Psychosexual outcomes in women of reproductive age at more than two-years from excisional cervical treatment – a cross-sectional study (2018)

Type of publication:
Journal article

Author(s):
Sparić, Radmila; *Papoutsis, Dimitrios; Kadija, Saša; Stefanović, Radomir; *Antonakou, Angeliki; Nejković, Lazar; Kesić, Vesna

Citation:
Journal of Psychosomatic Obstetrics and Gynaecology; Mar 2018 ; p. 1-10

Abstract:
PURPOSE To investigate the long-term psychosexual outcomes in women following excisional cervical
treatment. MATERIALS AND METHODS Women with cold-knife conization (CKC) or large loop excision of the transformation zone (LLETZ) treatment were interviewed after a follow-up colposcopy visit. Their demographics, treatment and psychosexual characteristics were recorded. RESULTS One hundred and forty six women with a mean age of 35.2 ± 5.4 years underwent either LLETZ (68.5%) or CKC (31.5%) treatment within 4.7 ± 2.7 years (range: 2-15) before the interview. 27.4% of women were less interested in sexual intercourse following treatment in comparison with their interest before. Those women with less interest in sexual intercourse after treatment had higher anxiety and depression scores and were more worried about disease progression. Women with post-treatment complications were at risk of less interest in sexual intercourse and of greater anxiety and depression. Women with abnormal smears at follow-up were at risk of greater anxiety. The type of treatment and grade of dysplasia did not affect their interest in sexual intercourse or the anxiety and depression scores. CONCLUSIONS Approximately, one-third of women at more than two years posttreatment may suffer from less interest in sexual intercourse, have relatively greater anxiety and depression, and might still be concerned about the possibility of disease progression.

Early and late pregnancy outcomes in women treated with cold-coagulation versus LLETZ cervical treatment for cervical intraepithelial neoplasia; a retrospective cohort study (2018)

Type of publication:
Journal article

Author(s):
*Papoutsis, Dimitrios; *Underwood, Martyn; *Parry-Smith, William; *Panikkar, Jane

Citation:
Archives of gynecology and obstetrics; Apr 2018; Vol.297(4):1015-1025

Abstract:
PURPOSE To compare the pregnancy outcomes between women who were treated with cold-coagulation versus large loop excision of the transformation zone (LLETZ) for cervical intraepithelial neoplasia. METHODS This was a retrospective cohort study of women who had a single cervical treatment between 2010 and 2011. We identified those women who had a singleton pregnancy subsequent to their cervical treatment until September 2017. Women with previous cervical treatment, previous miscarriage or preterm delivery were excluded. RESULTSWe identified 86 women with a pregnancy after LLETZ treatment and 75 women after cold coagulation. Those who had LLETZ when compared to cold coagulation miscarried more often in the first trimester (33.7 vs 17.3%; p = 0.01) than in the second trimester. In women with LLETZ this effect of increased early miscarriage was shown to be prolonged and to persist up to 17 months after excision. Women with LLETZ when compared to cold coagulation had higher spontaneous preterm birth rates (8.9 vs 6.7%) even though the difference was non significant, with the earliest spontaneous preterm birth occurring at 32 weeks and 34 weeks, respectively. CONCLUSION We found that women who received LLETZ treatment when compared to cold coagulation had higher spontaneous preterm birth rates in their subsequent pregnancy and miscarried more frequently in the first trimester, and demonstrated an increased early miscarriage risk that persisted for more than a year after excisional treatment.

Endocervical Crypt Involvement by CIN2-3 as a Predictor of Cytology Recurrence After Excisional Cervical Treatment. (2015)

Type of publication:
Journal article

Author(s):
*Papoutsis, Dimitrios, *Panikkar, Jane, *Underwood, Martyn, Blundell, Sue, *Sahu, Banchita, *Blackmore, Jill, *Reed, Nicholas

Citation:
Journal of Lower Genital Tract Disease, Oct 2015, vol. 19, no. 4, p. 311-318

Abstract:
The primary objective was to determine whether endocervical crypt involvement (ECI) by cervical intraepithelial neoplasia (CIN) on the excised cervical tissue after large loop excision of the transformation zone (LLETZ) represents a predictor of cytology recurrence. Secondary objective was to identify the ability of a pretreatment cervical punch biopsy to predict cytology recurrence. This was a case series study conducted in an NHS hospital. Women with LLETZ treatment performed over a 2-year period (2010-2011) were identified through our colposcopy database. Women with previous cervical treatment, cervical cancer on cone histopathology, or missing follow-up data were excluded. A group of 526 eligible women was identified over the study period. Crypt involvement was not a predictor of recurrence in the total sample. However, in the subgroup of women with CIN2-3 on pretreatment punch biopsy and with ECI on cone specimen in comparison to those without ECI, we identified an increased risk for overall cytology recurrence (HR, 3.1; 95% CI, 1.04-9.28; P = 0.043) and a trend for increased risk of high-grade cytology recurrence (HR, 4.62; 95% CI, 0.84-25.28; P = 0.07). A pretreatment punch biopsy showing crypt involvement by CIN2-3 was indicative of women at risk for abnormal cytology after excision. In women with CIN2-3 on pretreatment punch biopsy and ECI on excised tissue, the high-grade cytology recurrence was significantly reduced if more than 1.9 cm of cervix was removed. It seems that the presence of crypt involvement on the excised cervix in the subgroup of women with CIN2-3 on pretreatment punch biopsy is predictive of cytology recurrence.