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Yücel E, Koca Yıldırım HE, Şahin Duran F, Çakır C, Korkmaz V. The role of cervical elastography in the differential diagnosis of preinvasive and invasive lesions of the cervix. Arch Gynecol Obstet 2024; 309:1585-1595. [PMID: 38282023 DOI: 10.1007/s00404-023-07345-6] [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: 09/12/2023] [Accepted: 12/05/2023] [Indexed: 01/30/2024]
Abstract
STUDY OBJECTIVE This study aims to evaluate the role of cervical elastography in the differential diagnosis of preinvasive and invasive lesions of the cervix. MATERIALS AND METHODS A total of 95 women participated in this prospective study and were divided into the following groups: 19 healthy subjects (group 1) with normal cervicovaginal smear (CVS) and negative human papillomavirus test (HPV DNA), 19 women with normal cervical biopsy and normal final pathological result of cervical biopsy (group 2), 19 women with low-grade squamous intraepithelial lesion (LSIL) (group 3), 19 women with high-grade squamous intraepithelial lesion (HSIL) (group 4), and 19 women with cervical cancer (group 5). Clinical, demographic, histopathological, and elastographic results were compared between these groups. RESULTS Comparing groups, age (40.42 ± 8.31 vs. 39.53 ± 8.96 vs. 38.79 ± 9.53 vs. 40.74 ± 7.42 vs. 54.63 ± 12.93, p < 0.001 respectively), gravida (1.74 ± 1.33 vs. 2.16 ± 1.68 vs. 2.21 ± 1.96 vs. 2.53 ± 1.93 vs. 4.63 ± 2.17 p < 0.001 respectively), parity (1.37 ± 0.68 vs. 1.68 ± 1.20 vs. 1.58 ± 1.30 vs. 2.00 ± 1.67 vs. 3.37 ± 1.61, p < 0.001 respectively), and the proportion of patients at menopause (10.5% vs., 15.8% vs. 10.5% vs. 5.3% vs. 57.9%, p < 0.01 respectively), a statistically significant difference was found (Table 1). However, no statistically significant difference was found in the number of abortions, BMI, mode of delivery, smoking, additional disease status, history of surgery, and family history (p > 0.05) (Table 2. As a result of the applied roc analysis, mean cervical elastographic stiffness degree (ESD) was found to be an influential factor in predicting cervical cancer (p < 0.05). The mean cut-off value was 44.65%, with a sensitivity of 94.7% and a specificity of 96.1% (Table 7). CONCLUSION Measurement of ESD by elastography is a low-cost, easily applicable, and non-invasive indicator that can distinguish cervical cancer from normal cervical and preinvasive lesions. However, it is unsuitable for determining preinvasive cervical lesions from normal cervix.
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Affiliation(s)
- Ecem Yücel
- Niğde Ömer Halis Demir Training and Research Hospital, Niğde, Turkey
| | - Hande Esra Koca Yıldırım
- Department of Gynecologic Oncology, Faculty of Medicine, Ankara Etlik City Hospital, University of Health Sciences, Ankara, Turkey.
| | - Firdevs Şahin Duran
- Department of Pathology, Faculty of Medicine, Ankara Etlik City Hospital, University of Health Sciences, Ankara, Turkey
| | - Caner Çakır
- Department of Gynecologic Oncology, Faculty of Medicine, Ankara Etlik City Hospital, University of Health Sciences, Ankara, Turkey
| | - Vakkas Korkmaz
- Department of Gynecologic Oncology, Faculty of Medicine, Ankara Etlik City Hospital, University of Health Sciences, Ankara, Turkey
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Mayeri DG, Kahasha PM, Kibalama IB, Mongane J, Louguè M, Birindwa EK, Mwimangire SC, Kikuru CK, Materanya JM, Bisimwa YK, Kasago B, Mukengeshai LEM. Cervical precancerous and cancerous lesions screening using Pap smear test at Provincial Referral Hospital of Bukavu, Eastern DR Congo: profile and recommendations to stakeholders. Pan Afr Med J 2024; 47:57. [PMID: 38646136 PMCID: PMC11032072 DOI: 10.11604/pamj.2024.47.57.39090] [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: 01/26/2023] [Accepted: 12/28/2023] [Indexed: 04/23/2024] Open
Abstract
Introduction cervical cancer is a health concern worldwide. The South Kivu Province in the Eastern DR Congo is facing many cases of this disease but poorly screened and reported. The objective of this was to determine the prevalence of cell abnormalities at cervical cytology in a tertiary teaching hospital in Bukavu and their association with common risk factors of cervical cancer. Methods a cross-sectional study was conducted on 142 women attending the Provincial Referral Hospital of Bukavu (HPGRB) from February to December 2021. Quantitative variables were described by their median following their asymmetric distributions and the qualitative variables in absolute and relative frequencies. Then the Chi-square test was used for the comparison of proportion. Results forty-five percent of the participants had between three and five children. Twenty-two (15.5%) of the 142 patients reported to have two or more sexual partners and 17.5% reported the use of hormonal contraception. The prevalence of cell abnormalities at cervical cytology was 17% of which Low- Grade Squamous Intraepithelial Lesion (LSIL) was the most representative (12.9%). There was no statistically significant association between the common cervical risk factors and the occurrence of cell abnormalities. Conclusion cervical pre-cancerous lesions are frequent in South Kivu province. The Pap smear test remains an early and affordable screening method and constitutes a secondary prevention strategy in women of 18 years and older in a low-income country such as DR Congo where vaccination against HPV is still hypothetic.
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Affiliation(s)
- Daniel Garhalangwanamuntu Mayeri
- Department of Pathology, Faculty of Medicine, Hôpital Provincial Général de Référence de Bukavu, Université Catholique de Bukavu, Bukavu, Democratic Republic of Congo
- Ecole Régionale de Santé Publique, Université Catholique de Bukavu, Bukavu, Democratic Republic of Congo
- Department of Pathology, Université Joseph Ki-Zerbo, Ouagadougou, Burkina Faso
| | - Pierre Mulumeoderhwa Kahasha
- Department of Pathology, Faculty of Medicine, Hôpital Provincial Général de Référence de Bukavu, Université Catholique de Bukavu, Bukavu, Democratic Republic of Congo
| | - Isaac Barhishindi Kibalama
- Department of Gynaecology, Faculty of Medicine, Hôpital Provincial Général de Référence de Bukavu, Université Catholique de Bukavu, Bukavu, Democratic Republic of Congo
| | - Jules Mongane
- Department of Gynaecology, Faculty of Medicine, Hôpital Provincial Général de Référence de Bukavu, Université Catholique de Bukavu, Bukavu, Democratic Republic of Congo
| | - Medina Louguè
- Department of Pathology, Université Joseph Ki-Zerbo, Ouagadougou, Burkina Faso
| | - Etienne Kajibwami Birindwa
- Department of Gynaecology, Faculty of Medicine, Hôpital Provincial Général de Référence de Bukavu, Université Catholique de Bukavu, Bukavu, Democratic Republic of Congo
| | - Serge Chentwali Mwimangire
- Department of Gynaecology, Faculty of Medicine, Hôpital Provincial Général de Référence de Bukavu, Université Catholique de Bukavu, Bukavu, Democratic Republic of Congo
| | - Claude Kalegamire Kikuru
- Department of Gynaecology, Faculty of Medicine, Hôpital Provincial Général de Référence de Bukavu, Université Catholique de Bukavu, Bukavu, Democratic Republic of Congo
| | - Jeanne Maningo Materanya
- Department of Gynaecology, Faculty of Medicine, Hôpital Provincial Général de Référence de Bukavu, Université Catholique de Bukavu, Bukavu, Democratic Republic of Congo
| | - Yvette Kujirakwinja Bisimwa
- Department of Gynaecology, Faculty of Medicine, Hôpital Provincial Général de Référence de Bukavu, Université Catholique de Bukavu, Bukavu, Democratic Republic of Congo
| | - Benjamin Kasago
- Department of Gynaecology, Faculty of Medicine, Hôpital Provincial Général de Référence de Bukavu, Université Catholique de Bukavu, Bukavu, Democratic Republic of Congo
| | - Léon-Emmanuel Mubenga Mukengeshai
- Department of Surgery, Faculty of Medicine, Hôpital Provincial Général de Référence de Bukavu, Université Catholique de Bukavu, Bukavu, Democratic Republic of Congo
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Torous VF. Challenging lesions in cervical cytology: The elusive HSIL. Cytopathology 2024; 35:48-59. [PMID: 37706620 DOI: 10.1111/cyt.13303] [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: 06/30/2023] [Revised: 08/08/2023] [Accepted: 08/15/2023] [Indexed: 09/15/2023]
Abstract
Cervical cytology has been an integral part of cervical cancer screening since the mid-20th century with the implementation of screening protocols utilising Pap testing. During that time, cervical cancer has gone from the leading cause of cancer deaths in women to not even appearing in the top 10 causes of US cancer deaths. However, despite its long and widespread use, cervical cytology remains a diagnostically challenging area in the practice of cytopathology. Of particular importance for diagnosticians is the accurate diagnosis of high-grade squamous intraepithelial lesions (HSILs), given the significant risk of progression to invasive cervical cancer and the importance to patient management. Therefore, this review is presented in order to highlight the diagnostic features of HSIL, its various appearances, and important benign and neoplastic differential considerations with an emphasis on morphological clues that can aid in distinguishing between these different processes.
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Affiliation(s)
- Vanda F Torous
- Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
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Azimi T, Paryan M, Mondanizadeh M, Sarmadian H, Zamani A. Pap Smear miR-92a-5p and miR-155-5p as potential diagnostic biomarkers of squamous intraepithelial cervical cancer. Asian Pac J Cancer Prev 2021; 22:1271-1277. [PMID: 33906322 PMCID: PMC8325111 DOI: 10.31557/apjcp.2021.22.4.1271] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 04/20/2021] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND one of the female-specific diseases with a high incidence and mortality is cervical cancer. The main cause of cervical cancer is infection with Human papilloma virus (HPV). Low-grade squamous intraepithelial lesions (LSIL) and High-grade squamous intraepithelial lesions (HSIL) usually is caused by an HPV infection. Considering the role of microRNAs (miRNAs) as diagnostic biomarkers for a variety of cancers, the aim of this study was to determine miR-92a-5p and miR-155-5p expression levels in LSIL and HSIL Pap Smear samples. METHODS After initial bioinformatic studies, A total of 75 samples (25 samples of patients with LSIL, 25 patients with HSIL and 25 healthy individuals) were subjected to RNA extraction and cDNA synthesis. The expressions levels of confirmed miRNAs in samples of patients with LSIL, HSIL and healthy individuals were evaluated by Real time PCR analysis. To demonstration the role of predicted miRNAs as novel biomarkers in diagnosis of LSIL and HSIL, ROC curve analysis was done. RESULTS Bioinformatics results showed that miR-92a-5p and miR-155-5p target the HPV E6 and E7 genes. The expression levels of these miRNAs were strikingly higher in Pap smear of patients with LSIL than in the healthy individuals (35.36, P = 0.001) (62.23, P = 0.001). Similarity, expression levels of miR-92a-5p and miR-155-5p were amazingly higher in patients with HSIL than in the healthy individuals (33.62, P= 0.001) (69.07, P= 0.001). Although, the levels of miR-92a-5p (0.95, P = 0. 85) and miR-155-5p (1.11, P = 0.84) exhibited no statistical differences between patients with LSIL and HSIL. Also, ROC curve analyses verified that miR-92a-5p and miR-155-5p are specific and sensitive and may serve as new biomarkers for the early detection of cervical cancer. CONCLUSION These data suggest miR-92a-5p and miR-155-5p, which are upregulated in LSIL and HSIL, can be consider as predictive biomarkers for the prognosis of cervical cancer patients. .
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Affiliation(s)
- Tahereh Azimi
- Department of Biotechnology and Molecular Medicine, Arak University of Medical Sciences, Arak, Iran.
| | - Mahdi Paryan
- Department of Research and Development, Production and Research Complex, Pasteur Institute of Iran, Tehran, Iran.
| | - Mahdieh Mondanizadeh
- Department of Biotechnology and Molecular Medicine, Arak University of Medical Sciences, Arak, Iran.
- Molecular and Medicine Research Center, Arak University of Medical Sciences, Arak, Iran.
| | - Hossian Sarmadian
- Department of Infectious Diseases Research Center, School of Medicine, Arak University of Medical Sciences, Arak, Iran.
| | - Ashraf Zamani
- Department of Obstetrics and Gynecology, School of Medicine, Arak University of Medical Sciences, Arak, Iran.
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Loopik DL, Koenjer LM, Siebers AG, Melchers WJG, Bekkers RLM. Benefit and burden in the Dutch cytology-based vs high-risk human papillomavirus-based cervical cancer screening program. Am J Obstet Gynecol 2021; 224:200.e1-200.e9. [PMID: 32800820 DOI: 10.1016/j.ajog.2020.08.026] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [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: 04/22/2020] [Revised: 07/16/2020] [Accepted: 08/11/2020] [Indexed: 01/11/2023]
Abstract
BACKGROUND In 2017, the Dutch cervical cancer screening program had replaced the primary cytology-based screening with primary high-risk human papillomavirus-based screening, including the opportunity to participate through self-sampling. Evaluation and balancing benefit (detection of high-grade cervical intraepithelial neoplasia) and burden of screening (unnecessary referrals, invasive diagnostics, and overtreatment) is needed. OBJECTIVE This study aimed to compare the referral rates, detection of high-grade cervical intraepithelial neoplasia, overdiagnosis, and overtreatment in the new high-risk human papillomavirus-based screening program, including physician-sampled and self-sampled material, with the previous cytology-based screening program in the Netherlands. STUDY DESIGN A retrospective cohort study was conducted within the Dutch population-based cervical cancer screening program. Screenees with referrals for colposcopy between 2014 and 2015 (cytology-based screening) and 2017 and 2018 (high-risk human papillomavirus-based screening) were included. Data were retrieved from the Dutch Pathology Registry (PALGA) and compared between the 2 screening programs. The main outcome measures were referral rate, detection of high-grade cervical intraepithelial neoplasia or worse, overdiagnosis (cervical intraepithelial neoplasia grade 1 or less in the histologic specimen), and overtreatment (cervical intraepithelial neoplasia grade 1 or less in the treatment specimen). RESULTS Of the women included in the study, 19,109 received cytology-based screening, and 26,171 received high-risk human papillomavirus-based screening. Referral rates increased from 2.5% in cytology-based screening to 4.2% in high-risk human papillomavirus-based screening (+70.2%). Detection rates increased to 46.2% for cervical intraepithelial neoplasia grade 2 or worse, 32.2% for cervical intraepithelial neoplasia grade 3 or worse, and 31.0% for cervical cancer, and overdiagnosis increased to 143.4% with high-risk human papillomavirus-based screening. Overtreatment rates were similar in both screening periods. The positive predictive value of referral for detection of cervical intraepithelial neoplasia grade 2 or worse in high-risk human papillomavirus-based screening was 34.6% compared with 40.2% in cytology-based screening. Women screened through self-sampling were at higher risk of cervical intraepithelial neoplasia grade 2 or worse detection (odds ratio, 1.38; 95% confidence interval, 1.20-1.59) and receiving treatment (odds ratio, 1.31; 95% confidence interval, 1.16-1.48) than those screened through physician-sampling. CONCLUSION Compared with cytology-based screening, high-risk human papillomavirus-based screening increases detection of high-grade cervical intraepithelial neoplasia, with 462 more cervical intraepithelial neoplasia grade 2 or worse cases per 100,000 women but at the expense of 850 more cases per 100,000 women with invasive diagnostics indicating cervical intraepithelial neoplasia grade 1 or less.
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Affiliation(s)
- Diede L Loopik
- Department of Obstetrics and Gynaecology, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, the Netherlands.
| | - Lisanne M Koenjer
- Department of Obstetrics and Gynaecology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Albert G Siebers
- Department of Pathology, Radboud University Medical Center, Nijmegen, the Netherlands; PALGA Foundation, Houten, the Netherlands
| | - Willem J G Melchers
- Department of Medical Microbiology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Ruud L M Bekkers
- Department of Obstetrics and Gynaecology, Catharina Hospital, Eindhoven, the Netherlands; Department of Obstetrics and Gynaecology, GROW, School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, the Netherlands
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Bruehl FK, Dyhdalo KS, Hou Y, Clapacs E, Przybycin CG, Reynolds JP. Cytology and curetting diagnosis of endocervical adenocarcinoma. J Am Soc Cytopathol 2020; 9:556-562. [PMID: 32624383 DOI: 10.1016/j.jasc.2020.05.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 04/09/2020] [Revised: 05/06/2020] [Accepted: 05/11/2020] [Indexed: 12/29/2022]
Abstract
INTRODUCTION Papanicolaou testing is effective in identifying squamous intraepithelial lesions of the cervix. Endocervical adenocarcinoma (EAC) and adenocarcinoma in situ (AIS) are far less commonly identified. Endocervical curettings (ECCs) are usually obtained after colposcopic biopsy, sample the endocervical canal, and aid in the detection of endocervical glandular lesions. Here, we examine the utility of Papanicolaou testing and endocervical curetting for detecting AIS and EAC. MATERIALS AND METHODS Cases from 2007 to 2019 with a histologically confirmed diagnosis of AIS and EAC were identified and the clinical data and diagnostic material, including the cytology and surgical specimens, obtained. RESULTS A total of 108 cases of AIS and EAC were identified, Papanicolaou tests were performed in 97 of these cases, and ECC in 87. AIS or EAC were detected in 46.4% of Papanicolaou tests; 41.4% of ECC showed AIS or EAC. A total of 92.7% of cases were positive for high-risk human papillomavirus (HPV) and concurrent squamous intraepithelial lesion was present in 53.3% of cases. AIS or EAC were more commonly identified in cases without concurrent squamous intraepithelial lesions. CONCLUSIONS Papanicolaou testing and endocervical curettings have a low detection rate for AIS and EAC. The majority of AIS and EAC cases test positive for high-risk HPV. Papanicolaou test and ECC show different detection rates and are complementary tools in patients with AIS and EAC. In some settings, an ECC can increase the diagnostic sensitivity and specificity of the pathologic diagnosis.
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Affiliation(s)
- Frido K Bruehl
- Robert J. Tomsich Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, Ohio
| | - Kathryn S Dyhdalo
- Robert J. Tomsich Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, Ohio
| | - Yanjun Hou
- Robert J. Tomsich Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, Ohio
| | - Elisha Clapacs
- Robert J. Tomsich Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, Ohio
| | - Christopher G Przybycin
- Robert J. Tomsich Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, Ohio
| | - Jordan P Reynolds
- Robert J. Tomsich Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, Ohio.
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Vasques RB, Carramenha LL, Basílio I, Leão MEB, Carvalho GPSL, Amaral RMC, Rezende-Filho J, Guerra Neto NGM, Furtado YL. Evaluation of uterine cervical cancer in pregnancy: A cross-sectional study. Eur J Obstet Gynecol Reprod Biol 2020; 246:35-39. [PMID: 31927408 DOI: 10.1016/j.ejogrb.2019.12.030] [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: 06/13/2019] [Revised: 12/10/2019] [Accepted: 12/23/2019] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Evaluate the prevalence and the regression rate of cytological alteration in pregnant patients below the recommended age by the Brazilian Guidelines for the Screening of Uterine Cervical Cancer Guideline in the prenatal service of Maternidade Escola da Universidade Federal do Rio de Janeiro. STUDY DESIGN We included the cytopathological exams of all pregnant patients that attended on the outpatient from January 2010 to May 2016. For the identification of the pregnant women, the Management and Integrated System and the Uterine Cervical Cancer Information System of the institution were used. We performed X2 test. The level of significance was 0.05. RESULTS The study totaled 5825 cytopathological exams, of which 1822 were from pregnant patients ≤ 24 years of age. Only 4.06 % (74/1822) of altered results were found (p < 0.05). The most frequent change was low-grade squamous intraepithelial lesion with a prevalence of 1.92 % (35/1822) whereas high-grade squamous intraepithelial lesion had 0.16 % (3/1822). The regression rate in pregnant patients ≤24 years of age was 34,32 %. CONCLUSION There was a low prevalence of cytological abnormalities in pregnant patients ≤ 24 years, low frequency of high-grade squamous intraepithelial lesion among the altered cytologies and a high spontaneous regression rate, therefore screening is not recommended before the age determined by the Brazilian Guideline.
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Affiliation(s)
- Rafaela B Vasques
- Universidade Federal do Estado do Rio de Janeiro - UNIRIO, Rio de Janeiro, Rio de Janeiro, Brazil.
| | - Luiza L Carramenha
- Instituto de Ginecologia da Universidade Federal do Rio de Janeiro (IG-UFRJ), Rio de Janeiro, Rio de Janeiro, Brazil; Maternidade Escola da Universidade Federal do Rio de Janeiro (ME-UFRJ), Rio de Janeiro, Rio de Janeiro, Brazil
| | - Ivo Basílio
- Maternidade Escola da Universidade Federal do Rio de Janeiro (ME-UFRJ), Rio de Janeiro, Rio de Janeiro, Brazil
| | - Maria Eduarda B Leão
- Instituto de Ginecologia da Universidade Federal do Rio de Janeiro (IG-UFRJ), Rio de Janeiro, Rio de Janeiro, Brazil; Maternidade Escola da Universidade Federal do Rio de Janeiro (ME-UFRJ), Rio de Janeiro, Rio de Janeiro, Brazil
| | - Gabriela P S L Carvalho
- Instituto de Ginecologia da Universidade Federal do Rio de Janeiro (IG-UFRJ), Rio de Janeiro, Rio de Janeiro, Brazil; Maternidade Escola da Universidade Federal do Rio de Janeiro (ME-UFRJ), Rio de Janeiro, Rio de Janeiro, Brazil
| | - Raquel M C Amaral
- Instituto de Ginecologia da Universidade Federal do Rio de Janeiro (IG-UFRJ), Rio de Janeiro, Rio de Janeiro, Brazil
| | - Jorge Rezende-Filho
- Maternidade Escola da Universidade Federal do Rio de Janeiro (ME-UFRJ), Rio de Janeiro, Rio de Janeiro, Brazil
| | - Nereu G M Guerra Neto
- Instituto de Ginecologia da Universidade Federal do Rio de Janeiro (IG-UFRJ), Rio de Janeiro, Rio de Janeiro, Brazil
| | - Yara L Furtado
- Universidade Federal do Estado do Rio de Janeiro - UNIRIO, Rio de Janeiro, Rio de Janeiro, Brazil; Instituto de Ginecologia da Universidade Federal do Rio de Janeiro (IG-UFRJ), Rio de Janeiro, Rio de Janeiro, Brazil
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Karia N, Van Loon A, Simoens C, Benoy I, Bogers J. The Positive Predictive Value of High-Grade Squamous Intraepithelial Lesion on Cytology for the Histological Diagnosis of Cervical Intraepithelial Neoplasia 2 or Higher: A Systematic Review. Acta Cytol 2019; 63:206-214. [PMID: 30947186 DOI: 10.1159/000497110] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [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: 10/12/2018] [Accepted: 01/20/2019] [Indexed: 12/17/2022]
Abstract
Cervical cancer is a major worldwide health problem. Therefore, regular cervical screening in order to make an early diagnosis can help to prevent cervical cancer, through identifying and treating preinvasive cervical lesions. The aim of this review is to evaluate the correlation between the cytological screening result and the final gold standard histological outcome in the diagnosis of cervical lesions. More specifically, the correlation between high-grade intraepithelial lesion (HSIL) on cytology and histological cervical intraepithelial neoplasia grade 2 or higher (CIN2+) was intended, by calculating the positive predictive value (PPV). PPV is an important value from a clinical point of view. An electronic search was carried out in the electronic databases MEDLINE (through PubMed) and the Cochrane Library (last searched beginning of December 2017), supplemented with the related article feature in PubMed and snowballing. Article selection (predefined inclusion and exclusion criteria) and data extraction were evaluated by two independent reviewers (N.K. and A.V.L.). After identifying 1,146 articles, 27 articles were finally included in this systematic review, representing 28,783 cytological HSIL diagnoses in total. The PPV of HSIL was 77.5% (range: 45.4-95.2%) for the histological diagnosis of CIN2+ and 55.4% (range: 36.4-67.6%) for the diagnosis of CIN3+. In this systematic review, 77.5% of the HSIL-positive women eventually had a CIN2+ diagnosis. The diagnostic value of a cytological HSIL result (conventional or liquid-based cytology) in the diagnosis of CIN2+ lesions is good, but a combination of tests could raise this value.
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Affiliation(s)
- Nina Karia
- AMBIOR, Laboratory of Cell Biology and Histology, University of Antwerp, Antwerp, Belgium,
| | - Alison Van Loon
- AMBIOR, Laboratory of Cell Biology and Histology, University of Antwerp, Antwerp, Belgium
| | - Cindy Simoens
- AMBIOR, Laboratory of Cell Biology and Histology, University of Antwerp, Antwerp, Belgium
| | - Ina Benoy
- AMBIOR, Laboratory of Cell Biology and Histology, University of Antwerp, Antwerp, Belgium
- Laboratory of Molecular Pathology, Antwerp, Belgium
- National Reference Centre for HPV, Brussels, Belgium
| | - Johannes Bogers
- AMBIOR, Laboratory of Cell Biology and Histology, University of Antwerp, Antwerp, Belgium
- Laboratory of Molecular Pathology, Antwerp, Belgium
- National Reference Centre for HPV, Brussels, Belgium
- International Centre for Reproductive Health, Ghent University, Ghent, Belgium
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Srisomboon S, Tantipalakorn C, Charoenkwan K, Srisomboon J. Cervical Screening Results Leading to Detection of Adenocarcinoma in Situ of the Uterine Cervix. Asian Pac J Cancer Prev 2019; 20:377-382. [PMID: 30803195 PMCID: PMC6897002 DOI: 10.31557/apjcp.2019.20.2.377] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Accepted: 01/18/2019] [Indexed: 11/25/2022] Open
Abstract
Background: Adenocarcinoma in situ (AIS) of the uterine cervix is a preinvasive lesion of the invasive adenocarcinoma. We analyzed the cervical screening results leading to detecting the AIS lesions including the coexistence of AIS lesions with high-grade squamous intra-epithelial lesions (HSIL) and invasive carcinoma. Methods: Women who were diagnosed and received treatment for AIS at Chiang Mai University Hospital between January 1, 2007 and August 31, 2016 were retrospectively reviewed. The inclusion criteria were the women who had pathological diagnosis of AIS obtained from cervical punch biopsy or excisional cone biopsy with either loop electrosurgical excision procedure (LEEP) or cold-knife conization (CKC). The patient characteristics, diagnostic work-up and treatment details were reviewed, including the cervical screening results prior to the diagnosis of cervical AIS, pathologic results of excisional cone biopsy and hysterectomy specimens. Results: During the study period, 75 women with AIS pathology undergoing excisional cone biopsy with either LEEP (n=62) or CKC (n=13) were identified. The abnormal cytologic screening leading to detection of AIS was the squamous cell abnormality accounting for 57.3%. Abnormal glandular cytology accounted for 37.3%. The most common abnormal cervical screening results was HSIL cytology (n = 25) followed by AIS cytology (n = 13). Normal cytology was noted in 4 women in whom 3 were positive for HPV 18 and 1 had AIS on the endocervical polyp. AIS coexisted with HSIL and invasive carcinoma were detected in cone biopsy specimens in 21 (28%) and 29 (38.7%) patients, respectively. Conclusion: The majority of cervical screening results leading to detection of cervical AIS was the squamous cell abnormality accounting for 57.3% in which, HSIL cytology was the most common. Abnormal glandular cytology accounted for only 37.3%. Diagnostic cone excision is recommended if AIS lesion is noted in cervical biopsy specimen since nearly 40% have coexisting invasive lesions.
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Affiliation(s)
- Santipap Srisomboon
- Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University, Chiang aMai, Thailand.
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10
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Pyo JS, Kang G, Yoon HK, Kim HJ. Diagnostic Test Accuracy Review of Cytology for Squamous Intraepithelial Lesion and Squamous Cell Carcinoma of Uterine Cervix. J Korean Med Sci 2019; 34:e16. [PMID: 30636946 PMCID: PMC6327093 DOI: 10.3346/jkms.2019.34.e16] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Accepted: 10/25/2018] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Even though cervico-vaginal smears have been used as a primary screening test for cervical carcinoma, the diagnostic accuracy has been controversial. The present study aimed to evaluate the diagnostic accuracy of cytology for squamous intraepithelial lesion (SIL) and squamous cell carcinoma (SqCC) of the uterine cervix through a diagnostic test accuracy (DTA) review. METHODS A DTA review was performed using 38 eligible studies that showed concordance between cytology and histology. In the DTA review, sensitivity, specificity, diagnostic odds ratio (OR), and the area under the curve (AUC) on the summary receiver operating characteristic (SROC) curve were calculated. RESULTS In the comparison between abnormal cytology and histology, the pooled sensitivity and specificity were 93.9% (95% confidence interval [CI], 93.7%-94.1%) and 77.6% (95% CI, 77.4-77.8%), respectively. The diagnostic OR and AUC on the SROC curve were 8.90 (95% CI, 5.57-14.23) and 0.8148, respectively. High-grade squamous intraepithelial lesion (HSIL) cytology had a higher sensitivity (97.6%; 95% CI, 94.7%-97.8%) for predicting HSIL or worse histology. In the comparison between SqCC identified on cytology and on histological analysis, the pooled sensitivity and specificity, diagnostic OR, and AUC were 92.7% (95% CI, 87.3%-96.3%), 87.5% (95% CI, 87.2%-87.8%), 865.81 (95% CI, 68.61-10,925.12), and 0.9855, respectively. Geographic locations with well-organized screening programs had higher sensitivity than areas with insufficient screening programs. CONCLUSION These results indicate that cytology had a higher sensitivity and specificity for detecting SIL and SqCC of the uterine cervix during primary screening.
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Affiliation(s)
- Jung-Soo Pyo
- Department of Pathology, Eulji University Hospital, Eulji University School of Medicine, Daejeon, Korea
| | - Guhyun Kang
- Department of Pathology, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea
| | - Hye Kyoung Yoon
- Department of Pathology, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Hyun Jung Kim
- Department of Pathology, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea
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Thapa N, Maharjan M, Shrestha G, Maharjan N, Lindell D, Zuo N, Yang J, Maskey N, Cai H. Accuracy of Visual Tests for Primary Cervical Cancer Screening in Rural Nepal. JNMA J Nepal Med Assoc 2018. [PMID: 31065135 PMCID: PMC8827605 DOI: 10.31729/jnma.3857] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Introduction In Nepal, cervical cancer is the most common female cancer. Unfortunately, there is no uniform effective screening system available all around the country. The objective of this study is to evaluate the cytology, Visual Inspection with Acetic Acid and with Lugol's Iodine alone or in combination to detect a pre-cancerous lesion in rural Nepal. Methods It is an analytical cross-sectional study. Convenience sampling technique was used to select participants who were apparently healthy, married, non- pregnant women of aged 20–65 years for cervical cancer screening program. Screening tests were performed on all eligible women (n=2143) after socio-demographic and reproductive health data collection. A biopsy was applied as a gold standard test. Cross-tabulations were used to describe the test sensitivity, specificity, positive predictive value, and negative predictive value at a 95% confidence interval. Diagnostic odds ratio was also calculated. Results A majority, 2143 (94%), of women accepted and participated in this study. The sensitivity vs specificity of cytology, VIA, and VILI was 57.1% vs 98.3%, 71.4% vs 88.8% and 78.6% vs 85.1%, and of the co-testing of ‘Both positive VIA and VILI’ and ‘Either positive VIA or VILI’ was 64.3% vs 85.7% and 90.1% vs 83.7% respectively. Negative predictive value of all tests exceeded 99.7%. Cytology had the highest Diagnostic odds ratio (64.9), followed by the co-test ‘Either positive VIA or VILI’ (27.7). Conclusions Cervical cancer screening by co-testing ‘Either positive VIA or VILI’ is more useful than cytology; VIA and or VILI are easy, safe, feasible and well-accepted tests in a low resource setting, Nepal.
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Affiliation(s)
- Niresh Thapa
- Department of Gynecological Oncology, Zhongnan Hospital of Wuhan University, Hubei Cancer Clinical Study Center, Hubei Key Laboratory of Tumor Biological Behaviors, Wuhan, P. R. China
- Karnali Academy of Health Sciences, Jumla, Nepal
| | - Muna Maharjan
- HOPE School of Nursing, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China
| | | | - Narayani Maharjan
- Department of Clinical Laboratory Science, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China
| | - Deborah Lindell
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio, USA
| | - Na Zuo
- Department of Gynecological Oncology, Zhongnan Hospital of Wuhan University, Hubei Cancer Clinical Study Center, Hubei Key Laboratory of Tumor Biological Behaviors, Wuhan, P. R. China
| | - Jing Yang
- Department of Gynecological Oncology, Zhongnan Hospital of Wuhan University, Hubei Cancer Clinical Study Center, Hubei Key Laboratory of Tumor Biological Behaviors, Wuhan, P. R. China
| | - Ninu Maskey
- Department of Haemato-Pathology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Hongbing Cai
- Department of Gynecological Oncology, Zhongnan Hospital of Wuhan University, Hubei Cancer Clinical Study Center, Hubei Key Laboratory of Tumor Biological Behaviors, Wuhan, P. R. China
- Correspondence: Dr. Hongbing Cai, Department of Gynecological Oncology, Zhongnan Hospital of Wuhan University, Hubei Cancer Clinical Study Center, Hubei Key Laboratory of Tumor Biological Behaviors, Wuhan, P. R. China. , Phone: +86-13397168990
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Bozdag Z, Taslar AM, Tepe NB, Dizibuyuk OF, Ozcan HC, Karakök M. The re-awakening of hCG expression. Its role in the diagnosis of cervical squamous cell carcinoma. Saudi Med J 2018; 39:873-877. [PMID: 30251729 PMCID: PMC6201007 DOI: 10.15537/smj.2018.9.22710] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objectives: To compare immunohistochemical detection of Human chorionic gonadotropin (hCG) expression in paraffin embedded tissue of squamous cell carcinomas (SCC) and high grade squamous intraepithelial lesions (HSIL). Methods: The samples in this retrospective study were obtained from the archives of the Pathology Department at Gaziantep University, Gaziantep, Turkey, over the period from January 2012 to September 2016. The study group consisted of 55 cases of SCC and 45 cases of HSIL. Tissue expression of hCG was detected by specific binding of anti-hCG antibody using an automated immunohistochemistry staining device. The categorical variables of intensity and coverage were analyzed statistically using Pearson Chi-Square test. Results: High grade squamous cell lesions cases showed weak (84.4%, n=38/45) to no (15.6%, n=7/45) staining for hCG. None of the HSIL cases showed strong positivity. Strong positivity for hCG was detected in 90.9% (n=50/55) of SCC cases. Conclusion: Our study supports the association of ectopic hCG expression in cancer pathogenesis by demonstrating strong hCG immunoreactivity only in SCC cases. This finding can be helpful in supporting the diagnosis of invasive carcinoma in small or fragmented biopsies, which can on their own be confusing for the pathologists.
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Affiliation(s)
- Zehra Bozdag
- Department of pathology, Faculty of Medicine, Gaziantep University. E-mail.
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Des Marais AC, Zhao Y, Hobbs MM, Barclay L, Brewer NT, Smith JS. Home Self-Collection by Mail to Test for Human Papillomavirus and Sexually Transmitted Infections. Obstet Gynecol 2018; 132:1412-1420. [PMID: 30399091 PMCID: PMC6249061 DOI: 10.1097/aog.0000000000002964] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
OBJECTIVE To evaluate the validity and acceptability of at-home self-collection to test for high-risk human papillomavirus (HPV) and sexually transmitted infections among women overdue for cervical cancer screening by national guidelines. METHODS Low-income, infrequently screened women were recruited from the general population in North Carolina to participate in an observational study. Participants provided two self-collected cervicovaginal samples (one at home and one in the clinic) and a clinician-collected cervical sample. Samples were tested for high-risk HPV, Chlamydia trachomatis, Neisseria gonorrhoeae, Trichomonas vaginalis, and Mycoplasma genitalium. Cervical samples were also tested by liquid-based cytology. RESULTS Overall, 193 women had conclusive high-risk HPV results for all three samples and cytology results. Prevalence of high-risk HPV within self-home samples (12.4%) was not different from that within clinician samples (11.4%; P=.79) and from that within self clinic samples (15.5%; P=.21). Positivity for high-risk HPV in all sample types increased with increasing grades of cervical abnormality (P<.001). Self-home samples detected high-risk HPV in all identified cases of high-grade squamous intraepithelial lesions and of cervical intraepithelial neoplasia 2 or worse. Detection was comparable across sample types for T vaginalis (range 10.2-10.8%), M genitalium (3.3-5.5%), C trachomatis (1.1-2.1%), and N gonorrhoeae (0-0.5%). Kappa values between sample types ranged from 0.56 to 0.66 for high-risk HPV, 0.86-0.91 for T vaginalis, and 0.65-0.83 for M genitalium. Most participants reported no difficulty understanding self-collection instructions (93.6%) and were willing to use self-collection in the future (96.3%). CONCLUSION Mail-based, at-home self-collection for high-risk HPV and sexually transmitted infection detection was valid and well accepted among infrequently screened women in our study. These findings support the future use of high-risk HPV self-collection to increase cervical cancer screening rates among higher risk women in the United States.
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Affiliation(s)
- Andrea C. Des Marais
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC
| | - Yuqian Zhao
- Department of Cancer Epidemiology, Cancer Hospital, Chinese Academy of Medical Sciences (CAMS) & Peking Union Medical College (PUMC), National Cancer Centre, Beijing, China
| | - Marcia M. Hobbs
- School of Medicine, University of North Carolina, Chapel Hill, NC
| | | | - Noel T. Brewer
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill
| | - Jennifer S. Smith
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC
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Shachner TR, Van Meter SE. Metastatic melanoma of the uterine cervix diagnosed on cervical Pap smear: Case report and literature review. Diagn Cytopathol 2018; 46:1045-1049. [PMID: 30354020 DOI: 10.1002/dc.24058] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [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: 05/27/2018] [Revised: 07/15/2018] [Accepted: 07/25/2018] [Indexed: 02/03/2023]
Abstract
Metastatic cancer involving the uterine cervix is exceedingly rare, and accounts for less than 1% of cancer deaths. The cervix is an uncommon location for metastatic lesions due to its limited blood supply and fibrous stroma and metastatic melanoma of the cervix is particularly infrequent. To the best of our knowledge and literature review, there have only been nine reported cases in the literature of metastatic melanoma involving the uterine cervix that were diagnosed via cervicovaginal Pap smears, including the case being reported in this paper. Diagnosing metastatic melanoma on cervicovaginal cytology specimens is challenging, not only because of its rarity, but also because of the inherent ability of melanoma to take on many different cytomorphologic appearances. In such cases, the differential diagnosis may include a high-grade squamous intraepithelial lesion, atypical glandular cells, adenocarcinoma and other poorly differentiated malignancies. We report a case of malignant melanoma to the cervix diagnosed by a routine cervical Pap smear in a young woman who was diagnosed with cutaneous melanoma 3 years prior. Because of the diagnosis rendered on her cervical Pap smear, she was subsequently found to have widespread metastatic disease. Although the cervical Pap smear is primarily intended to screen for squamous intraepithelial lesions, a high index of suspicion must be maintained for other less common entities, particularly when there is no evidence of a squamous intraepithelial lesion.
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Affiliation(s)
- Tracy R Shachner
- Department of Pathology, University of Tennessee Medical Center, Knoxville, Tennessee
| | - Stuart E Van Meter
- Department of Pathology, University of Tennessee Medical Center, Knoxville, Tennessee
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Ebisch RMF, Ketelaars PJW, van der Sanden WMH, Schmeink CE, Lenselink CH, Siebers AG, Massuger LFAG, Melchers WJG, Bekkers RLM. Screening for persistent high-risk HPV infections may be a valuable screening method for young women; A retrospective cohort study. PLoS One 2018; 13:e0206219. [PMID: 30356297 PMCID: PMC6200272 DOI: 10.1371/journal.pone.0206219] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Accepted: 10/09/2018] [Indexed: 11/18/2022] Open
Abstract
Introduction Screening of young women is often discouraged because of the high risk of unnecessary diagnostics or overtreatment. Multiple countries therefore use cytology instead of high risk human papillomavirus (hrHPV)-testing as screening method for young women because of the limited specificity of hrHPV-testing. The objective of this study was to investigate how hrHPV screening before the age of 30, can be used to reduce the future prevalence of high-grade cervical lesions in young women. Methods We retrospectively analyzed follow-up data from a cohort study on HPV prevalence in unscreened Dutch women aged 18–29 years. Women performed multiple self-collected cervico-vaginal samples for HPV detection and genotyping. At least one valid cervical pathology result was obtained from 1,018 women. Women were categorized as hrHPV negative, cleared- or persistent hrHPV infection. Anonymized follow-up data for each group was obtained. Composite outcome measures were defined as; normal, low-grade squamous intraepithelial lesion (LSIL) or high-grade squamous intraepithelial lesion (HSIL). The association between prior hrHPV status and cytology and histology outcome was analyzed. Results After exclusion, a pathology result was registered for 962 women. The prevalence of HSIL was 19.3% in women with a persistent HPV infection at a younger age. This is significantly higher (p<0,001) compared with the HSIL prevalence of 1.5% in HPV-negative women, and 3.1% (n = 8) in women who cleared the hrHPV infection in the past. Conclusion Women with a persistent hrHPV infection in their 20s, show an increased prevalence of HSIL lesions in their early 30s. Screening for persistent hrHPV infections, instead of cytology screening before the age of 30, can be used to reduce the future prevalence of cervical cancer in young women.
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Affiliation(s)
- Renée M. F. Ebisch
- Department of Obstetrics and Gynaecology, Radboud university medical center, Nijmegen, the Netherlands
- * E-mail:
| | - Pleun J. W. Ketelaars
- Department of Obstetrics and Gynaecology, Radboud university medical center, Nijmegen, the Netherlands
| | | | - Channa E. Schmeink
- Department of Obstetrics and Gynaecology, Radboud university medical center, Nijmegen, the Netherlands
| | | | - Albert G. Siebers
- Department of Pathology, Radboud university medical center, Nijmegen, the Netherlands
| | - Leon F. A. G. Massuger
- Department of Obstetrics and Gynaecology, Radboud university medical center, Nijmegen, the Netherlands
| | - Willem J. G. Melchers
- Department of Medical Microbiology, Radboud university medical center, Nijmegen, the Netherlands
| | - Ruud L. M. Bekkers
- Department of Obstetrics and Gynaecology, Radboud university medical center, Nijmegen, the Netherlands
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Thamsborg LH, Napolitano G, Larsen LG, Lynge E. Impact of HPV vaccination on outcome of cervical cytology screening in Denmark-A register-based cohort study. Int J Cancer 2018; 143:1662-1670. [PMID: 29707775 PMCID: PMC6175001 DOI: 10.1002/ijc.31568] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Revised: 04/04/2018] [Accepted: 04/19/2018] [Indexed: 12/12/2022]
Abstract
4vHPV vaccination has been tested in randomized controlled trials under almost ideal conditions, and studies of real-life use have compared outcome between vaccinated and unvaccinated women from the same birth cohort and mostly before screening age. Here we present the first-to our knowledge-evaluation of the impact of the 4vHPV vaccination in real life without selection bias in the reported data. The study has been carried out by comparing the results after first cervical screening between an HPV-vaccinated and an unvaccinated birth cohort, consisting of women born in Denmark in 1993 and 1983, respectively. Cytology data covering an 8-year period, from the age of 15 (age of HPV-vaccination) to age 23 (age of invitation to first cervical screening), were retrieved from the Danish National Pathology Register. Abnormal cytology, defined as atypical squamous cell of undetermined significance and worse (ASCUS+) was detected in 9.4% of women born in 1993 as compared with 9.0% of women born in 1983; RR = 1.04 (95% CI 0.96-1.12), p = .29. Detection of high-grade squamous intraepithelial lesion (HSIL) was statistically significantly lower in the 1993 than in the 1983 cohort, RR = 0.6 (95% CI 0.5-0.7), p < .0001, while the opposite pattern was seen for ASCUS RR = 1.4 (95% CI 1.2-1.6), p < .0001. The decrease in HSIL means that more women can be spared referral for colposcopy and biopsy. The increase of ASCUS could be explained by transition from conventional to liquid-based cytology, but this observation requires further monitoring.
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Affiliation(s)
| | - George Napolitano
- Department of Public HealthUniversity of CopenhagenCopenhagen1014Denmark
| | - Lise Grupe Larsen
- Department of PathologyZealand University HospitalRoskilde4000Denmark
| | - Elsebeth Lynge
- Nykøbing Falster HospitalUniversity of CopenhagenEjegodvej 63DK‐4800Denmark
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Wilkin TJ. Human papillomavirus-related malignancies in HIV infection: anal and oropharyngeal cancers. Top Antivir Med 2018; 26:85-88. [PMID: 30384331 PMCID: PMC6291297] [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] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Human papillomavirus (HPV)-related cancers, including anal cancer and oropharyngeal cancer, occur more frequently in individuals living with HIV infection than in the general population. Strategies for prevention among individuals with HIV infection include HPV vaccination, anal cancer screening programs, and early initiation of antiretroviral therapy (ART). HPV vaccination is not yet optimally used; a stronger and more persistent effort is needed to increase vaccination rates. Although anal cancer screening is not recommended by all authorities, there is a least some evidence that screening and treatment of anal high-grade squamous intraepithelial lesions may prevent progression to cancer. However, more definitive evidence is needed. Early initiation of ART reduces the risk of infection-related cancers, with some evidence of benefit in preventing HPV-associated cancer in individuals with HIV infection. This article summarizes a presentation by Timothy J. Wilkin, MD, MPH, at the IAS-USA continuing education program held in Los Angeles, California in April 2018.
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Wu MZ, Li WN, Cha N, Tian LX, Zhang YI, Wu X, Guo KJ, Wu GP. Diagnostic Utility of HPV16 E6 mRNA or E7 mRNA Quantitative Expression for Cervical Cells of Patients with Dysplasia and Carcinoma. Cell Transplant 2018; 27:1401-1406. [PMID: 30056761 PMCID: PMC6168995 DOI: 10.1177/0963689718788521] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Current human papillomavirus (HPV)16 DNA testing has high sensitivity but low specificity, while mRNA testing (qualitative) improves the specificity. However, both techniques are not able to discriminate between transient and persistent infections. To overcome the disadvantages, we quantitatively detected E6 and E7 mRNAs by quantitative real-time polymerase chain reaction (qRT-PCR) in cervical brushing cells from 87 HPV16+ and 31 HPV16− patients. Our results showed that the expression levels of E6 mRNA or E7 mRNA were significantly increased in HPV16-positive cases than that in the negative cases. Furthermore, in HPV16+ cases, the expression levels of E6 mRNA were significantly increased in invasive cancer compared with high-grade squamous intraepithelial lesion (HSIL; p < 0.01), and HSIL compared with low-grade squamous intraepithelial lesion (LSIL; p < 0.01). There were no significant changes between LSIL and benign lesions. The expression levels of E7 mRNA presented no significant difference among the above-mentioned four groups. To test whether qRT-PCR can discriminate between transient and persistent infections, 57 HPV16+ patients were followed up for 1 year, and our results demonstrated that the expression levels of both E6 mRNA and E7 mRNA in the persistent infection group were significantly increased relative to the transient infection group (p < 0.01 or 0.05). Thus, a quantitative detection of the expression levels of E6 mRNA in cervical brushing cells may not only be used as an ancillary tool to cytological diagnosis of cervical neoplasia, but may also help to determine the severity of the lesions and the triage of transient infection.
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Affiliation(s)
- Ming-Zhe Wu
- Department of Gynecology, The First Affiliated Hospital, China Medical University, Shenyang, China
| | - Wei-Nan Li
- Department of Pathology, The First Affiliated Hospital and College of Basic Medical Sciences, China Medical University, Shenyang, China
| | - Na Cha
- Department of Pathology, Changchun Obstetrics-Gynecology Hospital, Changchun, China
| | - Li-Xiang Tian
- Department of Pathology, Changchun Obstetrics-Gynecology Hospital, Changchun, China
| | - YI Zhang
- Department of Gynecology, The First Affiliated Hospital, China Medical University, Shenyang, China
| | - Xin Wu
- Department of Gynecology, The First Affiliated Hospital, China Medical University, Shenyang, China
| | - Ke-Jun Guo
- Department of Gynecology, The First Affiliated Hospital, China Medical University, Shenyang, China
| | - Guang-Ping Wu
- Department of Pathology, The First Affiliated Hospital and College of Basic Medical Sciences, China Medical University, Shenyang, China
- Guang-Ping Wu, Department of Pathology, The First Affiliated Hospital and College of Basic Medical Sciences, China Medical University, No.155 Nanjing Bei Street Heping District Shenyang, PC 110001, China. E-mail:
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Ehrenpreis ED, Smith DG. Patients with newly diagnosed cervical cancer should be screened for anal human papilloma virus and anal dysplasia: Results of a pilot study using a STELLA computer simulation and economic model. Papillomavirus Res 2018; 5:38-45. [PMID: 29272853 PMCID: PMC5886984 DOI: 10.1016/j.pvr.2017.12.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Revised: 11/21/2017] [Accepted: 12/08/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND Women with cervical cancer often have anal human papillomavirus (HPV) infection and anal dysplasia. However, effectiveness of anal HPV screening is unknown. METHODS A dynamic model was constructed using STELLA. Populations are represented as "stocks" that change according to model rates. Initial anal cytology in new cervical cancer patients, dysplasia progression and regression, cost of treating high-grade squamous intraepithelial lesions (HSIL), and lifetime costs for anal cancer care were extrapolated from the literature. Local costs of anal HPV testing and cytology were obtained. Outcomes included anal cancer rates, anal cancer deaths, screening costs and cancer care. RESULTS Benefits in the screened group included reduction in anal cancers after three years and anal cancer deaths after four years. After 10 years, predicted costs per anal cancer prevented and anal cancer deaths were $168,796 and $210,057 and were $98,631 and $210,057 at 20 years. Predicted costs per quality of life year saved at 10 and 20 years were $9785 and $1687. Sensitivity analysis demonstrated cost-effectiveness of screening for a variety of cure rates HSIL with electrocautery. CONCLUSION Screening for anal HPV and treatment of anal HSIL in patients with cervical cancer is cost-effective, prevents anal cancer and reduces anal cancer deaths.
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Affiliation(s)
- Eli D Ehrenpreis
- University of Chicago, President E2Bio Consultants, 2906 Central St, Evanston, IL 60201, USA.
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Queiroz Filho J, Eleutério J, Ney Cobucci R, de Oliveira Crispim JC, Giraldo PC, Gonçalves AK. Does 100% Rapid Review Improve Cervical Cancer Screening? Acta Cytol 2018; 62:209-214. [PMID: 29788025 DOI: 10.1159/000488872] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 02/25/2018] [Accepted: 03/27/2018] [Indexed: 11/19/2022]
Abstract
OBJECTIVE The aim of this work was to evaluate 100% rapid review (100% RR) as a useful tool to detect false negative (FN) results. STUDY DESIGN A sample of 8,677 swabs was investigated; the unsatisfactory and negative results were referred to 100% RR, concordant results were taken as the final diagnosis, while the discordant results were debated in a consensus meeting to reach a conclusion. The positive results were examined by 2 cytologists. The data were entered into SAS statistical software, and the agreement of the 100% RR results with the final diagnosis was tested with the weighted kappa statistic. RESULTS There was a significant increase in unsatisfactory results from 348 to 1,927, and of positive results from 174 to 349. On the other hand, there was a substantial decrease in negative results from 8,155 to 6,401. Assessing the relative risk of FN results in smears that were not referred to quality control (100% RR) revealed the following results: atypical squamous cells of undetermined significance (ASC-US), 2.93; low-grade squamous intraepithelial lesion (LSIL), 2.72; high-grade squamous intraepithelial lesion/atypical squamous cells - cannot exclude HSIL (HSIL/ASC-H), 2.25. Evaluating by age group, a higher risk for LSIL (4.90) and ASC-US (3.85) was observed in patients aged under 25 years, whereas patients between 25 and 64 years and those over 64 years presented a higher risk for HSIL and ASC-H: 2.46 and 2.75, respectively. CONCLUSION 100% RR is an effective screening tool for FN results in countries where molecular tests for DNA-HPV and prophylactic vaccines are not available in cervical cancer screening programs.
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Affiliation(s)
| | - José Eleutério
- Department of Child and Motherhood, Faculty of Medicine, Federal University of Ceará, Fortaleza, Brazil
| | - Ricardo Ney Cobucci
- Department of Gynecology and Obstetrics, Faculty of Medicine, Federal University of Rio Grande do Norte, Natal, Brazil
| | | | - Paulo César Giraldo
- Department of Gynecology and Obstetrics, Faculty of Medicine, State University of Campinas, Campinas, Brazil
| | - Ana Katherine Gonçalves
- Federal University of Rio Grande do Norte, Natal, Brazil
- Department of Child and Motherhood, Faculty of Medicine, Federal University of Ceará, Fortaleza, Brazil
- Department of Gynecology and Obstetrics, Faculty of Medicine, Federal University of Rio Grande do Norte, Natal, Brazil
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Umulisa MC, Franceschi S, Baussano I, Tenet V, Uwimbabazi M, Rugwizangoga B, Heideman DAM, Uyterlinde AM, Darragh TM, Snijders PJF, Sayinzoga F, Clifford GM. Evaluation of human-papillomavirus testing and visual inspection for cervical cancer screening in Rwanda. BMC Womens Health 2018; 18:59. [PMID: 29699549 PMCID: PMC5921370 DOI: 10.1186/s12905-018-0549-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Accepted: 04/09/2018] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND A pilot screening campaign in Rwanda, based on careHPV-testing followed by visual inspection with acetic acid triage (careHPV+VIA triage), was evaluated against other WHO-recommended screening options, namely HPV screen-and-treat and VIA screen-and-treat. METHODS 764 women aged 30-69 underwent at visit 1: i) VIA, and cervical cell collection for ii) careHPV in Rwanda, and iii) liquid-based cytology and GP5+/6+ HR-HPV PCR in The Netherlands. All 177 women positive by VIA, careHPV and/or PCR were recalled, of whom 84% attended. At visit 2, VIA was again used to triage screen-positive women for treatment and to obtain biopsies from all women either from visible lesions or at 12 o'clock of the squamocolumnar junction. Cross-sectional screening indices were estimated primarily against histological high-grade squamous intraepithelial lesions or worse (hHSIL+), after imputation of missing histology data, based on 1-visit or 2-visit approaches. RESULTS In a 1-visit screen-and-treat approach, VIA had sensitivity and specificity of 41% and 96%, respectively, versus 71% and 88% for careHPV, and 88% and 86% for PCR. In a 2-visit approach (in which hHSIL+ imputed among women without visit 2 were considered untreated) careHPV sensitivity dropped to 59% due to loss of 13% of hHSIL+. For careHPV+VIA triage, sensitivity dropped further to 35%, as another 24% of hHSIL+ were triaged to no treatment. CONCLUSIONS CareHPV was not as sensitive as gold-standard PCR, but detected considerably more hHSIL+ than VIA. However, due to careHPV-positive hHSIL+ women being lost to follow-up and/or triaged to no treatment, 2-visit careHPV+VIA triage did not perform better than VIA screen-and-treat.
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Affiliation(s)
| | - Silvia Franceschi
- Cancer Epidemiology Unit, Aviano National Cancer Institute IRCCS, Aviano, Italy
| | - Iacopo Baussano
- International Agency for Research on Cancer, 150 cours Albert Thomas, 69372 Lyon Cedex 08, France
| | - Vanessa Tenet
- International Agency for Research on Cancer, 150 cours Albert Thomas, 69372 Lyon Cedex 08, France
| | | | - Belson Rugwizangoga
- Department of Pathology, University Teaching Hospital of Kigali, Kigali, Rwanda
- University of Rwanda School of Medicine and Pharmacy, Kigali, Rwanda
| | | | - Anne M. Uyterlinde
- Department of Pathology, VU University Medical Center, Amsterdam, the Netherlands
| | | | - Peter J. F. Snijders
- Department of Pathology, VU University Medical Center, Amsterdam, the Netherlands
| | | | - Gary M. Clifford
- International Agency for Research on Cancer, 150 cours Albert Thomas, 69372 Lyon Cedex 08, France
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Wang J, Andrae B, Sundström K, Ploner A, Ström P, Elfström KM, Dillner J, Sparén P. Effectiveness of cervical screening after age 60 years according to screening history: Nationwide cohort study in Sweden. PLoS Med 2017; 14:e1002414. [PMID: 29065127 PMCID: PMC5655486 DOI: 10.1371/journal.pmed.1002414] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2017] [Accepted: 09/25/2017] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND The relatively high incidence of cervical cancer in women at older ages is a continuing concern in countries with long-established cervical screening. Controversy remains on when and how to cease screening. Existing population-based studies on the effectiveness of cervical screening at older ages have not considered women's screening history. We performed a nationwide cohort study to investigate the incidence of cervical cancer after age 60 years and its association with cervical screening at age 61-65, stratified by screening history at age 51-60. METHODS AND FINDINGS Using the Total Population Register, we identified 569,132 women born between 1 January 1919 and 31 December 1945, resident in Sweden since age 51. Women's cytological screening records, cervical cancer occurrence, and FIGO stage (for those diagnosed with cancer) were retrieved from national registers and medical charts. We calculated the cumulative incidence of cervical cancer from age 61 to age 80 using a survival function considering competing risk, and estimated the hazard ratio (HR) of cervical cancer in relation to screening status at age 61-65 from Cox models, adjusted for birth cohort and level of education, conditioning on women's screening history in their 50s. In women unscreened in their 50s, the cumulative incidence up to age 80 was 5.0 per 1,000 women, and screening at age 61-65 was associated with a lower risk for cervical cancer (HR = 0.42, 95% CI 0.24-0.72), corresponding to a decrease of 3.3 cancer cases per 1,000 women. A higher cumulative incidence and similarly statistically significant risk decrease was seen for women with abnormal smears in their 50s. In women adequately or inadequately screened with only normal results between age 51 and age 60, the cumulative incidence of cervical cancer from age 61 to 80 was 1.6 and 2.5 per 1,000 women, respectively, and further screening at age 61-65 was not associated with statistically significant decreases of cervical cancer risk up to age 80, but with fewer cancer cases of advanced stages at age 61-65. Adjustment for potential lifestyle confounders was limited. CONCLUSIONS In this study, cervical screening with cytology at age 61-65 was associated with a statistically significant reduction of subsequent cervical cancer risk for women who were unscreened, or screened with abnormalities, in their 50s. In women screened with normal results in their 50s, the risk for future cancer was not sizeable, and the risk reduction associated with continued screening appeared limited. These findings should inform the current debate regarding age and criteria to discontinue cervical screening.
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Affiliation(s)
- Jiangrong Wang
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- * E-mail:
| | - Bengt Andrae
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Centre for Research and Development, Uppsala University/Region of Gävleborg, Gävle, Sweden
| | - Karin Sundström
- Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Alexander Ploner
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Peter Ström
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - K. Miriam Elfström
- Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Joakim Dillner
- Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden
- Karolinska University Laboratory, Karolinska University Hospital, Stockholm, Sweden
| | - Pär Sparén
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
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Mockler D, Escobar-Hoyos LF, Akalin A, Romeiser J, Shroyer AL, Shroyer KR. Keratin 17 Is a Prognostic Biomarker in Endocervical Glandular Neoplasia. Am J Clin Pathol 2017; 148:264-273. [PMID: 28821199 DOI: 10.1093/ajcp/aqx077] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [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] [Indexed: 01/07/2023] Open
Abstract
OBJECTIVES Previous work in our laboratory identified keratin 17 (K17) as a specific and sensitive biomarker for high-grade squamous intraepithelial lesions and cervical squamous cell carcinoma (SCC). K17, however, has not been previously evaluated in endocervical glandular neoplasia. Based on the similar pathogenesis of squamous and glandular lesions of the cervix, we hypothesized that K17 overexpression could also be a diagnostic and/or prognostic biomarker for endocervical neoplasia. METHODS Cases of endocervical adenocarcinoma (n = 90), adenocarcinoma in situ (AIS) (n = 32), benign glandular lesions (n = 36), and normal endocervical mucosa (n = 5) were selected from Stony Brook Medicine and the University of Massachusetts from 2002 to 2013. Immunohistochemical staining for K17 was performed by an indirect immunoperoxidase method and was scored based on the proportion of cells that showed strong (2+) staining. RESULTS K17 was highly expressed in 21 (65.6%) of 32 AIS and in 75 (83.0%) of 90 adenocarcinoma cases. In adenocarcinomas, K17 staining was detected in a mean of 33.9% of malignant cells. Staining tended to be strongest at the periphery of pseudoglandular groups and at the invasive front of tumors. K17 was not detected in the epithelial cells of benign glandular lesions, but groups of cuboidal cells, residing beneath the epithelial layer of benign glands, were frequently positive for K17, especially in cases of microglandular hyperplasia. High levels of K17 expression were significantly associated with decreased patient survival. CONCLUSIONS K17 is highly expressed in most cases of both invasive adenocarcinoma and in AIS and is a powerful, negative prognostic marker for patient survival.
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Affiliation(s)
| | - Luisa F Escobar-Hoyos
- Departments of Pathology
- David M. Rubenstein Center for Pancreatic Cancer Research, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Ali Akalin
- Department of Pathology, University of Massachusetts Medical School, Worcester
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Canfell K, Caruana M, Gebski V, Darlington-Brown J, Heley S, Brotherton J, Gertig D, Jennett CJ, Farnsworth A, Tan J, Wrede CD, Castle PE, Saville M. Cervical screening with primary HPV testing or cytology in a population of women in which those aged 33 years or younger had previously been offered HPV vaccination: Results of the Compass pilot randomised trial. PLoS Med 2017; 14:e1002388. [PMID: 28926579 PMCID: PMC5604935 DOI: 10.1371/journal.pmed.1002388] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Accepted: 08/10/2017] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Using primary human papillomavirus (HPV) testing for cervical screening increases detection of high-grade cervical intraepithelial neoplastic lesions and invasive cancer (cervical intraepithelial neoplasia grade 2+ [CIN2+]) compared to cytology, but no evaluation has been conducted in a population previously offered HPV vaccination. We aimed to assess colposcopy referral and CIN2+ detection rates for HPV-screened versus cytology-screened women in Australia's HPV-vaccinated population (by 2014, resident women ≤33 years had been age-eligible for HPV vaccination, with 3-dose uptake across age cohorts being about 50%-77%). METHODS AND FINDINGS Compass is an open-label randomised trial of 5-yearly HPV screening versus 2.5-yearly liquid-based cytology (LBC) screening. In the first phase, consenting women aged 25-64 years presenting for routine screening at 47 primary practices in Victoria, Australia, provided a cervical sample and were randomised at a central laboratory at a 1:2:2 allocation to (i) image-read LBC screening with HPV triage of low-grade cytology ('LBC screening'), (ii) HPV screening with those HPV16/18 positive referred to colposcopy and with LBC triage for other oncogenic (OHR) types ('HPV+LBC triage'), or (iii) HPV screening with those HPV16/18 positive referred to colposcopy and with dual-stained cytology triage for OHR types ('HPV+DS triage'). A total of 5,006 eligible women were recruited from 29 October 2013 to 7 November 2014 (recruitment rate 58%); of these, 22% were in the group age-eligible for vaccination. Data on 4,995 participants were analysed after 11 withdrawals; 998 were assigned to, and 995 analysed (99.7%) in, the LBC-screened group; 1,996 assigned to and 1,992 analysed (99.8%) in the HPV+LBC triage group; and 2,012 assigned to and 2,008 analysed (99.8%) in the HPV+DS triage group. No serious trial-related adverse events were reported. The main outcomes were colposcopy referral and detected CIN2+ rates at baseline screening, assessed on an intention-to-treat basis after follow-up of the subgroup of triage-negative women in each arm referred to 12 months of surveillance, and after a further 6 months of follow-up for histological outcomes (dataset closed 31 August 2016). Analysis was adjusted for whether women had been age-eligible for HPV vaccination or not. For the LBC-screened group, the overall referral and detected CIN2+ rates were 27/995 (2.7% [95% CI 1.8%-3.9%]) and 1/995 (0.1% [95% CI 0.0%-0.6%]), respectively; for HPV+LBC triage, these were 75/1,992 (3.8% [95% CI 3.0%-4.7%]) and 20/1,992 (1.0% [95% CI 0.6%-1.5%]); and for HPV+DS triage, these were 79/2,008 (3.9% [95% CI 3.1%-4.9%]) and 24/2,008 (1.2% [95% CI 0.8%-1.6%]) (p = 0.09 for difference in referral rate in LBC versus all HPV-screened women; p = 0.003 for difference in CIN2+ detection rate in LBC versus all HPV-screened women, with p = 0.62 between HPV screening groups). Limitations include that the study population involved a relatively low risk group in a previously well-screened and treated population, that individual women's vaccination status was unknown, and that long-term follow-up data on disease detection in screen-negative women are not yet available. CONCLUSIONS In this study, primary HPV screening was associated with significantly increased detection of high-grade precancerous cervical lesions compared to cytology, in a population where high vaccine uptake was reported in women aged 33 years or younger who were offered vaccination. It had been predicted that increased disease detection might be associated with a transient increase in colposcopy referral rates in the first round of HPV screening, possibly dampened by HPV vaccine effect; in this study, although the point estimates for referral rates in women in each HPV-screened group were 41%-44% higher than in cytology-screened women, the difference in referral rate between cytology- and HPV-screened women was not significant. These findings provide initial support for the implementation of primary HPV screening in vaccinated populations. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry ACTRN12613001207707.
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Affiliation(s)
- Karen Canfell
- Cancer Research Division, Cancer Council New South Wales, Sydney, New South Wales, Australia
- School of Public Health, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
- Prince of Wales Clinical School, University of New South Wales, Sydney, New South Wales, Australia
- * E-mail:
| | - Michael Caruana
- Cancer Research Division, Cancer Council New South Wales, Sydney, New South Wales, Australia
| | - Val Gebski
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, New South Wales, Australia
| | | | - Stella Heley
- Victorian Cytology Service, Melbourne, Victoria, Australia
| | - Julia Brotherton
- Victorian Cytology Service, Melbourne, Victoria, Australia
- School of Public Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Dorota Gertig
- School of Public Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Chloe J. Jennett
- Cancer Research Division, Cancer Council New South Wales, Sydney, New South Wales, Australia
| | - Annabelle Farnsworth
- School of Public Health, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
- Douglass Hanly Moir Pathology, Sydney, New South Wales, Australia
| | - Jeffrey Tan
- Department of Obstetrics and Gynaecology, Melbourne Medical School, University of Melbourne, Melbourne, Victoria, Australia
- Department of Oncology & Dysplasia, Royal Women’s Hospital, Melbourne, Victoria, Australia
| | - C. David Wrede
- Department of Obstetrics and Gynaecology, Melbourne Medical School, University of Melbourne, Melbourne, Victoria, Australia
- Department of Oncology & Dysplasia, Royal Women’s Hospital, Melbourne, Victoria, Australia
| | - Philip E. Castle
- Albert Einstein College of Medicine, New York, New York, United States of America
| | - Marion Saville
- Victorian Cytology Service, Melbourne, Victoria, Australia
- Department of Obstetrics and Gynaecology, Melbourne Medical School, University of Melbourne, Melbourne, Victoria, Australia
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Shim SH, Kim H, Sohn IS, Hwang HS, Kwon HS, Lee SJ, Lee JY, Kim SN, Lee K, Chang S. Nationwide cervical cancer screening in Korea: data from the National Health Insurance Service Cancer Screening Program and National Cancer Screening Program, 2009-2014. J Gynecol Oncol 2017; 28:e63. [PMID: 28657224 PMCID: PMC5540722 DOI: 10.3802/jgo.2017.28.e63] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Revised: 04/20/2017] [Accepted: 05/17/2017] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE The rates of participation in the Korean nationwide cervical cancer screening program and the rates of abnormal test results were determined. METHODS The database of the National Health Insurance Service (NHIS) was used during the study period (2009-2014). RESULTS The participation rate increased from 41.10% in 2009 to 51.52% in 2014 (annual percentage change, 4.126%; 95% confidence interval [CI]=2.253-6.034). During the study period, women ≥70 years of age had the lowest rate of participation (range, 21.7%-31.9%) and those 30-39 years of age the second-lowest (27.7%-44.9%). The participation rates of National Health Insurance beneficiaries (range, 48.6%-52.5%) were higher than those of Medical Aid Program (MAP) recipients (29.6%-33.2%). The rates of abnormal results were 0.65% in 2009 and 0.52% in 2014, with a decreasing tendency in all age groups except the youngest (30-39 years). Every year the abnormal result rates tended to decrease with age, from the age groups of 30-39 years to 60-69 years but increased in women ≥70 years of age. The ratio of patients with atypical squamous cells of undetermined significance compared with those with squamous intraepithelial lesions increased from 2.71 in 2009 to 4.91 in 2014. CONCLUSION Differences related to age and occurring over time were found in the rates of participation and abnormal results. Further efforts are needed to encourage participation in cervical cancer screening, especially for MAP recipients, elderly women and women 30-39 years of age. Quality control measures for cervical cancer screening programs should be enforced consistently.
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Affiliation(s)
- Seung Hyuk Shim
- Department of Obstetrics and Gynecology, Konkuk University School of Medicine, Seoul, Korea
| | - Hyeongsu Kim
- Department of Preventive Medicine, Konkuk University School of Medicine, Seoul, Korea.
| | - In Sook Sohn
- Department of Obstetrics and Gynecology, Konkuk University School of Medicine, Seoul, Korea
| | - Han Sung Hwang
- Department of Obstetrics and Gynecology, Konkuk University School of Medicine, Seoul, Korea
| | - Han Sung Kwon
- Department of Obstetrics and Gynecology, Konkuk University School of Medicine, Seoul, Korea
| | - Sun Joo Lee
- Department of Obstetrics and Gynecology, Konkuk University School of Medicine, Seoul, Korea
| | - Ji Young Lee
- Department of Obstetrics and Gynecology, Konkuk University School of Medicine, Seoul, Korea
| | - Soo Nyung Kim
- Department of Obstetrics and Gynecology, Konkuk University School of Medicine, Seoul, Korea
| | - Kunsei Lee
- Department of Preventive Medicine, Konkuk University School of Medicine, Seoul, Korea
| | - Sounghoon Chang
- Department of Preventive Medicine, Konkuk University School of Medicine, Seoul, Korea
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Del Pino M, Alonso I, Rodriguez-Trujillo A, Bernal S, Geraets D, Guimerà N, Torne A, Ordi J. Comparison of the analytical and clinical performance of five tests for the detection of human papillomavirus genital infection. J Virol Methods 2017; 248:238-243. [PMID: 28739302 DOI: 10.1016/j.jviromet.2017.07.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [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: 11/19/2016] [Revised: 07/03/2017] [Accepted: 07/19/2017] [Indexed: 01/09/2023]
Abstract
HPV-based screening provides greater protection against cervical cancer (CC) than cytology-based strategies. Currently, several molecular diagnostic assays for the detection of human papillomavirus (HPV) are available. In this study, we analyzed 5 different HPV testing and genotyping techniques (Hybrid Capture 2 [HC2; Qiagen, Hilden, Germany], AnyplexTMII HPV28 [Anyplex; Seegene, Seoul, Korea], Linear Array [Roche, Branchburg, NJ, USA], GP5+/6+ PCR-EIA-RH [Labo Bio-medical Products, Rijswijk, The Netherlands] and CLART2 [Genomica, Madrid, Spain]) in 295 women referred to the hospital Colposcopy Clinic from 2007 to 2008 due to positive HPV test results or an abnormal Pap test. DNA extraction for HPV genotyping was performed in cervical sample specimens after Pap test and HPV detection by HC2. The inclusion criteria were: (1) adequate cervical sampling with sufficient material for the Pap test and HPV detection and genotyping, and (2) colposcopically-directed biopsy and/or endocervical curettage. HC2 showed the highest sensitivity for high-grade squamous intraepithelial lesion and CC (HSIL+) detection (96.1%), but all the HPV genotyping tests showed a higher specificity. (Anyplex 86.8%; Linear Array 86.0%; GP5+/6+ 78.8%; CLART2 76.5%). The agreement between HC2 results and the other techniques was similar: 82.4%, kappa=0.650 for Anyplex; 83.4%, kappa=0.670 for Linear Array, 79.93%, kappa=0.609 for GP5+/6+ and 82.4%, kappa=0.654 for CLART2. HPV 16 and/or 18 infection was a risk factor for underlying HSIL+ in the univariate analysis. Anyplex showed the highest risk of underlying HSIL+ after positive HPV 16 and/or 18 tests (OR 31.1; 95% CI 12.1-80.0).
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Affiliation(s)
- M Del Pino
- Institut Clinic of Gynecology, Obstetrics and Neonatology, Hospital Clínic-Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Faculty of Medicine, University of Barcelona, Barcelona, Spain
| | - I Alonso
- Institut Clinic of Gynecology, Obstetrics and Neonatology, Hospital Clínic-Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Faculty of Medicine, University of Barcelona, Barcelona, Spain
| | - A Rodriguez-Trujillo
- Institut Clinic of Gynecology, Obstetrics and Neonatology, Hospital Clínic-Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Faculty of Medicine, University of Barcelona, Barcelona, Spain
| | - S Bernal
- Department of Pathology, ISGlobal (Instituto de Salud Global) Hospital Clínic, University of Barcelona, Faculty of Medicine, Barcelona, Spain
| | - D Geraets
- DDL Diagnostic Laboratory, Rijswijk, The Netherlands
| | - N Guimerà
- DDL Diagnostic Laboratory, Rijswijk, The Netherlands
| | - A Torne
- Institut Clinic of Gynecology, Obstetrics and Neonatology, Hospital Clínic-Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Faculty of Medicine, University of Barcelona, Barcelona, Spain
| | - J Ordi
- Department of Pathology, ISGlobal (Instituto de Salud Global) Hospital Clínic, University of Barcelona, Faculty of Medicine, Barcelona, Spain.
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Nasser H, AlAyyaf M, Atallah A, Aminulislam M, Rizwan L, Aodah A, Alkahtani Y, Alshammari H, Alsayed A, Szpunar S. Eleven-year review of data on Pap smears in Saudi Arabia: We need more focus on glandular abnormalities! Ann Saudi Med 2017; 37:265-271. [PMID: 28761025 PMCID: PMC6150586 DOI: 10.5144/0256-4947.2017.265] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND We reviewed data from Saudi Arabia on epithelial cell abnormalities (ECA) detected by Pap smear after noticing a slight increase in the incidence of cervical glandular abnormalities in our regional laboratory in recent years. OBJECTIVE Clarify data on adenocarcinoma (ADCA) on Pap smears in Saudi Arabia. DESIGN Descriptive, retrospective study. SETTINGS Regional laboratory, Riyadh. PATIENTS AND METHODS We reviewed all Pap smears of adult females between 2006 and 2016 and compared our data with previously published results from Saudi Arabia. MAIN OUTCOME MEASURE(S) Descriptive data on ECAs. RESULTS Among 19759 cases, atypical squamous cell of undetermined significance (ASC-US) was the most prevalent ECA (1.16%). ADCA occurred more than squamous cell carcinoma (SCC). In a comparison of published data before 2014 and after 2014 (including ours), there was a significant rise in ADCA (28 vs 48 cases; P=.004) with a significant drop in SCC, high-grade squamous intraepithelial lesions (HSIL) and low-grade squamous intraepithelial lesions (LSIL) (P < .0001, .004, and < .0001, respectively). CONCLUSION We recommend that pathologists and cytotechnologists be vigilant in screening Pap smears in our population, particularly for glandular abnormalities. We also recommend use of Pap smears in the initial workup of women with suspected gynecological abnormalities, regardless of evolutions in HPV testing. LIMITATIONS The pooling of data instead of analyzing by study year.
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Affiliation(s)
- Haitham Nasser
- Dr. Haitham Nasser, Department of Histopathology,, King Saud Medical City,, Riyadh 11575, T: +966-11-4355555;, F: +966-11-4353045, , ORCID: http://orcid.org/0000-0001-5939-1542
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Tsiambas E, Riziotis C, Mavrikos I, Armatas E, Patsouris E. Novel techniques for morphometric and geometrical analysis in squamous intraepithelial lesions on cervical smears. J BUON 2017; 22:1081-1083. [PMID: 28952232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Affiliation(s)
- Evangelos Tsiambas
- Department of Pathology, Medical School, University of Athens, Athens, Greece
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Leventakos K, Tsiodras S, Kelesidis T, Kefala M, Kottaridi C, Spathis A, Gouloumi AR, Pouliakis A, Pappas A, Sioulas V, Chrelias C, Karakitsos P, Panayiotides I. γH2Ax Expression as a Potential Biomarker Differentiating between Low and High Grade Cervical Squamous Intraepithelial Lesions (SIL) and High Risk HPV Related SIL. PLoS One 2017; 12:e0170626. [PMID: 28118377 PMCID: PMC5261776 DOI: 10.1371/journal.pone.0170626] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Accepted: 01/07/2017] [Indexed: 01/10/2023] Open
Abstract
Background γH2AX is a protein biomarker for double-stranded DNA breakage; its expression was studied in cervical squamous intraepithelial lesions and carcinomas. Methods Immunostaining for phospho-γH2AX was performed in sections from histologically confirmed cervical SIL and carcinomas, as well as from normal cervices used as controls. In total, 275 cases were included in the study: 112 low grade SIL (LGSIL), 99 high grade SIL (HGSIL), 24 squamous cell carcinoma (SCC), 12 adenocarcinoma and 28 cervical specimens with no essential lesions. Correlation of histological grading, high risk vs. low risk HPV virus presence, activated vs. non-activated status (by high risk HPV mRNA expression) and γH2AX expression in both basal and surface segments of the squamous epithelium was performed. Results Gradual increase of both basal and surface γH2AX expression was noted up from normal cervices to LGSIL harboring a low risk HPV type, to LGSIL harboring a high risk virus at a non-activated state (p<0.05). Thereafter, both basal and surface γH2AX expression dropped in LGSIL harboring a high risk virus at an activated state and in HGSIL. Conclusions γH2AX could serve as a potential biomarker discriminating between LGSIL and HGSIL, as well as between LGSIL harboring high risk HPV at an activated state.
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Affiliation(s)
- Konstantinos Leventakos
- 2 Department of Pathology, University Hospital “Attikon”, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
- 4 Department of Internal Medicine, University Hospital “Attikon”, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Sotirios Tsiodras
- 4 Department of Internal Medicine, University Hospital “Attikon”, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
- * E-mail:
| | - Theodore Kelesidis
- 4 Department of Internal Medicine, University Hospital “Attikon”, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Maria Kefala
- 2 Department of Pathology, University Hospital “Attikon”, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Christine Kottaridi
- Department of Cytopathology, University Hospital “Attikon”, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Aris Spathis
- Department of Cytopathology, University Hospital “Attikon”, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Alina-Roxani Gouloumi
- 2 Department of Pathology, University Hospital “Attikon”, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Abraham Pouliakis
- Department of Cytopathology, University Hospital “Attikon”, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Asimakis Pappas
- 3 Department of Obstetrics and Gynecology, University Hospital “Attikon”, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Vasileios Sioulas
- 3 Department of Obstetrics and Gynecology, University Hospital “Attikon”, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Charalambos Chrelias
- 3 Department of Obstetrics and Gynecology, University Hospital “Attikon”, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Petros Karakitsos
- Department of Cytopathology, University Hospital “Attikon”, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Ioannis Panayiotides
- 2 Department of Pathology, University Hospital “Attikon”, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
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Basta T, Gawron I, Mirocki K, Babczyk D, Jach R. [Analysis of histological type and staging of cervical cancer as prognostic factors among women treated in the Department of Gynecology and Oncology, Jagiellonian University in the years 2001-2014]. Przegl Lek 2017; 74:13-20. [PMID: 29693995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
INTRODUCTION Cervical cancer (CC) is the fourth most common, in terms of incidence of new cases, cancer in women and the third leading cause of cancer deaths in women worldwide. Survival of patients with CC depends on many factors, including the type of cancer, grading, FIGO staging and treatment. MATERIAL AND METHODS Analysis of survival of 524 patients diagnosed with invasive and non-invasive CC depending on histopathologic diagnosis, clinical staging, tumor grading and combination of therapy. RESULTS The 2-fold increase in the risk of death at diagnosis in order of HSIL> ca planoepitheliale> adenocarcinoma> sarcoma was noted. Grading 2 and 3 significantly reduces the average survival in patients diagnosed with CC. The higher staging, the shorter the average survival. Each pass by one FIGO stage was shown to increase the risk of death by 46%. The risk of death increases by 4% with every year of woman’s life. The longest average survival, 72 months, characterized a group of women undergoing curettage, followed by radical hysterectomy/ trachelectomy and lymphadenectomy without adiuvant radio-/ chemotherapy. The shortest survival, 26.9 months, was observed in the group treated with curettage followed by chemoradiation. CONCLUSIONS Histopathology, clinical staging, grading, age and combination of treatment proved to be significant factors affecting survival in women with CC.
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Ding Z, Li Y, Chen A, Song M, Zhang Y. Punch biopsy guided by both colposcopy and HR-HPV status is more efficient for identification of immediate high-grade squamous intraepithelial lesion or worse among HPV-infected women with atypical squamous cells of undetermined significance. Eur J Obstet Gynecol Reprod Biol 2016; 207:32-36. [PMID: 27816739 DOI: 10.1016/j.ejogrb.2016.10.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [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: 05/15/2016] [Revised: 08/11/2016] [Accepted: 10/10/2016] [Indexed: 11/19/2022]
Abstract
OBJECTIVES To investigate the accuracy of colposcopy for diagnosing high-grade squamous intraepithelial lesion (HSIL) or worse (HSIL+) in human papillomavirus (HPV)-infected patients with atypical squamous cells of undetermined significance (ASCUS) cytology, and determine whether genotyping and viral load quantitation can be useful for detecting immediate HSIL+ risk in these patients. STUDY DESIGN This study included 620 cases with ASCUS and positive for high-risk (HR)-HPV within 1 month before or after cervical cytology at Qilu Hospital between February 2013 and February 2014. Based on the colposcopic impression, lesion-targeted punch biopsy, endocervical curettage biopsy or random cervical punch biopsy in four quadrants was performed on these patients within 1 month. The accuracy of colposcopy for diagnosing HSIL+ was evaluated through comparison with the biopsy results. HR-HPV status determined by Hybrid Capture 2 or HPV genotyping was analysed retrospectively as a possible predictor of HSIL+. RESULTS Agreement between colposcopic impression and cervical pathology was matched perfectly in 89.2% of cases (553/620), and the strength of agreement with the κ statistic was 0.698 (p<0.001). Colposcopy had high specificity (96.9%) but low sensitivity for detecting HSIL+ (67.5%). The risk of HSIL+ was significantly higher in patients with HPV-16 infection (52.3%) than in patients infected with other types of HPV (17.9%, p<0.001). HSIL+ and virus load was correlated at cut-offs (CO) of 50 relative light units (RLU)/CO and 100 RLU/CO (p=0.024 and 0.044, respectively). If considering HPV16 infection or high virus load (at 50 RLU/CO) as a diagnostic standard of HSIL+ when colposcopic impression was negative, sensitivity was improved to 74.7% and 81.0%, respectively. CONCLUSIONS Good agreement was found between colposcopic and pathologic diagnosis. HR-HPV genotyping or virus load is relevant to the detection of HSIL+ among HPV-infected patients with ASCUS cytology. In these patients, biopsies considering HPV-16 infection or virus load ≥50 RLU/CO may be helpful for increasing the HSIL+ detection rate.
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Affiliation(s)
- Z Ding
- Qilu Hospital, Shandong University, Jinan, Shandong, China; The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Y Li
- The Second People's Hospital of Liao Cheng, Liao Cheng, Shandong, China
| | - A Chen
- The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - M Song
- Qingdao Tumour Hospital, Qingdao, Shandong, China
| | - Y Zhang
- Qilu Hospital, Shandong University, Jinan, Shandong, China.
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Bergeron C, von Knebel Doeberitz M. The Role of Cytology in the 21st Century: The Integration of Cells and Molecules. Acta Cytol 2016; 60:540-542. [PMID: 27788516 DOI: 10.1159/000449402] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Accepted: 08/24/2016] [Indexed: 12/24/2022]
Abstract
OBJECTIVES Cervical cancer screening test performance has been hampered by either a lack of sensitivity in Pap cytology or a lack of specificity of human papillomavirus (HPV) testing. This is disturbing for patients and a cause of high costs for health care providers. STUDY DESIGN The identification of p16INK4a as a specific marker for the neoplastic transformation of cervical squamous epithelial cells by HPVs allows the identification of HPV-transformed cells in cytopathology specimens. RESULTS When compared to molecular HPV tests for triaging minor cytologic atypia, such as atypical squamous cells of undetermined significance or low-grade squamous intraepithelial lesions, the immunochemical detection of dual p16INK4a/Ki-67-stained cells demonstrates a significantly improved specificity with good relative sensitivity. CONCLUSIONS HPV testing has shown earlier detection of persistent high-grade squamous intraepithelial lesions (HSIL) compared to cytology and is more effective in preventing invasive cervical cancer. The next challenge for the HPV primary screening program is to find the best method(s) for selecting, among HPV-positive women, those patients in need of immediate colposcopy because they are at a higher risk of developing a precancerous lesion. An HSIL cytology result and/or dual p16/Ki-67 staining could be the best candidates, but further randomized studies are required before these approaches can be used in routine practice.
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Sugiyama Y, Sasaki H, Komatsu K, Yabushita R, Oda M, Yanoh K, Ueda M, Itamochi H, Okugawa K, Fujita H, Tase T, Nakatani E, Moriya T. A Multi-Institutional Feasibility Study on the Use of Automated Screening Systems for Quality Control Rescreening of Cervical Cytology. Acta Cytol 2016; 60:451-457. [PMID: 27673689 DOI: 10.1159/000449499] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Accepted: 08/30/2016] [Indexed: 12/26/2022]
Abstract
OBJECTIVE To evaluate the efficacy of the automated screening system FocalPoint for cervical cytology quality control (QC) rescreening. False-negative rates (FNRs) were evaluated by a multi-institutional retrospective study. STUDY DESIGN Cervical cytology slides that had already been reported as negative for intraepithelial lesion or malignancy (NILM) were chosen arbitrarily for FocalPoint rescreening. Slides stratified into the highest 15% probability of being abnormal were rescreened by a cytotechnologist. The slides that were abnormal were reevaluated by a cytopathologist to be false negatives. RESULTS Rescreening of 12,000 slides, i.e. 9,000 conventional slides and 3,000 liquid-based cytology (LBC) slides, was performed; 9,826 (7,393 conventional and 2,433 LBC) were satisfactory for FocalPoint (2,174 were determined unsatisfactory) and those within the highest 15% of probability (1,496, i.e. 1,123 conventional and 373 LBC) were rescreened. As a result, 117 (96 conventional and 21 LBC) were determined as abnormal (other than NILM) and the FNR was 1.19%. Among these 117 slides, 40 (35 conventional and 5 LBC) were determined as high-grade squamous intraepithelial lesion and greater (HSIL+). CONCLUSION Of 117 (1.19%) abnormal slides detected, 40 (0.41%) were determined to be HSIL+. This result suggests that FocalPoint is effective for QC rescreening of cervical cytology.
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Affiliation(s)
- Yuko Sugiyama
- The Japanese Society of Clinical Cytology Study Group on the Use of Automated Screening Systems for Quality Control Purposes regarding Cervical Cytology, Cancer Institute Hospital, Tokyo, Japan
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Hui Y, Hansen K, Murthy J, Chau D, Sung CJ, Quddus MR. Relevance of the Pap Test: A Report of HPV-DNA Test-Negative High-Grade Squamous Intraepithelial Lesions of the Female Lower Genital Tract. Acta Cytol 2016; 60:445-450. [PMID: 27578366 DOI: 10.1159/000448470] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Accepted: 07/14/2016] [Indexed: 12/30/2022]
Abstract
OBJECTIVE A vast majority of cervicovaginal intraepithelial lesions are caused by high-risk human papillomaviruses (HPVs). The Pap test has been the sole method used for the screening of cervicovaginal squamous intraepithelial lesions (SIL). Recently, the FDA approved an HPV-DNA assay as a method of primary screening. We report on a series of FDA-approved HPV-DNA test-negative SIL with HPV genotyping, using an alternative method on the corresponding surgical biopsy specimens. STUDY DESIGN A retrospective review identified cytology-positive HPV-negative cases over a 15-month period at a tertiary care gynecologic oncology institution. Corresponding biopsies were reviewed and genotyped for high-risk HPVs. RESULTS Of the 18,200 total cases, 17 patients meeting the study criteria were selected with 27 surgical specimens corresponding to their cytologic diagnoses. Four patients with high-grade lesions were identified, 3 of whom (75%) were positive for HPV. One of these 4 patients (25%) showed high-grade SIL on biopsies from 4 separate sites in the cervix and vagina. Multiviral HPV infections were frequent. CONCLUSIONS We discuss the relevance of cotesting for screening cervical SILs and emphasize that false-negative results are possible with the FDA-approved HPV screening assay, also in patients with high-grade SIL. These cases may be detectable by cytologic examination and this suggests that the Pap test remains an important diagnostic tool.
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Affiliation(s)
- Yiang Hui
- Department of Pathology, Women and Infants Hospital, Alpert Medical School of Brown University, Providence, R.I., USA
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Placidi A, Capparucci P, Di Luzio A, Manca G, Mania E, Filippini T, Giorgi Rossi P. Team Reading (Peer Review) of Suspicious/Positive Slides for Continuous Quality Improvement in Cervical-Vaginal Cytology: A Comparison between Methods and Indicators. Acta Cytol 2016; 60:458-464. [PMID: 27504992 DOI: 10.1159/000448370] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Accepted: 07/08/2016] [Indexed: 11/19/2022]
Abstract
AIM In 2013, the Local Health Unit Roma 2 ex C screening laboratory introduced a new set of indicators for quality assurance. We compare 2 sets of indicators based on routine multiple readings (peer review) for their ability to identify problems in single-reader accuracy. METHODS All suspect slides were blindly reviewed by all the cytologists of the laboratory. The standard set of indicators includes interreader Cohen's kappa, positivity rate and atypical squamous cell of undetermined significance/squamous intraepithelial lesion (ASC-US/SIL) ratio. The new set included sensitivity for cervical intraepithelial neoplasia of grade 2 or worse (CIN2+), positive predictive value (PPV) and percentage of positive high-risk (HR)-HPV cases among ASC-US. In order to estimate sensitivity and PPV, we considered all women for whom there was a consensus of negative cytology, negative HR-HPV test, negative colposcopy or negative histology true negative. RESULTS Kappa values ranged from 0.521 to 0.753, with narrow 95% confidence intervals (CIs). Positivity rate ranged from 73.9 to 85.7 and the ASC-US/SIL ratio from 0.61 to 0.81. Sensitivity for CIN2+ at the low-grade SIL threshold ranged from 85.8 to 94.2, PPV ranged from 14.8 to 19.4, and both had a broad 95% CI. Readers with low sensitivity did not show low kappa values. The percentage proportion of HR-HPV-positives (HR-HPV+) among ASC-US ranged from 39.9 to 43.8% with a narrow 95% CI. CONCLUSION The proportion of HR-HPV+ among ASC-US cases is a powerful indicator to address in training.
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Affiliation(s)
- Antonio Placidi
- U.O.C. Oncologic Screening, Local Health Unit Roma 2 ex C, Rome, Italy
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Chen CC, Huang LW, Bai CH, Lee CC. Predictive value of p16/Ki-67 immunocytochemistry for triage of women with abnormal Papanicolaou test in cervical cancer screening: a systematic review and meta-analysis. Ann Saudi Med 2016; 36:245-51. [PMID: 27478909 PMCID: PMC6074396 DOI: 10.5144/0256-4947.2016.245] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND The Papanicolaou (Pap) test is one screening strategy used to prevent cervical cancer in developed countries. The p16/Ki-67 immunocytochemistry is a triage test performed on Pap smears in women with atypical squamous cells of undetermined significance (ASCUS) or low grade squamous intraepithelial lesion. OBJECTIVE Our objective was to review studies investigating the diagnostic performance of p16/Ki-67 dual stain for triage of women with abnormal Pap tests. DESIGN We conducted a systematic review and meta-analysis of diagnostic test accuracy studies. SETTINGS We followed the protocol of systematic review of diagnostic accuracy studies. PATIENTS AND METHODS We searched PubMed, The Cochrane Library, BioMed Central, and ClinicalTrials.gov for relevant studies. We included research that assessed the accuracy of p16/Ki-67 dual stain and high risk human papillomavirus testing for triage of abnormal Pap smears. Review articles and studies that provided insufficient data to construct 2.2 tables were excluded. Data synthesis was conducted using a random-effects model. MAIN OUTCOME MEASURES Sensitivity and specificity. RESULTS In seven studies encompassing 2628 patients, the pooled sensitivity and specificity of p16/Ki-67 for triage of abnormal Pap smear results were 0.91 (95% CI, 0.89 to 0.93) and 0.64 (95% CI, 0.62 to 0.66), respectively. No study used a case-control design. A subgroup analysis involving liquid-based cytology showed a sensitivity of 0.91 (95%CI, 0.89 to 0.93) and specificity of 0.64 (95%CI, 0.61 to 0.66). CONCLUSIONS Our meta-analysis of p16/Ki-67 dual stain studies showed that the test achieved high sensitivity and moderate specificity for p16/Ki-67 immunocytochemistry for high-grade squamous intraepi.thelial lesion and cervical cancer. We suggest that p16/Ki-67 dual stain might be a reliable ancillary method identifying high-grade squamous intraepithelial lesions in women with abnormal Pap tests. LIMITATIONS No study in the meta-analysis examined the accuracy of the p16/Ki-67 dual stain for inter.pretation of glandular neoplasms.
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Affiliation(s)
- Cheng-Chieh Chen
- Dr. Chin-Cheng Lee, Department of Pathology and Laboratory Medicine,, Shin Kong Wu Ho-Su Memorial Hospital,, No. 95, Wen Change Road, Shih Lin District,, Taipei City, Taipei, 111 Taiwan, T: 886-2-28332211 ext. 2121,, F: 886-2-28389360, , ORCID: http://orcid.org/0000-0002-3064-5016
| | | | | | - Chin-Cheng Lee
- Dr. Chin-Cheng Lee, Department of Pathology and Laboratory Medicine,, Shin Kong Wu Ho-Su Memorial Hospital,, No. 95, Wen Change Road, Shih Lin District,, Taipei City, Taipei, 111 Taiwan, T: 886-2-28332211 ext. 2121,, F: 886-2-28389360, , ORCID: http://orcid.org/0000-0002-3064-5016
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Landy R, Castanon A, Hamilton W, Lim AWW, Dudding N, Hollingworth A, Sasieni PD. Evaluating cytology for the detection of invasive cervical cancer. Cytopathology 2016; 27:201-9. [PMID: 26126636 PMCID: PMC4913744 DOI: 10.1111/cyt.12259] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/23/2015] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To assess the sensitivity, the number needed to screen (NNS) and the positive predictive value (PPV) of cervical cytology for the diagnosis of cancer by age in a screening population. METHODS A retrospective cohort of women with invasive cervical cancer nested within a census of cervical cytology. All (c. 8 million) women aged 20-64 years with cervical cytology (excluding tests after an earlier abnormality). From April 2007 to March 2010, 3372 women had cervical cancer diagnosed within 12 months of such cytology in England. The sensitivity of cervical cytology to cancer, NNS to detect one cancer and predictive values of cytology were calculated for various 'referral' thresholds. These were calculated for ages 20-24, 25-34, 35-49 and 50-64 years. RESULTS The sensitivity of at least moderate dyskaryosis [equivalent to a high-grade squamous intraepithelial lesion (HSIL) or worse] for cancer of 89.4% [95% confidence interval (CI) 88.3-90.4%] in women offered screening was independent of age. At all ages, women with borderline-early recall or mild dyskaryosis on cytology (equivalent to ASC-US and LSIL, respectively, in the Bethesda system) had a similar risk of cervical cancer to the risk in all women tested. The PPV of severe dyskaryosis/?invasive and ?glandular neoplasia cytology (equivalent to squamous cell carcinoma and adenocarcinoma/adenocarcinoma in situ, respectively, in the Bethesda System) were 34% and 12%, respectively; the PPV of severe dyskaryosis (HSIL: severe dysplasia) was 4%. The NNS was lowest when the incidence of cervical cancer was highest, at ages 25-39 years, but the proportion of those with abnormal cytology who have cancer was also lowest in younger women. CONCLUSIONS The PPV of at least severe dyskaryosis (HSIL: severe dysplasia) for cancer was 4-10% of women aged 25-64 years, justifying a 2-week referral to colposcopy and demonstrating the importance of failsafe monitoring for such patients. The sensitivity of cytology for cervical cancer was excellent across all age groups.
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Affiliation(s)
- R Landy
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Bart's & The London School of Medicine, Queen Mary University of London, London, UK
| | - A Castanon
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Bart's & The London School of Medicine, Queen Mary University of London, London, UK
| | - W Hamilton
- College House, St Luke's Campus, Exeter, UK
| | - A W W Lim
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Bart's & The London School of Medicine, Queen Mary University of London, London, UK
| | - N Dudding
- Cytology Department, Sheffield Teaching Hospitals, NHS Foundation Trust, Sheffield, UK
| | - A Hollingworth
- Whipps Cross University, Hospital, Barts Health NHS Trust, London, UK
| | - P D Sasieni
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Bart's & The London School of Medicine, Queen Mary University of London, London, UK
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Cheah PL, Koh CC, Nazarina AR, Teoh KH, Looi LM. Correlation of p16INK4a immunoexpression and human papillomavirus (HPV) detected by in-situ hybridization in cervical squamous neoplasia. Malays J Pathol 2016; 38:33-38. [PMID: 27126662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Persistence and eventual integration of high-risk HPV (hrHPV) into the cervical cell is crucial to the progression of cervical neoplasia and it would be beneficial to morphologically identify this transformation in routine surgical pathology practice. Increased p16(INK4a) (p16) expression is a downstream event following HPV E7 binding to pRB. A study was conducted to assess the correlation between hrHPV detection using a commercial in-situ hybridization assay (Ventana INFORM HPV ISH) and p16 immunoexpression (CINtec Histology Kit) in cervical squamous intraepithelial lesions and squamous carcinoma. 27 formalin-fixed, paraffin-embedded cervical low-grade squamous intraepithelial lesions (LSIL), 21 high-grade squamous intraepithelial lesions (HSIL) and 51 squamous carcinoma (SCC) were interrogated. hrHPV was significantly more frequent in HSIL (76.2%) and SCC (88.2%) compared to LSIL(37.0%). p16 expression was similarly more frequent in HSIL (95.2%) and SCC (90.2%) compared to LSIL(3.7%). That the rates of hrHPV when compared with p16 expression were almost equivalent in HSIL and SCC while p16 was expressed in only 1 of the 10 LSIL with hrHPV, are expected considering the likelihood that transformation has occurred in HSIL and SCC but does not occur in majority of LSIL.
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Affiliation(s)
- P L Cheah
- University of Malaya, Faculty of Medicine, Department of Pathology, 50603 Kuala Lumpur, Malaysia.
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Fitzgerald P, Cox B, Miller A, Hill S, Reid J. The proposed change to primary HPV screening in New Zealand: reasons for caution. N Z Med J 2016; 129:18-22. [PMID: 27005869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
- Peter Fitzgerald
- Southern Community Laboratories, Plunket House, 472 George Street, Dunedin 9016, New Zealand.
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Chung JH, So MW, Kim SG. Paraneoplastic dermatomyositis presenting myopathy combined with synchronous cervical and sigmoid colon cancer. Korean J Intern Med 2016; 31:413-6. [PMID: 26828248 PMCID: PMC4802196 DOI: 10.3904/kjim.2014.333] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2014] [Revised: 02/24/2015] [Accepted: 03/03/2015] [Indexed: 11/28/2022] Open
Affiliation(s)
- Jae Heun Chung
- Department of Internal Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Min Wook So
- Department of Internal Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Seong-Geun Kim
- Department of Internal Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea
- Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
- Correspondence to Seong-Geun Kim, M.D. Division of Hemato-Oncology, Department of Internal Medicine, Pusan National University Yangsan Hospital, 20 Geumo-ro, Mulgeum-eup, Yangsan 50612, Korea Tel: +82-55-360-1425 Fax: +82-55-360-1425 E-mail:
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Lertvutivivat S, Chanthasenanont A, Chanthasenanont A, Muangto T, Nanthakomon T, Pongrojpaw D, Bhamarapravatana K, Suwannarurk K. Silent High Grade Cervical Intraepithelial Neoplasia in Atypical Smears from Liquid Based Cervical Cytology - Three Years Experience in Thammasat University Hospital. Asian Pac J Cancer Prev 2016; 17:4353-4356. [PMID: 27797243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023] Open
Abstract
PURPOSE To study the prevalence of CIN2+ diagnosis in women with atypical Papaniculoau (Pap) smears to suggest appropriate management option for Thai health care. MATERIALS AND METHODS Data from all patients with liquid based cytology with human papillomavirus (HPV) testing between May 2013 - May 2016 were collected from medical records. Women with atypical cervical Pap smears were recruited. Results for age, HPV testing, HPV 16, 18, 45 and other genotypes tested, colposcopic examination and histopathological assessment were all collected. Atypical smears were defined as atypical squamous cells of undetermined significance (ASC-US) and atypical squamous cells cannot be exclude high grade squamous intraepithelial lesion (ASC-H). RESULTS A total of 2,144 cases were recruited. Twenty six women with ASC-US on cytology had high risk (HR) HPV detection while eight cases with ASC-H had HR-HPV (40.0% VS 72.7%, p=0.005). Among the 26 women with ASC-US cytology and positive HR-HPV, HPV type 16 (n=8, 30.8%), type 18 (n=1, 3.8%), type 45 (n=1, 3.8%) and other HPV types (n=17, 65.4%) were found. Eight women with ASC-H and positive HR-HPV demonstrated type 16 (n=6, 75%) and other HPV types (n=2, 25%). Fifty seven women with ASC-US had normal colposcopy, CIN1 and CIN2+ at percentages of 80.7 (46/57), 14.0 (8/57) and 5.3 (3/57), respectively. In the ASC-H group, 7 out of 10 women had normal colposcopy and three (30%) had CIN2+ results. CONCLUSIONS In women with ASC-US cytology, immediate colposcopy is highly recommended. HPV testing can be performed if colposcopy is not an available option because there was high prevalence (5.3%) of CIN2+ in our findings. ASCCP recommendations for ASC-H that colposcopy should be performed on all ASC-H cases regardless of HPV result are thereby supported by the findings of this investigation.
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Affiliation(s)
- Supapen Lertvutivivat
- Gynecologic Oncology Unit, Department of Obstetrics and Gynecology, Faculty of Medicine, Thammasat University Hospital, Bangkok, Thailand E-mail :
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Vitale SG, Valenti G, Rapisarda AMC, Cali I, Marilli I, Zigarelli M, Sarpietro G, Cianci A. P16INK4a as a progression/regression tumour marker in LSIL cervix lesions: our clinical experience. EUR J GYNAECOL ONCOL 2016; 37:685-688. [PMID: 29787011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
PURPOSE OF INVESTIGATION The aim of this prospective study was the evaluation of low-grade intraepithelial lesion (LSIL) lesions evolvement in woman with evidence of high risk HPV infection and p 16 4a negative expression. MATERIALS AND METHODS 150 women with cytological diagnosis of LSIL were selected to be underwent to three years of follow-up consisting in smear test, colposcopy, and protein p16I4a investigation every six months and HPV-test every 12 months. RESULT Final follow-up showed 45 cases of spontaneous lesion regression and 42 cases of persistence with absence of protein p164NK4a in all of them. There were three cases of disease progression to CIN2, two at 18-month follow-up and one at last follow-up. Disease progression was characterized of p16NK4a expression. CONCLUSION p16l4a should help to identify which LSIL cases are inclined to the progression of the disease and focalize which patients are eligible for specific treatment.
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Abstract
AIM Anal intraepithelial neoplasia precedes the development of anal squamous cell carcinoma. Detection of the lesion is essential to management. This paper describes a prospective study to detect and ablate anal squamous intraepithelial lesions (SILs) using white light narrow band imaging (NBI) and NBI with acetic acid (NBIA). METHOD Sixty patients with abnormal anal cytology and risk factors for anal dysplasia underwent examination of the anoderm with a high definition gastroscope and NBIA. Targeted biopsies were taken and the lesions were ablated and characterized histopathologically. Visualization of the anal transitional zone was facilitated by retroflexion and examination through a disposable anoscope. RESULTS Targeted biopsies were taken from lesions in 58 patients. No lesion was seen in two patients. Histopathology showed SIL in 48 (80.0%) of 60 biopsies. One biopsy showed lymphoid aggregates. Biopsies in nine (15%) of the 60 patients showed normal mucosa. Lesions were seen in white light in 27 (45%) of the 60 cases, NBI in 39 (65%) and NBIA in 57 (95%). There was no major morbidity. Sensitivity analysis showed that all methods were significantly different from each other. CONCLUSION Anal SIL in the anal transitional zone and anal canal can be identified by NBIA. Patient selection influences findings. Limitations include small sample size and non-randomization.
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Affiliation(s)
- M D Inkster
- Departments of Gastroenterology/Hepatology and Colorectal Surgery, Digestive Disease Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - H O Wiland
- Department of Pathology and Laboratory Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | - J S Wu
- Departments of Gastroenterology/Hepatology and Colorectal Surgery, Digestive Disease Institute, Cleveland Clinic, Cleveland, Ohio, USA
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Kong LY, Du W, Wang L, Yang Z, Zhang HS. PAX1 Methylation Hallmarks Promising Accuracy for Cervical Cancer Screening in Asians: Results from a Meta-Analysis. Clin Lab 2015; 61:1471-9. [PMID: 26642709 DOI: 10.7754/clin.lab.2015.150232] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND DNA methylation has been proposed as a potential biomarker for cervical cancer detection. This study aimed to evaluate the diagnostic role of paired boxed gene 1 (PAX1) methylation for cervical cancer screening in Asians. METHODS Eligible studies were retrieved by searching the electronic databases, and the quality of the enrolled studies was assessed via the quality assessment for studies of diagnostic accuracy (QUADAS) tool. The bivariate meta-analysis model was employed to generate the summary receiver operator characteristic (SROC) curve using Stata 12.0 software. Cochran's Q test and I2 statistics were applied to assess heterogeneity among studies. Publication bias was evaluated by the Deeks' funnel plot asymmetry test. RESULTS A total of 9 articles containing 15 individual studies were included. The SROC analysis showed that single PAX1 methylation allowed for the discrimination between cancer/high-grade squamous intraepithelial lesion (HSIL) patients and normal individuals with a sensitivity (95% confidence interval) of 0.80 (0.70 - 0.87) and specificity of 0.89 (0.86 - 0.92), corresponding to an area under curve (AUC) of 0.92. Notably, our subgroup analysis suggested that combing parallel testing of PAX1 methylation and HPV DNA (AUC, sensitivity, and specificity of 0.90, 0.82, and 0.84, respectively) seemed to harbor higher accuracy than single HPV DNA testing (AUC, sensitivity, and specificity of 0.81, 0.86, and 0.67, respectively). CONCLUSIONS PAX1 methylation hallmarks a potential diagnostic value for cervical cancer screening in Asians, and parallel testing of PAX1 methylation and HPV in cervical scrapings confers an improved accuracy than single HPV DNA testing.
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Longatto-Filho A, Levi JE, Martins TR, Cohen D, Cury L, Villa LL, Eluf-Neto J. Critical Analyses of the Introduction of Liquid-Based Cytology in a Public Health Service of the State of São Paulo, Brazil. Acta Cytol 2015; 59:273-7. [PMID: 26279162 DOI: 10.1159/000435801] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2015] [Accepted: 06/08/2015] [Indexed: 12/17/2022]
Abstract
OBJECTIVE The aim of this study was to compare the performance of the current conventional Pap smear with liquid-based cytology (LBC) preparations. STUDY DESIGN Women routinely undergoing their cytopathological and histopathological examinations at Fundação Oncocentro de São Paulo (FOSP) were recruited for LBC. Conventional smears were analyzed from women from other areas of the State of São Paulo with similar sociodemographic characteristics. RESULTS A total of 218,594 cases were analyzed, consisting of 206,999 conventional smears and 11,595 LBC. Among the conventional smears, 3.0% were of unsatisfactory preparation; conversely, unsatisfactory LBC preparations accounted for 0.3%. The ASC-H (atypical squamous cells - cannot exclude high-grade squamous intraepithelial lesion) frequency did not demonstrate any differences between the two methods. In contrast, the incidence of ASC-US (atypical squamous cells of undetermined significance) was almost twice as frequent between LBC and conventional smears, at 2.9 versus 1.6%, respectively. An equal percentage of high-grade squamous intraepithelial lesions were observed for the two methods, but not for low-grade squamous intraepithelial lesions, which were more significantly observed in LBC preparations than in conventional smears (2.2 vs. 0.7%). The index of positivity was importantly enhanced from 3.0% (conventional smears) to 5.7% (LBC). CONCLUSIONS LBC performed better than conventional smears, and we are truly confident that LBC can improve public health strategies aimed at reducing cervical lesions through prevention programs.
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Affiliation(s)
- Adhemar Longatto-Filho
- Laboratx00F3;rio de Investigax00E7;x00E3;o Mx00E9;dica (LIM) 14, Faculdade de Medicina, Universidade de Sx00E3;o Paulo, Sx00E3;o Paulo, Brazil
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Moscicki AB, Darragh TM, Berry-Lawhorn JM, Roberts JM, Khan MJ, Boardman LA, Chiao E, Einstein MH, Goldstone SE, Jay N, Likes WM, Stier EA, Welton ML, Wiley DJ, Palefsky JM. Screening for Anal Cancer in Women. J Low Genit Tract Dis 2015; 19:S27-42. [PMID: 26103446 PMCID: PMC4479419 DOI: 10.1097/lgt.0000000000000117] [Citation(s) in RCA: 95] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE The incidence of anal cancer is higher in women than men in the general population and has been increasing for several decades. Similar to cervical cancer, most anal cancers are associated with human papillomavirus (HPV), and it is believed that anal cancers are preceded by anal high-grade squamous intraepithelial lesions (HSIL). Our goals were to summarize the literature on anal cancer, HSIL, and HPV infection in women and to provide screening recommendations in women. METHODS A group of experts convened by the American Society for Colposcopy and Cervical Pathology and the International Anal Neoplasia Society reviewed the literature on anal HPV infection, anal SIL, and anal cancer in women. RESULTS Anal HPV infection is common in women but is relatively transient in most. The risk of anal HSIL and cancer varies considerably by risk group, with human immunodeficiency virus-infected women and those with a history of lower genital tract neoplasia at highest risk compared with the general population. CONCLUSIONS While there are no data yet to demonstrate that identification and treatment of anal HSIL leads to reduced risk of anal cancer, women in groups at the highest risk should be queried for anal cancer symptoms and required to have digital anorectal examinations to detect anal cancers. Human immunodeficiency virus-infected women and women with lower genital tract neoplasia may be considered for screening with anal cytology with triage to treatment if HSIL is diagnosed. Healthy women with no known risk factors or anal cancer symptoms do not need to be routinely screened for anal cancer or anal HSIL.
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Affiliation(s)
- Anna-Barbara Moscicki
- Division of Adolescent and Young Adult Medicine, Department of Pediatrics, University of California, San Francisco, CA, USA
| | - Teresa M. Darragh
- Department of Clinical Pathology, University of California, San Francisco, CA, USA
| | | | | | - Michelle J. Khan
- Division of Women's Reproductive Healthcare Department of OB/GYN, School of Medicine, University of Alabama at Birmingham, AL, USA
| | - Lori A. Boardman
- Florida Hospital for Women, Florida Hospital System, University of Central Florida College of Medicine, FL, USA
| | - Elizabeth Chiao
- Center for Innovations in Quality, Effectiveness, and Safety, Michael E. DeBakey VA Medical Center, Houston, TX, USA
| | - Mark H. Einstein
- Department of Obstetrics and Gynecology & Women's Health, Albert Einstein College of Medicine, Montefiore Medical Center, New York, NY
| | | | - Naomi Jay
- Anal Neoplasia Clinic, Research and Education (ANCRE) Center, University of California, San Francisco, CA, USA
| | - Wendy M. Likes
- College of Medicine, Department of Obstetrics and Gynecology, University of Tennessee Health Science Center, Memphis, TN, USA
| | | | - Mark Lane Welton
- Colon & Rectal Surgery, Stanford University School of Medicine Stanford Hospital and Clinics, Stanford, CA, USA
| | - Dorothy J. Wiley
- School of Nursing, University of California, Los Angeles, CA, USA
| | - Joel M. Palefsky
- Department of Infectious Diseases, University of California, San Francisco, CA, USA
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Shi YH, Wang BW, Tuokan T, Li QZ, Zhang YJ. Association between micronucleus frequency and cervical intraepithelial neoplasia grade in Thinprep cytological test and its significance. Int J Clin Exp Pathol 2015; 8:8426-8432. [PMID: 26339413 PMCID: PMC4555741] [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] [Subscribe] [Scholar Register] [Received: 05/22/2015] [Accepted: 06/28/2015] [Indexed: 06/05/2023]
Abstract
A micronucleus is an additional small nucleus formed due to chromosomes or chromosomal fragments fail to be incorporated into the nucleus during cell division. In this study, we assessed the utility of micronucleus counting as a screening tool in cervical precancerous lesions in Thinprep cytological test smears under oil immersion. High risk HPV was also detected by hybrid capture-2 in Thinprep cytological test smears. Our results showed that micronucleus counting was significantly higher in high-grade squamous intraepithelial lesion (HSIL) and invasive carcinoma cases compared to low-grade squamous intraepithelial lesion (LSIL) and non-neoplastic cases. Receiver operating characteristic (ROC) curve analysis revealed that micronucleus counting possessed a high degree of sensitivity and specificity for identifying HSIL and invasive carcinoma. Cut-off of 7.5 for MN counting gave a sensitivity of 89.6% and a specificity of 66.7% (P = 0.024 and AUC = 0.892) for detecting HSIL and invasive carcinoma lesions. Multiple linear regression analysis showed that only HSIL and invasive cancer lesions not age, duration of marital life and number of pregnancy are significantly associated with MN counting. The positive rate of high risk HPV was distinctly higher in LSIL, HSIL and invasive cancer than that in non-neoplstic categories. In conclusions, MN evaluation may be viewed as an effective biomarker for cervical cancer screening. The combination of MN count with HPV DNA detection and TCT may serve as an effective means to screen precancerous cervical lesions in most developing nations.
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Affiliation(s)
- Yong-Hua Shi
- Department of Pathology, Basic Medicine College of Xinjiang Medical UniversityUrumqi, Xinjiang, China
| | - Bo-Wei Wang
- Department of Pathology, First Affiliated Hospital of Xinjiang Medical UniversityUrumqi, Xinjiang, China
| | - Talaf Tuokan
- Department of Pathology, Basic Medicine College of Xinjiang Medical UniversityUrumqi, Xinjiang, China
| | - Qiao-Zhi Li
- Department of Pathology, Basic Medicine College of Xinjiang Medical UniversityUrumqi, Xinjiang, China
| | - Ya-Jing Zhang
- Department of Pathology, Hospital of Traditional Chinese Medicine Affiliated to Xinjiang Medical UniversityUrumqi, Xinjiang, China
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Washiya K, Saito C, Nanjo H, Sugiyama T, Abe K, Watanabe J. Cytological Analysis of Low-grade Squamous Intraepithelial Lesion with a Histodiagnosis of Cervical Intraepithelial Neoplasia 3 (Severe Dysplasia) Prospectively. Anal Quant Cytopathol Histpathol 2015; 37:153-158. [PMID: 26173352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
OBJECTIVE To reanalyze the cytological features of the first cytological specimens of cervical intraepithelial neoplasia 3 (CIN3) (severe) cases that were initially cytodiagnosed as LSIL and followed up for up to 5 years. STUDY DESIGN Among 14,556.patients in 2009, 236 (1.6%) were cytodiagnosed with low-grade squamous intraepithelial lesion (LSIL). Among those, 128 cases could be histologically diagnosed from 2009 to 2013. Among those 128 cases, 16 were diagnosed as CIN3 (severe). The first cytological specimens of those 16 cases were reanalyzed morphologically. RESULTS The first cytological specimens of the 16 cases diagnosed as LSIL and histodiagnosed as CIN3 (severe) showed a few small atypical cells in 13 and a cluster of small atypical cells in 1 case. Atypical cells indicating CIN1 were predominant in 14 LSIL cases and there were a few small atypical cells in these cases (LSIL, cannot exclude high-grade squamous intraepithelial lesion [LSIL-H]). CONCLUSION We show the existence of LSIL-H (LSIL, cannot exclude HSIL) cases, for which biopsy with colposcopy should be applied actively.
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Hidalgo-Tenorio C, Rivero-Rodriguez M, Gil-Anguita C, Esquivias J, López-Castro R, Ramírez-Taboada J, de Hierro ML, López-Ruiz MA, Martínez RJ, Llaño JP. The role of polymerase chain reaction of high-risk human papilloma virus in the screening of high-grade squamous intraepithelial lesions in the anal mucosa of human immunodeficiency virus-positive males having sex with males. PLoS One 2015; 10:e0123590. [PMID: 25849412 PMCID: PMC4388587 DOI: 10.1371/journal.pone.0123590] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2014] [Accepted: 02/19/2015] [Indexed: 01/15/2023] Open
Abstract
Objectives To evaluate the advantages of cytology and PCR of high-risk human papilloma virus (PCR HR-HPV) infection in biopsy-derived diagnosis of high-grade squamous intraepithelial lesions (HSIL = AIN2/AIN3) in HIV-positive men having sex with men (MSM). Methods This is a single-centered study conducted between May 2010 and May 2014 in patients (n = 201, mean age 37 years) recruited from our outpatient clinic. Samples of anal canal mucosa were taken into liquid medium for PCR HPV analysis and for cytology. Anoscopy was performed for histology evaluation. Results Anoscopy showed 33.8% were normal, 47.8% low-grade squamous intraepithelial lesions (LSIL), and 18.4% HSIL; 80.2% had HR-HPV. PCR of HR-HPV had greater sensitivity than did cytology (88.8% vs. 75.7%) in HSIL screening, with similar positive (PPV) and negative predictive value (NPV) of 20.3 vs. 22.9 and 89.7 vs. 88.1, respectively. Combining both tests increased the sensitivity and NPV of HSIL diagnosis to 100%. Correlation of cytology vs. histology was, generally, very low and PCR of HR-HPV vs. histology was non-existent (<0.2) or low (<0.4). Area under the receiver operating characteristics (AUROC) curve analysis of cytology and PCR HR-HPV for the diagnosis of HSIL was poor (<0.6). Multivariate regression analysis showed protective factors against HSIL were: viral suppression (OR: 0.312; 95%CI: 0.099-0.984), and/or syphilis infection (OR: 0.193; 95%CI: 0.045-0.827). HSIL risk was associated with HPV-68 genotype (OR: 20.1; 95%CI: 2.04-197.82). Conclusions When cytology and PCR HR-HPV findings are normal, the diagnosis of pre-malignant HSIL can be reliably ruled-out in HIV-positive patients. HPV suppression with treatment protects against the appearance of HSIL.
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Affiliation(s)
- Carmen Hidalgo-Tenorio
- Infectious Disease Unit, University Hospital Virgen de las Nieves, Granada, Spain
- * E-mail:
| | - Mar Rivero-Rodriguez
- Infectious Disease Unit, University Hospital Virgen de las Nieves, Granada, Spain
| | | | - Javier Esquivias
- Pathology Service, University Hospital Virgen de las Nieves, Granada, Spain
| | | | | | | | - Miguel A. López-Ruiz
- Infectious Disease Unit, University Hospital Virgen de las Nieves, Granada, Spain
| | - R. Javier Martínez
- Infectious Disease Unit, University Hospital Virgen de las Nieves, Granada, Spain
| | - Juan P. Llaño
- Infectious Disease Unit, University Hospital Virgen de las Nieves, Granada, Spain
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Abstract
CONTEXT AND OBJECTIVE Inadequate Pap smears do not provide satisfactory cell samples for evaluation, thus making it more difficult to detect cervical cytological abnormalities. The objective of this study was to determine the cytological and histological follow-up results from women with inadequate smear reports in primary healthcare centers in Santiago, Chile 2010-2011. DESIGN AND SETTING Prospective cohort study at primary healthcare clinics in Santiago, Chile. METHODS The population was taken from the "Cito-Expert" database of 2010. The data were then organized according to the cytological and histological follow-up results of 2,547 women with inadequate cervical cytological reports over the 12-month period. The samples were assigned to groups based on the cause of inadequacy (smears with endocervical cells alone; insufficient, hemorrhagic, inflammatory or poorly fixed samples; insufficient and hemorrhagic samples; or insufficient and inflammatory specimens). The data were analyzed using the "conditional probability tree diagram" and descriptive statistics. RESULT Half of the women (n = 1,285) met the requirements of the Ministry of Health for repeating these inadequate smears, and 1,104 of these women had normal cytological results (85.9%). The detection rate for cervical lesions according to group ranged from 0% (smears with endocervical cells alone or insufficient and hemorrhagic specimens) to 4.1% (poor fixation). CONCLUSION The large proportion of normal results justifies revision of the current clinical guidelines. The results showed that it is not necessary to repeat the Pap test early on, with the exception of inadequate hemorrhagic and inflammatory cytological results.
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Affiliation(s)
| | | | - Orlando Quezada Poblete
- MT. Medical Technologist, Cytology Laboratory, Complejo Asistencial Barros Luco, Santiago, Chile
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