Southern African Journal of Gynaecological Oncology
Welcome to the online journal of the Southern African Journal of Gynaecological Oncology. We continue to strive towards the publication of original research in women's cancer for local healthcare workers and gynaecologists, focusing on all aspects of cancer prevention, detection, diagnosis and treatment.
South African Journal of Gynaecological Oncology (SAJGO) Copyright is held by South African Society of Gynaecologic Oncology (SASGO). Copyright of the articles is held by the authors. The work is licensed under a Creative Commons Attribution-Non-Commercial Works 4.0 South Africa License (CC BY NC). Material submitted for publication in the SAJGO is accepted provided it has not been published elsewhere. The SAJGO does not hold itself responsible for statements made by the authors. The opinions expressed in this publication are those of the authors. They do no purport to reflect the opinions or views of SASGO or its members.
Welcome readers to the round-up of our 2025 contributions. As always, we thank all that took the time to contribute to our journal and present relevant research for the resource-constrained environment in which we work. This issue includes published research in cervical, vulvar, ovarian cancer and GTD groups. So, we hope, you find something relevant to your own practice.
Copyright (c) 2025 Hannah Simonds, Linda Rogers https://creativecommons.org/licenses/by-nc/4.0
SASGO on-the-go; Congress news.
Copyright (c) 2025 Editorial Office https://creativecommons.org/licenses/by-nc/4.0
The demographics of women with multizonal anogenital HPV disease:a retrospective cohort study in Cape Town, South Africa
Objectives: Multizonal human papillomavirus (HPV)-associated disease refers to HPV involvement at different anatomical sites of the lower genital tract. This study aimed to document the prevalence of multizonal HPV-associated disease (multizonal intraepithelial neoplasia [MUZIN]) in women attending the colposcopy clinic at Groote Schuur Hospital in 2018, and describe the demographics of this population. Methods: We conducted a retrospective review of all new women at the colposcopy clinic in 2018. Evidence of HPV disease was based on clinical findings and pathology reports. HPV deoxyribonucleic acid (DNA) testing was not routinely done at our centre during the study period. We specifically aimed to calculate the prevalence of multizonal HPV-associated disease and identify risk factors. Results: In 2018, 653 women attended the clinic, of whom 104 (16%) had evidence of MUZIN. Of the entire cohort, 320 (49%) were human immunodeficiency virus (HIV)-positive. This contrasts with the 78/104 women (75%) with multizonal disease who were HIV-positive (p < 0.001). Tuberculosis was also a significant association among MUZIN patients and all patients (p = 0.004). In the MUZIN cohort, most women were on antiretroviral treatment, and 89% were virologically suppressed. In South Africa, CD4 counts are taken at diagnosis, and 75.6% of women had initiated treatment when their CD4 counts were < 500. Conclusion: This study suggests that MUZIN may be related to an inadequate or non-functional immune response, although prospective studies are required to confirm this hypothesis.
Copyright (c) 2025 Author/s https://creativecommons.org/licenses/by-nc/4.0
Thank you for your ongoing support in this difficult and challenging environment of academia in low-resource settings. We appreciate that you take the time to undertake research in our underserved communities and commit to providing a final publication. In particular we are thankful you undertake research in our unique setting, asking relevant questions that directly affect our patient care.
Copyright (c) 2024 Southern African Journal of Gynaecological Oncology
Molar pregnancy: a 15-year experience in a single tertiary institution
Background: Gestational trophoblastic disease (GTD) is a group of uncommon conditions associated with pregnancy that arise from abnormal trophoblastic tissue following abnormal fertilisation. There is minimal data from African countries. We studied the management outcomes of hydatidiform mole (HM) at a single tertiary institution in South Africa. Methods: This was a retrospective descriptive study of HM from January 2004 to December 2019. We included all women with a confirmed histological diagnosis. Results: There were 554 057 deliveries and 235 molar pregnancy cases, with an incidence of 0.42/1 000 deliveries. Suction evacuation was performed in 97.4% of patients. Patients between 20 and 40 years constituted 78.7% of cases, with most patients (51.3%) diagnosed in the second trimester. The most common presenting complaint was vaginal bleeding (37.4%). The most common complication was hyperthyroidism (16.6%). A blood transfusion was required by 26 patients (11.2%). Due to ongoing bleeding, 17 patients (7.2%) required a second evacuation, with four patients (1.7%) requiring a hysterectomy due to excessive haemorrhage. Patients with molar pregnancy normalised their human chorionic gonadotropin (hCG) at 12 weeks post-evacuation. There were 42 cases of persistent trophoblastic disease (PTD), expressing hCG levels above 6 000 mIU/ml and 4 000 mIU/ml at four and eight weeks, respectively. Almost 45% of patients never completed follow-up. Conclusion: The incidence of GTD at our centre is declining but remains an important cause of morbidity. We recommend a revised follow-up protocol for patients with complex socio-economic backgrounds, as the current protocol is associated with an increased rate of follow-up loss.
Borderline ovarian tumours in a middle-income country setting: a 10-yearretrospective review of cases in a tertiary hospital in South Africa
Background: The diagnosis and management of borderline ovarian tumours (BOT) remain controversial almost a century after their initial description. Little research has been done in Africa to provide answers on the prevalence and outcomes of these tumours. This study reviewed cases of BOTs at Groote Schuur Hospital over 10 years. Methods: A retrospective review of women diagnosed with BOTs at Groote Schuur Hospital between January 2005 and December 2014 was undertaken. Women with multiple primary tumours, who were lost to follow-up or had inadequate clinical data, were excluded. Demographic characteristics, preoperative, operative, postoperative, oncological, and pathological data were retrieved and analysed. Results: In the study period, 91 patients were diagnosed with BOTs. Of these, 19 were eliminated, and 72 were analysed. BOTs accounted for 22.3% of the 409 ovarian neoplasms. Fertility-sparing surgery was done in 31.9% (n = 23). Mucinous histology was the most common histological subtype (57%). Our overall recurrence rate was 13.9% (n = 10), with 40% being invasive (n = 4). The five-year overall survival (OS) rate was 91.7%, and the five-year relapse-free survival (RFS) rate was 89.9%. Despite small numbers, all patients with invasive recurrence died within five years of recurrence, while all patients who recurred with borderline histology were alive five years after recurrence. Conclusion: Mucinous histology was the most common histological subtype (57%). Despite BOTs having a generally favourable prognosis, patients who recurred with invasive disease were all dead five years after recurrence. Patients who recurred with borderline histology were all alive five years after recurrence.
The incidence, management, and outcomes of stage IIIB cervical cancer in a middle-income setting
Background: Cervical cancer is the second most common cancer in South Africa, and most women present with stage III disease. Hydronephrosis is a frequent complication of advanced disease, and it is associated with poorer clinical outcomes. Aim: This review aims to evaluate the management and outcomes of patients with stage IIIB cervical cancer and determine if the presence of hydronephrosis adversely influences the outcome in this disease stage. Methods: A retrospective audit was conducted to assess the clinical data of patients treated for stage IIIB cervical cancer at Groote Schuur Hospital (GSH) between January 2017 and December 2018. The data collected included demographics, human immunodeficiency virus (HIV) status, comorbidities, pelvic sidewall involvement, presence of hydronephrosis, treatment intent and modalities, nephrostomy referral, treatment response, and survival outcome. Results: A total of 132 patients were deemed eligible for our study, with a mean age of 52 years. The median overall survival (OS) was 15 months, and the median disease-free survival (DFS) for patients who completed radical treatment was 13 months. HIV status was the only factor that affected OS (p = 0.05) and DFS (p = 0.03). Neither age nor the presence of hydronephrosis influenced OS or DFS (p > 0.05). Conclusion: Hydronephrosis did not affect OS or DFS. HIV was associated with an increased incidence of stage IIIB cervical cancer, and a negative prognostic factor for OS and DFS.
Human papillomavirus-human immunodeficiency virus coinfection and host cell DNA methylation in vulvar carcinogenesis
Vulvar cancer accounts for about 5% of all gynaecological malignancies. Previously, it was regarded as a disease of the elderly because it occurred in women over 60 years old. Its incidence is rising due to the coinfection of human papillomavirus (HPV) and human immunodeficiency virus (HIV). High-risk HPV (HR-HPV) predominantly drives both the premalignant and invasive diseases of the vulva in the young population. Women living with HIV have compromised immunity, and the synergism of HPV and HIV might be responsible for their higher predisposition to anogenital neoplasia. They are at a higher risk of infection with multiple HPV genotypes, multifocal disease, persistent infection, and reactivation of latent infections. Genomic alteration through deoxyribonucleic acid (DNA) methylation by persistent HPV infection is implicated in carcinogenesis through the E6/E7 oncogenic pathway. These epigenetic alterations progressively accumulate in HPV-infected cells and induce cancers over time. Premalignant lesions that display abnormal methylation patterns similar to those in cancerous lesions are likely to progress to malignancy within a short period. Such methylation biomarkers can be used to triage premalignant lesions to treatment or monitoring. This review describes the distribution of HPV genotypes and host cell DNA methylation patterns across vulvar premalignant and invasive lesions.
Acceptability and safety of thermal ablation treatment for cervical cytological abnormalities in Pretoria, South Africa
Background: Cervical cancer is one of the leading causes of cancer deaths in women, and 90% of the deaths occur in low- to middle-income countries (LMICs). Accessible cervical cancer screening and treatment options are an urgent priority. Thermal ablation (TA) is an alternative treatment option available for cervical premalignant conditions. The World Health Organization (WHO) has endorsed TA and published guidelines on its use. Most studies on the treatment’s efficacy, safety, and acceptability are from high-income countries. Methods: A prospective cohort study that recruited women who presented with abnormal cytology results from three hospitals in Pretoria, South Africa. Colposcopy examinations were done to assess patients’ eligibility for TA. Post-treatment questionnaires were completed by participating doctors and women to assess the acceptability and safety profile of the treatment. Follow-ups were scheduled on day 7 to assess the safety profile further, and adverse events (AEs) were recorded. Results: The analysis included 58 women. The mean age was 42.4 years. Our findings showed a safety rate of 91.4% and a patient satisfaction rate of 96.6%. All the participating doctors and women recommended the treatment. Most of our findings were consistent with those from previous studies. Conclusion: Our study demonstrated TA as a safe and acceptable treatment method for cervical premalignant conditions in low-resource settings. The treatment does not require expensive infrastructure and can be performed by generalist doctors.
Exploring the experiences of informal primary caregivers of women with advanced or terminal gynaecological cancer in a low-resource setting during the COVID-19 pandemic
Background: Gynaecological cancer patients rely on informal primary caregivers, typically family members, to provide care an support. This can place a heavy burden on caregivers, especially when patients have advanced or terminal cancer. The COVID-19 pandemic affected healthcare systems worldwide, which may have added to the responsibilities and strain of caregivers. However, literature exploring the experiences of informal caregivers of advanced or terminal gynaecological cancer patients during the COVID-19 pandemic is limited within the South African context. To address this gap, we explored the experiences of informal primary caregivers of women with advanced or terminal gynaecological cancers. This description provides insight into caregivers’ experiences during a challenging period in their lives. Methods: We conducted an exploratory, qualitative study with 16 informal primary caregivers. The caregivers participated in individual, semi-structured interviews, which were audio-recorded, transcribed, and analysed using reflexive thematic analysis. Results: We identified three themes, namely 1) limited hospital access for caregivers, 2) hypervigilance of caregivers, and 3) an opportunity to bond. The findings highlight the extent to which informal caregivers protected and prioritised the well-being of patients during their illness trajectory. Participants experienced a communication gap with healthcare professionals, making it more challenging for them to administer care to patients at home. Caregivers were hypervigilant and spent much time and effort protecting patients from contracting COVID-19. Conclusion: While COVID-19 introduced additional challenges to caregivers, it also provided an opportunity to strengthen their bond with the patients.
Identifying the informational needs, challenges, and opportunities to improve quality of life for women with ovarian cancer at Tygerberg Hospital in CapeTown, South Africa
Background: Ovarian cancer has the highest case-fatality ratio, and most women in the world with ovarian cancer live in low- to middle-income countries (LMICs).1,4 The Every Woman Study™ (EWS) was introduced in LMICs, as there is limited data on ovarian cancer in these areas. The EWS’s primary aim was to identify the challenges patients with ovarian cancer experience and to find opportunities to improve diagnosis time and quality of life outcomes. Methods: An observational, cross-sectional study was conducted at the Tygerberg Hospital (TBH) Gynaecological Oncology Unit between 1 June and 31 December 2023. Women with ovarian cancer over the age of 18 who were diagnosed within five years of the date of their participation, were included. Results: Surveys were completed by 36 women. The median age of patients was 54 years. The most common symptom experienced was increased abdominal size (72.2%). Most patients (66.7%) sought advice about their symptoms from their family doctor as their first healthcare provider. Only 25% of patients had heard about ovarian cancer before they were diagnosed. The most important sources of information were identified as attending healthcare workers. More than half of the women (65.5%) had never used the Internet to search for information. A large percentage of patients (82.4%) indicated that their hospital should provide information. Conclusion: Few women were aware of ovarian cancer in this study. Patients diagnosed with ovarian cancer need more information. With an expected rise in the number of cases, awareness amongst patients and healthcare workers should be prioritised to improve earlier ovarian cancer diagnosis and better quality of life.
Endometrial carcinoma diagnosis in the molecular era: a review and new considerations for low- to middle-income countries
The incidence of endometrial carcinoma (EC) has seen a steady increase globally over the years. According to the Cancer Association of South Africa (CANSA), EC is the fourth most common carcinoma in women. The publication of the International Federation of Gynecology and Obstetrics (FIGO) 2023 staging for the management of EC has incorporated molecular EC subtyping in addition to commonly used histopathological diagnosis. The four molecular subtypes of EC defined by The Cancer Genome Atlas (TCGA) research group have been renamed: 1) POLEmut (POLE ultramutated), 2) p53abn (p53-abnormal, copy number high), 3) MMRd (mismatch repair deficient, microsatellite instability hypermutated), and 4) NSMP (no specific molecular profile, copy number low). The molecular profiling of EC by TCGA used whole exome sequencing with determination of somatic copy number alterations (SCNA) on multiple platforms, which may prove costly in low- to middle-income countries (LMIC). The Proactive Molecular Risk Classifier of Endometrial Cancer (ProMisE) aims to validate TCGA results and investigate the correlation between the traditional clinicopathological prognostic features using a simple decision tree focused on immunohistochemistry and simple molecular testing. In a LMIC healthcare facility, the two molecular subtypes that can be tested using surrogates in immunohistochemical stains are p53 and MMRd, MLH1, PMS2, MSH2, and MSH6. There is no surrogate at present to test for POLE mutation; however, there is QPOLE – a low-cost quantitative multiplex polymerase chain reaction (PCR) that can detect the 11 most common and pathogenic POLE mutations. The use of a flow diagram in the daily clinical practice of patients with EC should be considered in LMIC. Future translational research in determining the cost-effectiveness of preoperative molecular pathology testing for treatment planning and risk stratification of patients is needed in resource-limited settings.
High-risk gestational trophoblastic neoplasia: a case report – an atypical presentation with salient features to the suspicious clinician
Gestational trophoblastic neoplasia (GTN) is a cancer originating from placental tissue with the potential for widespread metastases. Varied presentations present clinicians with a diagnostic challenge. A high index of suspicion will promote timely diagnosis and improved prognosis. This case report discusses an atypical presentation of a young woman with high-risk GTN, with salient features on a routine investigation. It highlights learning points for both gynaecologists and non-gynaecologists regarding GTN, the importance of gynaecological ultrasonography, the relevance of human chorionic gonadotropin (hCG), and how essential gestational trophoblastic disease (GTD) is in the differential diagnoses for reproductive women presenting with amenorrhoea.
The effects of cervical cancer screening campaigns: follow-up discussions with women in Makhuduthamaga sub-district, Sekhukhune District, Limpopo Province, South Africa
Background: Cervical cancer remains a global burden and is regarded as the fourth most common cancer in women worldwide. The high mortality of cervical cancer among women in the Makhuduthamaga sub-district is a major concern to the researcher. Consequently, a study was conducted to explore the perceptions of women about cervical cancer screening, aiming to discover the possible factors contributing to mortality. The objectives were to gather the perceptions of women regarding cervical cancer screening to empower women about cervical cancer screening in the Makhuduthamaga sub-district. Methods: A qualitative, descriptive, and exploratory approach was used. Women between the ages of 30 and 70 years from the randomly selected 10 clinics of the Makhuduthamaga sub-district were chosen through purposive sampling. Data obtained from the study were analysed thematically using categorisation. Results: The findings revealed participants’ inadequate knowledge about cervical cancer screening. There was an indication that participants who screened for cervical cancer were fearful of death and loss of the uterus and did not undertake screening for prophylactic purposes. Furthermore, participants did not know to screen for cervical cancer due to ignorance. Conclusion: Knowledge about cervical cancer influenced participants’ decisions about cervical cancer screening. The results revealed a great need for health education for all women, health workers, and home-based carers about the importance of cervical cancer and screening. Cervical cancer screening awareness campaigns are crucial to reduce cancer mortality.
Welcome to our 2023 edition of the Southern African Journal of Gynaecological Oncology. 2023 has been a year of health budget cuts, making it even more critical than before to work in a cost-effective manner. The Enhanced Recovery After Surgery (ERAS) programme has been shown to improve recovery and shorten hospital stays after colorectal and urological surgery, and this programme is being trialled in gynaecological oncology at Groote Schuur Hospital. Prof. Tracey Adams has written a guest editorial about the challenges of and opportunities in setting up such a programme in a low-resource setting.
Copyright (c) 2023 Southern African Journal of Gynaecological Oncology
Novel use of the Bakri® postpartum balloon in gestational trophoblasticneoplasia with bleeding vaginal metastatic lesions refractory to conventionaltreatment modalities
Introduction: Although gestational trophoblastic neoplasia (GTN) tumours are exquisitely chemosensitive with survival rates from 90% to 100%, bleeding vaginal metastatic lesions pose a clinical conundrum. Whilst these patients should be treated in specialised centres, they may present to non-specialised centres requiring emergency lifesaving treatment. We review the current management of haemorrhage from vaginal metastatic lesions and describe a novel, lifesaving technique that is readily available and easy to use in emergencies in most settings. Methods: We discuss a 21-year-old patient referred with GTN stage III and score 14 with extensive vaginal metastasis. Sequentially she received antibiotics and tranexamic acid, percutaneous embolisation of the anterior branches of the internal iliac arteries and feeder vessels, and required haemostatic radiotherapy. Two attempts at removing her vaginal pack resulted in catastrophic bleeds and haemodynamic instability. Results: On the third attempt, we inserted a Bakri® postpartum balloon into the vaginal canal, inflated it with 230 ml of sterile water, and strapped the balloon’s catheter tubing to the patient’s thigh to secure the balloon. Over the next 24 hours, after draining 150 ml, the haemorrhage seized. The controlled and slow reduction of the balloon in theatre resulted in the atraumatic removal of the balloon and no further significant haemorrhage. We suggest that using the Bakri® balloon as described is an effective and easy measure to tamponade vaginal GTN lesions. We propose that the manner in which the balloon applies the tamponade effect, by pressing against the tissue and not integrating with the tissue as a porous gauze would, ensures less tissue trauma upon removal. In addition to allowing accurate monitoring of any continuous haemorrhage, the balloon can be deflated incrementally and reinflated quickly should a haemorrhage ensue, whereas a gauze pack is removed in its entirety and replaced if bleeding is noted. Conclusion: The use of the Bakri® postpartum balloon in bleeding vaginal GTN lesions should be considered as an emergency tamponade method in both specialised and non-specialised centres as a primary tamponading method.
Setting up an enhanced recovery after surgery (ERAS) programme in gynaecological oncology in low-to middle-income countries (LMIC): the challenges and opportunities
The International Agency for Research (IARC) has predicted a global increase of cancer by 54,5% by 2040 (Cancer Tomorrow tool), but this is more significant in low-to middle-income (LMIC) countries with a predicted increase of 88,6% in Africa. In terms of gynaecological malignancies, cervical cancer predominates in Africa and South Africa. There is a global predicted increase of 40% in both uterine and ovarian cancer by 2040, but a predicted increase of 96% and 88% of uterine and ovarian cancer in Africa, respectively.1 LMIC must be strategic in their cancer care planning: this includes revisiting resources such as systems for anticancer care. This includes surgery and surgical care pre- and postoperatively.
Simplicity sacrificed in the FIGO 2023 endometrial cancer staging: Demystifying the complexity of twelve stages and seventeen substages
Endometrial cancer incidence is rapidly rising globally, and in recent years, research has gained significant momentum. Surgical techniques, histopathology classification, risk stratification and understanding of different adjuvant modalities have progressed a great deal since the last endometrial cancer FIGO (The International Federation of Gynecology and Obstetrics) staging revision in 2009.1 Simultaneous rapid advances in the development of targeted therapies, accompanied by improved molecular and genetic diagnostics have contributed to a significant change in our understanding of the disease.
Feasibility and safety of the sentinel lymph node procedure for early vulval cancer in a low-resource high HIV-prevalence setting: a pilot study
Background: The Groningen International Study on Sentinel Nodes in Vulval cancer (GROINSS-V) showed that if a sentinel lymph node (SLN) is negative, the risk of groin relapse due to a false negative finding is less than 3%. The SLN procedure (SLNP) is the standard of care in the management of early vulval squamous cell carcinoma (SCC). We aimed to evaluate the feasibility and safety of the SLNP in a low-resource setting with a high prevalence of HIV and human papillomavirus (HPV)-associated vulval SCC. Methods: Between August 2012 and August 2016, women with early vulval SCC managed at Groote Schuur Hospital (GSH), Cape Town, South Africa, who fit the criteria, were offered the SLNP. For quality control, full inguinofemoral lymphadenectomy (IFL) was also done in the first 10 patients. Results: In our setting, 40% of women with vulval SCC are HIV-infected and there is a predominance of HPV-associated vulval SCC, consequently, only 10.4% (10/96) of women were suitable for the SLNP. Most patients have multifocal tumours and/or enlarged groin nodes. Women with HIV and SCC presented at a younger age than those who were HIV-negative and had more SLN, which were expensive to ultra-stage. Conclusion: At GSH, multifocal vulval SCC arising in vulval high-grade intraepithelial lesion (VHSIL) in HIV-infected women is relatively common. The main resource issue was the ultrastaging cost. However, more significant limiting factors to safely performing the SLNP were the multifocality of the disease, as well as enlarged (mainly reactive) groin lymph nodes, which could not be distinguished from metastases preoperatively. As a result, relatively few of our patients are suitable for the SLNP, so maintenance of skills is a concern.
Low- and middle-income countries (LMICs), including South Africa, continue to bear the brunt of new cases and the highest mortality from cervical cancer. High-income countries (HICs) and some middle-income countries (MICs) are currently looking at self-sampling HPV DNA testing as a strategy to further improve cervical cancer screening and elimination. While this step is important for eliminating cervical cancer, we still need to acknowledge that there are significant gaps in our healthcare system which need to be identified and rectified to reduce cervical cancer and its socio-economic impact in LMIC. Our study highlights that women living with HIV, who frequently visit healthcare facilities for their treatment, are not screened for cervical cancers in accordance with national and international recommendations. Our findings are aimed at accumulating data on this negative healthcare system-related factor.
The prevalence of macroscopic cervical cancer in women on antiretroviral therapy in the Pietermaritzburg metropolitan area
Background: Women living with HIV (WLWH) are screened for cervical cancer at diagnosis or within a year of sexual debut. Our study looked at the prevalence of macroscopic invasive cervical cancer in WLWH on antiretroviral treatment (ART). Methods: This was a descriptive retrospective chart review of WLWH on ART. The women were referred with invasive cervical cancer to the Gynaecological Oncology Unit of Greys Tertiary Hospital from January 2018 to December 2019. Results: We reviewed 220 records. The prevalence of macroscopic invasive cervical cancer was 95%. Of these women, 151 (68.64%) did not have an initial screening test. Of all patients with cervical cancer, 129 (58.64%) were not screened in the previous three years prior to the diagnosis of cervical cancer. There were 212 (96.4%) patients on ART for more than six months. Squamous cell carcinoma made up 212 (96.36%) of the cases, five (2.27%) adenocarcinoma, and two (0.91%) adenosquamous carcinoma. Only 5% of cases were FIGO stage 1A, while the majority were locally advanced disease FIGO stage 2B and 3B (23.2% and 52.3% respectively). Conclusion: The prevalence of macroscopic and locally advanced cervical cancer is still unacceptably high in WLWH on ART. We need to strengthen cervical cancer screening practices at all healthcare centres that are caring for WLWH in line with national guidelines.
The year 2022 went by so quickly, as each and every one of us tried hard to catch up and reconnect with life post-COVID. SASGO is a non-profit organisation open to all interested members. We welcome generalists, gynae-oncologists, pathologists, registrars, nurses and all allied members with an interest in Gynae Oncology.
Copyright (c) 2022 Southern African Journal of Gynaecological Oncology
Thank you to all the authors who have submitted to the journal this year. We greatly appreciate your ongoing support in the difficult and challenging environment of research and publishing in academia.
Visual inspection using naked eye and colposcopy as a predictor of high-grade lesions on final histology in HIV-positive and -negative South African women
Background: Although potentially preventable, cervical cancer is the fourth most common cancer among women globally and a leading cause of cancer-related deaths. Women living in resource-limited countries are especially at risk due to poor access to cervical cancer screening and treatment. Alternative cervical cancer screening methodologies have been investigated where cytology-based screening is not feasible. This study aimed to assess the test performance of naked eye visual inspection analysis, in addition to the comparative performance of physician/colposcopist clinical impression to Reid’s colposcopic index (RCI) grading system for histopathology, in the South African setting. Methods: Women living with HIV (WLWH) and HIV-negative women aged 25 to 65 were recruited from three sites in South Africa. A cross-sectional study which assessed visual inspection with acetic acid (VIA), visual inspection with lugols iodine (VILI), colposcopic impression and RCI for the detection of histologically confirmed CIN2+ and CIN3+ was performed. Test positivity rates, sensitivity, specificity, and predictive values were calculated. Results: Three hundred and forty-four WLWH and 409 HIV-negative women, with a median age of 40 years, were included in this analysis. Histologically confirmed CIN2+ was present in 38.51% and CIN3+ in 18.99%. Overall, positive test rates for VIA were 42.76%; VILI were 45.68%, colposcopic impression were 48.26% and RCI were 46.65%. Overall sensitivities/specificities for VIA and VILI for CIN3+ were 76.92/65.25% and 75.52/61.31%, respectively. The sensitivities however increased for WLWH (VIA 82.61%; VILI 80.43%) and decreased in HIV-negative women (VIA 66.67%; VILI 66.67%). Colposcopic impression/RCI performed better in WLWH (PPV 37.96/37.74%) than in HIV-negative women (PPV 25.63/26.80%). Conclusion: The current study demonstrates that visual inspection methods perform better in WLWH than in HIV-negative women. VIA and VILI performed similarly within each sub-population, as did colposcopic impression and RCI. The use of visual inspection methods in cervical cancer screening in WLWH is warranted.
visual inspection with acetic acid (VIA)
visual inspection with lugols iodine (VILI)
Gestational choriocarcinoma in a postmenopausal woman: a case report – lessons for the junior clinician
Choriocarcinoma is a rare form of malignancy originating from epithelial trophoblastic tissue. Unusual and varied presentations of choriocarcinoma present clinicians with a diagnostic challenge. Education is pertinent to ensure a high index of suspicion of the condition to promote a timely diagnosis and better prognosis for patients. This case report discusses an atypical presentation of a 48-year-old postmenopausal woman with gestational choriocarcinoma, with a possible preceding molar pregnancy. It highlights learning points for clinicians regarding gestational trophoblastic diseases, the relevance of persistently high quantitative serum Beta human chorionic gonadotrophin (Beta HCG) values, differential diagnoses for postmenopausal bleeding, co-existent pathologies and choriocarcinoma.