Purpose Persistent high-risk HPV infection is associated with an elevated risk for prevalent CIN II + despite normal cytology (NILM). Our study aims to evaluate the clinical relevance of a persistent high-risk HPV infection without cytologic changes in women aged ≥ 65 and to determine the role of colposcopy for triage in these cases. Methods 211 patients aged ≥ 65 with persistent HPV infection and normal cytology (NILM) who presented for colposcopy at five certified centers between January 2021 and April 2022 were included in the study. Colposcopic findings, HPV subtypes, when available, histology and p16/Ki67 staining were assessed as well as individual risk factors such as smoking and previous HPV-related surgery. Results 87.7% (185/211) of the included women had a type 3 transformation zone. In 83.4% (176/211), a biopsy was taken [thereof 163 endocervical curettages (ECC)]. In 35/211 women (16.6%), sampling was not possible during colposcopy due to an inaccessible cervix, pain during examination or obliteration of the cervical canal. Out of these, 6 women received a diagnostic excision. CIN II + was detected in 10.6% of all histologies (excisional or biopsy) (20/182). 50% of the women with a CIN II + where HPV 16 positive. Taking only the women diagnosed with CIN III or AIS into account, ( n = 12) 75% were HPV 16 positive. Interestingly, 80% of the women with CIN II + had an abnormal cytology when repeatedly taken during colposcopy, vice versa an endocervical lesion was diagnosed in 53% of women with abnormal repeat cytology (27/51). Conclusion The prevalence of CIN II + in women is ≥ 65 with persistent hr HPV infection but NILM cytology is similar to that in younger women. However, more than 85% of the women have a type 3 transformation zone. Colposcopy is, therefore, not helpful to diagnose the women who need treatment in this age group.

Background In 2020, cervical cancer screening has changed from a solely cytology based to a combined HPV and cytology based strategy for all women aged 35 and older. Within the screening algorithm all women with persisting high risk HPV Infection >12 months undergo a colposcopic evaluation of the cervix. However, in elderly women the transformation zone is often hidden, and colposcopy might not be the ideal diagnostic procedure for these women. Furthermore, little is known about the course of an HPV infection at this age with regard to different subtypes.

Zielsetzung: Vulvakarzinome mit einer Stromainvasion ≤1 mm und Durchmesser ≤20 mm werden als mikroinvasiv bezeichnet. Diese Karzinome gelten als prognostisch günstig. Daten liegen kaum vor. Diese Arbeit untersucht Verlauf und Prognose beim mikroinvasiven Vulvakarzinom.

Die Inzidenzen der chronisch entzündlichen Darmerkrankungen Morbus Crohn und Colitis ulcerosa sind ansteigend. Aufgrund der relativ hohen Inzidenz bei Patientinnen im reproduktiven Alter sowie verbesserter medikamentöser und chirurgischer Methoden sind geburtshilflich Tätige häufiger mit Fragestellungen zur optimalen Betreuung vor und während einer Schwangerschaft konfrontiert. Die vorliegende Übersichtsarbeit soll einerseits den aktuellen Kenntnisstand im Hinblick auf Kinderwunsch und Schwangerschaftsbetreuung von Patientinnen mit chronisch entzündlichen Darmerkrankungen darstellen, andererseits therapeutische Optionen im Hinblick auf ihre Anwendbarkeit in Gravidität und Stillzeit überprüfen.

The incidence of inflammatory bowel diseases such as ulcerative colitis and Crohn's disease is rising. Due to their relatively high incidence in the reproductive period and improved conservative and surgical options, obstetricians are more frequently being confronted with questions concerning the optimal therapy before and during the pregnancy of patients with inflammatory bowel diseases. It is the aim of this review to present the current state of knowledge on fertility and medical care during pregnancy and to discuss the therapeutic options with regard to their applicability in pregnancy and during the period of breast feeding in patients with ulcerative colitis and Crohn's disease.

505 Background: In hormone receptor positive, node-negative breast cancer, many patients receive chemo-endocrine therapy although endocrine therapy alone would have been sufficient in view of their excellent prognosis. In a microarray study, we recently reported that PITX2 methylation correlates strongly with the risk of recurrence after adjuvant tamoxifen. Here, we present results from a large multicenter study initiated to validate PITX2 methylation as an outcome predictor for adjuvant tamoxifen using paraffin-embedded tumor tissue. Methods: A real-time PCR assay was developed to test PITX2 methylation in paraffin-embedded tissue. Matched frozen and embedded samples (n=89) were analyzed to ensure comparability of Results: Then, we analyzed paraffin-embedded tumors of 422 node-negative patients from 9 clinical centers treated with tamoxifen alone; none of the patients had been included in the prior studies. Results: Results from the matched pairs indicated that the assay works well on paraffin-embedded material (correlation coefficient = 0.81). In the independent cohort, PITX2 methylation was strongly correlated with outcome (Cox proportional hazard model, p=0.025). In the group with low PITX2 methylation (45% of the cohort), 98% of the patients were metastasis-free after 10 years, compared to only 85% in the group with high PITX2 methylation. In a multivariate model, PITX2 methylation added significant information to conventional factors such as tumor size, grade, and age. Conclusions: This study validates PITX2 methylation as outcome predictor after adjuvant tamoxifen. Together with our previous studies, we have now analyzed over 750 patients, using two different Methods: In all studies, PITX2 methylation was consistently associated with poor outcome. Furthermore, we have now shown that PITX2 methylation can be reliably measured in paraffin-embedded tissue. The results provide substantial evidence that PITX2 DNA methylation is suitable for routine clinical use in order to predict outcome in node-negative, tamoxifen-treated patients, and to identify low-risk patients who can be spared the burden of additional cytotoxic therapy.