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Background: Cervical cancer is the second most commoncancer among women in Bangladesh where CIN is theforerunner. Visual inspection of cervix with acetic acid (VIA) isadopted as national cervical cancer screening programme inBangladesh. All positive VIA cases are evaluated bycolposcopy.Objective: This population-based study was conducted inFaridpur Medical College Hospital for 6 years (2013 - 2018) toevaluate the prevalence of CIN among the VIA positive casesand performance of the clinic for colposcopic management ofCIN.Materials and Methods: A total of 2102 VIA positive caseswere evaluated by colposcopy during the study period.International Federation of Cervical Pathology and Colposcopy(IFCPC) 2011 nomenclature was used for colposcopicdiagnosis. Diagnosed CIN were treated accordingly.Results: During the study period, 548 (26.1%) cases werecolposcopically diagnosed as CIN. Among them, 370 (65.5%)were low grade squamous intraepithelial lesion (CIN-I) and 178(32.5%) were high grade squamous intraepithelial lesion (CINII and III). Colposcopicaly diagnosed 237 (64.1%) of low gradesquamous intraepithelial lesion (LSIL) and 132 (74.2 %) of highgrade squamous intraepithelial lesion (HSIL) casesreceived treatment and histopathological confirmation.Treatment produces were used like thermocoagulation, LoopElectrosurgical Excision Procedure (LEEP), biopsy,hysterectomy and post treatment follow up.Conclusion: From this study, we got information about thedemography and prevalence of CIN among VIA positive casesat the same time management of CIN to prevent invasivecervical cancer. We adopted ‘See and treat’ protocol formanagement, which is well accepted, feasible and useful inBangladesh.
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Objective·To investigate the clinical significance and predictive value of human papillomavirus (HPV) 16/18 E6 protein in the different cervical intraepithelial neoplasia. Methods·The expression of HPV16/18 E6 in 10 normal cervical tissues, 33 cervical intraepithelial neoplasiaⅠ (CINⅠ ), 31 CINⅡ- Ⅲ, 30 cervical cancers was detected by immunohistochemistry, explored the expression difference and the relationship with the clinicopathological characteristics of cervical cancer and the prognosis of different CIN. Results·The positive expression rates of HPV16/18 E6 in normal cervical tissues, CINⅠ , CINⅡ - Ⅲ and cervical cancer group were up-regulated (χ2=19.82, P=0.000). HPV16/18 E6 increased positive expression rates in the low grade and the big size tumors of cervical cancer tissues were detected (P=0.033, P=0.011). There were positive correlations between the overexpression and the pathological grade, tumor size, poor prognosis of cervical cancers respectively (r=0.456, P=0.011; r=0.578, P=0.000; r=0.645, P=0.000).The sensitivity,specificity,and diagnostic accuracy rates of HPV16/18 E6 positive expression to the progression of CINⅠ,CINⅡ-Ⅲand cervical cancer were respectively 100.00%, 62.50%, 43.75%; 96.77%, 91.30%, 92.86%; 96.97%, 83.87%, 66.67%. Conclusion·HPV16/18 E6 overexpression plays an important role in the generation, development and the poor prognosis of cervical cancer. HPV16/18 E6 has a good predictive value for the prognosis and hierarchical management of cervical diseases.
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An in vitro synthesized random ssDNA library was subjected to 12 rounds of selection against anti-screening cells and sieving cells by SELEX. Normal and inflammatory cervical exfoliation cells were selected as anti-screening cells, and the cervical exfoliation cells of low-grade squamous intraepithelial lesion (CIN1), high-grade squamous intraepithelial lesion (CIN2, CIN3) and cervical carcinoma were selected as sieving cells during the screening process. Then, the highly specific aptamer CIN-Ap4 was established by the analysis of the specificity, affinity and cell immunofluorescence, which can be used as biomarker for Cervical Intraepithelial Neoplasia. Prime Premier 5.0 was applied to design a random ssDNA library. According to the fixed sequence at both ends of the library, a pair of primers were designed and synthesized. At the same time, the optimal annealing temperature, cycle times and primer concentration ratio of PCR procedure were selected. The results under the optimal condition are shown as follows. In the 50 μL reaction system, the optimum reaction conditions of symmetry PCR are as follows: annealing temperature is 49.5 ℃, number of cycles is 15. The optimal reaction conditions of indirect asymmetric PCR are as follows: the primer concentration ratio is 80:1, and the number of cycles is 35. The experiment proves that the oligonucleotide library is constructed successfully, and the highly specific dsDNA and ssDNA can be obtained under optimal PCR conditions with good repeatability, which establishes the foundation for the further exploration and experimentation.
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Objective: To investigate the clinical significance and predictive value of human papillomavirus (HPV) 16/18 E6 protein in the different cervical intraepithelial neoplasia. Methods: The expression of HPV16/18 E6 in 10 normal cervical tissues, 33 cervical intraepithelial neoplasia I (CIN I ), 31 CIN II-III, 30 cervical cancers was detected by immunohistochemistry, explored the expression difference and the relationship with the clinicopathological characteristics of cervical cancer and the prognosis of different CIN. Results: The positive expression rates of HPV16/18 E6 in normal cervical tissues, CIN I, CIN II-III and cervical cancer group were up-regulated (χ2=19.82, P=0.000). HPV16/18 E6 increased positive expression rates in the low grade and the big size tumors of cervical cancer tissues were detected (P=0.033, P=0.011). There were positive correlations between the overexpression and the pathological grade, tumor size, poor prognosis of cervical cancers respectively (r=0.456, P=0.011; r=0.578, P=0.000; r=0.645, P=0.000). The sensitivity, specificity, and diagnostic accuracy rates of HPV16/18 E6 positive expression to the progression of CIN I, CIN II-III and cervical cancer were respectively 100.00%, 62.50%, 43.75%; 96.77%, 91.30%, 92.86%; 96.97%, 83.87%, 66.67%. Conclusion: HPV16/18 E6 overexpression plays an important role in the generation, development and the poor prognosis of cervical cancer. HPV16/18 E6 has a good predictive value for the prognosis and hierarchical management of cervical diseases.
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OBJETIVOS: En la actualidad, existe una alta tasa de sobre-tratamiento de lesiones precursoras cervicales, la cual, en su causalidad, depende de la inexperiencia del operador que toma las decisiones. El objetivo del presente trabajo fue desarrollar un método estandarizado de ponderación/juicio de variables diagnósticas y tratamiento útiles de ser usadas por especialistas jóvenes a fin de minimizar el riesgo de manejo inadecuado. MATERIALES Y MÉTODOS: Se incluyeron 471 pacientes referidos por citología anormal y tratados mediante asa de LEEP. Se calcularon la sensibilidad, la especificidad, los valores predictivos y las relaciones de probabilidad para el diagnóstico de NIE2+ para cada uno de los métodos de diagnóstico. A cada residente se le enseñó un protocolo estandarizado de tratamiento mediante asa. Una vez identificados los mejores predictores, se construyó una escala de puntaje que ponderaba las variables y se definió mediante curva ROC el major punto de corte para la predicción de NIE2+. Las diferencias entre los grupos se compararon mediante Chi-cuadrado, ANOVA o t-test. Se construyó curva de fallas mediante el método de 1-Kaplan Meier. RESULTADOS: La prevalencia de NIE2+ en esta cohorte fue 66%. La concordancia entre las pruebas diagnósticas fue baja, teniendo la colposcopia el peor valor predictivo positivo y el mayor riesgo de sobre-tratamiento. Para la escala de puntaje se incluyeron la edad, la citología, la colposcopia (estratificación basada en la extensión de compromiso por cuadrantes), la biopsia por mascada y la concordancia entre pruebas diagnósticas. Un puntaje≥ 9 asociado al uso de un protocolo estandarizado, obtuvo tasas de sobre-tratamiento <15%, de recurrencias de NIE2+ <5% a 5 años y una baja tasa de procedimientos sub-óptimos o con complicaciones (<2 %). CONCLUSIONES: El método CONO-UC al combinar un sistema de puntaje integrado (punto de corte) con un protocolo estandarizado de excisión, permite minimizar el riesgo de sobretratamiento o tratamiento inadecuado, por parte de especialistas jóvenes, de lesiones preinvasoras del cuello uterino, reduciendo además el número de procedimientos indicados innecesariamente y manteniendo una alta tasa de éxito terapéutico.
GOALS: Currently, there is a high rate of over-treatment of precursor cervical lesions, which, in their causality, depends on the inexperience of the decision-making operator. The objective of the present study was to develop a standardized method of weighting / judgment of diagnostic variables and treatment useful to be used by young specialists in order to minimize the risk of improper handling. MATERIAL AND METHODS: We included 471 patients referred by abnormal cytology and treated by LEEP. Sensitivity, specificity, predictive values and likelihood ratios for the diagnosis of CIN2+ were calculated for each of the diagnostic methods. Each resident was taught a standardized protocol to carry out a LEEP procedure. Once the best predictors were identified, a scoring scale was constructed that weighted the variables and the best cut-off point for the prediction of CIN2+ was defined by ROC curve. Differences between groups were compared using Chi-square, ANOVA or t-test. Failure curves were built up using the 1-Kaplan Meier method. RESULTS: The prevalence of CIN2+ in this cohort was 66%. The agreement between the diagnostic tests was low, with colposcopy having the worst positive predictive value and the highest risk of over-treatment. Age, cytology, colposcopy (stratification based on the extent of compromise by quadrants), punch biopsy, and agreement between diagnostic tests were included for building the scoring scale. A score ≥ 9 in association with the use of a standardized protocol obtained rates of over-treatment <15%, recurrences of CIN2+ <5% at 5-year follow-up and a low rate of suboptimal procedures or complications (<2%). CONCLUSIONS: The UC-CONE method, by combining an integrated scoring system with a standardized excision protocol, minimizes the risk of over-treatment or inadequate treatment of pre-invasive cervical lesions by young specialists, reducing the number of procedures indicated unnecessarily and maintaining a high rate of therapeutic success.
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Humans , Female , Adolescent , Adult , Middle Aged , Aged , Young Adult , Uterine Cervical Dysplasia/surgery , Uterine Cervical Dysplasia/pathology , Colposcopy/methods , Electrosurgery/methods , Biopsy , Logistic Models , Cervix Uteri/pathology , Predictive Value of Tests , Retrospective Studies , ROC Curve , Analysis of Variance , Sensitivity and Specificity , Uterine Cervical Dysplasia/diagnosis , Conization , Decision MakingABSTRACT
Objective To explore the expressions of clusterin and E-cadherin in cervical squamous tissues and their correlation.Methods Immunohistochemical technique was used to measure the expressions of clusterin and E-cadherin in 18 normal cervical tissues,32 cervical intraepithelial neoplasia (CIN)tissues and 40 cervical squamous carcinoma (CSC)tissues.Results There were on significant differences in baseline characteristics among the three groups based on standardized differences.The expressions of clusterin in CSC,CIN2 and CIN3 tissues were significantly higher than those in normal cervical tissues (P <0.05 ).The expression of clusterin was significantly lower in grade Ⅰ than in grade Ⅲ (P <0.01)and was connected with clinical stage (P <0.05 )instead of lymph node metastasis and cancer stromal invasion depth (P > 0.05 ).The expressions of E-cadherin in tissues of CSC, CIN2 and CIN3 were significantly lower than those in normal cervical tissues (P <0.05).E-cadherin expression was both significantly higher in grade Ⅰ and grade Ⅱ than in grade Ⅲ (P <0.05),and was associated with lymph node metastasis (P < 0.05 )rather than clinical stage and cancer stromal invasion depth (P > 0.05 ).A negative correlation was found between the expressions of clusterin and E-cadherin in CSC (r = - 0.339,P < 0.05 ). Conclusion The significantly different expressions of clusterin and E-cadherin may be related to the development of CSC,suggesting that the two may be used as potential markers for early diagnosis of CSC.
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Objective To explore the expressions of clusterin and E-cadherin in cervical squamous tissues and their correlation.Methods Immunohistochemical technique was used to measure the expressions of clusterin and E-cadherin in 18 normal cervical tissues,32 cervical intraepithelial neoplasia (CIN)tissues and 40 cervical squamous carcinoma (CSC)tissues.Results There were on significant differences in baseline characteristics among the three groups based on standardized differences.The expressions of clusterin in CSC,CIN2 and CIN3 tissues were significantly higher than those in normal cervical tissues (P <0.05 ).The expression of clusterin was significantly lower in grade Ⅰ than in grade Ⅲ (P <0.01)and was connected with clinical stage (P <0.05 )instead of lymph node metastasis and cancer stromal invasion depth (P > 0.05 ).The expressions of E-cadherin in tissues of CSC, CIN2 and CIN3 were significantly lower than those in normal cervical tissues (P <0.05).E-cadherin expression was both significantly higher in grade Ⅰ and grade Ⅱ than in grade Ⅲ (P <0.05),and was associated with lymph node metastasis (P < 0.05 )rather than clinical stage and cancer stromal invasion depth (P > 0.05 ).A negative correlation was found between the expressions of clusterin and E-cadherin in CSC (r = - 0.339,P < 0.05 ). Conclusion The significantly different expressions of clusterin and E-cadherin may be related to the development of CSC,suggesting that the two may be used as potential markers for early diagnosis of CSC.
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Objective To study the application value of the cervical cell pathology liquid production technol-ogy in cervical intraepithelial neoplasia (CIN)screening.Methods 4 212 patients were chosen and detected by TCT and the pap staining,TBS (the Bethesda system)to finish thin layer liquid based cytology grading diagnosis,including 558 patients with cervical biopsy,the pathological results were analyzed.Results for histopathological examination results of CIN1,CIN2,CIN3 and cervical cancer cases,a thin layer of liquid based cytology detection rate was 76.00%(57 /75),78.21%(61 /78),95.76%(113 /118),100.00%(7 /7),the comparison between the CIN3 CIN2 group,a thin layer of liquid based cytology detection rate had differences in significant statistical significance (χ2 =14.53,P <0.01),with the histopathological detection of cervical lesions,thin layer of liquid based cytology detection rate was obviously rising trend.Cervical liquid based cytology screening cervical lesion (CIN and above),the sensitiv-ity was 85.61%(238 /278),83.73%(206 /246),positive predictive value 76.28%(238 /312),negative predictive value 72.79%(206 /283).Conclusion The positive results and histopathological results coincidence rate of using thinprep cytologic test to screening for cervical intraepithelial neoplasia (CIN)is high,the precancerous lesions in screening and prevention has important significance,which is worth clinical promotion.
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Objective To investigate the diagnosis value of p16 combined with Ki67 protein in cervical lesions.Methods Totally 1 542 women with previous liquid-based cytology smear result of abnormality underwent a colposcopy-directed biopsy excision procedure.Biopsy specimens were detected by p16 and Ki67 immunostaining alongside hematoxylin and eosin (H&E) staining.A four-semiquantitative class was used to describe the immunohistochemical results.Results Biopsy results revealed 1 542 women included 473 women with negative for dysplasia (NEG),629 women with cervical intraepithelial neoplasia (CIN) Ⅰ,206 women with CIN Ⅱ,206 women with CINⅢ and 28 women with cervical squamous cell carcinoma (SCC).The averageage of this study population was 34.47 years.CINs mainly occurred in women aged 20-29 years and 30-39 years.The positive rates of p16 in NEG,CIN Ⅰ,CIN Ⅱ,CINⅢ and SCC were 15.22％,60.25％,98.06％,99.51％,100.00％ respectively,and the positive rates of Ki67 were 12.05％,63.12％,96.12％,98.06％,100.00％ respectively.p16 expression and Ki-67 expression significantly increased with disease progression (p16:r =0.758,P =0.000 ; Ki67:r =0.773,P =0.000).Expression level of p16 was positively related with Ki-67 (r =0.774,P =0.000).The positive expression rates of p16 and Ki-67 of NEG were significantly lower than those of CIN and SCC (p16:x2 =1 127.46,P =0.000;Ki67:x2 =1 316.85,P =0.000).The positive expression rates of p16 and Ki-67 were markedly higher in CIN Ⅰ than those in CINⅡ,CINⅢⅢ and SCC (p16:x2 =500.19,P =0.000;Ki67:x2 =603.23,P=0.000).Conclusion Women aged 20-39 years are key subjects for cervical cancer screening.p16 and Ki67 immunohistochemistry is important in the ancillary diagnosis of cervical lesions.
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Objetivo: Avaliar a distribuição de diagnósticos citológicos de neoplasia intraepitelial cervical (NIC), considerando a idade das mulheres incluídas. Material e Métodos: Osresultados citológicos de mulheres com NIC 1 (721), NIC 2(218) e NIC 3 (84) foram analisados em um modelo estratificado por faixa etária. Resultados e Conclusão: As prevalências encontradas foram de 70,48% (721/1023) para NIC 1, 21,31% (218/1023) para NIC 2 e 8,21% (84/1023) para NIC 3. Os diagnósticos citológicos de NIC 1 foram observados com maior frequência em mulheres com menos de 40 anos (88,35%; 637/721). Os diagnósticos citológicos de NIC 2 também foram mais frequentes emmulheres com menos de 40 anos, com uma prevalência de 43,6% (95/218), observada na faixa etária de 20-30 anos, e de 22,5% (49/218) em mulheres de 31-40 anos. Osdiagnósticos de NIC 3 foram mais frequentes em mulheres com mais de 30 anos (83,3%; 70/84). Houve uma maior prevalência de NIC 1 e NIC 2 em mulheres na faixa etária de 20 a 30 anos, enquanto que NIC 3 teve prevalência maior em mulheres com mais de 30 anos. É possível que a história natural da NIC 2 seja mais próxima a de NIC 1, quando comparadaà de NIC 3.
Objective: To evaluate the distribution of the cytological diagnosesof cervical intraepithelial neoplasia (CIN) considering the includedwomen's age group. Material and Methods: The cytological resultsof woman with CIN 1 (721), CIN 2(218) and CIN 3 (84) were analyzedin a stratified model by age group. Results and Conclusion: Thetotal prevalences founded were 70.48% (721/1023) for CIN 1, 21.31%(218/1023) for CIN 2 and 8.21% (84/1023) for CIN 3. The cytologicdiagnosis of CIN 1 were observed more frequently in women underthe age of 40 (88.35% 637/721). The cytologic diagnosis of CIN 2were also more frequent in women under 40 years of age with aprevalence of 43.6% (95/218) observed in the age group of 20-30years and 22.5% (49/218) in women of 31-40 years. The diagnosis ofCIN 3 were more frequent in women over 30 years (83.3% 70/84).There is a higher prevalence of CIN 1 and CIN 2 in women aged 20to 30 years while CIN 3 prevalence is higher in women over 30 years.It is possible that the natural history of CIN 2 is closer to CIN 1 whencompared to CIN 3.
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Humans , Female , Adolescent , Young Adult , Middle Aged , Aged, 80 and over , Vaginal Smears/methods , Uterine Cervical Dysplasia/diagnosis , PrevalenceABSTRACT
El diagnóstico morfológico de neoplasia intraepitelial cervical de bajo grado (NIC-I) no permite determinar su real riesgo de progresión a cáncer de cérvix, llevando a seguimiento estricto a un alto número de pacientes cuyas lesiones, en su mayoría, regresarán espontáneamente. La detección de p16INK4A se ha propuesto como biomarcador que permite diferenciar entre infección productiva-autolimitada por virus del papiloma humano (VPH) y transformación celular inducida por cepas oncogénicas del VPH, sin embargo, es necesario aportar evidencias de su capacidad predictiva. Se presenta una serie de 14 casos de NIC-I con detección inmunohistoquímica de p16INK4a en biopsia de cérvix (8 positivos y 6 negativos), cuya revisión retrospectiva de historial clínico de más de 12 meses de seguimiento cito-histopatológico, permite describir regresión espontánea en todos los casos p16INK4a negativo y en 3 casos p16INK4a positivo (37,5 por ciento). Los hallazgos en esta serie coinciden con lo descrito en estudios previos en los que se ha demostrado el valor predictivo negativo del marcador para descartar riesgo de progresión-persistencia y evitar seguimientos y tratamientos innecesarios. Además señalan debilidades a evaluar respecto al valor predictivo positivo de la prueba, al no discriminar algunos factores independientes de la transformación celular, determinantes en la progresión-persistencia de la NIC-I, como lo son variables genéticas y/o inmunológicas del huésped.
The morphological diagnosis of low grade-cervical intraepithelial neoplasia (CIN-1) can not determine its true risk of progression to cervical cancer, leading to strict adherence to a high number of patients whose lesions, most will return spontaneously. The detection of p16INK4a has been proposed as biomarker to differentiate between productive infection self-limiting by human papillomavirus (HPV) and cell transformation induced by oncogenic strains of HPV, however, it is necessary provide evidence of its predictive capacity. We present a series of 14 cases of CIN-1 with immunohistochemical detection of p16INK4a in cervical biopsy (8 positive and 6 negative), whose retrospective review of medical records of more than 12 months of cyto-histopathological follow, can describe spontaneous regression in all cases p16INK4a negative and in 3 cases p16INK4a positive (37.5 percent). The findings in this series of cases coincide with that described in previous studies that has been demonstrated the negative predictive value of the marker to exclude risk of progression-persistence and avoid follow-ups and unnecessary treatments. Additionally, these indicates weaknesses to evaluate about the positive predictive value of the test, by not discriminating factors independent of cellular transformation, determining the progression-persistent CIN-1, such as genetic and / or immunologic variables of the host.
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Female , /metabolism , Uterine Cervical Dysplasia/pathology , Uterine Cervical Neoplasms/pathology , Clinical Evolution , Disease Progression , Follow-Up Studies , Immunohistochemistry , Biomarkers, Tumor/metabolism , Uterine Cervical Dysplasia/metabolism , Uterine Cervical Neoplasms/metabolism , Papillomavirus Infections , Predictive Value of Tests , Retrospective StudiesABSTRACT
La citología y la colposcopia se han utilizado a través de los años con el objetivo de sospechar las afecciones premalignas y malignas del cérvix uterino que solo la histología confirmará. OBJETIVO: Evaluar la correlación colpohistológica en pacientes portadoras de neoplasia Intraepitelial cervical (NIC) diagnosticadas y tratadas con radiocirugía. MÉTODOS: Se realizó una investigación descriptiva longitudinal retrospectiva de 2 657 pacientes a las que se les realizó conización cervical en el Hospital Docente Ginecoobstétrico de Guanabacoa, en el periodo comprendido entre enero 1998 y diciembre 2008. Para dar curso al estudio se evaluaron variables como: exámenes colposcópicos previos y resultado histológico del tejido del cérvix uterino obtenido por conización con asa diatérmica. Para el análisis estadístico se utilizaron medidas de resumen descriptivas: la frecuencia porcentual, la media la desviación estándar y la prueba de Chi cuadrado con nivel de significación de p ú 0,05, como significativo, p ú 0,01 muy significativo y p ú 0,001 altamente significativo, lo que permitió evaluar la confiabilidad y significación de las variables a estudiar. RESULTADOS: La relación colpohistológica fue altamente significativa en las pacientes estudiadas. CONCLUSIÓN: Se comprobó una buena correlación entre la colposcopía y la histología en las pacientes diagnosticada de neoplasia intraepitelial cervical
The cytology and the colposcopy have been used over years looking for premalignant and malignant affections of the cervix uteri only confirmed by histology. OBJECTIVE: to assess the colpohistologic correlation in patients presenting with cervical intraepithelial neoplasia (CIN) diagnosed and treated with radiosurgery. METHODS: A retrospective, longitudinal and descriptive research was made in 2 657 patients underwent cervical conization in the Gynecology and Obstetrics Teaching Hospital of Guanabacoa municipality between January, 1998 and December, 2008. The following variables were assessed: prior colposcopy examinations and histological result of cervix uteri tissue obtained by conization with diathermic loop. For statistic analysis the descriptive abstract measures were used: the percentage frequency, the standard deviation mean and the Chi² test with a significance level of p ú 0,05, as significant, p ú 0,01 as very significant and p ú 0,001 highly significant, allowing assessment of the reliability and significance of variable to be studied. RESULTS: The colposcopy and histology relation was very significant in study patients. CONCLUSION: There was verified a good correlation between colposcopy and histology in patients diagnosed with cervical intraepithelial neoplasia
Subject(s)
Humans , Female , Colposcopy , Uterine Cervical Dysplasia/surgery , Uterine Cervical Dysplasia/etiology , Epidemiology, Descriptive , Longitudinal Studies , Retrospective StudiesABSTRACT
OBJETIVO: Caracterizar a la paciente biopsiada por electrocirugía en el Hospital Ginecoobstétrico de Guanabacoa durante el periodo de enero 1998 a diciembre 2008. MÉTODOS: Se realizó un estudio descriptivo, longitudinal retrospectivo en 2 696 expedientes clínicos correspondientes a pacientes diagnosticadas con neoplasia intraepitelial cervical (NIC) y cáncer invasor del cérvix uterino (CCU) atendidas en el hospital materno de Guanabacoa durante el periodo antes mencionado. El procesamiento de la información fue a partir de la recolección de datos de las historias clínicas y libro de control de biopsias, llevándolos a una base de datos en Microsoft Excel y el procesamiento estadístico utilizando fue el paquete SPSS versión 15 y EPIDAT. RESULTADOS: Del total de casos el 36,2 por ciento se diagnosticó y trató entre los 31 y 40 años, el 60 por ciento inició precozmente sus relaciones sexuales, 2 fue el promedio de partos por pacientes, el 2 por ciento de la muestra se encontraba embarazada en el momento de la toma de biopsia, el 80,1 por ciento tenía el hábito de fumar y el 93,5 por ciento presentó virus de papiloma humano (VPH) en el resultado histológico asociados la NIC. CONCLUSIÓN: La precocidad en el inicio de la primera relación sexual, la presencia de VPH y hábito de fumar fueron factores que estuvieron presentes en un elevado porcentaje de las pacientes tratadas; la multiparidad y la adolescencia no incidieron de forma significativa en la población estudiada
OBJECTIVE: To characterize the patient undergoes biopsy by electrosurgery in Gynecology and Obstetric Hospital of Guanabacoa municipality over January, 1998 and December, 2008. METHODS: A retrospective, longitudinal and descriptive study was conducted in 2 696 medical records corresponding to patients diagnosed with cervical intraepithelial neoplasia (CIN) and invasive cancer of cervix uteri (CCU) seen in the mother hospital of Guanabacoa municipality over above mentioned period. The information processing was from the data retrieval from medical records and biopsy control registry entering in a database in Microsoft Excel and the statistic processing using the SPSS package version 15 and EPIDAT. RESULTS: From the total of cases, the 36.2 percent was diagnosed and treated between the 31 and 40 years old, the 60 percent had early sexual intercourses, 2 was the labor average per patient, the 2 percent of the sample was pregnant at biopsy taking, the 80.1 percent was smoker and the 93.5 percent had human papilloma virus (HPV) according to the histological result associated with CIN. CONCLUSION: The early onset of the first sexual intercourse, the presence of human papilloma virus, smoking, were the factors present in a high rate of treated patients' multiparity and adolescence not influenced significantly in the study population
Subject(s)
Humans , Female , Adult , Biopsy/methods , Uterine Cervical Dysplasia/epidemiology , Risk Factors , Epidemiology, Descriptive , Longitudinal Studies , Retrospective StudiesABSTRACT
Objective: To improve the sensitivity of Human Papillomavirus (HPV) detection in plasma from high-grade cervical neoplasia patients (CIN III) and cervical cancer (CC) evaluating any likely correlation with disease stage.Method: We subjected plasma DNA isolates from 112 patients (CIN and ICC) to a pre-PCR restoration treatment to improve detection sensitivity. HPV-specific sequences were detected by conventional PCR both in cervical scrapes and plasma DNA obtained from each patient. For every single DNA sample, both non-restored and restored isolates were PCR analyzed.Results: We detected HPV in plasma DNA isolates with significantly higher efficiency on restored plasma-DNA as compared to each non-restored equivalent, still maintaining close correlation with the clinical stage of the cases. By analyzing plasma-DNA isolates we could classify as HPV positive >50.0% of the cases that were previously known to be positive from the cervical scrape based assay. Interestingly, 100% of the cases in which subtype HPV18 was detected in cervical scrapes were also positive in plasma DNA.Conclusions: Restoration of plasma DNA from cervical cancer patients allows a more sensitive PCR-based HPV detection, maintaining the correlation to disease stage traditionally observed.
Objetivo: Mejorar la sensibilidad y la detección del virus del papiloma humano (VPH) en el plasma de pacientes con neoplasias intraepiteliales de alto grado (NIEAG) y cáncer de cuello uterino (CCU) para evaluar si existe una relación con el estadío de la enfermedad.Método: Los ADN de plasma aislados de 112 pacientes (NIC y CCU) se sometieron a restauración mediante reacción de la polimerasa en cadena (siglas en inglés, PCR), para mejorar su calidad como sustrato para PCR. En cada paciente se detectaron secuencias específicas del VPH por PCR convencional, tanto en exudados cérvico-vaginales como en ADN del plasma. Por cada muestra se analizaron por PCR, cantidades equivalentes del ADN aislado, tanto no restaurado como restaurado.Resultados: Para las muestras pareadas se pudo detectar VPH en ADN de plasma de forma más eficiente en los materiales restaurados, pues se mantuvo una estrecha correlación con el estadío clínico de los casos. Mediante el análisis de ADN de plasma es posible detectar como VPH positivas más de 50% de los casos que se identificaron previamente como positivos en citología de cuello uterino. Se enfatiza el hecho que 100% de los casos en los que el subtipo VPH18 fue descubierto en exudado cérvico-vaginal también fueron positivos en el ADN de plasma.Conclusiones: El proceso de restauración de ADN de plasma de pacientes con cáncer de cuello uterino permite mejorar la detección de VPH, por PCR, y mantener la correlación con el estadío de la enfermedad.
Subject(s)
Humans , Female , DNA , DNA Probes, HPV , Plasma , Uterine Cervical Neoplasms , Cell BiologyABSTRACT
Cervical cancer continues to be the commonest cause of death among women in developing countries, largely due to the failure to the inability to sustain effective cytology-based screening programs. While this burden may come down following implementation of the human papillomavirus (HPV) vaccine, screening will still be required. HPV DNA testing is a promising new technology for cervical cancer prevention and is the most reproducible of all cervical cancer screening tests. Presently, the two assays most widely used for the detection of genital types are the polymerase chain reaction (PCR) and Hybrid Capture 2 assays (hc2). Rapid, affordable tests are expected to be available soon. HPV DNA testing can be used in a variety of clinical scenarios that include primary screening in women older than 30 yr; as an adjunctive test to cytology; in the triage of women with an equivocal cytologic report, e.g., ASC-US; or for follow-up post-treatment for cervical intraepithelial neoplasia (CIN). HPV DNA testing can also be performed on self-collected samples, which allows screening in remote areas and also in women who refuse gynecologic examination.
Subject(s)
DNA, Viral/analysis , DNA, Viral/genetics , Female , Humans , India , Mass Screening/methods , Papillomaviridae/genetics , Papillomaviridae/isolation & purification , Polymerase Chain Reaction , Uterine Cervical Neoplasms/diagnosis , Uterine Cervical Neoplasms/prevention & controlABSTRACT
OBJECTIVE: Conization is the popular procedure to diagnose or treat in most cases of cervical intraepithelial neoplasia (CIN) and some cases of early cervical cancer. Many reports show the conservative management of positive margin is reasonable. Nevertheless, it is generally accepted the positive margin of conization is the major cause of being received additional operation such as hysterectomy. The aim of this study is to evaluate the risk factors of positive margin. PATIENTS AND METHODS: 283 CIN or early cervical cancer women who underwent conization were enrolled this study. We evaluated many possible risk factors for positive margin, including age, weight, height, body mass index (BMI), gravity, parity, abortion, severity of disease, glandular involvement, and human papillomavirus (HPV) infection. RESULTS: Of the 283 patients, 80 (28.2%) had positive margin in their conization specimens. Statistical significant risk factors of positive margin included older age (P(trend) < 0.001), higher BMI (P(trend) = 0.036), more severity of disease (P(trend) < 0.001), and involvement of endocervical gland (OR = 2.5, 95% CI 1.5-4.2). Parity (P(trend) = 0.054) showed statistically marginal significance. Weight (P(trend) = 0.154), height (P(trend) = 0.456), gravity (P(trend) = 0.194), abortion (P(trend) = 0.813), and HPV infection (OR = 1.2, 95% CI 0.5-2.5) were not statistically significant risk factors. CONCLUSIONS: The data of present study demonstrated that older age, high BMI, and higher pathologic diagnosis are statistical risk factors of positive margin we can know preoperatively.
Subject(s)
Female , Humans , Body Height , Uterine Cervical Dysplasia , Conization , Diagnosis , Gravitation , Hysterectomy , Parity , Risk Factors , Uterine Cervical NeoplasmsABSTRACT
Cervical carcinoma is a continuous pathological procedure from preinvasive lesion to carcinoma.Cervicalintraepithelial neoplasia-the preinvasive disease of cervix carcinoma-is currently regarded to be associated with HPV infection.HPV is a small double-stranded DNA virus composed of protein shell and DNA core.The gene group includes early coding region,late coding region and long control region.E6 and E7 protein which are coded in the early coding region play a crucial role in virus copy.HPVs in reproductive system are very common in sex-active people.At least 75% of women who have sexual life will infect HPVs in some period of their life.Most of them can regress,and only those infected by high risk type virus and combined with other high risk factors could progress to HSIL or cervical carcinoma.As to HPV infection,people should neither overlook it nor got scared.Currently,treatment of the local vulva or cervical lesion caused by HPV infection is the most effective.
ABSTRACT
Objective To study the relativity analysis of abnormal cervical pathology results in cytology and histology.Methods With retrospective analysis of 31,634 cases of fluid-based thin-layer method(ThinPrep Cytology Test,TCT)of PUMC Hospital from January,2001 to March,2003,which reported in the Bethesda System,we checked the abnormal results and advised different diagnose biopsy of vaginoscopy and/or conization,and got the relativity description of abnormal results in TCT and CINⅢ/CIS results validated by vaginoscopy,match analysis of the CINⅡ～Ⅲ and CINⅢ/CIS results validated by vaginoscopy and conization labeled by the age group,and relativity analysis of abnormal results in TCT and CINⅢ/CIS results validated by vaginoscopy.Results Among 31,634 cases of TCT test,948 cases had confirmed biopsy results validated by vaginoscopy,of which 70 cases were of CINⅡ～Ⅲ,56 cases were of CINⅢ/CIS.The risk ratio(RR)of different abnormal TCT results in predicting CINⅢ/CIS results validated by vaginoscopy is:ASCUS group,14.7(95% confidence interval 8.0～27.0,P=0.00);CINⅠ group,13.9(6.3～30.9,P=0.00);CINⅡ group,44.2(15.5～126.5,P=0.00);CINⅢ group,272.2(161.6～458.6,P=0.00);Cancer group,unmeasured.As noted,there is no significant difference between the RR of ASCUS group and CINⅠ group(P=0.951)in predicting CINⅢ/CIS results.Conclusions Vaginoscopy examination and biopsy could verify histology abnormity of CINⅡ～Ⅲ及CINⅢ/CIS from abnormal results of TCT,and has a good accordance along with biopsy results of conization.There are significantly greater risk of being CINⅢ/CIS validated by vaginoscopy in the abnormal TCT patients,among which ASCUS group and CINⅠ group have the coequal risk.
ABSTRACT
OBJECTIVE: The aim of this study was to analyze a relation between the recurrence of cervical intraepithelial neoplasia (CIN) and the detection of high-risk human papillomavirus (HPV) DNA after loop electrosurgical excision procedure (LEEP), and to evaluate the clinical efficacy of HPV DNA test by Hybrid Capture Assay as a predictor of the recurrence of CIN after LEEP. METHODS: From January 2000 through March 2003, the charts of 238 women diagnosed as CIN and treated with LEEP were reviewed retrospectively. HPV DNA test (Hybrid Capture System I) for high-risk HPV was performed in all patients before LEEP. They were followed up with Papanicolaou smears and HPV DNA tests at the interval of 3 months during the first 6 months and then at the interval of 6 months. The Chi-square test was used for the statistical analysis. RESULTS: The rate of detection of high-risk HPV declined chronologically after LEEP. A higher recurrence rate was noted in the HPV DNA positive group after LEEP, comparing with the negative group, at 3 months (54.5% in positive vs. 6.5% in negative; p<0.05), at 6 months (61.1% in positive vs. 5.4% in negative; p<0.05), at 12 months (50.0% in positive vs. 14.0% in negative; p<0.05), and at 18 months (50.0% in positive vs. 15.2% in negative; p<0.05). The negative predictive value was high at 3 months (93.5%), at 6 months (94.6%), at 12 months (86.0%), and at 18 months (84.6%). There were significant associations between the recurrence of CIN and positive resection margin except for glandular involvements. CONCLUSION: The detection of high-risk HPV is a risk factor for the presence of CIN after LEEP. HPV DNA test by Hybrid Capture Assay after LEEP may be useful marker for the negative prediction of recurrence of CIN after LEEP.
Subject(s)
Female , Humans , Uterine Cervical Dysplasia , DNA , Human Papillomavirus DNA Tests , Papanicolaou Test , Recurrence , Retrospective Studies , Risk FactorsABSTRACT
OBJECTIVE: The purpose of this study was to determine the relationship between the cervical intraepithelial neoplasia (CIN) and human papillomavirus (HPV) DNA load and to evaluate the efficacy of viral load in prediction of histologic severity. METHODS: The cervical cytology and Hybrid Capture II tests for HPV detection were performed in 2411 women visited our hospital, from August 2003 to October 2004. A total of 259 consecutive women underwent cervical colposcopy directed biopsy and operations with confirmed final histologic diagnoses were included. Viral load was measured by Hybrid Capture II system expressed as relative lights unit (RLU) ratio of specimens and controls. RESULTS: There was no significant difference of CIN 1, CIN 2, CIN 3, SCC group and control group in the clinical characteristics. The higher the viral load, the higher stage of CIN was shown. HPV viral load test showed sensitivity of 82.9%, specificity of 37.7%, positive predictability of 60.0%, negative predictability of 66.2% in detecting CIN, while 94.4%, 34.3%, 67.5%, 80.8% in detecting HGSIL. The viral loads were categorized into four groups (negative, low, intermediate, high) for analysis and it was shown that higher viral load group tended to exist CIN more frequently (odds ratio=1, 1.8, 3.4, 3.5). In addition, viral load was more strongly associated with the risk of HGSIL than that of LGSIL (odds ratio=1, 6.7, 9.0, 9.6). CONCLUSION: We found that the higher HPV viral load is significantly associated with the higher stage of CIN. The measurement of HPV DNA load is useful for predicting the severity of lesions of the uterine cervix and making decision of treatment plans.