A shift to a peripheral Th2-type cytokine pattern during the carcinogenesis of cervical cancer becomes manifest in CIN III lesions.

BACKGROUND: A shifted balance between T helper 1 (Th1)-type and Th2-type cytokines has been hypothesised in cervical dysplasia. AIMS: To evaluate possible deregulation of the cytokine network by estimating the expression of peripheral cytokines in different stages of cervical disease and in relation to the presence or absence of high risk human papillomavirus (HR-HPV). METHODS: Twenty one HR-HPV positive women with high grade cervical intraepithelial neoplasia (CIN II-III) and 12 patients with invasive cervical carcinoma formed the study groups. Two control groups consisted of 10 HR-HPV positive and 11 HR-HPV negative women without CIN. Differences in leucocyte subgroups were evaluated by a differential leucocyte count. Plasma concentrations of tumour necrosis factor alpha (TNFalpha), TNFalpha receptors TNFRI and TNFRII, interferon gamma (IFNgamma), interleukin 2 (IL-2), IL-12, IL-4, and IL-10 were determined by enzyme linked immunosorbent assays. RESULTS: Leucocyte counts in patients with CIN III and carcinoma were significantly higher than in controls. Plasma IFNgamma concentrations were significantly lower in patients with CIN III and carcinoma than in women with CIN II or controls. Plasma concentrations of IL-12, IL-2, IL-4, and TNFalpha did not differ significantly between groups, but significantly lower plasma concentrations of TNFRII were found in CIN III and carcinoma compared with CIN II. IL-10 was detected with increased frequency in the plasma of patients with CIN III and carcinoma. CONCLUSIONS: These results indicate that a shift to a Th2-type cytokine pattern during the carcinogenesis of cervical cancer occurs in women with CIN III lesions.

HPV testing and monitoring of women after treatment of CIN 3: review of the literature and meta-analysis.

According to the current guidelines in most western countries, women treated for cervical intraepithelial neoplasia grade 3 (CIN 3) are followed for at least 2 years after treatment by cytology.High-risk human papillomavirus (hrHPV) infections are necessary for the development and maintenance of CIN 3. HrHPV testing could be used to improve monitoring of women treated for CIN 3. This has prompted numerous studies for the implementation of hrHPV testing in monitoring of women treated for CIN 3. Included in this review are 20 studies, published between 1996 and 2003, comparing hrHPV testing with either resection margins or cervical cytology to predict recurrent/residual disease, and 11 of them could be used in a meta-analysis. In the meta-analysis of the 11 studies, the negative predictive value (NPV) for recurrent/residual disease of hrHPV testing was 98% (95% CI 97-99%), that of resection margins 91% (95% CI 87-94%), and that of cervical cytology 93% (95% CI 90-95%). When hrHPV testing was performed in conjunction with cytology, the sensitivity was 96% (95% CI 89-99%), specificity was 81% (95% CI 77-84%), the associated positive predictive value (PPV) was 46% (95% CI 38-54%), and the NPV was 99% (95% CI 98-100%). Combined hrHPV and cytology testing yielded the best test characteristics. We propose to include hrHPV testing in conjunction with cytology for monitoring women treated for CIN 3. Some follow-up visits for women testing negative for both hrHPV and cytology can be skipped. In western countries, this could mean that for women double negative at 6 months, retesting at 12 months should be skipped while keeping the 24-month follow-up visit.

[Follow up after an abnormal pap smear: time interval acceptable, nature of follow up leaves room for improvement]. / Vervolgonderzoek na een afwijkend uitstrijkje: tijdsinterval acceptabel, aard van het vervolgonderzoek vaak niet.

OBJECTIVE: To investigate whether the interval between an abnormal Pap smear and follow-up is too long and whether the guidelines for histological follow-up after an abnormal Pap smear are being followed. DESIGN: Descriptive. METHOD: Data on all Pap smears of a minimum Pap class 3a (moderate dysplasia) from the national cervical-cancer screening programme in the Rotterdam area of the Netherlands were acquired from the Pathological Anatomical National Automated Archive (PALGA). The test results from each woman were arranged chronologically and the nature of the follow-up cervical examinations (cytological and histological) was recorded. The observation period was 360 days. The average interval in days between Pap smear and follow-up as well as the nature of the follow-up were analysed. RESULTS: In total, data on 156 women were analysed. In 93% of women follow-up was done during our observation period. The average interval was 60 days. In 80% of the women follow-up took place within 3 months and in 90% within 6 months. In 32% of women in the follow-up group the Pap smear was repeated at their first follow-up visit and in the remaining cases, a histological examination was performed according to the guidelines. In 7% of cases no cytological or histological follow-up at all took place within the year. CONCLUSION: The average interval between an abnormal Pap smear and follow-up is acceptable because of the slow natural course of cervical carcinoma. Attention should be focused on the incorrect repetition of the cytological test and on the fact that in a number of cases no follow-up at all is done within 1 year.

[Diagnostic image (142). A woman with persistent dyspareunia and vaginal discharge. Vaginal adenosis]. / Diagnose in beeld (142). Een vrouw met persisterende dyspareunie en fluor. Vaginale adenose.

In a 30-year-old woman with persistent dyspareunia and vaginal discharge additional investigations revealed a vaginal adenosis.