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M299 NEW FRONTIERS OF INGUINAL LYMPHADENECTOMY FOR VULVAR CANCER: VIDEO-ENDOSCOPIC APPROACH
Poster presentations / International Journal of Gynecology & Obstetrics 119S3 (2012) S531–S867
underwent two punctures. Results of the punctures were correlated with pathology reports of surgical specimens. 29 patients (41.42%) underwent FNA alone, and the results were as follows: 6 (20.68%) were positive for carcinoma, which is confirmed in its entirety with the pathology of the surgery, negative: 8 (27.58%) than in whole correlated with surgery, suspicious: 14 (48.29%), 4 (28.57%) were negative and 10 (71.42%) positive, unsatisfactory: 1 (3.44%). About to CB, 11 (15.74%) patients underwent only this method, and the results are the following: positive: 7 (63.63%), negative 3 (27.27%), suspect: 1 (9.09%) in all cases were confirmed by pathology from surgery, the suspect corresponded a fibroadenoma. Both procedures (FNA + CB) were performed in 25 patients (35.71%), whose results are: 20 (80%) were positive in 3 (12%) were negative in these cases were correlated with surgical pathology, in 2 patients (8%) there was no coincidence. Conclusions: The validity of skin punctures in the diagnosis of breast cancer, has been checked and are standard practice and accessibility, low cost, low technical difficulty and low complication rate makes them a useful tool not only for diagnosis but to optimize the therapeutic strategy. Our experience, having achieved a 92% correspondence in the diagnosis of breast cancer, these techniques makes the method of choice for initial diagnosis of breast cancer T size
N
%
T1 T2 T3 T4
27 21 8 13
39 30 11.42 18.47
Figure: FNA+COREBIOPSY. M298 CLINICAL CHARACTERISTICS OF MUCINOUS ADENOCARCINOMA OF THE OVARY Y. Li1 . 1 Gynecology & Obstectrics, People’s Hospital Peking University, Beijing, China Objectives: To summarize the clinical characteristics of mucinous carcinoma of the ovary. Materials: Retrospective reviewed medical records of 24 mucinous and 108 non-mucinous ovarian carcinoma patients. Methods: Retrospective reviewed medical records of 24 mucinous and 108 non-mucinous ovarian carcinoma patients including age, FIGO stage, residual disease, response rate to paclitaxel/platinum chemotherapy, compared the survival time and analyzed the prognostic factors. Results: The average age was similar between two groups, while the mucinous carcinoma group had less advanced FIGO stage (P = 0.001) and lower tumor grading (P = 0.000). Although the overall rate of optimal debulking surgery was higer in mucinous group with all stages (P = 0.020), but there was no difference in advanced patients (P = 0.453). Response rate to platinum-based chemotherapy was 63.2% and 85.2%, respectively (P = 0.212). Platium-resistant patients of mucinous group seemed have no relation with FIGO stage and residual disease, the response rate dramatically reduced to 40% in recurrent patients. The median progression-free survival (PFS) of all stages of mucinous and non-mucinous group was 22 months
S627
and 17 months (P = 0.393), the median overall survival (OS) was 22 months and 37.5 months (P = 0.670). While the median PFS of early stages was 37.5 months and 44 months (P = 0.304), the median OS was 49 months and 45 months (P = 0.621). The median PFS was shorter in stage III/IV mucinous patients after optimal debulking surgery (mucinous vs non-mucinous: 12 vs 27 months, P = 0.003), as well as shorter OS (mucinous vs non-mucinous: 18 vs 45 months, P = 0.044); but there was no difference between stage III/IV patients after sub-optimal debulking surgery. Cox regression analysis showed the mucinous histology, FIGO stage and residual disease were prognostic factors for PFS, only residual tumor size was the progostic factor for OS. Conclusions: Mucinous ovarian carcinoam was an unique type in epithelial carcinoma. The survival was worse in advanced mucinous carcinoma patients. Cytoreductive surgery was the first line therapy, resistance to platinum-based chemotherapy maybe associate with worse prognosis. New effective chemotherapy regimen should be developed. M299 NEW FRONTIERS OF INGUINAL LYMPHADENECTOMY FOR VULVAR CANCER: VIDEO-ENDOSCOPIC APPROACH D. Huber1 , N. Schneider2 . 1 Gynecological Oncology Unit, University Hospital Geneva, Geneva, Switzerland; 2 CHCv Sion Hospital, Sion, Switzerland Objectives: Inguinal lymphadenectomy is a part of the surgical treatment of invasive vulvar cancers. Node metastasis represents a major prognostic factor, therefore inguinal lymphadenectomy has a central role in oncological patient management. Nevertheless, inguinal node dissection is associated with significant morbidity. Recently, several publications have reported experiences with video-endoscopic assisted techniques attempting to reduce the high morbidity related to open inguinal lymphadenectomy. Materials: A 55-year-old postmenopausal female presented with an exophytic mass in both the minor labia and clitoris. The superficial anterior vulvectomy established the diagnosis of invasive vulvar carcinoma, pathological stage pT1b. Video-assisted inguino-femoral lymphadenectomy was scheduled 5 weeks after the vulvectomy. Methods: A 15 mm incision was made 2 cm below the vertex of the femoral triangle. The second and the third 10 mm incisions were placed at 6 cm external and internal to the first incision. The distal lymphatic tissue and saphenous veins were divided at the vertex of the femoral triangle. Inguinal lymphadenectomy was continued medially to the femoral vein up to the Cloquet node. At the level of the inguinal ligament the lymphatic tissue was divided and liberated. The nodal tissue was removed through the lateral 10 mm incision using an endobag. A suction drainage was placed and exteriorized at the lateral port incision.
Results: The total operative time for the bilateral inguinal lymphadenectomy was 260 minutes. The estimated blood loss was less than 50 ml on each side. The inguinal drainage was maintained until the 24 hours output was less than 50 ml (7th postoperative day for both sides).
S628
Poster presentations / International Journal of Gynecology & Obstetrics 119S3 (2012) S531–S867
Since 2006 several articles published results of endoscopic assisted inguinal lymphadenectomy for penile cancer. In 2011 Liang published the first serie of 17 patients with endoscopic assisted inguinal lymphadenectomy for invasive vulvar cancer using an novel abdominal approach. Conclusions: Endoscopic inguinal lymph node dissection for patients with invasive vulvar cancer it is a feasible and safe technique that might diminish wound related complications associated with classical open approach. The middle term outcome of the initial series in cases with penile carcinoma seems to fulfill the oncological objectives, but extended follow-up and gynecological patients’ inclusion is needed for more definitive conclusions. M300 FACTORS ASSOCIATED WITH ENDOCERVICAL MARGIN INVOLVEMENT IN CONIZATION: WHAT IS THE APPROPRIATE CONE DEPTH TO AVOID ENDOCERVICAL MARGIN INVOLVEMENT IN PATIENTS YOUNGER THAN 40? H.S. Bae1 , Y.W. Chung1 , J.Y. Song1 , K.W. Lee1 . 1 Obsteterics and Gynecology, Korea University Anam Hospital, Seoul, Korea, Republic of Objectives: Cone margin status has been reported to be the most important predictor of residual disease in patients with cervical intraepithelial neoplasia (CIN) and early invasive cervical cancer undergoing conization. The purpose of this study was to analyze these factors associated with endocervical cone margin involvement and to suggest the appropriate cone depth in the conization procedure. Materials: The study population included 1,220 patients undergoing conization for cervical intraepithelial neoplasia (CIN) 2, 3 or stage IA1 microinvasive cervical carcinoma between January 1996 and December 2010. Methods: The following factors were analyzed: age, parity, gravida, conization type, margin status, disease severity and specimen depth. Receiver operating characteristic (ROC) curve analyses were employed to determine the best cut-off points to define the appropriate cone depth in patients younger than 40. Results: Of the 1,220 patients, 91 patients had endocervical margin involvement (7.5%). On multivariate analysis, the frequency of endocervical margin involvement was positively associated with disease severity and age; this inversely related to cone depth. On ROC curve analysis, cut-off value was achieved at 1.7 cm of cone depth with high sensitivity and relatively low specificity (AUC 0.64, sensitivity 0.82, specificity 0.29, P = 0.02). In subgroup localized to moderate dysplasia, the cut-off value was achieved at 1.3 cm (AUC 0.78, sensitivity 0.86, specificity 0.61, P = 0.01). Conclusions: Age, disease severity, cone depth are the preoperative predictive factors of endocervical margin involvement. In patients younger than 40, cone depth <1.7 cm can be used as a reference value to predict the endocervical margin involvement. In the case of moderate dysplasia, the cut-off point is achieved at a lower level (cone depth <1.3 cm). M301 ACCURACY OF PET/CT IN THE DETECTION OF LYMPH NODE METASTASES IN PATIENTS WITH LOCALLY ADVANCED CERVICAL CANCER Y. Delpech1 , A. Peres1 , M. Koskas2 , A.L. Margulies1 , J.P. Brouland1 , I. Perreti1 , L. Sarda2 , A. Thoury1 , D. Luton2 , E. Barranger1 . 1 Obstetric and Gynecology, APHP, Lariboisiere Hospital, Paris, France; 2 APHP, Bichat Hospital, Paris, France Objectives: The aim of this multicentric retrospective study was to evaluate the accuracy of positron emission tomography/computed tomography (PET/CT) for detecting lymph node metastasis in patients with locally advanced cervical carcinoma. Materials: This was a multicentric retrospective study of 41 consecutive untreated patients with histopathologically confirmed
FIGO stage IB-IVA invasive cervical carcinoma, as determined by a conventional workup that included CT scans (computed tomography scanning), magnetic resonance imaging (MRI) and PET/CT scans. These patients had been managed in two French institutions, the Lariboisiere Hospital and the Bichat Hospital between April 2006 and November 2010. Inclusion criteria were FIGO stage >Ib1, availability of both MRI and PET/CT and no treatment before surgical staging. Methods: A hybrid PET/CT system combining a third generation multislice spiral CT with a PET scanner was used. All PET/CT images were evaluated visually by experienced nuclear medicine and radiology physicians. Thirty-one patients had pelvic and para aortic lymphadenectomy and 10 patients had only para aortic lymphadenectomy. All the staging surgeries were performed by experimented gynaecologic surgeons who were aware of the MRI and PET/CT lymph node findings prior to the lymph node dissections. The lymph nodes were submitted for routine sectioning and pathologic evaluation. If all lymph nodes sampled were negative, the case was submitted for further processing. The value of preoperative PET/CT was assessed by estimating the sensitivity, specificity, negative predictive value (NPV), and positive predictive value (PPV) of the PET/CT to identify pelvic and para aortic lymph node metastasis that was identified by laparoscopic pelvic and para aortic lymphadenectomy. Results: The median time between the PET/CT and surgical staging was 8 days. The sensitivity, specificity and positive and negative predictive value of the PET/CT were 54, 50, 44, and 60%, respectively, for the detection of pelvic lymph node metastasis. The false negative rate was 46%. For the detection of the para aortic lymph node metastasis, the sensitivity, specificity and positive and negative predictive value of the PET/CT were 17, 100, 100, and 88%, respectively. The false negative rate was 83%. Conclusions: Our results suggested that PET/CT cannot be used as an alternative to surgical lymph node staging for the detection of pelvic and para-aortic lymph node metastasis in locally advanced cervical cancer due its low sensitivity. M302 REFERRALS TO COLPOSCOPY WITH CLINICAL INDICATIONS – THE HILLINGDON EXPERIENCE J. Wahba1 , L. Cherfan1 , N. Nicholas1 . 1 Obstetrics and Gynaecology, Hillingdon Hospital, London, United Kingdom Objectives: The guidelines according to the National Health Service Cervical Screening Programme (NHS CSP) advocate that a referral to colposcopy should be made if malignancy is suspected in women presenting with an abnormal cervix, or women over the age of 40 with post-coital bleeding (PCB), inter-menstrual bleeding (IMB), or persistent discharge. Referrals are divided into ‘Non-Urgent’ and ‘Urgent’, depending on the clinical presentation and suspicion of malignancy. This group of women therefore accounts for a significant proportion of patients seen in the colposcopy clinic and has raised the debate regarding whether this is appropriate. Materials: A retrospective review of all clinical indication referrals from 1 April 2010 to 31 March 2011. Methods: Data was collected from the colposcopy database CIMS Infloflex using a proforma annonamising patients’ details. This was then manually transposed onto Excel for data analysis. Results: Over the specified time period, there were 737 referrals to our colposcopy unit. Of these, 158 (21.4%) were for clinical indications. 62 (39%) of these were ‘Urgent’. A third of the referrals were from the 21–40 age group. 61% of the referrals were for PCB, IMB, persistent discharge and/or an abnormal cervix. The remainder included referrals for ectropion, polyps, insertion of IUCD, fitting of a ring pessary, and follow-up post-LLETZ. Furthermore, 82% did not have a smear prior to referral. There was 22% detection rate of abnormalities which included 1 case adenocarcinoma in-situ, 1 case of glandular neoplasia, 27 cases of CIN 1, 8 cases of CIN 2 and 1 case
underwent two punctures. Results of the punctures were correlated with pathology reports of surgical specimens. 29 patients (41.42%) underwent FNA alone, and the results were as follows: 6 (20.68%) were positive for carcinoma, which is confirmed in its entirety with the pathology of the surgery, negative: 8 (27.58%) than in whole correlated with surgery, suspicious: 14 (48.29%), 4 (28.57%) were negative and 10 (71.42%) positive, unsatisfactory: 1 (3.44%). About to CB, 11 (15.74%) patients underwent only this method, and the results are the following: positive: 7 (63.63%), negative 3 (27.27%), suspect: 1 (9.09%) in all cases were confirmed by pathology from surgery, the suspect corresponded a fibroadenoma. Both procedures (FNA + CB) were performed in 25 patients (35.71%), whose results are: 20 (80%) were positive in 3 (12%) were negative in these cases were correlated with surgical pathology, in 2 patients (8%) there was no coincidence. Conclusions: The validity of skin punctures in the diagnosis of breast cancer, has been checked and are standard practice and accessibility, low cost, low technical difficulty and low complication rate makes them a useful tool not only for diagnosis but to optimize the therapeutic strategy. Our experience, having achieved a 92% correspondence in the diagnosis of breast cancer, these techniques makes the method of choice for initial diagnosis of breast cancer T size
N
%
T1 T2 T3 T4
27 21 8 13
39 30 11.42 18.47
Figure: FNA+COREBIOPSY. M298 CLINICAL CHARACTERISTICS OF MUCINOUS ADENOCARCINOMA OF THE OVARY Y. Li1 . 1 Gynecology & Obstectrics, People’s Hospital Peking University, Beijing, China Objectives: To summarize the clinical characteristics of mucinous carcinoma of the ovary. Materials: Retrospective reviewed medical records of 24 mucinous and 108 non-mucinous ovarian carcinoma patients. Methods: Retrospective reviewed medical records of 24 mucinous and 108 non-mucinous ovarian carcinoma patients including age, FIGO stage, residual disease, response rate to paclitaxel/platinum chemotherapy, compared the survival time and analyzed the prognostic factors. Results: The average age was similar between two groups, while the mucinous carcinoma group had less advanced FIGO stage (P = 0.001) and lower tumor grading (P = 0.000). Although the overall rate of optimal debulking surgery was higer in mucinous group with all stages (P = 0.020), but there was no difference in advanced patients (P = 0.453). Response rate to platinum-based chemotherapy was 63.2% and 85.2%, respectively (P = 0.212). Platium-resistant patients of mucinous group seemed have no relation with FIGO stage and residual disease, the response rate dramatically reduced to 40% in recurrent patients. The median progression-free survival (PFS) of all stages of mucinous and non-mucinous group was 22 months
S627
and 17 months (P = 0.393), the median overall survival (OS) was 22 months and 37.5 months (P = 0.670). While the median PFS of early stages was 37.5 months and 44 months (P = 0.304), the median OS was 49 months and 45 months (P = 0.621). The median PFS was shorter in stage III/IV mucinous patients after optimal debulking surgery (mucinous vs non-mucinous: 12 vs 27 months, P = 0.003), as well as shorter OS (mucinous vs non-mucinous: 18 vs 45 months, P = 0.044); but there was no difference between stage III/IV patients after sub-optimal debulking surgery. Cox regression analysis showed the mucinous histology, FIGO stage and residual disease were prognostic factors for PFS, only residual tumor size was the progostic factor for OS. Conclusions: Mucinous ovarian carcinoam was an unique type in epithelial carcinoma. The survival was worse in advanced mucinous carcinoma patients. Cytoreductive surgery was the first line therapy, resistance to platinum-based chemotherapy maybe associate with worse prognosis. New effective chemotherapy regimen should be developed. M299 NEW FRONTIERS OF INGUINAL LYMPHADENECTOMY FOR VULVAR CANCER: VIDEO-ENDOSCOPIC APPROACH D. Huber1 , N. Schneider2 . 1 Gynecological Oncology Unit, University Hospital Geneva, Geneva, Switzerland; 2 CHCv Sion Hospital, Sion, Switzerland Objectives: Inguinal lymphadenectomy is a part of the surgical treatment of invasive vulvar cancers. Node metastasis represents a major prognostic factor, therefore inguinal lymphadenectomy has a central role in oncological patient management. Nevertheless, inguinal node dissection is associated with significant morbidity. Recently, several publications have reported experiences with video-endoscopic assisted techniques attempting to reduce the high morbidity related to open inguinal lymphadenectomy. Materials: A 55-year-old postmenopausal female presented with an exophytic mass in both the minor labia and clitoris. The superficial anterior vulvectomy established the diagnosis of invasive vulvar carcinoma, pathological stage pT1b. Video-assisted inguino-femoral lymphadenectomy was scheduled 5 weeks after the vulvectomy. Methods: A 15 mm incision was made 2 cm below the vertex of the femoral triangle. The second and the third 10 mm incisions were placed at 6 cm external and internal to the first incision. The distal lymphatic tissue and saphenous veins were divided at the vertex of the femoral triangle. Inguinal lymphadenectomy was continued medially to the femoral vein up to the Cloquet node. At the level of the inguinal ligament the lymphatic tissue was divided and liberated. The nodal tissue was removed through the lateral 10 mm incision using an endobag. A suction drainage was placed and exteriorized at the lateral port incision.
Results: The total operative time for the bilateral inguinal lymphadenectomy was 260 minutes. The estimated blood loss was less than 50 ml on each side. The inguinal drainage was maintained until the 24 hours output was less than 50 ml (7th postoperative day for both sides).
S628
Poster presentations / International Journal of Gynecology & Obstetrics 119S3 (2012) S531–S867
Since 2006 several articles published results of endoscopic assisted inguinal lymphadenectomy for penile cancer. In 2011 Liang published the first serie of 17 patients with endoscopic assisted inguinal lymphadenectomy for invasive vulvar cancer using an novel abdominal approach. Conclusions: Endoscopic inguinal lymph node dissection for patients with invasive vulvar cancer it is a feasible and safe technique that might diminish wound related complications associated with classical open approach. The middle term outcome of the initial series in cases with penile carcinoma seems to fulfill the oncological objectives, but extended follow-up and gynecological patients’ inclusion is needed for more definitive conclusions. M300 FACTORS ASSOCIATED WITH ENDOCERVICAL MARGIN INVOLVEMENT IN CONIZATION: WHAT IS THE APPROPRIATE CONE DEPTH TO AVOID ENDOCERVICAL MARGIN INVOLVEMENT IN PATIENTS YOUNGER THAN 40? H.S. Bae1 , Y.W. Chung1 , J.Y. Song1 , K.W. Lee1 . 1 Obsteterics and Gynecology, Korea University Anam Hospital, Seoul, Korea, Republic of Objectives: Cone margin status has been reported to be the most important predictor of residual disease in patients with cervical intraepithelial neoplasia (CIN) and early invasive cervical cancer undergoing conization. The purpose of this study was to analyze these factors associated with endocervical cone margin involvement and to suggest the appropriate cone depth in the conization procedure. Materials: The study population included 1,220 patients undergoing conization for cervical intraepithelial neoplasia (CIN) 2, 3 or stage IA1 microinvasive cervical carcinoma between January 1996 and December 2010. Methods: The following factors were analyzed: age, parity, gravida, conization type, margin status, disease severity and specimen depth. Receiver operating characteristic (ROC) curve analyses were employed to determine the best cut-off points to define the appropriate cone depth in patients younger than 40. Results: Of the 1,220 patients, 91 patients had endocervical margin involvement (7.5%). On multivariate analysis, the frequency of endocervical margin involvement was positively associated with disease severity and age; this inversely related to cone depth. On ROC curve analysis, cut-off value was achieved at 1.7 cm of cone depth with high sensitivity and relatively low specificity (AUC 0.64, sensitivity 0.82, specificity 0.29, P = 0.02). In subgroup localized to moderate dysplasia, the cut-off value was achieved at 1.3 cm (AUC 0.78, sensitivity 0.86, specificity 0.61, P = 0.01). Conclusions: Age, disease severity, cone depth are the preoperative predictive factors of endocervical margin involvement. In patients younger than 40, cone depth <1.7 cm can be used as a reference value to predict the endocervical margin involvement. In the case of moderate dysplasia, the cut-off point is achieved at a lower level (cone depth <1.3 cm). M301 ACCURACY OF PET/CT IN THE DETECTION OF LYMPH NODE METASTASES IN PATIENTS WITH LOCALLY ADVANCED CERVICAL CANCER Y. Delpech1 , A. Peres1 , M. Koskas2 , A.L. Margulies1 , J.P. Brouland1 , I. Perreti1 , L. Sarda2 , A. Thoury1 , D. Luton2 , E. Barranger1 . 1 Obstetric and Gynecology, APHP, Lariboisiere Hospital, Paris, France; 2 APHP, Bichat Hospital, Paris, France Objectives: The aim of this multicentric retrospective study was to evaluate the accuracy of positron emission tomography/computed tomography (PET/CT) for detecting lymph node metastasis in patients with locally advanced cervical carcinoma. Materials: This was a multicentric retrospective study of 41 consecutive untreated patients with histopathologically confirmed
FIGO stage IB-IVA invasive cervical carcinoma, as determined by a conventional workup that included CT scans (computed tomography scanning), magnetic resonance imaging (MRI) and PET/CT scans. These patients had been managed in two French institutions, the Lariboisiere Hospital and the Bichat Hospital between April 2006 and November 2010. Inclusion criteria were FIGO stage >Ib1, availability of both MRI and PET/CT and no treatment before surgical staging. Methods: A hybrid PET/CT system combining a third generation multislice spiral CT with a PET scanner was used. All PET/CT images were evaluated visually by experienced nuclear medicine and radiology physicians. Thirty-one patients had pelvic and para aortic lymphadenectomy and 10 patients had only para aortic lymphadenectomy. All the staging surgeries were performed by experimented gynaecologic surgeons who were aware of the MRI and PET/CT lymph node findings prior to the lymph node dissections. The lymph nodes were submitted for routine sectioning and pathologic evaluation. If all lymph nodes sampled were negative, the case was submitted for further processing. The value of preoperative PET/CT was assessed by estimating the sensitivity, specificity, negative predictive value (NPV), and positive predictive value (PPV) of the PET/CT to identify pelvic and para aortic lymph node metastasis that was identified by laparoscopic pelvic and para aortic lymphadenectomy. Results: The median time between the PET/CT and surgical staging was 8 days. The sensitivity, specificity and positive and negative predictive value of the PET/CT were 54, 50, 44, and 60%, respectively, for the detection of pelvic lymph node metastasis. The false negative rate was 46%. For the detection of the para aortic lymph node metastasis, the sensitivity, specificity and positive and negative predictive value of the PET/CT were 17, 100, 100, and 88%, respectively. The false negative rate was 83%. Conclusions: Our results suggested that PET/CT cannot be used as an alternative to surgical lymph node staging for the detection of pelvic and para-aortic lymph node metastasis in locally advanced cervical cancer due its low sensitivity. M302 REFERRALS TO COLPOSCOPY WITH CLINICAL INDICATIONS – THE HILLINGDON EXPERIENCE J. Wahba1 , L. Cherfan1 , N. Nicholas1 . 1 Obstetrics and Gynaecology, Hillingdon Hospital, London, United Kingdom Objectives: The guidelines according to the National Health Service Cervical Screening Programme (NHS CSP) advocate that a referral to colposcopy should be made if malignancy is suspected in women presenting with an abnormal cervix, or women over the age of 40 with post-coital bleeding (PCB), inter-menstrual bleeding (IMB), or persistent discharge. Referrals are divided into ‘Non-Urgent’ and ‘Urgent’, depending on the clinical presentation and suspicion of malignancy. This group of women therefore accounts for a significant proportion of patients seen in the colposcopy clinic and has raised the debate regarding whether this is appropriate. Materials: A retrospective review of all clinical indication referrals from 1 April 2010 to 31 March 2011. Methods: Data was collected from the colposcopy database CIMS Infloflex using a proforma annonamising patients’ details. This was then manually transposed onto Excel for data analysis. Results: Over the specified time period, there were 737 referrals to our colposcopy unit. Of these, 158 (21.4%) were for clinical indications. 62 (39%) of these were ‘Urgent’. A third of the referrals were from the 21–40 age group. 61% of the referrals were for PCB, IMB, persistent discharge and/or an abnormal cervix. The remainder included referrals for ectropion, polyps, insertion of IUCD, fitting of a ring pessary, and follow-up post-LLETZ. Furthermore, 82% did not have a smear prior to referral. There was 22% detection rate of abnormalities which included 1 case adenocarcinoma in-situ, 1 case of glandular neoplasia, 27 cases of CIN 1, 8 cases of CIN 2 and 1 case