1
|
Chen Y, Dong Z, Yuan L, Xu Y, Cao D, Xiong Z, Zhang Z, Wu D. A comparative study of treatment of cervical low-grade squamous intraepithelial lesions (LSIL). Photodiagnosis Photodyn Ther 2024; 45:103920. [PMID: 38043760 DOI: 10.1016/j.pdpdt.2023.103920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 11/29/2023] [Accepted: 12/01/2023] [Indexed: 12/05/2023]
Abstract
BACKGROUND AND AIMS Low-grade squamous intraepithelial lesion (LSIL) is one of two categories of cervical intraepithelial lesions. Given that controversy exists regarding its management, this comparative study aimed to evaluate the effect of 5-aminolevulinic acid photodynamic therapy (ALA-PDT) in treating LSIL of the high-risk human papillomavirus (HR-HPV)-infected cervix. METHODS A total of 218 patients (25-45 years old) with cervical LSIL associated with HR-HPV who underwent ALA-PDT, loop electrosurgical excision procedure (LEEP), or observation only were included. The clearance rates of cervical LSIL and HR-HPV between the ALA-PDT, LEEP, and observation groups were compared at 6 and 12 months follow-up. Adverse reactions were also compared. The factors affecting the clearance on ALA-PDT of cervical LSIL were evaluated. RESULTS There were no statistically significant differences in lesion and HR-HPV clearance rates between the ALA-PDT and LEEP groups at 6 and 12 months. However, the lesion and HR-HPV clearance rates were significantly higher in the ALA-PDT group than that in the observation group. The adverse reaction rate was significantly lower in the ALA-PDT group than in the LEEP group. CONCLUSION For patients with cervical LSIL, the lesion and HR-HPV clearance rates after ALA-PDT were close to those after LEEP and significantly higher than in the observation group. Moreover, the adverse reaction rate for ALA-PDT was much lower than that for LEEP. Therefore, ALA-PDT provides a new option for the minimally invasive treatment of cervical LSIL.
Collapse
Affiliation(s)
- Yi Chen
- The Center for Cervical Disease, The International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200030, China; Shanghai Key Laboratory of Embryo Original Diseases, Shanghai 200030, China
| | - Zhangli Dong
- The Center for Cervical Disease, The International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200030, China; Shanghai Key Laboratory of Embryo Original Diseases, Shanghai 200030, China
| | - Lirong Yuan
- The Center for Cervical Disease, The International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200030, China; Shanghai Key Laboratory of Embryo Original Diseases, Shanghai 200030, China
| | - Ying Xu
- The Center for Cervical Disease, The International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200030, China; Shanghai Key Laboratory of Embryo Original Diseases, Shanghai 200030, China
| | - Dan Cao
- The Center for Cervical Disease, The International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200030, China; Shanghai Key Laboratory of Embryo Original Diseases, Shanghai 200030, China
| | - Zhenhong Xiong
- The Center for Cervical Disease, The International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200030, China; Shanghai Key Laboratory of Embryo Original Diseases, Shanghai 200030, China
| | - Zhengrong Zhang
- The Center for Cervical Disease, The International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200030, China; Shanghai Key Laboratory of Embryo Original Diseases, Shanghai 200030, China.
| | - Dan Wu
- The Center for Cervical Disease, The International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200030, China; Shanghai Key Laboratory of Embryo Original Diseases, Shanghai 200030, China.
| |
Collapse
|
2
|
Li J, Jin H, Sun Y, Wang C, Chen H, Gong S, Jiang L. Reconnoitering correlation between human papillomavirus infection-induced vaginal microecological abnormality and squamous intraepithelial lesion (SIL) progression. BMC Womens Health 2024; 24:5. [PMID: 38167014 PMCID: PMC10763377 DOI: 10.1186/s12905-023-02824-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 12/01/2023] [Indexed: 01/05/2024] Open
Abstract
OBJECTIVE This study aims to investigate the relationship between abnormal vaginal microecology and human papillomavirus (HPV) infection, as well as the squamous intraepithelial lesions (SIL) progression. METHODS A total of 383 patients diagnosed with HPV infection in our hospital between March 2017 and February 2022 were selected as the experimental group. In addition, several volunteers (n = 898) who underwent physical examination during the same period were randomly selected as the control group. Subsequently, we conducted several investigations, such as HPV detection and gene typing, examined vaginal microecological imbalances, and performed cytological examinations to analyze the correlation between microecological changes, different types of HPV infection, and SIL progression. RESULTS HPV detection primarily included single and high-risk types of HPV infections. Moreover, significant disparities in the vaginal microecological environment between patients with persistent HPV infection and the control group, as well as patients with low-grade and high-grade SIL (LSIL and HSIL), were observed. The regression analysis revealed a correlation between LSIL and microflora density, diversity, bacteriological vaginosis (BV), vulvovaginal candidiasis (VVC), trichomonas vaginalis (TV), sialidase, as well as Lactobacillus. In addition, we identified an association between HSIL and pH, flora density, diversity, BV, VVC, candida vaginitis (CV), leukocyte esterase, catalase, and Lactobacillus levels. CONCLUSION These findings revealed a significant association between abnormal vaginal microecology and both HPV infection and the SIL progression.
Collapse
Affiliation(s)
- Jiawei Li
- Department of Gynecology, Qinhuangdao First Hospital, 258 Wenhua Road, Haigang District, Qinhuangdao, Hebei, 066099, China
| | - Haihong Jin
- Department of Gynecology, Qinhuangdao First Hospital, 258 Wenhua Road, Haigang District, Qinhuangdao, Hebei, 066099, China
| | - Yongmei Sun
- Department of Gynecology, Qinhuangdao First Hospital, 258 Wenhua Road, Haigang District, Qinhuangdao, Hebei, 066099, China
| | - Chunhua Wang
- Department of Inspection Center, Qinhuangdao First Hospital, Qinhuangdao, Hebei, 066099, China
| | - Hongjuan Chen
- Department of Gynecology, Qinhuangdao First Hospital, 258 Wenhua Road, Haigang District, Qinhuangdao, Hebei, 066099, China
| | - Shan Gong
- Department of Gynecology, Qinhuangdao First Hospital, 258 Wenhua Road, Haigang District, Qinhuangdao, Hebei, 066099, China
| | - Li Jiang
- Department of Gynecology, Qinhuangdao First Hospital, 258 Wenhua Road, Haigang District, Qinhuangdao, Hebei, 066099, China.
| |
Collapse
|
3
|
He M, Jia R, Liu X, Su C, Qin Y, Li C, Jia Y. Attributes underlying patient choice of treatment modality for low-grade squamous intraepithelial lesion complicated by high-risk human papillomavirus infection. Int J Hyperthermia 2023; 40:2168075. [PMID: 36683163 DOI: 10.1080/02656736.2023.2168075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
OBJECTIVE To use logistic regression to analyze the attributes underlying patients' treatment options for low-grade squamous intraepithelial lesion (LSIL) complicated with high-risk human papillomavirus (HR-HPV) infection, and identify the best benefit group of different treatment options. METHODS Clinical data of 197 LSIL patients with HR-HPV infection between June 2009 and February 2022 were collected. According to the treatment options chosen by the patients, they were divided into the interferon, photodynamic therapy, follow-up observation, and focused ultrasound (FUS) treatment groups. One-way analysis of variance (ANOVA) and multivariate logistic regression analysis were used to analyze the influencing factors, including age, occupation, education level, maternity history, reason for encounter, route of consultation, annual personal and household income, screening for related risk factors, and identifying the best benefit group of different treatment options. RESULTS One-way ANOVA revealed a statistically significant difference in age, education level, maternity history, reason for encounter, and annual household income (p < 0.05). Multivariate logistic regression analysis was performed on these five factors, indicating that age ≤35 years, high school educational level or higher, and no childbirth history were independent risk factors influencing patients' choices of FUS treatment. The receiver operating characteristic curve was used to determine the age threshold of 31 years. CONCLUSION Age, educational level, and maternity history were independent risk factors influencing patients' choice of treatment modality for LSIL complicated with HR-HPV infection. Age ≤31 years, high school, equivalent, or higher educational level, and no childbirth yielded a higher rate of choosing FUS treatment for LSIL patients with HR-HPV infection.
Collapse
Affiliation(s)
- Miaomiao He
- State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Key Laboratory of Biomedical Engineering, Chongqing Medical University, Chongqing, China
| | - Ru Jia
- State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Key Laboratory of Biomedical Engineering, Chongqing Medical University, Chongqing, China
| | - Xinglin Liu
- State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Key Laboratory of Biomedical Engineering, Chongqing Medical University, Chongqing, China
| | - Chang Su
- State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Key Laboratory of Biomedical Engineering, Chongqing Medical University, Chongqing, China
| | - Yi Qin
- State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Key Laboratory of Biomedical Engineering, Chongqing Medical University, Chongqing, China
| | - Chengzhi Li
- State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Key Laboratory of Biomedical Engineering, Chongqing Medical University, Chongqing, China.,Chongqing Haifu Hospital, Chongqing, China
| | - Ying Jia
- State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Key Laboratory of Biomedical Engineering, Chongqing Medical University, Chongqing, China.,The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| |
Collapse
|
4
|
Kir G, Ozen S. Histopathologic Follow-Up of Women with Inadequate ThinPrep™ Cervical Pap Tests and Positive High-Risk Human Papillomavirus Test Results. Acta Cytol 2023; 67:533-538. [PMID: 37494923 DOI: 10.1159/000531957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 06/27/2023] [Indexed: 07/28/2023]
Abstract
INTRODUCTION We found only a few studies that had performed high-risk human papillomavirus (hrHPV) analyses of inadequate ThinPrep™ Papanicolaou (Pap) tests. Therefore, this study aimed to analyze unsatisfactory ThinPrep Pap tests using hrHPV tests. The colposcopic biopsy results of cases with an unsatisfactory ThinPrep Pap test and positive hrHPV results were revealed. METHODS Between January 1, 2018, and October 31, 2022, 965 (3.7%) of 25,958 liquid-based cytology specimens were evaluated as unsatisfactory. Ninety-five (9.8%) of 965 patients were positive for hrHPV. The colposcopic evaluation was performed in 28 (29.4%) of 95 patients, in whom 23 tests were adequate. RESULTS Twenty-three colposcopy biopsy results showed that 17 (73.9%) of 23 patients had benign biopsy results. High-grade squamous intraepithelial lesions were observed in three (13%) of the 23 patients, and low-grade squamous intraepithelial lesions were observed in two (8.6%) of the 23 patients. One of the 23 (4.3%) patients had keratinized squamous cell carcinoma of the cervix diagnosed histologically, although no tumor was visible upon gynecologic examination. CONCLUSION For the management of unsatisfactory Pap tests, The American Society for Colposcopy and Cervical Pathology (ASCCP) recommends repeat cytology within 2-4 months. Evaluation of such patients using hrHPV tests may triage those with squamous intraepithelial lesions, even invasive cervical cancer. More studies with a larger number of cases are needed to analyze the hrHPV status and biopsy follow-up of cases with unsatisfactory cytology.
Collapse
Affiliation(s)
- Gozde Kir
- Department of Pathology Istanbul, Istanbul Medeniyet University Göztepe Prof. Dr. Süleyman Yalçın City Hospital, Istanbul, Turkey
| | - Suleyman Ozen
- Department of Obstetrics and Gynecology, Istanbul Medeniyet University Göztepe Prof. Dr. Süleyman Yalçın City Hospital, Istanbul, Turkey
| |
Collapse
|
5
|
Thrall MJ. A Practical Approach to Squamous Abnormalities on Cervical Cytology: Overview of Interpretive Criteria and Guidance for Altering Thresholds in Response to Quality Assurance Findings. Acta Cytol 2023; 67:129-142. [PMID: 36702101 DOI: 10.1159/000528531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 11/08/2022] [Indexed: 01/28/2023]
Abstract
BACKGROUND Squamous intraepithelial lesions observed in Papanicolaou (Pap) test gynecologic cytology arise as a result of infection of the cervicovaginal tract by human papillomavirus (HPV). The viral cytopathic effect of HPV manifests as koilocytosis, also known as low-grade squamous intraepithelial lesion (LSIL) in The Bethesda System (TBS). Integration of HPV genetic material into the genome of squamous cells can, in some women, result in progressive accumulation of mutations and abnormalities of growth and maturation leading to high-grade squamous intraepithelial lesion (HSIL) and possibly invasive squamous cell carcinoma. Due to morphologic overlap between reactive processes and these changes related to HPV, TBS includes equivocal categories that may be applied to Pap tests with uncertain morphology: atypical squamous cells of undetermined significance (ASC-US) and atypical squamous cells cannot exclude HSIL (ASC-H). Quality assurance (QA) measures in gynecologic cytology laboratories aim to maximize the sensitivity for LSIL and HSIL lesions while simultaneously keeping the use of ASC-US at reasonable levels. SUMMARY TBS provides a comprehensive nomenclature for squamous abnormalities encountered in screening, but subjectivity in interpretation remains. QA practices attempt to identify problematic patterns of misinterpretation for correction. KEY MESSAGE This review aimed to provide practical recommendations for cytology practitioners seeking to alter their interpretive thresholds for ASC-US, LSIL, and HSIL in response to feedback from QA procedures indicating deviation from desired norms.
Collapse
Affiliation(s)
- Michael James Thrall
- Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, Texas, USA
| |
Collapse
|
6
|
Wang W, Liu Y, Yang Y, Ren J, Zhou H. Changes in vaginal microbiome after focused ultrasound treatment of high-risk human papillomavirus infection-related low-grade cervical lesions. BMC Infect Dis 2023; 23:3. [PMID: 36604622 PMCID: PMC9814320 DOI: 10.1186/s12879-022-07937-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Accepted: 12/09/2022] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND In this study, the changes of vaginal microbiome after focused ultrasound (FU) treatment were evaluated to explore the possible mechanism of FU in the treatment of high-risk human papillomavirus (HR-HPV) infection. METHODS This study was nested in the FU arm of a prospective cohort study. A total of 37 patients diagnosed with HR-HPV infection-related cervical low-grade squamous intraepithelial lesion (LSIL) who met the inclusion criteria were enrolled in this study from October 2020 to November 2021, and these patients were treated with FU. We used 16S ribosomal RNA (16S rRNA) gene amplicon sequencing to profile the vaginal microbiota composition of patients before and 3 months after FU treatment. RESULTS After FU treatment, HR-HPV was cleared in 24 patients, with a clearance rate of 75.0% (24/32). Lactobacillus iners was the predominant species among all samples. No significant difference was found in alpha-diversity index before and 3 months after FU treatment (P > 0.05), but the rarefaction curves showed that the vaginal microbial diversity before FU treatment was higher than that after FU treatment. Linear discriminant analysis (LDA) effect size (LEfSe) showed that Bifidobacterium contributed the most to the difference between the two groups at the genus level, and the abundance after FU treatment was significantly higher than that before treatment (P = 0.000). CONCLUSIONS The decrease of vaginal microbial diversity may be related to the clearance of HR-HPV infection, and FU treatment contributed to the decrease of vaginal microbial diversity. Increased Bifidobacterium abundance in the vaginal microbiome may be associated with clearance of HR-HPV infection, and FU treatment may contribute to the increase in Bifidobacterium abundance. TRIAL REGISTRATION NUMBER This study was registered in the Chinese Clinical Trial Registry on 23/11/2020 (ChiCTR2000040162).
Collapse
Affiliation(s)
- Wenping Wang
- grid.413387.a0000 0004 1758 177XDepartment of Gynecology, Affiliated Hospital of North Sichuan Medical College, Wenhua Road 63, Nanchong, 637000 China
| | - Yujuan Liu
- grid.413387.a0000 0004 1758 177XDepartment of Gynecology, Affiliated Hospital of North Sichuan Medical College, Wenhua Road 63, Nanchong, 637000 China
| | - Yamei Yang
- grid.413387.a0000 0004 1758 177XDepartment of Gynecology, Affiliated Hospital of North Sichuan Medical College, Wenhua Road 63, Nanchong, 637000 China
| | - Jiaojiao Ren
- grid.413387.a0000 0004 1758 177XDepartment of Gynecology, Affiliated Hospital of North Sichuan Medical College, Wenhua Road 63, Nanchong, 637000 China
| | - Honggui Zhou
- grid.413387.a0000 0004 1758 177XDepartment of Gynecology, Affiliated Hospital of North Sichuan Medical College, Wenhua Road 63, Nanchong, 637000 China
| |
Collapse
|
7
|
Staats PN, Davey DD, Witt BL, Ghofrani M, Zhao C, Dodd LG, Goodrich K, Husain M, Kurtycz DFI, Russell DK, Shen RZ, Souers RJ, Tabatabai ZL, Crothers BA. Performance of specific morphologic features in distinguishing low-grade squamous intraepithelial lesions from high-grade squamous intraepithelial lesions in borderline cases: a College of American Pathologists Cytopathology Committee multiobserver study. J Am Soc Cytopathol 2021; 11:102-113. [PMID: 34903496 DOI: 10.1016/j.jasc.2021.11.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 11/03/2021] [Accepted: 11/05/2021] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Distinguishing between low-grade squamous intraepithelial lesions (LSIL) and high-grade squamous intraepithelial lesions (HSIL) can be difficult on certain Papanicolaou (Pap) tests, hindering interobserver concordance. We investigated the variables influencing the interpretation of LSIL versus HSIL in Pap test slides rejected from the College of American Pathologists PAP education program. MATERIALS AND METHODS Eleven cytologists, who were unaware of the reference interpretation, examined 21 Pap slides (11 submitted as LSIL and 10 as HSIL) rejected from the PAP education program and recorded the number of LSIL cells, HSIL cells, keratinized dysplastic cells, LSIL clusters with mixed HSIL cells, atypical squamous metaplasia, atypical glandular cells, the presence of inflammation or infectious organisms, and the overall interpretation (LSIL or HSIL). We evaluated the significance of these 11 variables using a nonlinear mixed model analysis. RESULTS LSIL had greater concordance (92 of 121 responses; 76.0% concordance) than HSIL (68 of 110 responses; 61.8% concordance; P < 0.001). The only predictors of misclassified cases were the number of atypical squamous metaplastic cells and the number of HSIL cells (P < 0.001). The more of these cells identified, the more likely the reviewers were to classify the slide as HSIL. The reproducibility of the diagnosis was fair (Gwet's agreement coefficient, 0.33). CONCLUSIONS Interobserver reproducibility is a challenge for a subset of cases with features intermediate between LSIL and HSIL. Atypical squamous metaplasia and dysplastic nuclei with a nuclear/cytoplasmic ratio greater than one half of the cell volume (HSIL) present on a Pap test influenced the likelihood that a reviewer would interpret the case as HSIL rather than LSIL.
Collapse
Affiliation(s)
- Paul N Staats
- Department of Pathology, University of Maryland School of Medicine, Baltimore, Maryland.
| | - Diane Davis Davey
- Department of Clinical Sciences, University of Central Florida College of Medicine, Orlando, Florida
| | - Benjamin L Witt
- Department of Pathology, University of Utah Health Sciences Center, Salt Lake City, Utah
| | - Mohiedean Ghofrani
- Department of Pathology, PeaceHealth Southwest Medical Center, Vancouver, Washington
| | - Chengquan Zhao
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Leslie G Dodd
- Department of Pathology, University of North Carolina Hospital, Chapel Hill, North Carolina
| | | | - Mujtaba Husain
- Department of Clinical Sciences, University of Central Florida College of Medicine, Orlando, Florida
| | - Daniel F I Kurtycz
- Department of Pathology and Laboratory Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Donna K Russell
- Department of Pathology, University of Rochester, Rochester, New York
| | - Rulong Z Shen
- Department of Pathology, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Rhona J Souers
- Biostatistics Department, College of American Pathologists, Northfield, Illinois
| | - Z Laura Tabatabai
- Department of Pathology, University of California, San Francisco, and San Francisco Veterans Affairs HealthCare System, San Francisco, California
| | - Barbara A Crothers
- Divisions of Gynecology and Breast Pathology and Cytopathology, Joint Pathology Center, Silver Spring, Maryland
| |
Collapse
|
8
|
Kim H, Woo HY, Lee SH, Do SI, Kim HS. Placental Site Plaque of the Uterine Cervix Misinterpreted as Low-Grade Squamous Intraepithelial Lesion in Liquid-Based Cervicovaginal Cytology: Usefulness of Inhibin-α Immunocytochemistry. Case Rep Oncol 2020; 13:1415-1420. [PMID: 33442365 PMCID: PMC7772827 DOI: 10.1159/000510310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Accepted: 07/19/2020] [Indexed: 11/23/2022] Open
Abstract
Cytological features of placental site plaques in liquid-based cervicovaginal preparations have been seldom documented in the literature. We present a rare case of endocervical placental site plaque misinterpreted as a low-grade squamous intraepithelial lesion in a liquid-based cytological preparation. A 32-year-old woman with polycystic ovarian syndrome gave birth 7 months previously. After delivery, she was diagnosed with cervical low-grade squamous intraepithelial lesion during routine cytological examination. Cytologically, many atypical cells showed large hyperchromatic nuclei with irregular membranes. The perinuclear cytoplasmic clearing closely resembled koilocytosis. Histologically, the endocervix showed typical histological features of a placental site plaque. Immunohistochemically, the trophoblasts were positive for p63, CD10, and inhibin-α but negative for p16. Based on genotyping, both the cytological and biopsied specimens tested negative for human papillomavirus. We re-examined the liquid-based preparation cytology slides thoroughly and concluded that the atypical cells initially misinterpreted as low-grade squamous intraepithelial lesion were actually trophoblasts. Immunocytochemical staining revealed uniform cytoplasmic inhibin-α expression in the trophoblasts. In summary, we demonstrated that endocervical placental site plaques can mimic low-grade squamous intraepithelial lesions in liquid-based cytological preparations. Immunocytochemical staining results and negative results on human papillomavirus genotyping further support that atypical cells resembling koilocytes are trophoblasts obtained from the placental site plaque.
Collapse
Affiliation(s)
- Hyunjin Kim
- Department of Pathology and Translational Genomics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Ha Young Woo
- Department of Pathology, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Sang Hwa Lee
- Pathology Center, Seegene Medical Foundation, Seoul, Republic of Korea
| | - Sung-Im Do
- Department of Pathology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Hyun-Soo Kim
- Department of Pathology and Translational Genomics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| |
Collapse
|
9
|
Koeneman MM, van Lint FHM, van Kuijk SMJ, Smits LJM, Kooreman LFS, Kruitwagen RFPM, Kruse AJ. A prediction model for spontaneous regression of cervical intraepithelial neoplasia grade 2, based on simple clinical parameters. Hum Pathol 2016; 59:62-69. [PMID: 27697590 DOI: 10.1016/j.humpath.2016.09.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Revised: 08/30/2016] [Accepted: 09/09/2016] [Indexed: 12/12/2022]
Abstract
This study aims to develop a prediction model for spontaneous regression of cervical intraepithelial neoplasia grade 2 (CIN 2) lesions based on simple clinicopathological parameters. The study was conducted at Maastricht University Medical Center, the Netherlands. The prediction model was developed in a retrospective cohort of 129 women with a histologic diagnosis of CIN 2 who were managed by watchful waiting for 6 to 24months. Five potential predictors for spontaneous regression were selected based on the literature and expert opinion and were analyzed in a multivariable logistic regression model, followed by backward stepwise deletion based on the Wald test. The prediction model was internally validated by the bootstrapping method. Discriminative capacity and accuracy were tested by assessing the area under the receiver operating characteristic curve (AUC) and a calibration plot. Disease regression within 24months was seen in 91 (71%) of 129 patients. A prediction model was developed including the following variables: smoking, Papanicolaou test outcome before the CIN 2 diagnosis, concomitant CIN 1 diagnosis in the same biopsy, and more than 1 biopsy containing CIN 2. Not smoking, Papanicolaou class <3, concomitant CIN 1, and no more than 1 biopsy containing CIN 2 were predictive of disease regression. The AUC was 69.2% (95% confidence interval, 58.5%-79.9%), indicating a moderate discriminative ability of the model. The calibration plot indicated good calibration of the predicted probabilities. This prediction model for spontaneous regression of CIN 2 may aid physicians in the personalized management of these lesions.
Collapse
Affiliation(s)
- Margot M Koeneman
- Department of Obstetrics and Gynecology, Maastricht University Medical Center, 6202 AZ, Maastricht, the Netherlands; GROW-School for Oncology and Developmental Biology, Maastricht University, 6200 MD, Maastricht, the Netherlands.
| | - Freyja H M van Lint
- Department of Obstetrics and Gynecology, Maastricht University Medical Center, 6202 AZ, Maastricht, the Netherlands; GROW-School for Oncology and Developmental Biology, Maastricht University, 6200 MD, Maastricht, the Netherlands
| | - Sander M J van Kuijk
- Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Center, 6202 AZ, Maastricht, the Netherlands
| | - Luc J M Smits
- Department of Epidemiology, Maastricht University, 6200 MD, Maastricht, the Netherlands
| | - Loes F S Kooreman
- Department of Pathology, Maastricht University Medical Center, 6202 AZ, Maastricht, the Netherlands
| | - Roy F P M Kruitwagen
- Department of Obstetrics and Gynecology, Maastricht University Medical Center, 6202 AZ, Maastricht, the Netherlands; GROW-School for Oncology and Developmental Biology, Maastricht University, 6200 MD, Maastricht, the Netherlands
| | - Arnold J Kruse
- Department of Obstetrics and Gynecology, Maastricht University Medical Center, 6202 AZ, Maastricht, the Netherlands; GROW-School for Oncology and Developmental Biology, Maastricht University, 6200 MD, Maastricht, the Netherlands
| |
Collapse
|
10
|
Clark JL, Lu D, Kalir T, Liu Y. Overdiagnosis of HSIL on cervical biopsy: errors in p16 immunohistochemistry implementation. Hum Pathol 2016; 55:51-6. [PMID: 27134110 DOI: 10.1016/j.humpath.2016.04.010] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Revised: 04/01/2016] [Accepted: 04/15/2016] [Indexed: 01/10/2023]
Abstract
In 2012, the lower anogenital squamous terminology (LAST) project introduced new nomenclature for human papillomavirus-related squamous lesions of the lower genital tract: low-grade and high-grade squamous intraepithelial lesion (LSIL and HSIL). Biomarker p16(INK4a) immunohistochemistry (IHC) was also recommended to assist classification: block-like positive staining supports the diagnosis of HSIL. We aim to assess the impact of LAST recommendations on our practice as well as to identify challenges and errors in p16 IHC implementation. We studied 262 cervical biopsies meeting 3 criteria: (1) HSIL diagnosis; (2) p16 IHC performed at time of diagnosis; and (3) patient's follow-up more than 12 months, including cervical cytology, biopsy, and excision. Among these patients, subsequent loop electrosurgical excision procedure and surveillance revealed 163 HSILs (62%), 28 LSILs (11%), and 71 "nondysplastic changes" (27%). We reviewed the latter 2 groups' original hematoxylin and eosin and p16 IHC slides. The diagnosis of HSIL was confirmed in 49 cases (49%), whereas 50 (51%) were reclassified as LSIL (n=46) or negative for dysplasia (n=4). These cases were initially overdiagnosed as HSIL because pathologists (1) overused p16 IHC on unequivocal LSIL (n=27) or (2) upgraded questionable lesions to HSIL based on nonblock p16 staining patterns (patchy or focal, n=23). To implement LAST recommendations successfully, we advocate judicious use of p16 in the designated circumstances and careful interpretation of staining patterns in the context of morphology. A standardized threshold for p16 positivity and supplementary guidance will help clarify the biomarker's utility and will facilitate LAST implementation in routine practice.
Collapse
Affiliation(s)
- Jennifer L Clark
- Department of Pathology, UMass Memorial Medical Center, University of Massachusetts Medical School, Worcester, MA 01605
| | - Dan Lu
- Division of Gynecologic Pathology, Department of Pathology, Icahn School of Medicine at Mount Sinai, Mount Sinai Health System, New York, NY 10029
| | - Tamara Kalir
- Division of Gynecologic Pathology, Department of Pathology, Icahn School of Medicine at Mount Sinai, Mount Sinai Health System, New York, NY 10029
| | - Yuxin Liu
- Division of Gynecologic Pathology, Department of Pathology, Icahn School of Medicine at Mount Sinai, Mount Sinai Health System, New York, NY 10029.
| |
Collapse
|
11
|
Barron S, Austin RM, Li Z, Zhao C. Follow-up outcomes in a large cohort of patients with HPV-negative LSIL cervical screening test results. Am J Clin Pathol 2015; 143:485-91. [PMID: 25779999 DOI: 10.1309/ajcpu57uelkuzcyy] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
OBJECTIVES Cervical screening guidelines now recommend repeat cotesting of patients aged 30 years and older having a human papillomavirus (HPV)-negative low-grade squamous intraepithelial lesion (LSIL) in 1 year as preferred management. Only limited follow-up data on patients with HPV-negative LSILs are available from routine US clinical practice settings. METHODS In total, 680 patients with Hybrid Capture 2 (Qiagen, Hinden, Germany) high-risk HPV-negative LSIL ThinPrep (Hologic, Marlborough, MA) results were identified. Patients' ages and histopathologic, cytologic, and HPV follow-up results were identified. RESULTS Among 680 patients with HPV-negative LSILs, 468 had follow-up within 1 year. During the study period, 14 (3.0%) of 468 had follow-up high-grade squamous intraepithelial lesion (HSIL) and 184 (39.3%) LSIL findings. No diagnoses of cervical carcinoma were documented. There were no significant follow-up differences between age groups. Of the 321 patients who had follow-up HPV testing, 271 (84.4%) had negative and 50 (15.6%) had positive HPV results. CONCLUSIONS This is the largest study documenting follow-up results for patients with HPV-negative LSIL results based on prevalent US FDA-approved co-testing methods from one collection vial. These data document that risk for follow-up HSILs in these patients is low and also that no cervical cancers were diagnosed. These findings support recent recommendations for repeat co-testing after 1 year as an appropriate option for patients with HPV-negative LSIL results.
Collapse
Affiliation(s)
- Stacey Barron
- Department of Pathology, Magee-Womens Hospital of University of Pittsburgh Medical Center, Pittsburgh, PA
| | - R. Marshall Austin
- Department of Pathology, Magee-Womens Hospital of University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Zaibo Li
- Department of Pathology, Magee-Womens Hospital of University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Chengquan Zhao
- Department of Pathology, Magee-Womens Hospital of University of Pittsburgh Medical Center, Pittsburgh, PA
| |
Collapse
|
12
|
Nakamura Y, Matsumoto K, Satoh T, Nishide K, Nozue A, Shimabukuro K, Endo S, Nagai K, Oki A, Ochi H, Morishita Y, Noguchi M, Yoshikawa H. HPV genotyping for triage of women with abnormal cervical cancer screening results: a multicenter prospective study. Int J Clin Oncol 2015; 20:974-81. [PMID: 25652908 DOI: 10.1007/s10147-015-0789-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Accepted: 01/20/2015] [Indexed: 10/24/2022]
Abstract
BACKGROUND In cervical cancer screening programs, women with abnormal cytology are referred for colposcopy for histological evaluation. We examined whether a human papillomavirus (HPV) genotyping assay could be used to identify women who do not need immediate colposcopy and biopsy because of low risk of cervical intraepithelial neoplasia grade 3 or worse (CIN3+). METHODS We prospectively evaluated test performance for 2 carcinogenic HPV genotypes (HPV16/18), for 8 types (HPV16/18/31/33/35/45/52/58), and for 13 types (HPV16/18/31/33/35/45/51/52/56/58/59/68) for prediction of histological CIN3+ results among 427 screen-positive women referred for colposcopy. The study subjects consisted of 214 women with low-grade squamous intraepithelial lesion (LSIL), 184 with high-grade squamous intraepithelial lesion (HSIL), and 29 with atypical squamous cells, cannot exclude HSIL (ASC-H). RESULTS Among women with LSIL cytology, HPV16/18 positivity was 29.4 % and increased to 58.9 % for 8 types and to 74.8 % for 13 types (P < 0.001). The risk of CIN3+ biopsy results was still 7.9 % for women testing negative for HPV16/18, but decreased to 0.0 % for those testing negative for at least eight types of HPV (HPV16/18/31/33/35/45/52/58). Although HPV genotyping results enabled additional risk stratification among women with HSIL/ASC-H cytology, the risk of histological CIN3+ diagnosis among women testing negative for eight types or more was still sufficiently high (>35 %) to warrant immediate colposcopy referral. CONCLUSIONS Of women with LSIL cytology, those testing negative for at least eight of the highest-risk types of HPV (HPV16/18/31/33/35/45/52/58) may not need immediate colposcopy and biopsy. This would reduce the number of colposcopy referrals by approximately 40 %. However, the HPV genotyping assay is not likely to alter the clinical management of women with HSIL/ASC-H.
Collapse
|
13
|
Selvaggi SM. The utility of high-risk HPV testing in the management of women 30 to 64 years of age with low-grade squamous intraepithelial lesions on cervical cytology. J Am Soc Cytopathol 2015; 4:290-293. [PMID: 31051767 DOI: 10.1016/j.jasc.2015.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2014] [Revised: 02/17/2015] [Accepted: 02/18/2015] [Indexed: 11/28/2022]
Abstract
INTRODUCTION The current American Society for Colposcopy and Cervical Pathology guidelines recommend high risk-human papillomavirus testing for patients 30 to 64 years of age with a low-grade squamous intraepithelial lesion on Papanicolaou (Pap) tests. This study presents our experience since the introduction of the new guidelines. MATERIALS AND METHODS From September 1, 2013 through August 31, 2014, 20,014 ThinPrep Pap tests were processed, of which 17,989 (90%) were negative, 863 (4.3%) were atypical squamous cells of undetermined significance (ASCUS), and 540 (2.7%) were low-grade squamous intraepithelial lesions (LSIL). Thirty-eight percent of the negative cases, 87% of the ASCUS cases, and 76% of the LSIL cases were processed for high risk-human papillomavirus genotypes. Of the 1,163 patients with a Pap test diagnosis of ASCUS and LSIL, 656 (56%) underwent colposcopic examination and, of those, 240 (37%) had cervical biopsies performed. RESULTS In our cohort, 247 (33%) of the 754 ASCUS Pap tests were hr-HPV-positive and 507 (67%) were hr-HPV-negative. Of the 409 LSIL Pap tests, 245 (60%) were hr-HPV-positive and 164 (40%) were hr-HPV-negative. Colposcopy/biopsy follow-up within 3-months of the ThinPrep Pap test showed cervical intraepithelial lesion grade 2/3 lesions in 16% of the hr-HPV-positive ASCUS cases, in 15% of the hr-HPV-positive LSIL cases and in 9% of the hr-HPV-negative LSIL cases. CONCLUSIONS This study supports the current management guidelines of colposcopy for women 30 to 64 years of age with hr-HPV-positive ASCUS and LSIL on Pap tests and repeat Pap test with cotesting for women with hr-HPV-negative LSIL.
Collapse
Affiliation(s)
- Suzanne M Selvaggi
- Department of Pathology and Laboratory Medicine, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, Madison, Wisconsin.
| |
Collapse
|
14
|
Lin H, Chen TC, Chang TC, Cheng YM, Chen CH, Chu TY, Hsu ST, Liu CB, Yeh LS, Wen KC, Huang CY, Yu MH. Methylated ZNF582 gene as a marker for triage of women with Pap smear reporting low-grade squamous intraepithelial lesions - a Taiwanese Gynecologic Oncology Group (TGOG) study. Gynecol Oncol 2014; 135:64-8. [PMID: 25134998 DOI: 10.1016/j.ygyno.2014.08.012] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2014] [Revised: 08/05/2014] [Accepted: 08/06/2014] [Indexed: 01/14/2023]
Abstract
OBJECTIVE Our previous work revealed that host genes ZNF582, PTPRR, PAX1, and SOX1 are highly methylated in cervical intraepithelial neoplasias grade 3 or worse (CIN3(+)). In this study, we used a standardized testing assay to evaluate the clinical efficacy of these biomarkers in the triage of cytological diagnoses of low-grade squamous intraepithelial lesions (LSILs), and compared the performance with human papillomavirus (HPV) testing. METHODS This 2-year multicenter prospective study examined a population of 230 women from 12 medical centers who were diagnosed with LSILs on cervical cytology. Cervical scrapings were obtained prior to a colposcopy-directed biopsy for quantitative methylation analysis of ZNF582, PTPRR, PAX1, and SOX1, and HPV testing. Using logistic regression and receiver operating characteristic curve analyses, the abilities of methylated genes and HPV to predict CIN3(+) were assessed. RESULTS Fifteen (6.5%) of the 230 women with a cytological diagnosis of LSIL were confirmed to have CIN3(+) after a colposcopy-directed biopsy. Among the 4 methylated genes, ZNF582 was found to be the best biomarker for detecting CIN3(+). The sensitivities for methylated ZNF582 and HPV testing were 73% and 80%, and the specificities were 71% and 28%, respectively. The odds ratio for predicting CIN3(+) using methylated ZNF582 was 6.8 (95% confidence interval (CI) 2.1-22.1), which was much better than HPV testing (OR=1.6, 95% CI 0.4-5.8). CONCLUSION This is the first study to show that ZNF582 methylation analysis of cervical swabs may be a promising choice in the positive triage of cytological diagnoses of LSILs.
Collapse
Affiliation(s)
- Hao Lin
- Department of Obstetrics and Gynecology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Tze-Chien Chen
- Department of Obstetrics and Gynecology, Mackay Memorial Hospital, Taiwan
| | - Ting-Chang Chang
- Department of Obstetrics and Gynecology, Linkou Chang Gung Memorial Hospital, Taiwan
| | - Ya-Min Cheng
- Department of Obstetrics and Gynecology, National Cheng Kung University Hospital, Taiwan
| | - Chi-Hau Chen
- Department of Obstetrics and Gynecology, National Taiwan University Hospital, Taiwan
| | - Tang-Yuan Chu
- Department of Obstetrics and Gynecology, Buddhist Tzu Chi General Hospital, Taiwan
| | - Shih-Tien Hsu
- Department of Obstetrics and Gynecology, Taichung Veterans General Hospital, Taiwan
| | - Cheng-Bin Liu
- Department of Obstetrics and Gynecology, Kaohsiung Veterans General Hospital, Taiwan
| | - Lian-Shung Yeh
- Department of Obstetrics and Gynecology, China Medical University Hospital and College of Chinese Medicine, China Medical University, Taichung 40402, Taiwan
| | - Kuo-Chang Wen
- Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taiwan
| | - Chia-Yen Huang
- Department Obstetrics and Gynecology, Cathay General Hospital, Taiwan
| | - Mu-Hsien Yu
- Department of Obstetrics and Gynecology, Tri-Service General Hospital, National Defense Medical Center, Taiwan
| |
Collapse
|
15
|
Razmpoosh M, Sansregret A, Oligny LL, Patey N, Dormoy-Raclet V, Ducruet T, Bouron-Dal Soglio D. Assessment of correlation between p16INK4a staining, specific subtype of human papillomavirus, and progression of LSIL/CIN1 lesions: first comparative study. Am J Clin Pathol 2014; 142:104-10. [PMID: 24926093 DOI: 10.1309/ajcpbx74qxcpxikk] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
OBJECTIVES To study and compare the effectiveness of p16(INK4a) staining and specific human papillomavirus (HPV) subtypes as a prognostic marker in cervical intraepithelial neoplasia grade 1 (CIN1; low-grade squamous intraepithelial lesions). METHODS Sixty-four cervical samples diagnosed as CIN1 and stained with p16(INK4a), with HPV status assessed by polymerase chain reaction-direct sequencing. RESULTS Of the 34 p16(INK4a)-negative biopsy specimens, 26 regressed, seven persisted, and one progressed. Of the 20 p16(INK4a) diffusely positive biopsy specimens, seven regressed, eight persisted, and five progressed. Ten biopsy specimens stained positive only in the lower one-third of the sample, of which seven regressed and three persisted. p16(INK4a) diffusely positive CIN1 lesions were associated with only high-risk HPV subtypes, with the exception of one HPV-negative biopsy specimen. Three different high-risk HPV subtypes and one low-risk HPV subtype (HPV66) were identified in the six CIN1 lesions that progressed. CONCLUSIONS There is a significant relationship between p16(INK4a) immunostaining and follow-up (P = .002). p16(INK4a)-negative specimens or positivity in the lower one-third of CIN1 lesions seldom progress to a CIN2-3 lesion.
Collapse
Affiliation(s)
| | - Andrée Sansregret
- Department of Gyneco-Obstetrics, Université de Montréal, Québec, Canada
| | - Luc L. Oligny
- Department of Pathology, Université de Montréal, Québec, Canada
| | - Natalie Patey
- Department of Pathology, Université de Montréal, Québec, Canada
| | - Virginie Dormoy-Raclet
- Laboratory of Molecular Diagnosis, CHU Sainte-Justine, Université de Montréal, Québec, Canada
| | - Thierry Ducruet
- URCA-CHU Sainte-Justine, Université de Montréal, Québec, Canada
| | | |
Collapse
|
16
|
Conesa-Zamora P, Torres-Moreno D, Isaac MA, Pérez-Guillermo M. Gene amplification and immunohistochemical expression of ERBB2 and EGFR in cervical carcinogenesis. Correlation with cell-cycle markers and HPV presence. Exp Mol Pathol 2013; 95:151-5. [PMID: 23827764 DOI: 10.1016/j.yexmp.2013.06.011] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2012] [Accepted: 06/20/2013] [Indexed: 11/28/2022]
Abstract
Although the members of the epidermal growth factor receptor family ERBB2 and EGFR are important therapeutic targets in the treatment of malignant neoplasias, little is known about their role in cervical carcinogenesis. Our objective was to evaluate the dysfunction of ERBB2 and EGFR at the gene copy number and protein expression level in neoplastic lesions of the uterine cervix with the aim of obtaining information about its role in cervical carcinogenesis and their possible use as therapeutic targets in these diseases. We studied gene amplification and protein expression of ERBB2 and EGFR and their relationship with Ki67, p16 and p53 and HPV presence in 22 normal/benign (N/B) cervices, 20 low-grade squamous intraepithelial lesions (LSILs), 70 high-grade SILs (HSILs) and 32 invasive squamous cervical carcinomas (ISCCs). No cases showed selective amplification of ERBB2 or EGFR but corresponding chromosome-specific probes displayed chromosome 17 and 7 polyploidy associated with the grade of the lesion (p<0.0001 and p=0.004, respectively) and with the positive expression of Ki67 and p16 (p<0.01). Concurrent polyploidy for both chromosomes was statistically related (p<0.0001). ERBB2 immunohistochemical expression was not observed in any of the study cases except for one ISCC but EGFR was associated with higher-grade lesions (N/B plus LSIL 21.4% vs. HSIL plus ISCC 45.5%; p=0.007). No association was observed between EGFR expression and that of cell-cycle markers or HPV presence. Increased copy number of EGFR and ERBB2 is due to polyploidy of 7 and 17 chromosomes, this being a phenomenon associated with lesion severity and with an increase in the expression of cell-cycle markers. EGFR, but not ERBB2, is expressed in precursor lesions of squamous cervical neoplasia and is related to the neoplastic progression but not to proliferation marker expression and therefore ERBB2 and this calls into question the usefulness of ERBB2 as a therapeutic target.
Collapse
Affiliation(s)
- Pablo Conesa-Zamora
- Molecular Pathology and Pharmacogenetic Group, Santa Lucía General University Hospital (HUGSL), 30202 Cartagena, Spain.
| | | | | | | |
Collapse
|