What is the current understanding of treating precancerous lesions of the cervix according to research?

The role of papillomavirus infection in the development of precancerous diseases and cervical cancer is known. Bacterial vaginosis was found to induce the deficiency of immune response of the vaginal mucosa surface. This disease is a frequent satellite of papillomavirus infection. Colposcopy and cytology are routinely used in the detection of precancerous processes of the cervix. A biopsy is used to confirm the diagnosis, thereby reducing the invasiveness of treatment and related complications. A study of the possible role of bаcterial vaginosis in the pathogenesis of cervical intraepithelial lesion and cervical cancer in patients with human papillomavirus infection was performed. 126 reproductive-aged women were enrolled in the study, 30 of them were practically healthy and included in Group I. In Group II, 46 women with pathological processes of the uterine cervix and human papillomavirus infection were observed. In group III, there were 50 patients with cervical intraepithelial lesions, human papillomavirus infection and bacterial vaginosis. The vaginal discharge bacterioscopy, colposcopy, cytology, quantification and typing of vaginal commensals by polymerase chain reaction were done in the study population. It was found that even with the normal type of cytological smear, chronic cervicitis was observed in 17.7 % of patients, and cervical intraepithelial neoplasia in 11.5 %. The sensitivity of cytological Pap smears with respect to the diagnosis of cervical intraepithelial neoplasia and cervical cancer was 86.5 %, and specificity 70.0 %. The incidence of cervical intraepithelial neoplasia and cervical cancer was 42.0 % and 23.3% in Group III and Group II, respectively. The presence of bacterial vaginosis in patients with papillomavirus infection was a possible factor that increased the risk of diagnosing cervical intraepithelial neoplasia and cervical cancer by 15.8 %. This result demonstrates the necessity for further study of vaginal biotope disorders in women with papillomavirus infection and associated cervical intraepithelial neoplasia and cervical cancer.

Cervical cancer is one of the most common gynecological malignancies and has a great impact on women's health. Cervical intraepithelial neoplasia (CIN) is a precancerous lesion of cervical cancer and is closely related to each other. Therefore, early detection and treatment of cervical intraepithelial neoplasia can effectively prevent the occurrence and development of cervical cancer. TCM treatment of CIN has the advantages of less side effects and high safety. In this study, through collating the understanding of CIN in TCM, the diagnosis of CIN, and the treatment of CIN, we explore the advantages of TCM treatment methods, and at the same time, early and effective prevention of cervical cancer, to provide reference and reference for modern medical treatment of CIN.

Objective To explore the clinical efficacy of the combination of the vaginal and high frequency electric wave loop(LEEP) in the treatment of cervical precancerous lesions. Methods The clinical data of 76 cases with cervical precancerous lesions confirmed by postoperative pathological examination were collected, Pathologic biopsy was conducted under colposcope. For patients with operative indication, LEEP operation was carried out under colposcope and analyzed vaginal microscopic pathological biopsy diagnosis accurate rate. The operation time, bleeding volume and treatment were observed. Results Satisfactory colposcopy and biopsy results difference had statistical significance; colposcopy with biopsy diagnosis accurate rate was 90.79%.The average operation time was (6.42±1.21)min. The mean operative bleeding was (10.45±2.31)mL. Postoperative 3 months, TCT negative rate was 95.83%(92/96). After 6 months of TCT negative rate was 100.00%(76/76). Conclusion LEEP combined with vaginal cytology in the treatment of cervical precancerous lesions has less invasion, less bleeding, shorter hospitalization time, and can effectively remove the lesion site, it is worthy of recommending. Key words: Precancerous lesion; Vaginal cytology; LEEP operation; Cervical

Background. The relevance of the problem is supported by the lack of effective secondary prevention measures against human papillomavirus (HPV)-associated cervical intraepithelial neoplasia (CIN) and cervical cancer. The only currently verified treatment for lower genital neoplasia is destructive therapy, with the recurrence rate of viral infection remaining quite high even after such interventions. The preventive role of HPV vaccine at pre-existing cervical lesions is actively debated worldwide, but the evidence remains scattered and contradictory. The present study surveys the scientific publications available that evaluate the efficacy of human papillomavirus vaccination as a secondary prevention measure against related cervical pathology.Objectives. An evidence survey on the efficacy of adjuvant vaccination against human papillomavirus in patients undergoing destructive therapy for cervical intraepithelial neoplasia.Methods. We have conducted a 10 year-depth review of scientific literature on the adjuvant human papillomavirus (HPV) vaccination efficacy for reducing the recurrence risk of precancerous cervical neoplasia. The results are presented in form of the difference of mean or pooled 95% confidence-interval odds ratios (OR; 95% CI). Statistical analyses were conducted with Review Manager v. 5.4 (The Cochrane Collaboration, 2020).Results. Thirteen Russian- and English-language studies were selected for final analysis. A total of 21,702 cervical dysplasia patients were included: 5,941 (27.4%) received a perioperative HPV vaccine, while 15,761 (72.6%) only had surgical treatment. Recurrences of CIN I (mild cervical intraepithelial neoplasia; OR 0.45, 95% CI 0.27–0.73; p = 0.001) and CIN II (moderate cervical intraepithelial neoplasia; OR 0.33, 95% CI 0.20–0.52; p <0.0001) were lower in the vaccinated vs. unvaccinated cohort.Conclusion. Adjuvant HPV vaccination associates with a lower risk of recurrence in cervical intraepithelial neoplasia. Further research is necessary to shed more light on the role of human papillomavirus vaccination as a secondary prevention measure against its associated lesions.

HIGHLIGHTS 1. One of the most prevalent disease in females worldwide is cervical cancer.2. Simple and safe modality with high efficacy to treat cervical precancerous lesions before being progressed to cancer is necessary. 3. Trichloroacetic acid (TCA) has those advantages, so it will become an effective treatment for cervical precancerous lesions in the future. ABSTRACT Cervical cancer becomes one of the most prevalent disease in female worldwide. Human papillomavirus (HPV) is main etiology of cervical cancer, thus this disease is preventable. Before progressed into invasive cervical cancer, cervical precancerous lesions developed and classified into 3 stages: CIN1 (LSIL), CIN2, and CIN3 (CIN2+ also referred as HSIL). World Health Organization (WHO) arranged ‘screen-and-treat’ programme to treat cervical precancerous lesions immediately before it progressed to cancer. However, a simple and safe modality with high efficacy is necessary to accommodate this strategy. Trichloroacetic acid (TCA) has those advantages and some research suggested high efficacy to treat cervical precancerous lesions with simple, safe, and cost-effective. TCA has potential to become effective treatment for cervical precancerous lesions in the future.

Aims. Worldwide, cervical cancer is the fifth most deadly cancer in women, but screening prevents cancer by detecting precancerous lesions. The purpose of this study is to present the treatment profile for precancerous lesions of the uterine cervix, according to demographic data. Methods. An annual retrospective study was conducted in two public primary health care centres in Greece. The total number of Pap smears and colposcopies performed as well as the management of women with cervical intraepithelial neoplasia was collected and analysed. Results. Demographic characteristics and correlations with levels of Cervical Intraepithelial Neoplasia (CIN) and treatment path are presented. For each case, we noted the patients' age, the marital and educational status, and the professional and insurance type. From a total of 238 diagnostic procedures, 118 (49.5%) showed precancerous lesions, 83.3% of these were high grade while 16.7% were low grade. Conclusions. This study provides an estimate of the extensiveness of precancerous lesions of the uterine cervix. Management of CIN should be accounted for when balancing the benefits and unfavourable effects of this screening.

Several molecular biomarkers (p16INK4a,Ki-67,and so on) are abnormally expressed in cervical precancerous lesions,many of which are involved in human papilloma virus (HPV)-induced molecular alterations.Cervical intraepithelial neoplasia (CIN) can not accurately predict the possibility of progress in precancerous lesions.Atypical squamous cells of undetermined significance (ASCUS) and low-grade squamous intraepithelial lesions (LSIL) are often over-treated clinically,while it lacks accurate screening methods to identify the precancerous lesions with high possibility of progression.Combining cytology diagnosis with biomarkers can help predict the progress of precancerous lesions and distinguish benign lesions which are difficult to identify morphologically.It appears promising to consider biomarkers as potential cervical precancerous lesions screening method. Key words: Cervical intraepithelial neoplasia; Biomakers; p16INK4a; Ki-67; HPV

Cervical intraepithelial neoplasia (CIN) is the most common pre-malignant lesion. Atypical squamous changes occur in the transformation zone of the cervix with mild, moderate or severe changes described by their depth (CIN 1, 2 or 3). Cervical intraepithelial neoplasia is treated by local ablation or lower morbidity excision techniques. Choice of treatment depends on the grade and extent of the disease. To assess the effectiveness and safety of alternative surgical treatments for CIN. We searched the Cochrane Gynaecological Cancer Group Trials Register, Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library), MEDLINE and EMBASE (up to November 2012). We also searched registers of clinical trials, abstracts of scientific meetings and reference lists of included studies. Randomised controlled trials (RCTs) of alternative surgical treatments in women with cervical intraepithelial neoplasia. Two review authors independently abstracted data and assessed risks of bias. Risk ratios that compared residual disease after the follow-up examination and adverse events in women who received one of either laser ablation, laser conisation, large loop excision of the transformation zone (LLETZ), knife conisation or cryotherapy were pooled in random-effects model meta-analyses. Twenty-nine trials were included. Seven surgical techniques were tested in various comparisons. No significant differences in treatment failures were demonstrated in terms of persistent disease after treatment. Large loop excision of the transformation zone appeared to provide the most reliable specimens for histology with the least morbidity. Morbidity was lower than with laser conisation, although the trials did not provide data for every outcome measure. There were not enough data to assess the effect on morbidity when compared with laser ablation. The evidence suggests that there is no obvious superior surgical technique for treating cervical intraepithelial neoplasia in terms of treatment failures or operative morbidity.

In recent years, with the application of cervical cytology and virological screening methods, the early diagnosis and treatment of cervical precancerous lesions and cervical cancer emerge an encouraging trend. But, the prevention and control situation is still not optimistic because the overall incidence of cervical cancer has not declined in our country. High-grade cervical intraepithelial neoplasia is a precancerous lesion and an inevitable stage of cervical cancer. It is necessary to detect and treat the cervical lesion in blocking the occurrence of cervical cancer. At present, cervical conization resection plays an important role in the diagnosis and treatment of cervical precancerous lesions and derives a variety of different types of cervical conization. This article briefly elucidates the relevant issues and its future of this operation. Key words: Cervical conization; High-grade cervical intraepithelial neoplasia; Hysteroscopy

BACKGROUNDCervical cancer is the third most common gynecological malignancy in Saudi women with an estimated incidence rate of 1.9 cases per 100 000 women-years. More than 40% of cervical cancer cases are diagnosed at advanced stages due to lack of a routine screening program in Saudi Arabia. Thus, national guidelines for routine screening and treatment of precancerous cervical lesions are needed.METHODSThe Saudi Centre for Evidence-Based Healthcare invited a panel of local experts and partnered them with a team from McMaster University in Canada for methodological support, to develop national clinical practice guidelines on the screening and treatment of precancerous lesions for cervical cancer. After the panel identified key clinical questions, the McMaster University working group updated existing systematic reviews that had been used for the 2013 WHO Guidelines for screening and treatment of precancerous lesions for cervical cancer prevention. Recommendations were based on the GRADE (Grading of Recommendations, Assessment, Development and Evaluation) approach. Those recommendations took into account the available evidence, patient values and preferences, and resource use in the Saudi context. The panel provided recommendations on two major issues: screening for precancerous lesions (cervical intraepithelial neoplasia 2 & 3) and treatment of those lesions to prevent cervical cancer in women who tested positive after screening.CONCLUSIONSThe Saudi expert panel recommends using the HPV DNA test followed by colposcopy or cytology (Pap test) followed by colposcopy to screen for CIN2+ in women at risk of cervical cancer. The panel recommends cryotherapy or loop excision electrosurgery procedure (LEEP) over cold knife cone biopsy to treat women at risk of cervical cancer that tests positive for CIN2+. Universal screening for precancerous cervical dysplasia in women in Saudi Arabia is recommended using HPV testing and or cytology. Either cryotherapy or LEEP are preferred for treatment.LIMITATIONSNational studies on cervical cancer screening modalities and treatment of precancerous cervical lesions, including HPV prevalence and its association with cervical cancer, are scarce.