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Igor Jeremic

 

Igor Jeremic

HPV Diagnostic Center
Serbia

Abstract Title: Colposcopic diagnostics cervical glandular intra-epithelial neoplasia and new therapy

Biography:

Research Interest:

Problem Statement: The strongest disagreement that exists between the Pap test and histopathological finding is in glandular intraepithelial neoplasia. The first reason is anatomic - histological position of endocervical glands. The second reason is the two-fold way of emergence (HPV and non HPV-mutation of p 53 gene).

Method: My study includes 100 patients between the ages of 18 and 45 years with a diagnosis of cervical intraepithelial neoplasia and adenocarcinoma in situ. In 70% of patients, the Pap test was normal. In 20%, the Pap test was ASCUS and in 15%, there was accompanying squamous intraepithelial neoplasia SIL). In 10% of cases, the Pap test was IIIa. HPV typing was positive in 80% and negative in 20%. Due to the anatomic position of cervical glands, the biopsy doesn’t provide any diagnostic safety.

Result: The first step towards the exact diagnostics is colposcopy examination, not the Pap test. From the pathological colposcopy images, abnormal vascular pattern dominates within which areas with AW epithelium can be seen. In younger patients with HPV genesis, there are images of coarse mosaics and punctations. Radio wave LOOP excision gives absolute diagnostic therapeutic safety which I perform for 2 minutes in local anesthesia. The change is excised completely and the lumen of cervical glands is removed entirely.

Conclusion: The education of gynecologists that is directed towards colposcopy and not towards the Pap test and HPV typing, is necessary for diagnostics of glandular intraepithelial neoplasia.  Relying on the biopsy as the safest diagnostic procedure, leads to a mistake in over 50%. The method which I invented (RF LOOP excision) involves, as the most significant part, a complete removal of the lumen of cervical glands. The most important thing is that the above-mentioned method doesn’t lead to narrowing and shortening of the cervical canal in young girls that didn’t give birth.