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Abnormal pap smear in adolescence
80
WEDNESDAY,
Population: Pregnant women admitted to the hospital. Method: Three random urine specimens and 24.hour urine collection were ordered for 90 subjects. Random urine proteinicreatinine ratio and estimated total urine protein were compared with the 24.hour urine protein. Main Outcome Measures: Correlation of random urine proteinicreatinine ratio and estimated total urine protein with the 24.hour urine protein excretion; 2. Sensitivity, specficity, positive and negative predictive values of random urine proteinicreatinine ratio for significant and nephrotic-range proteinuria. Results: Log random urine proteinicreatinine ratio and log estimated total urine protein showed good correlation with log 24.hour urine protein (r=0.70 to 0.80; p=O.OOOl). A log/log transformation of data was necessary due to the wide variability of values. A protein/creatinine ratio s-300 mg/g was the discriminant value for significant proteinuria, with sensitivity and specificity of 70.80% and a positive predictive value of 90%. However, its negative predictive value was only 20.30%. A protein/creatinine ratio s-3000 mg/g was the discriminant value for nephrotic-range proteinuria, with sensitivity, specificity, and negative predictive value of 80.90% and positive predictive value of 70%. Conclusion: Random urine protein/creatinine ratio may be useful in determining proteinuria in pregnant women. Because of large standard deviations associated with this method, caution must be taken in applying overconfidence to the values obtained with this technique.
P3.02 CERVIX P3.02.01 ABNORMAL PAP SMEAR IN ADOLESCENCE Tacla . M.; Tubaki, M.E.; Schwarzschild, M.M.S.; Luca, P.D.; Meniconi, M.C.; Barrueco ,A.K.; Lopes, E.A.; Duarte, M.I.S. Laboratdrio Fleury SBo Paula Brazil Objective: The purpose of this retrospective study is to evaluate the age distribution of cytologic abnormalities in adolescence and its correlation with the histopathologic findings. Material and Methods: Between January 1994 to December 1999, 3.483 cervicovaginal smears from upper and middle class adolescents ranging from 11 to 19 years old, that were referred to Laboratdrio Fleury , were taken. 155 smears were identified as abnormal. Colposcopy, vaginoscopy and/or colposcopically directed biopsy were performed in 110 adolescents. Results : Table I: Cervicovaginal Smear Age Distribution Total of Age
Cervicovaginal
11
13
Percentage of Abnormal Smears
Abnormal Smears
12
15
13
24
17
669
31
4.6
18
956
44
4.6
19
1293
61
4.7
Table II: Abnormal Cervicovaninal
Smear Ane Distribution
101 cervical biopsies were performed resulting in: 1 Condiloma Acuminatum ,2 Condiloma Acuminatum + CIN II, 9 Chronic Cervicitis, 45 Chronic Cervicitis + HPV , 1 Endocervicitis , 38 CIN I and 5 CIN II. Conclusion: The importance of these data is to establish the correlation between the age distribution of abnormal cytology and histopathology in the screening of cervical cancer and evaluate the severity of these
SEPTEMBER
6
abnormalities. Screening of cervical intraepithelial neoplasia among adolescents is essential to avoid the early evolution of this disease.
P3.02.02 CERVICAL CANCER IN PEMBROKESHIRE SINCE NATIONAL CANCER SCREENING PROGRAMME: IS SCREENING DISINVESTMENT DESIRABLE? S.N. Roy, W.M.Clow, J.Hall, Withybush Hospital, Dept. of Obstetrics & Gynaecology, Haverfordwest, Pembrokeshire, United Kingdom, SA 61 2PZ. Objectives: In the light of possible screening disinvestment, to assess the presentation of Cervical Cancer in Pembrokeshire since the starting of National Screening Programme (1988). Study Methods: Retrospective study of Cervical Screening history of patients diagnosed with Cervical Cancer in Pembrokeshire between 1988.1998. The screening coverage of the population was also assessed during the same period. Results: Screening coverage in Pembrokeshire was only 45% in 1988. This rapidly escalated to 81% in 1991 and stayed around 85% since 1993. Total 83 patients developed Cervical Cancer. Ten of these were above the age of 65 at 1988 and therefore not included in screening. The highest incidence of Cervical Cancer was in women who were never screened. A large number of cases were detected at the time of first call for screening (29). In the ‘recall programme, there were 7 interval cancers. Five of these were diagnosed because of ‘unscheduled’ smears. Six cases in this group (30%) would have not been diagnosed if screening was curtailed at the age of 50 for well screened patients. Conclusion: The present policy of 3 yearly screening till the age of 65 should be continued in Pembrokeshire.
P3.02.03 CONIZATION POSTOPERATIVE COMPLICATIONS M.Temellcovski M. Trajanova, .I. Kostadinov, A. Sopova, Special Gynecology and Obstretrics Hospital, Skopje, Macedonia Cervical conization is a rapid and relatively save surgical procedure. The advance is both, diagnostic and therapeutic. Analyzed were154 conization cases performed in two techniques. Patients were between 28 and 54 years old, and different pregnancies and births number. 90 patients (59%) had two, 17 (11%) had three and the remaining 32 (21%) more than 3 children. 41 (27%) had 2 artificial abortions and 46 (30%) had one. Indications were: unsatisfactory colposcopy following abnormal cervical smear, colposcopy prediction of early invasion or suspicion of cytology invasion, early invasion on direct biopsy, positive endocervical curettage, cytology discrepancy with colposcopy or direct biopsy and recurrent disease following previous ablative therapy. The operative technique is classical conization; hemeostasis obtained with a circular suture in 70 % (108 cases) and Shtrumdorf suture 30% (46). Postoperatively was ordinated for 3-5 days: cephalosporin, sulfonamide or tetracycline. Complications occurred in 7,79% (12 patients). Postoperative hemorrhagy within 1 to 10 days appeared: O-2 days 1 (0.64%); 3-5’h 3 (1.94%); 6-gth 2 (1.29%); 9-10th 2 (1.29%), postoperative cevicitis 1 (0.64%), urinary infections 3 (1.94%) and one had adhesions of the cervical channel. Preoperative findings were: CIN III in 98 cases (63.63%), CIN II in 32 (20.77%); susp’mousinvasion in 24 (15.58%). There was a high correlation between pathohystological results and preoperative findings with the postoperative diagnosis in 93% (143) cases, and the conization technique associated with the postoperative complications revealed no differences with the literature.
P3.02.04 DETERMINING THE COST EFFECTIVENESS OF MASS SCREENING FOR CERVICAL CANCER USING COMMON ANALYTIC MODELS S., G. Matsunaga, A. Yajima, Dept. OBIGYN, Tohoku University School of Medicine, Sendai, Japan. Objectives: To estimate the cost per life-year saved (cost-effectiveness ratio [CER]) for cervical cancer and to evaluate the influence of the decreased incidence upon the cost per life-year saved.
WEDNESDAY,
Population: Pregnant women admitted to the hospital. Method: Three random urine specimens and 24.hour urine collection were ordered for 90 subjects. Random urine proteinicreatinine ratio and estimated total urine protein were compared with the 24.hour urine protein. Main Outcome Measures: Correlation of random urine proteinicreatinine ratio and estimated total urine protein with the 24.hour urine protein excretion; 2. Sensitivity, specficity, positive and negative predictive values of random urine proteinicreatinine ratio for significant and nephrotic-range proteinuria. Results: Log random urine proteinicreatinine ratio and log estimated total urine protein showed good correlation with log 24.hour urine protein (r=0.70 to 0.80; p=O.OOOl). A log/log transformation of data was necessary due to the wide variability of values. A protein/creatinine ratio s-300 mg/g was the discriminant value for significant proteinuria, with sensitivity and specificity of 70.80% and a positive predictive value of 90%. However, its negative predictive value was only 20.30%. A protein/creatinine ratio s-3000 mg/g was the discriminant value for nephrotic-range proteinuria, with sensitivity, specificity, and negative predictive value of 80.90% and positive predictive value of 70%. Conclusion: Random urine protein/creatinine ratio may be useful in determining proteinuria in pregnant women. Because of large standard deviations associated with this method, caution must be taken in applying overconfidence to the values obtained with this technique.
P3.02 CERVIX P3.02.01 ABNORMAL PAP SMEAR IN ADOLESCENCE Tacla . M.; Tubaki, M.E.; Schwarzschild, M.M.S.; Luca, P.D.; Meniconi, M.C.; Barrueco ,A.K.; Lopes, E.A.; Duarte, M.I.S. Laboratdrio Fleury SBo Paula Brazil Objective: The purpose of this retrospective study is to evaluate the age distribution of cytologic abnormalities in adolescence and its correlation with the histopathologic findings. Material and Methods: Between January 1994 to December 1999, 3.483 cervicovaginal smears from upper and middle class adolescents ranging from 11 to 19 years old, that were referred to Laboratdrio Fleury , were taken. 155 smears were identified as abnormal. Colposcopy, vaginoscopy and/or colposcopically directed biopsy were performed in 110 adolescents. Results : Table I: Cervicovaginal Smear Age Distribution Total of Age
Cervicovaginal
11
13
Percentage of Abnormal Smears
Abnormal Smears
12
15
13
24
17
669
31
4.6
18
956
44
4.6
19
1293
61
4.7
Table II: Abnormal Cervicovaninal
Smear Ane Distribution
101 cervical biopsies were performed resulting in: 1 Condiloma Acuminatum ,2 Condiloma Acuminatum + CIN II, 9 Chronic Cervicitis, 45 Chronic Cervicitis + HPV , 1 Endocervicitis , 38 CIN I and 5 CIN II. Conclusion: The importance of these data is to establish the correlation between the age distribution of abnormal cytology and histopathology in the screening of cervical cancer and evaluate the severity of these
SEPTEMBER
6
abnormalities. Screening of cervical intraepithelial neoplasia among adolescents is essential to avoid the early evolution of this disease.
P3.02.02 CERVICAL CANCER IN PEMBROKESHIRE SINCE NATIONAL CANCER SCREENING PROGRAMME: IS SCREENING DISINVESTMENT DESIRABLE? S.N. Roy, W.M.Clow, J.Hall, Withybush Hospital, Dept. of Obstetrics & Gynaecology, Haverfordwest, Pembrokeshire, United Kingdom, SA 61 2PZ. Objectives: In the light of possible screening disinvestment, to assess the presentation of Cervical Cancer in Pembrokeshire since the starting of National Screening Programme (1988). Study Methods: Retrospective study of Cervical Screening history of patients diagnosed with Cervical Cancer in Pembrokeshire between 1988.1998. The screening coverage of the population was also assessed during the same period. Results: Screening coverage in Pembrokeshire was only 45% in 1988. This rapidly escalated to 81% in 1991 and stayed around 85% since 1993. Total 83 patients developed Cervical Cancer. Ten of these were above the age of 65 at 1988 and therefore not included in screening. The highest incidence of Cervical Cancer was in women who were never screened. A large number of cases were detected at the time of first call for screening (29). In the ‘recall programme, there were 7 interval cancers. Five of these were diagnosed because of ‘unscheduled’ smears. Six cases in this group (30%) would have not been diagnosed if screening was curtailed at the age of 50 for well screened patients. Conclusion: The present policy of 3 yearly screening till the age of 65 should be continued in Pembrokeshire.
P3.02.03 CONIZATION POSTOPERATIVE COMPLICATIONS M.Temellcovski M. Trajanova, .I. Kostadinov, A. Sopova, Special Gynecology and Obstretrics Hospital, Skopje, Macedonia Cervical conization is a rapid and relatively save surgical procedure. The advance is both, diagnostic and therapeutic. Analyzed were154 conization cases performed in two techniques. Patients were between 28 and 54 years old, and different pregnancies and births number. 90 patients (59%) had two, 17 (11%) had three and the remaining 32 (21%) more than 3 children. 41 (27%) had 2 artificial abortions and 46 (30%) had one. Indications were: unsatisfactory colposcopy following abnormal cervical smear, colposcopy prediction of early invasion or suspicion of cytology invasion, early invasion on direct biopsy, positive endocervical curettage, cytology discrepancy with colposcopy or direct biopsy and recurrent disease following previous ablative therapy. The operative technique is classical conization; hemeostasis obtained with a circular suture in 70 % (108 cases) and Shtrumdorf suture 30% (46). Postoperatively was ordinated for 3-5 days: cephalosporin, sulfonamide or tetracycline. Complications occurred in 7,79% (12 patients). Postoperative hemorrhagy within 1 to 10 days appeared: O-2 days 1 (0.64%); 3-5’h 3 (1.94%); 6-gth 2 (1.29%); 9-10th 2 (1.29%), postoperative cevicitis 1 (0.64%), urinary infections 3 (1.94%) and one had adhesions of the cervical channel. Preoperative findings were: CIN III in 98 cases (63.63%), CIN II in 32 (20.77%); susp’mousinvasion in 24 (15.58%). There was a high correlation between pathohystological results and preoperative findings with the postoperative diagnosis in 93% (143) cases, and the conization technique associated with the postoperative complications revealed no differences with the literature.
P3.02.04 DETERMINING THE COST EFFECTIVENESS OF MASS SCREENING FOR CERVICAL CANCER USING COMMON ANALYTIC MODELS S., G. Matsunaga, A. Yajima, Dept. OBIGYN, Tohoku University School of Medicine, Sendai, Japan. Objectives: To estimate the cost per life-year saved (cost-effectiveness ratio [CER]) for cervical cancer and to evaluate the influence of the decreased incidence upon the cost per life-year saved.