ABSTRACT
Abstract Objective Similar to Human Papillomavirus (HPV) genotypes, different lineages of a genotype also have different carcinogenic capabilities. Studies have shown that specific genotype lineages of oncogenic HPV are associated with variable risks for the development of cervical intraepithelial neoplasia (CIN2/CIN3) and cervical cancer. The present study aimed to analyze the genetic diversity of the HPV16 genotype in women with CIN2/CIN3 and cervical cancer, from the northeast region of Brazil. Methods A cross-sectional multicenter study was conducted in the northeast region of Brazil, from 2014 to 2016. This study included 196 cases of HPV16 variants (59 and 137 cases of CIN2/CIN3 and cervical cancer, respectively). The difference of proportion test was used to compare patients with CIN2/CIN3 and cervical cancer, based on the prevalent HPV16 lineage (p < 0.05). Results According to the histopathological diagnosis, the percentage of lineage frequencies revealed a marginal difference in the prevalence of lineage A in CIN2/CIN3, compared with that in cervical cancer (p = 0.053). For lineage D, the proportion was higher in cancer cases (32.8%), than in CIN2/CIN3 cases (16.9%), with p = 0.023. Conclusion HPV16 lineage A was the most frequent lineage in both CIN2/CIN3 and cervical cancer samples, while lineage D was predominant in cervical cancer, suggesting a possible association between HPV16 lineage D and cervical cancer.
Resumo Objetivo Tanto os tipos quanto as linhagens do Papilomavírus Humano (HPV) parecem ter diferentes capacidades carcinogênicas e estão associados a riscos variados para o desenvolvimento de neoplasia intraepitelial cervical (NIC) e câncer de colo do útero. O presente estudo tem como objetivo analisar a diversidade genética do genótipo HPV 16 nos casos de NIC2/NIC3 e câncer de colo de útero em mulheres da região Nordeste do Brasil. Métodos Estudo transversal de base hospitalar realizado na região Nordeste do Brasil no período de 2014 a 2016. A amostra foi composta por 196 casos da variante HPV-16 (59 casos de NIC2/NIC3 e 137 de câncer do colo do útero). O teste de diferença de proporção foi usado para comparar os grupos NIC2/NIC3 e câncer de colo do útero por linhagem viral em relação à prevalência da linhagem HPV-16. Foi considerada significância estatística o valor de p < 0,05. Resultados As frequências de linhagem por diagnóstico histopatológico mostraram diferença limítrofe da linhagem A no grupo NIC2/NIC3 em relação ao grupo câncer de colo de útero (p = 0,053). Por outro lado, em relação à linhagem D, houve uma proporção maior nos casos de câncer (32,8%) quando comparado ao grupo NIC2/NIC3 (16,9%) e esta diferença se mostrou estatisticamente significante (p = 0,023). Conclusão A linhagem A do HPV-16 foi a mais frequente tanto nas amostras CIN2/CIN3 quanto nas amostras de câncer de colo de útero, enquanto a linhagem D predominou no câncer de colo do útero, sugerindo uma possível associação da linhagem D de HPV-16 com câncer de colo de útero.
Subject(s)
Humans , Female , Human papillomavirus 16ABSTRACT
Background: This study aimed to examine whether genotype categories of high-risk human papillomaviruses (HR-HPVs), when divided into HPV16/18, HPV 31/33/45/52/58, and HPV35/39/51/56/59/68, had an effect on the time required for and the proportion of cases that progressed to cervical intraepithelial neoplasia (CIN) grade 3 among women with CIN2.Patients: A total of 160 women aged 20–49 years and having CIN2 were recruited between January 2008 and June 2018. The time required for progression to CIN3 was determined by Kaplan-Meier time-to-event analysis. HPV genotypes were determined using the Linear Array HPV genotyping test.Results: During an average follow-up time of 22 months, 62 (39%) women with CIN2 progressed to CIN3, whereas 34 (21%) eliminated HR-HPVs and became cytologically normal. The majority (63%) of the women harboring HPV16/18 progressed to CIN3 with a 50% progression time of 11 months, whereas 26% of those harboring HPV31/33/45/52/58 progressed to CIN3 with a 50% progression time of 70 months.Conclusion: For every patient diagnosed with CIN2, genotyping to distinguish HPV16/18 from other HR-HPVs should be performed. Therefore, electing a surgical treatment, such as conization, should be considered as the primary option for women who are positive for HPV16/18, particularly when they are likely to be lost for follow-up or are 40 years old or older. In contrast, follow-up cytology should be repeated every 12 months for women harboring non-16/18 HR-HPVs. Those who tested negative for HR-HPV may be followed at the maximum interval of 24 months.
ABSTRACT
OBJECTIVE: To evaluate the therapeutic value of conization using right-angled triangular shape loop cone biopsy excisor in patients with CIN 3 who want preserve the uterus. METHODS: A retrospective review of 64 patients was performed who underwent therapeutic conization for CIN 3 by using right-angled triangular shape loop cone biopsy excisor from January 2000 to August 2005. RESULTS: The mean duration of 64 follow-up patients who had conization for therapeutic purpose was 21.5 months (range 10-68). Their mean age was 41.1 years old and mean parity was 1.7. Two of 64 patients had CIN 3 on exocervix margin. During the followed up period, only one person (1/64) had relapse of CIN 3, hence, a simple hysterectomy was done. CONCLUSION: Right-angled triangular shape loop cone biopsy excisor is more effective than U-shaped loop with low rate of margin positive and recurrent rate in conservative treatment in CIN 3 patients who want to preserve uterus or fertility.
Subject(s)
Female , Humans , Biopsy , Uterine Cervical Dysplasia , Conization , Fertility , Follow-Up Studies , Hysterectomy , Parity , Recurrence , Retrospective Studies , UterusABSTRACT
OBJECTIVE: To know the ratio of hysterectomies and cones for the treatment of CIN 3 in Incheon and Bucheon area, and to know the trend of changes of treatments according to the year operated and age of patients. METHODS: From Jan. of 1996 to Mar. of 2005, clinical information was reviewed for the patients with CIN3 at 5 hospitals, which were members of Gynecologic Oncology Study Group in Incheon and Bucheon area. RESULTS: Among 1428 patients with CIN 3, 808 patients underwent hysterectomies and 620 underwent cone (57% vs. 43%). Before 2000, almost 10-30% of patients selected cones for themselves. After 2003, however, 70% have selected cones. And younger patients prefer cones and older patients prefer hysterectomies. 60% of patients of their 5th decades have selected hysterectomies and remainders have selected cones for their CIN3 treatments. CONCLUSION: In Incheon and Bucheon area, hysterectomies have been performed slightly more than conization of cervix for the patients with CIN3. After 2003, however, about 70% of patients with CIN3 have been treated by cone. As patients get old, they get to prefer hysterectomy.