Role of the association of high-risk HPV identified by real-time PCR in cervical preneoplastic lesions.

OBJECTIVE: To evaluate the effects of infection in multiple types of high-risk human papilloma virus (HPV) in cervical preneoplastic lesions in patients undergoing colposcopy following a diagnosis of atypical squamous cells of unknown significance (ASCUS) and low-grade squamous intraepithelial (LSIL) cytology. MATERIALS AND METHODS: Between 2009 and 2010, 2,500 patients were recruited with a mean age of 35 +/- 5 years. Screening for cervical cancer was performed and in case of ASCUS and LSIL the patients underwent colposcopy. The tests for the detection and typing of viral DNA (HPV - DNA test) were performed on cervical swab with real-time PCR amplification. RESULTS: The prevalence of infection was 70% (1579/2256) in the patients recruited. In relation to the degree of preneoplastic lesions some high-risk HPV viral genotypes were identified: HPV 16 (319/1466), HPV 18 (164/1466), HPV 45 (76/1466), HPV 31 (215/1466), HPV 52 (145/1466), HPV 58 (55/1466) HPV 56 (79/1466), HPV 51 (110/1466), HPV 6(138/1466), HPV 11 (88/1466), HPV 42 (34/1466), HPV 53 (43/1466). In case of high-grade lesions of CIN (CIN2 and CIN3) a greater HPV co-infection was detected and in particular the association from 16 to 18 (70%), 16-33 (18%) and 16 to 52 (12%). CONCLUSIONS: Infection caused by the simultaneous presence of multiple HPV genotypes appears to be associated with a significantly increased risk of high-grade lesions of CIN or invasive cancer than the presence of single viral infections. The infection with multiple HPV types is a significant risk factor for high-grade lesions of CIN in women undergoing colposcopy for ASCUS cytology/LSIL. The use of real-time PCR has shown the ability not only to identify the different types of HPV, but also to monitor quantitatively the same over time, and during the study phase, to evaluate the sensitivity and specificity of the method in comparison with other techniques.

Ovarian cancer: lymph node metastases.

PURPOSE OF INVESTIGATION: To analyze pelvic and paraaortic lymph node involvement in epithelial ovarian cancer. METHODS: Between 1995 and 2006, 60 patients with FIGO Stages II, III, IV epithelial ovarian cancer underwent surgical treatment, including systematic pelvic and paraaortic lymphadenectomy. RESULTS: Aortic lymph node metastases were documented in 45 (75%) patients and pelvic nodal metastases in 42 (70%). The incidence of paraaortic nodal involvement was 20% (12/60) in the absence of positive pelvic nodes while the incidence of pelvic nodal involvement was 15% (9/60) in the absence of paraaortic disease; both pelvic and paraaortic lymph node involvement occurred in 55% of patients. The most frequent groups for nodal metastases are paracaval (56%), externaliliac (60%), and obturator (55%). CONCLUSION: The rate of nodal involvement is important in ovarian cancer and there is a high prevalence of both pelvic and paraaortic lymph node metastases. For this reason bilateral pelvic and paraaortic lymphadenectomy is necessary for staging and as treatment for micrometastases, also in patients with unilateral tumors.

Performance of alcoholism screening questionnaires in elderly veterans.

PURPOSE: To validate three alcoholism screening questionnaires in elderly male veterans. PATIENTS: Participants were 120 male veterans aged 65 years or older. METHODS: In this cross-sectional study, consecutive patients in the outpatient general medical practice at the Omaha VA Medical Center were interviewed with the alcohol module of the Revised Diagnostic Interview Schedule (DIS-III-R) and three alcoholism screening questionnaires, the Michigan Alcoholism Screening Test-Geriatric Version (MAST-G), the CAGE, and the Alcohol Use Disorders Identification Test (AUDIT). Performance characteristics (sensitivity, specificity, predictive values, likelihood ratios, and areas under the receiver operating curve [ROC]) of the screening questionnaires were determined in comparison with the DIS-III-R. RESULTS: Forty-three participants (36%) met DSM-III-R (Diagnostic and Statistical Manual of Mental Disorders) criteria for alcohol abuse or dependence; 23% were active drinkers and 13% were inactive. Fifty of the 120 (42%) reported abstinence from drinking during the preceding year. A MAST-G score > or = 5 had a sensitivity and specificity of 70% and 81%, respectively. A CAGE score > or = 2 had a sensitivity and specificity of 63% and 82%. Using active drinkers only, an AUDIT score of > or = 8 had a sensitivity and specificity of 33% and 91%. The positive predictive values (PPV) for the MAST-G, CAGE, and AUDIT were 67%, 66%, and 69%, respectively; the negative predictive values were 83%, 80%, and 68%, respectively. Areas under the receiver operating curves for the MAST-G, CAGE, and AUDIT were 0.84 +/- 0.04, 0.77 +/- 0.05, and 0.56 +/- 0.08, respectively. CONCLUSION: The MAST-G and the CAGE outperformed the AUDIT for detecting alcohol abuse and dependence in an elderly male veteran population. The CAGE, requiring only four easily memorized questions to achieve similar accuracy, appears to offer an advantage over the 24-item MAST-G.