The Society of Gynecologic Oncology (SGO) 2022 Annual Meeting was held between 18-21 March in Phoenix, Arizona. Multiple scientific plenary sessions covered key research concepts that included novel therapeutics, precision oncology, clinical trials, cancer care delivery, diversity, equity and inclusion, surgical trials and translational research. In the present report presentations that may impact clinical care are summarized.

2022 Society of Gynecologic Oncology meeting report

Objectives The study aims are to evaluate the utility of cervical or vaginal human papillomavirus (HPV) status in predicting recurrence of noncervix lower genital tract (LGT) high-grade squamous intraepithelial lesion (HSIL), assess factors associated with HPV positivity, and explore patterns of HSIL surveillance. Methods This retrospective cohort included patients undergoing ≥12 months of surveillance after biopsy-proven vulvar, vaginal, or anal HSIL between 2015 and 2023 at an Australian hospital with a laboratory that performs universal p16 and p53 immunohistochemistry for vulvar squamous neoplasia. Data collected included demographics, HPV results, medical comorbidities, vulvar dermatoses, treatment, frequency of surveillance, outcomes, and follow-up duration. Data were stratified by HPV status at the time of LGT HSIL diagnosis. Results Of 143 patients with a median age of 54 years, 23% used topical steroids for lichen sclerosus or planus, 93% had a recent or concurrent HPV test, and 53% of these were positive. Positive HPV was more frequent in vaginal versus vulvar HSIL (92% vs 46%; p = .003) and less frequent in patients with diabetes (23% vs 3%; p &lt; .001). Recurrent or persistent HSIL occurred in 65%. HPV positivity was not associated with overall recurrence, but afforded a 6-fold higher vaginal HSIL recurrence risk. There was a documented surveillance strategy in 92% with 78% of these having 6-monthly assessments for 5 disease-free years, then annually. Conclusions Cervical or vaginal oncogenic HPV results do not predict vulvar HSIL recurrence but may inform surveillance for vaginal disease. Limitations include the retrospective design, potential referral bias, and limited generalizability. 

The Role of Cervical or Vaginal HPV Testing in Surveillance of Vulvar, Vaginal, and Anal HPV-Associated Neoplasia

This study represents a follow-up analysis of the 

Concomitant Cervical and Anal Screening for Human Papilloma Virus (HPV): Worth the Effort or a Waste of Time?

Objective Timely treatment of anal high-grade intraepithelial lesions (HSIL) prevents progression to anal cancer. Available screening tools (anal Pap test and high-risk human papillomavirus testing) have inconsistent and suboptimal performance, often leading to overreferral to high-resolution anoscopy, the gold standard test for HSIL diagnosis. We aimed to develop and externally validate a clinical prediction model for histologic HSIL to improve triage to high-resolution anoscopy among individuals at increased risk for anal cancer. Materials and Methods Medical records from 2 institutions were reviewed to identify candidate predictors of histologic HSIL. A penalized logistic regression model with elastic net regularization was developed and internally validated with five-fold cross-validation. External validation was performed in a third institution cohort. Candidate predictors were age, sex, HIV status, history of anogenital HPV-related disease, immunosuppressant use, anal cytology, anal high-risk HPV (hrHPV) status, and interaction terms (HIV status*hrHPV infection) and (HIV status*history of anogenital HPV-related disease). Results The derivation dataset included 536 patients, 382 (71.3%) were people living with HIV, 168 (31.3%) were women, and HSIL prevalence was 21.1%. The area under the ROC on the derivation dataset was 0.80 (95% CI = 0.69; 0.90). The external validation dataset included 242 patients, 159 (65.7%) people living with HIV, 18 (7.4%) women, with HSIL prevalence of 37.2%. The final model included age, sex, anal cytology, anal hrHPV, immunosuppressant use, history of anogenital HPV-associated disease, and the 2 interaction terms. The area under the receiver operating characteristic (ROC) on the external validation dataset was 0.73 (95% CI = 0.67; 0.80). Conclusions This clinical prediction model demonstrated a promising performance and included objective factors that are easily obtained. 

Clinical Prediction Model for Anal High-Grade Squamous Intraepithelial Lesions Risk

Anal cancer is caused by HPV, and its incidence has increased globally over the last five decades. We conducted an anal HPV natural history study nested in the Costa Rica HPV Vaccine Trial (CVT) to quantitatively describe the natural history and clinical outcomes of anal HPV in HIV-negative women. CVT was a randomized clinical trial of the bivalent HPV vaccine, and an anal substudy included women selected based on a priori criteria to enrich for anal disease. For women in the anal substudy, anal samples were collected for cytology and determination of HPV16/18/45 for up to four annual visits. Women were referred for high-resolution anoscopy (HRA) based on abnormal anal cytology or anal HPV16/18/45 positivity. We describe the analytic cohort for this study according to inclusion criteria and factors associated with referral criteria for HRA during study follow-up. 9,416 women, 1,178 were included in the anal substudy (age-range = 23-35-years): 93 had prevalent anal HPV16, 236 had cervical HPV16, 364 had an anal high-risk HPV infection other than 16, 295 had anal low-risk HPV, and 227 were included as anal HPV-negative controls; 352 women were included because of a CIN3+ in study follow-up. From 3,033 study visits over a median of 70 months follow-up, 71 (6%) women were referred to HRA. This anal study nested within the CVT infrastructure and enriched for anal disease provides a unique setting to address research questions related to the natural history of anal HPV infections and associated lesions in women without HIV. 

Design and initial findings of a natural history study of anal HPV and associated lesions among young adult women in Costa Rica.

BACKGROUND
High-risk HPV (HR-HPV) infection is a risk factor for anal cancer, yet no anal cancer screening guidelines exist for women with lower genital tract HPV-related disease. We sought to describe the prevalence of anal HR-HPV or cytologic abnormalities in such women.


METHODS
This cross-sectional study was performed between October 2018 and December 2021. Inclusion criteria were >21 years of age and a prior diagnosis of high-grade dysplasia/cancer of the cervix, vagina, or vulva. Participants underwent anal cytology and anal/cervicovaginal HR-HPV testing. Women with abnormal anal cytology were referred for high-resolution anoscopy (HRA).


RESULTS
324 evaluable women were enrolled. Primary diagnosis was high-grade dysplasia/cancer of the cervix (77%), vagina (9%), and vulva (14%). Anal HR-HPV was detected in 92 patients (28%) and included HPV-16 in 24 (26%), HPV-18 in 6 (7%), and other HR-HPV types in 72 (78%) patients. Anal cytology was abnormal in 70 patients (23%) and included ASCUS (80%), LSIL (9%), HSIL (1%), and ASC-H (10%). Of these patients, 55 (79%) underwent HRA. Anal biopsies were performed in 14 patients: two patients had AIN 2/3, one patient had AIN 1, and 11 patients had negative biopsies. Both patients with AIN 2/3 had a history of cervical dysplasia.


CONCLUSION
Our results suggest an elevated risk of anal HR-HPV infection and cytologic abnormalities in women with lower genital tract dysplasia/cancer.


IMPACT
These results add to the growing body of evidence suggesting the need for evaluation of screening methods for anal dysplasia/cancer in this patient population to inform evidence-based screening recommendations.

A cross-sectional study of the prevalence of anal dysplasia among women with high-grade cervical, vaginal, and vulvar dysplasia or cancer: The PANDA Study.

Rethinking Lafontaine Criteria: Second Metacarpal Cortical Percentage as a Reliable Predictor of Distal Radius Fracture Instability.

PANDA: A prospective study of the prevalence of anal dysplasia among women with high-grade cervical, vaginal, and vulvar dysplasia or cancer (107)

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A cross-sectional study of the prevalence of anal dysplasia among women with high-grade cervical, vaginal, and vulvar dysplasia or cancer: The PANDA Study.

Rethinking Lafontaine Criteria: Second Metacarpal Cortical Percentage as a Reliable Predictor of Distal Radius Fracture Instability.

PANDA: A prospective study of the prevalence of anal dysplasia among women with high-grade cervical, vaginal, and vulvar dysplasia or cancer (107)