ABSTRACT
Cervical cancer is the second leading cancer in women worldwide, with 85-100% of cervical cancers being HPV DNA positive. Our study aimed at evaluating the use of HPV DNA testing as an adjunct to the routine cervical cytology evaluation of Lebanese women. Cervical cytology evaluation and testing for human papillomavirus [HPV], as well as high-risk HPV were performed on two groups of women. One group consisted of 274 healthy women attending gynecology clinics for routine evaluation, while the other included 199 women selected based on a high-risk lifestyle and/or abnormal findings at cytology. HPV and HR-HPV DNA were 4 and 10 times higher, and HPV was 4 to 5 times more frequent at all age groups in selected, compared to healthy women. HPV infection decreased in healthy women with age but did not decrease in selected women. HPV positive-normal cytology decreased with age in both groups. Although HR-HPV detection decreased with age in healthy women, it doubled in selected women. In addition, more severe cytology was associated almost uniquely with selected women. HR-HPV detection and advanced cytology lesions correlated well and were mutually predictive. The overall sensitivity, specificity, positive and negative predictive values of HPV testing for squamous intraepithelial lesions were [85.5%], [90.95], [67.8%] and 96.5%, respectively. Based on these findings, we recommend implementing HPV screening as an adjunct to routine cervical cytology in selected Lebanese women older than 30 years of age
ABSTRACT
Several endoscopic aspects of duodenal mucosa have been described in patients with villous atrophy [VA] and celiac disease. We assessed the accuracy of three endoscopic markers in patients referred for duodenal biopsy.methods: From January 1992 to June 2000 all patients undergoing upper gastrointestinal [UGI] endoscopy by a single operator [n = 4102], had the second part of the duodenum examined, without any magnification technique or addition of vital dye staining, for the presence of three markers of VA, [1] reduction or loss of Kerkring's folds, [2] scalloped configuration of the duodenal folds, and [3] mosaic appearance of the mucosa.Biopsy samples were taken from those in whom the mucosa was abnormal [n = 51], and from those in whom it Was normal but where biopsy was indicated [n = 230].None of the 230 endoscopically normal controls had VA. Seven out of 51 patients [14%] with an abnormal mucosa had a normal histology, the remaining 44 [86%] had some degree of VA confirmed at histology, partial VA in 11 patients [25%] and subtotal or total VA in 33 patients [75%]. 63% of the patients with only one endoscopic marker had VA confirmed at histology whereas the coexistence of more than one marker was always associated with histological villous atroluphy. The overall sensitivity, specificity, positive and negative predictive values of the endoscopic markers were respectively, 100%, 97%, 86%, and 100%.mg 44 [86%] had some degree of VA confirmed at histology, partial VA in 11 patients [25%] and subtotal or total VA in 33 patients [75%]. 63% of the patients with only one endoscopic marker had VA confirmed at histology whereas the coexistence of more than one marker was always associated with histological villous atrophy. The overall sensitivity, specificity, positive and negative predictive values of the endoscopic markers were respectively, 100%, The appearance of the second part of the duodenal mucosa as assessed during routine UGI endoscopy, is a sensitive and specific indicator of the presence of VA on biopsy, and should alert the endoscopist to the possibility of a celiac disease