Citologia oncótica cervicovaginal na população lésbica e transgêneros / Cervicovaginal oncotic cytology in the lesbian and transgender population

O câncer de colo uterino causa a morte de milhares de mulheres no mundo. Entre essas mulheres, há grupos como o de lésbicas e transgêneros que têm dificuldade no rastreio devido à discriminação e ao desconhecimento. As lésbicas e transgêneros masculinos que não fizeram histerectomia total devem se manter no rastreio da mesma forma que as mulheres cisgêneros. Transgêneros femininos devem ser seguidas, porém ainda não há protocolos definidos.(AU)

Cervical cancer causes the death of thousands of women worldwide. Among these women, there are groups, like lesbians and transgenders that present difficulty in screening due to discrimination and lack of knowledge. The lesbians and transgenders men who didn´t have total hysterectomy, must keeping in screening the same way as cisgenders. Transgender woman must be followed, but there aren't definitive guidelines.(AU)

Evaluation of Swede score and Reid score to improve the predictive value of colposcopy and its correlation with histology

Background: Cervical carcinoma is the second most common malignancy amongst women in India. It is regarded as a public health problem and a priority in cancer control programmes by the WHO. Colposcopy has proven to be very useful in identifying and guiding the biopsy of dysplastic lesion. To minimize inter-observer variation, colposcopic scoring system has been introduced.Methods: A prospective cross- sectional study including 250 women in whom the prevalence of different grades CIN was done. Co-relation of Pap (cytology) with colposcopy scoring system viz. Reid’s and Swede scores, has been made in this study. The two screening methods were compared and their statistical association with histological findings were analyzed.Results: Per speculum examination performed in 250 sexually active women with suspicious looking cervix, belonging to 25-60 years of age, with most common presenting complaints of pain abdomen (38.8%) followed by leucorrhoea, irregular cycles and Post coital bleed. Unhealthy cervix (49.2%) and persistent discharge (28%) were the most common indications for colposcopy. An assessment of both SWEDE score and Reid score as a function of histological findings was done, while Swede score of >5 showed slightly more sensitivity (100%) for diagnosing CIN1+ lesions, Reids score of >5 was more specific (100%) with a higher positive predictive value (100%) for diagnosing  CIN 1, 2, 3 and invasive cervical carcinoma. There was a marked positive association between Reid score and SWEDE score.Conclusions: The colposcopic scoring systems and histopathology showed significant compliance. Predictive accuracy of colposcopy increased with increasing severity of disease.

A study of visual inspection of cervix under acetic acid and visual inspection of cervix under Lugol's iodine for screening of carcinoma cervix

Background: Carcinoma cervix is the most common cancer among women in developing countries. The objectives of the study were to study the sensitivity and specificity of visual inspection of  the cervix with acetic acid (VIA) and Lugol's iodine (VILI) for cervical cancer screening. To study the correlation of demographic data like age, socioeconomic status, education residential area, parity, age at marriage in premalignant lesion of  the cervix.Methods: The present study was conducted in the department of Obstetrics and Gynecology  at a Tertiary Medical Care Center over a period of two years. Five hundred fifty women between 20-65 years of age who fulfilled the selection criteria were enrolled in our study. Positive tests for VIA was opaque aceto white lesion on applying 5% acetic acid or detection of definite yellow iodine non uptake areas with Lugol's iodine in the transformation zone or close to touching the squamocolumnar junction. Positive cases were scheduled for cervical biopsy. Ethical approval of the study protocol was obtained from the ethics committee of the institute.Results: On down staging 7.2% (40/550) of cases  had an unhealthy cervix and 0.36% (2/550) with a suspicious cervix. VIA positive in 4.55% (25/550), VILI positive in 2.73% (15/550). Biopsy was taken from positive with VIA and VILI. On histology 2.9% (16) were chronic cervicitis, CIN I had (1), 0.2%, CIN II (2) 0.4%, CIN III (4) 0.7% and squamous cell carcinoma (2) 0.4% VIA sensitivity 72.22%, specificity 97.74%. VILI sensitivity 100%, specificity 98.89%.Conclusions: VIA and VILI are simple, inexpensive, low resources technique. Both have high sensitivity and specificity.

The role of p16 as putative biomarker for cervical neoplasia: A controversial issue? / O Papel da Proteina p16 como marcador putativo para neoplasia cervical: um tema controverso?

INTRODUCTION: Protein p16 has been extensively studied as a potential biomarker for precursor lesions to distinguish cervical Intraepithelial neoplasia (CIN) from their mimics. However, the use of p16 as prognostic biomarker for diagnosis of cervical cancer and precancer is controversial. This study focuses on the assessment of peer-reviewed scientific data related to the use of p16 to predict disease severity and its controversies. METHODS: We reviewed publications in MEDLINE/PubMed assessing the clinical, diagnostic and prognostic significance of p16 in CIN and cervical cancer; we included publications from 2009 to June 2017. RESULTS: The use of p16 as a prognostic marker is still unreliable, although it could be a useful tool for diagnosis of Cervical Intraepithelial Neoplasia lesions with undetermined morphology. Moreover, p16 appears to be a specific marker of high-risk oncogenic HPV infection. CONCLUSION: This review shows the potential utility and drawbacks of p16 for clinical practice and the diagnosis of cervical cancer. Further studies are required to substantiate the role of p16 in conjunction with other more sensitive and specific biomarkers for diagnosing CIN and predicting its progression.

INTRODUÇÃO: A proteína p16 tem sido estudada como um biomarcador potencialmente específico de lesões cervicais precursoras e como uma forma de diferenciar as lesões parecidas com Neoplasia intra-epitelial cervical (NIC). Contudo existem várias controvérsias sobre a utilização de p16 como um biomarcador prognóstico e como uma ferramenta para o diagnóstico de câncer cervical e de lesões pré-câncer. O objetivo deste estudo foi a revisão de dados científicos por pares de bases, relacionados com a utilização da p16 e suas controvérsias. MÉTODOS: O estudo foi projetado como uma revisão da literatura das publicações do Medline/PubMed que avaliam o significado clínico, diagnóstico ou prognóstico do p16 em lesões de NIC e no câncer cervical no período de janeiro de 2009 a junho de 2017. RESULTADOS: o uso do p16 como um marcador prognóstico ainda não é confiável, apesar de que a p16 poderia ser uma ferramenta útil para o diagnóstico em lesões de NIC com morfologia indeterminada. Além disso, a p16 parece ser um marcador específico de infecção por HPV de alto risco oncogênico. CONCLUSÃO: A presente revisão mostra a potencial utilidade da proteína p16, bem como os inconvenientes para uso clínico-patológico e diagnóstico no câncer cervical. Contudo são necessários mais estudos para fundamentar o papel da p16 em conjunto com os outros biomarcadores mais sensíveis e específicos para diagnosticar NIC e prever a sua progressão.

Utility of Pap Smear Screening for Prevention of Cervical Cancer-A 3yrs Study from Rural Tripura-A Northeastern State of India

Background: Cancer cervix is a leading cause of mortality and morbidity among women worldwide. According to National Cancer Registry Program of India, cancers of cervix and breast are leading malignancies in Indian women. The morbidity and mortality could be significantly reduced with an active cervical smear screening programme. Objective: The study was done to evaluate the knowledge and attitudes of women about cervical smear testing, to establish a cervical smear screening program and to evaluate the cervical cytological abnormalities. It was done to determine the applicability, limitations and utility of this screening in a district hospital. Materials and Methods: A total of 287 married women were included in our study. Knowledge about Pap smear testing was determined through printed questionnaires. Pap smear screening was performed on every woman in our study group. Detailed clinical data and cytology reports were noted in a proforma. Results: About 92% women of our study group had never heard or undergone Pap smear screening before. Maximum number of patients was in 4th decade. Of the 287 smears, 276(96.16%) were adequate. Normal smear were 78(27.18%), inflammatory 168(58.54%), whereas epithelial cell abnormalities were seen in 26(9.05%) cases. The 26 abnormal cases comprised of 17(5.92%) cases with ASCUS, 5(1.74%) cases of LSIL, 1(0.35%) cases of HSIL, 3(1.04%) cases of squamous cell carcinoma. Conclusions: Epithelial cell abnormality in our study group was less than Western countries. There is poor knowledge about Pap smear screening. Pap smear study can be easily done through a chain built between the primary health care unit and district hospital and laboratory

Utility of Pap Smear Screening for Prevention of Cervical Cancer-A 3yrs Study from Rural Tripura-A Northeastern State of India

Background: Cancer cervix is a leading cause of mortality and morbidity among women worldwide. According to National Cancer Registry Program of India, cancers of cervix and breast are leading malignancies in Indian women. The morbidity and mortality could be significantly reduced with an active cervical smear screening programme. Objective: The study was done to evaluate the knowledge and attitudes of women about cervical smear testing, to establish a cervical smear screening program and to evaluate the cervical cytological abnormalities. It was done to determine the applicability, limitations and utility of this screening in a district hospital. Materials and Methods: A total of 287 married women were included in our study. Knowledge about Pap smear testing was determined through printed questionnaires. Pap smear screening was performed on every woman in our study group. Detailed clinical data and cytology reports were noted in a proforma. Results: About 92% women of our study group had never heard or undergone Pap smear screening before. Maximum number of patients was in 4th decade. Of the 287 smears, 276(96.16%) were adequate. Normal smear were 78(27.18%), inflammatory 168(58.54%), whereas epithelial cell abnormalities were seen in 26(9.05%) cases. The 26 abnormal cases comprised of 17(5.92%) cases with ASCUS, 5(1.74%) cases of LSIL, 1(0.35%) cases of HSIL, 3(1.04%) cases of squamous cell carcinoma. Conclusions: Epithelial cell abnormality in our study group was less than Western countries. There is poor knowledge about Pap smear screening. Pap smear study can be easily done through a chain built between the primary health care unit and district hospital and laboratory

The roles of CD4+CD25+ FOXP3+ regulatory T cells and PD-1+CD4+T cells on prognosis of cervical intraepithelial lesion / 重庆医学

Objective This study aims to investigate the correlation of CD4+ CD25+ FOXP3+ Tregs and PD‐1+ CD4+ T cells located at cervical lesions and the prognosis of CIN .PD‐1 expression on T cells induces Tregs .Methods Cervical lymphocytes were collected from CIN patients and analyzed by FACS .Comparisons were made between populations of cervical Tregs and PD‐1+CD4+T cells in CIN regressors and non‐regressors .Results A median of 11 .8% of cervical CD4+ T cells were CD4+ CD25+ FOXP3+Tregs ,while a median of 30 .3% were PD‐1+ CD4+ T cells .The proportions of CD4+ CD25+ FOXP3+ Tregs and PD‐1+ cells were significantly lower in CIN regressors when compared with non‐regressors .Conclusion The prevalence of CD4+ CD25+ FOXP3+Tregs negative correlates with spontaneous regression of CIN ,suggesting that cervical Tregs may play an important role in HPV‐related neoplastic immunoevasion .

Immunohistochemical expression of MIB-1 and PCNA in precancerous and cancerous lesions of uterine cervix.

BACKGROUND AND OBJECTIVE: The present study was done to analyze the immunoexpression of diagnostic markers (MIB-1: molecular immunology borstel and PCNA: proliferating cell nuclear antigen) in grading cervical intraepithelial lesion (CIN) and squamous cell carcinoma (SCC) in cervix. SETTING AND DESIGN: Total 150 cervical biopsies were divided into four groups respectively; Group I-Normal (n = 32), Group II- CIN (n = 60), Group III- SCC (n = 44), Group IV- CA cervix (n = 14) respectively. MATERIALS AND METHODS: These biopsies were stained with monoclonal antibodies by streptavidin-- biotin method. Mean labeling index was calculated and grading was performed using the I--III scoring system. STATISTICAL ANALYSIS: Findings were correlated with age and menopausal status. Statistical analysis was done by using student sample‘t’ test and analysis of variance (ANOVA) by SPSS 10 package. RESULTS: MIB-1 immunostaining was positive in 112/150 (74.6%) cases and PCNA in 118 /150 (78.6%) cases. Labeling indices showed linear progression from normal to CIN to SCC to cancer lesion. Few cases of low-grade CIN lesion had high proliferative index. A significant positive correlation was found between age and PCNA and MIB-1 values (P < 0.05) when comparison was made for all the cases. CONCLUSION: These markers may be useful in identifying low-grade CIN lesion with high proliferative index. These cases should be kept for follow up studies so that proper intervention can be taken at an early stage. This method is simple and cost effective and can easily be done in formaline-fixed paraffin embedded tissues in a clinical laboratory for grading CIN and SCC lesions in cervix.

Investigation on the prevalence of high risk human papillomavirus and cervical cancer among adult women, in Shenzhen / 中华流行病学杂志

Objective To investigate the prevalence of high risk human papillomavirus (HPV) genital infection and cervical cancer in adult women from Shenzhen.Methods Cluster sampling was used to investigate the prevalence of HPV infection and cervical cancer from women aged 20-59 years old living in Luohu,Futian,Nanshan,Longgang and Baoan districts in Shenzhen from April 2006 to April 2010.All women were detected for liquid-based cytology test (LCT) or Thinprep cytologic test (TCT)and high-risk HPV-DNA test with hybrid capture Ⅱ (HC-Ⅱ ).All women with ≥ASC-US by cytology and/or a positive HC- Ⅱ test were asked to return for colposcopy and four-quadrant biopsy.Endocervical curettage was performed.Pathological finding were used as the gold standard of the diagnosis of cervical intraepithelial neoplasia.Results 10 210 women were involved in the study and 10 017 of them having completed data.The overall positive rate of high-risk HPV-DNA was 16.29％.HPV positive rates in 20-,30-,35-,40-,45-,50-59 age groups were 17.37％,15.59％,16.33％,14.74％,17.16％ and 17.98％,respectively.The curve of HPV infection rates in different age groups appeared a ‘W' shape.HPV infection rates in the 25-years-olds and 50-59 year-olds groups were significantly higher than the other age groups (x2=4.50,P=0.03 ).The overall prevalence rate of cervical intraepithelial lesions (CIN) was 7.52％,of which the prevalence rates of low-grade cervical intraepithelial lesions (CIN Ⅰ) was 5.32％ high-grade cervical intraepithelial lesions (CIN Ⅱ/Ⅲ ) was 2.21％,cervical cancer was 0.12％.The prevalence of CIN Ⅰ was significantly higher than the CIN Ⅱ/Ⅲ (x2=134.15,P＜0.001 ).The prevalence of cervical cancer in 45- age group was 0.12％,the highest.HPV infection rates increased with the grades of cervical lesions including women without CIN as 44.31％,in CIN Ⅰ as 70.73％,in CIN Ⅱ as 86.73％,and in CIN Ⅲ as 96.75％ and in cancer as 100.00％.The HPV infection rates were different in districts (x2=17.81,P=0.03 ),with Futian and Luohu higher than those of Nanshan,Longgang and Baoan district.The prevalence rate of CIN in Baoan was lower than other districts.The CIN prevalence rates were not significantly different among the other districts of Shenzhen (x2=4.84,P=0.18).Conclusion The prevalence of cervical cancer was low in adult women living in Shenzhen,with cervical lesions still in the early stage.Prevention of HPV infection and treatment of CIN were the key points for the prevention of cervical cancer.

Loss of Fhit Expression in Cervical Intraepithelial lesion and Invasive Cervical Carcinoma / 대한산부인과학회잡지

OBJECTIVE: The author evaluated the relationship between the loss of Fhit and prognostic factors of invasive cervical carcinomas. METHODS: The formalin prepared tissue specimens of 64 CINs and 27 invasive cervical carcinomas patients diagnosed and treated at the department of obstetrics and gynecology, Yeungnam university hospital from June 1977 to February 2001 were obtained. And then the tissue specimens were analysed & measured by immunohistochemical methods. RESULTS: The loss of Fhit was significantly reduced in invasive cervical carcinomas compared to CINs. But we found there is no relationships between the loss of Fhit and prognostic factors, stage, tumor marker, lymphatic spread and radiation therapy of invasive cervical carcinomas. CONCLUSIONS: Although the loss of Fhit was not related to the precancerous lesion of cervix, we could confirm that the loss of Fhit was important in the progression of precancerous lesions to invasive cervical carcinomas.

The Clinical Significance of The Qualification of Atypical Squamous Cells of Undetermined Significance (ASCUS) in Cervicovaginal Smears / 대한산부인과학회잡지

OBJECTIVE: The Bethesda System (1991) recommended that the diagnosis of atypical squamous cells of undetermined significance (ASCUS) be qualified when possible to indicate whether a reactive process, or premalignant/malignant process, is favored. In order to evaluate the clinical significance of the qualification, we reviewed our hospital's experience with cervicovaginal smears diagnosed as ASCUS. METHOD: A retrospective study from June 1994 to December 2000 was performed on all cervicovaginal smears with the diagnosis of ASCUS. 3759 cases were included in study group. The 1200 cases of 3759 were not followed up. Histopathologic diagnosis and cervicovaginal smear results were reviewed and compared according to the qualification of ASCUS. The Chi-square test was used. RESULTS: Histopathologic diagnosis of low-grade squamous intraepithelial lesion (LGSIL) was seen in 46.1%, 47.8%, and 44.3% of the ASCUS FR, ASCUS FD and ASCUS NOS group, respectively. Histopathologic diagnosis of high-grade squamous intraepithelial lesion (HGSIL) was seen in 6.0%, 17.2% and 7.8% of the ASCUS FR, ASCUS FD and ASCUS NOS group, respectively. In ASCUS FR group, 1 invasive carcinoma was detected. In ASCUS FD group, 6 carcinoma in situ (CIS), 2 microinvasive carcinoma, 1 invasive carcinoma and 1 adenosquamous cell carcinoma were detected. In ASCUS NOS group, there were 20 CIS, 5 microinvasive carcinoma, 7 invasive carcinoma and 2 invasive adenocarcinoma. The ASCUS FD group demonstrated significant risk for SIL and more severe lesion but ASCUS FR and ASCUS NOS demonstrated no significant difference. CONCLUSION: ASCUS FD group has increased risk for detection of SIL or more severe lesion than ASCUS FR or ASCUS NOS group. But there were also significant number of SIL and even invasive cancer in ASCUS FR and ASCUS NOS group, so qualification of ASCUS was not useful for management and colposcopy-directed biopsy is advocated even in ASCUS FR group.

The Study of Low-risk and High-risk Human Papillomaviruses Infection in cervical Carcinomas and Cervical Instaepithelial Lesions with Hybrid Capture system / 대한산부인과학회잡지

The assocication between human papillomavirus infection (HPV) and cervical lesionhas been well established. for detection and typing human papilloma virus deoxyribonucleic acid in cervical tissues, Southern blot hybridzation and polymerase chain reaction are commonly regarded as reference standard methods. However it has the limitation includeing technical difficulty, safety, subjectivey in result interpretation. Recently the chemilnuminescent molecular hybridization assay method has been windely used and it has been known that it can detect less hybridization assay method has been windely used and it has been known that it can detect less then 1 pg of DNA in a 100n1 aliquot of a crude specimen. This study was perfomed to determine the usefulness of hybrid capture HPV DNA assay for detecting low-risk and high-risk human papillomaviruses in histologically confirmed normal, cervical intraepithelial lesion(CIN) and invasive squamous cell carcinoma of the cervix, and to compare the correlation among cervical cytology, hiopsy finding and HPVs infelction ,and to detirmine whether the additon of the hybrid capture test to cytologic studies would improve the ability to identify signifcant lesions. Cervical cytologic smears, hybrid capture HPVs DNA assay, and pucnh bhiopsies were performed on 78 women who have normal cervix(28cases),cervical intraepithelila lesion (24cases), and invasive squamous cell carcinoma(26cases). At first the probes for low-risk HPV(6,11,42,43,44) and the proves for high-risk HPV(16,18,31,33,35,45,51,52,56)were used and secondly retyping was done for HPV 16 abd 18 in high-risk HPV positive cases.the results obtained were as follows; 1. Low-risk HPVs infections were 14.3% and 8.3% in normal cervix and cervical intraepithelial lesion respectively. High-risk HPVs infection were 7.1%, 70.8% and 73.1% in normal cervix, cervical intraeithelial lesion and squamous cell carcinoma respecitively. These was highly significant corelation between positive high-risk HPVs test, cervical intraepithelial lesion and squamous cell carcinoma. 2. Positivities of low and high-risk human papillomaviruses in patients with negative cytologic result were 9.1% and 15.1% respectinvely. 3. In patients with high-risk human papillomaviruses infection, human papilloma viurs 16 and 18 types were detected in 47.4% and 13.2%, respectinvely, and both HPV 16 and 18 positive and negative detention were 15.7% 23.7% respectinvely. Among 12patinent of cervical intraepithelial neoplasia with high risk HPVs infection, HPV 16 was detected in 66.6% and HPV 18 in 16.7% Among 24 squamous cell carcinomas with high risk HPVs infection, HPV 16was detected in 41.7% and HPV 16 in 12.5% and both HPV and 18 in 25% 4. In patients without koilocytosis by cervical tytology, low and high-risk human papillomaviruses or both were positive in 30.7% 5. In patients with positive high-risk HPVs, sensitivitives of koilocytosis were 64% and 69% in histologic and cytologc diagnosis, and specificities and specifictites were 58.5% and 62% respectively. Above result suggest that detection for high-risk human papilloma viruses type by hybrid capture assay improves the management of cervical intraepithelial neoplasia and is more useful method over cervical cytology only.

The Study of Low-risk and High-risk Human Papillomaviruses Infection in cervical Carcinomas and Cervical Instaepithelial Lesions with Hybrid Capture system / 대한산부인과학회잡지

The assocication between human papillomavirus infection (HPV) and cervical lesionhas been well established. for detection and typing human papilloma virus deoxyribonucleic acid in cervical tissues, Southern blot hybridzation and polymerase chain reaction are commonly regarded as reference standard methods. However it has the limitation includeing technical difficulty, safety, subjectivey in result interpretation. Recently the chemilnuminescent molecular hybridization assay method has been windely used and it has been known that it can detect less hybridization assay method has been windely used and it has been known that it can detect less then 1 pg of DNA in a 100n1 aliquot of a crude specimen. This study was perfomed to determine the usefulness of hybrid capture HPV DNA assay for detecting low-risk and high-risk human papillomaviruses in histologically confirmed normal, cervical intraepithelial lesion(CIN) and invasive squamous cell carcinoma of the cervix, and to compare the correlation among cervical cytology, hiopsy finding and HPVs infelction ,and to detirmine whether the additon of the hybrid capture test to cytologic studies would improve the ability to identify signifcant lesions. Cervical cytologic smears, hybrid capture HPVs DNA assay, and pucnh bhiopsies were performed on 78 women who have normal cervix(28cases),cervical intraepithelila lesion (24cases), and invasive squamous cell carcinoma(26cases). At first the probes for low-risk HPV(6,11,42,43,44) and the proves for high-risk HPV(16,18,31,33,35,45,51,52,56)were used and secondly retyping was done for HPV 16 abd 18 in high-risk HPV positive cases.the results obtained were as follows; 1. Low-risk HPVs infections were 14.3% and 8.3% in normal cervix and cervical intraepithelial lesion respectively. High-risk HPVs infection were 7.1%, 70.8% and 73.1% in normal cervix, cervical intraeithelial lesion and squamous cell carcinoma respecitively. These was highly significant corelation between positive high-risk HPVs test, cervical intraepithelial lesion and squamous cell carcinoma. 2. Positivities of low and high-risk human papillomaviruses in patients with negative cytologic result were 9.1% and 15.1% respectinvely. 3. In patients with high-risk human papillomaviruses infection, human papilloma viurs 16 and 18 types were detected in 47.4% and 13.2%, respectinvely, and both HPV 16 and 18 positive and negative detention were 15.7% 23.7% respectinvely. Among 12patinent of cervical intraepithelial neoplasia with high risk HPVs infection, HPV 16 was detected in 66.6% and HPV 18 in 16.7% Among 24 squamous cell carcinomas with high risk HPVs infection, HPV 16was detected in 41.7% and HPV 16 in 12.5% and both HPV and 18 in 25% 4. In patients without koilocytosis by cervical tytology, low and high-risk human papillomaviruses or both were positive in 30.7% 5. In patients with positive high-risk HPVs, sensitivitives of koilocytosis were 64% and 69% in histologic and cytologc diagnosis, and specificities and specifictites were 58.5% and 62% respectively. Above result suggest that detection for high-risk human papilloma viruses type by hybrid capture assay improves the management of cervical intraepithelial neoplasia and is more useful method over cervical cytology only.