and platelet counts and neutrophil-to-lymphocyte ratio), did not differ (p>0.05). For DNI, at a cut-off value of 0.025, area under the curve (AUC) was 0.572 and it was statistically significant [p=0.042; 95% confidence interval (CI): 0.503-0.642, sensitivity: 45.9%, specificity: 67.6%, Youden’s index: 0.135]. For RDW, AUC: 0.601 for cut-off value of 13.65 was statistically significant (p=0.004, 95% CI: 0.553-0.669, sensitivity: 50.8%, specificity: 67.6%, Youden’s index: 0.184). The logistic regression model established with the combined marker obtained by multiplying the DNI and RDW was statistically significant (p<0.001, Nagelkerke R2=0.72, 95% CI: 2.58-47.26, B: 2.40, negative predictive value: 78.6%, positive predictive value: 37.7%).

Conclusion: DNI, a new inflammatory marker, and RDW, known to be associated with inflammation, may be useful minimally invasive biomarkers of endometriosis.

Skene gland abnormalities include skene gland cysts and abscess. These can be differentiated from urethral diverticulum based on clinical findings. The exact incidence of Skene gland abnormalities is unknown as they are relatively rare. They are usually seen in middle-aged female patients but have recently been reported in newborn girls. We present a video case of a large, adult-onset Skene gland cyst, which was evaluated based on clinical findings, radiological aspects and histopathological findings. The differential diagnosis was carried out step-by-step in order to avoid sequelae and complete excision was performed in order to achieve optimal results, both for long-term functional and anatomical outcomes.

Objective: The aim of this study was to describe characteristics and outcomes of assisted reproductive technology (ART) cycles performed in 2019 in Turkey.

Material and methods: One-hundred and sixty-five ART centers in Turkey were invited to submit data. The survey was sent to center directors via e-mail with anonymous links by Qualtrics™. The survey involved questions about their patient characteristics, clinical practices, and outcomes.

Results: Forty-one (24.8%) centers responded to e-mails, and data gathered from 25 centers was included in the analyses. In 25 centers, 18,127 fresh or frozen transfers were carried out during the study period, of which 7796 (43.0%) were fresh and the rest were either frozen (45.2%) or embryo transfers (ET) with preimplantation genetic testing (PGT) (11.8%). The live birth rate per ET was as 30.6%, 40.1%, and 50.7% in fresh, frozen and PGT cycles, respectively. A single embryo was transferred in 65.3% of all transfers and singleton live births comprised 86.1% of all deliveries. For cycles with intrauterine insemination, 1407 were started in 2019, and 195 clinical pregnancies, 150 live births with 19 multiple pregnancies occurred. A total of 1513 ART cycles were initiated for foreign patients. Russia (29.6%), Germany (7.4%), Iraq (4.6%), Uzbekistan (3.1%), and Syria (1.4%) were the top five countries with most patients coming to Turkey for ART.

Conclusion: The survey results are in parallel with the reports of international institutions and organizations. With repeated editions, the data collected with annual surveys can be used to inform ART practices in the coming years.

Objective: To determine factors affecting obstetric outcomes in pregnancies after conization by loop electrosurgical excision procedure (LEEP) or cold-knife conization (CKC) due to cervical intraepithelial neoplasia (CIN).

Material and methods: The maternal and clinical characteristics and obstetric outcomes of CKC, LEEP and control groups were evaluated and compared. Risk factors for adverse pregnancy outcomes were evaluated using multiple logistic regression analyses.

Results: The incidence of preterm delivery, PPROM, low APGAR scores, fetal mortality, and late-period spontaneous abortus was highest in patients who underwent CKC (p<0.05). Cone depth of CKC was longer than LEEP (p=0.025). Cervical length (CL) at pregnancy was CKC

Conclusion: Compared with CKC, LEEP has shorter cone depth and fewer adverse pregnancy outcomes. The t-CP<14 months was a risk for preterm delivery and <15 months was a risk for PPROM. CL at pregnancy <31 mm was a risk for preterm delivery and <32 mm was a risk for PPROM.

Objective: The umbilicus is traditionally circumvented while performing a vertical midline abdominal incision. There is a gap in knowledge pertaining to avoiding the umbilicus. Our aim was to investigate whether a transumbilical (TU) or periumbilical (PU) midline incision conferred any advantage to the patient.

Material and methods: This was a retrospective cohort study of patients undergoing ovarian cancer surgery with a midline incision, from the pubic tubercle to the xiphoid. All surgery was performed by the same team of gyneacological oncologists. Patients were classified into two groups according to the midline incision used, TU or PU. The primary endpoint was the incision wound complication rate.

Results: TU and PU midline incisions were performed in 54 and 68 patients, respectively. There were no differences between the two groups in terms of patient characteristics and operative details. The two groups had comparable rates of complications, including wound infection (7.4% vs. 10.3%, p=0.75), deep surgical site infection (11.1% vs. 4.4%, p=0.18), evisceration (3.7% vs. 4.4%, p=0.99) and incisional hernia (33.3% vs. 33.8%, p=0.99).

Conclusion: Our findings suggest that circumventing the umbilicus during laparotomy did not have any advantage. Future prospective randomized trials are warranted to validate this finding.

Objective: Ultrasonography (US) is an acceptable tool to diagnose the placenta accreta spectrum (PAS) among pregnant women. However, the lack of a robust criteria for diagnosis and predicting the severity of the consequences facing pregnant women requires identification of novel biomarkers.

Material and methods: This prospective, cross-sectional study was performed on pregnant women with a probable diagnosis of PAS. Their demographic information, medical and surgical history, blood loss severity (severe ≥2500 mL) following hysterectomy, and the histopathology after the surgery were collected. In addition, the Doppler imaging of both uterine arteries, including the pulsatility index, resistance index, peak systolic velocity (PSV), the PSV of the posterior part of the bladder, cervix, the largest lacuna, and the posterior lacuna of the bladder were calculated by Doppler US. Data were analyzed to investigate the relationship between Doppler markers and the severity of PAS in terms of bleeding, hysterectomy, and histopathology.

Results: Fifty-one women were enrolled with a mean age of 35.4±4.11 years and 17 (33.3%) had severe bleeding. There were significant differences between median (range) bladder PSV [57 (34-90) vs. 33 (20-64); p<0.001], cervix PSV [26 (0-63) vs. 18 (0-76); p=0.04] and left uterine artery [89 (81-135) vs. 68 (61-113); p=0.045] for women with and without severe bleeding, respectively. Thirty-four (66.66%) had hysterectomy. Comparison of bladder PSV, cervix PSV, and left uterine PSV for women with and without hysterectomy were 46 (20-90) vs. 39.5 (33-46) (p=0.005), 20 (0-76) vs. 20 (14-26) (p=0.013) and 68 (61-135) vs. 82 (63-101) (p=0.003), respectively.

Conclusion: Bladder PSV, cervix PSV, and uterine PSV were significantly higher in pregnant women with PAS, and they may be useful diagnostic and prognostic markers.

The aim was to demonstrate that the technique of near infrared range/indocyanine green (NIR/ICG) could aid the detection of inguinal sentinel lymph nodes in patients with vulvar cancer, in addition to technetium-99m (Tc-99m) scanning. We present a case report of sentinel lymph node detection in a patient with vulvar cancer with two methods: Tc-99m scan and NIR/ICG. The video showed that bilateral inguinal lymph nodes were detected both by Tc gamma probe and NIR/ICG. NIR/ICG may be a safe and effective alternative method for identifying sentinel lymph nodes in cases of early-stage vulvar cancer, although more evidence is required.

Objective: The purpose of this study was to assess prognostic factors correlated with recurrence and decreased oncologic outcomes, as well as the role of adjuvant treatment on survival in women with stage I and II endometrioid endometrial cancer without lymphovascular space invasion (LVSI).

Material and methods: Patients with LVSI negative, early-stage endometrioid endometrial cancer patients were retrospectively reviewed. Multivariable logistic regression models were used for identifying predictors of recurrence. Overall survival (OS) and disease-free survival (DFS) were estimated using the Kaplan-Meier method, and survival curves were compared by log-rank test. Univariable and multivariable analyses were performed to establish factors affecting OS and DFS. Hazard ratios with 95% confidence intervals were calculated.

Results: A total of 289 patients were included, with a mean age of 58 years and the median surveillance time of 45 (6-147) months. The majority of the patients (54%) had grade 1 tumors. Adjuvant therapy was administered to 68 (23.5%). A total of 13 (4.5%) recurred with median time to recurrence of 52 months. Patients receiving adjuvant treatment were more likely to recur (p=0.015), and grade was the only independent predictor of recurrence (p=0.029). Five-year OS and DFS were 95.8% and 97.9%, respectively. While tumor size (p=0.018) and grade 3 histology (p=0.045) were related with shorter DFS, age (p<0.001) was the only related factor for decreased OS.

Conclusion: Recurrence rate was low among LVSI negative, early-stage endometrioid endometrial cancer patients. Although recurrences were seen more frequently in patients who received adjuvant treatment, it wasn't an independent prognostic factor. Neither recurrence nor adverse uterine risk factors were associated with shorter OS. While age was the only prognostic factor for decreased OS, grade 3 histology and tumor size were associated with decreased DFS.