[Modern biomarkers for precancerous lesions of the uterine cervix : Histological-cytological correlation and use]

Construction of Urokinase-Type Plasminogen Activator Receptor-Targeted Heterostructures for Efficient Photothermal Chemotherapy against Cervical Cancer To Achieve Simultaneous Anticancer and Antiangiogenesis

Rational design and construction of theranostic nanomedicines based on clinical characteristics of cervical cancer is an important strategy to achieve precise cancer therapy. Herein, we fabricate a cervical cancer-targeting gold nanorod-mesoporous silica heterostructure for codelivery of synergistic cisplatin and antiangiogenic drug Avastin (cisplatin-AuNRs@SiO₂-Avastin@PEI/AE105) to achieve synergistic chemophotothermal therapy. Based on database analysis and clinical sample staining, conjugation of the AE105-targeting peptide obviously improves the intracellular uptake of the nanosystem and enhances the cancer-killing ability and selectivity between cervical cancer and normal cells. It could also be used to specifically monitor the urokinase-type plasminogen activator receptor (uPAR) expression level in clinical cervical specimens, which would be an early indicator of prognosis in cancer treatment. Under 808 nm laser irradiation, the nanosystem demonstrates smart NIR-light-triggered drug release and prominent photodynamic activity via induction of reactive oxygen species overproduction-mediated cell apoptosis. The nanosystem also simultaneously suppresses HeLa tumor growth and angiogenesis in vivo, with no evident histological damage observed in the major organs. In short, this study not only provides a clinical data-based rational design strategy of smart nanomedicine for precise treatment and rapid clinical diagnosis of cervical cancer but also contributes to the development of the clinical translation of nanomedicines.

[Squamous cell precancerous lesions of the cervix uteri]

BACKGROUND

The histological and immunohistochemical evaluation of tissue samples obtained in the course of the investigation and treatment of precancerous squamous lesions of the cervix uteri is an essential task of the pathologist. Given the surprising variety of morphological findings, including the many possible differential diagnoses of dysplastic changes, this is not an easy task.

DIFFERENTIATION

Biologically, only two prognostically different groups can be distinguished, which according to the WHO classification are referred to as low-grade or high-grade squamous intraepithelial lesions (LSILs or HSILs). An additional distinction as CIN1, CIN2 or CIN3 should also be made, in particular because CIN2 lesions represent a  heterogeneous group of dysplastic changes.

USAGE OF BIOMARKERS

The p16 biomarker, which has been widely studied, is extremely helpful in the diagnosis and differential diagnosis of these lesions, as regenerative and reparative changes as well as non-HPV-associated squamous cell metaplasia, are p16 negative or show patchy staining only. The indications for its use were clearly defined in the LAST project. In contrast to the diagnostic advantage, the prognostic significance of p16 in the low-grade intraepithelial lesions is controversial. Other markers such as CK7 and HPVE4 may help here. The immunohistochemistry for p16 may also be useful in examining the resection margins of a conization specimen, especially if thermoeffects make it difficult to make an unambiguous assessment. However, for the prognostic assessment of the clinical course after conization, the HPV test is more important because it better captures the risk of persistence or the risk of recurrence.