Prognostic value of HPV 16/18 genotyping and geminin mRNA quantification in low-grade cervical squamous intraepithelial lesion

CINtec PLUS: A Novel Alternative Screening Method for Detecting High-Risk Cervical Lesions in Romania

Introduction CINtec PLUS is a relatively recent method introduced in Romania for detecting cervical precancerous lesions. This technique utilizes simultaneous double immunostaining with p16 and Ki67 to identify potentially transformative human papillomaviruses (HPVs). CINtec PLUS has demonstrated superior sensitivity and specificity compared to conventional Papanicolaou (PAP) cytology and PAP liquid-based cytology, allowing for more accurate identification of HPV infections that may progress to malignancy among women with abnormal screening results. The objectives of this study are to evaluate CINtec PLUS test results in comparison with PAP cytology and HPV genotype detection among Romanian women and to assess its potential as a complementary screening method within existing national cervical cancer screening programs. Materials and methods Cases were collected between December 22, 2022, and June 15, 2024. All 96 women enrolled in the study, regardless of the presence of pathological cervical lesions, underwent the CINtec PLUS test. The samples were stained using the Roche CINtec PLUS kit. Statistical analyses were performed using IBM SPSS Statistics for Windows, Version 26.0 (Released 2019; IBM Corp., Armonk, NY, USA). To assess correlations and compare variables, we utilized crosstabulation tables, frequency tables, the chi-square test, and the Pearson correlation coefficient. Results The age range of participants in our study was from 19 to 64 years, with a mean age of 35.77 years and a standard deviation of 9.608. Among the women who underwent the CINtec PLUS test, over two-thirds were aged between 20 and 39 years. In 7.3% of cases with no history of HPV infection or cervical cytologic lesions, the CINtec PLUS test yielded a positive result. The study also revealed that CINtec PLUS showed a positive result in 23.3% of cases diagnosed with atypical squamous cells of undetermined significance on PAP cytology. Additionally, 36.5% of women who underwent CINtec PLUS testing as a screening method had a positive result, with more than one-fifth of these cases being positive. Conclusions The CINtec PLUS test is a valuable tool for identifying high-risk cervical lesions. Despite the limitations of our study, it provides a foundation for further research into the long-term benefits and cost-effectiveness of this test. Future studies could explore its potential for integration into national screening programs.

Reevaluation of negative cervical conizations: Frequency, diagnostic errors, risk factors and management

OBJECTIVE

Cervical conization is an effective treatment for precancerous lesions. However, in cases where no high-grade lesion is identified in the surgical specimen, managing these patients may be challenging due to the absence of established follow-up protocols for negative conizations. This study aimed to assess the negative conization rates at our institution by histopathological review, identify diagnostic errors, possible risk and recurrence factors and propose follow-up strategies for this group of patients.

METHODS

A retrospective study from January-2010 to December-2020 analyzed patients with negative conization including all surgical techniques and procedure indications. Biopsy and cervical conizations slides were reviewed and patients who kept a negative result underwent deeper levels sectioning of the paraffin blocks with immunohistochemical stains application: p16, Ki-67 and geminin. Data were compared with a control group composed by 29 women with CIN3.

RESULTS

Out of 1022 conizations, 186 were negative (18.1%), with 151 cases selected for the study after excluding 35 patients. Following pathology review, 4 patients were excluded due to false-positive cervical biopsy results, 16 for false-negative conization results and 9 for hidden dysplasia identified after deeper sectioning. The remaining 122 patients were considered truly negative cones (11.9%) and exhibited IHC staining with p16 positive in 20.4% of cases, low Ki-67 expression, and low geminin score in most cases. Specimens with CIN 1 had higher prevalence of p16 staining, Ki-67 expression and geminin score when compared to absence of neoplasia, nevertheless geminin had no statistical difference. Older age, higher parity and IHC pattern with negative p16, low Ki-67 and geminin expressions were identified as risk factors for negative cones (p<0.05). Only 10 patients recurred for high-grade lesions, with no statistically significant risk factors identified.

CONCLUSIONS

The negative conization rate was 11.9%, with diagnostic errors identified across pre-surgical biopsy, cone specimen, and deeper levels. Risk factors included older age, higher parity, low expression of p16, Ki-67 and geminin (p<0.05). Recurrence represented 8.1% of the negative cones, without identification of statistically significant risk factors. Pathological review with deeper level sections and 2-year follow-up are recommended for patients with negative conizations.

Role of Geminin as a Tool for Augmenting Accurate Diagnosis of Cervical Neoplasia

AIM

To determine the role of geminin as a tool for differentiating various types of cervical intraepithelial neoplasia (CIN) and cervical carcinoma (CC).

METHODS

Seventy women newly diagnosed with CIN or CC undergoing cervical biopsy were included; their clinical profile, human papilloma virus (HPV) positivity, and colposcopy findings were noted, and biopsy tissue was analyzed for geminin content.

RESULTS

On geminin immunohistochemistry, 100% of women with CIN3 and 96.29% of women with CC had geminin two plus or more. When analyzed as ordinal variables, there was a significant correlation (spearman's rho 0.35, p 0.01) between geminin and biopsy results (CIN1, CIN2, CIN3, and CC).

CONCLUSIONS

Screening tests for cervical cancer, like conventional pap smears, liquid-based pap smears, and triaging with HPV, have limitations. It is important to be able to differentiate between high-grade lesions, invasive cancer, and low-grade lesions. The detection of geminin in these cells may aid in the confirmation of the diagnosis and ensure adequate treatment. Cervical intraepithelial lesions and carcinoma cervix demonstrated a correlation between increased geminin expression in CIN1 vs. CC and CIN2 vs. CC. Geminin may be a potential surrogate marker for higher-grade cervical lesions, and further research is needed to corroborate evidence in this direction.

Increased expression of SRPK1 (serine/arginine-rich protein-specific kinase 1) is associated with progression and unfavorable prognosis in cervical squamous cell carcinoma

Previous studies suggest that SRPK1 (serine/arginine-rich protein-specific kinase 1) is involved in tumorigenesis and closely related to unfavorable outcomes. However, its expression pattern in cervical squamous cell carcinoma (CESC) remains uncovered. In this study, we initially investigated the clinical significance and function of SRPK1 in human CESC. Data mining and analysis on SRPK1 mRNA expression in CESC samples were conducted using TCGA database, which indicated that SRPK1 mRNA was significantly upregulated in CESC samples. Protein expression of SRPK1 was tested by immunohistochemistry in a retrospective cohort (n = 122), revealing a higher SRPK1 protein abundance in CESC specimens whose aberrant up-regulation was obviously related to worse survival. Cox proportional hazards regression analysis further confirmed the role of SRPK1 as an independent prognostic factor of CESC. Cellular experiments validated that SRPK1 may function through enhancing CESC proliferation, migration, and invasion. In conclusion, aberrant up-regulation of SRPK1 is remarkably related to progression and unfavorable prognosis of CESC, which can serve as a novel prognostic biomarker and therapeutic target for CESC.