Papillomavirus research update: highlights of the Barcelona HPV 2000 international papillomavirus conference.

The 18th international papillomavirus conference took place in Barcelona, Spain in July 2000. The HPV clinical workshop was jointly organised with the annual meeting of the Spanish Association of Cervical Pathology and Colposcopy. The conference included 615 abstracts describing ongoing research in epidemiology, diagnosis/screening, treatment/prognosis, immunology/human immunodeficiency virus, vaccine development/trials, transformation/progression, replication, transcription/translation, viral protein functions, and viral and host interactions. This leader summarises the highlights presented at the conference (the full text of the abstracts and lectures can be found at www.hpv2000.com). Relevant material in Spanish can be found at www.aepcc.org.

Treatment of cervical intraepithelial neoplasia in a prospective study comparing large-loop excision of the transformation zone, laser vaporization, and knife cone biopsy.

OBJECTIVE: Our aim was to compare cervical intraepithelial neoplasia (CIN) treatment results in the use of large-loop excision of the transformation zone (LLETZ), laser vaporization, and cold-knife cone biopsy. MATERIALS AND METHODS: We included in the study patients with CIN lesions diagnosed at the Hospital Universitario Materno-Infantil Vall d'Hebron and Hospital Clinic i Provincial de Barcelona, Barcelona, Spain, between March 1991 and March 1994. Patients with unsatisfactory colposcopy were excluded from the study. One hundred twenty-three patients were included in this study: 98 patients were compared for LLETZ treatment versus laser vaporization, and 69 CIN3 patients were compared for three treatments: LLETZ, laser vaporization, and knife cone biopsy. Patients were followed at 3-month intervals for at least 1 year. Follow-up included physical examination, cervical Papanicolaou (Pap) smear, cervical colposcopy, and a colposcopically guided biopsy when required. Treatment failure (persistence or recurrence) was defined by the presence of CIN confirmed histologically by a colposcopically guided biopsy. RESULTS: The mean age of patients was 34.1 years. The agreement between histology from the colposcopically guided biopsy and the surgical specimen was 60%, and the kappa coefficient was 40.7% (moderate agreement). Three cases of microinvasive carcinoma were diagnosed in patients whose initial diagnosis was CIN3 on colpobiopsy (4% of invasion in the initial CIN3 group of patients). In a comparison of LLETZ with laser treatment for all CIN grades, the unique independent prognostic factor for persistence-recurrence of the disease was the colposcopic size of the primary lesion (relative risk, 4.9; Cl, 1.33-18.45). CONCLUSIONS: We conclude that the LLETZ procedure for CIN treatment demonstrates an advantage over destructive methods for detection of occult microinvasive and invasive cancer. This process is a simple outpatient technique with the same failure as that of laser vaporization in all CIN grades. In the treatment of CIN3, cold-knife cone biopsy had better cure rates. Close follow-up is required in these patients, because of their risk of developing recurrent CIN or invasive carcinoma.

[The detection of papillomavirus by in situ hybridization. Clinico-pathological and virological correlation in patients with squamous intraepithelial lesions of the uterine cervix]. / Determinación del papiloma virus mediante hibridación in situ. Correlación clinicopatológica y virológica en pacientes con lesiones escamosas intraepiteliales del cérvix uterino.

BACKGROUND: Clinical usefulness of human papillomavirus (HPV) detection by molecular techniques is not well established. The aim of the study is to determine, by in situ hybridization, HPV DNA in patients with cervical intraepithelial neoplasia (CIN), assessing the prevalence rate, the association with epidemiologic factors and the correlation with classic diagnostic procedures (cytology, colposcopy and histology). PATIENTS AND METHODS: Among 138 patients diagnosed with CIN, HPV was determined in 75 treated by excisional procedures. All cases underwent pap-smear, colposcopy, and colposcopically directed biopsy. RESULTS: Histologic diagnosis was as follows: 1 cervical condyloma (1.3%); 31 CIN-I (41.3%); 23 CIN II (30.7%), and 20 CIN-III (26.7%). HPV was detected in 31 cases (41.3%), being more frequent in higher histologic grades (35.5%) CIN-I, 43.5% CIN-II and 45% CIN-III). No association between cytologic, colposcopic and histologic diagnoses and HPV positivity was observed. HPV detection in patients with false negative cytologies was lower than in positive ones (p = 0.021). Smoking was the only epidemiologic factor significantly associated to HPV presence (chi 2 for trend = 4.022; p = 0.045). CONCLUSIONS: Clinical usefulness of in situ hybridization for HPV detection remains controversial because of its low sensitivity, and the scarce relationship between its results and those obtained by cytology, colposcopy and histology. Smoking is associated with a higher detection rate of HPV in patients with squamous intraepithelial lesions of the uterine cervix.

Treatment of CIN with the CO2 laser vaporization.

A group of two hundred and sixty women, most of them young, with histologic diagnosis of CIN located at the exocervix, has been treated by means of CO2 laser vaporization. The entire transformation zone and a minimum of 10 mm at the base of cervical canal was vaporized to a depth of 6-7 mm. Of the treated group, 239 patients (114 CIN I, 78 SIN II and 47 CIN III), were followed for a mean of 19 months. The failure rate of a single treatment was 8.8% for CIN I, 11.5% for CIN II and 12.7% for CIN III. These results are in agreement with world Literature The majority of failures, diagnosed within the first year of follow-up were small areas of CIN I-II located around the squamo-columnar junction, and only two CIN III were detected. No evidence of CIN was observed after a second treatment. No case of invasive cancer has been detected. Fertility was not affected by the treatment. It is concluded that CO2 laser vaporization is a safe and effective method for treatment of CIN. Patient selection, proper technique, close follow-up and adequate treatment of failures are essential to this end.

Carcinoma primario de trompa / Primary tubal carcinoma

Entre 1969 y 1985 fueron tratadas en el Hospital Clínico de Barcelona diez pacientes con cáncer primario de la trompa. La edad promedio del grupo fue de 58,9 años; 7 de las 10 eran nulíparas, y 8 se hallaban en la posmenopausia. Los síntomas más comunes fueron pérdida de sangre por vagina en 7 casos y dolor pelviano en 3. Ninguna presentó patología en el Papanicolau. En ningún caso se hizo diagnóstico preoperatorio correcto. A 8 de las pacientes se les practicó histerectomía abdominal total con salpingooforectomía bilateral; a una se le hizo histerectomía subtotal con salpingooforectomía bilateral y a otra se le realizó una resección incompleta del tumor. A una paciente se le hizo radioterapia pelviana posoperatoria; 2 recibieron en el posoperatorio radioterapia y quimioterapia; y 5 quimioterapia solamente. En 8 pacientes el Ca. afectaba la trompa izquierda, y una tenia un tumor bilateral. Microscópicamente, en 2 casos el tumor era un adenocarcinoma grado II y en 8 grado III. De acuerdo con la clasificación del Comité de Terminología del American College of Obstetricians and Gynecologiats, 2 casos pertenecían al período 1ª, 5 al IIª y 3 al estadio IV. El porvenir fue malo: 6 pacientes murireon antes de los 3 años; solamente viven y están bien 3 casos, a los 15, 12 y 4 meses de operadas

Carcinoma primario de trompa / Primary tubal carcinoma

Entre 1969 y 1985 fueron tratadas en el Hospital Clínico de Barcelona diez pacientes con cáncer primario de la trompa. La edad promedio del grupo fue de 58,9 años; 7 de las 10 eran nulíparas, y 8 se hallaban en la posmenopausia. Los síntomas más comunes fueron pérdida de sangre por vagina en 7 casos y dolor pelviano en 3. Ninguna presentó patología en el Papanicolau. En ningún caso se hizo diagnóstico preoperatorio correcto. A 8 de las pacientes se les practicó histerectomía abdominal total con salpingooforectomía bilateral; a una se le hizo histerectomía subtotal con salpingooforectomía bilateral y a otra se le realizó una resección incompleta del tumor. A una paciente se le hizo radioterapia pelviana posoperatoria; 2 recibieron en el posoperatorio radioterapia y quimioterapia; y 5 quimioterapia solamente. En 8 pacientes el Ca. afectaba la trompa izquierda, y una tenia un tumor bilateral. Microscópicamente, en 2 casos el tumor era un adenocarcinoma grado II y en 8 grado III. De acuerdo con la clasificación del Comité de Terminología del American College of Obstetricians and Gynecologiats, 2 casos pertenecían al período 1¬, 5 al II¬ y 3 al estadio IV. El porvenir fue malo: 6 pacientes murireon antes de los 3 años; solamente viven y están bien 3 casos, a los 15, 12 y 4 meses de operadas (AU)