Patrick Petignat

University of Geneva, Genève, Geneva, Switzerland

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Publications (100)312.86 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: The World Health Organization recently advocated a two-stage strategy with HPV testing followed by Visual inspection of the cervix with Acetic acid (VIA) as a suitable option for cervical cancer screening. However, its accuracy has never been directly assessed in the context of primary screening. To evaluate effectiveness of HPV testing on self-obtained specimens (self-HPV) followed by VIA (sequential testing) in a low income setting, we recruited 540 women aged between 30 and 65 years in two Cameroonian peri-urban areas. Eligible women were counseled about cervical cancer and how to perform self-sampling. HPV positive and a random sample of HPV negative women were called back for VIA and biopsy. Disease was defined by interpretation of cervical intraepithelial neoplasia grade 2 or worse (CIN2+). Performances of VIA, self-HPV and sequential testing were determined after adjustment for verification bias. HPV prevalence was 27.0%. VIA positivity was 12.9% and disease prevalence was 5%. Sensitivity and specificity of VIA for CIN2+ were 36.4% (95% CI: 15.2%-64.6%) and 90.4% (95% CI: 85.4%-93.7%), respectively. Sensitivity of self-HPV (100.0% (95% CI: 79.6%-100.0%)) was 66% higher than that of sequential testing (33.3% (95% CI: 15.2%-58.3%)). Meanwhile, specificity of self-HPV (74.5% (95% CI: 70.6%-78.1%)) was 22% lower than that of sequential testing (96.7% (95% CI: 94.8%-97.9%)). A two-stage screening strategy with self-HPV followed by VIA improves specificity of cervical cancer screening, but at the cost of an important loss of sensitivity. Ways to improve VIA performance or other tools are needed to increase positive predictive value of HPV testing. © 2014 Wiley Periodicals, Inc.
    International Journal of Cancer 10/2014; · 6.20 Impact Factor
  • Patrick Dällenbach, Patrick Petignat
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    ABSTRACT: This study evaluated the feasibility and safety of 3-port robotically assisted laparoscopic hysterectomy (RALH), using a consecutive series of women who underwent 3-port RALH in a university hospital. From November 2010 until June 2013 we operated on 53 women, whose mean age was 48.4 ± 7.7 years (range 35–68 years), and mean body mass index was 27.1 ± 5.1 kg/m2 (range 19.5–42.9 kg/ m2). The indications for hysterectomy were myoma in 31 (58.5 %), adenomyosis in 10 (18.9 %), cervical dysplasia in 4 (7.5 %), neoplasia in 4 (7.5 %), and recurrent polyps or postmenopausal bleeding in the remaining 4 women (7.5 %). We performed total RALH in 50 cases (94.3 %) and subtotal in the others. The median duration of total intervention was 169 min (interquartile range 147.5–206.5 min). The mean weight of the uterus was 209.8 ± 166.6 g (range 36–790 g) and mean estimated blood loss was 72.3 ± 75.9 ml (range 0–300 ml). There were no perioperative complications, in particular no blood transfusions nor conversions to laparotomy. The median hospital stay was 4 days (interquartile range 3–4 days). One patient was reoperated 1 month later for vaginal vault hematoma and another was readmitted 3 weeks post-operatively due to vaginal vault dehiscence after premature intercourse, but did not require reoperation. Three-port RALH is feasible and safe for simple hysterectomy. We believe this experience using minimum ports to be useful to prepare for robotically assisted single-port hysterectomy.
    Journal of Robotic Surgery 09/2014; 8(3):221-226.
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    ABSTRACT: OBJECTIVE: Nonattendees to cervical cancer screening are at a higher risk of developing cervical cancer. This study assessed women's willingness to perform a home-based self-sampling for human papillomavirus testing (Self-HPV) and explored the feasibility of establishing a home-based Self-HPV screening strategy in Switzerland. MATERIALS AND METHODS: Underscreened women (n = 158) who had not underwent a Pap test in the preceding 3 years were recruited between September 2011 and September 2013. Participants completed 2 questionnaires evaluating reasons for non-attendance at a screening program, sociodemographic issues, and satisfaction with and acceptability of the Self-HPV. Descriptive data and multivariate logistic regression were used to identify variables associated with women's willingness to perform at-home self-sampling for HPV testing. RESULTS: Lack of time because of work or childcare was the most common reason for nonattendance at a screening program. One hundred six women (82%) preferred the Self-HPV because it is easy to perform, convenient, comfortable, and private. Women were more likely to accept the Self-HPV as a future screening strategy if they had missed cervical cancer screening in the past because of lack of time (odds ratio [OR] = 6.2, 95% confidence interval [CI] = 1.6-23.6; p < .01). Twenty-six women felt pain during self-sampling. Previous negative experiences with screening and stress during sampling were associated with higher risk for pain (OR = 7.14, 95% CI = 2.0-25.3, p < .01 and OR = 4.73, 95% CI = 1.5-14.5, p < .01, respectively). CONCLUSIONS: The Self-HPV was accepted by nonattendees of cervical cancer screening programs. Self-sampling may promote screening among the unscreened and underscreened population of women in Switzerland while overcoming some practical barriers.
    Journal of Lower Genital Tract Disease 08/2014; · 1.21 Impact Factor
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    Marie Cohen, Patrick Petignat
    Cell cycle (Georgetown, Tex.) 07/2014; 13(15). · 5.24 Impact Factor
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    ABSTRACT: Endocrine disorders play a major role in approximately 8% to 12% of recurrent pregnancy loss (RPL). Indeed, the local hormonal milieu is crucial in both embryo attachment and early pregnancy. Endocrine abnormalities, including thyroid disorders, luteal phase defects, polycystic ovary syndrome, hyperprolactinaemia and diabetes have to be evaluated in any case of RPL. Moreover, elevated androgen levels and some endocrinological aspects of endometriosis are also factors contributing to RPL. In the present article, we review the significance of endocrine disease on RPL.
    Hormones (Athens, Greece) 07/2014; 13(3):314-322. · 2.01 Impact Factor
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    G. Lo Monte, JM Wenger, P Petignat, R Marci
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    ABSTRACT: Endometriosis-the presence of endometrial tissue outside the uterine cavity-is first suspected on the basis of its signs and symptoms. The diagnosis is confirmed by imaging and surgery. Imaging, particularly transvaginal ultrasonography and magnetic resonance imaging, is essential to confirm the diagnosis and guide surgical treatment.
    Cleveland Clinic Journal of Medicine 06/2014; 81(6):361-366. · 3.40 Impact Factor
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    ABSTRACT: Endometriosis-the presence of endometrial tissue outside the uterine cavity-is first suspected on the basis of its signs and symptoms. The diagnosis is confirmed by imaging and surgery. Imaging, particularly transvaginal ultrasonography and magnetic resonance imaging, is essential to confirm the diagnosis and guide surgical treatment.
    Cleveland Clinic Journal of Medicine 06/2014; 81(6):361-6. · 3.40 Impact Factor
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    ABSTRACT: Dehydroepiandrosterone (DHEA) and its sulfate ester, DHEAS, are the most abundant steroid hormones in the humans. However, their physiological significance, their mechanisms of action and their possible roles in disease are not fully clarified. Biological actions of DHEA(S) in the brain involve neuroprotection, neurite growth, neurogenesis and neuronal survival, apoptosis, catecholamine synthesis and secretion, as well as anti-oxidant, anti-inflammatory and antiglucocorticoid effects. In addition, DHEA affects neurosteroidogenis and endorphin synthesis/release. We also demonstrated in a model of ovariectomized rats that DHEA therapy increases proceptive behaviors, already after 1 week of treatment, affecting central function of sexual drive. In women, the analyses of clinical outcomes are far from being conclusive and many issues should still be addressed. Although DHEA preparations have been available in the market since the 1990s, there are very few definitive reports on the biological functions of this steroid. We demonstrate that one year DHEA administration at the dose of 10mg provided a significant improvement in comparison with vitamin D in sexual function and in frequency of sexual intercourse in early postmenopausal women. Among symptomatic women, the spectrum of symptoms responding to DHEA requires further investigation, to define the type of sexual symptoms (e.g. decreased sexual function or hypoactive sexual desire disorder) and the degree of mood/cognitive symptoms that could be responsive to hormonal treatment. In this regard, our findings are promising, although they need further exploration with a larger and more representative sample size.
    The Journal of steroid biochemistry and molecular biology. 05/2014;
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    ABSTRACT: The WHO guidelines for screening and management of cervical precancerous lesions updated in 2013 made an emphasis on the use of the 'screen-and-treat' approach for cervical cancer prevention. In order to facilitate scaling-up in low income settings, most of these screen-andtreat strategies do not involve confirmatory biopsy. This yields a certain rate of overtreatment. In other words, a majority of people undergoing screen-and-treat intervention who are treated does not necessarily benefit from the treatment. Therefore, the issue of potential short term and long term complications of the recommended treatment procedures (cryotherapy and LEEP) arises. This question has seldom been studied in resource poor countries, particularly in sub Saharan Africa where HIV infection is rampant in an epidemic fashion and where the procreative capacities are socially rewarding for women. We draw the attention of the scientific community and policy makers to the fact that the lack of evidence supporting the safety of these treatment procedures in African populations may have an impact on the acceptability of these strategies and therefore on the effectiveness of screening programs.
    Preventive medicine. 05/2014;
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    ABSTRACT: Estetrol (E4), a naturally occurring estrogen only produced by the human fetal liver, is being evaluated in human studies for potential use in contraception and menopausal care. The present study was designed to profile E4 in the central nervous system, to assess the in vivo effects of E4 administration on allopregnanolone (AP) synthesis in specific brain structures and to evaluate whether E4 has synergic or antagonistic effects on estradiol-mediated AP synthesis. Intact female adult rats received different doses of E4, and ovariectomized OVX rats received different doses of E4 or E2V or combinations of both drugs. The concentrations of AP were assessed in the frontal and parietal cortex, hippocampus, hypothalamus, anterior pituitary, and serum. E4 did not alter AP in intact animals in any region. E4 at a dosage of 5mg/kg/day increased AP levels in different brain areas and in the serum of OVX animals. However, in the presence of estradiol, E4 showed an estrogen-antagonistic effect on the brain and serum levels of AP. E4 increases the CNS and peripheral levels of AP, behaving as a weak estrogen-agonist in OVX rats. The antagonistic effect observed with E2V co-administration further profile E4 as a natural SERM.
    The Journal of steroid biochemistry and molecular biology 04/2014; · 3.98 Impact Factor
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    ABSTRACT: Our objective was (i) to assess if a self-collected test for human papillomavirus (HPV) may serve as a primary cervical cancer screening method in a low-resource setting, (ii) to evaluate its implication in a screen and treat approach, and (iii) to identify the most eligible age group in a screening program. Women were recruited through a cervical cancer screening campaign conducted in Cameroon. Written and oral instructions were given to participants by a health-care professional to carry out an unsupervised self-collected HPV-test (SelfHPV), followed by a physician-collected cervical sample for HPV testing (Physician-HPV) and cytology. Differences in performance between Self-HPV versus Physician-HPV and their ability to detect abnormal cytology results (ASC-US+) were evaluated. Descriptive analyses were used to examine the correlation between HPV positivity and cervical abnormalities by age. A sample of 789 women was prospectively enrolled. HPV prevalence was 14.6% and 12.7% for Self-HPV and Physician-HPV, respectively (Cohen's kappa = 0.74). HPV positivity by cytological diagnosis for ASC-US+ was similar with the two tests. PPV of the Self-HPV for ASC-US+ was 20.4; OR and NNT were 6.5 (3.2-13.4) and 6 (4.2-10.9), respectively. We observed a trend of increasing cytological abnormalities in 30-49 year-old women and a concomitant trend of decreasing HPV prevalence supporting that this age group might be the most eligible group for screening. In conclusion, Self-HPV can be used as a primary screening test but needs to be followed by a triaging test that would identify the subset of women affected by clinically significant precancer or cancer. © 2014 Wiley Periodicals, Inc.
    International Journal of Cancer 03/2014; · 6.20 Impact Factor
  • Nicola Pluchino, Patrick Petignat, Jean-Marie Wenger
    Annals of surgery 01/2014; · 7.90 Impact Factor
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    ABSTRACT: A 33-year-old woman with a history of tubal sterilisation, presented to our gynaecological emergency unit with acute abdominal pain and signs of peritonism. The first day of her last menstruation occurred 4 weeks and 4 days before. Urine pregnancy test was positive and transvaginal ultrasound revealed an empty uterus with a heterogeneous mass below the right ovary. We performed a laparoscopy, which confirmed a previous isthmic partial salpingectomy and the presence of an ectopic pregnancy in the right distal remnant tube. Total salpingectomy of the remnant parts of the tube was performed and the postoperative course was uneventful.
    Case Reports 01/2014; 2014.
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    ABSTRACT: Objective To investigate missed opportunities for diagnosing female genital mutilation (FGM) at an obstetrics and gynecology (OB/GYN) department in Switzerland. Methods In a retrospective study, we included 129 consecutive women with FGM who attended the FGM outpatient clinic at the Department of Gynecology and Obstetrics at the University Hospitals of Geneva between 2010 and 2012. The medical files of all women who had undergone at least 1 previous gynecologic exam performed by an OB/GYN doctor or a midwife at the study institution were reviewed. The type of FGM reported in the files was considered correct if it corresponded to that reported by the specialized gynecologist at the FGM clinic, according to WHO classification. Results In 48 (37.2%) cases, FGM was not mentioned in the medical file. In 34 (26.4%) women, the diagnosis was correct. FGM was identified but erroneously classified in 28 (21.7%) cases. There were no factors (women’s characteristics or FGM type) associated with missed diagnosis. Conclusion Opportunities to identify FGM are frequently missed. Measures should be taken to improve FGM diagnosis and care.
    International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics 01/2014; · 1.41 Impact Factor
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    ABSTRACT: Human papillomavirus (HPV) self-sampling (Self-HPV) may be used as a primary cervical cancer screening method in a low resource setting. Our aim was to evaluate whether an educational intervention would improve women's knowledge and confidence in the Self-HPV method.
    PLoS ONE 01/2014; 9(10):e109788. · 3.53 Impact Factor
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    ABSTRACT: The recent controversy over the effectiveness of mammography highlights the urgent need for a clear regulation of the mammography screening programmes, which will permit clinicians to give confident recommendations to their patients, and public health decision-makers to make more global recommendations. Today, many clinicians and patients have the impression that a mammogram is simply an innocuous test able to detect a breast cancer sooner, with a better prognosis for cure and less invasive surgery. But the report of Swiss Medical Board demonstrated that this screening may end up harming more women than it helps. It is therefore essential to give balanced information that will ensure a good understanding of the benefits and harms of mammography. Balancing harms and benefits becomes a question that relies not only on scientific evidence but also on our values and how much our society is willing to pay to save one life. The authors of this Letter to the editor believe that it is now imperative to verify the accomplishment of the expected objectives that have been announced along with the implementation of breast cancer screening programmes in Switzerland.
    Schweizerische medizinische Wochenschrift 01/2014; 144:w13969. · 1.88 Impact Factor
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    ABSTRACT: To focus on and compare the tumor hormone receptor profiles on core needle biopsy (CNB) and subsequent surgical excision specimens in a large clinical series of invasive breast carcinoma patients, with regard to guidelines proposed at the St. Gallen International Expert Consensus on the Primary Therapy of Early Breast Cancer 2011. A total of 993 consecutive patients who had hormone receptors (HR) assays performed on both CNB and subsequent surgical excision specimens of invasive carcinomas were included (1,110 tumors). Concordant tumor HR profiles between CNB and surgical excision specimens were noted in 1,085 of 1,110 tumors (97.75%). Among 138 tumors considered negative on CNB (both HR assays <1%), 10 cases (7.2%) displayed an HR profile positive on surgical excision specimen. Discrepancies between CNBs and surgical excision specimens are very seldom noted. HR assay evaluation on surgical excision specimens should only be considered in patients when both HR assays are negative on CNBs.
    The Breast Journal 11/2013; 19(6):605-10. · 1.83 Impact Factor
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    ABSTRACT: ABSTRACT The steroidogenic endocrine glands and local synthesis both contribute to the pool of steroids present in the central nervous system and peripheral nervous system. Although the synthesis of neurosteroids in the nervous system is now well established, the spectrum of respective functions in regulating neuronal and glial functions remains to be fully elucidated. From the concept of neurosteroids derives another treatment strategy: the use of pharmaceutical agents that increase the synthesis of endogenous neurosteroids within the nervous system. This approach has so far been hampered by lack of knowledge concerning the regulation of the biosynthetic pathways of neurosteroids and their relationship with sex steroids produced by the peripheral gland or with exogenous steroids. The present review summarizes some of the available clinical and experimental findings supporting the critical role of neurosteroids during fertile life and reproductive aging and their relationship with endogenous and exogenous sex steroids. The brain metabolism of synthetic progestins and the implications of DHEA treatment in postmenopausal women will also be discussed.
    Climacteric 08/2013; 16 Suppl 1:8-17. · 1.96 Impact Factor
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    ABSTRACT: To evaluate if human papillomavirus (HPV) self-sampling (Self-HPV) using a dry vaginal swab is a valid alternative for HPV testing. Women attending colposcopy clinic were recruited to collect two consecutive Self-HPV samples: a Self-HPV using a dry swab (S-DRY) and a Self-HPV using a standard wet transport medium (S-WET). These samples were analyzed for HPV using real time PCR (Roche Cobas). Participants were randomized to determine the order of the tests. Questionnaires assessing preferences and acceptability for both tests were conducted. Subsequently, women were invited for colposcopic examination; a physician collected a cervical sample (physician-sampling) with a broom-type device and placed it into a liquid-based cytology medium. Specimens were then processed for the production of cytology slides and a Hybrid Capture HPV DNA test (Qiagen) was performed from the residual liquid. Biopsies were performed if indicated. Unweighted kappa statistics ([cyrillic small letter ka]) and McNemar tests were used to measure the agreement among the sampling methods. A total of 120 women were randomized. Overall HPV prevalence was 68.7% (95% Confidence Interval (CI) 59.3--77.2) by S-WET, 54.4% (95% CI 44.8--63.9) by S-DRY and 53.8% (95% CI 43.8--63.7) by HC. Among paired samples (S-WET and S-DRY), the overall agreement was good (85.7%; 95% CI 77.8--91.6) and the kappa was substantial (0.70; 95% CI 0.57-0.70). The proportion of positive type-specific HPV agreement was also good (77.3%; 95% CI 68.2-84.9). No differences in sensitivity for cervical intraepithelial neoplasia grade one (CIN1) or worse between the two Self-HPV tests were observed. Women reported the two Self-HPV tests as highly acceptable. Self-HPV using dry swab transfer does not appear to compromise specimen integrity. Further study in a large screening population is needed.Trial registration: ClinicalTrials.gov: NCT01316120 http://clinicaltrials.gov/show/NCT01316120.
    BMC Cancer 07/2013; 13(1):353. · 3.33 Impact Factor
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    ABSTRACT: To assess how many epithelial ovarian cancer (EOC) patients are eligible for fertility-sparing surgery (FSS) in a population-based study. Using data from the Geneva Cancer Registry, we conducted a retrospective review of all women diagnosed with epithelial ovarian cancer (EOC) between January 1979 and December 2008. Patients were classified into two age groups ("young group"≤45 years and "old group">45 years) and as "eligible for FSS" (FIGO IA, G1-G2 or unilateral ICG1) and "non-eligible for FSS" (FIGO IA, G3; IC G2-G3; IB or II-IV). Patients and tumor characteristics were tested with the chi-square test. Estimates of survival were calculated using the Kaplan-Meyer method and differences between groups were analyzed by the log-rank test. A total of 888 EOC patients were analyzed. The young group included 87 patients (9.8%): eleven (1.2%) were identified as eligible for FSS and 6 (0.6%) were nulliparous. The annual incidence of EOC women eligible for FSS in Geneva was 0.48/100,000 (0.5 women/year) and the expected annual incidence rate for Switzerland (8 million inhabitants) is 6.5 women/year. Only a very small proportion of EOC patients are eligible for FSS. These results highlight the need to centralize FSS data in dedicated European units, in order to maintain expertise and quality of care for these patients.
    European journal of obstetrics, gynecology, and reproductive biology 07/2013; · 1.97 Impact Factor

Publication Stats

619 Citations
312.86 Total Impact Points

Institutions

  • 2002–2014
    • University of Geneva
      • • Department of Obstetrics and Gynaecology
      • • Division of Gynecology
      Genève, Geneva, Switzerland
  • 2013
    • Università di Pisa
      • Department of Clinical and Experimental Medicine
      Pisa, Tuscany, Italy
  • 2010–2012
    • McGill University
      • Department of Obstetrics and Gynecology
      Montréal, Quebec, Canada
  • 2006–2012
    • Université de Montréal
      Montréal, Quebec, Canada
    • New York University
      • Department of Obstetrics and Gynecology
      New York City, NY, United States
  • 2006–2010
    • Centre hospitalier de l'Université de Montréal (CHUM)
      Montréal, Quebec, Canada
  • 2005–2007
    • Hôpital Notre-Dame
      Montréal, Quebec, Canada