Random biopsy in colposcopy-negative quadrant is not effective in women with positive colposcopy in practice.

AIM: To assess the efficacy of random biopsy in diagnosing those high-grade squamous intraepithelial lesions or carcinomas (HSIL+) missed by colposcopy-directed biopsy, and to identify the scenarios of cervical cancer screening when random biopsy is necessary. PATIENTS/INTERVENTIONS: Data from 1997 women who participated in the Shanxi Province Cervical Cancer Screening Study I (SPOCCS I) were reviewed. Each woman received human papillomavirus (HPV) testing with the second-generation hybrid capture, liquid-based cytology, four-quadrant biopsy and endocervical curettage. The final diagnosis was based on the most severe pathological result obtained. The efficacy of random biopsy and colposcopy-directed biopsy was evaluated on the basis of the final pathological results. RESULTS: For women with severe cytological abnormalities (HSIL+) and negative colposcopy, the yield of HSIL+ diagnosed by random biopsy was 25%. On the other hand, the yield of HSIL+ diagnosed by random biopsies in the negative quadrant was no more than 4% when the colposcopy was positive, regardless of the cytological findings. For women with negative HPV, no HSIL+ was found by random biopsy. For women with severe cytological abnormalities (HSIL+) and positive HPV, the yield of HSIL+ diagnosed by random biopsy was 35% when colposcopy was negative. For women with low-grade intraepithelial lesion (LSIL) and positive HPV, the yield of HSIL+ diagnosed by random biopsy was 12.5% when colposcopy was negative. CONCLUSION: Random biopsy is not effective in the negative quadrant in women with positive colposcopy, but should be performed in women with cytological HSIL+ but negative colposcopy, or in those with cytological LSIL or HGSL+ and positive HPV but negative colposcopy.

Human papillomavirus genotype distribution in cervical intraepithelial neoplasia grades 1 or worse among 4215 Chinese women in a population-based study.

PURPOSE: To estimate the burden of human papillomavirus (HPV) infection and cervical disease among sexually active women in a sample of Chinese women. METHODS: A multicenter, population-based study was conducted between May 2006 and April 2007. A total of 4215 sexually active women aged 17-54 years were surveyed from five geographical sites representing both urban and rural areas: Beijing, Shanghai, Shanxi, Henan and Xinjiang. Women were referred for colposcopy on the basis of results of Pap testing and HPV screening. HPV genotyping of the CIN1+ specimens was performed with INNO-LiPA. Attribution of HPV types to lesions was estimated using a fractional contribution approach. RESULTS: 13.3% of the women (559/4215) were referred for colposcopy; 4.3% (183/4215) of these were diagnosed with CIN1+. Of the latter, 88.5% (162/183) were typed and 94.4% (153/162) were HPV-positive. HPV16 was the most prevalent type in lesions in both urban and rural settings. Combined, HPV16 and 18 were attributable to 71.4% of HPV-positive CIN2+ lesions. In addition, HPV31, 33, 52 and 58 were prevalent in CIN1+ lesions, with HPV33, 52, and 58 combined accounting for 24.1% CIN2+ lesions. Though prevalent, HPV31 always occurred as a co-infection with another HPV type and therefore was attributed minimal causality. CONCLUSIONS: HPV16 and 18 are associated with the majority of cervical lesions in Chinese women from which this population-based sample was drawn. In addition, other HPV types, such as 33, 52, and 58, also play an important role in cervical disease.

[Clinical study of delivery method in modified vaginal hysterectomy for large uterus].

OBJECTIVE: To prospectively explore the techniques, feasibility and safety of modified vaginal hysterectomy for large uterus. METHODS: A total of 158 patients undergoing hysterectomy at Beijing Hospital from January 2008 to December 2010 were divided into three groups: 12-16 gestational weeks large uterus for vaginal hysterectomy (n = 65, group 1), 12-16 gestational weeks uterus for abdominal hysterectomy (n = 47, group 2) and <10 gestational weeks uterus for vaginal hysterectomy (n = 46, group 3). The pattern and techniques of delivery in group 1 was based on the location of fibroids/adenomyoma (in anterior wall, posterior wall, uterine horn or broad ligament, cervix) and the direction of overall shape maximum diameter (direction towards abdomen defined as long type while the direction towards lateral pelvic wall wide type). The completion and safety were observed intraoperatively. The outpatient follow-up period was 1 month. RESULTS: A total of 158 cases of hysterectomy were performed successfully. The locations of fibroids/adenomyoma included anterior wall (n = 17), posterior wall (n = 24), unilateral uterine horn (n = 6), broad ligament (n = 3) and cervix (n = 2). in group 1, and there were long (n = 6) and wide (n = 7) types. They were all successfully delivered through vagina through various techniques. No case was converted into laparotomy. The average largest size (judged by as large as number of gestational weeks) and weight of uterus was group 2 and followed by group 1. But the difference of size and weight between two groups was insignificant (P > 0.05). Sorted by mean operative duration, mean amount of bleeding and decrease of hemoglobin, the declining order was the group 2, group 1 and group 3. The amount of bleeding for group 1 was less than that for group 2 (P < 0.05). But it was more than group 3 (P > 0.05). According to postoperative hospitalization duration, flatus time and indwelling catheter time, no statistical differences existed between groups 1 and 3. But the values of group 1 were significantly better than those of group 2 (P < 0.01, <0.05, <0.01). CONCLUSION: Vaginal hysterectomy is a safe and effective option for removing enlarged uterus. This pattern of operation can reduce the postoperative hospitalization time, flatus time and indwelling catheter time.

[Expression and clinical values of HPV L1 and p16INK4a protein in uterine cervical lesions].

OBJECTIVE: To analyze the expression and clinical values of HPV L1 capsid protein and p16INK4a protein in uterine cervical lesions. METHODS: Fifty-four cervical intraepithelial neoplasias CIN1, 44 CIN2, 78 CIN3, and 48 squamous cell carcinoma were included in this study. All CIN and squamous carcinomas were stained with anti-HPV L1 capsid protein antibodies and anti-p16INK4a antibody. Forty-five CIN1 patients were followed up for 6 years. RESULTS: Forty-five CIN1 patients were followed up for 6 years, among them 6 cases showed a progression (One case changed to CIN3, 5 cases to CIN2). L1 positivity was found in 50 cases which decreased with CIN increasing (χ(2) = 259.923, P < 0.001) while p16INK4a positivity was found in 177 cases which co-increased with CIN (χ(2) = 48.842, P < 0.001). L1(-)p16INK4a (-) or L1(+)p16INK4a(-) appeared mainly in CIN1 while L1(-)p16INK4a(+) appeared mainly in CIN2 lesions. No progression was found in the group of L1(-)p16INK4a(-) CIN1 patients. The risk of CIN1 progression in L1(-)p16INK4a(+) group was 66.7% while L1(+)p16INK4a(-) group was 9.5%, and L1(+)p16INK4a(+) group was 33.3%. CONCLUSIONS: The expression of p16INK4a together with HPV L1 are different in various cervical lesions, and the combined detection of p16INK4a and HPV L1 can be helpful for estimating the biological potentiality of CIN lesions.

[Vaginal repair operation for anterior pelvic organ prolapse in elderly women].

OBJECTIVE: To identify the safety and efficacy of individualized vaginal surgery for anterior pelvic organ prolapse (POP) in elderly women so as to provide a clinical basis for studies on improving life quality by treatment in elderly women. METHODS: The individuation group consisted of 90 patients with a diagnosis of anterior POP. All over 60 years old, they underwent individualized vaginal surgery. The safety and efficacy, POP quantitative examination POP-Q change, cure and recurrence rate and life quality scores on incontinence and pelvic floor distress and impact were assessed. The control group (n = 60) was composed of patients (> 60 yr old) with a diagnosis of anterior POP were performed with Kelly-Kennedy operation. Their safety, efficacy, cure and recurrence rates were compared. RESULTS: Individualized vaginal surgery in elderly women was both safe and effective. The post-therapeutic recovery time was shorter (P < 0.05), the cure rate higher and the recurrence rate lower (P < 0.05) than that of control group. The life quality after individualized surgery improved (P < 0.01). CONCLUSION: The individualized vaginal surgery is safe and effective for a correction of anterior POP in elderly women. The life quality improves after operation.

[Expression pattern of E-cadherin and p120-catenin in infiltrating lobular carcinoma and ductal carcinoma of the breast and its significance].

OBJECTIVE: To determine how patients with infiltrating lobular carcinoma (ILC) differ from patients with the more common infiltrating ductal carcinoma (IDC), and observe the different expression patterns of E-cadherin and p120-catenin proteins in both ILCs and IDCs. METHODS: The patients with ILC admitted to our hospital from Jan 1999 to Dec 2006 and patients with IDC from Jan 2000 to Dec 2000 were included in this study. All their pathological slides were reviewed, and their clinical data and treatment variables were analyzed retrospectively. Then the expression patterns of E-cadherin and p120-catenin proteins in both ILCs and IDCs were detected by immunohistochemistry on tissue microarray. RESULTS: The 5-year overall survival was 81.7% for ILCs and 79.1% for IDCs (P = 0.055). The 5-year disease-free survival was 61.8% for ILCs and 83.7% for IDCs (P < 0.001). Cytoplasmic localization of p120-catenin and loss of E-cadherin expression were more common in ILCs than in IDCs. The complete losses of E-cadherin in ILCs and IDCs were 55.6% (20/36) and 20.4% (45/221, P < 0.001), respectively. The p120-catenin showed a diffuse cytoplasmic localization in 66.7% (24/36) of ILCs and 16.3% (36/221) of IDCs (P < 0.001). Interestingly, the cytoplasmic localization of p120-catenin was clearly associated with the absence of E-cadherin expression in ILCs (P = 0.002), cytoplasmic localization of p120-catenin and absence of E-cadherin expression were observed 55.6% (20/36) in ILCs compared with 4.1% (9/221) in IDCs (P < 0.001). CONCLUSION: ILC has several specific biological and prognostic characteristics which are different in IDC. Different expression patterns of E-cadherin and p120-catenin proteins can be helpful to recognize ILC from IDC.

[Differential diagnostic value of B72.3, Ber-EP4 and calretinin in serous effusions].

OBJECTIVE: To determine the diagnostic value of B72.3, BerEP4 and calretinin in differentiating metastatic carcinoma cells from reactive mesothelial cells (RMC) in serous effusions by using immunocytochemical method (ICC), and to investigate the feasibility of ThinPrep (TP) preparation for ICC. METHODS: One hundred fifty eight serous effusion specimens were examined by ICC on cell block (CB) sections (CB-ICC) using antibodies against of B72.3, BerEP4 and calretinin. Fourty-nine of the samples, ICC on ThinPrep slides (TP-ICC) and CB-ICC were performed concurrently. RESULTS: The sensitivities of B72.3 and Ber-EP4 for detecting carcimoma cells were 76.9% and 69.2% respectively, and when combined the sensitivity was increased to 89.7%. The sensitivity and specificity of Calretinin for detecting mesothelial cells were 90.9% and 87.2% respectively. The sensitivity of B72.3 in differentiating cancer cells from reactive mesothelial cells by CB-ICC and TP-ICC was 78.9% and 68.4%. It was 78.9% and 68.4% of BerEP4 respectively. No statistical significance was observed between CB-ICC and TP-ICC in differentiating metastatic carcinoma cells from reactive mesothelial cells. CONCLUSION: The combination of antibodies of B72.3, Ber-EP4 and calretinin is quite helpful as an auxiliary in differentiating metastatic carcinoma cells from reactive mesothelial cells. ThinPrep preparation slides may effectively replace the cell block sections for ICC in differential diagnosis of serous effusions.