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AS03. Cervical cancer
EP086/#497  Scaling cervical cancer screening in mozambique: analysis of loop electrosurgical excision procedure (LEEP) specimens
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  1. Sydney Chambule1,
  2. Samantha Batman2,
  3. Eva Lathrop3,
  4. Nafissa Osman4,
  5. Andrea Neves5,
  6. Ricardina Rangeiro6,
  7. Arlete Mariano7,
  8. Jean Claude Batware8,
  9. Carla Carrilho9,
  10. Eliane Monteiro10,
  11. Rosita Mugolo11,
  12. Joseph Thomas12,13,
  13. Jennifer Carns14,
  14. Viviane Andrade15,
  15. Hira Atif6,
  16. Ellen Baker2,
  17. Rebecca Richards-Kortum16,
  18. Kathleen M Schmeler2,
  19. Cesaltina Lorenzoni17 and
  20. Mila P Salcedo2
  1. 1Perelman School of Medicine at the University of Pennsylvania, Medical School, Philadelphia, USA
  2. 2The University of Texas MD Anderson Cancer Center, Department of Gynecologic Oncology and Reproductive Medicine, Houston, USA
  3. 3Population Services International, Global Medical Director, Washington, USA
  4. 4Eduardo Mondlane University, Obstetrics and Gynecology, Maputo, Mozambique
  5. 5Hospital Geral e Centro de Saúde José Macamo, Obstetrics and Gynecology, Maputo, Mozambique
  6. 6Hospital Central de Maputo, Obstetrics and Gynecology, Maputo, Mozambique
  7. 7Hospital Geral e Centro de Saúde de Mavalane, Obstetrics and Gynecology, Maputo, Mozambique
  8. 8Hospital Provincial de Xai-Xai, Obstetrics and Gynecology, Gaza, Mozambique
  9. 9Maputo Central Hospital, Anatomical Pathology, Maputo, Mozambique
  10. 10Hospital Geral e Centro de Saúde de Mavalane, Pathology, Maputo, Mozambique
  11. 11Hospital Central de Maputo, Pathology, Maputo, Mozambique
  12. 12The University of Texas MD Anderson Cancer Center, Department of Oncology Care and Research Information Systems, Houston, USA
  13. 13The University of Texas MD Anderson Cancer Center, Oncology Care and Research Information Systems, Houston, USA
  14. 14Rice360 Institute for Global Health Technologies, Rice University, Department of Bioengineering, Houston, USA
  15. 15ICON Strategic Solutions, Research, São Paulo, Brazil
  16. 16Rice University, Bioengineering, Houston, USA
  17. 17Maputo Central Hospital, Pathology, Maputo, Mozambique

Abstract

Introduction As cervical cancer screening programs are implemented, an increasing number of women require loop electrosurgical excision procedure (LEEP). Our objective was to describe the pathologic results of LEEP specimens performed as part of the MULHER Study, a prospective trial of primary HPV testing for cervical cancer screening in Mozambique.

Methods 9,014 women underwent HPV testing followed by thermal ablation for those with positive results. 169 women had cervical lesions ineligible for ablation and underwent LEEP. Pathology reports were reviewed for specimen size/volume, number of pieces, pathologic diagnosis and margin status. A multivariable regression analysis was performed to identify variables associated with positive margins.

Results The median age was 38 years (range 30–49). 65.1% were women living with human immunodeficiency virus (HIV). Pathologic diagnosis was available for 154 patients and included carcinoma (n=6,3.9%); cervical intraepithelial neoplasia (CIN)2–3 (n=75,48.7%); CIN1 (n=67, 43.5%) and normal/benign findings (n=6,3.9%). 31.8% of LEEP specimens were removed in >1 piece. The mean specimen volume was 2.9 mm3 (range 0.2–15.0). LEEP margin status was available for 130 patients. Positive margins (ectocervical/endocervical only, or both) were noted in 76 (58.5%) patients and associated with HIV+ status (p=0.0499) and a diagnosis of CIN2 or worse (p=0.0197). There were no associations between margin status and age, number of pieces or specimen volume.

Conclusion/Implications There were a high number of LEEP specimens with positive margins. As cervical cancer screening programs are scaled in Mozambique and other lower-resource countries, there is a need to train providers to perform high-quality LEEP as well as accurate pathologic interpretation.

https://doi.org/10.1136/ijgc-2023-IGCS.190

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