Cancerous Lesions Of Cervix Research Articles

The cytological pattern of cervical papanicolaou smear in a tertiary hospital of India

Background: Cervical cancer continues to be listed among the top gynecologic cancers worldwide. According to current data, it is ranked fourteenth among all cancers and fourth-ranked cancer among women worldwide. In India alone 1,30,000 new cases occur with the death toll of 70,000 per year. A “PAP’ test should be performed during the second half of the menstrual cycle (Day 14). The patient is placed in lithotomy position and the cervix is visualized by means of a speculum. The smaller end of the Ayre’s spatula is introduced through the external os and the squamocolumnar junction is scraped by rotating the spatula to 360°. Aims and Objectives: The objective of the study is to evaluate the use of the Pap smear screening method for detection of precancerous lesions. Cervical cancer accounts for 15% of all cancers in females. If treated or detected earlier, cervical cancer can be prevented. Materials and Methods: This study was done on 1000 patients during reproductive and later age groups (postmenopausal), attending Obstetric and Gynaecological Outpatient Department of Panna Dhai Hospital associated with RNTMC, Udaipur during the period of November 2012–April 2014 with history of white discharge per vagina, bleeding per vagina, pain in lower abdomen and post coital bleeding. Results: Most of the smears (90.1%) were NILM and 9.9% of smears showed cytological abnormality. Majority 834 (83.4%) of smears were inflammatory, Bacterial vaginosis was seen in 119 cases (11.9%), Candidiasis in 78 cases (7.8%), Trichomoniasis in 35 cases (3.5%), Atrophic vaginitis in 4 cases (0.4%) and Radiation changes in 4 cases (0.4%). There were 99 samples reported as having epithelial cell abnormality. Out of which 75 were LSIL, 14 were high grade squamous intraepithelial, 5 were atypical squamous cells (ASC)-US, 1 was ASC-H and 4 were squamous cell carcinoma. Conclusion: Due to high sensitivity, specificity and accuracy found in this study Pap test is proved to be highly useful to detect precancerous and cancerous lesions of cervix. From the above facts, it can be concluded that early diagnosis and prompt specific treatment of preinvasive or early stages of the disease (mainly in high risk women), reduces the prevalence of invasive carcinoma of uterine cervix.

Assessment of Two Mass Screening Campaigns for Pre-Cancerous and Cancerous Lesions of the Uterine Cervix using Colposcopy

Objectives: Study the epidemiological profile of patients seen for colposcopy, specify the indications for colposcopy, describe the lesions encountered and their treatment and determine the factors associated with cervical lesions. Material and methods: This was a cross-sectional study conducted during October 2021. It concerned 2 “fairground” campaigns for systematic mass screening of pre-cancerous and cancerous lesions of the cervix at the Institute of social Hygiene in Dakar and at the Inter-Army Medical Center in Thiès. The parameters studied were the epidemiological data, the results of the colposcopic examination and histology. Data analysis was performed with Excel 2010 and Epi info 7.2. softwares. Results: During the two mass screening campaigns, we performed 50 colposcopic examinations. The epidemiological profile was a woman aged 45 on average, married (86%), multiparous (54%), in period of genital activity (54%) with a first sexual intercourse made on average at 22 years old. All the patients had benefited from a visual inspection with acetic acid and lugol. Visual inspection with acetic acid and lugol showed 15 positive VIA (30%), 14 positive VIL (28%) and 21 cases of positive VIA and VIL (42%). Colposcopy was satisfactory in most patients (78%). It found 36% atypical grade 2 transformation, 10% atypical grade 1 transformation, 2% association of atypical grade 1 and 2 transformation and 10% viral colpitis. We also recorded 18% of normal colposcopy. In our series, the majority of patients in whom the VIA and VIL tests were positive presented at colposcopy either an atypical grade 2 transformation lesion (72.2%) or a ATG 1+2 lesion (5.5%). This rate was only 14.3% in those who only had the positive IVA test and 50% in the case of positive VIL. A biopsy under colposcopy was performed in 20 patients (40%). Of these, only 5 (25%) had brought back the results. It was a CIN 2 and 4 normal results. A multivariate analysis allowed us to find that TAG 2 lesions were more frequent in patients aged 45 and over (60%) (p=0.46), primiparous (100%) (p=0.62), those who had had first sexual intercourse before the age of 20 (69.2%) (p=0.39) and who had not used a contraceptive (88.9%) (p=0.13). Conclusion: Mass screening campaigns constitute in our developing countries an opportunity to diagnose and treat pre-cancerous and cancerous lesions of the cervix. However, it will be necessary to sensitize the patients screened for a better adhesion to the follow-up.

Cyto-histo correlation of conventional Pap smear with cervical biopsy in diagnosis of precancerous and cancerous lesions of cervix

Introduction: Carcinoma of uterine cervix is the third most common cancer among women worldwide and it contributes significantly to cancer related morbidity and mortality. The incidence of cervical carcinoma is incredibly high in developing countries (almost 80%) due to lack of proper knowledge. The extensive use of cervical screening with Pap smears has considerably increased the detection of precancerous and cancerous lesions of uterine cervix. Aims: To evaluate cyto-histo correlation of precancerous and cancerous lesions of uterine cervix and to calculate the sensitivity and specificity of Pap smear in diagnosing invasive malignancy. Materials and Methods: This was a retrospective observational study conducted in the Department of Pathology, Chirayu Medical College & Hospital, Bhopal from January 2013 to April 2018. All the cases reported in Pap smear as cervical intraepithelial lesions and invasive malignancies were retrieved. We also retrieved the same cases, if they had undegone cervical biopsy for correlation. Result: During the study period total 303 cases which were positive for intraepithelial lesions and malignancies were retrieved. Out of these 303 cases we excluded 23 cases because in these cases cervical biopsy had not been done. So in the final analysis 280 cases were included. Of the 280 Pap smears, maximum cases (33.92%) were reported as low grade squamous intraepithelial lesion (LSIL), followed by high grade squamous intraepithelial lesion (HSIL) (24.28%), atypical squamous cells of undetermined significance (ASCUS) (19.64%), atypical squamous cells – cannot rule out HSIL (ASC-H) (10%). We had 23 cases of invasive malignancy which includes 21 cases of squamous cell carcinoma (SCC) and 2 cases of adenocarcinoma. There were 11 cases of atypical glandular cells of undetermined significance (AGUS). We found that total numbers of concordant cases were 68.57% (192/280) and discordant cases were 31.43% (88/280). We also found that sensitivity and specif

EVALUATION OF PAP SMEARS BY CONVENTIONAL CYTOLOGY AND CORRELATION WITH CLINICAL AND HISTOPATHOLOGICAL FINDINGS

Introduction: Cervical cancer is considered preventable, as majority of cancers are preceded by a long-standing precancerous lesion. This lesion may exist in the non-invasive stage for years and shed abnormal cells that can be detected on cytological examination.
 Aims: The study was carried out with aim to evaluate cervical smears for epithelial abnormalities and study the relationship of cervical smear findings with clinical features like age, parity, vaginal discharge, lower abdominal pain, backache, postcoital bleeding, infertility, postmenopausal bleeding and also Correlate cervical smear findings with cervical biopsy. Material and methods: All the pap smears received from the gynecology department from 2013 to 2015 were included in the study. In each case, personal information and clinical history were recorded. Correlation with histopathological findings was done in cases where cervical biopsy was available.
 Results: The mean age of the women was 31 years. Normal pap smear was reported in 8.33%. The most common finding reported was inflammatory pap smear.(75%) Highest incidence of premalignant lesion (LSIL) was noted in women with parity 5 and above. The most common presenting complaint was discharge per vaginum which was present in 54 (39.13%) cases. Of the total 60 biopsies, 45 were reported as chronic cervicitis and 11 as LSIL, 2 as HSIL and 2 were normal. Conclusion: This study establishes the importance of conventional cervical Pap smear test in cervical cancer screening for diagnosis of precancerous and cancerous lesions of cervix especially in India where majority of population is rural-based and belong to low socioeconomic group.

ROLE OF PAP SMEAR AS A SCREENING TEST IN PRECANCEROUS AND CANCEROUS LESIONS OF CERVIX.

Introduction: A pap smear is a simple, co-effective, non invasive screening test in detecting precancerous and cancerous lesion of cervix and also useful for early detection and implementation of appropriative treatment in pre invasive cervical lesions. Early epithelial changes are recognised by pap smear test. Based on pap smear results to educate the women regarding symptoms of cervical cancer. Aim: Based on results of study, to differentiate between pre invasive and invasive carcinoma of cervix. Materials and Methods: The present study was done over a period of three years period (February 2016 - January 2019). The total number of 966 cases was studied in department of pathology, Government medical college, Kadapa. All the cases were categorised based on cyto-morphological features of pap smear. Requirement of materials: Cervical smears, coupling jars, suitable fixative is Isopropyl alcohol, Alcohol fixed slides were taken for Papanicolaou stain. Results: The present study done on total 966 cases, out of these inflammatory lesions were 628 cases (65.01%), ASCUS were 228 cases (23.60%), LSIL were 62 cases (6.41%), HSIL were 28 cases (2.89%) and malignancy seen in 20 cases (2.07%). Predominate age group in ASCUS and LSIL was fourth decade. HSIL was seen in Fifth decade. Depending on clinical data predominant cases 760cases (78.67%) were presented with leucorrhoea.
 Keywords: Cervical smears, Papanicolaou stain, Cervical lesions

Immunocytochemical staining of cervical smears – A comparative study with routine cytology for confirmation of precancerous and cancerous lesions of cervix

Introduction: Carcinoma cervix is one of the leading causes of morbidity and mortality. The most effective method of screening is based on Pap smear study. However, Pap smear has relatively low sensitivity and irreducible false negative & false positive rates. In countries like India, it is not always feasible to follow the patient for confirmation by histology. In the present study, we have tried to fill this gap by staining the cervical smears with, epithelial cell markers including CK17 and CEA expressed by dysplastic squamous cells. Materials & Method s: 50 cervical smears reported as precancerous or cancerous were stained with anti CK17 and anti CEA. The patients were followed for histopathology. Results: Out of 20 cases of ASCUS, three were positive both for anti-CK17 and anti-CEA and six were positive for anti-CK17 only. Out of 18 cases of LSIL, nine were positive for both anti-CK17 and anti-CEA and fifteen were positive for anti-CK17 only. Out of eight cases of HSIL, three were positive for both anti-CK17 and anti-CEA and six were positive for anti-CK17 only. Out of 4 cases of SCC, three were positive for both anti-CK17 and anti-CEA and all four were positive for anti-CK17. Conclusion: Positive result in staining was higher in high grade lesions. CK 17 was found to be better marker than CEA. CK17 and CEA can be used as adjunct to Pap smear screening but its high cost may restrict its use in routine.

Comparative analysis of p53 and p21 proteins in normal cervix and HPV associated precancerous and cancerous lesions of cervix

IntroductionHPV-E6 oncoprotein of High-Risk HPV plays critical role in the degradation of p53 protein for acquisition of malignant phenotype in cervix cells. The present study, was sought to analyze the expression of HPV-E6, p53 and p21 in cervical cancer to explore possible impact of HPV-E6 in the modulation of these proteins. MethodsThe expression of HPV16/18-E6, p53 and p21 proteins in cervix tissues [normal (n = 100), cervical intraepithelial neoplasia (CIN; n = 67), squamous cell carcinoma (SCCs; n = 153)] was analyzed by immunohistochemistry and revalidated by Western Blotting. The p53 protein functionality was determined by using phosphospecific p-p53-ser46 antibody. ResultsThe negative expression of HPV-E6 and p53 but, mild immunoreactivity of p21 was noticed in normal stratified squamous epithelium. In CIN and SCCs, the HPV-E6 was found to be predominantly over-expressed in 80.0% and 84.9% of cases respectively. Significant nuclear accumulation of p53 was observed in 77.6% of precancerous and 83.0% of cancerous tissues whereas, 74.6% of CIN and 73.8% of SCCs represented loss of nuclear p21 expression as compared to normal (p = 0.0001, p = 0.0001). Pearson's correlation test revealed significant inverse association between p53 and p21 proteins both in CIN (p = 0.0001) and SCCs (p = 0.0001). Interestingly, significant positive association of HPV-E6 with p53 and negative association with p21 were also detected in CIN (p = 0.0001) and SCCs (p = 0.0001). No positive expression of p-p53-ser46 was detected in any of the cases. DiscussionThe present study provides the evidences of inhibition of p53 and p21 transactivity by HPV-E6 resulting alteration of cell growth inhibitory signals in cervical cancer.

Optical Imaging: Future Tool in Detection of Pre-cancerous and Cancerous Lesions of Cervix and Its Comparison to Colposcopy

To study the diagnostic potential of optical imaging and its comparison with colposcopy, in detecting early cervical dysplasia. The study was conducted on 200 patients attending the outdoor of UISE maternity hospital with symptoms suspicious of cervical lesions. All patients were subjected to colposcopy, followed by histo-pathological examination. Out of all HPE, 18 samples each from normal and dysplastic histology were sent to IIT Physics lab, Kanpur for optical imaging. Statistical analysis was done using sensitivity, specificity, PPV, and NPV. Chi square test was applied to calculate p value. In optical imaging, depolarization images had shown significant changes in the epithelium region of the dysplastic tissue as compared to normal one. It is found that the mean value of depolarization power for normal cervix tissues is less than 0.32, while for dysplastic tissues it is greater than 0.32. Optical imaging is fast, non-invasive tool with high sensitivity and specificity, comparable to colposcopy (sensitivity 88.9 vs 100%, specificity 83.3 vs 86.6%) and thus is useful in both for screening and diagnosis of cervical dysplasia.

Visual inspection with acetic acid a screening method for cervical lesions

BackgroundCarcinoma cervix accounts for 12% of all malignancies worldwide. Pap smear is the most popular screening tool to detect cervical lesion since 1960s. However, this screening method requires an established laboratory a trained cytologist and a repeat visit for its report and further evaluation. In 1982 visual inspection after application of acetic acid on the cervix was reported as an alternative method for screening of cervical cancer. Application of 3–5% acetic acid causes dehydration of cells and surface coagulation of proteins in active cells, giving its white appearance called acetowhite areas. MethodWe conducted a cross sectional study in the outpatient Department of Obstetrics and Gynaecology, Sir Ganga Ram Hospital from November 2008 to November 2010. The objectives of this study were to evaluate the utility of visual inspection with acetic acid (VIA) for screening of precancerous or cancerous lesion of cervix and to compare it with papanicolaou smear. ResultsThe prevalence of abnormal smear (more than CIN II) amongst women screened with Pap smear in our study was 5.8%. The sensitivity of VIA and Pap smear in our study to diagnose precancerous and invasive disease was comparable 93.1% vs 86.2%. Both screening tests had low specificity VIA 32.2% and Pap smear 60%. ConclusionWe suggest that VIA with high sensitivity is comparable to Pap smear can be used as an alternative screening test, especially in low resource settings where the expertise for definite tests is not available. The screen and refer approach for further tests can be used, although there are limitations of this method in terms of low specificity and lack of standardization.

Correlation of Cytology and Colposcopic Findings Using Reid's Index in VIA-Positive Women.

Cervical cancer is the most common cancer among Indian women. Only 5% of women in developing countries have ever been screened for cervical abnormalities. To study the correlation of cytology and colposcopy in VIA-positive women attending the Gynaecology clinic. This prospective cross-sectional study on 200 symptomatic women compares the role of cytology and colposcopy in the assessment of subjects testing positive for acetowhite lesions on the cervix after application of 5% acetic acid (VIA). 200/637 women screened in OPD tested VIA positive, giving a positivity rate of 31%. Six smears were reported as LGSIL or HGSIL giving a cytological abnormality rate of 3%. The association between cytology and Reid's score was statistically significant at a p value of 0.02. Of the 4 cases with biopsy-confirmed invasive cancer, cytology reported 2 as LGSIL and 2 as HGSIL. Colposcopy reported all these women as CIN 2/3. The accuracies of Pap smear cytology and colposcopy in the diagnosis of precancerous and cancerous lesions of cervix were good.

Result of Colposcopy among VIA positive cases attending in Colposcopy Clinic of BSMMU

This study was carried out among women attending Gynae out door of BSMMU with different clinical complaints like per vaginal discharge, post coital bleeding, dyspareunia, irregular per vaginal bleeding, backache, abnormal cervix on examination, age between 18-60 years and was advice for VIA test. This test was carried at VIA center. The aim of this study was to evaluate the role of colposcopy for detecting pre cancerous and early cancerous lesion of cervix. Women with positive result were referred for Colposcopy. Colposcopic examination was carried at colposcopic clinic of BSMMU. Women with VIA positive result found in Colposcopic examination underwent colposcopic directed biopsy. Then both sensitivity and specificity of colposcopy was determined and result was compared with other studies of home & abroad. This prospective study was conducted from July 2011 to December 2011 on 164 women attending in "Colposcopy Clinic" of BSMMU. Only VIA positive cases were consideration of the study. Colposcopy evaluated 106 cases as CIN(CIN1- 35.9%,CIN II -25.47%,CIN III -15%) and 3.7% as invasive carcinoma. Biopsy evaluated 36.5% as (CIN I -17%, CIN II-10%,CIN III-9.1%) and 1.2% as invasive lesions. The sensitivity and specificity of Colposcopy were 85.48% and 48.03% respectively.

Undifferentiated embryonic cell transcription factor-1 (UTF1) inhibits the growth of cervical cancer cells by transactivating p27Kip1

Undifferentiated embryonic cell transcription factor-1 (UTF1) is an important transcription factor during development, which plays critical roles in cell fate determination. However, its expression and function in somatic tissues remain unclear. Here, we investigated the expression pattern of the UTF1 in the human normal and cancerous lesions of cervix and found that UTF1 was downregulated in cervical carcinogenesis, which was related to the hypermethylation of UTF1 promoter. Exogenous expression of UTF1 resulted in the significant inhibition of cell proliferation in vitro and tumorigenesis in vivo through attenuating cell cycle arrest via increasing the level of p27 (Kip1) . Luciferase reporter assay indicated that the region containing an intact activating transcription factor site between nucleotides -517 and -388 of the p27 (Kip1) promoter was indispensable for its activation by UTF1. Chromatin immunoprecipitation analysis confirmed the physical interaction between UTF1 and the p27 (Kip1) promoter. Taken together, our findings reveal that UTF1 attenuates cell proliferation and is inactivated in cervical carcinogenesis through epigenetic modification, which strongly supports that UTF1 is a potential tumor suppressor.

The molecular biology of cervical cancer.

Infections with specific high-risk of human papillomavirus constitute a major risk factor in the development of precancerous and cancerous lesions of the uterine cervix. Laboratory studies suggest that the human papillomavirus has a mechanistic role in development of these lesions. The two viral proteins consistently expressed in cervical carcinomas functionally abrogate critical cell cycle regulatory pathways, including those governed by the p53 tumor suppressor protein and the product of the retinoblastoma susceptibility gene, pRB. Subversion of these pathways by viral proteins causes genomic instability, resulting in the accumulation of chromosomal abnormalities followed by clonal expansion of malignant cells. Since continued expression of the papillomavirus proteins is critical for maintenance of the transformed state, they are attractive targets for prevention and therapy of precursor as well as cancerous lesions of the cervix.

Early detection of cervical intraepithelial lesions by simple visual inspection after acetic acid among women in Rajshahi medical college hospital

Aim: To evaluate the performance of visual inspection of acetic acid (VIA) in the detection of precancerous and early cancerous lesions of cervix. Materials and methods: Total 5593 eligible women who randomly came to the Gyenae out patient department (OPD) of RMCH (Rajshahi Medical College Hospital) were examined by VIA. Detection of well defined, opaque, acetowhite lesions close to the squamocolumner junction or in transitional zone or dense acetowhitening of ulceroproliferative growth on the cervix constituted a positive VIA. Those who had abnormal results in screening test & those who had clinically suspicious lesions were sent for colposcopic evaluation (n= 442) & directed biopsy were taken from colposcopically suspected areas (n=214). The final diagnosis was based on histology. Results: Out of 5593 patients, 442 (7.20%) were VIA positive. 442 patients were colposcopically evaluated .Among them, 228 (51.58%) were normal and 202(45.70%) had different stages of cervical intraepithelial lesions (CIN) and 12 ( 2.71 % ) had carcinoma of cervix. Out of 214 patients biopsied, 23.36 % patients had a final diagnosis of CIN lesions, 5 (2.33%) had carcinoma in-situ & 17 cases (7.94%) had invasive carcinoma. Besides to find out the predictable factors of cervical lesions data have been collected from VIA positive patients regarding age of first coitus and first delivery, history of extra marital exposure and STI, use of contraceptive methods and family history of cancer. Age of first coitus between 12 to 15 years and 16 to 20 years were observed among 203 (46 %) and 40 % (177) women respectively. More than half of the patients (62%) were experienced with their first delivery within the age 15-20 years which was below 15 years of 12 % (53) patients. Fifty four percent patients used OCP and barrier methods used were only 10 %. Family history of cancer was observed among 09 % women. 58% patients were belonged to lower middle class and upper group were only 9% (table 1) Conclusion: In our study detection of different grades of intraepithelial lesions (CIN-I, CIN-II, CIN-III, invasive carcinoma) of cervix by VIA was comparable to that of colposcopy. So VIA is suitable for detection of precursor lesions of cervical cancer in low resource settings and also for diagnosis, follow up treatment and epidemiological studies of cervical cancer. Key words: Visual inspection; VIA; cervical carcinoma; colposcopy; screening; epidemiological studies. DOI: http://dx.doi.org/10.3329/bjms.v10i4.9494 BJMS 2011; 10 (4): 240-244