Asociación entre el inicio de la vida sexual y las lesiones intraepiteliales / Association between age at onset of active sexual life and intraepithelial lesion

Introducción: El cáncer cervicouterino inicia con una lesión precancerosa llamada displasia, pudiendo ser de bajo grado o alto grado; uno de los factores más importantes en este sentido es la edad de inicio de la vida sexual activa (IVSA). Objetivo: Conocer si existe asociación entre la edad de inicio de la vida sexual activa y la lesión intraepitelial escamosa de alto grado (LIEAG). Material y métodos: Estudio descriptivo, retrospectivo, observacional, en 52 expedientes de mujeres de 15 a 60 años, con Papanicolaou en el HGZ MF No. 1, previa autorización del CLIS 301 y el CEI 3018, con folio R-2022-301-021. Se recolectaron los datos de expedientes que cumplieron los criterios de inclusión; se realizó un análisis estadístico con frecuencias, porcentajes para variables cualitativas nominales, con medidas de tendencia central y dispersión en variables cuantitativas, con determinación de chi2 y prueba de Kruskal-Wallis, respetándose los principios de Belmont en consideración a la Justicia y Beneficencia, los principios éticos de la Declaración de Helsinki 1964 y la Ley General de Salud en México. Resultado: Al evaluar 52 expedientes de pacientes, la edad fue de 37.81 ± 9.949 años; se encontró asociación entre el IVSA y la LIEAG, sin significación estadística, de acuerdo con la prueba de chi2, con un valor de p = 0.538 (IC 95%: 0.403-0.674), y una asociación significativa por la prueba de Kruskal-Wallis entre la LIEAG y la edad de la paciente, con un valor de p = 0.019 (IC 95%: 0.000-0.057). Conclusión: El IVSA no se correlaciona con el tipo de LIEAG.

Introduction: Cervical cancer begins with a precancerous lesion called dysplasia, which can be low grade or high grade. One of the most important factors is the age at which an active sexual life begins. Objective: To know if there is an association between the age of beginning of active sexual life (BASL) and high-grade squamous intraepithelial lesions (HGSIEL). Material and methods: Descriptive, retrospective, observational study, in 52 files of women aged 15 to 60 years with Pap smear at HGZ MF No. 1, prior authorization from CLIS 301 and CEI 3018 with folio R-2022-301-021. Data were collected from files that met the inclusion criteria, a statistical analysis was carried out with frequencies, percentages for nominal qualitative variables, with measures of central tendency and dispersion in quantitative variables, with determination of chi2 and Kruskal-Wallis, respecting the principles of Belmont in consideration of Justice and Beneficence, the ethical principles of the Declaration of Helsinki 1964, the General Health Law in México. Result: When evaluating 52 patient records, the age was 37.81 ± 9.949 years, the association of BASL and HGSIEL was found without statistical significance according to the chi2 with a p = 0.538 (95% CI, 0.403-0.674) and a significant association by Kruskal-Wallis between HGSIEL and patient age, with p = 0.019 (95% CI, 0.000-0.057). Conclusion: The beginning of an active sexual life has no association with the type of high-grade squamous intraepithelial lesions.

Cytology-based Screening for Anal Intraepithelial Neoplasia in Immunocompetent Brazilian Women with a History of High-Grade Cervical Intraepithelial Neoplasia or Cancer / Triagem citológica de neoplasia intraepitelial anal em mulheres brasileiras imunocompetentes com histórico de neoplasia intraepitelial cervical de alto grau ou câncer

Abstract Objective To determine the prevalence and possible variables associated with anal intraepithelial neoplasia and anal cancer in immunocompetent women with high-grade cervical intraepithelial neoplasia. Methods A cross-sectional study involving immunocompetent women with a histological diagnosis of high-grade cervical intraepithelial neoplasia and cervical cancer, conducted between January 2016 and September 2020. All women underwent anal cytology and answered a questionnaire on characterization and potential risk factors. Women with altered cytology were submitted to anoscopy and biopsy. Results A total of 69 women were included in the study. Of these, 7 (10.1%) had abnormal anal cytology results: (high-grade lesion, atypical squamous cells of undetermined significance, and atypical squamous cells, cannot exclude high-grade lesions: 28,5% each; low grade lesion: 14,3%). Of the anoscopies, 3 (42.8%) showed alterations. Of the 2 (28,5% of all abnormal cytology results) biopsies performed, only 1 showed low-grade anal intraepithelial neoplasia. The average number of pregnancies, vaginal deliveries, and abortions was associated with abnormal anal cytology. However, the highest mean regarding the cesarean sections was associated with normal cytology. Conclusion The prevalence of anal intraepithelial neoplasia was compatible with data from recent studies, especially those conducted in Brazil. Opportunistic screening for anal intraepithelial neoplasia in this high-risk population should be considered. Anal cytology is suitable for this purpose, due to its low cost and feasibility in public health services.

Resumo Objetivo Determinar a prevalência e as possíveis variáveis associadas à neoplasia intraepitelial anal e ao câncer anal em mulheres imunocompetentes com neoplasia intraepitelial cervical de alto grau. Métodos Estudo transversal em mulheres imunocompetentes com diagnóstico histológico de neoplasia intraepitelial cervical de alto grau e câncer cervical, feito entre janeiro de 2016 e setembro de 2020. Todas as mulheres foram submetidas a citologia anal e responderam a um questionário de caracterização e potenciais fatores de risco. Mulheres com citologia alterada foram submetidas a anuscopia e biópsia. Resultados No total, 69 mulheres foram incluídas no estudo. Destas, 7 (10,1%) tiveram resultados anormais de citologia anal (lesão de alto grau, células escamosas atípicas de significado indeterminado, e células escamosas atípicas, não se pode excluir lesões de alto grau: 28,5% cada; lesão de baixo grau: 14,3%). Das anuscopias, 3 (42,8%) demonstraram alterações. Das 2 biópsias realizadas, apenas 1 apresentou neoplasia intraepitelial anal de baixo grau. O número médio de gestações, partos vaginais e abortos estava associado à citologia anal anormal. No entanto, a maior média de partos cesáreos estava associada à citologia normal. Conclusão A prevalência de neoplasia intraepitelial anal foi compatível com dados de estudos recentes, principalmente daqueles feitos no Brasil. O rastreamento oportunista para neoplasia intraepitelial anal nesta população de alto risco deve ser considerado. A citologia anal é adequada para esse fim, devido ao seu baixo custo e viabilidade nos serviços públicos de saúde.

Virus de papiloma humano y lesión intraepitelial cervical enadolescentes embarazadas / Human papilloma virus and cervical intraepithelial lesion inpregnant adolescents

Objetivo: Comparar la presencia del Virus de Papiloma Humano (VPH) y de lesión Intraepitelial Cervical (LIE) en adolescentes embarazadas y no grávidas atendidas en la Maternidad Dr. Armando Castillo Plaza de Maracaibo, Venezuela. Método: Investigación comparativa con diseño no experimental transeccional y de campo; donde se incluyeron 46 adolescentes embarazadas (casos) y 46adolescentes no embarazadas (controles), escogidas mediante muestreo probabilístico aleatorio, a quienes se les realizó identificación de factores asociados a la patología, evaluación por citología cervicovaginal y Genotipificación del VPH por reacción en cadena de la polimerasa (PCR). Resultados: se encontró que 32,6% de las embarazadas presentaron LIE de bajo grado (VPH o NIC 1) respecto a 21,7% en las no grávidas, común riesgo dos veces mayor (OR [IC95%]= 2,44 [1,05-5,65]). El diagnóstico molecular resultó positivo en la mitad del total de la muestra, siendo mayor en las embarazadas (52,1 vs. 47,9p<0,05);predominado las infecciones pro genotipos de alto riesgo 47,8vs 30,5; p <0,05). El VPH 16 resulto el más prevalente entre las embarazadas (21,7%) y la co-infección por genotipos debajo riesgo (6-11) en las no grávidas (17,4%) Conclusiones: las embarazadas adolescentes presentan una mayor prevalencia de LIE e infección genital por VPH, asociado a un riesgo significativo del doble de probabilidad de presentar una LIE respecto a las adolescentes no grávidas(AU)

Aim: To compare the presence of Human PapillomaVirus (HPV) and Squamous Intraepithelial Lesion (SIL)in pregnant and non-pregnant adolescents treated at the "Maternidad Dr. Armando Castillo Plaza" in Maracaibo, Venezuela. Patients and Methods: A comparative research with non-experimental transectional and field design was performed; where 46 pregnant adolescents (cases) and 46 non-pregnant adolescents (controls) was included, chosen by random probability sampling, who under went identification off actors associated with the pathology, evaluation by pap-smearand HPV genotyping by chain reaction of polymerase (PCR). Results: It was found that 32.6% of pregnant women had lowgrade SIL ( HPV or CIN 1) compared to 21.7% in non-pregnant women, with a risk twice higher (OR [95% CI] = 2.44 [1.05-5.65]). thee molecular diagnosis was positive in half of the total sample, being higher in pregnant women (52.1 vs. 47.9p <0.05);infections with high-risk genotypes predominated 47.8 vs 30.5;p <0.05). HPV 16 was the most prevalent among pregnant women (21.7%) and co-infection by low-risk genotypes (6-11) in non-pregnant women (17.4%). Conclusions: adolescent pregnant women have a higher prevalence of LIE and genital HPV infection, associated with a significant risk of twice the probability of presenting an LIE compared to non-pregnant adolescents(AU)

Comparative analysis of anal colposcopy with histology in the follow-up of patients under treatment for anal condyloma

Objectives: To compare morphological abnormalities on anal colposcopy against histology to determine anal high-grade squamous intraepithelial lesions (HSILs). Methods: This is a retrospective data assessment of HIV-negative and HIV-positive patients undergoing outpatient follow-up. The sample comprised 54 patients presenting acetowhite lesions on anal colposcopy. Acetowhite lesions were classified according to their morphology into punctation, verrucous, mosaic, ulcerated, or hypervascularized, and biopsies of these specimens were classified as anal HSIL, low-grade squamous intraepithelial lesion (LSIL), or normal. The data were analyzed using SPSS forWindows version 13.0 (SPSS Inc., Chicago, IL, USA). The results were analyzed using the nonparametric Mann-Whitney test, the Fisher exact test and the chi-squared parametric test. A 95% confidence interval (CI) was used and a level of significance <5% was adopted for all statistical tests. Results Fifty-four patients (50 males, 80% HIV+) with biopsied acetowhite lesions were assessed. There were 31 punctation lesions, 1 classified as HSIL (3.2%; 95%CI: 0- 40.0), 17 verrucous lesions, 3 HSIL (17.7%; 95%CI: 0-10.7), and 1 ulcerated, classified as HSIL (100%), and 4 mosaic and 1 atypical vessel lesion, all classified as LSIL. The results showed no association of presence of anal HSIL with positivity for HIV infection or with counts above or below 500/µl in HIV+patients. Statistical analysis was performed using the Mann-Whitney nonparametric test, the Fisher exact test, and the chi-squared parametric test. Conclusion: The comparison of morphological findings on anal colposcopy against histology revealed no morphological pattern suggesting anal HSIL. (AU)

Neoplasia intraepitelial escamosa cervical de alto grau: abordagem ambulatorial / High-grade cervical intraepithelial neoplasia: outpatient approach

As neoplasias intraepiteliais cervicais correspondem a alterações identificadas por rastreamento citológico cervical e estudo histológico, pós-biópsia incisional guiada por colposcopia ou procedimento diagnóstico excisional. Podem ser tratadas com abordagens conservadoras e procedimentos excisionais. A vacinação anti-HPV e o tratamento excisional oportuno constituem, respectivamente, prevenção primária e secundária contra o câncer do colo uterino.(AU)

Cervical intraephitelial neoplasms correspond to changes identified by cervical citological screening and histological study, post-incisional biopsy guided by colposcopy or excisional diagnostic procedure. They can be treated with conservative approaches and excision procedures. Anti-HPV vaccination and timely excional treatment are primary and secondary prevention against cervical cancer, respectively.(AU)

Value of Endocervical Curettage in Detection of High-grade Cervical Squamous Intraepithelial Lesion / 肿瘤防治研究

Objective To explore the value of endocervical curettage (ECC) in the detection of high-grade cervical squamous intraepithelial lesion (HSIL). Methods We retrospectively analyzed the clinical features and colposcopical characteristics of 678 female patients with complete clinical data. Results Among 678 cases, 391 cases were confirmed by cervical biopsy only and 7 cases by ECC only (57.67% vs. 1.03%, P < 0.001). ECC checked out 287 HSIL patients (42.33%, including cervical biopsy positive and negative cases) and cervical biopsy checked out 671 HSIL cases (98.97%, including ECC positive and negative cases). There were 68 positive ECC cases in the conversion area of Type 1+Type 2 and 247 positive ECC cases in the conversion area of Type 3(33.33% vs. 52.11%, P < 0.001). The positive rates of ECC in patients≥45 years old and < 45 years old were 145 and 170, respectively (55.13% vs. 40.96%, P < 0.001). Conclusion The cervical biopsy plays a dominant role in the detection of HSIL, and ECC can only be used as a supplement to it. Female patients older than 45 years or with Type 3 transformation zone examined by colposcopy should be concerned with cervical lesions.

Analytical study of Pap smear reports over a period of 1 year in a tertiary care centre

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.

Experience of cervical Pap smear screening in tertiary care hospital

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.

Characteristics and significance of hr-HPV distribution of HSIL and cervical cancer in Hainan / 公共卫生与预防医学

Objective To explore the characteristics and significance of human papillomavirus (HPV) and high-risk HPV infection in cervical high-grade squamous intraepithelial lesions (HSIL) and cervical cancer (CC) in Hainan, and to provide a reference for the prevention of HPV infection and cervical cancer screening. Methods From May 2017 to December 2019, 379 gynecological inpatients in our hospital were selected (as case group), including 220 cases in the HSIL group and 159 cases in the CC group. A total of 182 healthy females undergoing physical examination in the same period of time were selected as a control group. Using PCR technology and DNA reverse dot hybridization technology, the patients were tested for HPV-DNA subtypes which were divided into 13 high-risk types and 10 low-risk types according to HPV genotypes. The relationship between HSIL and CC of patients and high-risk HPV infection was analyzed. Results (1) The HPV infection rate of HSIL and CC patients in the case group (85.75%) was significantly higher than that in the control group (26.92%) (P50-year-old group were significantly higher than those in other age groups. (4) In both the case group and the control group, single subtype infection was higher than multiple infection (P<0.001). Conclusion HSIL and CC patients in this area are mainly infected with single subtype and high-risk HPV. The infection exhibited certain differences in different ages.

Association between asymptomatic sexually transmitted infections and high-risk human papillomavirus in cervical lesions / 西安交通大学学报(医学版)

Objective To determine the association of asymptomatic sexually transmitted infections (STIs) with high-risk human papillomavirus (hrHPV) in cervical squamous intraepithelial lesions and neoplasms. Methods From July 2017 to July 2018, 320 hrHPV-positive and 160 hrHPV-negative women in The First Affiliated Hospital of Xi'an Jiaotong University were divided into normal+low-grade squamous intraepithelial lesion (LSIL) and high-grade squamous intraepithelial lesion (HSIL)+ invasive cervical cancer (ICC) subgroups, respectively, based on their pathological cervical lesion grades. Cervical brush specimens including Ureaplasma urealyticum (UU) and its serotypes, Mycoplasma hominis (MH), Mycoplasma genitalium (MG), Chlamydia trachomatis (CT), and hrHPV were amplified and hybridized using PCR kits (Hybribio Biochemistry Co., Ltd.). The differences between groups were examined by the chi-squared test, continuity correction and Logistic regression. Results The overall infection (at least one of the non-hrHPV pathogens was positive) rates of the two groups were 62.5% and 59.4%, which were not significantly different. The prevalence of UU was the highest. The prevalence of UU serotype 14 (Uup14) and MH was associated with hrHPV (P=0.003, P=0.005, respectively), but not with certain hrHPV genotypes or with single or multiple genotypes. Compared with cases of normal+LSIL, cases of HSIL+ICC had significantly different Uup14 infection rates (OR: 12.579, 95% CI: 3.638-43.497, P<0.001) in the positive group. In hrHPV-negative cases, there were obvious differences in Uuu and Uup1 infections based on different cervical lesion types (OR: 11.646, 95% CI: 1.493-90.850, P=0.019; OR: 7.474, 95% CI: 1.140-49.015, P=0.036). Conclusion Asymptomatic STIs in female lower reproductive tract are widespread. Uup14 may increase the risk of HSIL+ICC when hrHPV is positive. Uuu and Uup1 cause an increased risk of HSIL+ICC without hrHPV.

Value of transformation zone type in the evaluation of random biopsy among patients without visible lesions under colposcopy / 上海交通大学学报（医学版）

Objective: To explore the value of cervical transformation zone (TZ) type in assessing whether a random biopsy should be used to diagnose high-grade squamous intraepithelial lesion (HSIL) among patients without visible lesions under colposcopy. Methods: A total of 517 patients who underwent colposcopy (without visible lesions) due to high risk subtype infection of human papillomavirus (HPV) or thinprep cytologic test (TCT) abnormality were enrolled. TZ types were identified, random biopsies were performed, and the value of TZ type, Ⅱand III in the diagnosis of HSIL was evaluated. Results: There were 517 cases without visible lesions under colposcopy. Three hundred and ninety-six of them were TZ type III, and the detection rate of HSIL was 3.8% (15/396) by random biopsy, while one hundred and twenty one of them were TZ type and Ⅱ, and the detection rate of HSIL was 8.3% (10/121). Compared with the TZ type III, the detection rate of HSIL in the TZ type and Ⅱ was significantly increased (P=0.000). Logistic regression showed that TCT abnormality, TZ type and Ⅱ were the risk factors for HSIL detection in patients without visible lesions under colposcopy. Conclusion: Random multipoint biopsy can significantly increase detection rate of cervical HSIL when no visible lesion is visualized under colposcopy, particularly in women with abnormal TCT results or TZ type and Ⅱ.

Diagnostic Test Accuracy Review of Cytology for Squamous Intraepithelial Lesion and Squamous Cell Carcinoma of Uterine Cervix

BACKGROUND: Even though cervico-vaginal smears have been used as a primary screening test for cervical carcinoma, the diagnostic accuracy has been controversial. The present study aimed to evaluate the diagnostic accuracy of cytology for squamous intraepithelial lesion (SIL) and squamous cell carcinoma (SqCC) of the uterine cervix through a diagnostic test accuracy (DTA) review. METHODS: A DTA review was performed using 38 eligible studies that showed concordance between cytology and histology. In the DTA review, sensitivity, specificity, diagnostic odds ratio (OR), and the area under the curve (AUC) on the summary receiver operating characteristic (SROC) curve were calculated. RESULTS: In the comparison between abnormal cytology and histology, the pooled sensitivity and specificity were 93.9% (95% confidence interval [CI], 93.7%–94.1%) and 77.6% (95% CI, 77.4–77.8%), respectively. The diagnostic OR and AUC on the SROC curve were 8.90 (95% CI, 5.57–14.23) and 0.8148, respectively. High-grade squamous intraepithelial lesion (HSIL) cytology had a higher sensitivity (97.6%; 95% CI, 94.7%–97.8%) for predicting HSIL or worse histology. In the comparison between SqCC identified on cytology and on histological analysis, the pooled sensitivity and specificity, diagnostic OR, and AUC were 92.7% (95% CI, 87.3%–96.3%), 87.5% (95% CI, 87.2%–87.8%), 865.81 (95% CI, 68.61–10,925.12), and 0.9855, respectively. Geographic locations with well-organized screening programs had higher sensitivity than areas with insufficient screening programs. CONCLUSION: These results indicate that cytology had a higher sensitivity and specificity for detecting SIL and SqCC of the uterine cervix during primary screening.

Impact of focused ultrasound on expression of hypoxia inducible factor-1α, vascular endothelial growth factor and mutant type p53 in vulvar skin of rat models with low grade squamous intraepithelial lesion / 中国介入影像与治疗学

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.

Application of AHPV and Its Genotyping in Low-grade Squamous Intraepithelial Lesions / 实用妇产科杂志

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.

Cervical cancer screening in rural India: Status & current concepts

Cervical carcinoma is one of the most common and dreaded diseases of women, and in India, it accounts for 16 per cent of total cervical cancer cases occurring globally. The situation is more alarming in the rural areas where the majority of women are illiterate and ignorant about the hazards of cervical cancer. Different screening strategies such as rural cancer registries and camp approach for cancer detection have been found useful in minimizing the problem of cervical cancer in the villages. Various screening techniques such as visual inspection with acetic acid, visual inspection with Lugol's iodine, visual inspection with magnification devices-magnavisualizer, Pap smear and HPV-DNA testing have been suggested and tried under low-resource settings of our country, and cervical cytology screening has been found effective in reducing incidence of the disease. In the present review, feasibility of different screening methods has been assessed to find out the most suitable mode applicable at the rural level. Single lifetime screening particularly of high-risk women along with analysis of cost-effective tumour markers such as Argyrophilic nucleolar organizer regions (AgNOR) counts to discriminate high-risk dysplasia cases appears to be an appropriate approach in fighting against cervical cancer.

Clinicopathological Pattern of Cervical Papanicolaou (PAP) Smears: A hospital based experience

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.

Therapeutic assessment of vulvar squamous intraepithelial lesions with CO2 laser vaporization in immunosuppressed patients / Avaliação terapêutica das lesões intraepiteliais escamosas da vulva com vaporização a laser CO2 em pacientes com imunossupressão

Abstract Objective A vulvar squamous intraepithelial lesion is deemed to be a preceding lesion to vulvar cancer, especially in women aged under 40 years, holders of an acquired or idiopathic immunosuppression. Several treatments have been used to treat these lesions. One of the aesthetically acceptable therapeutic methods is the CO2 laser vaporization. Methods In a transversal study, 46 records of immunosuppressed women bearing a vulvar low grade and/or high grade squamous intraepithelial lesion were selected out of the retrospective analysis, computing age, date of record, date of vulvar lesion treatment with CO2 laser, the time elapsed between the first and the last visit (in months), the number of visits, the presence or absence of condylomatous lesions in other female lower genital tract sites and whether or not recurrences and persistence of intraepithelial lesions have been noticed during the follow-up. Results Patients bearing vulvar high-grade squamous intraepithelial lesion and immunosuppressed (serumpositive forhumanimmunodeficiency virus [HIV] or with solid organs transplantation) have shown a higher level of persistence of lesions and a higher chance of having other areas of the female lower genital tract involved. Conclusion While the CO2 laser vaporization is the most conservative method for the treatment of vulvar high-grade intraepithelial lesions, it is far frombeing the ideal method, dueto the intrinsic infection features considered. The possibility of persistence, recurrences and spontaneous limited regression indicates that a closer surveillance in the long-term treated cases should be considered, in special for immunosuppressed patients.

Resumo Objetivo A lesão intraepitelial escamosa da vulva é considerada uma lesão precursora do câncer vulvar, emespecial emmulheres com idade inferior a 40 anos, portadoras de imunossupressão adquirida ou idiopática. Vários tratamentos têm sido utilizados para tratar esse tipo de lesão. Um dos métodos terapêuticos esteticamente aceitáveis é a vaporização a laser CO2. Métodos Em um estudo transversal, foram selecionados da análise retrospectiva de prontuários arquivados no setor de patologia do trato genital inferior 46 prontuários de mulheres comimunossupressão e portadoras de lesão intraepitelial escamosa de baixo grau e/ou alto grau computando-se: idade, data de registro, data do tratamento da lesão vulvar com laser CO2, tempo entre a primeira e a última consulta (em meses), número de consultas, presença ou ausência de lesões condilomatosas em outros locais do aparelho reprodutor feminino e a ocorrência ou não de recidivas e persistência de lesões intraepiteliais durante o período de acompanhamento. Resultados Pacientes com lesão intraepitelial de alto grau vulvar e imunocomprometidas (soropositivas para HIV ou com transplante de órgãos sólidos) mostraram maior índice de persistência das lesões e maior chance de ter outras áreas do órgão genital feminino comprometidas. Conclusão Embora a vaporização a laser CO2 seja o método mais conservador para o tratamento das lesões intraepiteliais vulvares de alto grau, está longe de ser o método ideal pelas características intrínsecas da afecção em foco. A possibilidade de persistência, recidivas e regressão espontânea limitada recomenda maior vigilância para os casos tratados a longo prazo, em especial para as pacientes com imunossupressão.

Study on HPV infection types distribution in ASC-US ,LSIL and HSIL of uterine cervix / 国际检验医学杂志

Objective To analyze the genotypes distribution and clinical significance of human papillomavir-us(HPV) infection in atypical squamous cells of undetermined significance (ASC-US) ,low squamous intraepi-thelial lesion (LSIL) and high squamous intraepithelial lesion (HSIL) of uterine cervix ,meanwhile to conduct the cervical histopathological diagnostic analysis in the patients with ASC-US、LSIL and HSIL .Methods The gene amplification technique (PCR) combined with gene-chips technology were adopted to conduct the 23 kinds of HPV genotype detection on 236 cases of cervical ASC-US ,36 cases of cervical LSIL and 61 cases of cervical HSIL specimens .All cases of ASC-US ,LSIL and HSIL were performed the cervical biopsy his-topathological diagnosis .And then the subjects related data were analyzed .Results Among 236 cases of cervi-cal ASC-US specimens ,139 cases of HPV infection were detected with the total HPV infection rate 58 .90％(139/236) ,in which the single genotypes infection rate was 38 .14％ (90/236)and the multiple genotypes infec-tion rate was 20 .76％ (49/236);26 cases of HPV infection were detected from 36 cases of cervical LSIL speci-mens with the total HPV infection rate of 72 .22％ (26/36) ,in which the single genotypes infection rate was 52 .78％ (19/36) and the multiple genotypes infection rate was 19 .44％ (7/36);61 cases of HPV infection were detected from 58 cases of cervical HSIL specimens with the total HPV infection rate of 95 .08％ (58/61) , in which the single genotypes infection rate was 68 .85％ (42/61)and the multiple genotypes infection rate was 26 .23％ (16/61) .The total infection rates had statistically significantly differences among the cervical ASC-US group ,LSIL group and HSIL group (P<0 .05) .Conclusion HPV16 ,52 ,58 are the main types in the patients with cervical ASC-US ,LSIL and HSIL .The gene-chip technology can be used in the HPV genotypes detection of cervical cells ,which has an important clinical significance for further distribution management on ASC-US patients and should draw great attention of gynecologist .

Establishment of a rat model of dimethylbenzanthracene-induced vulvar squamous intraepithelial lesions / 南方医科大学学报

OBJECTIVE@#To establish a SD rat model of vulvar squamous intraepithelial lesions.@*METHODS@#Seventy female SD rats were randomized into 4 groups, namely the blank control group (=10), mechanical irritation group (=10), acetone solution group (=10), and mechanical irritation with DMBA acetone solution group (=40, model group), and the corresponding treatments were administered 3 times a week for 14 weeks. The changes of the vulvar skin of the rats were observed regularly until the 18th week. The expression of mutant p53 (mtp53) and vascular endothelial growth factor (VEGF) proteins were detected using immunohistochemistry and Western blotting, and the expressions of mtp53 and VEGF mRNA were detected with qRT- PCR in the blank control group and model group.@*RESULTS@#No significant differences were found in the morphological or histopathological changes of the skin among the blank control group, mechanical irritation group and acetone solution group. In the model group, low-grade squamous intraepithelial lesions (LSIL) occurred in 28 rats (70%) and high-grade squamous intraepithelial lesions (HSIL) in 11 rats (27.5%) at 14 weeks, with a success rate of 97.5% in inducing vulvar squamous intraepithelial lesions. Compared with the blank control group, the rats in the model group showed significantly increased expressions of mtp53 and VEGF at both the protein level ( < 0.05) and the mRNA level ( < 0.05).@*CONCLUSIONS@#DMBA in acetone solution combined with mechanical irritation can induce vulvar squamous intraepithelial lesions in female SD rats.

Analysis of the influencing factors for overtreatment in patients with high-grade squamous intraepithelial lesion on primary cervical cytology diagnosis / 中国综合临床

Objective To explore the influencing factors for overtreatment in patients with high-grade squamous intraepithelial lesion(HSIL)on primary cervical cytology diagnosis.Methods Two hundred and thirty-nine patients with initially diagnosed HSIL on cervical cytology and received cervical conization from January 2012 and December 2016 were selected in this study.Overtreatment was defined as he highest level of pathologic diagnosis which was less than or equal to the low-grade squamous intraepithelial lesion(LSIL).The relevance of patients' age,menstrual status,colposcopy finding,the level of high-risk-HPV-DNA and treatment protocol to overtreatment were investigated.Results The most serious pathological diagnosis confirmed that no CIN,LSIL,HSIL,adenocarcinoma in situ(AIS)and squamous carcinoma of cervix(SCC)were detected,with 3.8%(9/239),5.6%(14/239),87.9%(210/239),0.4%(1/239),2.1%(5/239)respectively.The overall overtreatment rate was 9.6%(23/239).The level of high-risk-HPV-DNA and colposcopic findings were significantly related to overtreatment, and colposcopic finding with LSIL was the risk factor for HSIL overtreatment(OR= 8.786,95%CI= 1.671-17.311,P= 0.015),while HPV-DNA≥1000 ng/L was the protective factor(OR=0.201,95%CI=0.043-0.951,P=0.041).Conclusion The level of high-risk-HPV-DNA and the colposcopic finding are the influencing factors for overtreatment in patients with HSIL on primary cervical cytology diagnosis.