Principales indicadores del Programa de Diagnóstico Precoz del Cáncer Cervicouterino en un hospital de Santiago de Cuba

Introducción: El cáncer cervicouterino ocupa el tercer lugar como causa de defunción por neoplasias malignas a nivel mundial, afectando principalmente a los países de ingresos bajos y medianos. Hacia el 2020 se estimó una incidencia de 604 000 nuevos casos. Objetivo: Caracterizar los principales indicadores hospitalarios del Programa de Diagnóstico Precoz del Cáncer Cervicouterino. Métodos: Se realizó un estudio observacional, descriptivo y transversal, que permitió caracterizar los principales indicadores hospitalarios del Programa en el Servicio de Patología de Cuello del Hospital General Dr. Juan Bruno Zayas Alfonso de Santiago de Cuba, de enero del 2020 a diciembre del 2022. La población de estudio estuvo constituida por 443 mujeres. Los datos recopilados fueron analizados mediante técnicas de estadística descriptiva, expresándose en frecuencia y porcentajes. Resultados: De las mujeres estudiadas, 60,9 % presentaron lesión intraepitelial cervical de alto grado de malignidad, con 32,6 % positivo a cáncer cervicouterino. El porcentaje global de pruebas citológicas no útiles fue de 2,07 y sin células de la zona de transformación, de 4,01; ambos indicadores de calidad. Existió una alta significación en cuanto a la tasa de cobertura global de las mujeres en riesgo (K=0,615), demostrando que los resultados de la citología reflejan en gran medida los diagnósticos de la histología, con una buena concordancia. Conclusiones: La prueba citológica cérvico-vaginal sigue siendo el método diagnóstico de mayor valor para detectar neoplasia intraepitelial cervical y carcinoma en estadio precoz en grandes masas de población.

Introduction: Cervical cancer is the third leading cause of death from malignancies worldwide, affecting mainly low- and middle-income countries. By 2020 an incidence of 604,000 new cases was estimated. Objective: To characterize the main hospital indicators of the Cervical Cancer Early Diagnosis Program. Methods: An observational, descriptive and cross-sectional study was carried out to characterize the main hospital indicators of the Program in the Neck Pathology Service of the General Hospital Dr. Bruno Zayas Alfonso of Santiago de Cuba, from January 2020 to December 2022. The study population consisted of 443 women. The data collected were analyzed using descriptive statistic techniques, expressed in frequency and percentages. Results: Of the women studied, 60.9 %had cervical intraepithelial lesion of high degree of malignancy, with 32.6 % positive for cervical cancer. The overall percentage of useless cytological tests was 2.07 and no cells from the processing zone was 4.01, both quality indicators. There was a high significance in terms of the overall coverage rate of women at risk (K=0.615), showing that the results of the cytology largely reflect the diagnosis of histology, with a good agreement. Conclusions: Cervical-vaginal cytology remains the most valuable diagnostic method for detecting cervical intraepithelial neoplasm and early-stage carcinoma in large populations

Cervical Intraepithelial Neoplasia grade 2 biopsy: Do p16INK4a and Ki-67 biomarkers contribute to the decision to treat? A cross-sectional study

ABSTRACT BACKGROUND: Managing cervical intraepithelial neoplasia grade 2 (CIN2) is challenging, considering the CIN2 regression rate, perinatal risks associated with excisional procedures, and insufficient well-established risk factors to predict progression. OBJECTIVES: To determine the ability of p16INK4a and Ki-67 staining in biopsies diagnosed with CIN2 to identify patients with higher-grade lesions (CIN3 or carcinoma). DESIGN AND SETTING: Cross-sectional study conducted at a referral center for treating uterine cervical lesions. METHODS: In 79 women, we analyzed the correlation of p16INK4a and Ki-67 expression in CIN2 biopsies with the presence of a higher-grade lesions, as determined via histopathology in surgical specimens from treated women or via two colposcopies and two cytological tests during follow-up for untreated women with at least a 6-month interval. The expression of these two biomarkers was verified by at least two independent pathologists and quantified using digital algorithms. RESULTS: Thirteen (16.8%) women with CIN2 biopsy exhibited higher-grade lesions on the surgical excision specimen or during follow-up. p16INK4a expression positively and negatively predicted the presence of higher-grade lesions in 17.19% and 86.67% patients, respectively. Ki-67 expression positively and negatively predicted the presence of higher-grade lesions in 40% and 88.24% patients, respectively. CONCLUSIONS: Negative p16INK4a and Ki67 immunohistochemical staining can assure absence of a higher-grade lesion in more than 85% of patients with CIN2 biopsies and can be used to prevent overtreatment of these patients. Positive IHC staining for p16INK4a and Ki-67 did not predict CIN3 in patients with CIN2 biopsies.

¿Está la virtud en el punto medio? La incertidumbre del CIN2 y el papel del VPH / Is virtue at the midpoint? The uncertainty of CIN2 and the role of HPV

Objetivo: La biopsia guiada por colposcopia (BGC) marca el manejo de la neoplasia intraepitelial cervical. El objetivo de este estudio fue evaluar la concordancia de los resultados entre la BGC y la escisión amplia de la zona de transformación (LLETZ, large loop excision of the transformation zone), y la utilidad del genotipado del virus del papiloma humano (VPH) para seleccionar a las pacientes con riesgo de lesión intraepitelial escamosa de alto grado/neoplasia intraepitelial cervical 3 (HSIL/CIN3). Método: Se compararon los resultados de la BGC y de la LLETZ, siendo esta última el método de referencia. Se evaluó la relación del genotipo del VPH con el diagnóstico final de HSIL/CIN3. Resultados: La precisión de la biopsia comparada con LLETZ fue del 61,4%. La tasa de concordancia fue del 64,4% para CIN1, del 31,4% para CIN2 y del 77,4% para CIN3. La tasa global de sobrediagnóstico fue del 18,68% y la de subdiagnóstico del 19,89%. En mujeres menores de 30 años, la concordancia fue del 62,79% (CIN1 65%, CIN2 39,58% y CIN3 73,08%), la tasa de sobrediagnóstico del 22,67% y la tasa de subdiagnóstico del 15,11%. La infección por VPH16 tuvo una odds ratio de 3,86 para el diagnóstico final de HSIL/CIN3+. Conclusiones: El diagnóstico de CIN2 por BGC parece insuficiente para seleccionar a las pacientes para tratamiento escisional, principalmente en mujeres jóvenes. El hallazgo de VPH16 es un factor de riesgo de HSIL/CIN3+ independientemente del resultado de la biopsia.

Objective: Colposcopy-guided biopsy (CGB) is a basic tool for the management of cervical intraepithelial neoplasia. The aim of this study is to evaluate the concordance of results between CGB and large loop excision of the transformation zone (LLETZ), and the usefulness of human papillomavirus (HPV) genotyping to select patients at risk of H-SIL/CIN3. Method: The results of colposcopy-guided biopsy and LLETZ were compared, with LLETZ being the gold standard. The relationship of HPV genotype to the final diagnosis of CIN3 was assessed. Results: The accuracy of CGB compared to LLETZ was 61.4%. The concordance rate was 64.4% for CIN1, 31.4% for CIN2 and 77.4% for CIN3. The overall overdiagnosis rate was 18.68% and underdiagnosis rate was 19.89%. In women under 30 years of age the concordance rate was 62.79% (CIN1 65%, CIN2 39.58% and CIN3 73.08%), and the rate of overdiagnosis and underdiagnosis was 22.67% and 15.11%, respectively. HPV16 infection had an odds ratio of 3.86 for the final diagnosis of CIN3+ and the result was significant regardless of the biopsy result. Conclusions: The CGB result as CIN2 is inaccurate and seems insufficient to select patients for excisional treatment, mainly in young women. HPV16 infection is a risk factor for CIN3+ regardless of the colposcopy-guided biopsy result.

Asociación entre el perfil inmunohistoquímico de la neoplasia intraepitelial de alto grado y del adenocarcinoma acinar de próstata / Association of high-grade prostatic intraepithelial neoplasia immunohistochemical profile with acinar adenocarcinoma of the prostate

Resumen Antecedentes: En el mundo, el carcinoma de próstata constituye la segunda causa de cáncer y la quinta causa de muerte por cáncer en hombres. Objetivo: Conocer el perfil inmunohistoquímico de la neoplasia intraepitelial prostática de alto grado y del adenocarcinoma acinar de próstata. Material y métodos: Estudio observacional, analítico, transversal y retrospectivo de especímenes obtenidos por biopsia con aguja cortante y resección de próstata debido a diagnóstico de adenocarcinoma acinar de próstata y neoplasia intraepitelial de alto grado, entre enero de 2015 y diciembre de 2020. Se realizaron microarreglos tisulares y, posteriormente, estudios de inmunohistoquímica para BCL2, EGFR, p53, Her2/neu y Ki67. Se realizó estadística descriptiva para analizar los factores clinicopatológicos; las variables cualitativas se compararon con prueba exacta de Fisher. Resultados: Se estudiaron 23 pacientes, ocho (34 %) con invasión angiolinfática, 14 (60.8 %) con invasión perineural, cinco (21.2 %) con prostatitis y cuatro (17.3 %) con hiperplasia fibroadenomatosa. Se observó expresión de HER2/neu (p = 0.1023), p53 (p = 1) y BCL2 (p = 0.4136). Conclusión: Se identificó mayor expresión de HER2/neu en la neoplasia intraepitelial prostática de alto grado y el adenocarcinoma acinar de próstata.

Abstract Background: Prostate carcinoma is the second leading cause of cancer and the fifth cause of cancer death in men worldwide. Objective: To know high-grade prostatic intraepithelial neoplasia and prostate acinar adenocarcinoma immunohistochemical profiles. Material and methods: Observational, analytical, cross-sectional, retrospective study of specimens obtained by cutting needle biopsy and prostate resection from subjects diagnosed with acinar adenocarcinoma of the prostate and high-grade prostatic intraepithelial neoplasia between January 2015 and December 2020. Tissue microarrays were performed and, subsequently, immunohistochemical studies for BCL2, EGFR, p53, Her2/neu and Ki67. Descriptive statistics were used to analyze clinicopathological factors. Qualitative variables were compared with Fisher's exact test. Results: Twenty-three patients were studied; eight (34%) with angiolymphatic invasion, 14 (60.8%) with perineural invasion, five (21.2%) with prostatitis, and four (17.3%) with fibroadenomatous hyperplasia. HER2/neu (p = 0.1023), p53 (p = 1) and BCL2 expression (p = 0.4136) was observed. Conclusion: HER2/neu increased expression was identified in high-grade prostatic intraepithelial neoplasia and acinar adenocarcinoma of the prostate.

Effect of Bhandira (Clerodendrum Viscosum) in Cervical Intraepithelial Neoplasia

Cervical Intraepithelial Neoplasia is precursor or pre-invasive lesions of cervical squamous cell cancers. These are classified based on the degree of disruption in epithelial differentiation. Sexually transmitted HPV are the most important risk factor for CIN and Invasive cervical cancers. A pre-post interventional study was conducted in Govt. Ayurveda College Hospital for Women and Children, Poojappura, Thiruvananthapuram, to assess the effect of Bhandira in CIN. Objectives were, to evaluate the effect of Bhandira churna pancake and Bhandira churna yoni pratisarana on CIN, and also to study its effect on HPV infection and associated complaints like discharge per vaginum, vulval itching, burning sensation, lower abdominal pain and dyspareunia. Females of age group 20-50 years with CIN, confirmed by Pap smear and Colposcopy were included. The patients received treatment with Bhandira churna pancake internally and Bhandira churna as Yoni pratisarana for 3 months and follow up was done after 3 months. Outcome variables were changes in Pap smear and Colposcopy findings- regression, persistence or progression and changes in associated symptoms. Data were analyzed by Wilcoxon’s signed rank test and McNemar’s test. The treatment was effective with high statistical significance in making changes in Pap smear and Colposcopy findings (p<0.01) and also in reducing the associated symptoms.

Prevalence of HPV infection and cervical intraepithelial lesions in HIV positive and negative women in the city of Florianopolis / Prevalência da infecção pelo HPV e lesões intraepiteliais cervicais em mulheres HIV positivas e negativas na cidade de Florianópolis

Introduction: HPV infection is the most frequent sexually transmitted infection in women. The high oncogenic risk HPV, associated with others factors, there are a risk of progressing to a precancerous lesion of the cervix and even cancer. This evolution is related to the persistence of the infection and other factors, mainly those that interfere with the woman's immunity. The immunosuppression caused by HIV infection is an important factor for viral persistence and the appearance of these lesions. Objectives: To compare the prevalence of HPV infection and cervical intraepithelial lesions in HIV-positive and negative women and describe the possible associated risk factors. Methods: The sample consisted of 50 HIV positive women (study group) and 50 HIV negative women (control group) recruited from the public health system of Florianópolis during the months of January to April 2022. Cervical samples were collected for cytological analysis and for detection of high-risk oncogenic HPV DNA by polymerase chain reaction (PCR). Categorical variables were compared using the chi-square test, with a significance level set at 5% Results: HPV infection was more prevalent in the control group, however, HIV positive women had a higher frequency of intraepithelial lesions diagnosed on cytology. Factors such as greater number of sexual partners, depression and smoking were more frequent in the group of HIV positive women. The number of CD4 T cells less than 200 cels/mm3 was associated with a higher number of altered Pap smears and a positive HPV DNA test. The use of combination antiretroviral therapy and undetectable viral load were associated with a greater number of normal cytology and undetected HPV DNA. Conclusion: The prevalence of cervical intraepithelial lesions in HIV-infected women is higher than in women without infection. The presence of HIV infection was the most important risk factor associated with the development of cervical lesions. (AU)

Introdução: O Papilomavírus Humano (HPV) é a infecção de transmissão sexual mais frequente na mulher. O HPV de alto risco oncogênico, associado a outros fatores, apresenta risco de evoluir para uma lesão pré-cancerosa do colo de útero e até mesmo para o câncer. Essa evolução está relacionada à persistência da infecção e outros fatores, principalmente os que interferem na imunidade da mulher. A imunossupressão causada pela infecção HIV é um fator importante para a persistência viral e o aparecimento destas lesões. Objetivos: Comparar a prevalência da infecção pelo HPV e das lesões intraepiteliais do colo de útero em mulheres HIV positivas e negativas, e descrever os possíveis fatores de risco associados. Métodos: A amostra foi composta por 50 mulheres HIV positivas (grupo de estudo) e 50 mulheres HIV negativas (grupo controle) recrutadas no sistema público de saúde de Florianópolis durante os meses de janeiro a abril de 2022. Foram coletadas amostras cervicais para análise citológica e para detecção do DNA HPV de alto risco oncogênico por reação em cadeia da polimerase (PCR). As variáveis categóricas foram comparadas pelo teste qui-quadrado, com nível de significância estabelecido em 5%. Resultados: A infecção pelo HPV foi mais prevalente no grupo controle, entretanto, as mulheres HIV positivas tiveram uma maior frequência de lesões intraepiteliais diagnosticadas na citologia. Os fatores como maior número de parceiros sexuais, depressão e tabagismo foram mais frequentes no grupo de mulheres HIV positivas. O número de células TCD4 inferior a 200 células/mm3 esteve associado a maior número de colpocitologias alteradas e teste DNA HPV positivo. O uso da terapia antirretroviral combinada e a carga viral indetectável estiveram associadas a um número elevado de citologias normais e DNA HPV não detectado. Conclusão: A prevalência de lesões intraepiteliais do colo do útero em mulheres infectadas pelo HIV foi maior que em mulheres soronegativas. A presença de infecção pelo HIV foi o fator de risco mais importante associado ao desenvolvimento de lesões cervicais.Palavras-chave: HPV. HIV. coinfecção. lesões intraepiteliais escamosas cervicais. prevalência.. (AU)

Accuracy of visual inspection, cytology and colposcopy in the diagnosis of high-grade cervical intraepithelial neoplasia / Acurácia da inspeção visual, citologia e colposcopia no diagnóstico da neoplasia intraepitelial cervical de alto grau

Cervical cancer is still one of the leading causes of cancer and mortality in women, especially in low- and middle-income countries. Normally, the prevention of its occurrence is done through efficient screening and treatment programs for high-grade epithelial lesions, which are pre-malignant lesions. Cheaper diagnostic techniques ensure greater access to women, which can prevent a large number of cancer cases worldwide. Objective: The aim of the study was to evaluate the accuracy of visual inspection either with acetic acid or with Lugol's iodine, cervical cytology and colposcopy in the diagnosis of cervical intraepithelial neoplasia 2 and 3. Methods: This is a study of diagnostic accuracy. We evaluated 115 women with high-grade squamous intraepithelial lesion confirmed by biopsy, 54 with cervical intraepithelial neoplasia 2 and 61 with cervical intraepithelial neoplasia 3, from January 2016 to December 2018 at the Lower Genital Tract Pathology and Colposcopy Service of the Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil. A comparative analysis of the visual inspection, Pap smear and colposcopy diagnostic methods was performed. Results: The average age was 33.1 years (standard deviation=9.83) for cervical intraepithelial neoplasia 2 cases and 35.2 years (standard deviation=7.97) for cervical intraepithelial neoplasia 3. In the cervical intraepithelial neoplasia 2 group, visual inspection tests were positive for high-grade squamous intraepithelial lesion in 98.1% of the cases with acetic acid and 94.4% with Lugol's iodine. Colposcopy identified a probable high-grade squamous intraepithelial lesion in 94.4% of the cases, while cytology only in 42.6%. In the cervical intraepithelial neoplasia 3 group, the visual inspection tests were positive for high-grade squamous intraepithelial lesion in 91.8% of the cases with acetic acid and 95.1% with Lugol's iodine. Colposcopy identified a probable high-grade squamous intraepithelial lesion in 93.5% of the cases, while cytology in 65.6%. Conclusion: Visual inspection with acetic acid and Lugol's iodine, and colposcopy test were more accurate for the diagnosis of cervical intraepithelial neoplasia 2 and 3 than through cytopathology. (AU)

Introdução: O câncer do colo de útero ainda é uma das principais causas de câncer e mortalidade em mulheres, especialmente em países de baixa e média renda. Normalmente, a prevenção de sua ocorrência é feita por meio de programas eficientes de triagem e tratamento de lesões epiteliais de alto grau, que são as lesões pré-malignas. Técnicas diagnósticas mais baratas garantem maior acesso às mulheres, podendo evitar um grande número de casos de câncer no mundo inteiro. Objetivo: O objetivo deste estudo foi avaliar a acurácia da inspeção visual (com ácido acético e com solução de lugol), da citologia cervical e da colposcopia no diagnóstico de neoplasias intraepiteliais cervicais 2/3. Métodos: Trata-se de um estudo de acurácia diagnóstica. Foram avaliadas 115 mulheres com lesão intraepitelial escamosa de alto grau confirmada por biópsia, 54 com neoplasias intraepiteliais cervicais 2 e 61 com neoplasias intraepiteliais cervicais 3, no período de janeiro de 2016 a dezembro de 2018 no Serviço de Patologia e Colposcopia do Trato Genital Inferior do Hospital de Clínicas de Porto Alegre, em Porto Alegre, Brasil. Foi realizada análise comparativa dos métodos de diagnóstico Inspeção visual com ácido acético, Inspeção visual com Solução de Lugol, colpocitologia oncótica e colposcopia. Resultados: A média de idade foi de 33,11 anos (DP 9,83) para os casos de neoplasias intraepiteliais cervicais 2 e de 35,28 anos (DP 7,97) para neoplasias intraepiteliais cervicais 3. No grupo de neoplasias intraepiteliais cervicais 2, os testes de inspeção visual foram positivos para tratamento de lesões epiteliais de alto grau em 98,1% dos casos com Inspeção visual com ácido acético e em 94,4% daqueles com Inspeção visual com Solução de Lugol. A colposcopia identificou provável tratamento de lesões epiteliais de alto grau em 94,4% dos casos, enquanto a citologia apenas 42,6%. No grupo neoplasias intraepiteliais cervicais 3, os testes de inspeção visual foram positivos para tratamento de lesões epiteliais de alto grau em 91,8% dos casos com Inspeção visual com ácido acético e em 95,1% daqueles com Inspeção visual com Solução de Lugol. A colposcopia identificou provável tratamento de lesões epiteliais de alto grau em 93,5% dos casos, enquanto a citologia em 65,6%. Conclusão: A inspeção visual (com ácido acético e com Solução de Lugol) e a colposcopia foram mais precisas para o diagnóstico de neoplasias intraepiteliais cervicais 2/3 do que a citopatologia. (AU)

Expressions of peripheral blood lymphocytes in high-grade squamous intraepithelial lesions of the cervix and early cervical cancer and their significances / 肿瘤研究与临床

Objective:To investigate the expression levels of peripheral blood lymphocytes in patients with high-grade squamous intraepithelial lesions (HSIL) of the cervix and early cervical cancer, and to analyze their correlation with the clinicopathological characteristics of cervical cancer.Methods:The clinical data of 65 patients with HSIL and 78 patients with early cervical cancer (2018 International Federation of Gynecology and Obstetrics stage ≤ stage Ⅱ A) treated in Shanxi Province Cancer Hospital from October 2020 to November 2021 were retrospectively analyzed, and 31 healthy people undergoing physical examination during the same period were treated as the healthy control group. The expressions of CD3 + T cells, CD4 + T cells, CD8 + T cells, NK cells, NK/T cells and other immune cells in fasting peripheral blood of the patients were detected by using flow cytometry. Results:The expression levels of CD3 + T cells, CD4 + T cells, CD4 +/CD8 + and NK cells were 71±8, 39±7, 1.5±0.5, 16±7, respectively in HSIL group, and 73±9, 41±9, 1.5±0.6, 16±9, respectively in early cervical cancer group, which were lower than those in the healthy control group (76±9, 45±10, 2.0±1.3, 20±7) (all P < 0.05). The expression levels of CD8 + T cells was 28±7, 29±8, respectively in HSIL group and early cervical cancer group, which were higher than those in the healthy control group (24±7) (all P < 0.05). The expression level of total B cells in early cervical cancer group was lower than that in healthy control group (10±4 vs.12±3, P < 0.05). The expression level of CD3 + T cells in peripheral blood of early cervical cancer patients with tumor diameter >4 cm and nerve/vascular invasion was 71±10 and 72±8, which was lower than that of patients with tumor diameter 2-4 cm, ≤2 cm and without nerve/vascular invasion (72±8, 75±8, 78±7); the expression level of CD8 + T cell was 32±8 and 35±4, which was higher than that of patients with tumor diameter 2-4 cm, ≤2 cm, and without nerve/vascular invasion (28±8, 28±7, 29±8) (all P < 0.05). The levels of CD3 + T cells and total B cells were negatively correlated with the tumor diameter (all P < 0.05), while the level of CD8 + T cells was positively correlated with tumor diameter ( P < 0.05); the levels of CD3 + T cells and NK cells were negatively correlated with nerve/vascular invasion (all P < 0.05). Conclusions:The immune function of the body starts to change in the early progression of cervical cancer, and is related to the tumor diameter and nerve/vascular invasion of cervical cancer.

T helper cell and regulatory T-cell related cytokines changes in vaginal lavage fluid of patients with high risk-human papilloma virus 16 positive and the predictive effect on the development of cervical neoplasms / 肿瘤研究与临床

Objective:To investigate the changes of T helper cell (Th), regulatory T-cell (Treg cell) related cytokines in vaginal lavage fluid of patients with high risk-human papilloma virus 16 (HR-HPV16) positive and its predictive effect on the development of cervical neoplasms.Methods:A total of 200 cases of HR-HPV16 positive patients who admitted to Xingtai People's Hospital from January 2022 to December 2022 were selected as the experimental group. According to the results of pathological examination, all patients in the experimental group were divided into non pathological group (78 cases), low grade squamous intraepithelial lesion (LSIL) group (49 cases), high grade squamous intraepithelial lesion (HSIL) group (39 cases) and cervical cancer group (34 cases); and 100 healthy people undergoing the physical examination in the same period were taken as the healthy control group. Enzyme-linked immunosorbent assay (ELISA) double-antibody sandwich method was used to detect the levels of interleukin (IL)-2, IL-4, IL-6, IL-10, IL-12, IL-17, tumor necrosis factor α (TNF-α), interferon γ (IFN-γ) and transforming growth factor β (TGF-β) in vaginal lavage fluid of patients in different groups. Multivariate logistics regression was used to analyze the risk factors of cervical cancer, and a nomogram model was established. The receiver operating characteristics (ROC) curve was drawn with pathological results as the gold standard, and the area under the curve (AUC) was calculated to evaluate the predictive ability of the nomogram model.Results:The levels of IL-6, IL-10, IL-17, TNF-α, TGF-β in vaginal lavage fluid of patients in the experimental group were higher than those in the healthy control group, while the levels of IL-2, IL-12 and IFN-γ in the experimental group were lower than those in the healthy control group, and the differences were statistically significant (all P < 0.05); the difference in IL-4 level of both groups was not statistically significant ( P > 0.05). There were statistically significant differences in IL-6, IL-10, IL-17, TNF-α, TGF-β, IL-2, IL-12 and IFN-γ among non pathological group, LSIL group, HSIL group and cervical cancer group (all P < 0.05); the levels of IL-6, IL-10, IL-17, TNF-α, TGF-β in cervical cancer group were the highest, the levels of IL-2, IL-12 and IFN-γ were the lowest; the level of IL-4 in non pathological group, LSIL group, HSIL group and cervical cancer group had no statistically significant difference ( P > 0.05). Logistics regression analysis showed that low IL-2, high IL-4, high IL-6, high IL-10, low IL-12, high IL-17, high TNF-α, low IFN- γ and low TGF-β expressions in vaginal lavage fluid of patients with HR-HPV16 positive were independent risk factors for the development of cervical cancer (all P < 0.05). The results of nomogram analysis showed that IL-6, IL-10, IL-17, TNF-α, TGF-β in vaginal lavage fluid were the factors predicting the development of cervical cancer in HR-HPV16 positive patients. The ROC curve analysis showed that the AUC of nomogram model in predicting the development of cervical cancer in HR-HPV16 positive patients was 0.945 (95% CI 0.901-0.988), and the predictive efficacy was good. Conclusions:Th and Treg cell related cytokines levels in vaginal lavage fluid of patients with HR-HPV16 positive show pathological changes in cervical cancer patients and the above indicators have a high value in predicting the development of cervical cancer.

The trend and challenge of DNA methylation clinical application in cervical cancer / 中华检验医学杂志

According to the current cervical cancer screening strategy and the World Health Orgnization cervical cancer diagnosis/screening guidelines, gene methylation will be included in the new guidelines in the future. However, the value of detecting DNA methylation at specific sites in the clinical specimens during the cervical cancer treatment remains to be discussed. This article summarised the role of DNA methylation in the development of cervical cancer and discusses the potential clinical application of methylation detection in the management of high-risk human papillomavirus (hrHPV) positive female patients. It is believed that methylation test can not only be used for the preliminary classification of hrHPV positive female patients, but also for the secondary triage of female patients with slight cytological abnormalities to determine the high risk of cervical intraepithelial neoplasia 3(CIN3) or cancer. It can also be used for the withdrawal test of women in the screening program to support the management of CIN.

Analysis of risk factors for depth of invasion and angiolymphatic invasion for circumferential superficial esophageal squamous cell carcinoma and precancerous lesion / 中华肿瘤杂志

Objective: To analyze clinicopathological features of circumferential superficial esophageal squamous cell carcinoma and precancerous lesions and investigate the risk factors for deep submucosal invasion and angiolymphatic invasion retrospectively. Methods: A total of 116 cases of esophageal squamous epithelial high-grade intraepithelial neoplasia or squamous cell carcinoma diagnosed by gastroscopy, biopsy pathology and endoscopic resection pathology during November 2013 to October 2021 were collected, and their clinicopathological features were analyzed. The independent risk factors of deep submucosal invasion and angiolymphatic invasion were analyzed by logistic regression model. Results: The multivariate logistic regression analysis showed that drinking history (OR=3.090, 95% CI: 1.165-8.200; P<0.05), The AB type of intrapapillary capillary loop (IPCL) (OR=11.215, 95% CI: 3.955-31.797; P<0.05) were the independent risk factors for the depth of invasion. The smoking history (OR=5.824, 95% CI: 1.704-19.899; P<0.05), the presence of avascular area (AVA) (OR=3.393, 95% CI: 1.285-12.072; P<0.05) were the independent factors for the angiolymphatic invasion. Conclusions: The risk of deep submucosal infiltration is greater for circumferential superficial esophageal squamous cell carcinoma patients with drinking history and IPCL type B2-B3 observed by magnifying endoscopy, while the risk of angiolymphatic invasion should be vigilant for circumferential superficial esophageal squamous cell carcinoma patients with smoking history and the presence of AVA observed by magnifying endoscopy. Ultrasound endoscopy combined with narrowband imagingand magnification endoscopy can improve the accuracy of preoperative assessment of the depth of infiltration of superficial squamous cell carcinoma and precancerous lesions and angiolymphaticinvasion in the whole perimeter of the esophagus, and help endoscopists to reasonably grasp the indications for endoscopic treatment.

Detection rate and clinical characteristics of vulvar squamous intraepithelial lesion / 中华妇产科杂志

Objective:To explore the detection rate, clinical characteristics of vulvar squamous intraepithelial lesion (SIL).Methods:Women diagnosed with vulvar high-grade squamous intraepithelial lesions (HSIL) through colposcopy-guided biopsy from January 1, 2018 to August 31, 2022 in Obstetrics and Gynecology Hospital of Fudan University were included in a 1∶1 ratio with patients diagnosed with vulvar low-grade squamous intraepithelial lesions (LSIL) during the same period. Clinical characteristics including human papillomavirus (HPV) infection rate, genotype, cytology result, colposcopy impression, and lesion location were retrospectively analyzed.Results:(1) The proportion of vulvar SIL detected by colposcopy-guided biopsy increased annually from 2018 to 2022, with rates of 1.64% (740/45 057), 2.34% (1 110/47 402), 2.68% (1 108/41 335), 3.26% (1 536/47 078), 3.31% (667/20 155), with an average rate of 2.57% (5 161/201 027). (2) A total of 1 096 cases of vulvar HSIL and 1 096 cases of vulvar LSIL were included. The overall infection rate of HPV was 92.7% (1 993/2 150), with higher infection rate in vulvar HSIL patients than that in vulvar LSIL patients [96.0% (1 012/1 054) vs 89.5% (981/1 096); χ2=33.62, P<0.001]. Among vulvar HSIL patients, the common HPV genotype from high to low were HPV 16 (66.7%), HPV 52 (14.3%), and HPV 58 (10.0%). For vulvar LSIL patients, the most common HPV genotype were respectively HPV 16 (24.9%), HPV 6 (20.1%) and HPV 52 (17.1%). The overall sensitivity rate of cytology was 53.6%, with no significance difference between vulvar LSIL and HSIL groups (54.3% vs 52.9%; χ2=0.40, P=0.526). The accuracy of colposcopy impression for vulvar HSIL was lower than that for vulvar LSIL [40.2% (163/405) vs 81.7% (380/465); χ2=158.72, P<0.001]. About 57.3% (1 257/2 192) of the patients had concomitant cervical and vaginal lesions, with a higher rate in vulvar HSIL group than that in vulvar LSIL group [62.6% (686/1 096) vs 52.1% (571/1 096); χ2=24.67, P<0.001]. Unifocal lesion was the main type, with no significance difference between vulvar LSIL and HSIL groups [81.4% (381/468) vs 82.5% (386/468); χ2=0.18, P=0.671]. The most common lesion locations were the posterior commissure, followed by labia minora, vaginal vestibule, labia majora, perianal and clitoris. Conclusions:The detection rate of vulvar SIL under colposcopy is about 3%, and the infection rate of HPV is 92.7%. Vulvar SIL, especially vulvar HSIL, is likely to cause concomitant cervical and vaginal lesions. The accuracy of colposcopy in diagnosing vulvar HSIL is low. Therefore a comprehensive and careful examination of the vulva is necessary and suspicious vulvar lesions should be undergone colposcopy-guided biopsy for diagnosis.

Treatment topical with silver nanoparticles and Stryphnodendron Adstringens (Mart. ) Coville in cervical lesions: randomized clinical trial / Tratamento tópico com nanopartículas de prata e Stryphnodendron Adstringens (Mart. ) Coville em lesões cervicais: ensaio clínico randomizado / Tratamiento tópico con nanopartículas de plata y Stryphnodendron Adstringens (Mart. ) Coville en lesiones cervicales: ensayo clínico aleatorizado

ABSTRACT Objective: To assess the feasibility of incorporating technology as a new alternative for treating topics on cervical lesions. Method: This is a randomized, double-blind, controlled clinical trial with a prospective design. During the realization of this study, 43 women were included and divided between groups A (ointment without silver nanoparticles n = 23) and B (ointment with silver nanoparticles n = 20) clinically healthy and who used the unified health system. Results: There were no significant differences when comparing before and after the use of ointment for IVA test (p = 0.15), Schiller test (p = 0.15), cellular changes (p = 0.47) and microbiological analysis (p = 0.89) through cytology. After use, no adverse reaction was observed in the sample studied. Conclusion: Based on the results identified in this study, identified that the product is safe and does not promote adverse events. Regarding the effectiveness of the product in uterine cervical lesions, it is necessary to continue the study in phase II. Registro de Ensaios Clínicos Brasileiros: UTN: U1111-1218-2820.

RESUMO Objetivo: Avaliar a viabilidade da incorporação da tecnologia como uma nova alternativa para o tratamento de lesões cervicais. Método: Trata-se de um ensaio clínico randomizado, duplo-cego e controlado com um desenho prospectivo. Durante a realização deste estudo, foram incluídas 43 mulheres, divididas entre os grupos A (pomada sem nanopartículas de prata n = 23) e B (pomada com nanopartículas de prata n = 20), clinicamente saudáveis e usuárias do sistema único de saúde. Resultados: Não houve diferenças significativas na comparação entre antes e depois do uso da pomada para o teste IVA (p = 0,15), teste de Schiller (p = 0,15), alterações celulares (p = 0,47) e análise microbiológica (p = 0,89) por meio de citologia. Após o uso, não foi observada nenhuma reação adversa na amostra estudada. Conclusões: Com base nos resultados identificados neste estudo, identificou-se que o produto é seguro e não promove eventos adversos. Com relação à eficácia do produto em lesões cervicais uterinas, é necessária a continuidade do estudo na fase II. Registro de Ensaios Clínicos Brasileiros: UTN: U1111-1218-2820.

RESUMEN Objetivo: evaluar la viabilidad de la incorporación de la tecnología como una nueva alternativa para el tratamiento de temas sobre lesiones cervicales. Método: Se trata de un ensayo clínico aleatorizado, doble ciego, controlado y con un diseño prospectivo. Durante la realización de este estudio se incluyeron 43 mujeres divididas entre los grupos A (pomada sin nanopartículas de plata n = 23) y B (pomada con nanopartículas de plata n = 20) clínicamente sanas y usuarias del sistema unificado de salud. Resultados: No hubo diferencias significativas al comparar antes y después del uso de la pomada para la prueba de IVA (p = 0,15), la prueba de Schiller (p = 0,15), los cambios celulares (p = 0,47) y el análisis microbiológico (p = 0,89) mediante citología. Tras el uso, no se observó ninguna reacción adversa en la muestra estudiada. Conclusiones: Con base en los resultados identificados en este estudio, se identificó que el producto es seguro y no promueve eventos adversos. Con relación a la eficacia del producto en lesiones cervicales uterinas, es necesario continuar el estudio en fase II. Registro de Estudios Clínicos Brasileños: UTN: U1111-1218-2820.

Risk Profile of High-grade Cervical Lesions and Cervical Cancer Considering the Combination of Cytology, HPV Genotype, and Age among Women Undergoing Colposcopy / Perfil de risco de lesões cervicais de alto grau e câncer cervical considerando a combinação de citologia, genótipo do HPV e idade entre mulheres submetidas a colposcopia

Abstract Objective The present study aims to establish a risk profile for high-grade cervical lesions and cervical cancer (CIN2 + ) in women undergoing colposcopy at the Hospital do Câncer de Barretos, through the analysis of Human Papillomavirus (HPV) infection, cervical cytology, and patient's age. Methods Retrospective cross-sectional study based on a computerized database of women aged ≥ 18 years old who underwent colposcopy at the Prevention Department of the Hospital do Câncer de Barretos from 2017 to 2019. Results A total of 3,411 women were included, 58.0% were positive for high-risk-HPV test, with a higher prevalence of CIN2+ for HPV16 (30.3%) and other HPV (45.0%). Cytological findings that suggest invasive cervical cancer (squamous cells or adenocarcinoma), regardless of the status of HPV test, showed 100% diagnosis of CIN2 + , while atypias that suggest high-grade lesions, HSIL and ASC-H, positive for HPV test, showed in 86 and 55.2%, respectively, diagnosis of CIN2 + . ASC-H cytological results among women aged > 40 years old and negative HPV were mainly associated with benign findings. We observed that ≤ CIN1 has a higher prevalence among older women with negative HPV, while for high-grade lesions there is an increase among young women HPV16- and/or 18-positive. In cancer diagnosis, we observed a predominance of HPV 16/18 regardless of the age group. Conclusion The highest risks of precursor lesions and cervical cancer were found among women with positive HPV 16/18 tests and severe cytological atypia in population screening tests. In addition, cytological findings of ASC-H HPV negative in women > 40 years old usually represent benign findings in histological investigation.

Resumo Objetivo Estabelecer um perfil de risco de lesões intraepiteliais de alto grau e câncer do colo do útero (NIC2 + ) em mulheres submetidas a colposcopia considerando-se a infecção pelo papilomavírus humano (HPV), citologia cervical e idade. Métodos Estudo retrospectivo transversal em banco de dados informatizado de mulheres com idade ≥ 18 anos que realizaram colposcopia no departamento de Prevenção de Câncer no Hospital do Câncer de Barretos/SP no período de 2017 a 2019. Resultados Foram incluídas 3.411 mulheres, sendo 58,0% positivas para HPV de alto risco, e maior prevalência de NIC2+ para HPV16 (30,3%) e outros HPV (45,0%). Resultados citológicos sugestivos de lesões invasivas (epidermoide ou adenocarcinoma), independente do teste de HPV, apresentaram 100% de diagnóstico NIC2 + , enquanto atipias sugestivas de lesões de alto grau, HSIL e ASC-H, associados a HPV positivo, apresentaram 86 e 55,2%, respectivamente. Resultados citológicos de ASC-H entre mulheres > 40 anos e HPV negativo foram associados principalmente a achados benignos. Observamos que ≤ NIC1 apresenta uma maior prevalência entre mulheres mais velhas com HPV negativo, enquanto para lesões de alto grau, há um aumento entre mulheres mais jovens positivas para HPV16/18. Para diagnóstico de câncer, observamos que há um predomínio de HPV16/18 independente da faixa etária. Conclusão Foi identificado maior risco de lesões precursoras e câncer entre mulheres com HPV 16/18 positivo e atipias citológicas graves em testes de rastreio populacional. Além disso, resultados citológicos de ASC-H quando associados a HPV negativo com idade > 40 anos habitualmente representam achados benignos em investigação histológica.

Small cell neuroendocrine carcinoma with adenocarcinoma and high grade squamous intraepithelial neoplasia of the cervix

ABSTRACT Neuroendocrine neoplasm (NEN) of the cervix is a malignant tumor and is classified into low and intermediate-grade neuroendocrine tumor (NET), and high-grade small cell neuroendocrine carcinoma (SCNEC), and large cells neuroendocrine carcinoma (LCNEC). SCNEC of the cervix is an Infrequent tumor with an incidence of less than 1% of all gynecological malignancies. It is characterized by small to medium-sized tumor cells with scant cytoplasm and neuroendocrine differentiation. Most cases of SCNEC of the cervix manifest in pure forms, and only cases show coexisting, non-neuroendocrine component of HPV-associated adenocarcinoma or squamous cell carcinoma. In this report, reviewing the literature, we present one such unique case of SCNEC of the cervix with adenocarcinoma and high-grade squamous intraepithelial neoplasia.

Pólipo endometrial metaplásico: hallazgo histeroscópico de enfermedad premaligna en mujeres jóvenes. Reporte de tres casos / Endometrial metaplastic polyps: findings of premalignant disease on histeroscopy in young women, a report of 3 cases

ANTECEDENTES: Los pólipos endometriales son sobrecrecimientos de la mucosa endometrial, una de las causas más comunes de hemorragia uterina anormal, pueden estar asociados con lesiones premalignas y malignas del endometrio. Existen características histeroscópicas que ayudan a diferenciar una lesión benigna o maligna. El pólipo metaplásico es un hallazgo histeroscópico caracterizado por superficies laminares e hiperqueratosis, con zonas blancas e hiperrefringentes. CASOS CLÍNICOS: Tres casos clínicos de pacientes menores de 40 años, con hemorragia uterina anormal donde el hallazgo histeroscópico común fue el pólipo metaplásico, hallazgo premaligno que se confirmó mediante el análisis patológico y la positividad del marcador de inmunohistoquímica p63. Caso 1. Paciente de 28 años, nulípara, obesa, con antecedente de síndrome de ovario poliquístico, con engrosamiento endometrial e histeroscopia, con pólipo con superficie hiperqueratósica, a manera de láminas irregulares, con excrecencias y lesiones exofíticas. Caso 2. Paciente de 25 años, con endometrio irregular engrosado e histeroscopia con hallazgo de pólipos transparentes, con cambios vasculares leves y superficie con zonas hiperrefringentes blanquecinas. Caso 3. Paciente de 38 años, con antecedente de síndrome de ovario poliquístico y obesidad. En la histeroscopia el endometrio se encontró hiperplásico, irregular, con cambios vasculares y pólipos con zonas superficiales hiperrefringentes, sólidas y blancas. CONCLUSIONES: En pacientes jóvenes, con hallazgo histeroscópico de pólipo metaplásico debe considerarse y descartar la enfermedad premaligna y maligna endometrial. El estudio debe completarse con marcadores de inmunohistoquímica (p63), específicos de la metaplasia escamosa.

Abstract BACKGROUND: Endometrial polyps are overgrowths of the endometrial mucosa, one of the most common causes of abnormal uterine bleeding and may be associated with premalignant and malignant endometrial lesions. There are hysteroscopic features that help differentiate a benign or malignant lesion. Metaplastic polyp is a hysteroscopic finding characterized by lamellar surfaces and hyperkeratosis, with white and hyperreflective areas. CLINICAL CASES: Three clinical cases of patients under 40 years of age, with abnormal uterine bleeding where the common hysteroscopic finding was metaplastic polyp, a premalignant finding that was confirmed by pathological analysis and positivity of the immunohistochemistry marker p63. Case 1. 28-year-old female, nulliparous, obese, with a history of polycystic ovary syndrome, with endometrial thickening and hysteroscopy, with polyp with hyperkeratotic surface, in the form of irregular sheets, with excrescences and exophytic lesions. Case 2. 25-year-old patient, with irregular thickened endometrium and hysteroscopy with finding of transparent polyps, with mild vascular changes and surface with whitish hyperrefringent areas. Case 3. 38-year-old patient with a history of polycystic ovary syndrome and obesity. At hysteroscopy the endometrium was found to be irregularly hyperplastic, with vascular changes and polyps with hyper-refringent, solid, white superficial areas. CONCLUSIONS: In young patients, with hysteroscopic finding of metaplastic polyp should be considered and premalignant and malignant endometrial disease should be ruled out. The study should be completed with immunohistochemical markers (p63), specific for squamous metaplasia.

Detection of HPV DNA in vaginal samples self-collected by women living with HIV treated through the Brazilian public health system: Prevalence and analysis of risk factors

ABSTRACT Background: Women living with human immunodeficiency virus (HIV) (WLWH) are more likely to be infected with the oncogenic human papillomavirus (HPV). We assessed the prevalence of high-risk (HR) (16/18/31/33/35/39/45/51/52/56/58/59/68/73/82), probable high-risk (pHR) (26/53/66), and low-risk (LR) (6/11/40/42/43/44/54/61/70) HPV types and their associated risk factors. Methods: This cross-sectional study of WLWH aged 18-64 years included one laboratory and eight HIV-specialty healthcare facilities in the pilot network. Descriptive statistics were used to assess sociodemographic and behavioral characteristics. Adjusted analyses were conducted to evaluate risk factors associated with HR and/or pHR HPV infection in WLWH. Results: From May/2021 to May/2022, 1,914 (92.5%) WLWH participated in the pilot study and had valid HPV-DNA results of self-collected vaginal samples. The median age of the participants was 45 years, 60.1% had ≥ 9 years of schooling, 80.5% were ≤ 18 years at first sexual intercourse, and 51.7% had > 4 sexual partners throughout life. The prevalence of any HPV type, HR HPV, pHR HPV, and LR HPV was 65.8%, 49.6%, 16.7%, and 40.0%, respectively. Age was inversely associated with pHR and/or HR-HPV (p < 0.001), and education level was inversely associated with HR-HPV (p = 0.003) types. Any HR or pHR was associated with being single (p = 0.029) and exchanging sex for drugs (p = 0.037). Conclusions: The prevalence of HPV, especially HR HPV, among WLWH is high in Brazil, highlighting the need for HPV screening in this population. Self-collection of vaginal samples is an important strategy for increasing testing access.

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.

Tamizaje con citología anal en mujeres con lesiones premalignas del cuello uterino / Anal cytology screening in women with premalignant lesions of the uterine cervix / Rastreamento de citologia anal em mulheres com lesões pré-malignas do colo do útero

Objetivo: nuestro objetivo principal fue evaluar la prevalencia de citología anal patológica en mujeres con antecedentes de neoplasia intraepitelial cervical. Métodos: se trata de un estudio de cohorte transversal desde mayo de 2018 a agosto de 2020 en el Centro Hospitalario Pereira Rossell. Se estudiaron dos cohortes: una de mujeres que tenían diagnóstico de neoplasia intraepitelial cervical y otra de control de mujeres sanas que asistieron al control, con una proporción de 2:1. Se calculó un tamaño muestral total de 205 pacientes, siendo 135 pacientes con NIC con un IC del 95%, suponiendo una prevalencia del 10% de lesiones preneoplásicas anales. El tamaño muestral de la cohorte control fue de 70 pacientes según la relación preestablecida. Resultados: se encontró asociación entre la presencia de lesiones premalignas cervicales y anomalías epiteliales detectadas en la citología anal, con un cociente de prevalencia de 1,77 (IC del 95%: 1,19-2,62) y un odds ratio de 2,69 (1,36-5,30). No se encontraron diferencias significativas en las variables de raza, tipo de relación sexual o tabaquismo. Conclusiones: nuestro estudio concluye que existe una asociación entre la neoplasia intraepitelial cervical relacionada con el VPH y la citología anal patológica.

Objective: the main objective of the study was to assess the prevalence of anal cytology in women with a history of cervical intraepithelial neoplasia. Method: cohort transversal study conducted from May, 2018 until August, 2020 at Pereira Rossell Hospital. Two cohorts were studied, one of which included women with a diagnosis of cervical intraepithelial neoplasia and the other one included healthy women who attended their routine follow up, in a 2:1 ratio. The total size of the sample was 205 patients, 135 of which were patients with cervical intraepithelial neoplasia (confidence interval being 95%), presuming a 10% prevalence of anal pre-neoplasic lesions. The sample size of the control cohort was 70 patients as per the pre-defined ratio. Results: a association was found between the presence of malignant lesions of the cervix and epithelial anomalies detected in the anal cytology, with a prevalence coefficient of 1.77 (CI: 95%: 1,19 - 2,62) and odds ratio of 2,69 (1,36 - 5,30). No significant differences were found between race, type of sexual relationships or smoking variables. Conclusions: our study concludes there is an association between cervical intraepithelial neoplasia related to HPV and pathological anal screening.

Objetivo: Avaliar a prevalência de citologia anal patológica em mulheres com história de neoplasia intraepitelial cervical. Métodos: Trata-se de um estudo de coorte transversal de maio de 2018 a agosto de 2020, no Hospital Pereira Rossell. Foram estudadas duas coortes, uma de mulheres com diagnóstico de neoplasia intraepitelial cervical e outra de controle de mulheres saudáveis que compareceram ao controle na proporção de 2:1. Foi calculada uma amostra total de 205 pacientes, 135 pacientes com NIC com um IC de 95%, assumindo uma prevalência de 10% de lesões pré-neoplásicas anais. O tamanho da amostra da coorte controle foi de 70 pacientes de acordo com a relação pré-estabelecida. Resultados: Foi encontrada associação entre a presença de lesões pré-malignas cervicais e anormalidades epiteliais detectadas na citologia anal, com razão de prevalência de 1,77 (IC 95%: 1,19 - 2,62) e odds ratio 2,69 (1,36-5,30). Não foram encontradas diferenças significativas nas variáveis raça, tipo de relação sexual ou tabagismo. Conclusões: Nossos resultados mostram uma associação entre neoplasia intraepitelial cervical relacionada ao HPV e citologia anal patológica.

Concordancia de los hallazgos citológicos, colposcópicos e histológicos en lesiones premalignas del cuello uterino / Concordance in cytological, colposcopic and histological findings in premalignant lesions of the cervix

Resumen OBJETIVO: Determinar la concordancia de los hallazgos citológicos, colposcópicos e histopatológicos en lesiones premalignas del cuello uterino. MATERIALES Y MÉTODOS: Estudio transversal, retrospectivo y comparativo, efectuado en la Clínica de Displasias del Hospital General Regional 1 del estado de Querétaro, México, del 1 de enero a diciembre del 2020, con base en la información de los expedientes de mujeres con reporte citológico, colposcópico e histopatológico (biopsia) de lesión intraepitelial de bajo y alto grado. El plan de análisis estadístico incluyó intervalos de confianza para promedios y porcentajes. Se utilizó el Índice de Kappa ponderado para conocer el nivel de concordancia. RESULTADOS: Se analizaron 290 expedientes. La edad promedio de las pacientes fue 36 años, el índice de kappa ponderado fue k = 0.41 (IC95%: 0.33-0.53) para la citología y la colposcopia con un valor moderado (regular). Para la citología y la biopsia fue de k= 0.33 (IC95%: 0.22-0.49) con un valor escaso (medio). En cuanto a la colposcopia y la biopsia fue de k = 0.61 (IC95%: 0.49-0.72) con un valor de buena (sustancial) concordancia. CONCLUSIÓN: Entre la citología y la colposcopia el coeficiente de concordancia fue moderado, para la citología y la biopsia fue escaso, mientras que para la colposcopia y la biopsia fue un sustancial.

Abstract OBJECTIVE: To determine the concordance in cytologic, colposcopic and histopathologic findings in premalignant lesions of the uterine cervix. MATERIALS AND METHODS: Cross-sectional, retrospective and comparative study, carried out in the dysplasia clinic of the Hospital General Regional 1 of the state of Querétaro, Mexico, from January 1 to December 2020, based on information from the records of women with cytology, colposcopy and histopathology (biopsy) report with low- and high-grade intraepithelial lesion. The statistical analysis plan included confidence intervals for averages and percentages. The weighted Kappa Index was used to determine the level of concordance. RESULTS: Two hundred and ninety records were analyzed. The mean age of the patients was 36 years, the weighted kappa index was k = 0.41 (95%CI: 0.33-0.53) for cytology and colposcopy with a moderate value (fair). For cytology and biopsy, it was k= 0.33 (95%CI: 0.22-0.49) with a poor value (medium). For colposcopy and biopsy, it was k = 0.61 (95%CI: 0.49-0.72) with a value of good (substantial) agreement. CONCLUSION: Between cytology and colposcopy the concordance coefficient was moderate, for cytology and biopsy it was poor, while for colposcopy and biopsy it was a substantial.