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1. Prognostic value of Electrical Impedance Spectroscopy (EIS) when used as an adjunct to Colposcopy – a longitudinal study

Author

Brown B. H., Highfield P.E., and Tidy J. A.

Subjects
bioimpedance, cervical, cancer, impedance, spectroscopy, prognosis, colposcopy, Medicine (General), R5-920
Abstract

Colposcopy can be used with Electrical Impedance Spectroscopy (EIS) as an adjunct, to assess the presence of High Grade Cervical Intra-epithelial Neoplasia (CIN2+). This analysis of longitudinal data has used the results from women with a negative colposcopy, in order to see if the initial (index) EIS results were able to predict the women who subsequently developed CIN2+. A further objective was to investigate what tissue structural changes might be reflected in the electrical impedance spectra.

Published
2020
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6. Quality of life from cytoreductive surgery in advanced ovarian cancer: Investigating the association between disease burden and surgical complexity in the international, prospective, SOCQER-2 cohort study.

Author

Sundar, S, Cummins, C, Kumar, S, Long, J, Arora, V, Balega, J, Broadhead, T, Duncan, T, Edmondson, R, Fotopoulou, C, Glasspool, R, Kolomainen, D, Leeson, S, Manchanda, R, McNally, O, Morrison, J, Mukhopadhyay, A, Paul, J, Tidy, J, Wood, N, Sundar, S, Cummins, C, Kumar, S, Long, J, Arora, V, Balega, J, Broadhead, T, Duncan, T, Edmondson, R, Fotopoulou, C, Glasspool, R, Kolomainen, D, Leeson, S, Manchanda, R, McNally, O, Morrison, J, Mukhopadhyay, A, Paul, J, Tidy, J, and Wood, N

Abstract

OBJECTIVE: To investigate quality of life (QoL) and association with surgical complexity and disease burden after surgical resection for advanced ovarian cancer in centres with variation in surgical approach. DESIGN: Prospective multicentre observational study. SETTING: Gynaecological cancer surgery centres in the UK, Kolkata, India, and Melbourne, Australia. SAMPLE: Patients undergoing surgical resection (with low, intermediate or high surgical complexity score, SCS) for late-stage ovarian cancer. MAIN OUTCOME MEASURES: Primary: change in global score on the European Organisation for Research and Treatment of Cancer (EORTC) core quality-of-life questionnaire (QLQ-C30). Secondary: EORTC ovarian cancer module (OV28), progression-free survival. RESULTS: Patients' preoperative disease burden and SCS varied between centres, confirming differences in surgical ethos. QoL response rates were 90% up to 18 months. Mean change from the pre-surgical baseline in the EORTC QLQ-C30 was 3.4 (SD 1.8, n = 88) in the low, 4.0 (SD 2.1, n = 55) in the intermediate and 4.3 (SD 2.1, n = 52) in the high-SCS group after 6 weeks (p = 0.048), and 4.3 (SD 2.1, n = 51), 5.1 (SD 2.2, n = 41) and 5.1 (SD 2.2, n = 35), respectively, after 12 months (p = 0.133). In a repeated-measures model, there were no clinically or statistically meaningful differences in EORTC QLQ-C30 global scores between the three SCS groups (p = 0.840), but there was a small statistically significant improvement in all groups over time (p < 0.001). The high-SCS group experienced small to moderate decreases in physical (p = 0.004), role (p = 0.016) and emotional (p = 0.001) function at 6 weeks post-surgery, which resolved by 6-12 months. CONCLUSIONS: The global QoL of patients undergoing low-, intermediate- and high-SCS surgery improved at 12 months after surgery and was no worse in patients undergoing extensive surgery. TWEETABLE ABSTRACT: Compared with surgery of lower complexity, extensive surgery does not result in poore

Published
2022

8. Age‐specific outcomes from the first round of HPV screening in unvaccinated women : observational study from the English cervical screening pilot

Author

Rebolj, M., Mathews, C.S., Pesola, F., Cuschieri, K., Denton, K., Kitchener, H., Appleyard, T., Cruickshank, M., Ellis, K., Evans, C., Frew, V., Giles, T., Gray, A., Holbrook, M., Hunt, K., Levine, T., McBride, E., Mesher, D., Palmer, T., Parker, J., Rimmer, E., Pickard, H.R., Sargent, A., Smith, D., Smith, J., Soldan, K., Stubbs, R., Tidy, J., Tyler, X., and Waller, J.

Abstract

Objective\ud \ud To report detailed age-specific outcomes from the first round of an English pilot studying the implementation of high-risk human papillomavirus (HR-HPV) testing in primary cervical screening.\ud \ud \ud \ud Design\ud \ud Observational study with screening in 2013–2016, followed by two early recalls and/or colposcopy until the end of 2019.\ud \ud \ud \ud Setting\ud \ud Six NHS laboratory sites.\ud \ud \ud \ud Population\ud \ud A total of 1 341 584 women undergoing screening with HR-HPV testing or liquid-based cytology (LBC).\ud \ud \ud \ud Methods\ud \ud Early recall tests and colposcopies were recommended, depending on the nature of the screening-detected abnormality.\ud \ud \ud \ud Main outcome measures\ud \ud We reported standard screening process indicators, e.g. proportions with an abnormality, including high-grade cervical intraepithelial neoplasia (CIN2+) or cancer, and the positive predictive value (PPV) of colposcopy for CIN2+, by screening test and age group.\ud \ud \ud \ud Results\ud \ud Among unvaccinated women screened with HR-HPV testing at age 24–29 years, 26.9% had a positive test and 10.4% were directly referred to colposcopy following cytology triage, with a PPV for CIN2+ of 47%. At 50–64 years of age, these proportions were much lower: 5.3%, 1.2% and 27%, respectively. The proportions of women testing positive for HR-HPV without cytological abnormalities, whose early recall HR-HPV tests returned negative results, were similar across the age spans: 54% at 24–29 years and 55% at 50–64 years. Two-thirds of infections at any age were linked to non-16/18 genotypes. Among women with CIN2, CIN3 or cervical cancer, however, the proportion of non-16/18 infections increased with age. As expected, the detection of abnormalities was lower following screening with LBC.\ud \ud \ud \ud Conclusions\ud \ud These data provide a reliable reference for future epidemiological studies, including those concerning the effectiveness of HPV vaccination.

Published
2022

9. 718 Investigating impact of ultra-radical surgery in advanced ovarian cancer using population level data linked to the SOCQER 2 multicentre study

Author

Sundar, SS, primary, Cummins, C, additional, Balega, J, additional, Broadhead, T, additional, Duncan, T, additional, Edmondson, R, additional, Fotopoulou, C, additional, Kolomainen, D, additional, Kumar, S, additional, Manchanda, R, additional, Morrison, J, additional, Tidy, J, additional, and Wood, N, additional

Published
2021
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11. Randomized Trial of Cytoreductive Surgery for Relapsed Ovarian Cancer

Author

Philipp, H, Jalid, S, Ignace, V, Gwenael, F, Alexander, R, Werner, M, Stefano, G, Berit J, M, Frederic, S, Frédéric, G, Christophe, P, Fabrice, L, Rongyu, Z, Elisabeth, A, Jae-Weon, K, Jordi, P, Francesco, R, Gunnar, K, Jean-Marc, C, Peter, H, Pernille, J, Annette, H, Sadaf, G, Mansoor R, M, Bente, L, Ana, S, Adeola, O, Felix, H, Andreas, D, Buchholz, S, Burges, A, Canzler, U, Denschlag, D, El-Balat, A, Emons, G, Felberbaum, R, de Gregorio, N, Gropp-Meier, M, Hanf, V, Hanker, L, Hils, R, Kurzeder, C, Lampe, B, Mustea, A, Schmidt, M, Schutz, R, Weigel, M, Weiser, S, Zorr, A, Marth, C, Petru, E, Scholl, T, Beltran, M, Bover, I, Gomez di Laino, A, Lainez, N, Martinez, S, Poveda Velasco, A, Romeo, M, Crouet, H, de Gournay, E, Deplanque, G, Follana, P, Floquet, A, Lanvin, D, Leveque, J, Pujade-Lauraine, E, Raban, N, Resch, B, M Savoye, A, Aletti, G, Giorda, G, Landoni, F, Scaffa, C, Abu, J, Alexander-Sefre, F, Barton, D, Butler-Manuel, S, Clayton, R, Crawford, R, Duncan, T, El-Ghobashy, A, Fotopoulou, C, Hall, M, Intrivici, C, Lawrence, A, Luesley, D, Naik, R, Nordin, A, Tidy, J, Fokdahl, L, Hofsjö, A, Kjolhede, P, Eyjolfsdottir, B, Y Dai, Z, Zhang, P, Aminossadati, B, Hahmann, M, Nasemann, C, Yahiaoui, S, Wittenberg, M, Schade-Brittinger, C, Elser, G, Reddig, D, Kuncke, M, Polleis, S, Mattukat, Y, Riha, A, Berger, R, de Roover, J, Kaur, B, Crook, J, Nepote, F, Votan, B, Andriamamonjy, M, Bryce, J, Ristinge, S, Harter, Philipp, Sehouli, Jalid, Vergote, Ignace, Ferron, Gwenael, Reuss, Alexander, Meier, Werner, Greggi, Stefano, Mosgard, Berit J, Selle, Frederic, Guyon, Frédéric, Pomel, Christophe, Lécuru, Fabrice, Zang, Rongyu, Avall-Lundqvist, Elisabeth, Kim, Jae-Weon, Ponce, Jordi, Raspagliesi, Francesco, Kristensen, Gunnar, Classe, Jean-Marc, Hillemanns, Peter, Jensen, Pernille, Hasenburg, Annette, Ghaem-Maghami, Sadaf, Mirza, Mansoor R, Lund, Bente, Reinthaller, Alexander, Santaballa, Ana, Olaitan, Adeola, Hilpert, Felix, du Bois, Andreas, S Buchholz, A Burges, U Canzler, D Denschlag, A El-Balat, G Emons, R Felberbaum, N de Gregorio, M Gropp-Meier, V Hanf, L Hanker, R Hils, C Kurzeder, B Lampe, A Mustea, M Schmidt, R Schutz, M Weigel, S Weiser, A Zorr, C Marth, E Petru, T Scholl, M Beltran, I Bover, A Gomez di Laino, N Lainez, S Martinez, A Poveda Velasco, M Romeo, H Crouet, E de Gournay, G Deplanque, P Follana, A Floquet, D Lanvin, J Leveque, E Pujade-Lauraine, N Raban, B Resch, A M Savoye, G Aletti, G Giorda, F Landoni, C Scaffa, J Abu, F Alexander-Sefre, D Barton, S Butler-Manuel, R Clayton, R Crawford, T Duncan, A El-Ghobashy, C Fotopoulou, M Hall, C Intrivici, A Lawrence, D Luesley, R Naik, A Nordin, J Tidy, L Fokdahl, A Hofsjö, P Kjolhede, B Eyjolfsdottir, Z Y Dai, P Zhang, B Aminossadati, M Hahmann, C Nasemann, S Yahiaoui, M Wittenberg, C Schade-Brittinger, G Elser, D Reddig, M Kuncke, S Polleis, Y Mattukat, A Riha, R Berger, J de Roover, B Kaur, J Crook, F Nepote, B Votan, M Andriamamonjy, J Bryce, S Ristinge, Philipp, H, Jalid, S, Ignace, V, Gwenael, F, Alexander, R, Werner, M, Stefano, G, Berit J, M, Frederic, S, Frédéric, G, Christophe, P, Fabrice, L, Rongyu, Z, Elisabeth, A, Jae-Weon, K, Jordi, P, Francesco, R, Gunnar, K, Jean-Marc, C, Peter, H, Pernille, J, Annette, H, Sadaf, G, Mansoor R, M, Bente, L, Ana, S, Adeola, O, Felix, H, Andreas, D, Buchholz, S, Burges, A, Canzler, U, Denschlag, D, El-Balat, A, Emons, G, Felberbaum, R, de Gregorio, N, Gropp-Meier, M, Hanf, V, Hanker, L, Hils, R, Kurzeder, C, Lampe, B, Mustea, A, Schmidt, M, Schutz, R, Weigel, M, Weiser, S, Zorr, A, Marth, C, Petru, E, Scholl, T, Beltran, M, Bover, I, Gomez di Laino, A, Lainez, N, Martinez, S, Poveda Velasco, A, Romeo, M, Crouet, H, de Gournay, E, Deplanque, G, Follana, P, Floquet, A, Lanvin, D, Leveque, J, Pujade-Lauraine, E, Raban, N, Resch, B, M Savoye, A, Aletti, G, Giorda, G, Landoni, F, Scaffa, C, Abu, J, Alexander-Sefre, F, Barton, D, Butler-Manuel, S, Clayton, R, Crawford, R, Duncan, T, El-Ghobashy, A, Fotopoulou, C, Hall, M, Intrivici, C, Lawrence, A, Luesley, D, Naik, R, Nordin, A, Tidy, J, Fokdahl, L, Hofsjö, A, Kjolhede, P, Eyjolfsdottir, B, Y Dai, Z, Zhang, P, Aminossadati, B, Hahmann, M, Nasemann, C, Yahiaoui, S, Wittenberg, M, Schade-Brittinger, C, Elser, G, Reddig, D, Kuncke, M, Polleis, S, Mattukat, Y, Riha, A, Berger, R, de Roover, J, Kaur, B, Crook, J, Nepote, F, Votan, B, Andriamamonjy, M, Bryce, J, Ristinge, S, Harter, Philipp, Sehouli, Jalid, Vergote, Ignace, Ferron, Gwenael, Reuss, Alexander, Meier, Werner, Greggi, Stefano, Mosgard, Berit J, Selle, Frederic, Guyon, Frédéric, Pomel, Christophe, Lécuru, Fabrice, Zang, Rongyu, Avall-Lundqvist, Elisabeth, Kim, Jae-Weon, Ponce, Jordi, Raspagliesi, Francesco, Kristensen, Gunnar, Classe, Jean-Marc, Hillemanns, Peter, Jensen, Pernille, Hasenburg, Annette, Ghaem-Maghami, Sadaf, Mirza, Mansoor R, Lund, Bente, Reinthaller, Alexander, Santaballa, Ana, Olaitan, Adeola, Hilpert, Felix, du Bois, Andreas, S Buchholz, A Burges, U Canzler, D Denschlag, A El-Balat, G Emons, R Felberbaum, N de Gregorio, M Gropp-Meier, V Hanf, L Hanker, R Hils, C Kurzeder, B Lampe, A Mustea, M Schmidt, R Schutz, M Weigel, S Weiser, A Zorr, C Marth, E Petru, T Scholl, M Beltran, I Bover, A Gomez di Laino, N Lainez, S Martinez, A Poveda Velasco, M Romeo, H Crouet, E de Gournay, G Deplanque, P Follana, A Floquet, D Lanvin, J Leveque, E Pujade-Lauraine, N Raban, B Resch, A M Savoye, G Aletti, G Giorda, F Landoni, C Scaffa, J Abu, F Alexander-Sefre, D Barton, S Butler-Manuel, R Clayton, R Crawford, T Duncan, A El-Ghobashy, C Fotopoulou, M Hall, C Intrivici, A Lawrence, D Luesley, R Naik, A Nordin, J Tidy, L Fokdahl, A Hofsjö, P Kjolhede, B Eyjolfsdottir, Z Y Dai, P Zhang, B Aminossadati, M Hahmann, C Nasemann, S Yahiaoui, M Wittenberg, C Schade-Brittinger, G Elser, D Reddig, M Kuncke, S Polleis, Y Mattukat, A Riha, R Berger, J de Roover, B Kaur, J Crook, F Nepote, B Votan, M Andriamamonjy, J Bryce, and S Ristinge

Abstract

BACKGROUND Treatment for patients with recurrent ovarian cancer has been mainly based on systemic therapy. The role of secondary cytoreductive surgery is unclear. METHODS We randomly assigned patients with recurrent ovarian cancer who had a first relapse after a platinum-free interval (an interval during which no platinum-based chemotherapy was used) of 6 months or more to undergo secondary cytoreductive surgery and then receive platinum-based chemotherapy or to receive platinumbased chemotherapy alone. Patients were eligible if they presented with a positive Arbeitsgemeinschaft Gynäkologische Onkologie (AGO) score, defined as an Eastern Cooperative Oncology Group performance-status score of 0 (on a 5-point scale, with higher scores indicating greater disability), ascites of less than 500 ml, and complete resection at initial surgery. A positive AGO score is used to identify patients in whom a complete resection might be achieved. The primary end point was overall survival. We also assessed quality of life and prognostic factors for survival. RESULTS A total of 407 patients underwent randomization: 206 were assigned to cytoreductive surgery and chemotherapy, and 201 to chemotherapy alone. A complete resection was achieved in 75.5% of the patients in the surgery group who underwent the procedure. The median overall survival was 53.7 months in the surgery group and 46.0 months in the no-surgery group (hazard ratio for death, 0.75; 95% confidence interval, 0.59 to 0.96; P = 0.02). Patients with a complete resection had the most favorable outcome, with a median overall survival of 61.9 months. A benefit from surgery was seen in all analyses in subgroups according to prognostic factors. Quality-of-life measures through 1 year of follow-up did not differ between the two groups, and we observed no perioperative mortality within 30 days after surgery. CONCLUSIONS In women with recurrent ovarian cancer, cytoreductive surgery followed by chemotherapy resulted in longer overa

Published
2021

14. Demographics, natural history and treatment outcomes of non‐molar gestational choriocarcinoma: a UK population study

Author

Savage, P, primary, Winter, M, additional, Parker, V, additional, Harding, V, additional, Sita‐Lumsden, A, additional, Fisher, RA, additional, Harvey, R, additional, Unsworth, N, additional, Sarwar, N, additional, Short, D, additional, Aguiar, X, additional, Tidy, J, additional, Hancock, B, additional, Coleman, R, additional, and Seckl, MJ, additional

Published
2020
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24. EP1269 Quality of life after surgery of varying surgical complexity in advanced ovarian cancer: results from the international, prospective, multicenter cohort SOCQER2 study

Author

Sundar, S, primary, Cummins, C, additional, Kumar, S, additional, Long, J, additional, Arora, V, additional, Balega, J, additional, Broadhead, T, additional, Duncan, T, additional, Edmondson, R, additional, Fotopoulou, C, additional, Glasspool, R, additional, Kolomainen, D, additional, Leeson, S, additional, Manchanda, R, additional, McNally, O, additional, Morrison, J, additional, Mukhopadhyay, A, additional, Paul, J, additional, Tidy, J, additional, and Wood, N, additional

Published
2019
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29. Systematic review of health-related quality of life and patient-reported outcome measures in Gestational Trophoblastic Disease: A parallel synthesis approach

Author

Ireson, J, Jones, GL, Winter, M, Radley, S, Hancock, B, Tidy, J, Ireson, J, Jones, GL, Winter, M, Radley, S, Hancock, B, and Tidy, J

Abstract

Gestational Trophoblastic Disease (GTD) is a rare complication of pregnancy that can develop into cancer. Medical outcomes are well researched but evidence is required on the impact of GTD on health-related quality of life (HRQoL) to improve care. The review was conducted to determine the impact of GTD and its treatment on HRQoL and identify how HRQoL is measured and appropriateness of these measures. Quantitative studies found HRQoL in long-term survivors to be at or above population norms. GTD appeared to have a negative impact on HRQoL where patients experience physical, psychological and social sequelae related to the condition. Clinically significant levels of anxiety, depression, sexual dysfunction and fertility-related distress were found. The results should be treated with caution because the evidence base was limited to small heterogeneous samples, retrospective data and the wide range of measures used. Within the qualitative data, new themes emerged including nerve damage, fatigue, amenorrhea, and grief. Currently, these areas are not captured in patient reported outcome measures (PROMs) and the content may not be valid for this population. Further qualitative research could lead to development of a GTD specific PROM providing reliable, meaningful and valid assessments and allowing longitudinal data to be obtained.

Published
2018

30. Combat as a Moving Target: Masculinities, the Heroic Soldier Myth and Normative Martial Violence

Author

Millar, K.M. and Tidy, J.

Abstract

This article problematizes the conceptualization and use of ‘combat’ within critical scholarship on masculinities, militaries, and war. We trace, firstly, how combat appears as an empirical category within traditional war studies scholarship, describing an ostensibly self-evident physical practice. We then examine how feminist and gender approaches – in contrast – reveal ‘combat’ as a normative imagination of martial violence. This imagination of violence is key to the constitution of the masculine ideal, and normalization of military force, through the heroic soldier myth. We argue, however, that despite this critical impulse, much of feminist and gender analysis exhibits conceptual ‘slippage’: combat is still often treated as a ‘common-sense’ empirical category – a thing that ‘is’ – in masculinities theorizing. This treatment of gendered-imaginary-as-empirics imports a set of normative investments that limit the extent to which the heroic soldier myth, and the political work that it undertakes, can be deconstructed. As a consequence, whilst we know how masculinities are constituted in relation to ‘combat’, we lack the corollary understanding of how masculinities constitute combat, and how the resulting imagination sustains military authority and the broader social acceptance of war. We argue that unpacking these dynamics and addressing this lacuna is key to the articulation of a meaningfully ‘critical’ gender and military studies.

Published
2017

31. The impact of age and high‐risk human papillomavirus (hrHPV) status on the prevalence of high‐grade cervical intraepithelial neoplasia (CIN2+) in women with persistent hrHPV‐positive, cytology‐negative screening samples: a prospective cohort study

Author

Tidy, JA, Lyon, R, Ellis, K, Macdonald, M, Palmer, JE, Tidy, J A, and Palmer, J E

Subjects
CERVICAL intraepithelial neoplasia, LONGITUDINAL method, COHORT analysis, PAPILLOMAVIRUSES, ELECTRIC impedance, COLPOSCOPY, AGE distribution, MEDICAL screening, PAPILLOMAVIRUS diseases, DISEASE prevalence, CERVIX uteri tumors
Abstract

Objective: To establish the prevalence of high-grade cervical intraepithelial neoplasia (CIN2+) in women referred to colposcopy with persistent high-risk human papillomavirus (hrHPV) cytology-negative screening sample according to hrHPV genotype, age at referral and colposcopic performance.Design: Prospective cohort study.Setting: Single colposcopy clinic linked to a population-based screening programme.Population: Women referred with persistent hrHPV cytology-negative routine screening samples.Methods: Prospective study with descriptive statistics from a single colposcopy unit between June 2014 and July 2019.Main Outcome Measures: Prevalence of hrHPV genotypes and CIN2+, positive predictive value for colposcopic impression, and inadequate colposcopic examinations.Results: A total of 3107 women were referred. Prevalence of CIN2+ was highest for persistent HPV16 infections (10.7%) compared with HPV18 (3.6%) or HPVO (4.7%). Prevalence of CIN2+ declined with age (25-34 years 14.2% to 55-64 years 1.1%) whereas the percentage of women with an inadequate colposcopic examination increased (25-34 years 0.9% to 55-64 years 29.5%). High-grade colposcopic impression fell over time during the study from 16.1 to 5.1%. The positive predictive value for colposcopic impression of CIN2+ was affected by hrHPV genotype (57.3% for HPV16 versus 32.1% for nonHPV16). The adjunctive use of electrical impedance spectroscopy detected an extra 42 cases of CIN2+, which was irrespective of hrHPV genotype.Conclusions: Primary hrHPV cervical screening increases detection of CIN2+; however, low specificity results in more women being referred to colposcopy with a low prevalence of CIN2+. Colposcopy performs poorly in some groups, particularly with HPVO infections and women over 50 years of age. An appropriate threshold for referral to colposcopy in primary hrHPV screening has not been established.Tweetable Abstract: Low prevalence of CIN2+ in HPV-positive negative cytology samples. HPV genotype, age and prevalence of CIN2+ affect colposcopic performance. [ABSTRACT FROM AUTHOR]

Published
2020
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36. Are colposcopy and electrical impedance spectroscopy complementary when used to detect high-grade cervical neoplasia?

Author

Tidy, J. A., Brown, B. H., Lyon, R. E., Healey, T. J., and Palmer, J. E.

Subjects
*COLPOSCOPY, *CERVICAL intraepithelial neoplasia, *ELECTRICAL impedance tomography, *LOOP electrosurgical excision procedure, *CYTOLOGY
Abstract

Purpose of investigation: To evaluate if colposcopy and electrical impedance spectroscopy (EIS) are complementary and hence increase the detection of high-grade cervical intraepithelial neoplasia (HG-CIN). Materials and Methods:A cohort of 1,237 women with an abnormal cervical cytology result referred to a single colposcopy service to assess the value of EIS as an adjunct to colposcopy for the detection of HG-CIN. Results: Fifty-three (12.8%) extra cases of HG-CIN were detected by a combination of colposcopy and EIS (466 vs. 413). Ten cases were referred with high-grade cytology and 43 were associated with low-grade cytology. The increased detection of HG-CIN in women referred with low-grade cytology was 50% (129 vs. 86). The combination of colposcopy and EIS produced a highly significant improvement in the detection of HG-CIN. Conclusions: Comparison of the performance metrics with a previous multi-centre trial shows that use of EIS as an adjunct increases performance over that obtained from colposcopy alone. The largest improvement is in increased sensitivity and NPV when used to detect HG-CIN, particularly in women referred with low-grade cytology. [ABSTRACT FROM AUTHOR]

Published
2018
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40. 2A phase II study to determine the response to second curettage as initial management for persistent “low-risk” non-metastatic gestational trophoblastic neoplasia: A Gynecologic Oncology Group study

Author

Osborne, R.J., primary, Filiaci, V.L., additional, Mannel, R.S., additional, Davidson, S.A., additional, Hoffman, J.S., additional, Spirtos, N.M., additional, Chan, J.K., additional, Schink, J.C., additional, Tidy, J., additional, and Miller, D.S., additional

Published
2014
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45. Does LLETZ excision margin status predict residual disease in women who have undergone post-treatment cervical cytology and high-risk human papillomavirus testing?

Author

Palmer, J. E., Ravenscroft, S., Ellis, K., Crossley, J., Dudding, N., Smith, J. H., and Tidy, J. A.

Subjects
TREATMENT of cervical intraepithelial neoplasia, SURGICAL excision, PAPILLOMAVIRUS disease diagnosis, CELLULAR pathology, HISTOPATHOLOGY, FOLLOW-up studies (Medicine)
Abstract

Objective This study looks at the importance of large loop excision of the transformation zone ( LLETZ) excision margins and residual cervical intraepithelial neoplasia ( CIN) in women undertaking high-risk human papillomavirus (hr HPV) test of cure ( TOC). Methods A retrospective cohort study with interval analysis performed June 2007 and June 2012 on all women undertaking treatment for CIN and subsequent hr HPV TOC 6 months post LLETZ. Results Final analysis group comprised 2093 women treated by LLETZ (1396 completely excised; 697 incompletely excised). 298 out of 1794 women (13%) were hr HPV positive at TOC. Thirty-six women who failed TOC and attended colposcopy had residual CIN. No statistically significant difference existed between the completely and incompletely excised groups with regards to the detection of residual CIN at 6 months post-treatment. There was no correlation of margins of excision with hr HPV status at TOC. The overall cure rate at TOC was 98%. Conclusions TOC pathways recommend subsequent follow-up in primary care. This study identified no safety issues with TOC pathways. We can no longer assess histological failure rates at 12 months; we, therefore, recommend that this measure of treatment failure be redefined for post TOC women. It seems time to question the benefits of routine excision margins reporting, in the absence of invasion, for treated CIN. Future reporting needs to be reconsidered by the Royal College of Pathologists. [ABSTRACT FROM AUTHOR]

Published
2016
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46. A national audit of standards of care for women with vulval conditions and survey of attitudes to nurse practitioners in vulval services in the UK.

Author

Innamaa, A., Tidy, J. A., Nunns, D., and Palmer, J. E.

Subjects
*VULVAR diseases, *STANDARDS, *TREATMENT of diseases in women, *WOMEN'S attitudes, *NURSE practitioners, *MEDICAL care
Abstract

This national audit assessed whether UK specialist vulval clinics adhere to the British Society of Vulval Diseases (BSSVD) document ‘Standards of care for women with vulval conditions’ published in 2013 and benchmarked clinician attitudes towards nurse practitioners in vulval services. Audit standards were based on the BSSVD guidance. All BSSVD and British Society for Colposcopy and Cervical Pathology or BSCCP members were surveyed via two electronic questionnaires. Results demonstrate that the majority of specialist vulval clinics in the UK are non-compliant with the standards set out for specialist vulval services. The majority of clinicians would support the introduction of clinical nurse specialists to vulval services, but there is need for development of a national training programme. In conclusion, significant improvements are required in provision of patient information, guidelines, access to multidisciplinary services, multidisciplinary team or MDT processes and data recording in UK specialist vulval services. [ABSTRACT FROM PUBLISHER]

Published
2016
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49. Vascular cell adhesion molecule-1 expressed by peritoneal mesothelium partly mediates the binding of activated human T lymphocytes

Author

Cannistra, S. A., Christian Ottensmeier, Tidy, J., and Defranzo, B.

Subjects
Integrins, T-Lymphocytes, Humans, Vascular Cell Adhesion Molecule-1, Female, RNA, Messenger, Peritoneum, Intercellular Adhesion Molecule-1, Lymphocyte Activation, Cell Adhesion Molecules, Epithelium, Cell Line, Protein Binding
Abstract

Adhesion molecules such as selectins and integrins are known to mediate leukocyte attachment and transmigration through activated vascular endothelium. However, the molecules that mediate subsequent leukocyte entry into nonvascular spaces such as the abdominal cavity during states of peritoneal inflammation have not been identified. Because the peritoneal mesothelial lining represents the final barrier to leukocyte migration into the abdomen, it is likely that adhesion molecules expressed by mesothelial cells are involved in this process. We have developed an in vitro binding assay using confluent layers of normal human mesothelial cells to determine which adhesion molecules might be involved in T lymphocyte-mesothelial recognition. Normal peripheral blood T lymphocytes exhibit low-level specific binding to mesothelium (mean 13% specific binding, n = 4), which is enhanced by phorbol myristate acetate (PMA) treatment (mean 38% specific binding, n = 4). This binding is significantly inhibited in the combined presence of antibodies reactive with CD29 and CD18, suggesting a role for beta 1 and beta 2 integrins, respectively, in this interaction. Interestingly, cultured human mesothelial cells were shown to express vascular cell adhesion molecule-1 (VCAM-1), suggesting that this molecule might function as a counter-receptor for alpha 4 beta 1 expressed by T lymphocytes. Mesothelial cells were also noted to express ICAM-1, CD29, and CD44, but not CD18 or selectins. VCAM-1 expression was not a constitutive property of freshly obtained mesothelial cells but was inducible upon culture in the presence of either interleukin-1 (IL-1), tumor necrosis factor (TNF), or PMA. Neutralizing antibodies reactive with either alpha 4, VCAM-1, or CD29 were all equally capable of inhibiting the binding of activated leukocytes to mesothelial cells (in the presence of anti-CD18 antibody). Mesothelial VCAM-1 was found to have a molecular mass of 110 kD and an mRNA transcript of approximately 3.2 kb, consistent with the predominant VCAM-1 species found in activated endothelium. These data suggest that functional VCAM-1 is expressed on activated mesothelial cells and may play a role in the distal arm of leukocyte trafficking to the abdominal cavity.

Published
1994

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