Accuracy of abnormal pap smear at Thammasat University Hospital.

The aim of the present study was to assess the sensitivity, specificity and accuracy of the Pap smear in the diagnosis of squamous intraepithelial lesion (SIL) and squamous cell carcinoma (SCC). Pap smear of 15,345 women in 2 years were screened for early detection of abnormal cervix. In 299 cases (1.9%) were diagnosed as low-grade SIL (LSIL), high-grade SIL (HSIL) and SCC by the Bethesda system (TBS) 2001. Only 195 cases (1.3%) had definitive histologic diagnosis as negative, human papilloma virus (HPV) infection, cervical intraepithelial neoplasia (CIN) 1, CIN 2, CIN 3 and SCC. The sensitivity, specificity and accuracy in LSIL was 86.5%, 70% and 71.3%, respectively. For HSIL it was 80.8%, 89.7% and 86.2%, respectively. For SCC it was 100%, 96.9% and 96.9%, respectively. Our data had high diagnostic performance for HSIL and SCC group and moderate diagnostic performance for LSIL group.

Fine needle aspiration in a malignant lymphoepithelial lesion: a case report.

BACKGROUND: A primary malignant lymphoepithelial lesion (MLEL) of the salivary gland is a rare tumor. Though histologic morphology of this lesion is well documented, the cytologic findings regarding fine needle aspiration (FNA) are not yet well described. CASE: A 56-year-old Thai woman from Udonthanee was admitted to Srinagarind Hospital with a 2-year history of a painless mass in the left parotid gland. FNA of the left parotid mass was performed, and findings suggestive of malignancy were discovered. A wide local excision was performed 1 year later, and MLEL with metastasis to the regional lymph nodes was diagnosed by histopathology. CONCLUSION: We report our first experience of cytologic findings from FNA of histologically diagnosed MLEL. The aspirate comprised groups of cohesive and isolated malignant epithelials with a background of numerous lymphocytes. Cytotechnologists should be reminded of this rare lesion when confronted with a lymphocytic background from either benign or malignant lesions.

Selected risk factors, human papillomavirus infection and the p53 codon 72 polymorphism in patients with squamous intraepithelial lesions in northeastern Thailand.

Risk factors for cervical squamous intraepithelial lesions (SIL) including human papillomavirus (HPV) infection and the p53 codon 72 polymorphism were investigated in a case-control study with 103 cases and 105 controls in Northeastern Thailand. Increased risk for SIL was observed for age at menarche (odds ratio (OR) = 2.2; p< 0.005), age at the first sexual intercourse (OR=2.4; p< 0.05), number of sexual partners (OR=2.7; p< 0.005) and partners' smoking history (OR=2.3-3.2; p< 0.01). Prevalence of malignant type of HPV infection in the control and SIL groups was 18.1% and 60.2%, respectively. HPV infection significantly increased risk for SIL 6.8-fold (p< 0.001). HPV-16 infection was the commonest (31 out of 62 carriers) in SIL patients and highly associated with risk. The p53 codon 72 polymorphism was not identified as a genetic risk for SIL in this study, as demonstrated in Thai cervical cancer. Therefore, to prevent cervical neoplasia or HPV infection, inclusion of knowledge on sexual behavior and effects of smoking into public health programs is important and, at the same time, a nation-wide screening scheme for cervical abnormalities including HPV-typing is a high priority in Thailand.

Risk factors and histological outcome of abnormal cervix with human papilloma infection in northeastern Thai-women.

This study aimed to investigate the histological outcome of cervix with human papillomavirus (HPV) infection and the association of risk factors with cervical intraepithelial neoplasia (CIN) and invasive cervical carcinoma (ICC) development in Northeast Thai women. The study population (n=210) comprised 71 cases of normal cervix, 71 cases of CIN and 68 cases of ICC. The histological outcome of HPV infection was determined for 9.5% of the study population. Increased risk factors for CIN were observed for more than one partner (odds ratio (OR)=3.75, p<0.05), history of sexually transmitted disease (STD) (OR=2.28, p<0.05), menarche under 14 years of age (OR=0.31, p<0.05) and partners' smoking history (OR=3.98, p<0.01). Increased risk for ICC was observed for those with a history of STDs (OR=0.14, p<0.01) and multiparity (OR=2.53, p<0.01). Age at first sexual intercourse was not a risk factor in this study population. Further studies with HPV-DNA tests should more precisely quantify the risks.

Human papillomavirus genotypes and the p53 codon 72 polymorphism in cervical cancer of Northeastern Thailand.

Human papillomavirus (HPV) infection including sub-strain identification was studied in patients with squamous cell cervical cancer (SCCA) in Northeastern Thailand. Subjects were 90 cases of SCCA and 100 healthy controls. Prevalence of high-risk group of HPV infection in the controls and the SCCA patients were 13.0% and 86.7%, respectively. The HPV infection significantly increased the risk for cervical cancer 43.5-fold (95% confidential interval: 17.5-110.6; P <0.00001). Among HPV carrier patients with SCCA (n = 78), HPV-16 was also prominent (70.5%) followed by HPV-18 (23.1%). There was no statistical difference in the subtype distribution between the SCCA and the control groups. There was no significant association between genotype distribution of the p53 codon 72 polymorphism and HPV infection. HPV infection was confirmed as a critical risk factor for cervical cancer development in Northeast Thailand. Since polymorphism of the p53 itself as well as in combination with HPV infection may not be a genetic risk for cervical cancer, much attention should be paid to other risk factors such as sexual behavior and smoking.

Chromosome 3p alterations in northeastern Thai women with cervical carcinoma.

The purpose of this study was to determine the incidence of the loss of heterozygosity (LOH) among normal cervixes, cervical intraepithelial neoplasias (CINs) and invasive cervical cancers (ICCs). DNA samples (136) were obtained from 31 normal cervixes, 49 CINs and 56 ICCs. Four polymorphic microsatellite markers (D3S1300, D3S1351, D3S1478 and D3S4103) covering the chromosome 3p arm, were employed. LOH at one or more loci were identified in: 9/31 (8.1%) normal cervixes, 17/49 (14.6%) CINs and 26/56 (22.1%) invasive cancers. The incidence of the LOH at 3p varied for each locus and ranged from 5.6% for D3S1351 to the highest rate of 16.6% for D3S1300. We thus found that LOH of chromosome 3p can occur in normal cervixes and that incidences increase in CINs and ICCs. Deletion in the 3p14.2 (D3S1300) and 3p21.2 (D3S1478) regions might be an early event and, in fact, necessary for cervical cancer progression. The loss of function of tumor suppressor genes (TSGs) located in these regions may have a sequential effect in cervical cancer carcinogenesis.

Co-risk factors for HPV infection in Northeastern Thai women with cervical carcinoma.

HPV infection is the main cause of cervical cancer; however, factors that promote and maintain HPV infection are still unclear. This study was designed to search for factors responsible for the HPV infection in Northeastern Thai women. A total of 190 volunteers with a normal histopathologic appearance of cervix as controls (n=100) and with squamous cell cervical carcinoma (SCCA) (n=90) were the subjects. Variables of risk factors including sexual behaviors, history of reproduction, history of sexually transmitted diseases and smoking were conducted with self-report and direct interview. Number of sexual partners and smoking history increased the likelihood of high-risk HPV infection. Multiple sexual partners showed significantly higher 3.94-fold risk for HPV infection (95% CI = 1.82-8.82, p-value<0.001). Smoking history of partner increased the risk for HPV infection 3.03-fold (95%CI=1.42-6.58, p-value< 0.002). After OR were adjusted, significant difference was still observed in the number of sexual partners (p-value <0.0001) and smoking history of the partner (p-value<0.005). To decrease the incidence of cervical cancer, we should prevent HPV dissemination and be on the alert for having multiple sexual partners and a partner's smoking habit, which must be included in our public health planning.

Contribution of epigenetic risk factors but not p53 codon 72 polymorphism to the development of cervical cancer in Northeastern Thailand.

Relationships between cervical cancer and risk factors were investigated in Northeastern Thailand. Cases (n = 90) with squamous cell cervical cancer (SCCA) and age matched healthy controls (n = 100) were recruited. The p53 codon 72 polymorphism, proline and arginine allele, was studied by the polymerase chain reaction-restriction fragment length polymorphism. There was no significant difference in the allele and the genotype distribution between the SCCA and the control groups (P > 0.05). Significant difference was observed in the number of sexual partners (P < 0.003) age at the first sexual intercourse (P < 0.03) and number of parities ( P< 0.006). After adjusted by age and p53 genotype, significant difference was still observed in the number of sexual partners (P = 0.017) The partners' smoking increased the risk to develop SCCA. Increased odds ratios were observed when the partner had smoking history both at present (3.31; P < 0.003) and in the past (3.36; P < 0.003). The p53 polymorphism itself may not be a risk factor for cervical cancer in Northeastern Thailand. Much attention should be paid to the presence of other risk factors such as sexual behaviors and smoking habits in the prevention of cervical cancer in this region.