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Luo H, Lian Y, Tao H, Zhao Y, Wang Z, Zhou J, Zhang Z, Jiang S. Relationship between p16/ki67 immunoscores and PAX1/ZNF582 methylation status in precancerous and cancerous cervical lesions in high-risk HPV-positive women. BMC Cancer 2024; 24:1171. [PMID: 39304838 DOI: 10.1186/s12885-024-12920-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2024] [Accepted: 09/09/2024] [Indexed: 09/22/2024] Open
Abstract
BACKGROUND The risk of cervical cancer progression in high-risk human papillomavirus (HR-HPV)-positive women is associated with cervical lesion severity and molecular heterogeneity. Classification systems based on p16 and Ki67 expression cumulative scores (0-3 each)-p16/Ki67 collectively known as an immunoscore [IS]-are an accurate and reproducible method for grading cervical intraepithelial neoplasia (CIN) lesions. Meanwhile, DNA methylation is an early event in the development of cervical cancer. Hence, this study evaluated the relationship among CIN, p16/Ki-67 IS, and PAX1/ZNF582 methylation. METHODS In this study, 414 HPV-positive paraffin-embedded specimens were collected, and PAX1/ZNF582 methylation and the p16/ki67 IS were determined. A total of 43 invalid samples were excluded and 371 were included in the statistical analyses. There were 103 cervicitis, 95 CIN1, 71 CIN2, 89 CIN3, and 13 squamous cell carcinoma (SCC) cases. The association between PAX1/ZNF582 methylation and p16/Ki6 immunohistochemical staining scores was analyzed. RESULTS The ΔCp of PAX1m (PAX1 methylation) and ZNF582m (ZNF582 methylation) decreased with cervical lesion severity (Cuzick trend test, all P < 0.001). The severity of the cervical lesions and p16, Ki67, and p16/Ki67 IS showed an increasing trend (Multinomial Cochran-Armitage trend test, all P < 0.001). The prevalence of PAX1m/ZNF582m increased with an increase in the IS of p16, Ki67, and p16/Ki67 (Cochran-Armitage trend test, all P < 0.001). In cervical SCC, the IS was 5-6, and the PAX1m/ZNF582m was positive. Meanwhile, heterogeneity was observed in CIN lesions: 10 cases had an IS of 3-4 and were PAX1m/ZNF582m-positive in ≤ CIN1; 1 case had an IS of 0-2 and was PAX1m/ZNF582m-positive in CIN2/3. CONCLUSIONS Significant heterogeneity was observed in CIN lesions for p16 and Ki67 immunohistochemical staining scores and PAX1/ZNF582 methylation. This may help clinicians personalize the management of CIN based on the predicted short-term risk of cancer progression, minimizing the rate of missed CIN1 diagnoses and incorrect treatment of CIN2/3.
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Affiliation(s)
- Haijun Luo
- Department of Pathology, The Affiliated Changsha Central Hospital, Hengyang Medical School, University of South China, Changsha, 410004, China
| | - Yixiang Lian
- Department of Pathology, The Affiliated Changsha Central Hospital, Hengyang Medical School, University of South China, Changsha, 410004, China
| | - Hong Tao
- Department of Medical Statistics, Hunan Hoomya Gene Technology Co., Ltd., Changsha, 410205, China
| | - Yan Zhao
- Department of Pathology, The Affiliated Changsha Central Hospital, Hengyang Medical School, University of South China, Changsha, 410004, China
| | - Zhigan Wang
- Department of Pathology, The Affiliated Changsha Central Hospital, Hengyang Medical School, University of South China, Changsha, 410004, China
| | - Jing Zhou
- Department of Pathology, The Affiliated Changsha Central Hospital, Hengyang Medical School, University of South China, Changsha, 410004, China
| | - Zirong Zhang
- Department of Pathology, The Affiliated Changsha Central Hospital, Hengyang Medical School, University of South China, Changsha, 410004, China
| | - Shali Jiang
- Department of Pathology, The Affiliated Changsha Central Hospital, Hengyang Medical School, University of South China, Changsha, 410004, China.
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Okunade KS, Adejimi AA, John-Olabode SO, Oshodi YA, Oluwole AA. An Overview of HPV Screening Tests to Improve Access to Cervical Cancer Screening Amongst Underserved Populations: From Development to Implementation. Risk Manag Healthc Policy 2022; 15:1823-1830. [PMID: 36176779 PMCID: PMC9514784 DOI: 10.2147/rmhp.s296914] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Accepted: 09/14/2022] [Indexed: 12/12/2022] Open
Abstract
Cervical cancer is the most common human papillomavirus (HPV)-related disease. Knowledge of the natural history and aetiology of cervical cancer offers unique opportunities for its prevention, and the development of HPV screening tests is one of the most effective strategies. The current HPV diagnostics detect HPV DNA or E6/E7 mRNA in cervical/vaginal samples using molecular-based technologies. HPV screening tests are more sensitive than cytology or visual inspection with acetic acid (VIA) as a primary screening method and are even more clinically valuable in triaging mild cytological abnormalities as a hybrid test. As technical and laboratory resources are grossly limited in marginalized or underserved settings which thus require that women travel long distances for screening and treatment. The practical implementation of an HPV-based screening programme may face many challenges and measures should be instituted to overcome these challenges without compromising disease detection. These measures may include a reduction in screening frequency using the WHO global strategy of offering HPV screening tests at 35 and 45 years of age, adoption of a high throughput testing technology, and improved access to vaginal HPV self-sampling screening tests to women in remote settings or those who are reluctant to undergo gynecologic examination. Another important strategy is the implementation of a "see-and-treat" approach using a point-of-care platform that requires limited skills of laboratory technicians. In addition, the development and large-scale incorporation of more specific HPV testing technologies that are much cheaper and easier to use in non-laboratory settings than the currently available options should be prioritized for underserved settings. At the same time, there is a need to develop and commence the implementation of an affordable and readily available intermediate or secondary test with optimal specificity for triaging or segregating clinically unimportant HPV infections that do not require colposcopy.
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Affiliation(s)
- Kehinde S Okunade
- Department of Obstetrics & Gynaecology, College of Medicine, University of Lagos, Lagos, Nigeria
| | - Adebola A Adejimi
- Department of Community Health and Primary Care, College of Medicine, University of Lagos, Lagos, Nigeria
| | - Sarah O John-Olabode
- Department of Haematology and Blood Transfusion, College of Medicine, University of Lagos, Lagos, Nigeria
| | - Yusuf A Oshodi
- Department of Obstetrics & Gynaecology, Lagos State University College of Medicine, Lagos, Nigeria
| | - Ayodeji A Oluwole
- Department of Obstetrics & Gynaecology, College of Medicine, University of Lagos, Lagos, Nigeria
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Bradbury M, Rabasa J, Murcia MT, Dinarès MC, Sainz A, Castellet C, Pérez-Benavente A, Gil-Moreno A, Centeno C. Can We Reduce Overtreatment of Cervical High-Grade Squamous Intraepithelial Lesions? J Low Genit Tract Dis 2022; 26:20-26. [PMID: 34928250 DOI: 10.1097/lgt.0000000000000635] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVE The aim was to evaluate the cytology, colposcopic, and pathological factors associated with the absence of high-grade squamous intraepithelial lesion (HSIL)/cervical intraepithelial neoplasia (CIN) 2-3 lesion on loop electrosurgical excision procedure (LEEP) specimens in women with high-grade cytology and/or HSIL/CIN 2-3 biopsy and the risk of disease persistence/recurrence. MATERIALS AND METHODS Two-center retrospective study of women undergoing LEEP for high-grade cervical disease between January 2014 and December 2019. Clinical, cytology, colposcopy, and pathology results were evaluated to identify independent predictive factors associated with CIN 1/negative LEEP results. Univariate and multivariate logistic regression models were performed. Follow-up data was evaluated to assess the risk of HSIL/CIN 2-3 persistence/recurrence. RESULTS Six hundred thirty-nine of 801 women (79.8%) had high-grade cytology and 631 (78.8%) HSIL/CIN 2-3 biopsy. High-risk human papillomavirus test was positive in 98% of women. Loop electrosurgical excision procedure specimen showing CIN 1 or less was found in 27%-31%. Normal/low-grade colposcopy (odds ratio [OR] = 2.17, CI = 1.39-3.39, p = .001) and CIN 1/negative biopsy (OR = 3.25, CI = 2.12-4.99, p < .001) were predictors of negative/CIN 1 LEEP result in women with high-grade cytology. Normal/low-grade cytology (OR = 1.77, CI = 1.19-2.64, p = .005), normal/low-grade colposcopy (OR = 1.66, CI = 1.11-2.49, p = .013), and CIN 2 biopsy (OR = 2.75, CI = 1.73-4.39, p < .001) were predictors in women with HSIL/CIN 2-3 biopsy. Women with a negative/CIN 1 LEEP had lower recurrence/persistence than those with confirmed HSIL/CIN 2-3(1 vs 31, p = .002). Positive endocervical margin (OR = 2.85, CI = 1.10-7.36, p = .03) and high-risk human papillomavirus persistence (OR = 41.3, CI = 16-106.7, p < .01) were predictors of HSIL/CIN 2-3 persistence/recurrence. CONCLUSIONS A CIN 1/negative LEEP specimen in women with high-grade cytology and/or HSIL/CIN 2-3 biopsy is associated with negative/low-grade cytology, normal/low-grade colposcopic findings and CIN 2 biopsy result before treatment. The HSIL/CIN 2-3 disease persistence/recurrence is low when LEEP specimen does not confirm HSIL/CIN 2-3.
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Affiliation(s)
| | - Jordi Rabasa
- Department of Gynecology and Obstetrics, Hospital Universitari Sagrat Cor, Barcelona, Spain
| | - Maria Teresa Murcia
- Gynecological Oncology Unit, Department of Gynecology, Hospital Universitari Vall d'Hebron, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Maria Carme Dinarès
- Department of Pathology, Hospital Universitari Vall d'Hebron, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Alex Sainz
- Gynecological Oncology Unit, Department of Gynecology, Hospital Universitari Vall d'Hebron, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Cristina Castellet
- Department of Gynecology and Obstetrics, Hospital Universitari Sagrat Cor, Barcelona, Spain
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Ouh YT, Park JJ, Kang M, Kim M, Song JY, Shin SJ, Shim SH, Yoo HJ, Lee M, Lee SJ, Shin W, Chong GO, Choi MC, Choi CH, Min KJ. Comparative performance of various human papillomavirus assays available in Korea for detecting cervical intraepithelial neoplasia. J Obstet Gynaecol Res 2021; 48:207-214. [PMID: 34713538 DOI: 10.1111/jog.15078] [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: 06/20/2021] [Revised: 10/03/2021] [Accepted: 10/09/2021] [Indexed: 11/28/2022]
Abstract
AIM The aim of this study was to evaluate the clinical performance for detecting cervical intraepithelial neoplasia (CIN) 2 or higher lesions among available human papillomavirus infection (HPV) genotyping tests in Korea. METHODS Eligible patients visited 13 tertiary hospitals for colposcopic biopsy following cervical cytology and HPV genotyping test between January and December 2018. Baseline characteristics including age, body mass index (BMI), and parity were collected from 3798 patients. The performance of the Roche Cobas HPV 4800 was evaluated against other domestic HPV assays to detect CIN2 or higher. RESULTS A total of seven types of HPV genotyping tests were analyzed in the research institutes. A total of 1358 patients (35.8%) tested Anyplex II HPV 28 and 701 patients (18.5%) tested Cobas 4800 HPV. The overall sensitivity in the detection of CIN2 or higher was 41.5% (38.9-44.1) in patients positive for HPV 16/18. The Cobas test for HPV 16/18 was concordant with other assays evaluated for detection of CIN2 or higher and showed sensitivity of 46.6%, which was not significantly different from other assays. Although Anyplex II HPV28 (Seegene) showed slightly decreased sensitivity for detecting CIN2 or higher lesion with HPV 16/18 positive (39.8%, p < 0.05) compared to Cobas 4800, in aspect of high-risk HPV positive, Anyplex II HPV28 showed increased sensitivity (96.9%, p < 0.05). CONCLUSION The performance of the HPV genotype test that were commonly used in Korea was concordant with Cobas HPV test. Further studies are needed to evaluate the safety, efficiency, and cost-effectiveness of the various commercially available domestic HPV assays.
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Affiliation(s)
- Yung-Taek Ouh
- Department of Obstetrics and Gynecology, Korea University Guro Hospital, Seoul, South Korea.,Department of Obstetrics and Gynecology, School of Medicine, Kangwon National University, Gangwon-do, South Korea
| | - Ji Jeong Park
- National Evidence-based Healthcare Collaborating Agency (NECA), Seoul, South Korea
| | - Minjoo Kang
- National Evidence-based Healthcare Collaborating Agency (NECA), Seoul, South Korea
| | - Miseon Kim
- Department of Obstetrics and Gynecology, CHA Gangnam Medical Center, Seoul, South Korea
| | - Jae Yun Song
- Department of Obstetrics and Gynecology, Korea University Anam Hospital, Seoul, South Korea
| | - So Jin Shin
- Department of Obstetrics and Gynecology, Keimyung University Dongsan Medical Center, Daegu, South Korea
| | - Seung-Hyuk Shim
- Department of Obstetrics and Gynecology, Konkuk University Hospital, Seoul, South Korea
| | - Heon Jong Yoo
- Department of Obstetrics and Gynecology, Chung Nam National University Hospital, Daejeon, South Korea
| | - Maria Lee
- Department of Obstetrics and Gynecology, Seoul National University Hospital, Seoul, South Korea
| | - Sung-Jong Lee
- Department of Obstetrics and Gynecology, Catholic University of Korea Seoul St. Mary's Hospital, Seoul, South Korea
| | - Whan Shin
- Department of Obstetrics and Gynecology, Yonsei University Severance Hospital, Seoul, South Korea.,Department of Obstetrics and Gynecology, Dankook University, Dankook University Hospital, Yongin, South Korea
| | - Gun Oh Chong
- Department of Obstetrics and Gynecology, Kyungpook National University Chilgok Hospital, Daegu, South Korea
| | - Min Chul Choi
- Comprehensive Gynecologic Cancer Center, CHA Bundang Medical Center, Seongnam, South Korea
| | - Chel Hun Choi
- Department of Obstetrics and Gynecology, Samsung Medical Center, Seoul, South Korea
| | - Kyung-Jin Min
- Department of Obstetrics and Gynecology, South Korea University Ansan Hospital, Ansan, South Korea
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Ouh YT, Park JJ, Kang M, Kim M, Song JY, Shin SJ, Shim SH, Yoo HJ, Lee M, Lee SJ, Shin W, Chong GO, Choi MC, Choi CH, Min KJ. Discrepancy between Cytology and Histology in Cervical Cancer Screening: a Multicenter Retrospective Study (KGOG 1040). J Korean Med Sci 2021; 36:e164. [PMID: 34155836 PMCID: PMC8216990 DOI: 10.3346/jkms.2021.36.e164] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 05/24/2021] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Cervical cancer is the fourth common cancer in women worldwide. The Papanicolau test is the primary screening procedure to detect abnormal cervical cells. Colposcopy is the main procedure for discriminating high-grade cervical lesions. The study aimed at clarifying the discrepancy between cervical cytology and colposcopic biopsy histology as well as confounding factors. METHODS Eligible patients visited thirteen tertiary hospitals for colposcopic biopsy following cervical cytology and human papillomavirus (HPV) genotypes between January and December 2018. Baseline characteristics including age, body mass index (BMI), and parity were collected. RESULTS In our study, 3,798 eligible patients were included. Mean age of patients was 42.7 (19-88) years and mean BMI was 22.5 (16.9-34.1) kg/m². The referred cervical cytologic findings consisted of 495 normal, 1,390 atypical squamous cells of undetermined significance, 380 atypical squamous cells cannot exclude high-grade squamous intraepithelial lesion, 792 low-grade squamous intraepithelial lesion, 593 high-grade squamous intraepithelial lesion, 79 atypical glandular cells, 46 squamous cell carcinoma, and 23 adenocarcinoma. HPV-positive findings were found in 3,008 (79.2%) patients and were not detected in 914 (24.1%) cases. The risk of unexpected low-grade lesions from histology was higher in patients > 45 years (odds ratio [OR], 2.137; 95% confidence intervals [CIs], 1.475-3.096). In contrast, the risk of unexpected high-grade lesions from colposcopic biopsy was lower in patients ≥ 45 years (OR, 0.530; 95% CI, 0.367-0.747) and HPV 16/18 infection was higher than other HPV (OR, 1.848; 95% CI, 1.385-2.469). CONCLUSION Age and HPV genotypes were responsible for the discrepancies between cytology and histology. Precautions should be taken for women over the age of 45 in triage for colposcopy in order to avoid unnecessary testing.
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Affiliation(s)
- Yung Taek Ouh
- Department of Obstetrics and Gynecology, Korea University Guro Hospital, Seoul, Korea
- Department of Obstetrics and Gynecology, Graduate School of Medicine, Kangwon National University, Chuncheon, Korea
| | - Ji Jeong Park
- National Evidence-based Healthcare Collaborating Agency (NECA), Seoul, Korea
| | - Minjoo Kang
- National Evidence-based Healthcare Collaborating Agency (NECA), Seoul, Korea
| | - Miseon Kim
- Department of Obstetrics and Gynecology, CHA Gangnam Medical Center, Seoul, Korea
| | - Jae Yun Song
- Department of Obstetrics and Gynecology, Korea University Anam Hospital, Seoul, Korea
| | - So Jin Shin
- Department of Obstetrics and Gynecology, Keimyung University Dongsan Medical Center, Daegu, Korea
| | - Seung Hyuk Shim
- Department of Obstetrics and Gynecology, Konkuk University Hospital, Seoul, Korea
| | - Heon Jong Yoo
- Department of Obstetrics and Gynecology, Chungnam National University Hospital, Daejeon, Korea
| | - Maria Lee
- Department of Obstetrics and Gynecology, Seoul National University Hospital, Seoul, Korea
| | - Sung Jong Lee
- Department of Obstetrics and Gynecology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Whan Shin
- Department of Obstetrics and Gynecology, Yonsei University Severance Hospital, Seoul, Korea
- Department of Obstetrics and Gynecology, Dankook University Hospital, Dankook University, Cheonan, Korea
| | - Gun Oh Chong
- Department of Obstetrics and Gynecology, Kyungpook National University Chilgok Hospital, Daegu, Korea
| | - Min Chul Choi
- Comprehensive Gynecologic Cancer Center, CHA Bundang Medical Center, Seongnam, Korea
| | - Chel Hun Choi
- Department of Obstetrics and Gynecology, Samsung Medical Center, Seoul, Korea
| | - Kyung Jin Min
- Department of Obstetrics and Gynecology, Korea University Ansan Hospital, Ansan, Korea.
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Fan Q, Huang T, Sun X, Wang YW, Wang J, Liu Y, Ni T, Gu SL, Li YH, Wang YD. HPV-16/18 E6-induced APOBEC3B expression associates with proliferation of cervical cancer cells and hypomethylation of Cyclin D1. Mol Carcinog 2021; 60:313-330. [PMID: 33631046 DOI: 10.1002/mc.23292] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 02/14/2021] [Accepted: 02/15/2021] [Indexed: 12/13/2022]
Abstract
Oncogenic high-risk human papillomavirus (HR-HPV) infection causes a majority of cases of cervical cancer and pre-cancerous cervical lesions. However, the mechanisms underlying the direct evolution from HPV-16/18-infected epithelium to cervical intraepithelial neoplasia (CIN) III, which can progress to cervical cancer, remain poorly identified. Here, we performed RNA-seq after laser capture microdissection, and found that APOBEC3B was highly expressed in cervical cancer specimens compared with CIN III with HPV-16/18 infection. Furthermore, immunohistochemical analysis confirmed that high levels of APOBEC3B were correlated with lymph node metastasis in cervical cancer. Subsequent experiments revealed that HPV-16 E6 could upregulate APOBEC3B through direct binding to the promoter of APOBEC3B in cervical cancer cells. Silencing of APOBEC3B by stable short hairpin RNA-mediated knockdown reduced the proliferative capacity of Caski and HeLa cells in vitro and in vivo, but had only a small effect on the migration and invasion of two cervical cancer cell lines. Finally, we identified the changes in gene expression following APOBEC3B silencing in Caski cells by microarray, demonstrating a biological link between APOBEC3B and CCND1 in cervical cancer cells. Importantly, through methyl-capture sequencing and pyrosequencing, APOBEC3B was found to affect the levels of the downstream protein Cyclin D1 (which is encoded by the CCND1 gene) through hypomethylation of the CCND1 promoter. In conclusion, our study supports HPV-16 E6-induced APOBEC3B expression associates with proliferation of cervical cancer cells and hypomethylation of Cyclin D1. Thus, APOBEC3B may be a potential therapeutic target in human cervical cancer.
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Affiliation(s)
- Qiong Fan
- Department of Gynecologic Oncology, The International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.,Shanghai Municipal Key Clinical Specialty, Shanghai, China.,Shanghai Key Laboratory of Embryo Original Diseases, Shanghai, China
| | - Ting Huang
- Department of Gynecologic Oncology, The International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.,Shanghai Municipal Key Clinical Specialty, Shanghai, China.,Shanghai Key Laboratory of Embryo Original Diseases, Shanghai, China
| | - Xiao Sun
- Department of Gynecologic Oncology, The International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.,Shanghai Municipal Key Clinical Specialty, Shanghai, China.,Shanghai Key Laboratory of Embryo Original Diseases, Shanghai, China
| | - Yi-Wei Wang
- Department of Gynecologic Oncology, The International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Jing Wang
- Department of Gynecologic Oncology, The International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yao Liu
- Department of Gynecologic Oncology, The International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Ting Ni
- Department of Gynecologic Oncology, The International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Sheng-Lan Gu
- Department of Gynecologic Oncology, The International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yu-Hong Li
- Department of Gynecologic Oncology, The International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yu-Dong Wang
- Department of Gynecologic Oncology, The International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.,Shanghai Municipal Key Clinical Specialty, Shanghai, China.,Shanghai Key Laboratory of Embryo Original Diseases, Shanghai, China
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Karimi-Zarchi M, Allahqoli L, Nehmati A, Kashi AM, Taghipour-Zahir S, Alkatout I. Can the prophylactic quadrivalent HPV vaccine be used as a therapeutic agent in women with CIN? A randomized trial. BMC Public Health 2020; 20:274. [PMID: 32106837 PMCID: PMC7045378 DOI: 10.1186/s12889-020-8371-z] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Accepted: 02/18/2020] [Indexed: 12/14/2022] Open
Abstract
Background Human papillomavirus (HPV) is one of the most significant risk factors for cervical cancer. The HPV vaccine has a very significant impact on the incidence of cervical cancer. The present study aimed to investigate the impact of prophylactic quadrivalent HPV vaccine in the treatment of women with cervical intraepithelial neoplasia (CIN 1–3). Methods This randomized controlled trial was conducted in the Shahid Sadoughi University of Medical Sciences (SSUMS), Yazd, Iran, from October 2011 to November 2015 in women with histologically confirmed residual/recurrent CIN 1 or high-grade CIN (CIN 2–3). Eligible women were assigned randomly to an intervention and a control group. Women in the intervention group were given HPV vaccinations while those in the control group were not. Participants were followed up for 24 months. Primary and secondary outcomes, and adverse effects of the treatment in the two groups were compared using Student’s t test, the chi-square test, or Fisher’s exact test. P values < 0.05 or less were considered statistically significant. Results Three-hundred and twelve women were randomized to the two groups; the data of 138 in the intervention group and 104 in the control group were analyzed. The mean age of the women was 32.59 ± 4.85 years. Differences in age, marital status, and grades of CIN weren’t significant between the two groups. At the end of the two-year follow-up period, the number of women with CIN 2–3 in the intervention and control groups was reduced by 75% (from 93 to 23) versus 40% (from 69 to 41). The efficacy of the HPV vaccine in women with CIN 1–3 was 58.7% (p = 0.018). No serious adverse effects related to the vaccines were reported. Conclusions The prophylactic quadrivalent HPV vaccine after treatment may have a therapeutic effect in women with residual/recurrent CIN 1 or high-grade CIN (CIN 2–3). Trial registration Iranian Registry of Clinical Trials, IRCT20190603043801N1. Registered 24 July 2019 – Retrospectively registered, http://www.irct.ir/user/trial/40017/view
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Affiliation(s)
- Mojgan Karimi-Zarchi
- Endometriosis Research Center, Iran University of Medical Sciences (IUMS), Tehran, Iran.,Shahid Sadoughi University of Medical Science, Yazd, Iran
| | - Leila Allahqoli
- Endometriosis Research Center, Iran University of Medical Sciences (IUMS), Tehran, Iran
| | | | | | | | - Ibrahim Alkatout
- Department of Obstetrics and Gynecology, University Hospitals Schleswig-Holstein, Campus Kiel, Kiel, Germany.
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Raffone A, Travaglino A, D'Antonio A, De Marco M, Caccese M, Mascolo M, Insabato L, Zeppa P, Rosati A, Mollo A, Zullo F, Guida M. BAG3 expression correlates with the grade of dysplasia in squamous intraepithelial lesions of the uterine cervix. Acta Obstet Gynecol Scand 2019; 99:99-104. [PMID: 31444794 DOI: 10.1111/aogs.13716] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Revised: 08/09/2019] [Accepted: 08/20/2019] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Bcl-2-associated athanogene 3 (BAG3) is a protein involved in apoptosis and stress response, which is overexpressed in invasive cervical cancer. However, nothing is known about BAG3 expression in precancerous lesions of the uterine cervix. We aimed to evaluate the expression of BAG3 in cervical intraepithelial neoplasia/squamous intraepithelial lesions (CIN/SIL). MATERIAL AND METHODS Forty patients (16 CIN1/L-SIL, 11 CIN2/H-SIL and 13 CIN3/H-SIL) were assessed by immunohistochemistry for BAG3. The intensity of BAG3 expression was categorized as null, minimal, weak, moderate or strong. The association of BAG2 intensity of expression with the grade of dysplasia was assessed using Chi-square test (significant P value <0.05). RESULTS In all normal controls, BAG3 expression was negative. In L-SIL specimens, BAG3 expression was confined to the basal third of the epithelium, with an intensity minimal in nine cases (56.3%), weak in six (37.5%) and strong in one (6.3%). In H-SIL specimens, BAG3 expression involved also the two upper thirds of the epithelium, with an intensity moderate in 13 cases (54.2%; 8 CIN2 and 5 CIN3) and strong in 11 cases (45.8%; 3 CIN2 and 8 CIN3). The distribution of BAG3 expression correlated perfectly with the grade of dysplasia (P = 0.0); a moderate/strong expression of BAG3 was significantly associated with H-SIL (P < 0.0001), with no significant difference between CIN2 and CIN3 (P = 0.1228). CONCLUSIONS In CIN/SIL, both distribution and intensity of BAG3 expression correlate directly with the grade of dysplasia, supporting the involvement of BAG3 in all phases of cervical carcinogenesis and its possible diagnostic and prognostic role in cervical premalignant lesions.
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Affiliation(s)
- Antonio Raffone
- Gynecology and Obstetrics Unit, Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Antonio Travaglino
- Anatomic Pathology Unit, Department of Advanced Biomedical Sciences, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Antonio D'Antonio
- SS. Giovanni di Dio e Ruggi d' Aragona University Hospital, Schola Medica Salernitana, University of Salerno Hospital, Salerno, Italy.,Department of Medicine, Surgery and Dentistry, Schola Medica Salernitana, University of Salerno, Baronissi, Salerno, Italy
| | - Margot De Marco
- Department of Medicine, Surgery and Dentistry, Schola Medica Salernitana, University of Salerno, Baronissi, Salerno, Italy.,BIOUNIVERSA s.r.l., University of Salerno, Baronissi, Salerno, Italy
| | - Miriam Caccese
- Department of Medicine, Surgery and Dentistry, Schola Medica Salernitana, University of Salerno, Baronissi, Salerno, Italy
| | - Massimo Mascolo
- Anatomic Pathology Unit, Department of Advanced Biomedical Sciences, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Luigi Insabato
- Anatomic Pathology Unit, Department of Advanced Biomedical Sciences, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Pio Zeppa
- SS. Giovanni di Dio e Ruggi d' Aragona University Hospital, Schola Medica Salernitana, University of Salerno Hospital, Salerno, Italy.,Department of Medicine, Surgery and Dentistry, Schola Medica Salernitana, University of Salerno, Baronissi, Salerno, Italy
| | - Alessandra Rosati
- Department of Medicine, Surgery and Dentistry, Schola Medica Salernitana, University of Salerno, Baronissi, Salerno, Italy.,BIOUNIVERSA s.r.l., University of Salerno, Baronissi, Salerno, Italy
| | - Antonio Mollo
- Department of Medicine, Surgery and Dentistry, Schola Medica Salernitana, University of Salerno, Baronissi, Salerno, Italy
| | - Fulvio Zullo
- Gynecology and Obstetrics Unit, Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Maurizio Guida
- Gynecology and Obstetrics Unit, Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy
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Ye J, Cheng XD, Cheng B, Cheng YF, Chen XJ, Lu WG. MiRNA detection in cervical exfoliated cells for missed high-grade lesions in women with LSIL/CIN1 diagnosis after colposcopy-guided biopsy. BMC Cancer 2019; 19:112. [PMID: 30700264 PMCID: PMC6354336 DOI: 10.1186/s12885-019-5311-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Accepted: 01/21/2019] [Indexed: 12/12/2022] Open
Abstract
Background Low-grade squamous intraepithelial lesion/cervical intraepithelial neoplasia grade 1 (LSIL/CIN1) preceded by colposcopy guided biopsy is recommended conservative follow-up, although some of these lesions are actually high-grade lesions, which are missed on an initial colposcopy. Therefore, in this work, we evaluate the potential role of miRNA detection in cervical exfoliated cells in a clinic-based population for predicting missed high-grade lesions in women diagnosed with LSIL/CIN1 after colposcopy-guided biopsy. Methods A total number of 177 women with a diagnosis of LSIL/CIN1 obtained by colposcopy-guided biopsy were grouped into two categories according to the histology of the conization specimens: consistent LSIL/CIN1 group (surgical pathology consistent with colposcopic diagnosis) and missed high-grade lesion group (surgical pathology found high-grade lesion). The expression of eight miRNAs, such as miRNA195, miRNA424, miRNA375, miRNA218, miRNA34a, miRNA29a, miRNA16–2, and miRNA20a was detected by real time-quantitative polymerase chain reaction (RT-qPCR) in cervical exfoliated cells of the 177 patients. Pearson Chi-Square was used to compare the performance efficiency of patients’ characteristics. Nonparametric Man-Whitney U test was used to assess differences in miRNA expression. The receiver operating characteristic (ROC) curve was used to assess the performance of miRNA evaluation in detecting missed high-grade lesions. Results Among the 177 women with biopsy-confirmed CIN1, 15.3% (27/177) had CIN2+ in the conization specimen (missed high-grade lesion group) and 84.7% (150/177) had CIN1-(consistent LSIL/CIN1 group). The relative expression of miRNA-195 and miRNA-29a in the missed high-grade lesion group was significantly lower than that in the consistent LSIL/CIN1 group. The relative expression of miRNA16–2 and miRNA20a in the missed high-grade lesion group was significantly higher than that in the consistent LSIL/CIN1 group. No significant difference was observed between these two groups regarding the other four miRNAs. Of these significant miRNAs, miRNA29a detection achieved the highest Youden index (0.733), sensitivity (92.6%), positive predictive value (46.2%), negative predictive value (98.3%) and higher specificity (80.7%) when identifying missed high-grade lesions. Conclusions Detection of miRNA might provide a new triage for identifying a group at higher risk of missed high-grade lesions in women with colposcopy diagnosis of LSIL/CIN1. Electronic supplementary material The online version of this article (10.1186/s12885-019-5311-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jing Ye
- Department of Gynecologic Oncology, Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, 310006, Zhejiang, China
| | - Xiao-Dong Cheng
- Department of Gynecologic Oncology, Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, 310006, Zhejiang, China
| | - Bei Cheng
- Department of Gynecologic Oncology, Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, 310006, Zhejiang, China
| | - Yi-Fan Cheng
- Department of Gynecologic Oncology, Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, 310006, Zhejiang, China
| | - Xiao-Jing Chen
- Women's Reproductive Health Laboratory of Zhejiang Province, Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, 310006, Zhejiang, China
| | - Wei-Guo Lu
- Department of Gynecologic Oncology, Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, 310006, Zhejiang, China.
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Single type infection of human papillomavirus as a cause for high-grade cervical intraepithelial neoplasia and invasive cancer in Japan. PAPILLOMAVIRUS RESEARCH 2018; 6:46-51. [PMID: 30401640 PMCID: PMC6222286 DOI: 10.1016/j.pvr.2018.10.001] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Revised: 09/11/2018] [Accepted: 10/10/2018] [Indexed: 12/20/2022]
Abstract
To elucidate oncogenic human papilloma virus (HPV) types in Japan, HPV genotyping was performed in 1526 cervical intraepithelial neoplasia (CIN) and 371 invasive cervical cancer (ICC) patients with the novel Genosearch-31+5 HPV test. The HPV-positive rates were 89.3% and 90.8% in CIN and ICC. Regarding single-type infections, 13 internationally recognized high-risk (13HR) types excluding HPV 35, and probably HR HPV 53, 67, 69, and 70 were identified in ICC, suggesting that all these types may be oncogenic. HPV16 and 18 were identified in both SCC and adenocarcinoma (ADC). HPV HPV52, 31 and 58 (alpha-9) were predominantly detected in SCC, whereas HPV 18, 45, 39 and 59 (alpha-7) were in ADC. The prevalence of HPV 18 in SCC significantly decreased with increasing age of patients, whereas the opposite trend was observed in the other HR types. HPV18 is likely to induce SCC rapidly. All ICC cases aged 20–29 were positive for HPV 16 or 18, suggesting that present HPV 16, 18 vaccines may be quite effective to prevent ICC in young women.
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Risk for Cervical Intraepithelial Neoplasia Grade 3 or Higher in Follow-Up of Women With a Negative Cervical Biopsy. J Low Genit Tract Dis 2018; 22:201-206. [PMID: 29543686 DOI: 10.1097/lgt.0000000000000394] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The Norwegian Cervical Cancer Screening Programme recommends follow-up of histologically confirmed normal/cervical intraepithelial neoplasia (CIN) 1 with combined cytology and human papillomavirus testing within 6 to 12 months. This study examines adherence to guidelines and subsequent risk for CIN 3+ within this subset of women. MATERIALS AND METHODS Women aged 25 to 69 years attending the Norwegian Cervical Cancer Screening Programme in Norway's 2 northernmost counties were included. An exposed cohort with histologically confirmed normal/CIN 1 after an atypical squamous cells of undetermined significance/low-grade squamous intraepithelial lesion or atypical squamous cells - cannot exclude high-grade squamous intraepithelial lesion/high-grade squamous intraepithelial lesion enrolment cytology (n = 374) was compared with a nonexposed cohort with a normal enrolment cytology attending primary screening (N = 25,948). Risk calculations were stratified by outcomes of the first follow-up cytology. The study end point was CIN 3+ or censored at 78 months of follow-up. RESULTS In the exposed cohort, the 42-month cumulative incidence of CIN 3+ was 9.4% (95% CI = 4.1-14.7) for women with an abnormal first follow-up cytology and 1.6% (95% CI = 0.0-3.4) for women with a normal first follow-up cytology versus 0.21% (95% CI = 0.15-0.27) in the nonexposed cohort (p < .01). The CIN 3+ risk was higher in the exposed cohort when the first follow-up cytology was abnormal (hazard ratio = 20.4, 95% CI = 11.2-37.1) compared with normal (hazard ratio = 4.7, 95% CI = 1.9-11.6) with the nonexposed cohort as reference. CONCLUSIONS After a negative cervical biopsy, a normal first follow-up cytology provided a CIN 3+ risk considered acceptable to recommend return to routine screening in 3 years. Cytology and human papillomavirus co-testing in post-colposcopy follow-up of negative biopsies may improve risk stratification.
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Nedjai B, Reuter C, Ahmad A, Banwait R, Warman R, Carton J, Boer S, Cuzick J, Lorincz AT. Molecular progression to cervical precancer, epigenetic switch or sequential model? Int J Cancer 2018; 143:1720-1730. [PMID: 29679470 PMCID: PMC6175180 DOI: 10.1002/ijc.31549] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2017] [Revised: 03/23/2018] [Accepted: 04/04/2018] [Indexed: 12/11/2022]
Abstract
The evolution of precancerous cervical lesions is poorly understood. A widely held model of cervical intraepithelial neoplasia grade 3 (CIN3) development is sequential progression from normal through CIN1 and CIN2 to CIN3. Another hypothesis, the "molecular switch" model, postulates that CIN3 can evolve directly from human papillomavirus (HPV)-infected normal epithelium without progressing through CIN1 and CIN2. To shed light on this process, we compared DNA methylation of selected human biomarkers and HPV types in two groups of CIN1: CIN1 that were near or adjacent to CIN3 (adjacent-CIN1) and CIN1 that were the principal lesions with no CIN3 detected (principal-CIN1). 354 CIN (CIN1 and CIN3) and normal tissue areas were dissected and typed for HPV from 127 women who underwent loop electrosurgical excision procedures (LEEP). Methylation of genes EPB41L3 and the viral regions of HPV16-L1/L2, HPV18-L2, HPV31-L1, and HPV33-L2 were determined by a highly accurate quantitative pyrosequencing of bisulfite converted DNA. There was a significant trend of increased methylation with disease grade comparing normal to CIN1 and CIN3 (p < 0.0001). Adjacent-CIN1 predominantly shared the same HPV types as the CIN3, however, methylation differed substantially between adjacent-CIN1 and CIN3 (p = 0.008). In contrast diagnostically principal-CIN1 had an indistinguishable methylation distribution compared to adjacent-CIN1 (EPB41L3: p = 0.49; HPVme-All: p = 0.11). Our results suggest that progression from normal epithelium to CIN1 or CIN3 is usually promoted by the same HPV type but occurs via distinct DNA epigenotypes, thus favoring the "molecular switch" model.
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Affiliation(s)
- Belinda Nedjai
- Barts and the London School of Medicine, Charterhouse SquareCentre for Cancer Prevention, Wolfson Institute of Preventive MedicineLondonEC1M 6BQUnited Kindom
| | - Caroline Reuter
- Barts and the London School of Medicine, Charterhouse SquareCentre for Cancer Prevention, Wolfson Institute of Preventive MedicineLondonEC1M 6BQUnited Kindom
| | - Amar Ahmad
- Barts and the London School of Medicine, Charterhouse SquareCentre for Cancer Prevention, Wolfson Institute of Preventive MedicineLondonEC1M 6BQUnited Kindom
| | - Rawinder Banwait
- Barts and the London School of Medicine, Charterhouse SquareCentre for Cancer Prevention, Wolfson Institute of Preventive MedicineLondonEC1M 6BQUnited Kindom
| | - Rhian Warman
- Barts and the London School of Medicine, Charterhouse SquareCentre for Cancer Prevention, Wolfson Institute of Preventive MedicineLondonEC1M 6BQUnited Kindom
| | - James Carton
- Department of HistopathologyCharing Cross Hospital, Fulham Palace RoadLondonW6 8RFUnited Kingdom
| | - Sabrina Boer
- Department of UrologyRadboud University Medical Center, Radboud Institute for Molecular Life SciencesNijmegenThe Netherlands
| | - Jack Cuzick
- Barts and the London School of Medicine, Charterhouse SquareCentre for Cancer Prevention, Wolfson Institute of Preventive MedicineLondonEC1M 6BQUnited Kindom
| | - Attila T. Lorincz
- Barts and the London School of Medicine, Charterhouse SquareCentre for Cancer Prevention, Wolfson Institute of Preventive MedicineLondonEC1M 6BQUnited Kindom
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Hancock G, Hellner K, Dorrell L. Therapeutic HPV vaccines. Best Pract Res Clin Obstet Gynaecol 2018; 47:59-72. [PMID: 29108943 DOI: 10.1016/j.bpobgyn.2017.09.008] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Accepted: 09/20/2017] [Indexed: 12/22/2022]
Abstract
High-risk human papillomavirus (HPV) infection is known to be a necessary factor for cervical and anogenital malignancies. Cervical cancers account for over a quarter of a million deaths annually. Despite the availability of prophylactic vaccines, HPV infections remain extremely common worldwide. Furthermore, these vaccines are ineffective at clearing pre-existing infections and associated preinvasive lesions. As cervical dysplasia can regress spontaneously, a therapeutic HPV vaccine that boosts host immunity could have a significant impact on the morbidity and mortality associated with HPV. Therapeutic vaccines differ from prophylactic vaccines in that they are aimed at generating cell-mediated immunity rather than neutralising antibodies. This review will cover various therapeutic vaccine strategies in development for the treatment of HPV-associated lesions and cancers.
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Affiliation(s)
- Gemma Hancock
- Nuffield Department of Medicine, University of Oxford and Oxford NIHR Biomedical Research Centre, NDM Research Building, Old Road Campus, Headington, Oxford, UK.
| | - Karin Hellner
- Nuffield Department of Obstetrics and Gynaecology, University of Oxford, Women's Centre, John Radcliffe Hospital, Oxford, UK.
| | - Lucy Dorrell
- Nuffield Department of Medicine, University of Oxford and Oxford NIHR Biomedical Research Centre, NDM Research Building, Old Road Campus, Headington, Oxford, UK; Nuffield Department of Obstetrics and Gynaecology, University of Oxford, Women's Centre, John Radcliffe Hospital, Oxford, UK.
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14
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Cortés-Alaguero C, González-Mirasol E, Morales-Roselló J, Poblet-Martinez E. Do clinical data and human papilloma virus genotype influence spontaneous regression in grade I cervical intraepithelial neoplasia? J Turk Ger Gynecol Assoc 2017; 18:1-8. [PMID: 28506943 PMCID: PMC5450204 DOI: 10.4274/jtgga.2016.0138] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Accepted: 12/05/2016] [Indexed: 01/19/2023] Open
Abstract
OBJECTIVE To determine whether medical history, clinical examination and human papilloma virus (HPV) genotype influence spontaneous regression in cervical intraepithelial neoplasia grade I (CIN-I). MATERIAL AND METHODS We retrospectively evaluated 232 women who were histologically diagnosed as have CIN-I by means of Kaplan-Meier curves, the pattern of spontaneous regression according to the medical history, clinical examination, and HPV genotype. RESULTS Spontaneous regression occurred in most patients and was influenced by the presence of multiple HPV genotypes but not by the HPV genotype itself. In addition, regression frequency was diminished when more than 50% of the cervix surface was affected or when an abnormal cytology was present at the beginning of follow-up. CONCLUSION The frequency of regression in CIN-I is high, making long-term follow-up and conservative management advisable. Data from clinical examination and HPV genotyping might help to anticipate which lesions will regress.
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Affiliation(s)
- Caterina Cortés-Alaguero
- Department of Obstetrics and Gynecology, Complex Hospital of Albacete University, Albacete, Spain
| | - Esteban González-Mirasol
- Department of Obstetrics and Gynecology, Complex Hospital of Albacete University, Albacete, Spain
| | - José Morales-Roselló
- Department of Obstetrics and Gynecology, La Fe University and Polytechnic Hospital, Valencia, Spain
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Guerrero-Preston R, Valle BL, Jedlicka A, Turaga N, Folawiyo O, Pirini F, Lawson F, Vergura A, Noordhuis M, Dziedzic A, Pérez G, Renehan M, Guerrero-Diaz C, De Jesus Rodríguez E, Diaz-Montes T, Rodríguez Orengo J, Méndez K, Romaguera J, Trock BJ, Florea L, Sidransky D. Molecular Triage of Premalignant Lesions in Liquid-Based Cervical Cytology and Circulating Cell-Free DNA from Urine, Using a Panel of Methylated Human Papilloma Virus and Host Genes. Cancer Prev Res (Phila) 2016; 9:915-924. [DOI: 10.1158/1940-6207.capr-16-0138] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Revised: 08/23/2016] [Accepted: 09/07/2016] [Indexed: 11/16/2022]
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Vargas H, Sánchez JP, Guerrero ML, Ortiz LT, Rodríguez DM, Amaya J, Diaz LP, Gómez SL, Golijow C. Type-Specific Identification of Genital Human Papillomavirus Infection in Women with Cytological Abnormality. Acta Cytol 2016; 60:211-6. [PMID: 27215608 DOI: 10.1159/000446389] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Accepted: 04/20/2016] [Indexed: 11/19/2022]
Abstract
OBJECTIVES To estimate the frequency of human papillomavirus (HPV) infection and the genotype distribution of HPV among women with a Pap smear showing atypical squamous cells of undetermined significance (ASC-US) attending the Program for the Detection and Control of Cervical Cancer in Bogotá, Colombia. STUDY DESIGN Cervical samples from 200 women with an ASC-US Pap smear were analyzed for the presence of HPV DNA and genotype distribution using a commercial molecular technique (Linear Array®; Roche Molecular Systems, USA). RESULTS HPV infection was found in 140 women (70%). High-risk HPV types were present in 46.4% of the samples; 16.4% showed a low-risk HPV type, and 37.1% showed both. Of the positive samples, 42.9% were infected with a single viral genotype, whereas 57.1% exhibited multiple HPV infections. The most common HPV genotypes were HPV 16, 53, and 52 with a prevalence of 26.4, 16.4, and 13.6%, respectively. CONCLUSION The epidemiological characterization of HPV infections described in this study might guide actions for epidemiological surveillance to strengthen the program in Bogotá and to develop appropriate HPV vaccination programs.
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Affiliation(s)
- Hernán Vargas
- Laboratorio de Salud Pública, Dirección de Epidemiología, Análisis y Gestión de Políticas de Salud Colectiva, Subsecretaria de Salud Pública, Secretaría Distrital de Salud, Bogotá, Colombia
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Xiao M, Xu Q, Li H, Gao H, Bie Y, Zhang Z. Prevalence of Human Papillomavirus Genotypes Among Women With High-Grade Cervical Lesions in Beijing, China. Medicine (Baltimore) 2016; 95:e2555. [PMID: 26817906 PMCID: PMC4998280 DOI: 10.1097/md.0000000000002555] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
The aim of the study is to investigate the prevalence of high-risk human papillomavirus (hr-HPV) genotypes among Han women with high-grade cervical lesions in Beijing, China.Cervical cell specimens from patients with histopathologically confirmed cervical lesions at 7 hospitals in Beijing were examined with a validated HPV kit for 13 hr-HPV genotypes during the study period. The patients were divided into a low-grade cervical lesions group (cervical intraepithelial neoplasia grade 1, CIN1) and a high-grade cervical lesions group (CIN2+, including cervical intraepithelial neoplasia grade 2, CIN2; cervical intraepithelial neoplasia grade 3, CIN3; squamous cervical cancer, SCC; and adenocarcinoma of the cervix, ACC) based on the histopathology results.A total of 2817 eligible patients were enrolled, including 610 cases identified as CIN1 and 2207 as CIN2+. The hr-HPV positive rates in the CIN1 and CIN2+ groups were 78.2% (477/610) and 93.3% (2060/2207), respectively. The most frequently detected genotypes were HPV16, 58, 52 and18 in the CIN1 group and HPV16, 58, 33, and 52 in the CIN2+ group, in descending order of prevalence. In addition, the prevalence of HPV18 among the patients with ACC was 28.6% (14/49), significantly >7.2% (54/752) prevalence among the SCC patients (P < 0.001). Additionally, significantly more women in the CIN2+ group had multiple infections compared with those in the CIN1 group (38.1% and 24.9%, respectively; P < 0.001). However, as the cervical lesion grade increased, the prevalence of multiple hr-HPV infections gradually deceased to 44.2% in the CIN2 patients, 36.7% in the CIN3 patients, and 35.3% in the cervical cancer (CC) patients, which included SCC and ACC patients. In cases of multiple hr-HPV infections in the CIN2+ group, double infections accounted for ∼76.6%, and HPV16+58, HPV16+52, and HPV16+18 were the most common combinations, in descending order. The most frequent combination for triple infections was HPV16+58+31, with a rate of 4.2%. The highest positive rate occurred in the ≤24 year-old group for all types of cervical lesions.The prevalence of HPV genotypes in the targeted population with high-grade cervical lesions differs from that of other countries. This information could be helpful for the prevention of CC in Beijing, China.
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Affiliation(s)
- Meizhu Xiao
- From the Department of Obstetrics and Gynecology, Beijing Chaoyang Hospital, Capital Medical University (MX, QX, HG, YB, ZZ); and Department of Obstetrics and Gynecology, the General Hospital of the People's Liberation Army, Beijing, China (HL)
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18
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Reuschenbach M, Wentzensen N, Dijkstra MG, von Knebel Doeberitz M, Arbyn M. p16INK4a immunohistochemistry in cervical biopsy specimens: A systematic review and meta-analysis of the interobserver agreement. Am J Clin Pathol 2014; 142:767-72. [PMID: 25389329 DOI: 10.1309/ajcp3tphv4trizek] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
OBJECTIVES The interpretation of cervical biopsy specimens guides management of women with suspected cervical cancer precursors. However, morphologic evaluation is subjective and has low interobserver agreement. Addition of p16(INK4a) immunohistochemistry may improve interpretation. METHODS We performed a systematic review and meta-analysis of published data on interobserver agreement of p16(INK4a) positivity using p16(INK4a) immunohistochemistry and of cervical intraepithelial neoplasia grade 2 (CIN2+) and CIN grade 3 (CIN3+) classification using H&E morphology in conjunction with p16(INK4a) in comparison with H&E morphology alone. RESULTS The literature search revealed five eligible articles. The results show strong agreement of pathologists' interpretation of cervical biopsy specimens as p16(INK4a) positive or negative (pooled κ = 0.90; 95% confidence interval [CI], 0.88-0.92) and significantly higher agreement for a CIN2+ diagnosis with H&E morphology in conjunction with p16(INK4a) (κ = 0.73; 95% CI, 0.67-0.79) compared with H&E morphology alone (κ = 0.41; 95% CI, 0.17-0.65). Also, a slightly higher agreement for CIN3+ can be observed (κ = 0.66; 95% CI, 0.39-0.94 for H&E morphology in conjunction with p16(INK4a) and κ = 0.61; 95% CI, 0.44-0.78 for H&E morphology alone), but this difference was not statistically significant. CONCLUSIONS The published literature indicates improved interobserver agreement of the diagnosis of CIN2+ with the conjunctive use of H&E morphology with p16(INK4a) immunohistochemistry compared with H&E morphology alone.
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Affiliation(s)
- Miriam Reuschenbach
- Department of Applied Tumor Biology, Institute of Pathology, University of Heidelberg and Clinical Cooperation Unit, German Cancer Research Center, Heidelberg, Germany
| | - Nicolas Wentzensen
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD
| | - Maaike G. Dijkstra
- Department of Pathology, VU University Medical Center, Amsterdam, the Netherlands
| | - Magnus von Knebel Doeberitz
- Department of Applied Tumor Biology, Institute of Pathology, University of Heidelberg and Clinical Cooperation Unit, German Cancer Research Center, Heidelberg, Germany
| | - Marc Arbyn
- Unit of Cancer Epidemiology, Scientific Institute of Public Health, Brussels, Belgium
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Zhang SK, Kang LN, Chang IJ, Zhao FH, Hu SY, Chen W, Shi JF, Zhang X, Pan QJ, Li SM, Qiao YL. The natural history of cervical cancer in chinese women: results from an 11-year follow-up study in china using a multistate model. Cancer Epidemiol Biomarkers Prev 2014; 23:1298-305. [PMID: 24789847 DOI: 10.1158/1055-9965.epi-13-0846] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND It is important to understand the natural history of cervical cancer, which has implications for cancer prevention and management. However, a dearth of studies on the long-term development of cervical cancer exists in China. METHODS We investigated the natural history of cervical cancer in Chinese women by creating a multistate model using 11 years of follow-up data from the Shanxi Province Cervical Cancer Screening Study I conducted from 1999 to 2010. In 1999, a total of 1,997 eligible women, ages 35 to 45 years, were enrolled in Xiangyuan County, Shanxi Province. Participants were followed up in 2005 and 2010, respectively. RESULTS The average time a subject spent in CIN1 before transiting into another state was 1.4693 years [95% confidence interval (CI): 1.1215-1.9251] and the average time a subject spent in CIN2 was 2.9822 years (95% CI: 1.9790-4.4938). A subject's transition probability from CIN1 to normal increased with time. However, the transition probability from CIN1 to CIN2 was relatively lower, with 3-, 5-, and 10-year transition probabilities of 0.1415, 0.1066, and 0.0437. Comparison of 5-year transition probabilities between CIN2 to normal/CIN1 and CIN2 to CIN3(+) yielded a ratio of 2.74. CONCLUSIONS Women with CIN1 had a substantial tendency for regression. Similarly, women with CIN2 had a higher probability of regression to normal/CIN1 than progression to CIN3(+). Findings in this study may have significant implications for the development and evaluation of formal cervical cancer preventive strategies in China. IMPACT This study may serve as a valuable reference to future research on other multistate cancer processes.
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Affiliation(s)
- Shao-Kai Zhang
- Authors' Affiliations: Departments of Cancer Epidemiology
| | - Le-Ni Kang
- Authors' Affiliations: Departments of Cancer Epidemiology
| | - Irene J Chang
- Authors' Affiliations: Departments of Cancer Epidemiology, Miller School of Medicine, University of Miami, Miami, Florida
| | - Fang-Hui Zhao
- Authors' Affiliations: Departments of Cancer Epidemiology
| | - Shang-Ying Hu
- Authors' Affiliations: Departments of Cancer Epidemiology
| | - Wen Chen
- Authors' Affiliations: Departments of Cancer Epidemiology
| | - Ju-Fang Shi
- Authors' Affiliations: Departments of Cancer Epidemiology
| | | | | | - Shu-Min Li
- Gynecology, Cancer Institute/Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; and
| | - You-Lin Qiao
- Authors' Affiliations: Departments of Cancer Epidemiology,
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Spinillo A, Gardella B, Roccio M, Alberizzi P, Silini EM, Dal Bello B. Untypable human papillomavirus infection and risk of cervical intraepithelial neoplasia among women with abnormal cervical cytology. J Med Virol 2014; 86:1145-52. [DOI: 10.1002/jmv.23938] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/11/2014] [Indexed: 11/06/2022]
Affiliation(s)
- Arsenio Spinillo
- Department of Obstetrics and Gynecology; University of Pavia; IRCCS Fondazione Policlinico San Matteo; Pavia Italy
| | - Barbara Gardella
- Department of Obstetrics and Gynecology; University of Pavia; IRCCS Fondazione Policlinico San Matteo; Pavia Italy
| | - Marianna Roccio
- Department of Obstetrics and Gynecology; University of Pavia; IRCCS Fondazione Policlinico San Matteo; Pavia Italy
| | - Paola Alberizzi
- Department of Pathology; University of Pavia; IRCCS Fondazione Policlinico San Matteo; Pavia Italy
| | - Enrico Maria Silini
- Department of Pathology; Azienda Ospedaliero-Universitaria; Università di Parma; Parma Italy
| | - Barbara Dal Bello
- Department of Pathology; University of Pavia; IRCCS Fondazione Policlinico San Matteo; Pavia Italy
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Litjens RJ, Van de Vijver KK, Hopman AH, Ummelen MI, Speel EJM, Sastrowijoto SH, Van Gorp T, Slangen BF, Kruitwagen RF, Krüse AJ. The majority of metachronous CIN1 and CIN3 lesions are caused by different human papillomavirus genotypes, indicating that the presence of CIN1 seems not to determine the risk for subsequent detection of CIN3. Hum Pathol 2014; 45:221-6. [DOI: 10.1016/j.humpath.2013.10.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2013] [Revised: 09/24/2013] [Accepted: 10/09/2013] [Indexed: 11/30/2022]
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Gage JC, Schiffman M, Hunt WC, Joste N, Ghosh A, Wentzensen N, Wheeler CM. Cervical histopathology variability among laboratories: a population-based statewide investigation. Am J Clin Pathol 2013; 139:330-5. [PMID: 23429369 DOI: 10.1309/ajcpsd3zxjxp7nnb] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
To inform the proposed systematic adjudicative staining of cervical intraepithelial neoplasia grade 2 (CIN2) and equivocal diagnoses, we characterized diagnostic heterogeneity across 15 laboratories. Laboratory-specific distributions of 37,486 biopsy specimen diagnoses were compared after adjusting for preceding cytology. In a subset of preceding cytology specimens, HPV16 genotyping was considered an indicator of lesion severity. Distributions of normal and CIN1 diagnoses varied widely, with laboratories favoring either normal (5.5%-57.7%) or CIN1 diagnoses (23.3%-86.7%; P < .001 for normal:CIN1 variability). Excluding extreme values, 6.2% to 14.4% of diagnoses were CIN2 (P < .001). For CIN2 diagnoses, HPV16 positivity in the preceding cytology varied between 39.0% in the largest laboratory and 57.4% in others (P < .001), suggesting differential interpretation, not population differences, as a cause of variability. In conclusion, the frequency of diagnoses requiring special staining (p16(INK4a) immunostaining) to adjudicate equivocal CIN2 will be sizable and vary between laboratories, especially if extended to a fraction of CIN1 lesions.
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Affiliation(s)
- Julia C. Gage
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Department of Health and Human Services (DHHS), Bethesda, MD
| | - Mark Schiffman
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Department of Health and Human Services (DHHS), Bethesda, MD
| | - William C. Hunt
- Department of Pathology, University of New Mexico Health Sciences Center, Albuquerque, NM
| | - Nancy Joste
- Department of Pathology, University of New Mexico Health Sciences Center, Albuquerque, NM
| | - Arpita Ghosh
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Department of Health and Human Services (DHHS), Bethesda, MD
| | - Nicolas Wentzensen
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Department of Health and Human Services (DHHS), Bethesda, MD
| | - Cosette M. Wheeler
- Department of Pathology, University of New Mexico Health Sciences Center, Albuquerque, NM
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Giorgi Rossi P, Benevolo M, Vocaturo A, Caraceni D, Ciccocioppo L, Frega A, Terrenato I, Zappacosta R, French D, Rosini S. Prognostic value of HPV E6/E7 mRNA assay in women with negative colposcopy or CIN1 histology result: a follow-up study. PLoS One 2013; 8:e57600. [PMID: 23460880 PMCID: PMC3583834 DOI: 10.1371/journal.pone.0057600] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2012] [Accepted: 01/23/2013] [Indexed: 11/30/2022] Open
Abstract
Pap test, and especially HPV DNA test, identify a large group of women who do not have any clinically relevant lesions, i.e., CIN2+ (Cervical Intraepithelial Neoplasia grade 2 or worse), but who are at greater risk of getting lesions in the future. The follow up of these women needs new biomarkers with prognostic value. The objective of this study is to evaluate the prognostic value of E6/E7 mRNA over-expression assay (PreTect HPV-Proofer, Norchip) for 5 HR-HPV types (16, 18, 31, 33, and 45) for progression to CIN2+ after a negative colposcopy. This prospective study, conducted at four Italian centres, enrolled 673 women with either a negative colposcopy or a negative or CIN1 histology. The clinical end-point was histological confirmation of CIN2+. Women were classified at baseline according to mRNA results and managed according to local colposcopy protocols. At least one conclusive follow-up test was obtained for 347 women (25 months average lapse since recruitment, range 5–74). Only seven CIN2+ were detected during follow up, three among the 82 women positive for mRNA at baseline, two among the 250 negative (Fisher exact test, p = 0.02), and two among the 12 with an invalid test. Absolute CIN2+ risk was 6.7/1,000 person/years in the whole cohort. The absolute CIN2+ risk was 18.4/1,000 person/years and 3.6/1,000 person/years in mRNA-positive and mRNA-negative women, respectively. In conclusion, E6/E7 mRNA over-expression appears to be a good candidate as a prognostic biomarker to manage HR-HPV DNA-positive women with negative colposcopy or histology, particularly in order to decrease follow-up intensity in those who are negative.
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Affiliation(s)
- Paolo Giorgi Rossi
- Agency for Public Health Lazio Sanità, Rome, Italy; Epidemiology Unit, AUSL Reggio Emilia, Reggio Emilia, Italy
| | - Maria Benevolo
- Pathology Department, Regina Elena National Cancer Institute, Rome, Italy
- * E-mail:
| | - Amina Vocaturo
- Pathology Department, Regina Elena National Cancer Institute, Rome, Italy
| | | | | | - Antonio Frega
- Gynecology Department, 2nd Medicine Faculty of “La Sapienza” University, “Sant’Andrea” Hospital, Rome, Italy
| | - Irene Terrenato
- Epidemiology Department, Regina Elena National Cancer Institute, Rome, Italy
| | - Roberta Zappacosta
- Oncology and Neurosciences Department, Cytopathology Section, “G. D’Annunzio” University, Chieti, Pescara, Italy
| | - Deborah French
- Clinical and Molecular Medicine Department, 2nd Medicine Faculty of “La Sapienza” University, “Sant’Andrea” Hospital, Rome, Italy
| | - Sandra Rosini
- Oncology and Neurosciences Department, Cytopathology Section, “G. D’Annunzio” University, Chieti, Pescara, Italy
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Shen Y, Gong J, He Y, Cheng G, Okunieff P, Li X. Quantivirus® HPV E6/E7 RNA 3.0 assay (bDNA) is as sensitive, but less specific than Hybrid Capture 2 test. J Virol Methods 2013. [DOI: 10.1016/j.jviromet.2012.11.024] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Saraiya M, Watson M, Benard VB. Cervical cancer screening measures need to evolve to continue to tell the story. J Womens Health (Larchmt) 2012; 21:1128-9. [PMID: 23072328 PMCID: PMC5555393 DOI: 10.1089/jwh.2012.3994] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Cytology and human papillomavirus testing 6 to 12 months after ASCUS or LSIL cytology in organized screening to predict high-grade cervical neoplasia between screening rounds. J Clin Microbiol 2012; 50:1927-35. [PMID: 22518869 DOI: 10.1128/jcm.00265-12] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
We carried out a prospective study comparing the performance of human papillomavirus (HPV) E6/E7 mRNA (PreTect HPV-Proofer; NorChip, Klokkarstua, Norway) and DNA (Amplicor HPV test; Roche Diagnostics, Basel, Switzerland) triage testing of women 6 to 12 months after atypical-squamous-cells-of-undetermined-significance (ASCUS) or low-grade-squamous-intraepithelial-lesion (LSIL) cytology in organized screening to predict high-grade cervical intraepithelial neoplasia of grade 2 or worse (CIN2+) between screening rounds. Between January 2005 and April 2008, 692 study women with screening-detected ASCUS/LSIL cytology 6 to 12 months earlier returned for HPV mRNA and DNA testing and repeat cytology. The median follow-up time was 3 years, using existing health care facilities. Follow-up test results were available for 625 women. Of the 145 CIN2+ cases detected during the study period, 95 (65.5%) were HPV mRNA positive 6 to 12 months after screening-detected ASCUS/LSIL, 44 (30.4%) were HPV mRNA negative, and 6 (4.1%) were invalid. The corresponding HPV DNA results were 139 (95.9%), 5 (3.4%), and 1 (0.7%), respectively. The cumulative incidences of CIN2+ 3 years after a negative HPV mRNA and DNA test were 10.3% (95% confidence interval [CI], 7.2 to 13.3%) and 1.8% (95% CI, 0.0 to 3.6%), respectively. The cumulative incidences of CIN2+ 3 years after positive HPV mRNA and DNA tests were 52.8% (95% CI, 40.1 to 60.1%) and 41.3% (95% CI, 35.5 to 46.6%), respectively. In conclusion, both positive HPV mRNA and DNA test results have a high enough long-term prediction of CIN2+ risk to consider referral to colposcopy as good practice when performed in delayed triage of women with ASCUS/LSIL cytology. In addition, the low CIN2+ risk among women with a negative Amplicor HPV test in our study confirms its safe use in a clinical setting.
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Roberts JM, Ekman D. The reporting of anal cytology and histology samples: establishing terminology and criteria. Sex Health 2012; 9:562-7. [DOI: 10.1071/sh10140] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2010] [Accepted: 02/07/2012] [Indexed: 01/08/2023]
Abstract
Our understanding of the human papillomavirus (HPV) related cytomorphology and histopathology of the anal canal is underpinned by our knowledge of HPV infection in the cervix. In this review, we utilise cervical reporting of cytological and histological specimens as a foundation for the development of standardised and evidence-based terminology and criteria for reporting of anal specimens. We advocate use of the Australian Modified Bethesda System 2004 for reporting anal cytology. We propose the use of a two-tiered histological reporting system for noninvasive disease – low-grade and high-grade anal intraepithelial neoplasia. These classification systems reflect current understanding of the biology of HPV and enhance diagnostic reproducibility. Biomarkers such as p16INK4A may prove useful in further improving diagnostic accuracy. Standardisation is important because it will increase the value of the data collected as Australian centres develop programs for screening for anal neoplasia.
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Roberts JM, Thurloe JK. Comparison of the performance of anal cytology and cervical cytology as screening tests. Sex Health 2012; 9:568-73. [DOI: 10.1071/sh11178] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2011] [Accepted: 03/20/2012] [Indexed: 11/23/2022]
Abstract
Cervical cytology screening has a long history and has successfully reduced the impact of cervical cancer in many countries. Anal cytology is a relative newcomer and anal screening is currently offered in only a few centres around the world. Many questions need to be answered before anal screening is more widely adopted. While there are many similarities between cervical and anal squamous cell carcinoma, there are also important differences: differences in the prevalence of disease, in the ‘at-risk’ target populations and possibly in the robustness of the reference standard of biopsy. The performance of cytology as a screening test in the literature varies widely but it is essential to understand that some of this variability is due to differences in the definitions of key parameters in the various studies. For cervical screening, estimates of sensitivity have ranged from 19% to 94% and specificity from 94% to 98%. For anal screening, data are fewer and more limited. Estimates of the sensitivity of anal cytology in men who have sex with men and HIV-positive populations have ranged from 55% to 87% and specificity from 37% to 76%. Ultimately, rather than comparing anal with cervical cytology, it may be more helpful to assess the value of anal cytology independently through well designed trials.
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