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Background: Cervical cancer is the fourth most common cancer in women. In India and other developing countries cervical cancer is the leading cause of morbidity and mortality. Cancer cervix continues to be most common genital carcinoma in India accounting for 80% of all female genital malignancies. Pre-invase lesions can spontaneously regress to normal or remain stable for long period or progress to a higher degree of dysplasia. Cancer of cervix is preventable if diagnosed at the pre-invasive stage with regular intervals of cytological screening by Papanicolaou (Pap) smears. The aim of the study is to analyse the pap reports in terms of normal findings, infections, premalignant lesions and invasive cancers.Methods: All women attending the outpatient department gynaecology at TMMC and RC Moradabad, Uttar Pradesh over a period of 1 year from august 2017-18 presented of obstetrics and with white discharge per vagina were screened for cervical cancer using pap smear. All the smears were reported as per the 2014 Bethesda system.Results: Out of 1392 Pap smear reports ASCUS was reported in 27 cases (2%), LSIL in 27 cases (2%), HSIL in 15 cases (1%), malignant cells in 15 cases (1%) and normal including the infection is reported in 1308 cases (94%).Conclusions: Early cervical epithelial changes can be identified by a Pap smear test, which is the primary screening test for detection of precancerous cervical intraepithelial neoplasia and the early stage of invasive cervical cancer.
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Background: Cervical cancer is the leading cause of death in women in developing countries like India. It is preventable by regular screening by Pap smear and can be detected at pre-invasive stage. Thus, reducing the morbidity and mortality related with cervical cancers. Objective: This study aims at detecting the prevalence and current trends of various epithelial cell abnormalities (ECAs) in females attending a tertiary care hospital. Materials and Methods: This is a retrospective study conducted in a tertiary care hospital between July 2015 and May 2019. A total of 15,270 cases comprising 11,494 conventional and 3776 liquid-based cytology Pap smears were included in the study. Clinical data and history of the patients were retrieved. All cases were reported according to Bethesda system 2014. Results: Among 15,270 cases, 793 Pap smears were unsatisfactory, 14,153 Pap smears were negative for intraepithelial lesion/malignancy, and 325 cases had ECA. Conclusion: Large hospital-based studies are required for proper implementation of health services and for the selection of a feasible as well as sensitive screening test for early detection of cervical dysplasias which can be helpful in decreasing the burden of cervical cancer in our community.
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Objective:To investigate the application of Aptima high-risk human papillomavirus (HR-HPV) E6/E7 mRNA (AHPV) and its genotyping (GT) in the risk assessment of low-grade squamous intraepithelial lesions (LSIL).Methods:The AHPV and its genotype (AHPV-GT) incervical exfoliated cells were detectedin 529 women with LSIL.The DNA-Based Hybrid Capture 2 HPV Test (HC2-HPV), colposcopy and cervical biopsy were performedsimultaneously.Results:① In 529 patients with LSIL, the positive rate of HC2-HPV in the group of ＜30 years old was significantly higher than that in the group of ≥30 years old (92.2％ vs 83.6％, P=0.026).There was no significant difference in AHPV positive rate among different age groups (82.5％ vs 77.7％, P=0.284).No significant difference of the genotyping (AHPV-GT) was detected between the two groups, either.In the 529 cases, 83 cases of HSIL+were confirmed by histology.81 cases (97.6％) were AHPV positive in the patients with HSIL+;② Compared with other 11 positive types of HR-HPV, the incidence of HSIL+in GT+ women increased significantly (P＜0.05).In the group ≥30 years old, the OR value of HSIL+exposure risk of AHPV16 positive women was the highest (141.00), which was significantly higher than that of 18/45+, GT +, AHPV + (P=0.005, 0.000, 0.000).However, in the group of ＜30 years old, the OR value of HSIL+exposure risk of AHPV16 positive women was 8.50, which showed no significant difference from that of 18/45+ and AHPV-(P=1.000, 0.070).③ In group over 30 years old, the specificity of detecting HSIL+by AHPV was higher than that by HC2-HPV (P＜0.05).There was no significant difference in detection specificity between AHPV and HC2-HPV in women under 30 years old.Conclusions:AHPV and its GT detection are reliable methods for colposcopic screening and risk stratification in women aged over 30 years old with LSIL, more attention should be focused on AHPV16 positive.Better biological markers should be explored for younger women.
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Objective: To explore the impact of focused ultrasound on expression of hypoxia inducible factor-1α (HIF-1α),vascular endothelial growth factor (VEGF) and mutant type p53 (mtp53) in vulvar skin of rat models with low grade squamous intraepithelial lesion (LSIL). Methods: A total of 28 rat models with LSIL were established and randomly divided into treatment group and control group (each n=14). The rat models in treatment group were treated with focused ultrasound, while in control group only received sham irradiation (no power output from ultrasonic therapeutic instrument). Histological changes of vulvar skin in SD rats were observed 4 weeks later. The expression of HIF-1α, VEGF and mtp53 protein were detected using immunohistochemistry. Results: After 4 weeks of focused ultrasound irradiation/sham irradiation, there were 92.86% (13/14) rats return to normal in treatment group and 71.43% (10/14) rats progressed into high grade squamous intraepithelial lesion (HSIL) in control group. Compared with control group, HIF-1α, VEGF and mtp53 protein levels significantly decreased in treatment group (all P<0.05). Conclusion: Focused ultrasound treatment can improve the microenvironment of local vulvar tissue by decreasing the expression of HIF-1α, VEGF and mtp53 in vulvar skin, therefore can be used to treat LSIL safely and effectively in rat models.
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Background and Objectives: Cervical cancer is very common type of cancer in women globally. The objective of this study was to compare the cytopathological findings of the cervical pap smears using the revised 2001 Bethesda system and to compare the cytopathological findings with the clinical features.Material and Methods: A total of 1016 pap smear sent to the Department of Cytopathology at Peoples Dental college general hospital (PDCH), Kathmandu over a period of three years were studied. Relevant history and clinical findings were retrieved for the study. The age, caste, location, gravida of the patient, the nature of complaint of patient to the doctor along with the per speculum findings, per vaginal examination findings of the patient and their relation to the cytopathological findings of pap smears were evaluated.Results: No significant relationship was observed between the (30-39 years) aged women and the available outcome of pap smear (p=0.404). Most of the females were Brahmin and Newars. The statistical analysis showed no significant relationship (p>0.05) between the ethnicity and pap smear result. The number of asymptomatic women in this study was found 22.9%. This study found 20.37% of intraepithelial lesion or malignancy. Trichomonas vaginalis and bacterial vaginosis combinely contributed to 0.7% of the total cases in this study. Three smear cases were detected having malignant epithelial cell which were diagnosed with adenocarcinoma, squamous cell carcinoma.Conclusion: In this study cervical pap smear was able to differentiate inflammatory, benign precursors and malignant cases. So, it is desirable to conduct routine Pap smear screening in women of all reproductive age regardless of race, ethnic background and socioeconomic status.
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Introducción: La detección de las lesiones tempranas y precursoras al carcinoma del cérvix uterino se realiza con la interpretación del papanicolaou. Objetivo: Determinar la correlación entre la citología cervical comparada con el diagnóstico por colposcopia y de histología en la lesión escamosa intraepitelial de bajo grado (LEIBG). Material y métodos: A 100 pacientes con citología compatible con LEIBG se les realiza colposcopia y se toma biopsia dirigida para estudio histopatológico. Resultados: La edad promedio fue de 37 años, y el inicio de vida sexual activa 19.25 años, con un número de parejas sexuales de 2.57, uso de condón en 0.3%, y eran fumadoras 45% de las pacientes. La citología diagnosticó: LEIBG en 77 de las pacientes (77%); proceso inflamatorio 20% y lesiones escamosas intraepiteliales de alto grado (LEIAG) en 3%; sensibilidad de 88.23%; especificidad de 42.85%; valor predictivo positivo (VPP) de 94.93%, y valor predictivo negativo (VPN) de 23.07%. La citología de la unidad diagnosticó: LEIBG en 85% de las pacientes; proceso inflamatorio en 13%; LEIAG en 2%; sensibilidad en 79.12%; especificidad de 28.57%; VPP de 93.50%, y VPN de 9.52%. La colposcopia con el índice de Reid diagnosticó: LEIBG en 92%; proceso inflamatorio de 6%; LEIAG en 2%; sensibilidad en 93.47%; especificidad de 33.33%; VPP de 95.55%, y VPN de 25%. El estándar de oro fue por histopatología: en un 100% con diagnóstico a LEIBG. Conclusión: Ante una citología anormal debe realizarse colposcopia con toma de biopsia dirigida para un diagnóstico más exacto. La citología seguirá siendo un buen estudio de escrutinio ya que logra detectar lesiones tempranas.
Introduction: The detection of the early lesions precursors of uterine cervix carcinoma is carried out based on the interpretation of Papanicolaou smear. Objective: To determine the correlation that exists betweeen cervical cytology compared with the diagnosis by either colposcopy or histology in the Low-Grade Squamous Intraepithelial Lesion (LSIL). Material and methods: 100 patients with cytology compatible with LSIL are practiced colposcopy taking directed biopsy for histopathologic study. Results: Average age: 37; Average onset of sexually active life: 19.25 years old; number of sexual partners: 2.57; condom use in 0.3%. 45% of the patients were smokers. Diagnosis by cytology: LSIL in 77 (77%) of the patients, inflammatory process 20 (20%), and HSIL 3 (3%). Sensibility: 88.23%; specificity 42.85%; positive predictive value (PPV): 94.93%, and negative predictive value (NPV): 23.07%. LSIL diagnosis by cytology: 85 patients (85%); inflammatory process: 13 (13%); HSIL: 2 (2%); Sensibility: 79.12%; specificity: 28.57%; PPV: 93.50%; NPV: 9.52%. The colposcopy with Reid index and diagnosis of LSIL: 92 (92%) patients; inflammatory process: 6 (6%); HSIL: 2 (2%); Sensibility: 93.47%; Specificity: 33.33%; PPV: 95.55%; NPV: 25%. The gold standard was histopathology: 100% with a diagnosis of LSIL. Conclusion: Before an abnormal cytology, colposcopy with directed biopsy should be performed for a more accurate diagnosis. Cytology will remain a good screening test due to its usefulness to detect early cervical lesions.
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Objective: To examine the histological outcomes and the predictive value of clinical risks in women with liquid-based Papanicolaou tests (PTs) interpreted as "low-grade squamous intraepithelial lesion, cannot exclude high-grade squamous intraepithelial lesion" (LSIL-H) in comparison with the 2001 Bethesda System (TBS 2001) cytologic categories of low-grade squamous intraepithelial lesion (LSIL), high-grade squamous intraepithelial lesion (HSIL), and atypical squamous cells, cannot rule out a high grade lesion (ASC-H). Methods: The PTs which diagnosed as squamous cell abnormalities, including atypical squamous cells of undetermined significance (ASC-US), LSIL, ASC-H and HSIL, were reviewed by two pathologists who were blinded to the histology results. The diagnose of histology was used as gold standard, and the prevalence of high-risk human papillomavirus (HR-HPV) was examined. Results: Of 49 000 PTs, 88 (0.17%) were rediagnosed as LSIL-H. Before rediagnosed as LSIL-H, these 88 cases were diagnosed as ASC-US (19.32%, 17/88), LSIL (43.18%, 38/88), ASC-H (34.09%, 30/88) and HSIL (3.41%, 3/88). Women who diagnosed as LSIL-H had a higher incidence of cervical intraepithelial neoplasia 2 (CIN-2) /-3 or more severe lesion (CIN-3+) than that in women who diagnosed as LSIL ( P<0.01), but the incidences in these two groups were both lower than that in women who diagnosed as HSIL ( P<0.01). The difference of CIN-2/-3 incidence between LSIL-H and ASC-H was not significant. Conclusion: The similarity of histologic follow-up results between LSIL-H and ASC-H suggested that the similar management decisions should be made for women who were diagnosed as LSIL-H or ASC-H.
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Objective To discuss the significance of high-risk human papilloma virus ( HR-HPV) detection by hybrid capture 2 (Hc-2) in managing the women with atypical squamous cell of undetermined significance (ASCIIS) and low grade squamous intraepithelial lesion (LSIL) of thin prep liquid-based cytology (TCT). Methods One hundred and seventy-eight women with ASCUS and 108 women with LSIL were studied. The infection of HR-HPV in the women was analyzed. And sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were used to evaluate the significance of HR-HPV detection by Hc-2 in managing the women with ASCUS and LSIL of TCT. Results Sensitivity,specificity, PPV and NPV of HR-HPV DNA detection by Hc-2 in screening CIN II or above in ASCUS were 89.83% (53/59),53.78% (64/119), 49.07% (53/108), 91.43% (64/70) respectively,and in LSIL were 97.62%(41/42),22.73%(15/66), 44.57%(41/92), 93.75%( 15/16) respectively. Conclusion HR-HPV detection by Hc-2 is an effective measure in managing the women with ASCUS and LSIL of TCT.
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The purpose of this study was to investigate the number of Human Papillomavirus false positive cytological diagnosis in low grade squamous intraepithelial lesions (LSIL). Three hundred and two women who assisted to an Out-Patient Gynecologic Clinic in Maracaibo, Venezuela, were recruited for this study. Each patient had the Pap smear and a cervical swab for Hybrid Capture 2 (HC2). Three cytotechnologists reviewed the Pap smears and two pathologists rescreened all of them. The cytotechnologists reported 161 (53.3 percent) Pap smears negatives for intraepithelial lesion (IL) or malignancy, and 141 cases (46.7 percent) with epithelial abnormalities. They reported 46 percent of 302 patients with HPV infection in Pap smear slides. The pathologists found that 241 (79.8 percent) Pap smears were negatives for IL or malignancy and 61 (20.2 percent), with abnormal Pap smears. They found 14.6 percent HPV infection in all Pap smears (p<0.0001; 46 percent vs 14.6 percent). The HC2 study showed that 47 samples (15.6 percent) were positive for HPV. The study found that 114 Pap smears (False Positive: 85 percent) of 134 reported by the cytotechnologists and 24 (False Positive: 43 percent) of 56 cytologies reported by the pathologists as LSIL, were negative for HPV infection determined by HC2 (p<0.00003). The present study suggests that the cytotechnologists overdiagnosed cellular changes associated with HPV infection in the Pap smear, increasing the FP cytological diagnosis of LSIL.
El presente trabajo tuvo por objeto el investigar el número de falsos positivos reportados en la citología cervicovaginal (CCV) de la presencia del Virus del Papiloma Humano (VPH) con diagnóstico de Lesión Intraepitelial Escamosa de bajo grado (LIE-BG). Se estudiaron 302 mujeres que asistieron a la Consulta de Patología de Cuello Uterino del Hospital Manuel Noriega Trigo, en Maracaibo, Venezuela. A cada paciente se le practicaron una CCV y muestra para la captura de híbridos 2 (CH2). Tres citotecnólogos y 2 patólogos estudiaron las CCV. Los citotecnólogos reportaron 161(53,3 por ciento) de CCV negativas para lesión intraepitelial o malignidad y 141 casos (46,7 por ciento) con anomalías epiteliales. Éstos encontraron 46 por ciento de presencia de VPH en las 302 CCV. Los patólogos reportaron 241 CCV (79,8 por ciento) negativas y 61 CCV (20,2 por ciento) anormales. Estos encontraron en 14,6 por ciento de las CCV, la presencia de VPH (p < 0, 0001; 46 por ciento vs 14,6 por ciento). La CH2 mostró que 47 muestras (15, 6 por ciento) fueron positivas a VPH. Esta investigación mostró que 112 CCV de 134 (Falso Positivo: 85 por ciento) reportados por los citotecnólogos y 24 de 56 CCV (Falso Positivo: 43 por ciento) reportados por los patólogos como LIE-BG, fueron negativos a la infección del VPH determinados por la CH2 (p < 0,00003). La investigación sugiere un sobrediagnóstico de la presencia de cambios celulares debidos al VPH en la CCV, por parte de los citotecnólogos, incrementando los falsos positivos de la presencia del VPH en CCV con diagnóstico de LIE-BG.
Subject(s)
Humans , Female , Carcinoma in Situ , Uterine Cervical Dysplasia/diagnosis , False Positive Reactions , Papillomavirus Infections/diagnosis , Uterine Cervical Neoplasms/diagnosis , Cytological Techniques/methods , GynecologyABSTRACT
OBJECTIVE: To determine the clinical significance of high risk Human papillomavirus (HPV) DNA viral load measured by hybrid capture (HC) II assay in diagnosis of CIN II or above in women with cervical smear showing only Atypical squamous cells of undetermined significance (ASCUS)/Low-grade squamous intraepithelial lesion (LSIL). METHODS: This study was performed from September 2003 to September 2004 and included 111 patients with ASCUS/LSIL on PAP smear. All of them underwent high risk HPV DNA tests by HC II assay and colposcopy directed cervical biopsies. The histologic results were classified as low grade lesion (normal, CIN I) and high grade lesion (CIN II, III, and invasive cancer). The viral load was transformed into their logarithm (Log10RLU/PC ratio), and categorized as following four groups; negative HPV DNA (Log10RLU/PC or =2.0). We evaluated the relationships of the detection rate and viral load of high risk HPV DNA with histologic severity of cervical lesions. RESULTS: The rate of CIN II or above in 111 patients with ASCUS/LSIL was 25.2%. The detection rate of high risk HPV DNA using HC II assay was 96.4% in high grade lesion, and 66.3% in low grade lesion of histologic test. There was strong correlation between CIN II or above and positivity for HPV DNA when this group was compared with women with only CIN I or normal cervix (OR:13.7, 95% CI:1.7-106.4). The higher the viral load of HPV DNA infection observed, the higher the probability of being associated with stage of CIN (correlation coefficient:0.279). The frequency of high viral load observed in high grade lesion (89.3%) was significantly higher than low grade lesion (33.7%)(OR:16.3, 95% CI:4.5-58.9). When the cutoff of positivity was changed from 1.0RLU/PC ratio to 100.0RLU/PC ratio (Log10 RLU/PC ratio=2.0), the sensitivity for the prediction of high grade lesion was slightly decreased (96.4->89.3%), but pronounced gain in specificity (33.7->66.3%), and reduction in false positive rate (66.3->33.7%). CONCLUSION: The viral load of high risk HPV DNA measured by HC II assay was significantly associated with the severity of histology, and useful in diagnosis of CIN II or above in women referred because of ASCUS/LSIL on PAP smear.
Subject(s)
Female , Humans , Biopsy , Cervix Uteri , Colposcopy , Diagnosis , DNA , Human Papillomavirus DNA Tests , Sensitivity and Specificity , Vaginal Smears , Viral LoadABSTRACT
Papillary immature metaplasia (PIM) of the uterine cervix (immature condyloma) is a subset of low grade squamous intraepithelial lesion (LSIL) which is frequently associated with human papilloma virus (HPV) types 6 and 11. The histologic features of PIM include filiform papillae lined by evenly spaced immature metaplastic-type cells with frequent nucleoli, mild anisokaryosis, and a low mitotic index. To characterize the cytologic changes associated with PIM, we analyzed 14 cases of PIM from our file. We reviewed biopsy slides and the cervicovaginal smears taken proximate to the time of biopsy. Histologically, nine cases had either flat condyloma (7 cases) or high grade squamous intraepithelial lesion (HSIL) (2 cases). Cytologic changes included cells in various stages of maturation with karyomegaly (14 cases), cells with irregularities in the nuclear membrane (13 cases), intermediate cells with karyomegaly(13 cases), cells with binucleation (13 cases), and aborted koilocytes (11 cases). Cervicovaginal smears from all cases were interpreted as atypical squamous cells of undetermined significance (ASCUS), NOS or ASCUS, rule out squamous intraepithelial lesion (SIL) or LSIL in two cases with flat condyloma or HSIL in a case with severe dysplasia. PIM is a distinct histologic entity that can present with a spectrum of cytologic findings, but cytologic findings may resemble variable reactive conditions and immature HSIL. Therefore, it is difficult to diagnose PIM by cytology alone. However, the meticulous efforts for making the cytologic diagnoses which can induce active management of patients are recommended because PIM is a variant of LSIL and frequently has a flat condyloma or HSIL.