Journal of Lower Genital Tract Disease最新文献

Objectives: Cervical cancer is a preventable and manageable public health concern. This study aimed to evaluate the performance of a government-financed cervical cancer screening program and to discuss optimal primary screening approach and triage strategies for large-scale population screening.

Methods: This population-based study was conducted from 2015 to 2020 and included 6,373,279 eligible women. The performance of the cervical cancer screening program in Hunan Province was evaluated by comparing cancer incidence and mortality rates. The screening powers of primary human papillomavirus (HPV) testing and cytology were compared by calculating positive outcomes and cervical intraepithelial neoplasia 2 or worse (CIN2+) detection rates. Triage strategies for individuals positive for HPV-16/18 after primary HPV testing were discussed by comparing the CIN2+ detection rates and associated costs.

Results: The cervical cancer screening program has contributed to lower cancer mortality rates in Hunan Province. The HPV testing showed a higher CIN2+ detection rate than cytology as the primary screening approach (0.604% vs. 0.324%). For individuals positive for HPV-16/18, reflex cytology demonstrated a higher CIN2+ detection rate than direct colposcopy (51.11% vs 41.25%), although it was more expensive. For individuals with high-risk HPV types other than HPV-16/18, direct colposcopy exhibited a similar CIN2+ detection power as reflex cytology, but cost less.

Conclusions: The cervical cancer screening program should be expanded because the benefits outweigh the costs. Statistical data indicate that HPV testing is a cost-effective preliminary screening approach for large-scale population screening.

Objectives: Population-based cervical cancer screening in the Netherlands ends at age 60. This retrospective cohort study aims to identify a subgroup of people over 60 years who are at increased cervical cancer risk, and may benefit from extended screening.

Methods: People with a cervix, aged 59-61 with an abnormal exit smear (index smear), conducted as part of the screening program between 2000 and 2004, were identified from the Dutch nationwide pathology databank. A 1:3 matching was obtained with people without an abnormal screening smear at the same age. Incidence rate ratios (IRR) were calculated for the risk of developing cervical cancer or cervical intraepithelial neoplasia (CIN) later in life. Up to 22 years of follow-up was obtained.

Results: A total of 10,368 people were identified. The IRR for CIN and cervical cancer was increased for people with an abnormal index smear. This risk was highest for people with a high-grade index smear, compared with a normal index smear; IRR of high-grade CIN of 104.05 (95% CI = 38.18-353.18) and IRR for cervical cancer of 18.58 (95% CI = 5.31-61.07). The majority (82%) of people with an abnormal index test showed normal cytology or histology preceding their CIN or cervical cancer.

Conclusions: People with a cervix with abnormal cytology in their exit screening smear 59-61 years showed a 19 times increased lifelong risk of cervical cancer and more than 100 times increased risk for CIN. Because this increased risk was not limited to a specific timeframe, prolonged screening or adjusted diagnostic follow-up for this specific group should be considered.

Objectives: To assess the effectiveness of psychotherapy and psychotherapeutic techniques for reduction of vulvar pain and the improvement of sexual function and psychological adjustment in vulvodynia.

Methods: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. PubMed, Embase, Scopus, Web of Science, Cochrane Central Register of Controlled Trials, PsycInfo, and Clinical Trial Databases were searched on July 19, 2024. The authors included randomized controlled trials comparing psychotherapy interventions and psychotherapeutic techniques for vulvodynia. The risk of bias was assessed using the Cochrane Risk of Bias (RoB 2.0) tool. RevMan 5.4 was used for data synthesis. The Grading of Recommendations Assessment Development (GRADE) and Evaluation method was used to assess the strength of the evidence.

Results: A total of 1,884 articles were retrieved. Eight studies met the eligibility criteria and were included in the systematic review, comprising 689 participants. Two studies were included in the meta-analysis, these with 143 participants. When comparing the Acceptance and Commitment Therapy (ACT) with the control group, the mean difference (MD) in the pooled analysis for the Chronic Pain Acceptance Questionnaire did not differ significantly between ACT therapy and other therapies for posttreatment assessment (MD = 0.77; 95% CI = 3.45-4.99). Only 1 study was at high risk of bias due to a lack of clarity about the outcome measurement process. The GRADE rating for the certainty of the evidence for vulvar pain acceptance using ACT was considered low.

Conclusions: Psychotherapy significantly improves vulvar pain, psychological adjustment, and sexual function in women with vulvodynia. Additionally, this meta-analysis showed that ACT and other psychotherapeutic interventions improve psychological adjustment through pain acceptance. However, more rigorous studies are needed to improve the quality of evidence and inform clinical practice.

Objectives: In light of the rarity of vaginal cancer, the role of vaginal vault testing following hysterectomy for preinvasive or early cervical cancers is unclear. The objective was to determine the subsequent risk of VaIN2/3, and invasive vaginal cancer following hysterectomy, and to potentially identify individuals at higher risk who may benefit from vaginal vault testing.

Methods: The authors performed a population-based retrospective study using administrative databases to identify the study population. They identified patients who between 2005-2015 underwent hysterectomy after cervival intraepithelial neoplasia 3+ (CIN3+)/adenocarcinoma in situ (AIS) and calculated the rate of VAIN2 and invasive vaginal cancer. Exclusion criteria are as follows: <21 years and CIN3+ diagnosis prior to 2005. Patients were followed until 2021.

Results: During the study period, 6,230 patients underwent hysterectomy for a diagnosis of CIN3+/AIS. The subsequent rates of VaIN2/3, in situ, and invasive cancer were 1.9% (119/6,230) and 0.3 (18/6,230), respectively. Of these, most (84.7%) were made within 5 years of hysterectomy and remained stable over time (2.0% in 2005-2009, 2.4% in 2010-2015). However, only 54% of patients had vault cytology after hysterectomy; among these, 8.2% were abnormal of which 22.8% were diagnosed with VAIN2+. In addition, the risk of VaIN2+ was 5.8% when there was residual CIN3+ versus 2.1% when absent.

Conclusions: Individuals with evidence of CIN3+/AIS at time of hysterectomy are at elevated risk of developing VAIN 2+, with the highest risk occurring within 5 years from surgery. Vault cytology within 1 year of surgery will identify most cases of VAIN2+, but further data monitoring and integration of HPV testing will be required to determine this screening strategy.

Objectives: Imiquimod (IMQ) is an immunomodulatory topical drug with antiviral and antitumoral activity. Given its effectiveness and safety, IMQ is broadly off-label used for many vulvovaginal conditions as monotherapy and in association with other therapeutic approaches. However, standardized dose regimens and the total duration of therapy are still debated. This review aimed to summarize the current evidence on off-label uses of IMQ in different vulvovaginal conditions and compare its effectiveness to other gold standard treatments.

Methods: The literature review used PubMed/MEDLINE and ClinicalTrial.gov as primary sources, including articles from January 2000 to June 2024.

Results: Overall, 105 articles were included, of which 26 articles on vulvar Paget disease, 36 articles on vulvar intraepithelial neoplasia, 20 articles on vaginal intraepithelial neoplasia, 6 articles on vulvovaginal melanoma, and 17 articles on other conditions (molluscum contagiosum, herpes simplex type II infection, plasma cell vulvitis, and candidiasis). Most treatments included IMQ as monotherapy, or in combination and/or in alternative to other approaches, such as surgery, laser, human papillomavirus vaccination, systemic therapies (antiviral drugs, steroids), local therapies (1% cidofovir, 5% 5-fluorouracil, photodynamic therapy), and observation. The most frequent dose regimen was 3 times/week for 12-16 weeks. Outcomes widely varied among different conditions.

Conclusion: Off-label topical IMQ represents a noninvasive and effective option for treating lower genital tract conditions as monotherapy or in association with other treatments. The IMQ therapy must be personalized based on physician and patient preference.

Objectives: This study evaluates a new vaginal self-sampling device for high-risk human papillomavirus (HR-HPV) detection compared to clinician-collected samples using real-time polymerase chain reaction (PCR).

Methods: A total of 345 women aged between 23 and 72 were enrolled in this study. After receiving information about the study, women were provided with a vaginal collecting device to collect self-sample, and then a medical professional collected the cervical sample. All the clinician-collected samples were processed using the Cobas 4800 HPV assay, and the self-samples were processed with the automated MAIS extraction system. These results were used to compare the new device's performance to the clinician-collected cervical samples. All the clinician-collected samples were also analyzed with a new HPV screening assay to compare the performance of this assay on 2 different types of samples.

Results: Overall agreement for detecting any HR-HPV between clinician-collected samples and self-samples was 93.7% with a Cohen κ coefficient of 0.842. As both assays allow to identify genotypes 16, 18 and to detect the same 12 HR-HPV genotypes in a pool, the authors analyzed the agreement between self- and clinician-collected samples by genotypes and it was shown to be also excellent for HPV16 and the pool of other HR-HPV.

Conclusions: This self-sampling device has demonstrated detection rates that are comparable to those of samples collected by clinicians.

Objective: Lichen planus (LP) is a chronic inflammatory skin disease that may affect the skin, scalp, nails, and mucosa. The aim of this study was to investigate the risk of genital premalignant and malignant conditions in patients with anogenital LP (agLP).

Methods: The authors identified 60 male and 56 female patients with agLP by searching the biobank archives for a genital or perianal skin biopsy showing LP between 2004 and 2020. They also included 10 randomly selected age- and sex-matched controls for each patient. The risks of genital cancers and their precursors were evaluated.

Results: The incidence of agLP was 1.54 per 100,000 men and 1.36 per 100,000 women. There was no statistical difference between male and female incidence ( p = .5721). The odds ratio (OR) for high-grade squamous intraepithelial lesion (HSIL) of the vulva was 31.2 (95% CI = 2.46-1645.00; p = .01). The OR for penile neoplasias could not be calculated because control patients had no neoplasias, but the difference was suggestive of statistical significance (95% CI = 1.90-infinite; p = .008). The mean age at the time of diagnosis of agLP was 59.9 years (median 62 years) in female patients and 40.8 years (median 33 years) in male patients. The difference in the mean ages of female and male patients was statistically significant (95% CI = 11.92-26.13; p < .001).

Conclusions: Patients with agLP may have an increased risk for vulvar HSIL and penile neoplasia.