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Hashimoto K, Kumagai T, Nomura K, Miyagawa Y, Tago S, Takasaki K, Takahashi Y, Nishida H, Ichinose T, Hirano M, Hiraike H, Wada-Hiraike O, Sasajima Y, Kim SH, Nagasaka K. Validation of an on-chip p16 ink4a/Ki-67 dual immunostaining cervical cytology system using microfluidic device technology. Sci Rep 2023; 13:17052. [PMID: 37816765 PMCID: PMC10564753 DOI: 10.1038/s41598-023-44273-6] [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: 03/11/2023] [Accepted: 10/05/2023] [Indexed: 10/12/2023] Open
Abstract
More specific screening systems for cervical cancer may become necessary as the human papillomavirus (HPV) vaccine becomes more widespread. Although p16/Ki-67 dual-staining cytology has several advantages, it requires advanced diagnostic skills. Here, we developed an automated on-chip immunostaining method using a microfluidic device. An electroactive microwell array (EMA) microfluidic device with patterned thin-film electrodes at the bottom of each microwell was used for single-cell capture by dielectrophoresis. Immunostaining and dual staining for p16/Ki-67 were performed on diagnosed liquid cytology samples using the EMA device. The numbers of p16/Ki-67 dual-stained cells captured by the EMA device were determined and compared among the cervical intraepithelial neoplasia (CIN) lesion samples. Seven normal, fifteen CIN grade 3, and seven CIN grade 2 samples were examined. The percentage of dual-positive cells was 18.6% in the CIN grade 2 samples and 23.6% in the CIN grade 3 samples. The percentages of dual-positive staining increased significantly as the severity of the cervical lesions increased. p16/Ki67 dual immunostaining using the EMA device is as sensitive as the conventional method of confirming the histopathological diagnosis of cervical samples. This system enables a quantified parallel analysis at the individual cell level.
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Affiliation(s)
- Kei Hashimoto
- Department of Obstetrics and Gynecology, Teikyo University School of Medicine, Kaga 2-11-1, Itabashi-Ku, Tokyo, 173-8605, Japan
| | - Tomoo Kumagai
- Department of Obstetrics and Gynecology, Teikyo University School of Medicine, Kaga 2-11-1, Itabashi-Ku, Tokyo, 173-8605, Japan
| | - Kyosuke Nomura
- Department of Obstetrics and Gynecology, Teikyo University School of Medicine, Kaga 2-11-1, Itabashi-Ku, Tokyo, 173-8605, Japan
| | - Yuko Miyagawa
- Department of Obstetrics and Gynecology, Teikyo University School of Medicine, Kaga 2-11-1, Itabashi-Ku, Tokyo, 173-8605, Japan
| | - Saori Tago
- Institute of Industrial Science, University of Tokyo, Tokyo, Japan
| | - Kazuki Takasaki
- Department of Obstetrics and Gynecology, Teikyo University School of Medicine, Kaga 2-11-1, Itabashi-Ku, Tokyo, 173-8605, Japan
| | - Yuko Takahashi
- Department of Obstetrics and Gynecology, Teikyo University School of Medicine, Kaga 2-11-1, Itabashi-Ku, Tokyo, 173-8605, Japan
| | - Haruka Nishida
- Department of Obstetrics and Gynecology, Teikyo University School of Medicine, Kaga 2-11-1, Itabashi-Ku, Tokyo, 173-8605, Japan
| | - Takayuki Ichinose
- Department of Obstetrics and Gynecology, Teikyo University School of Medicine, Kaga 2-11-1, Itabashi-Ku, Tokyo, 173-8605, Japan
| | - Mana Hirano
- Department of Obstetrics and Gynecology, Teikyo University School of Medicine, Kaga 2-11-1, Itabashi-Ku, Tokyo, 173-8605, Japan
| | - Haruko Hiraike
- Department of Obstetrics and Gynecology, Teikyo University School of Medicine, Kaga 2-11-1, Itabashi-Ku, Tokyo, 173-8605, Japan
| | - Osamu Wada-Hiraike
- Department of Obstetrics and Gynecology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Yuko Sasajima
- Department of Pathology, Teikyo University School of Medicine, Tokyo, Japan
| | - Soo Hyeon Kim
- Institute of Industrial Science, University of Tokyo, Tokyo, Japan
| | - Kazunori Nagasaka
- Department of Obstetrics and Gynecology, Teikyo University School of Medicine, Kaga 2-11-1, Itabashi-Ku, Tokyo, 173-8605, Japan.
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Effah K, Tekpor E, Wormenor CM, Essel NOM. Transformation zone types: a call for review of the IFCPC terminology to embrace practice in low-resource settings. Ecancermedicalscience 2023; 17:1612. [PMID: 38414959 PMCID: PMC10898880 DOI: 10.3332/ecancer.2023.1612] [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: 07/17/2023] [Indexed: 02/29/2024] Open
Abstract
Most cervical cancers develop in the transformation zone (TZ). Type 3 TZs, where the full circumference of the squamocolumnar junction (SCJ) is not visible pose problems during cervical screening with visual inspection methods, as (pre)cancerous lesions may be missed. Several practical strategies can be implemented to convert type 3 TZs into TZ 1 or TZ 2, including the use of an endocervical speculum or hygroscopic cervical dilators, opening the vaginal speculum more widely, skillful use of cotton-tipped applicators, performing colposcopy in midcycle, and use of oral or vaginal misoprostol and estrogen to 'ripen' the cervix. With the 2011 International Federation for Cervical Pathology and Colposcopy (IFCPC) terminology, settings with better resources to manipulate the cervix for a better view of the endocervical canal may assign patients to different categories from those in low-resource settings during a colposcopic examination. Here, we propose a colposcopic revision to the current IFCPC classification by segregating TZ 2 according to the extent of endocervical involvement and TZ 3 according to whether any attempt is made to open the endocervical canal, if such attempt(s) were successful, and the extent to which the practitioner can visualise parts of the uterine cervix beyond the border of the SCJ in the endocervical canal. In this proposed reclassification, TZ 2A has no part of the SCJ extending beyond 5 mm into the endocervical canal, whereas TZ 2B has part or all of the SCJ extending beyond 5 mm into the endocervical canal. TZ 3 is further subclassified into TZ 3A if the practitioner does not attempt to open the endocervical canal or the endocervical canal is opened, but not beyond 5 mm and TZ 3B if the full circumference cannot be visualised after opening the endocervical canal beyond 5 mm. We believe this revision will improve and better standardise the classification of TZ types, with huge implications for practice in low-resource settings, due to limited options for referral and treatment, to reduce the risk of missed cervical cancers and suboptimal treatment resulting from ablating lesions that extend too far into the endocervical canal.
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Affiliation(s)
- Kofi Effah
- Cervical Cancer Prevention and Training Centre (CCPTC), Catholic Hospital, Battor, PO Box 2, Battor, via Sogakope, Volta Region, Ghana
- https://orcid.org/0000-0003-1216-2296
| | - Ethel Tekpor
- Cervical Cancer Prevention and Training Centre (CCPTC), Catholic Hospital, Battor, PO Box 2, Battor, via Sogakope, Volta Region, Ghana
| | - Comfort Mawusi Wormenor
- Cervical Cancer Prevention and Training Centre (CCPTC), Catholic Hospital, Battor, PO Box 2, Battor, via Sogakope, Volta Region, Ghana
| | - Nana Owusu Mensah Essel
- Department of Emergency Medicine, College of Health Sciences, Faculty of Medicine and Dentistry, University of Alberta, 730 University Terrace, Edmonton, AB T6G 2T4, Canada
- https://orcid.org/0000-0001-5494-5411
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Paternostro C, Joura EA, Ranftl C, Langthaler EM, Ristl R, Dorittke T, Pils S. Rate of Involved Endocervical Margins According to High-Risk Human Papillomavirus Subtype and Transformation Zone Type in Specimens with Cone Length ≤ 10 mm versus > 10 mm-A Retrospective Analysis. Life (Basel) 2023; 13:1775. [PMID: 37629632 PMCID: PMC10455508 DOI: 10.3390/life13081775] [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: 07/28/2023] [Revised: 08/16/2023] [Accepted: 08/18/2023] [Indexed: 08/27/2023] Open
Abstract
The aim of this study was to evaluate the endocervical margin status according to transformation zone (TZ) and high-risk HPV (hr-HPV) subtype in specimens with cone length ≤ 10 mm versus > 10 mm to provide data for informed decision making and patients counseling especially for women wishing to conceive. In this retrospective cohort study, 854 patients who underwent large loop excision of the transformation zone during a nine-year period (2013-2021) for cervical disease were analyzed. The main outcome parameters were excision length, histological result, TZ type, HPV subtype and endocervical margin status. A subgroup analysis was performed according to excision length, with a cut-off value of 10 mm. A two-step surgical procedure was performed in case of an excision length of > 10 mm. The overall rate of positive endocervical margins irrespective of excision length was 17.2%, with 19.3% in specimens with ≤ 10 mm and 15.0% with > 10 mm excision length. Overall, 41.2% of women with a visible TZ and HPV 16/hr infection and 27.0% of women with HPV 18 received an excisional treatment of > 10 mm length without further oncological benefit, respectively. In contrast, assuming that only an excision of ≤ 10 mm length had been performed in women with visible TZ, the rate of clear endocervical margins would have been 63.7% for HPV 16/hr infections and 49.3% for HPV 18 infections. In conclusion, the decision about excision length should be discussed with the patient in terms of oncological safety and the risk of adverse pregnancy events. An excision length > 10 mm increases the number of cases with cervical tissue removed without further oncological benefit, which needs to be taken into account in order to provide an individual therapeutic approach. Furthermore, HPV 18 positivity is related to a higher rate of positive endocervical margins irrespective of TZ.
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Affiliation(s)
- Chiara Paternostro
- Department of Obstetrics and Gynecology, Medical University of Vienna, 1090 Vienna, Austria; (C.P.); (C.R.); (T.D.); (S.P.)
| | - Elmar A. Joura
- Department of Obstetrics and Gynecology, Medical University of Vienna, 1090 Vienna, Austria; (C.P.); (C.R.); (T.D.); (S.P.)
| | - Christina Ranftl
- Department of Obstetrics and Gynecology, Medical University of Vienna, 1090 Vienna, Austria; (C.P.); (C.R.); (T.D.); (S.P.)
| | | | - Robin Ristl
- Center of Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, 1090 Vienna, Austria;
| | - Tim Dorittke
- Department of Obstetrics and Gynecology, Medical University of Vienna, 1090 Vienna, Austria; (C.P.); (C.R.); (T.D.); (S.P.)
| | - Sophie Pils
- Department of Obstetrics and Gynecology, Medical University of Vienna, 1090 Vienna, Austria; (C.P.); (C.R.); (T.D.); (S.P.)
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Su Y, Tang Y, Zhang T, Xu Y, Zhang Y, Shen Y, Qin L, Zhang L, Cao L, Zhou Y, Liou Y, Zhang M. Methylated ZNF582 as a triage marker for occult cervical cancer and advanced cervical intraepithelial neoplasia. Future Oncol 2022; 18:2583-2592. [PMID: 35758002 DOI: 10.2217/fon-2021-1625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: To explore the appropriate triage methods for women infected with high-risk human papillomavirus (hrHPV). Materials & methods: A total of 424 out of 872 hrHPV-infected women were divided into cervicitis (n = 123), cervical intraepithelial neoplasia grade 1 (CIN1; n = 89), CIN2 (n = 72), CIN3 (n = 87) and cervical cancer (n = 53) groups. Results: The sensitivity/specificity of ZNF582m, PAX1m and liquid-based cytology (LBC) for hrHPV-infected women with transformation zone 3 CIN3+ was 83.9/93.1, 77.4/90.6 and 80.6/58.5%, respectively. The ZNF582m/PAX1m test had a higher specificity than LBC (p < 0.001) and similar sensitivity to that observed for LBC (p > 0.05). ZNF582m/PAX1m improved the positive predictive value of CIN3+ (64.7/60.0%) in low-grade LBC (negative predictive value: 91.7/88.7%). Conclusion: ZNF582m was superior to PAX1m and LBC tests in detecting CIN3+ in hrHPV-infected women.
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Affiliation(s)
- Yuehui Su
- Gynecology, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yujie Tang
- Gynecology, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Ting Zhang
- Gynecology, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yue Xu
- Pathology, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yingcui Zhang
- Gynecology, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yan Shen
- Gynecology, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Lihong Qin
- Gynecology, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Luoman Zhang
- Gynecology, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Lili Cao
- Gynecology, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yingying Zhou
- Gynecology, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yuligh Liou
- Xiangya Medical Laboratory, Central South University, Changsha, China
| | - Mengzhen Zhang
- Gynecology, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
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Wei B, Zhang B, Xue P, Seery S, Wang J, Li Q, Jiang Y, Qiao Y. Improving colposcopic accuracy for cervical precancer detection: a retrospective multicenter study in China. BMC Cancer 2022; 22:388. [PMID: 35399061 PMCID: PMC8994905 DOI: 10.1186/s12885-022-09498-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Accepted: 04/06/2022] [Indexed: 12/24/2022] Open
Abstract
Background Colposcopy alone can result in misidentification of high-grade squamous intraepithelial or worse lesions (HSIL +), especially for women with Type 3 transformation zone (TZ) lesions, where colposcopic assessment is particularly imprecise. This study aimed to improve HSIL + case identification by supplementing referral screening results to colposcopic findings. Methods This is an observational multicenter study of 2,417 women, referred to colposcopy after receiving cervical cancer screening results. Logistic regression analysis was conducted under uni- and multivariate models to identify factors which could be used to improve HSIL + case identification. Histological diagnosis was established as the gold standard and is used to assess accuracy, sensitivity, and specificity, as well as to incrementally improve colposcopy. Results Multivariate analysis highlighted age, TZ types, referral screening, and colposcopists’ skills as independent factors. Across this sample population, diagnostic accuracies for detecting HSIL + increased from 72.9% (95%CI 71.1–74.7%) for colposcopy alone to 82.1% (95%CI 80.6–83.6%) after supplementing colposcopy with screening results. A significant increase in colposcopic accuracy was observed across all subgroups. Although, the highest increase was observed in women with a TZ3 lesion, and for those diagnosed by junior colposcopists. Conclusion It appears possible to supplement colposcopic examinations with screening results to improve HSIL + detection, especially for women with TZ3 lesions. It may also be possible to improve junior colposcopists’ diagnoses although, further psychological research is necessary. We need to understand how levels of uncertainty influence diagnostic decisions and what the concept of “experience” actually is and what it means for colposcopic practice.
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