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

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.

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.

Comportamiento de las alteraciones citológicas en mujeres atendidas en una IPS de la ciudad de Medellín / Behavior of cytological alterations in women treated at an IPS in the city of Medellín

Resumen Objetivo: Analizar las características relacionadas con el diagnóstico de cáncer de las pacientes que consultan una IPS de la ciudad de Medellín. Metodología: Estudio observacional analítico. La población fueron todas las mujeres atendidas en la IPS Unidad Video Diagnóstica de la Mujer, institución que se dedica a realizar confirmación diagnóstica de mujeres con citologías alteradas. Se analizaron todos los registros de la base de datos de la institución correspondientes a las mujeres que consultaron durante el período 2012- 2017, un total de 55655 mujeres. Resultados: Se analizaron los registros de 55655 usuarias, la mediana de edad fue de 40 años (RIQ 19) y el 66.1% (36812) pertenecen al régimen subsidiado. La principal indicación para la realización de la colposcopia fueron las alteraciones citológicas con un 89.8% (49984) y más frecuente fue el LIEBG 35.3% (19649). El principal cáncer diagnosticado fue el escamocelular con 0.5% (284) y los factores asociados fueron residir en el Valle de Aburrá (OR 0.60 IC 0.42-0.84) y el resultado de citología LIEAG (OR 3.31 IC 2.22-4.94). Conclusiones: Se encontró una prevalencia de cáncer de cérvix de 7.8 por cada 1000 pacientes que consultan en la IPS.

Abstract Objective: To analyze the characteristics related to the diagnosis of cancer of the patients who consult an IPS in the city of Medellín. Methodology: Analytical observational study. The population consisted of all the women treated at the IPS Unidad Video Diagnóstica de la Mujer, an institution dedicated to performing diagnostic confirmation of women with altered cytologies. All the records of the institution's database corresponding to the women who consulted during the period 2012-2017 were analyzed, a total of 55,655 women. Results: The records of 55,655 users were analyzed, the median age was 40 years (RIQ 19) and 66.1% (36,812) belonged to the subsidized regime. The main indication for performing colposcopy was cytological alterations with 89.8% (49984) and the most frequent was LIEBG 35.3% (19649). The main cancer diagnosed was squamous cells with 0.5% (284) and the associated factors were residing in the Valle de Aburrá (OR 0.60 IC 0.42-0.84) and the LIEAG cytology result (OR 3.31 IC 2.22-4.94). Conclusions: A cervical cancer prevalence of 7.8 was found for every 1000 patients who consulted the IPS.

Benign stratified intraepithelial mucinous proliferation of the uterine cervix: Significance of a previously unreported potential mimic of SMILE.

Stratified mucin-producing intraepithelial lesion (SMILE) is a histologic subtype of HPV-associated endocervical adenocarcinoma in situ. We have observed benign endocervical changes resembling SMILE. We aim to characterize this pattern and explore its potential association with dysplasia. We retrospectively retrieved all 296 consecutive cases accessioned as endocervical biopsies. Some included multiple specimens, totaling 483 biopsies and 219 endocervical curettages (ECC), n = 702. We included cases showing endocervical epithelial stratification often with pencillate (triangular-shaped) nuclei. We rejected cases in which layering represented tangential sectioning, metaplasia, microglandular hyperplasia, gastric type epithelial changes, and dysplasia. We found benign stratified intraepithelial mucinous proliferation in 51 patients, either with a multilayered (n = 27) or a two-layered appearance (n = 24). Overall, multilayered proliferation occurred in 6 % (29/483) of biopsies and in 0.9 % of ECCs (2/219). Two-layering was identified in 4 % of all biopsies (20/482) and was not seen in ECCs. Histologic findings included stratification, intracytoplasmic mucin, paler cytoplasm, low nuclear-to-cytoplasmic ratio, often pencillate nuclei, rare mitoses, and no apoptotic bodies. P16 immunohistochemistry (n = 12) was negative, suggesting absence of underlying high-risk HPV infection. HSIL was concomitant in 29.6 % (8/27) of patients with multilayered proliferation. Concurrent SMILE was not observed. We also reviewed 13 SMILE cases. Concurrent multilayered benign proliferation was identified in 54 % (7/13) of cases. We describe benign stratified intraepithelial mucinous proliferation of the cervix, which morphologically may overlap with SMILE. Its presence in most SMILE cases suggests a potential relationship. The multilayered form represents a diagnostic pitfall when mitotically active. Because of the often-coexistent HSIL, we propose that its presence should prompt scrutiny to rule out any associated dysplasia.

Alterações em exames citopatológicos realizados em Unidade Básica de Saúde: um estudo analítico transversal / Alterations in cytopathological tests performed in a Basic Health Unit: a cross-cutting analytical study

Objetivo: Com o presente estudo, buscou-se verificar a quantidade de exames de colpocitologia oncótica coletados em Unidade Básica de Saúde (UBS) escolhida, determinar quantas e quais são as alterações encontradas nesses exames e quais foram as condutas e acompanhamentos realizados em pacientes com exames alterados. Métodos: Foram analisados 446 exames de colpocitologia oncótica realizados em uma UBS do centro-oeste do Paraná. As pacientes com exame alterado foram selecionadas e foi feita uma análise desses prontuários a fim de verificar a conduta e o acompanhamento dessas pacientes. Resultados: Foram encontrados 32 exames com alterações, sendo três de uma mesma paciente. Dessas 30 pacientes, a grande maioria correspondia a células escamosas atípicas de significado indeterminado (ASC-US), possivelmente não neoplásicas, e 28 pacientes retornaram para receber uma conduta inicial, sendo principalmente o encaminhamento para a coleta de novo preventivo em seis meses ao serviço de oncologia clínica. Conclusão: O presente estudo concluiu que a hipótese principal foi verdadeira, a qual foi descrita como prevalência significativa de lesões intraepiteliais de alto grau, embora não seja a mais frequente, e descontinuidade por parte das pacientes que obtiveram esse resultado. Além disso, notou-se grande encaminhamento à atenção terciária, o que não é indicado pelo Ministério da Saúde.(AU)

Objective: With the present study, we sought to verify the amount of cytopathological tests collected in the chosen basic health unit, to determine how many and what are the alterations found in these tests and what were the conducts and follow-ups performed in patients with altered exams. Methods: We analyzed 446 preventive tests performed in a basic health unit in the Midwest of Paraná, and patients with altered examination were selected and an analysis of these medical records was made in order to verify the conduct and follow-up of the patients. Results: Thirty-two tests with alterations were performed, 3 of which were the same patient. Of these 30 patients, the vast majority corresponded to atypical cells of squamous meaning ­ possibly non-neoplastic (ASC-US), and 28 patients returned to receive an initial approach, mainly being referred to the collection of preventive new in 6 months and to the clinical oncology service. Conclusion: The present study concluded that the main hypothesis was true, which was described as a significant prevalence of high-grade intraepithelial lesions (HSIL), although not the most frequent, and discontinuity on the part of the patients who obtained this result. In addition, there was a large referral to tertiary care, which is not indicated by the Ministry of Health.(AU)

Estudio Descriptivo: Colposcopia en el diagnóstico de lesiones de cuello uterino en el Hospital de Especialidades José Carrasco Arteaga, Cuenca ­ Ecuador. 2015-2019 / Descriptive Study: Colposcopy as a diagnostic method for cervix lesions in Hospital de Especialidades Jose Carrasco Arteaga, Cuenca-Ecuador. 2015-2019

INTRODUCCIÓN: El cáncer de cuello uterino es un problema de salud pública, siendo una de las principales causas de morbilidad y mortalidad en países en vía de desarrollo. Para el screening y diagnóstico de las lesiones del cuello uterino se realiza citología cervical (Papanicolaou). Ante un reporte de citología sospechosa, la colposcopia es un procedimiento imprescindible en la evaluación del tracto genital inferior para detectar lesiones tempranas y cáncer. El objetivo de la presente investigación fue caracterizar los procedimientos colposcópicos realizados, como método diagnóstico y terapéutico, en las pacientes con resultados anormales del Papanicolaou. MATERIALES Y MÉTODOS: El presente es un estudio observacional, descriptivo de corte transversal, cuyo universo lo conformaron todas las pacientes con diagnóstico citológico anormal en Papanicolaou, que se realizaron un procedimiento colposcópico entre el año 2015 hasta el año 2019 en el Hospital José Carrasco Arteaga, con un total de 1 628 pacientes. RESULTADOS: Se incluyen 1 628 procedimientos colposcópicos. El 55.46% de la población estuvieron entre los 27 a 46 años de edad. El estado civil predominante fue casada (75%). El 63.45% de las mujeres iniciaron vida sexual entre los 21 a 30 años. El 95.20% de las pacientes tuvieron entre 1 y 3 parejas sexuales. Los resultados de Papanicolaou anormales representan; el 37.28% a LIE-BG, seguido de 35.81% con ASC-US y 14.18% como LIE-AG. El 67.32% de colposcopías fueron satisfactorias. Se realizó biopsia en el 71% de las pacientes, seguido de la toma de muestra de cono con ASA-LEEP (13.69%), legrado endocervical en el 11.05%. Los resultados de anatomía patológica reportaron LIE-AG en 46.56% de los casos, seguido de 22.23 % como LIE-BG y cervicitis crónica en el 16.27%, 12.28% de los resultados fueron negativos. CONCLUSIÓN: Tres cuartas partes de las colposcopias se realizaron en mujeres entre los 27 y 56 años de edad. Los resultados anormales más frecuentemente encontrados en el Papanicolaou fueron: LIE-BG, seguido de ASC-US. 67% de las colposcopias realizadas fueron satisfactorias. Tras la colposcopia, en la mayoría de pacientes se realizó biopsia, en un menor porcentaje y en orden de frecuencia: conización electro quirúrgica con asa (ASA-LEEP), legrado endocervical e histerectomía diagnóstica. Los resultados de anatomía patológica reportaron LIE-AG en el 46.56%, LIE-BG en el 22.23 % como y cervicitis crónica en el 16.27%; 12.28% de estudios fueron negativos.(au)

BACKGROUND: Cervical cancer is a public health issue, being one of the main causes of morbidity and mortality in developing countries. Cervical cytology (Papanicolaou) is performed for screening and diagnosis of cervical lesions. In case of a suspicious cytology report, colposcopy is an essential procedure for evaluation of the lower genital tract, to detect early lesions and cancer. The aim of this study was to characterize the colposcopy procedures performed, as a diagnostic and therapeutic method, in patients with abnormal Papanicolaou results. METHODS: This is an observational, descriptive cross-sectional study, whose universe were all the patients with abnormal cytological diagnosis in pap smear, who underwent a colposcopy procedure between 2015 and 2019 at Hospital José Carrasco Arteaga, with a total of 1 628 patients. RESULTS: 1 628 colposcopic procedures were included. 55.46% of the population were between 27 to 46 years of age. The predominant marital status was married status (75%). 63.45% of women had their first sexual experience between 21 and 30 years of age. 95.20% of the patients had between 1 and 3 sexual partners. Abnormal pap smear results represent; 37.28% to LSIL, followed by ASC-US (35.81%), and HSIL (14.18%). 67.32% of colposcopies were classified as satisfactory. Biopsy was performed in 71% of the patients, followed by loop electrosurgical excision procedure (LEEP) (13.69%), endocervical curettage in 11.05%. The pathology results reported HSIL in 46.56% of the cases, followed by 22.23% as LSIL and chronic cervicitis in 16.27%, 12.28% of the results were negative. CONCLUSION: Three-quarters of all colposcopies were performed on women between 27 and 56 years of age. The most frequently abnormal Pap smear results were: LSIL, followed ASC-US. 67% of the colposcopies were satisfactory. After colposcopy, biopsy was performed in most of the patients, in lower percentage: loop electrosurgical excision procedure (LEEP), endocervical curettage and diagnostic hysterectomy. Pathology results reported HSIL in 46.56%, LSIL IN 22.23% and chronic cervicitis in 16.27%; 12.28% of studies were negative.(au)

Impacto da estrogenização vaginal no seguimento de citologia oncótica de significado indeterminado na pós-menopausa / Impact of vaginal estrogenization in follow-up of oncotic cytology of undetermined significance in postmenopausal women

Avaliar a estrogenização tópica vaginal no seguimento de citologia oncótica de significado indeterminado, tipo ASC-H, na pós-menopausa. Estudo, tipo caso-controle, que avaliou mulheres menopausadas com diagnóstico de ASC-H, divididas em dois grupos, com e sem uso de estrogênio tópico vaginal (GE e GNE). Foi calculada razão de chance a partir de tabelas de contingência construídas com variação robusta. Foram analisados 128 prontuários, sendo 27% de pacientes do GNE e 72% do GE. Houve aumento de diagnósticos ASC-H no GNE. No GE, aproximadamente 68 vezes menos colposcopias inadequadas e diminuição do número de colposcopias e Cirurgia de Alta Frequência (CAF), com evidência na redução em 21 e 12,5 vezes, respectivamente. Diminuição do número de colposcopias com melhor adequação ao exame, número de biópsias inalterado e diminuição do número de cirurgias de alta frequência, no grupo com uso de estrogênio tópico vaginal durante o seguimento.

Current paper evaluates topic vaginal estrogenization following oncotic cytology of undetermined significance, type ASC-H, in postmenopausal women. A case-control study evaluated menopausal women diagnosed with ASC-H, divided into two groups, with and without the use of topic vaginal estrogen (GE and GNE). Odds ratios were calculated from contingency tables built with robust variation. 128 medical records were analyzed, 27% of which were from the GNE and 72% from the GE. There was an increase in ASC-H diagnoses in GNE. In GE, approximately 68 times less inappropriate colposcopies and a decrease in the number of colposcopies and High Frequency Surgery (HFS), with a reduction of 21 and 12.5 times, respectively. Decrease in the number of colposcopies with better adaptation to the exam, unchanged number of biopsies and decrease in the number of high-frequency surgeries, in the group using topic vaginal estrogen during the follow-up.

Características citológicas previas al diagnóstico de cáncer de cérvix en mujeres de Medellín (Colombia) / Cytological characteristics prior to the diagnosis of cervical cancer in women from Medellin (Colombia)

Resumen Introducción: Actualmente, el cáncer de cérvix sigue siendo una enfermedad importante por su incidencia y mortalidad. Aunque se conoce su etiología generada por la infección del virus del Papiloma Humano (PVH) y sus métodos de tamizaje como la citología convencional y el test de ADN-PVH, aún es necesario reconocer diversas características que se relacionan con la aparición de este tipo de cáncer. Objetivo: Describir las características citológicas previas al diagnóstico de cáncer cervical en mujeres de una institución de salud de la ciudad de Medellín. Materiales y métodos: Estudio descriptivo. Se tomaron los registros clínicos correspondientes a mujeres con diagnóstico confirmado de cáncer de cérvix entre 2012 y 2017 y se revisaron los resultados de citología previos al diagnóstico. Se realizó análisis univariado para describir las variables de estudio. Resultados: La muestra de mujeres con cáncer fue de 714, la mediana de edad fue 51 años (rango intercuartílico: 42-60), la alteración citológica más frecuente fue lesión intraepitelial de alto grado (33,8%), el principal cáncer diagnosticado fue carcinoma escamocelular (70,6%). Conclusiones: Los resultados de citología alteradas son un indicador para riesgo de cáncer de cérvix, de ahí la importancia de continuar con el protocolo de tamizaje establecido.

Abstract Introduction: Currently, cervical cancer continues to be an important disease because of its high incidence and mortality. Even though its etiology (Human Papilloma Virus infection) and screening methods (conventional cytology and HPV-DNA test) are well known, understanding the various characteristics associated with the appearance of cervical cancer is fundamental. Objective: To describe the cytological characteristics that precede the diagnosis of cervical cancer in women diagnosed in a health care institution from the city of Medellín. Materials and methods: A descriptive study. The clinical records corresponding to women with a confirmed diagnosis of cervical cancer between 2012 and 2017 were used. Also, the citology results obtained before the diagnosis were reviewed. An univariate analysis was carried out in oder to describe the study variables. Results: The sample size of women with cervical cancer was 714, the age median was 51 years old (interquartile range: 42-60), the most frequent cytological alteration was high-grade intraepithelial lesion (33.8%), and the main diagnosed cancer type was squamous cell carcinoma (70.6%). Conclusions: Results showing an altered cytology are indicators of cervical cancer risk. Therefore, it is important to continue with the stablished screening protocol.

Age-specific predictors of cervical dysplasia recurrence after primary conization: analysis of 3,212 women.

OBJECTIVE: This study aimed to identify predictors of recurrence/persistence of cervical intraepithelial neoplasia grade 2+ (CIN2+) lesion (r-CIN2+) after primary conization. METHODS: Retrospective analysis involving all consecutive women having conization for CIN2+ between 1998 and 2018. The risk of r-CIN2+ was assessed using Kaplan-Meier and Cox models. RESULTS: Data of 3,212 women were retrospectively identified. After a mean follow-up of 47 (±22.2) months, 112 (3.5%) patients developed r-CIN2+. Mean time interval between prior conization and diagnosis of r-CIN2+ was 26.2 (±13.2) months. Via multivariate analysis, presence of high-risk human papillomavirus (HPV) types at the time of CIN2+ diagnosis, hazard ratio (HR)=3.40 (95% confidence interval [CI]=1.66-6.95) for HPV16/18 and HR=2.59 (95% CI=1.21-5.55) for HPV types other than 16/18, positive margins at primary conization, HR=4.11 (95% CI=2.04-8.26) and HPV persistence after conization, HR=16.69 (95% CI=8.20-33.9), correlated with r-CIN2+, independently. Considering age-specific HPV types distribution, we observed that HPV16/18 infection correlated to an increased risk of r-CIN2+ only in young women (aged ≤25 years; p=0.031, log-rank test); while in the older population (>25 years) HPV type(s) involved had not impact on r-CIN2+ risk (p>0.200, log-rank test). CONCLUSION: HPV persistence is the main factor predicting r-CIN2+. Infection from HPV16/18 has a detrimental effect in young women, thus highlighting the need of implementing vaccination against HPV in this population. Further prospective studies are warranted for tailoring clinical decision-making for post-conization follow-up on the basis of risk factors.

Características sociodemográficas y clínicas de las mujeres con alteraciones citológicas tipo ascus

Introducción: La citología cervicouterina es la prueba de tamización utilizada para identificar cambios celulares de forma temprana Objetivo: Describir las características sociodemográficas y clínicas de las mujeres con alteraciones citológicas tipo Ascus. Métodos: Estudio observacional. Se analizaron reportes citológicos de Ascus durante el período 2012-2017. Se realizó análisis univariado para describir las variables de estudio. Resultados: La mediana de edad fue 42 años (RIQ 18), el 58,8 % pertenecía al régimen subsidiado de salud. El resultado de la colposcopia fue negativo con un 84,9 %. De las 21180 usuarias se les realizó biopsia al 38,7 % y se encontró resultado negativo al 80 %. La alteración histológica más frecuente en las mujeres entre 40 y 59 años fue el adenocarcinoma en un 66,7 %. Conclusión: Las alteraciones citológicas tipo Ascus siguen siendo frecuentes, por lo que es importante continuar con un adecuado cumplimiento de los programas para detección temprana de cáncer de cuello uterino, especialmente en mujeres a partir de los 40 años.

Introduction: Cervical cytology is the screening test used to identify early cellular changes. Objective: To describe the sociodemographic and clinical characteristics of women with ASCUS-type cytological alterations. Method: Observational study. Cytological reports of AS-CUS were analyzed during the period 2012-2017. Univariate analysis was performed to describe the study variables. Results: The median age was 42 years (IQR 18), 58.8% belonged to the subsidized health regime. The colposcopy result was negative with 84.9%. Of the 21,180 users, a biopsy was performed in 38.7%, finding a negative result in 80%, the most frequent histological alteration in women between 40 and 59 years was adenocarcinoma in 66.7%. Conclusion: ASCUS-type cytological alterations are still frequent, so it is important to continue with adequate compliance with programs for early detection of cervical cancer, especially in women over 40 years old.

Predictive value of p16INK4a, Ki-67 and ProExC immuno-qualitative features in LSIL progression into HSIL.

The current nested case-control study was conducted to explore the prognostic value of cyclin-dependent kinase inhibitor 2A (p16INK4a), marker of proliferation Ki-67 (Ki-67) and immunohistochemical cocktail containing antibodies directed against topoisomerase IIα (TOP2A) and minichromosome maintenance 2 (MCM2) proteins (ProExC) immuno-qualitative features to predict low-grade squamous intraepithelial lesion (LSIL) progression. A total of 92 LSIL patients were followed-up for 2 years, where those with high-grade squamous intraepithelial lesion (HSIL) or persistent LSIL were designated as the case group and those who spontaneously regressed were designated as the control group. The infection status of human papillomavirus (HPV) was evaluated using flow-through hybridization and gene chip, whilst the expression of p16INK4a, Ki-67 and ProExC were tested in LSIL patient biopsies by immunohistochemistry. All data were collected at the beginning of the follow-up and patient outcomes were diagnosed by histopathological examination. To analyze the risk factors for LSIL progression, sensitivity, specificity, positive-negative predictive value (PPV-NPV), positive-negative likelihood ratio (PLR-NLR), Youden's index (YI) and multinomial logistic regression analysis was performed. The expression rates of p16INK4a, Ki-67, and ProExC were found to be higher in the progression group compared with those in the persistence and regression groups. Only p16INK4a expression significantly associated with high-risk HPV infection. With respect to predicting HSIL, p16INK4a staining was the most sensitive but Ki-67 staining was found to be the most specific. YI was the highest (42.1%) for p16INK4a expression in the present study, followed by ProExC (39.5%) and Ki-67 (28.3%). However, the expression of ProExC was found to be an independent risk factor for LSIL progression into HSIL. In conclusion, whilst immunohistochemical staining for p16INK4a, Ki-67, and ProExC can be used to predict HSIL progression, only ProExC expression can be applied an independent risk factor for LSIL progression.

Implementación de la nueva guía práctica clínica para la detección y manejo de lesiones precancerosas de cuello uterino en mujeres de la ciudad de Cali, Colombia / Implementation of the new clinical practice guideline for the detection and management of precancerous lesions of the cervix in women from the city of Cali, Colombia

Objetivos del trabajo: Se determinaron los porcentajes de las lesiones precancerosas de cuello uterino en un grupo de mujeres diagnosticadas positivas por la prueba ADN-VPH. Materiales y métodos: El presente estudio es un análisis exploratorio descriptivo transversal de una base de datos con resultados de las pruebas de ADN-VPH (genotipo y tipo de infección), citología y colposcopia, realizadas en 58 mujeres de 30 años o más, para el periodo de octubre del 2018 a febrero del 2019. Resultados: De las 58 mujeres positivas para la prueba ADN-VPH, el 57% (n=33) fueron positivas para la prueba citológica cervical. De este grupo de mujeres fueron diagnosticadas negativas para LEI el 21% (n=7); para LEI-BG el 33% (n=11); y para LEI-AG el 45% (n=15) mediante la prueba de colposcopia. El VPH-16 mostró la mayor frecuencia relativa de detección en las LEI-AG con un 46,7% (n=7). Igualmente, los genotipos que cubre la vacuna Gardasil_4 fueron identificados en mayor porcentaje en las LEI-AG en comparación con los otros tipos histopatológicos diagnosticados, siendo esta asociación estadísticamente significativa, valor de p = 0,033. Conclusiones: La implementación de la nueva guía de práctica clínica para la detección y manejo de lesiones precancerosas de cuello uterino muestra resultados satisfactorios, siendo concordante la detección de ADN-VPH, con la identificación de anormalidades citológicas e histopatológicas, permitiendo la identificación precoz de mujeres en riesgo de desarrollar cáncer cervical.

Objectives of the study: To determine the percentages of precancerous lesions in the cervix in a group of women with positive diagnostic to the DNA-HPV test. Materials and methods: The present study is a cross-sectional exploratory analysis of a database with information on the results of DNA-HPV tests (genotype and type of infection), cytology and colposcopy, carried out on 58 women aged 30 or older, for the period from October 2018 to February 2019. Results: Of the 58 women positive for the DNA-HPV test, 57% (n=33) were positive for the cervical cytology test. Of this group of women, 21% (n=7) were diagnosed LEI-negative; for LEI-BG 33% (n=11); and for LEI-AG, 45% (n=15) using the colposcopy test. HPV-16 has a higher detection frequency in the LEI-AG with 46.7% (n=7). Likewise, the genotypes that cover the Gardasil_4 vaccine were members in a greater percentage in the LEI-AG in comparison with other diagnosed histopathological types, this association being statistically significant, value of p = 0.033. Conclusions: The implementation of the new clinical practice guideline for the detection and management of precancerous lesions of the cervix shows satisfactory results, the DNA-HPV detection being consistent, with the identification of cytological and histopathological abnormalities, allowing the early identification of women at risk to develop cervical cancer.

Comparison of the long-term impact and clinical outcomes of fewer doses and standard doses of human papillomavirus vaccine in the United States: A database study.

BACKGROUND: Human papillomavirus (HPV)-related disease remains a significant source of morbidity and mortality, and this underscores the need to increase HPV vaccination to reduce the burden of the disease. The objective of this study was to examine the association between the number of HPV vaccine doses and the risk of histologically confirmed preinvasive cervical disease and high-grade cytology. METHODS: This retrospective matched cohort study used administrative data from Optum's Clinformatics DataMart Database to identify females aged 9 to 26 years who received 1 or more quadrivalent HPV vaccine doses between January 2006 and June 2015. Cases and controls were matched on region, age, sexually transmitted disease history, and pregnancy. All had a Papanicolaou test ≥1 year after the date of the matched case's final dose. Cox proportional hazards models were used to examine the association between the number of HPV vaccine doses and the incidence of preinvasive cervical disease and high-grade cytology. The Kaplan-Meier method was used to estimate the cumulative incidence rate at the 5-year follow-up. RESULTS: The study included 133,082 females (66,541 vaccinated and 66,541 unvaccinated) stratified by the number of HPV vaccine doses and the vaccine initiation age. Among those aged 15 to 19 years, the hazard ratio (HR) for high-grade cytology for the 3-dose group was 0.84 (95% confidence interval [CI], 0.73-0.97), whereas the HRs for histologically confirmed preinvasive cervical disease for 1, 2, and 3 doses were 0.64 (95% CI, 0.47-0.88), 0.72 (95% CI, 0.54-0.95), and 0.66 (95% CI, 0.55-0.80), respectively. CONCLUSIONS: The receipt of 1, 2, or 3 doses of an HPV vaccine by females aged 15 to 19 years was associated with a lower incidence of preinvasive cervical disease in comparison with unvaccinated females, and this supports the use of any HPV vaccination in reducing the burden of the disease.

Factores de riesgo en las lesiones intraepiteliales del cuello uterino / Risk Factors in Intraepithelial Lesions of the Cervix

RESUMEN Fundamento: los factores de riesgo de las lesiones intraepiteliales se comportan similares a los del cáncer cervicouterino. Objetivo: identificar la influencia de distintos factores de riesgo relacionados con la aparición de lesiones intraepiteliales de cuello uterino. Método: se realizó un estudio observacional de casos y controles en el Policlínico Docente Gustavo Aldereguía de la provincia Granma en el período comprendido desde el 1ro de enero del 2016 hasta el 30 de junio del 2017. Se definieron como casos a las 105 pacientes con neoplasia intraepitelial cervical confirmadas histopatológicamente y como controles a las mujeres que se les realizó la prueba citológica, seleccionadas por muestreo simple aleatorio. A cada paciente se le realizó: interrogatorio, examen físico y medios de diagnóstico. Para el análisis de los factores de riesgo se utilizó una estrategia univariada y multivariada. Se delimitaron como variables explicativas aquellos factores considerados como hipotéticamente de riesgo y que serían sometidos a evaluación. Como variable respuesta se consideró la aparición de la neoplasia intraepitelial. Se obtuvieron estimaciones puntuales y por intervalo de confianza del 95 %. Resultados: la sepsis vaginal y menarquía precoz fueron significativas, no así el no uso del condón, infección por virus del papiloma humano, anticoncepción oral, edad, dispositivo intrauterino y tabaquismo como factores indiferentes. La erosión y sepsis vaginal fueron los más significativos por el modelo de regresión logística. Hubo interacciones entre cervicitis, múltiples parejas sexuales y tabaquismo; moderadamente significativo se comportaron la edad y la menarquía precoz; cervicitis y erosión, infección por el virus del papiloma humano y múltiples parejas sexuales. Conclusiones: se determinó que la sepsis vaginal y la erosión cervical presentaron una asociación estadísticamente significativa e importante con la probabilidad de aparición de las lesiones intraepiteliales propias del cuello uterino.

ABSTRACT Foundation: the risk factors of intraepithelial lesions behave similar to those of cervical cancer. Objective: to identify the influence of different risk factors related to the appearance of intraepithelial lesions of the cervix. Method: an observational case-control study was carried out in the Gustavo Aldereguía Teaching Polyclinic of the Granma province in the period from January 1, 2016 to June 30, 2017. The 105 patients with cervical intraepithelial neoplasia were defined as cases histopathologically confirmed and as controls to women who underwent the cytological test, selected by simple random sampling. Each patient was performed: interview, physical examination and diagnostic means. For the analysis of risk factors, a univariate and multivariate strategy was used. Explanatory variables were defined as factors considered as hypothetically risky which would be subject to evaluation. The appearance of intraepithelial neoplasia was considered as a response variable. Punctual and 95 % confidence interval estimates were obtained. Results: vaginal sepsis and early menarche were noticeable, however not the use of condoms, human papillomavirus infection, oral contraception, age, intrauterine device and smoking as indifferent factors. Erosion and vaginal sepsis were the most significant due to the logistic regression model. There were interactions between cervicitis, multiple sexual partners and smoking; moderately significant were age and early menarche; cervicitis and erosion, human papillomavirus infection and multiple sexual partners. Conclusions: it was determined that vaginal sepsis and cervical erosion presented a statistically significant and important association with the probability of the appearance of intraepithelial lesions of the cervix.

[Analysis of recurrence and its influencing factors in patients with cervical HSIL within 24 months after LEEP].

Objective: To analyze clinical outcome of high grade squamous intraepithelial lesion (HSIL) within 24 months after loop electrosurgical excision procedure (LEEP), and to explore risk factors of recurrent cervical HSIL, the risk of progress into cervical cancer and methods of follow-up. Methods: This retrospective study was carried out on 1 005 patients who underwent LEEP, diagnosing with HSIL after LEEP from January 2011 to December 2013 at Obstetrics and Gynecology Hospital Affiliated to Fudan University to confer the difference between non-recurrent group and recurrent group 24 months after the LEEP conization. Patients were followed with ThinPrep cytologic test (TCT), high risk HPV (HR-HPV) test, colposcopy guided biopsy. Results: A total of 1 005 cases were enrolled in this study with HSIL in the LEEP specimen, no residual HSIL in the 6-month follow up, and have follow up records in 24 months after LEEP. HSIL recurred in 5 cases, microinvasive carcinoma in 1 case, low grade squamous intraepithelial lesion (LSIL) in 17 cases at 12 months follow-up. HSIL recurred in 8 cases, LSIL in 11 cases, adenocarcinoma in situ in 1 case, and invasive cervical carcinoma in 1 case in Ⅰb1 stage at 24 months after LEEP. The recurrence rate was 1.3% (13/1 005) , and the progression rate was 0.3% (3/1 005) . There was no significant difference in age, length, circumference and width of LEEP between recurrent and non-recurrent patients (P>0.05) . The recurrence rate was highest in the endocervical positive margin group with 3/16, which was higher than ectocervical positive margin and negative margin (P<0.01, P=0.040, respectively). The recurrence rate of endocervical positive margin group and fibrous interstitial positive margin group showed no significant difference (P=0.320) . There was no significant difference between ectocervical positive margin and negative margin [2.8% (2/72) vs 0.7% (6/882), P=0.117]. Postoperative cytological examination combined with HR-HPV detection has a high sensitive and high negative predictor value of HSIL recurrence with both 100.0%. Multivariate logistic regression analysis showed that positive endocervical positive margin, abnormal follow-up cytological examination and positive HR-HPV after LEEP were independent factors affecting recurrence of HSIL patients after LEEP (P<0.05). Conclusions: Age, length, circumference and width of LEEP have no effect on recurrence within 24 months after HSIL. The high risk factors for HSIL recurrence within 24 months after LEEP in HSIL patients include: positive HPV, abnormal cytology, and positive endocervical positive margin. Colposcopy biopsy and endocervical curettage have important role in diagnosing HSIL recurrence and progression.

[Discussion on the diagnosis and treatment of high-grade squamous intraepithelial lesions in post-menopausal women].

Objective: To analyze the performance of colposcopy and investigate the diagnosis and treatment characteristics of high-grade squamous intraepithelial lesion (HSIL) diagnosed by cervical tissue sampling in post-menopausal women. Methods: A retrospective study was performed on 1 449 patients with HSIL diagnosed by cervical tissue sampling under colposcopy and treated by loop electrosurgical excision procedure (LEEP) or extrafascial hysterectomy as the primary therapy at the First Affiliated Hospital of Nanjing Medical University, from November 2015 to October 2017. In order to investigate the diagnosis and treatment of HSIL in post-menopausal women, a case-control study was conducted to compare the difference in performance of colposcopy and treatment modality between 213 post-menopausal patients (14.7%, 213/1 449) and 1 236 pre-menopausal patients (85.3%, 1 236/1 449). Results: (1)The proportion of cases pathologically upgraded to cervical cancer was significantly greater in post-menopausal patients (9.4%, 20/213) compared with pre-menopausal patients (3.8%, 47/1 236; P<0.05). (2) The proportion of ≥HSIL diagnosed by colposcopy showed no significant difference between post-menopausal patients (76.1%, 162/213) and pre-menopausal patients (78.2%, 967/1 236; P=0.479). The proportion of type Ⅲ transformation zone (TZ) was significantly greater in post-menopausal patients (91.1%, 194/213) compared with pre-menopausal patients (59.1%, 731/1 236; P<0.05). The rate of missed diagnosis of cervical cancer was significantly higher in type Ⅲ TZ (6.4%, 59/925) compared with type Ⅰ and(or) Ⅱ TZ (1.5%, 8/524; P<0.05). The proportion of HSIL detected by endocervical curettage alone was greater in post-menopausal patients (9.9%, 21/213) compared with pre-menopausal patients (2.6%, 32/1 236; P<0.05). (3)Initial treatment with LEEP: the positive rate of endocervical margin was significantly greater in post-menopausal patients (20.5%, 36/176) compared with pre-menopausal patients (10.5%, 130/1 236;P<0.05); in patients who were diagnosed as HSIL after LEEP, the positive rate of endocervical margin and the residual rate were both greater in post-menopausal patients compared with pre-menopausal patients [15.4% (25/162) versus 8.8% (105/1 189), P=0.008; 52.0% (13/25) versus 26.7% (28/105), P=0.014]. (4)Thirty-seven post-menopausal patients were treated by extrafascial hysterectomy as the primary therapy, 5 cases (13.5%, 5/37) were diagnosed as cervical cancer (stage Ⅰa1) after the surgery. Conclusions: (1) The lesions of HSIL in post-menopausal patients still have definite features under colposcopy as same as pre-menopausal patients. Endocervical curettage could help detect more HSIL in post-menopausal patients. Compared with pre-menopausal patients, post-menopausal HSIL patients have an increased risk of cervical cancer and are more likely missed by cervical tissue sampling. (2) LEEP has the dual effects of diagnosis and treatment, and is still the recommended treatment for post-menopausal HSIL patients. However, the increase in positive rate of endocervical margin and residual rate requires further active intervention. (3) Considering those post-menopausal HSIL patients who cannot accept conization as the initial treatment, the selection of hysterectomy type requires more thorough study.

Age-specific HPV type distribution in high-grade cervical disease in screened and unvaccinated women.

BACKGROUND AND AIM: Age-specific type-distribution of high-risk human papillomavirus (hrHPV) in cervical precancerous lesions is subject to change in the HPV vaccination era. Knowing the pre-vaccination type-distribution helps to anticipate changes induced by mass vaccination and optimize screening. METHODS: We recruited 1279 women referred to colposcopy for abnormal cytology into a population-based study on HPV type distribution in diagnostic cervical samples (ISRCTN10933736). The HPV genotyping findings were grouped as: HPV16/18+, other hrHPV+ (HPV31/33/35/39/45/51/52/56/58/59/66/68), non-vaccine targeted hrHPV+ (HPV35/39/51/56/59/66/68), low-risk HPV, and HPV negative. We estimated the HPV group-specific prevalence rates according to diagnostic histopathological findings in the age groups of <30 (n = 339), 30-44.9 (n = 614), and ≥45 (n = 326). RESULTS: Altogether 503 cases with high grade squamous intraepithelial lesion or worse (HSIL+) were diagnosed. More than half, 285 (56.7%) of HSIL+ cases were associated with HPV16/18: 64.3% (101/157) in women <30 years (reference group), 58.4% (157/269) in women 30-44.9 years (risk ratio (RR) 0.91, 95% confidence interval (95% CI) 0.78-1.06), and 35.1% (27/77) in women ≥45 years of age (RR 0.55, 95% CI 0.39-0.75). Conversely, other hrHPV's were associated with 191 (38.0%) of HSIL+: 31.9% (50/157) in women <30, 36.8% (99/269) in women 30-44.9 years, 54.6% (42/77) and in women ≥45 (RR 1.71, 95% CI 1.26-2.33). The proportion of non-vaccine targeted hrHPV and HPV negative HSIL+ increased with advancing age. CONCLUSIONS: Pre-vaccination HPV type distribution in HSIL+ was distinctly polarised by age with HPV16/18 attributed disease being markedly more prevalent in women aged <30. In the older women the other hrHPV types, however, dominated suggesting a need for more age-dependent screening strategies.