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Ye Z, Zhao Y, Chen M, Lu Q, Wang J, Cui X, Wang H, Xue P, Jiang Y. Distribution and diagnostic value of single and multiple high-risk HPV infections in detection of cervical intraepithelial neoplasia: A retrospective multicenter study in China. J Med Virol 2024; 96:e29835. [PMID: 39087721 DOI: 10.1002/jmv.29835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Revised: 06/24/2024] [Accepted: 07/18/2024] [Indexed: 08/02/2024]
Abstract
The risk associated with single and multiple human papillomavirus (HPV) infections in cervical intraepithelial neoplasia (CIN) remains uncertain. This study aims to explore the distribution and diagnostic significance of the number of high-risk HPV (hr-HPV) infections in detecting CIN, addressing a crucial gap in our understanding. This comprehensive multicenter, retrospective study meticulously analyzed the distribution of single and multiple hr-HPV, the risk of CIN2+, the relationship with CIN, and the impact on the diagnostic performance of colposcopy using demographic information, clinical histories, and tissue samples. The composition of a single infection was predominantly HPV16, 52, 58, 18, and 51, while HPV16 and 33 were identified as the primary causes of CIN2+. The primary instances of dual infection were mainly observed in combinations such as HPV16/18, HPV16/52, and HPV16/58, while HPV16/33 was identified as the primary cause of CIN2+. The incidence of hr-HPV infections shows a dose-response relationship with the risk of CIN (p for trend <0.001). Compared to single hr-HPV, multiple hr-HPV infections were associated with increased risks of CIN1 (1.44, 95% confidence interval [CI]: 1.20-1.72), CIN2 (1.70, 95% CI: 1.38-2.09), and CIN3 (1.08, 95% CI: 0.86-1.37). The colposcopy-based specificity of single hr-HPV (93.4, 95% CI: 92.4-94.4) and multiple hr-HPV (92.9, 95% CI: 90.8-94.6) was significantly lower than negative (97.9, 95% CI: 97.0-98.5) in detecting high-grade squamous intraepithelial lesion or worse (HSIL+). However, the sensitivity of single hr-HPV (73.5, 95% CI: 70.8-76.0) and multiple hr-HPV (71.8, 95% CI: 67.0-76.2) was higher than negative (62.0, 95% CI: 51.0-71.9) in detecting HSIL+. We found that multiple hr-HPV infections increase the risk of developing CIN lesions compared to a single infection. Colposcopy for HSIL+ detection showed high sensitivity and low specificity for hr-HPV infection. Apart from HPV16, this study also found that HPV33 is a major pathogenic genotype.
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Affiliation(s)
- Zichen Ye
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yuankai Zhao
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Mingyang Chen
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Qu Lu
- School of Health Policy and Management, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jiahui Wang
- School of Health Policy and Management, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xiaoli Cui
- Department of Gynecologic Oncology, Cancer Hospital of China Medical University, Liaoning Cancer Hospital & Institute, Shenyang, Liaoning Province, China
| | - Huike Wang
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Peng Xue
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yu Jiang
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- School of Health Policy and Management, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Tsampazis N, Vavoulidis E, Margioula-Siarkou C, Symeonidou M, Intzes S, Papanikolaou A, Dinas K, Daniilidis A. The Diagnostic Accuracy of Electrical Impedance Spectroscopy-Assisted Colposcopy, HPV mRNA Test, and P16/Ki67 Immunostaining as CIN2+ Predictors in Greek Population. Diagnostics (Basel) 2024; 14:1379. [PMID: 39001269 PMCID: PMC11240963 DOI: 10.3390/diagnostics14131379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2024] [Revised: 06/21/2024] [Accepted: 06/27/2024] [Indexed: 07/16/2024] Open
Abstract
OBJECTIVE To evaluate the diagnostic accuracy of Electrical Impedance Spectroscopy (EIS)-assisted colposcopy in detecting CIN2+ Greek women towards standalone colposcopy, HPV mRNA testing, and p16/Ki67 immunostaining. METHODS We conducted a cross-sectional observational study at the Cervical Pathology Clinic of the 2nd Obstetrics-Gynecology University Department of Hippokration Hospital Thessaloniki involving 316 patients from January 2022 to August 2023. All participants provided liquid-based cervical samples for cytology, HPV mRNA testing, and p16/Ki67 immunostaining. MAIN OUTCOME MEASURES Subsequently, participants underwent both standalone colposcopy and EIS/ZedScan-assisted colposcopy, followed by cervical punch biopsies. RESULTS The incorporation of EIS significantly enhanced the sensitivity of colposcopy, increasing it from 54.17% to 100%, equivalent to that of HPV mRNA testing and p16/Ki67 immunostaining, while achieving a high specificity (95.45%). The specificities observed with EIS/ZedScan-assisted and standalone colposcopy were notably superior to those of HPV-related biomarkers (HPV mRNA test and p16/Ki67 immunostaining). When compared to standalone colposcopy, HPV mRNA testing, and p16/Ki67 immunostaining, EIS/ZedScan-assisted colposcopy demonstrated the most favorable combination of Positive and Negative Predictive Values, at 90.57% and 100%, respectively. The inclusion of EIS/ZedScan in colposcopy led to the detection of 44 additional cases of true CIN2+ (100% of the total CIN2+ confirmed histologically) that were missed by standalone colposcopy. This discovery suggests a 45.83% increase in the detection of CIN2+ cases. CONCLUSIONS The integration of EIS with colposcopy has demonstrated effectiveness in detecting cervical lesions, resulting in a significant detection increase of CIN2+ cases while offering optimal levels of sensitivity, specificity, and predictive values for CIN2+ detection.
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Affiliation(s)
- Nikolaos Tsampazis
- 2nd Department of Obstetrics & Gynecology, Medical Faculty, Aristotle University of Thessaloniki, Hippokration General Hospital, 56429 Thessaloniki, Greece
| | - Eleftherios Vavoulidis
- 2nd Department of Obstetrics & Gynecology, Medical Faculty, Aristotle University of Thessaloniki, Hippokration General Hospital, 56429 Thessaloniki, Greece
| | - Chrysoula Margioula-Siarkou
- 2nd Department of Obstetrics & Gynecology, Medical Faculty, Aristotle University of Thessaloniki, Hippokration General Hospital, 56429 Thessaloniki, Greece
| | - Marianthi Symeonidou
- 2nd Department of Obstetrics & Gynecology, Medical Faculty, Aristotle University of Thessaloniki, Hippokration General Hospital, 56429 Thessaloniki, Greece
| | - Stergios Intzes
- 2nd Department of Obstetrics & Gynecology, Medical Faculty, Aristotle University of Thessaloniki, Hippokration General Hospital, 56429 Thessaloniki, Greece
| | - Alexios Papanikolaou
- 2nd Department of Obstetrics & Gynecology, Medical Faculty, Aristotle University of Thessaloniki, Hippokration General Hospital, 56429 Thessaloniki, Greece
| | - Konstantinos Dinas
- 2nd Department of Obstetrics & Gynecology, Medical Faculty, Aristotle University of Thessaloniki, Hippokration General Hospital, 56429 Thessaloniki, Greece
| | - Angelos Daniilidis
- 1st Department of Obstetrics & Gynecology, Medical Faculty, Aristotle University of Thessaloniki, Papageorgiou General Hospital, 54124 Thessaloniki, Greece
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Camli B, Andrus L, Roy A, Mishra B, Xu C, Georgakoudi I, Tkaczyk T, Ben-Yakar A. Two photon imaging probe with highly efficient autofluorescence collection at high scattering and deep imaging conditions. BIOMEDICAL OPTICS EXPRESS 2024; 15:3163-3182. [PMID: 38855663 PMCID: PMC11161376 DOI: 10.1364/boe.520729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Revised: 04/05/2024] [Accepted: 04/06/2024] [Indexed: 06/11/2024]
Abstract
In this paper, we present a 2-photon imaging probe system featuring a novel fluorescence collection method with improved and reliable efficiency. The system aims to miniaturize the potential of 2-photon imaging in the metabolic and morphological characterization of cervical tissue at sub-micron resolution over large imaging depths into a flexible and clinically viable platform towards the early detection of cancers. Clinical implementation of such a probe system is challenging due to inherently low levels of autofluorescence, particularly when imaging deep in highly scattering tissues. For an efficient collection of fluorescence signals, our probe employs 12 0.5 NA collection fibers arranged around a miniaturized excitation objective. By bending and terminating a multitude of collection fibers at a specific angle, we increase collection area and directivity significantly. Positioning of these fibers allows the collection of fluorescence photons scattered away from their ballistic trajectory multiple times, which offers a system collection efficiency of 4%, which is 55% of what our bench-top microscope with 0.75 NA objective achieves. We demonstrate that the collection efficiency is largely maintained even at high scattering conditions and high imaging depths. Radial symmetry of arrangement maintains uniformity of collection efficiency across the whole FOV. Additionally, our probe can image at different tissue depths via axial actuation by a dc servo motor, allowing depth dependent tissue characterization. We designed our probe to perform imaging at 775 nm, targeting 2-photon autofluorescence from NAD(P)H and FAD molecules, which are often used in metabolic tissue characterization. An air core photonic bandgap fiber delivers laser pulses of 100 fs duration to the sample. A miniaturized objective designed with commercially available lenses of 3 mm diameter focuses the laser beam on tissue, attaining lateral and axial imaging resolutions of 0.66 µm and 4.65 µm, respectively. Characterization results verify that our probe achieves collection efficiency comparable to our optimized bench-top 2-photon imaging microscope, minimally affected by imaging depth and radial positioning. We validate autofluorescence imaging capability with excised porcine vocal fold tissue samples. Images with 120 µm FOV and 0.33 µm pixel sizes collected at 2 fps confirm that the 300 µm imaging depth was achieved.
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Affiliation(s)
- Berk Camli
- Department of Mechanical Engineering, UT Austin, Austin, Texas, USA
| | - Liam Andrus
- Department of Biomedical Engineering, UT Austin, Austin, Texas, USA
| | - Aditya Roy
- Department of Mechanical Engineering, UT Austin, Austin, Texas, USA
| | - Biswajit Mishra
- Department of Mechanical Engineering, UT Austin, Austin, Texas, USA
| | - Chris Xu
- School of Applied and Engineering Physics, Cornell University, Ithaca, New York, USA
| | - Irene Georgakoudi
- Department of Biomedical Engineering, Tufts University, Medford, Massachusetts, USA
| | - Tomasz Tkaczyk
- Department of Bioengineering, Rice University, Houston, Texas, USA
| | - Adela Ben-Yakar
- Department of Mechanical Engineering, UT Austin, Austin, Texas, USA
- Department of Biomedical Engineering, UT Austin, Austin, Texas, USA
- Department of Electrical and Computer Engineering, UT Austin, Austin, Texas, USA
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Li X, Zhao Y, Xiang F, Zhang X, Chen Z, Zhang M, Kang X, Wu R. Evaluation of the diagnostic performance of colposcopy in the detection of cervical high-grade squamous intraepithelial lesions among women with transformation zone type 3. BMC Cancer 2024; 24:381. [PMID: 38528547 DOI: 10.1186/s12885-024-12156-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 03/20/2024] [Indexed: 03/27/2024] Open
Abstract
BACKGROUND Inaccurate colposcopy diagnosis may lead to inappropriate management and increase the incidence of cervical cancer. This study aimed to evaluate the diagnostic accuracy of colposcopy in the detection of histologic cervical intraepithelial neoplasia grade 2 or worse (CIN2+) in women with transformation zone type 3 (TZ3). METHODS Records from 764 patients with TZ3 who underwent colposcopy-directed biopsy and/or endocervical curettage in Putuo Hospital China between February 2020 and March 2023 were retrospectively collected. Colposcopy was carried out based on 2011 International Federation of Cervical Pathology and Colposcopy (IFCPC) and Colposcopy nomenclature. The diagnostic performance of colposcopy for identifying CIN2 + was evaluated compared with biopsies. The Kappa and McNemar tests were used to perform statistical analyses. RESULTS Among the study population, 11.0% had pathologic CIN2+. The relative sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of colposcopy for histologic CIN2 + were 51.2%, 96.5%, 64.2% and 94.1%, respectively. The senior colposcopists (80.6%) had a higher colposcopic accuracy to diagnose histologic CIN2 + than junior colposcopists (68.6%). In subgroup analyses, age group ≥ 60 years (70.3%) showed lowest diagnostic accuracy when compared with age groups of < 45 years (84.4%) and 45-59 years (74.9%). CONCLUSION Our findings suggest an increased risk of diagnostic inaccuracy of colposcopy in identifying CIN2 + in those ≥ 60 years of age with TZ3, and the accuracy of colposcopy is required to be further improved.
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Affiliation(s)
- Xiaoxiao Li
- Department of Laboratory Medicine, Putuo Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Yunzhi Zhao
- Department of Obstetrics and Gynecology, Putuo Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Fenfen Xiang
- Department of Laboratory Medicine, Putuo Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Xinpei Zhang
- Department of Obstetrics and Gynecology, Putuo Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Zixi Chen
- Department of Laboratory Medicine, Putuo Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Mengzhe Zhang
- Department of Laboratory Medicine, Putuo Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Xiangdong Kang
- Department of Laboratory Medicine, Putuo Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China.
| | - Rong Wu
- Department of Laboratory Medicine, Putuo Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China.
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Zhou Y, Wang C, Li W, Lu W, Liu X, Xi L, Li P, Lu J, Wei J. Fluorescence colposcope with TMTP1-PEG4-ICG is comparable to the conventional colposcope in identifying cervical precancerous lesions: A randomized controlled trial. Int J Gynaecol Obstet 2023; 162:969-976. [PMID: 36939553 DOI: 10.1002/ijgo.14752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 02/22/2023] [Accepted: 03/03/2023] [Indexed: 03/21/2023]
Abstract
OBJECTIVE To compare the diagnostic efficiency of a fluorescence colposcope with TMTP1-PEG4-ICG dye versus a conventional colposcope with acetic acid and Lugol's iodine in identifying cervical precancerous lesions. METHODS In all, 218 women with abnormal cervical cancer screening results including cytology and/or human papillomavirus (HPV) test were involved in the randomized controlled trial. Patients in the fluorescence colposcope group had TMTP1-PEG4-ICG dye applied to the cervix uteri before colposcopy. Patients in the conventional colposcope group were routinely administered acetic acid and Lugol's iodine to stain the cervix uteri. Two to four cervical sites per patient were taken out for biopsy. The diagnostic efficiency of fluorescence colposcopy and conventional colposcopy was calculated on a per-patient and per-site basis. χ2 test or Fisher exact test was used. RESULTS A total of 194 patients and the corresponding 662 cervical sites were included in the final analysis. There was no statistically significant difference in the diagnostic efficiency between the two groups both on a per-patient and a per-site basis, including accuracy, sensitivity, specificity, positive predictive value, and negative predictive value. CONCLUSIONS The fluorescence colposcope with TMTP1-PEG4-ICG dye was comparable to the conventional colposcope in identifying cervical precancerous lesions.
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Affiliation(s)
- Ying Zhou
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Chen Wang
- Britton Chance Center and MoE Key Laboratory for Biomedical Photonics, Wuhan National Laboratory for Optoelectronics, Huazhong University of Science and Technology, Wuhan, China
| | - Wei Li
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Wanrong Lu
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Xiaohu Liu
- Britton Chance Center and MoE Key Laboratory for Biomedical Photonics, Wuhan National Laboratory for Optoelectronics, Huazhong University of Science and Technology, Wuhan, China
| | - Ling Xi
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Pengcheng Li
- Britton Chance Center and MoE Key Laboratory for Biomedical Photonics, Wuhan National Laboratory for Optoelectronics, Huazhong University of Science and Technology, Wuhan, China
- Research Unit of Multimodal Cross Scale Neural Signal Detection and Imaging, Chinese Academy of Medical Sciences, 2019RU002, HUST-Suzhou Institute for Brainsmatics, JITRI, Suzhou, China
| | - Jinling Lu
- Britton Chance Center and MoE Key Laboratory for Biomedical Photonics, Wuhan National Laboratory for Optoelectronics, Huazhong University of Science and Technology, Wuhan, China
| | - Juncheng Wei
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
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Li X, Xiang F, Zhao Y, Li Q, Gu Q, Zhang X, Chen Z, Zhang M, Wang J, Liu R, Kang X, Wu R. Detection of cervical high-grade squamous intraepithelial lesions and assessing diagnostic performance of colposcopy among women with oncogenic HPV. BMC Womens Health 2023; 23:411. [PMID: 37542333 PMCID: PMC10403922 DOI: 10.1186/s12905-023-02538-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 07/12/2023] [Indexed: 08/06/2023] Open
Abstract
BACKGROUND HPV screening tests may improve cervical cancer risk stratification and better guide decisions about follow-up with colposcopy/biopsy. This study aimed to estimate the risk of cervical intraepithelial neoplasia grade 2 or worse (CIN2+) among women with oncogenic HPV types and evaluate the performance of colposcopy in the diagnosis of histologic CIN2 + at Putuo Hospital, Shanghai, China. METHODS This cross-sectional survey was conducted from February 2020 to December 2022 among women who were referred to colposcopy. Women with high-risk (HR) HPV-positive, cytology testing and colposcopy-directed biopsy were included. RESULTS Univariate and multivariate analysis indicated that high-grade colposcopic impression ((OR, 17.61%, 95%CI: 11.54-26.85%) was associated with the highest risk for detecting CIN2+, followed by HSIL + cytology (OR, 6.90%, 95%CI: 3.56-13.37%) and HPV16/18 positive (OR, 2.91%, 95%CI: 2.12-3.99%). Overall, CIN2 + was detected in 14.6% of 2007 women. HPV16/18 had higher CIN2 + risks than other HR-HPV genotypes (30.1% vs. 10.2%, P<0.001). Among women with low-grade cytology, 24.1% had CIN2+, and the risks for HPV16/18 (58.2%) were higher than for other HR-HPV(16.8%). For those with high-grade cytology, there was no significant difference between HPV groups ( 75.0% vs. 72.9%, P > 0.05). The diagnostic performance of colposcopy in diagnosis of CIN2 + by senior and junior colposcopists was comparable. CONCLUSIONS The results indicated that referral to colposcopy is recommended in managing women with HR-HPV positive, and colposcopic impressions provide key clues for identification CIN2+.
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Affiliation(s)
- Xiaoxiao Li
- Laboratory Medicine Department, Putuo Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Fenfen Xiang
- Laboratory Medicine Department, Putuo Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Yunzhi Zhao
- Department of Obstetrics and Gynecology, Putuo Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Qian Li
- Laboratory Medicine Department, Putuo Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Qing Gu
- Laboratory Medicine Department, Putuo Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Xinpei Zhang
- Department of Obstetrics and Gynecology, Putuo Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Zixi Chen
- Laboratory Medicine Department, Putuo Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Mengzhe Zhang
- Laboratory Medicine Department, Putuo Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Jun Wang
- Laboratory Medicine Department, Putuo Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Rongrong Liu
- Laboratory Medicine Department, Putuo Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Xiangdong Kang
- Laboratory Medicine Department, Putuo Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China.
| | - Rong Wu
- Laboratory Medicine Department, Putuo Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China.
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Mergui JL, Gondry J, Hocquemiller R, Carcopino X. [Revision of the French colposcopic terminology]. GYNECOLOGIE, OBSTETRIQUE, FERTILITE & SENOLOGIE 2023; 51:239-248. [PMID: 36858178 DOI: 10.1016/j.gofs.2023.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/02/2023]
Abstract
OBJECTIVES To revise the 1983 colposcopic terminology form the French Society of Colposcopy and cervicovaginal pathology (SFCPCV). METHODS All the three following steps of colposcopic examination were considered for the description of various colposcopic features: inspection without coloration, followed by the application of acetic acid and iodine staining. This revised terminology now includes the different possible colposcopic aspects of the normal cervix, including the ectropion and the normal transformation zone. It also includes colposcopic appearance of abnormal glandular cervical epithelium and of vaginal epithelium. The revised nomenclature was reviewed by all the board of the SFCPCV and was finally approved during the 45th annual conference of the SFCPCV. RESULTS Abnormal transformation zone grade (TAG) 1a and 1b have been brought together under the sole TAG1 designation. TAG2a and TAG2b now correspond to TAG2, whereas TAG2c corresponds to TAG3. Colposcopic report should mention the interpretability of the colposcopic examination, with the precise type of the squamocolumnar junction (1, 2 or 3), the colposcopic impression, the size of any TAG and finally mention whether one or multiple biopsies were taken and their precise location. Colposcopic impression must give priority to the most pejorative colposcopic aspect which takes precedence over others. CONCLUSION When performing colposcopy, one should keep in mind that this examination only relies on the interpretation of various colposcopic signs and images with this not guaranteeing for diagnosis. Only histological analysis of a possible guided cervical biopsy provides for a precise diagnosis.
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Affiliation(s)
- J-L Mergui
- Société française de colposcopie et pathologie cervico-vaginale (SFCPCV), Paris, France
| | - J Gondry
- Société française de colposcopie et pathologie cervico-vaginale (SFCPCV), Paris, France; Service de Gynécologie Obstétrique, Centre hospitalier universitaire Amiens Picardie, Université Picardie Jules-Verne, Amiens, France
| | - R Hocquemiller
- Société française de colposcopie et pathologie cervico-vaginale (SFCPCV), Paris, France; Service de chirurgie gynécologique, Hôpital de la Pitié Salpêtrière (APHP), Paris, France
| | - X Carcopino
- Société française de colposcopie et pathologie cervico-vaginale (SFCPCV), Paris, France; Service de chirurgie gynécologique, Centre hospitalier universitaire Nord (APHM), Aix-Marseille Université (AMU), Univ Avignon, CNRS, IRD, IMBE UMR 7263, 13397 Marseille, France.
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Qin D, Bai A, Xue P, Seery S, Wang J, Mendez MJG, Li Q, Jiang Y, Qiao Y. Colposcopic accuracy in diagnosing squamous intraepithelial lesions: a systematic review and meta-analysis of the International Federation of Cervical Pathology and Colposcopy 2011 terminology. BMC Cancer 2023; 23:187. [PMID: 36823557 PMCID: PMC9951444 DOI: 10.1186/s12885-023-10648-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 02/14/2023] [Indexed: 02/25/2023] Open
Abstract
BACKGROUND Colposcopy is an important tool in diagnosing cervical cancer, and the International Federation of Cervical Pathology and Colposcopy (IFCPC) issued the latest version of the guidelines in 2011. This study aims to systematically assess the accuracy of colposcopy in predicting low-grade squamous intraepithelial lesions or worse (LSIL+) / high-grade squamous intraepithelial lesions or worse (HSIL+) under the 2011 IFCPC terminology. METHODS We performed a systematic review and meta-analysis, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We searched for studies about the performance of colposcopy in diagnosing cervical intraepithelial neoplasia under the new IFCPC colposcopy terminology from PubMed, Embase, Web of Science and the Cochrane database. Data were independently extracted by two authors and an overall diagnostic performance index was calculated under two colposcopic thresholds. RESULTS Totally, fifteen articles with 22,764 participants in compliance with the criteria were included in meta-analysis. When colposcopy was used to detect LSIL+, the combined sensitivity and specificity were 0.92 (95% CI 0.88-0.95) and 0.51 (0.43-0.59), respectively. When colposcopy was used to detect HSIL+, the combined sensitivity and specificity were 0.68 (0.58-0.76) and 0.93 (0.88-0.96), respectively. CONCLUSION In accordance with the 2011 IFCPC terminology, the accuracy of colposcopy has improved in terms of both sensitivity and specificity. Colposcopy is now more sensitive with LSIL+ taken as the cut-off value and is more specific to HSIL+. These findings suggest we are avoiding under- or overdiagnosis both of which impact on patients' well-being.
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Affiliation(s)
- Dongxu Qin
- grid.506261.60000 0001 0706 7839School of Population Medicine and Public Health, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730 China
| | - Anying Bai
- grid.506261.60000 0001 0706 7839School of Population Medicine and Public Health, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730 China
| | - Peng Xue
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China.
| | - Samuel Seery
- grid.9835.70000 0000 8190 6402Faculty of Health and Medicine, Division of Health Research, Lancaster University, Lancaster, LA1 4YW UK
| | - Jiaxu Wang
- grid.506261.60000 0001 0706 7839School of Population Medicine and Public Health, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730 China
| | - Maria Jose Gonzalez Mendez
- grid.411971.b0000 0000 9558 1426School of Public Health, Dalian Medical University, Dalian, 116044 Liaoning China
| | - Qing Li
- grid.469593.40000 0004 1777 204XDiagnosis and Treatment for Cervical Lesions Center, Shenzhen Maternity and Child Healthcare Hospital, Shenzhen, 518028 China
| | - Yu Jiang
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China.
| | - Youlin Qiao
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China.
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Padavu S, Aichpure P, Krishna Kumar B, Kumar A, Ratho R, Sonkusare S, Karunasagar I, Karunasagar I, Rai P. An insight into clinical and laboratory detections for screening and diagnosis of cervical cancer. Expert Rev Mol Diagn 2023; 23:29-40. [PMID: 36697264 DOI: 10.1080/14737159.2023.2173580] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
INTRODUCTION Cervical cancer is the most frequent malignancy among women caused by an unresolved long-term infection with distinct human papillomavirus (HPV) genotypes. It is the fourth most common form of cancer among women worldwide. The two oncogenic genotypes, HPV 16 and 18, are responsible for >70% of all cervical cancers worldwide. Cervical cancer is one of the most successfully preventable and treatable forms of cancer if detected early. AREAS COVERED In this review article, we have summarizedsummarised the different approaches used in clinical diagnosis and research laboratories to detect HPV-related changes associated with cervical cancer for a better understanding of the advantages and limitations of these tests. EXPERT OPINION Despite the well-known screening strategies for cervical cancer, developing nations lack effective implementation due to various factors. With the current rate of cervical cancer cases, precise and timely identification of HPV can significantly impact the prevention and efficient management of cervical cancer. Cervical cancer is the most common gynecological cancer in developing countries. The primary screening test with cytology and molecular testing of HPV is important for preventing cervical cancer. To address these issues, several point-of-care assays have been developed to facilitate rapid screening of HPV with the least turnaround time.
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Affiliation(s)
- Shruthi Padavu
- Nitte (Deemed to Be University), Nitte University Centre for Science Education and Research (NUCSER), Division of Infectious Diseases, Deralakatte, Mangaluru-575018, Karnataka, India
| | - Pooja Aichpure
- Nitte (Deemed to Be University), Nitte University Centre for Science Education and Research (NUCSER), Division of Infectious Diseases, Deralakatte, Mangaluru-575018, Karnataka, India
| | - Ballamoole Krishna Kumar
- Nitte (Deemed to Be University), Nitte University Centre for Science Education and Research (NUCSER), Division of Infectious Diseases, Deralakatte, Mangaluru-575018, Karnataka, India
| | - Anoop Kumar
- In Vivo Bioassay Laboratory & Animal Facility, National Institute of Biologicals (NIB), Ministry of Health & Family Welfare, Noida, India
| | - RadhaKanta Ratho
- Department of Virology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Shipra Sonkusare
- Nitte (Deemed to Be University), Department of Obstetrics & Gynaecology, KS Hegde Medical Academy (KSHEMA), Deralakatte, Mangaluru, India
| | - Indrani Karunasagar
- Nitte (Deemed to Be University), University Enclave, Medical Sciences Complex, Deralakatte, Mangaluru, India
| | - Iddya Karunasagar
- Nitte (Deemed to Be University), University Enclave, Medical Sciences Complex, Deralakatte, Mangaluru, India
| | - Praveen Rai
- Nitte (Deemed to Be University), Nitte University Centre for Science Education and Research (NUCSER), Division of Infectious Diseases, Deralakatte, Mangaluru-575018, Karnataka, India
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Concordance Rate of Colposcopy in Detecting Cervical Intraepithelial Lesions. Diagnostics (Basel) 2022; 12:diagnostics12102436. [PMID: 36292125 PMCID: PMC9600163 DOI: 10.3390/diagnostics12102436] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Revised: 10/05/2022] [Accepted: 10/06/2022] [Indexed: 11/25/2022] Open
Abstract
Background: The purpose of this research is to estimate the rate of concordance, sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of colposcopy for high-grade squamous lesions and carcinomas (HSIL+). Methods: We conducted a retrospective study of colposcopies performed in the certified Dysplasia Unit in Erlangen between January 2015 and May 2022 (7.5 years). The colposcopic findings were correlated with biopsies obtained during examinations or surgery. Cases without histology were excluded. The primary outcome was the rate of concordance between the colposcopic and histological findings in relation to the type of transformation zone (TZ), examiner’s level of experience and age of the patients. Results: A total of 4778 colposcopies in 4001 women were analyzed. The rates of concordance for CIN I/LSIL, CIN II/HSIL, CIN III/HSIL, and carcinoma were 43.4%, 59.5%, 78.5%, and 53.9%, respectively. The rate of concordance was lowest for TZ3 and highest for colposcopists with more than 10 years’ experience. Conclusions: Colposcopy is an important, feasible, and effective method. Careful work-up needs to be performed for women with TZ3 who are over 35 years old, as they are at the highest risk of being misdiagnosed. The highest concordance for detecting HSIL+ was seen for colposcopists with >10 years’ experience.
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Pleş L, Radosa JC, Sima RM, Chicea R, Olaru OG, Poenaru MO. The Accuracy of Cytology, Colposcopy and Pathology in Evaluating Precancerous Cervical Lesions. Diagnostics (Basel) 2022; 12:diagnostics12081947. [PMID: 36010299 PMCID: PMC9407050 DOI: 10.3390/diagnostics12081947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Revised: 08/07/2022] [Accepted: 08/10/2022] [Indexed: 11/16/2022] Open
Abstract
Introduction: Cervical cancer (CC) is the third most common cancer in the world, and Romania has the highest incidence of cervical cancer in Europe. The aim of this study was to evaluate the correlation between cytology, colposcopy, and pathology for the early detection of premalignant cervical lesions in a group of Romanian patients. Methods: This observational type 2 cohort study included 128 women from our unit, “Bucur” Maternity, who were referred for cervical cancer screening. Age, clinical diagnosis, cytology results, colposcopy impression, and biopsy results were considered. Colposcopy was performed by two experienced examiners. The pathological examination was performed by an experienced pathologist. Results: The cytology found high-grade squamous intraepithelial lesions in 60.9% of patients, low-grade squamous intraepithelial lesions in 28.1%, atypical squamous cells for which a high-grade lesion could not be excluded in 9.4%, and atypical squamous cells of undetermined significance, known as repeated LSIL, in 1.6%. The first evaluator identified low-grade lesions in 56.3%, high-grade lesions in 40.6%, and invasion in 3.1% of patients. The second evaluator identified low-grade lesions in 59.4%, high-grade lesions in 32.0%, and invasion in 8.6% of patients. The pathological exam identified low-grade lesions in 64.1%, high-grade lesions in 25%, and carcinoma in 14% of patients. The colposcopic accuracy was greater than the cytologic accuracy. Conclusions: Colposcopy remains an essential tool for the identification of cervical premalignant cancer cells. Standardization of the protocol provided an insignificant interobserver variability and can serve as support for further postgraduate teaching.
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Affiliation(s)
- Liana Pleş
- Department of Obstetrics and Gynecology, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Bucur Maternity, Saint John Hospital, 012361 Bucharest, Romania
| | - Julia-Carolina Radosa
- Department for Gynaecology, Obstetrics and Reproductive Medicine, Saarland University Hospital, Kirrberger Straße 100, Building 9, 66421 Homburg, Germany
| | - Romina-Marina Sima
- Department of Obstetrics and Gynecology, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Bucur Maternity, Saint John Hospital, 012361 Bucharest, Romania
- Correspondence:
| | - Radu Chicea
- Faculty of Medicine, Lucian Blaga University of Sibiu, 550024 Sibiu, Romania
| | - Octavian-Gabriel Olaru
- Department of Obstetrics and Gynecology, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Bucur Maternity, Saint John Hospital, 012361 Bucharest, Romania
| | - Mircea-Octavian Poenaru
- Department of Obstetrics and Gynecology, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Bucur Maternity, Saint John Hospital, 012361 Bucharest, Romania
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12
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Seyhan A, Aktürk E. Comparison of Colposcopic Biopsy and Conization Results in Association with Overtreatment or Missed Diagnosis. MEANDROS MEDICAL AND DENTAL JOURNAL 2022. [DOI: 10.4274/meandros.galenos.2022.47113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Bai A, Wang J, Li Q, Seery S, Xue P, Jiang Y. Assessing colposcopic accuracy for high-grade squamous intraepithelial lesion detection: a retrospective, cohort study. BMC Womens Health 2022; 22:9. [PMID: 35012523 PMCID: PMC8751223 DOI: 10.1186/s12905-022-01592-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Accepted: 12/31/2021] [Indexed: 01/03/2023] Open
Abstract
Background Inappropriate management of high-grade squamous intraepithelial lesions (HSIL) may be the result of an inaccurate colposcopic diagnosis. The aim of this study was to assess colposcopic performance in identifying HSIL+ cases and to analyze the associated clinical factors. Methods Records from 1130 patients admitted to Shenzhen Maternal and Child Healthcare Hospital from 12th January, 2018 up until 30th December, 2018 were retrospectively collected, and included demographics, cytological results, HPV status, transformation zone type, number of cervical biopsy sites, colposcopists’ competencies, colposcopic impressions, as well as histopathological results. Colposcopy was carried out using 2011 colposcopic terminology from the International Federation of Cervical Pathology and Colposcopy. Logistic regression modelling was implemented for uni- and multivariate analyses. A forward stepwise approach was adopted in order to identify variables associated with colposcopic accuracy. Histopathologic results were taken as the comparative gold standard. Results Data from 1130 patient records were collated and analyzed. Colposcopy was 69.7% accurate in identifying HSIL+ cases. Positive predictive value, negative predictive value, sensitivity and specificity of detecting HSIL or more (HSIL+) were 35.53%, 64.47%, 42.35% and 77.60%, respectively. Multivariate analysis highlighted the number of biopsies, cytology, and transformation zone type as independent factors. Age and HPV subtype did not appear to statistically correlate with high-grade lesion/carcinoma. Conclusion Evidence presented here suggests that colposcopy is only 69.7% accurate at diagnosing HSIL. Even though not all HSIL will progress into cancer it is considered pre-cancerous and therefore early identification will save lives. The number of biopsies, cytology and transformation zone type appear to be predictors of misdiagnosis and therefore should be considered during clinical consultations and by way of further research.
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Affiliation(s)
- Anying Bai
- Department of Epidemiology and Biostatistics, School of Population Medicine and Public Health, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China
| | - Jiaxu Wang
- Department of Epidemiology and Biostatistics, School of Population Medicine and Public Health, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China
| | - Qing Li
- Diagnosis and Treatment for Cervical Lesions Center, Shenzhen Maternity & Child Healthcare Hospital, Shenzhen, 518028, China
| | - Samuel Seery
- Division of Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster, LA1 4YW, UK
| | - Peng Xue
- Department of Epidemiology and Biostatistics, School of Population Medicine and Public Health, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China.
| | - Yu Jiang
- Department of Epidemiology and Biostatistics, School of Population Medicine and Public Health, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China.
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14
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Fu L, Xia W, Shi W, Cao GX, Ruan YT, Zhao XY, Liu M, Niu SM, Li F, Gao X. Deep learning based cervical screening by the cross-modal integration of colposcopy, cytology, and HPV test. Int J Med Inform 2021; 159:104675. [PMID: 34979436 DOI: 10.1016/j.ijmedinf.2021.104675] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 12/17/2021] [Accepted: 12/21/2021] [Indexed: 12/29/2022]
Abstract
PURPOSE To develop and evaluate the colposcopy based deep learning model using all kinds of cervical images for cervical screening, and investigate the synergetic benefits of the colposcopy, the cytology test, and the HPV test for improving cervical screening performance. METHODS This study consisted of 2160 women who underwent cervical screening, there were 442 cases with the histopathological confirmed high-grade squamous intraepithelial lesion (HSIL) or cancer, and the remained 1718 women were controls. Three kinds of cervical images were acquired from colposcopy including the saline image of cervix after saline irrigation, the acetic acid image of cervix after applying acetic acid solution, and the iodine image of cervix after applying Lugol's iodine solution. Each kind of image was used to build a single-image based deep learning model by the VGG-16 convolutional neural network, respectively. A multiple-images based deep learning model was built using multivariable logistic regression (MLR) by combining the single-image based models. The performance of the visual inspection was also obtained. The results of the cytology test and HPV test were used to build a Cytology-HPV joint diagnostic model by MLR. Finally, a cross-modal integrated model was built using MLR by combining the multiple-images based deep learning model, the cytology test results, and the HPV test results. The performances of models were tested in an independent test set using the area under the receiver operating characteristic curve (AUC). RESULTS The saline image, acetic acid image, and iodine image based deep learning models had AUC of 0.760, 0.791, and 0.840. The multiple-images based deep learning model achieved an improved AUC of 0.845. The AUC of the visual inspection was 0.751. The Cytology-HPV joint diagnostic model had an AUC of 0.837, which was higher than the cytology test (AUC = 0.749) and the HPV test (AUC = 0.742). The cross-modal integrated model achieved the best performance with AUC of 0.921. CONCLUSIONS Combining all kinds of cervical images were benefit for improving the performance of the colposcopy based deep learning model, and more accurate cervical screening could be achieved by incorporating the colposcopy based deep learning model, the cytology test results, and the HPV test results.
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Affiliation(s)
- Le Fu
- Department of Obstetrics and Gynecology, East Hospital, Tongji University School of Medicine, Shanghai, China; Department of Radiology, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai, China
| | - Wei Xia
- Suzhou Institute of Biomedical Engineering and Technology, Chinese Academy of Sciences, Suzhou, China; Jinan Guoke Medical Engineering and Technology Development Co., Ltd, Pharmaceutical Valley New Drug Creation Platform, Jinan, Shandong 250109, China
| | - Wei Shi
- Suzhou Institute of Biomedical Engineering and Technology, Chinese Academy of Sciences, Suzhou, China
| | - Guang-Xu Cao
- Department of Obstetrics and Gynecology, East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Ye-Tian Ruan
- Department of Obstetrics and Gynecology, East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Xing-Yu Zhao
- Suzhou Institute of Biomedical Engineering and Technology, Chinese Academy of Sciences, Suzhou, China
| | - Min Liu
- Department of Obstetrics and Gynecology, East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Su-Mei Niu
- Department of Obstetrics and Gynecology, East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Fang Li
- Department of Obstetrics and Gynecology, East Hospital, Tongji University School of Medicine, Shanghai, China.
| | - Xin Gao
- Suzhou Institute of Biomedical Engineering and Technology, Chinese Academy of Sciences, Suzhou, China; Jinan Guoke Medical Engineering and Technology Development Co., Ltd, Pharmaceutical Valley New Drug Creation Platform, Jinan, Shandong 250109, China.
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Zhang J, Tian X, Chen Y, Huang S, Cui Z, Tian R, Zeng Z, Liang W, Gong Q, Shang R, Hu Z, Cao C. Feasibility and Accuracy of Menstrual Blood Testing for High-risk Human Papillomavirus Detection With Capture Sequencing. JAMA Netw Open 2021; 4:e2140644. [PMID: 34940863 PMCID: PMC8703251 DOI: 10.1001/jamanetworkopen.2021.40644] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
IMPORTANCE High-risk human papillomavirus (hrHPV) persistent infection is the major etiology of cervical precancer and cancer. Noninvasive self-sampling HPV testing is a promising alternative cervical cancer screening for avoiding stigma and improving patient willingness to participate. OBJECTIVE To investigate the feasibility and accuracy of menstrual blood (MB) hrHPV capture sequencing in hrHPV detection. DESIGN, SETTING, AND PARTICIPANTS This cohort study collected 137 sanitary pads from 120 women who were premenopausal and had hrHPV as detected by cervical HPV GenoArray testing. Patients were recruited from September 1, 2020, to April 1, 2021, at Central Hospital of Wuhan, China. Target capture sequencing was performed to determine hrHPV genotypes in MB. Sanger sequencing was performed as the criterion standard for detecting hrHPV genotypes among enrolled women. Data were analyzed from April 1 through June 1, 2021. MAIN OUTCOMES AND MEASURES Complete concordance, incomplete concordance, and discordance of MB hrHPV capture sequencing and conventional HPV testing were defined according to genotype overlapping levels. Concordance of the 2 detection methods and comparative power of MB hrHPV capture sequencing during different menstrual cycle days (MCDs) were the main outcomes. RESULTS A total of 120 enrolled women with hrHPV (mean [SD; range] age, 33.9 [6.9; 20.0 -52.0] years) provided 137 sanitary pads. The overall concordance rate of MB hrHPV capture sequencing and cervical HPV testing was 92.7% (95% CI, 88.3%-97.1%), with a κ value of 0.763 (P < .001). Among 24 samples with incomplete concordance or discordant results, 11 samples with additional hrHPV genotypes (45.8%), 5 true-negative samples (20.8%), and the correct hrHPV genotypes of 2 samples (8.3%) were correctly identified by MB hrHPV capture sequencing. MB hrHPV detection of hrHPV was equivalent on different MCDs, with an MB hrHPV-positive rate of 27 of 28 patients (96.4%) for MCD 1, 52 of 57 patients (91.2%) for MCD 2, 27 of 28 patients for MCD 3, 4 of 4 patients (100%) for MCD 4, and 3 of 3 patients (100%) for MCD 5 (P = .76). The sensitivity of the MB hrHPV capture sequencing was 97.7% (95% CI, 95.0%-100%). CONCLUSIONS AND RELEVANCE These findings suggest that MB hrHPV capture sequencing is a feasible and accurate self-collected approach for cervical cancer screening. This study found that this method is associated with superior performance in identification of HPV genotypes and true-negative events compared with cervical HPV testing.
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Affiliation(s)
- Jingjing Zhang
- Department of Obstetrics and Gynecology, First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Xun Tian
- Department of Obstetrics and Gynecology, Academician Expert Workstation, Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ye Chen
- Department of Obstetrics and Gynecology, First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Sisi Huang
- Medical Examination Center, Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zifeng Cui
- Department of Obstetrics and Gynecology, First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Rui Tian
- Center for Translational Medicine, First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Zhen Zeng
- Department of Obstetrics and Gynecology, Academician Expert Workstation, Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Wenjia Liang
- Department of Obstetrics and Gynecology, Academician Expert Workstation, Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Qifen Gong
- Department of Obstetrics and Gynecology, Academician Expert Workstation, Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- School of Medicine, Jianghan University, Wuhan, China
| | - Ronghua Shang
- Department of Obstetrics and Gynecology, Academician Expert Workstation, Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- School of Medicine, Jianghan University, Wuhan, China
| | - Zheng Hu
- Department of Obstetrics and Gynecology, First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- Sun Yat-sen University Nanchang Research Institute, Nanchang, China
| | - Chen Cao
- Department of Obstetrics and Gynecology, Academician Expert Workstation, Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Afanasiev MDDSMS, Dushkin MDAD, Grishacheva DSTG, Afanasiev MDDSSS, Karaulov Academician Ras MDDSAV. Photodynamic therapy for early-stage cervical cancer treatment. Photodiagnosis Photodyn Ther 2021; 37:102620. [PMID: 34752947 DOI: 10.1016/j.pdpdt.2021.102620] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 10/14/2021] [Accepted: 11/01/2021] [Indexed: 12/21/2022]
Abstract
BACKGROUND The main aim of this article is a retrospective analysis of PDT effectiveness treatment in early-stage cervical cancer. MATERIAL AND METHODS 28 patients were analyzed retrospectively with PDT treatment of early-stage cervical cancer. A multi-course PDT approach should have been performed for each patient. Patients underwent one PDT session or multi-course PDT approach. It depended on individual reaction and response to therapy after the first session. A multi-course approach was performed in the next two months. Treatment was performed from 2015 to 2020. Relapse-free probability was assessed for these patients by Kaplan Meier estimator in 60 months. RESULTS HPV elimination was in 82% of cases in three-month period after PDT (R2 = 0.71). Among the analyzed cases, full HPV elimination was detected more than in 90% of cases. Relapse-free probability is 0,8 (CI95%: 0,53-1) in 60 months. Patients had mild (35.7%) and severe (28.6%) leucocyte reactions after PDT in three months. CONCLUSION The article demonstrates new treatment results of CC and detected a five-year period relapse-free probability after PDT. Only correct protocol using PDT for invasive cervical cancer provides high effectiveness and relapse-free survival.
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Affiliation(s)
- M D D Sc Maxim S Afanasiev
- I.M. Sechenov First Moscow State Medical University (Sechenov University), 119991, 8/2 Trubetskaya str., Moscow, Russian Federation
| | - M D Alexander D Dushkin
- The Loginov Moscow Clinical Scientific Center is State Institution funded by Moscow Health Department (The Loginov MCSC MHD), 111123, 86 Enthusiasts highway, Moscow, Russian Federation
| | - D Sc Tatyana G Grishacheva
- First Pavlov State Medical University of St. Petersburg, 197022, L'va Tolstogo str. 6-8, Saint Petersburg, Russian Federation
| | - M D D Sc Stanislav S Afanasiev
- G.N. Gabrichevsky Moscow Research Institute for Epidemiology and Microbiology, 125212, 10 Admiral Makarov str., Moscow, Russian Federation
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Vieira-Baptista P, Lima-Silva J, Sousa C, Preti M. Cytology Is Not Reliable to Evaluate Cervical Disease Regression. J Low Genit Tract Dis 2021; 25:328. [PMID: 34265819 DOI: 10.1097/lgt.0000000000000615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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18
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Zhao S, Hu S, Xu X, Zhang X, Pan Q, Chen F, Zhao F. Impact of HPV-16/18 AS04-adjuvanted vaccine on preventing subsequent infection and disease after excision treatment: post-hoc analysis from a randomized controlled trial. BMC Infect Dis 2020; 20:846. [PMID: 33198657 PMCID: PMC7667753 DOI: 10.1186/s12879-020-05560-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 10/30/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND It is widely acknowledged that HPV prophylactic vaccine could prevent new infections and their associated lesions among women who are predominantly HPV-naive at vaccination. Yet there still remains uncertainty about whether HPV vaccination could benefit to individuals who have undergone surgery for cervical disease. METHODS This post-hoc analysis intends to focus on intent-to-treat participants who underwent excision treatment at baseline and the follow-up period in a phase II/III, double-blind, randomized trial ( ClinicalTrials.gov , number NCT00779766 ) conducted in Jiangsu province, China. We evaluate the impact of HPV vaccination on preventing women from subsequent infection and cervical lesions (LSIL+ and CIN2+) after excision treatment. RESULTS One hundred sixty-eight (vaccine, n = 87; placebo, n = 81) performed excisional treatment in this clinical trial. We observed a significant effect of vaccination on acquiring 14 high-risk HPV (HR-HPV) infection after treatment (vaccine efficacy: 27.0%; 95% CI 4.9, 44.0%). The vaccine efficacy against new infections after treatment for 14 HR-HPV infection was estimated as 32.0% (95%CI 1.8, 52.8%), and was 41.2% (95%CI -162.7, 86.8%) for HPV16/18 infection. The accumulative clearance rates of the vaccine group and placebo group were 88.9 and 81.6% for HPV16/18 infection (P = 0.345), 63.4, 48.7% for 14 HR-HPV infection (P = 0.062), respectively. No significant difference was observed on the persistent rate of HPV16/18, 14 HR-HPV infection and occurrence rate of LSIL+ between the two groups. CONCLUSIONS No significant evidence from this study showed that HPV-16/18 AS04-adjuvanted vaccine could lead to viral faster clearance or have any effect on the rates of persistent infection among women who had excision treatment. However, the vaccine may still benefit post-treatment women with "primary prophylactic" effect. Further research is required in clarifying the effect of using the prophylactic HPV vaccine as therapeutic agents. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT00779766 . Date and status of trial registration: October 24, 2008. Completed; Has Results.
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Affiliation(s)
- Shuang Zhao
- Department of Epidemiology, National Cancer Center/ National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 17 South Panjiayuan Lane, PO Box 2258, Beijing, 100021, China
| | - Shangying Hu
- Department of Epidemiology, National Cancer Center/ National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 17 South Panjiayuan Lane, PO Box 2258, Beijing, 100021, China.
| | - Xiaoqian Xu
- Department of Epidemiology, National Cancer Center/ National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 17 South Panjiayuan Lane, PO Box 2258, Beijing, 100021, China
| | - Xun Zhang
- Department of Cytology and Pathology, National Cancer Center/ National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Qinjing Pan
- Department of Cytology and Pathology, National Cancer Center/ National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Feng Chen
- Department of Epidemiology, National Cancer Center/ National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 17 South Panjiayuan Lane, PO Box 2258, Beijing, 100021, China
| | - Fanghui Zhao
- Department of Epidemiology, National Cancer Center/ National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 17 South Panjiayuan Lane, PO Box 2258, Beijing, 100021, China.
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