High-risk Human Papillomavirus (hrHPV) Prevalence and Genotype Distribution among Turkish Women

Purpose

This study aimed to determine the rates of distribution of high-risk HPV (hrHPV) genotypes according to cervical smear samples and biopsy results in a large sample of Turkish women.

Methods

The study was conducted with 4,503 healthy volunteer women aged 19-65 years. Samples of cervical smears were collected during the examination and liquid-based cytology was used for the Pap tests. The Bethesda system was used for reporting the cytology. High-risk HPV genotypes including HPV16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 66, and 68 were investigated in samples. The study cohort was grouped according to age in decades, with comparisons made according to these age groups, Bethesda class, and cervix biopsy results.

Results

Among all cases, 903 (20.1%) participants were positive for 1074 hrHPV-DNA genotypes. HPV-DNA positive cases were most common in the 30-39 age group (28.0%), followed by women under the age of 30 (38.5%). HPV genotypes were determined as, in order of frequency: Other hrHPV (n = 590, 65.3%), HPV16 (n = 127, 14.1%), Other HPV + HPV16 (n = 109, 12.1%), HPV 18 (n = 33, 3.6%), and Other HPV + HPV 18 (n = 32, 3.5%). Cervical smears were reported as ASCUS in 304 (6.8%) samples and high-grade squamous intraepithelial lesion (HSIL) in 12 (0.3%) of the samples. Biopsy demonstrated the presence of HSIL in 110 (12.5%) participants, with 644 (73.3%) negative cases.

Conclusion

This showed an increasing incidence of Other HPVs besides the known importance of HPV 16 and 18 genotypes as risk factors for cervical cancer.

Effects of tissue cytomegalovirus quantitative polymerase chain reaction in the management of ulcerative colitis flare-ups: Should we wave aside?

BACKGROUND AND STUDY AIMS

The role of cytomegalovirus (CMV) infection for disease reactivation in ulcerative colitis (UC) patients remains controversial and diagnostic tests are yet to be standardized. We aimed to define the clinical relevance of CMV detection by mucosal polymerase chain reaction (PCR) in UC patients by comparing the clinical course of UC in CMV-treated and CMV-untreated groups in tissue CMV-PCR positive cases.

PATIENTS AND METHODS

In this retrospective study, 141 patients diagnosed with moderate-to-severe UC admitted to our clinic with disease flare, colonic tissue CMV PCR was assessed.

RESULTS

The median age of the study population was 39 years, and 99 (70.2%) patients were male. Eighty-eight (62.4%) patients were CMV-PCR (+) and 53 (37.6%) were CMV PCR (-). The CMV-PCR (+) and CMV PCR (-) groups showed no significant difference concerning age, sex, disease duration, site of involvement and disease activity and administered treatments. The median tissue CMV-PCR was 41,098 IU/mL (IQR:2,344.25-136,192). Thirty-four of 88 CMV-PCR (+) patients received antiviral therapy. The tissue CMV-PCR level of patients who received antiviral therapy was 124,381 IU/mL (IQR: 19,309-412,335), and it was 6,292 IU/mL (IQR: 997-71,154) in patients who did not receive antiviral therapy; (p < 0.001). Sixteen (47.1%) of 34 patients who received antiviral therapy achieved remission. Two of the non-responders underwent colectomy (one because of dysplasia and one who did not respond subsequent biologic agent either). Remaing 16 achieved remission by escalating the immunsuppresive/biologic agent therapy.

CONCLUSION

CMV infection is responsible for only a minority of cases of UC flares and all are steroid-resistant cases. Most of the patients non-responsive to antiviral treatment respond to increased anti-inflammatory treatment. Hesitancy in the decision of escalating immunsuppresive treatment rather than CMV disease may be responsible for worsening disease course and increased colectomy rate in a significant number of the patients who are tissue CMV-PCR (+).

A prospective comparative study to assess the contribution of radioisotope tracer method to dye-only method in the detection of sentinel lymph node in breast cancer

BACKGROUND

Metastasis in the axillary lymph nodes is the most important known prognostic factor for breast cancer. We aimed to investigate the contribution of the radioisotope tracer method to the dye-only method by performing sentinel lymph node biopsy on the same patient group during a single surgical session.

METHODS

Forty-two patients who underwent operations in our clinic from February 2010 to October 2011 and with masses of <5 cm and clinically and radiologicallly negative axilla (T1-2 N0) were prospectively included in this study. After paraffin examination results were obtained, the numbers and metastatic states of the lymph nodes that were unidentifiable during surgery (although they were stained) but were detected by a gamma probe, lymph nodes that were only stained, lymph nodes that were only radioactive (hot), and lymph nodes that were both stained and radioactive (stained-hot) were determined in all patients. In patients who underwent axillary lymph node dissection, the total numbers of lymph nodes removed and their metastatic states were determined separately.

RESULTS

At least one blue-stained sentinel lymph node was identified in all patients during the blue-stained lymph node detection stage. The average number of sentinel nodes removed at this stage was 2.1 ± 1.1. In the second surgical stage (the stage in which nodes with axillary counts were investigated with the gamma probe) in these 41 patients, at least one additional hot node was removed, or at least one of the nodes that was removed because it was blue was also hot. In addition to the lymph nodes removed in the dye stage, 34 hot lymph nodes were excised from 21 patients. Overall, the average number of hot lymph nodes removed was 2.9 ± 1.5. In all patients, subsequent frozen sections and histopathological examinations were 100% concordant with the sentinel lymph nodes that were removed; the stained sentinel lymph nodes that were removed first did not affect the decision to perform axillary dissection.

CONCLUSION

The results of our study indicate that performing sentinel lymph node biopsy with dye only is sufficient and as effective as the combined method.