Cervical Abnormalities Research Articles

Cytomorphological Variations in Pap Smears amongst Postmenopausal Women Reporting at a Tertiary Care Centre, Tamil Nadu, India

Introduction: In developing countries, cervical cancer is the leading cause of death amongst women. Since women spend one third of their lives in the postmenopausal period, which is most neglected phase, needs a technically simple, non invasive and, cost-effective screening tool for cervical cancer detection and the exact answer is the Pap smear screening test. This simple screening test when performed at regular intervals in post menopausal population, can detect precursor lesions there by reducing cervical cancer morbidity and mortality. Aim: This study was undertaken to evaluate the cytomorphological variations in Pap smears amongst postmenopausal women. Materials and Methods: In this prospective study, a total of 138 satisfactory smears were considered for study amongst 146 postmenopausal women from August 2020 to July 2022 at Bhaarath Medical College and Hospital and then evaluated and categorised based on Bethesda system for reporting cervical cytology 2014. {Reporting elements include specimen type, specimen adequacy, general categorisation, interpretation/result includes general categories of negative for Intraepithelial Lesion or Malignancy (NILM), epithelial cell abnormalities and other malignancies. Results: Out of 138 satisfactory cases, 78.26% (108 cases) 14.5% (20 cases) and 7.24% (10 cases) were diagnosed as of inflammatory/benign conditions, epithelial abnormalities and normal cytology respectively. The mean age for inflammatory/ benign lesions was 57.5 years and majority presenting with postmenopausal bleeding and white discharge. Amongst epithelial abnormalities Atypical Squamous Cells of Undetermined Significance (ASCUS) and Low-grade Squamous Intraepithelial Lesions (LSIL) were commonest. The incidence of ASCUS 7.27% (10 cases), and incidence of LSIL 2.89% (4 cases). The mean age was 57.5 years and majority of patients presented with postmenopausal bleeding and mass per vaginum. Incidence of High grade Squamous Intraepithelial Lesion (HSIL) was 2.17% (3cases), the mean age was 65.5 years and presented with white discharge and postmenopausal bleeding. Incidence of SCC was 2.17% (3 cases) and the mean age was 70.5 years, presented with, postmenopausal bleeding and white discharge. Conclusion: Pap smear is a simple, cheap, safe and gold standard diagnostic tool for screening postmenopausal women for all cervical abnormalities in particular pre-invasive and invasive lesions.

Older women testing positive for HPV16/18 on cervical screening and risk of high-grade cervical abnormality.

In Australia's HPV-based cervical screening program, we previously showed that risk of histological high-grade abnormality at 1year post screening decreased with age in women with oncogenic HPV. In this study, we followed 878 HPV16/18 positive women aged 55 years and over for up to 3 years post screening test, to determine the proportion with histological high-grade abnormality (HGA, incorporating high-grade squamous intraepithelial abnormality (HSIL), adenocarcinoma in situ (AIS), squamous cell carcinoma (SCC) and adenocarcinoma) and to correlate risk of HGA with liquid-based cytology result and with prior screening history. HGA was detected in 7.8% at 1year and 10.0% at 3 years, with no significant difference (P=.136), despite the number of women with follow-up information significantly increasing from 82.9% to 91.0% (P < .0001). The proportion of HPV16/18 positive women with HGA at 3 years was highest in those with an HSIL cytology result (79.0%) and lowest in those with negative cytology (6.2%). Women with an adequate screening history had fewer HGA than such women with inadequate prior screening (6.6% vs 16.0%, P=.001) or with a history of an abnormality (6.6% vs 14.4%, P=.001). HPV16/18 infection in women over 55 years may have a different natural history from that in younger women, in whom HGA are more common after HPV16/18 detection. In HPV-based cervical screening programs, management algorithms for screen-detected abnormalities based on risk stratification should include factors such as age, screening history and index cytology result, so that women receive appropriate investigation and follow-up.

Cervical Epithelial Abnormalities and Associated Factors among HIV-Infected Women in Lagos, Nigeria: A Cytology-Based Study

Introduction: As it may not be feasible to provide cervical cancer screening services to all HIV-infected women in most resource-limited settings, there is a need to identify those who are most at risk. We determined the prevalence, patterns, and associated factors of cervical cytological abnormalities among HIV-infected women in Lagos, Nigeria. Methods: This descriptive cross-sectional study was conducted among HIV-infected women at the adult HIV treatment and colposcopy clinics of a university teaching hospital in Lagos, Nigeria, between October 2018 and December 2019. A cervical sample was collected from each woman to detect cervical cytological abnormalities. Results: Of the 593 enrolled women, cervical cytological abnormalities were present in 40 (6.7%). Most (37.5%) of the women with cytological abnormalities had atypical squamous cells of undetermined significance. Age at coitarche (<20 vs. ≥20 years: adjusted odds ratio, 2.42; 95% confidence interval, 1.21–4.83, p = 0.01) was the only factor that was independently associated with cervical epithelial abnormalities. Conclusion: The prevalence of cervical cytological abnormalities in our study is lower than most previous reports in Africa. Sexual debut at an early age was significantly associated with cytological abnormalities. It is necessary to confirm the findings of this study through a well-designed and adequately powered longitudinal study.

The Risk Factors for Cervical Cytological Abnormalities Among Women Infected With Non-16/18 High-Risk Human Papillomavirus: Cross-sectional Study.

High-risk human papillomavirus (hrHPV) infection is a necessary cause of almost all cervical cancers. Relative to hrHPV 16/18 infection, non-16/18 hrHPV infection is of less concern. However, the increasing prevalence of non-16/18 hrHPV infections has become an important public health issue. The early identification and treatment of cervical cytological abnormalities in women infected with non-16/18 hrHPV reduces the incidence of cervical cancer. To date, no study has examined the risk factors for cytological abnormalities in this high-risk population. This population-based, cross-sectional study aimed to identify the risk factors for cervical cytological abnormalities in women infected with non-16/18 hrHPV. A total of 314,587 women from the general population were recruited for cervical cancer screening at 136 primary care hospitals in Xiangyang, China. Of these, 311,604 women underwent HPV genotyping, and 17,523 non-16/18 hrHPV-positive women were referred for cytological screening according to the screening program. A logistic regression model was used to assess the risk factors for cytological abnormalities among these non-16/18 hrHPV-positive women. A separate analysis was performed to determine the factors influencing high-grade cytological abnormalities. The non-16/18 hrHPV infection rate was 5.88% (18,323/311,604), which was 3-fold higher than that of hrHPV 16/18 (6068/311,604, 1.95%). Among the non-16/18 hrHPV-positive women who underwent ThinPrep cytologic test, the overall prevalence rates of cervical cytological abnormalities and high-grade cytological abnormalities were 13.46% (2359/17,523) and 1.18% (206/17,523), respectively. Multivariate logistic regression analysis revealed that women with middle or high school educational attainment were at a higher risk of having cytological abnormalities than those who received primary education (odds ratio [OR] 1.31, 95% CI 1.17-1.45; P<.001, and OR 1.32, 95% CI 1.14-1.53; P<.001, respectively). Living in rural areas (OR 2.58, 95% CI 2.29-2.90; P<.001), gravidity ≥3 (OR 2.77, 95% CI 1.19-6.45; P=.02), cervix abnormalities detected in pelvic examination (OR 1.22, 95% CI 1.11-1.34; P<.001), and having a cervical cancer screening 3 years ago (OR 0.79, 95% CI 0.62-1.00; P=.048) were associated with cytological abnormalities. The risk factors for high-grade cytological abnormalities included middle school education (OR 1.45, 95% CI 1.07-1.98; P=.02), living in rural regions (OR 1.52, 95% CI 1.10-2.10; P=.01), and cervix abnormality (OR 1.72, 95% CI 1.30-2.26; P<.001). The dominant epidemic of non-16/18 hrHPV infection is revealed in Chinese women. Multiple risk factors for cervical cytological abnormalities have been identified in women infected with non-16/18 hrHPV. These findings can provide important information for clinically actionable decisions for the screening, early diagnosis, intervention, and prevention of cervical cancer in non-16/18 hrHPV-positive women.

High-risk human papillomavirus in Turkish patients with clinically suspicious cervical lesions analyzed by multiplex-PCR.

Human papillomavirus (HPV) infection is known to be the main cause of cervical cancer. This study aimed to determine the prevalence of high-risk HPV genotypes in smear specimens taken from women who had normal or abnormal cytology using a multiplex PCR method. The study included 270 women aged between 19 and 69 yr with or without suspicious cervical abnormalities. A Pap smear sample from each patient was cytologically examined, and HPV typing was performed using a multiplex fluorescent PCR method. Those who were high-risk HPV positive and had a normal or abnormal cytology were further evaluated by colposcopy and biopsy. The total HPV positivity was 43 per cent (116/270). HPV positivity in the patients with an abnormal cytology was 77 per cent (33/43), whereas it was only 37 per cent (83/227) in women with normal cytology, which showed a significant difference (P<0.05). HPV positivity was also related to the age group when all the subjects were considered (P<0.05), and the highest prevalence of HPV infection was in the 30-39 yr age group. High-risk HPV types 16, 18, 31, 35, 51 and 56 were more common in the normal cytology patients, whereas high-risk HPV types 16, 31, 35, 45, 58 and 68 were commonly found in the abnormal cytology patients. The determination of high-risk HPV genotypes in women with clinically suspicious cervical lesions should be conducted during an annual follow-up, irrespective of a normal or abnormal cytology by the age of 30 years or above.

Surgical and Reproductive Outcomes in Patients with Complete Septate Uterus and Cervical Anomalies after Metroplasty

<h3>Study Objective</h3> to evaluate surgical and reproductive outcomes in patients with complete uterine septa with or without cervical anomalies undergone hysteroscopic metroplasty. <h3>Design</h3> Multicenter prospective observational cohort study. <h3>Setting</h3> Gynecological departments of participating centers. <h3>Patients or Participants</h3> 64 infertile women with ultrasonographic and hysteroscopic diagnosis of complete septate uterus with or without cervical anomalies (group A: U2bC1 + U2bC2 (n=34); group B (n=30): U2bC0 according to ESHRE/ESGE classification system) from January 2018 to December 2021. <h3>Interventions</h3> in-patient hysteroscopic metroplasty with 26Fr or 15Fr resectoscope or 5mm hysteroscope with 5Fr instruments; a second surgical step was performed when at postsurgical 3D ultrasonography a residual septum was detected (Y + Z > 15 mm). <h3>Measurements and Main Results</h3> Surgical outcomes (operative times; intra- and post-operative complications; surgical satisfaction); Reproductive outcomes (clinical pregnancy rate [CPR], live birth rate [LBR], miscarriage rate [MR]). All the surgical procedures were performed without any significant complication. 18/27 (67%) patients in group A and 9/18 (50%) in group B required a second surgical step. Operative times were statistically lower in group B (12.4 min ± 2 SD vs 27min ± 8 SD, p-value:0.034); less surgical difficulty was reported by clinicians in group B. Reproductive outcomes were evaluated for 36 patients (mean follow-up 20 months) and have shown significant differences between two groups; indeed, CPR was 36% in group A and 64% in group B (p. value 0.01). <h3>Conclusion</h3> Hysteroscopic metroplasty is an effective and safe procedure for the treatment of complete septate uterus with or without cervical abnormalities; a second surgical step is often required for the optimal treatment of these anomalies. Surgical outcomes are better in the group of patients without cervical anomalies, regardless of the instrumentation used. The presence of cervical anomalies seems to significantly affect reproductive outcomes.

Prevalence of cervical high-risk human papillomavirus and cytological abnormalities in elderly Turkish women

Objective: Cervical cancer (CC) screening ends at the age of 65 in Turkey, as in many countries. However, about a quarter of CCs occurs in women over the age of 65. Persistent high-risk human papillomavirus(HR-HPV) infection is the most important factor leading to CC. In this study, we aimed to investigate the prevalence of cervical HR-HPV and cytological abnormalities in Turkish women aged 65 and over. Patients and Methods: A total of 467 women between the ages of 66-84 who were referred to the gynecology outpatient clinics for any reason between January 2010 and December 2021 were included in the study. Pap smears (liquid-based) of patients were screened for HPV DNA typing using the COBAS test system and evaluated cytopathologicaly. Results: The mean age of women was 72.4 years. The prevalence of HR – HPV was 5.1% (n = 24), HPV-16 and HPV-18 subtypes constituted 58.4% of all positive cases. The rate of cervical HR-HPV and cytological abnormalities were not statistically different between age groups. Of the women with a positive HR-HPV test in Pap smear, cytological abnormalities were found to be more frequent when compared to HR-HPV negatives (95.8%, n=23 vs 4.3%, n=19, p&amp;lt;0.00001). Conclusion: We demonstrated a strong correlation between HR-HPV positivity and cytological abnormality in the elderly women population. Age groups were not significantly different regarding the prevalence of HR-HPV and abnormal cytology. We also revealed that the prevalence of HR-HPV and cytological abnormalities in the elderly population were not high enough to explain the second peak of cervical cancer seen in older ages. More studies are needed to explain which testing methods should be used in the elderly patient population.

Bacterial Vaginosis Decreases the Risk of Cervical Cytological Abnormalities.

Neither vulvovaginal candidiasis nor bacterial vaginosis was found to increase the incidence of cervical cytologic abnormalities with or without the presence of HPV. On the contrary, bacterial vaginosis may play a role in preventing cytologic abnormalities in women with HPV coinfection.

S891 Risk of Cervical Dysplasia/Cancer in Patients With Inflammatory Bowel Disease: A Systematic Review and Meta-Analysis

Introduction: There is inconsistent and conflicting evidence regarding the risk of cervical dysplasia/cancer in patients with inflammatory bowel disease (IBD). This systematic review was conducted to determine the risk of cervical abnormalities in patients with IBD and also estimate the comparative risk with respect to the general population. Methods: We searched various databases for studies which reported about rates of cervical intraepithelial neoplasia(CIN), cervical cancer or high risk HPV in IBD patients. We also extracted the rates of CIN, cervical cancer and high risk HPV in controls. Pooled prevalence of these lesions in IBD and relative risk in IBD patients in comparison to the healthy controls was estimated. We excluded studies which did not provide relevant data. All analysis were done in R version 4.1.1 using the meta and metafor packages. The random effects model was used with inverse variance approach for pooled prevalence and M-H method for calculation of relative risk. Results: We searched Embase, Medline and Pubmed and identified 522 relevant papers on 25th April 2022. Duplicates were removed and after initial screening, 44 papers were selected for full text screening. Eventually, 9 papers (5 case control and 4 cohort studies of 53,781 patients with IBD) were included in the quantitative synthesis. The pooled prevalence of CIN, cervical cancer and high risk HPV in the IBD population was 0.04 (0.01 - 0.11, I2= 100%). Patients with IBD were at a greater risk of cervical dysplasia/cancer when compared with healthy controls (relative risk 3.01, 1.44 - 6.31, I2= 100%). Conclusion: The patients with inflammatory bowel disease are at a heightened risk of developing cervical abnormalities like CIN,cervical cancer and high risk HPV lesions as compared to normal controls. These findings point to the importance of undergoing screening at regular intervals and significance of HPV vaccination in IBD patients in aiding to reduce the risk of developing cervical cancer.

Association Between Hormonal Contraceptives and Cervical Neoplasia in Local Population of Khyber Pakhtunkhwa

Background: Hormonal contraception and the risk of developing cervical cancer is a contentious topic. These debates may reduce the popularity of hormonal birth control. Objectives: The goal of this study is to assess the prevalence of Cervical Smear abnormalities among Peshawar's multiethnic population in relation to the usage of hormonal contraceptives. Methods: This was a Case Control Study conducted on the females visiting DHQ Teaching Hospital Swabi, RHSC (A) KTH, HMC, LRH and FWC’s in district Peshawar who were persistent long-term users for more than 5 years of any type of hormonal contraception. The study was conducted during the period from 1st August, 2021 to 30th January, 2022. We made two groups, one who had never used any method of contraception and the other persistent users of hormonal contraception. After approval from ethical committee and an informed consent of the client, enrollment in the study was made. Results: A total of 300 patients were included in this study. 150 were cases whereas 150 were controls. Mean and SDs For Age 30+4.6 28+4.92. In the hormonal group, for type of contraceptives used, 98 (65.33%) patients used injectable, 40 (26.66%) patients used OCP whereas 12 (8%) patients used implants. As per frequencies and percentages for duration of use of contraceptives in the hormonal group, 120 (80%) were using different types of contraceptives for less than or equal to seven years whereas 30 (20%) were found using contraceptives for more than seven years As per frequencies and percentages for smear results in both groups, only 3 (2%) patients were found having atypical smear results who using injectable contraceptives for more than seven years however in the control group only 02 (1.33%) patient were having atypical smear results. Conclusion: Our research did not identify any correlation between using birth control and having an abnormal Pap smear. Additional prospective research is needed. Keywords: Pap smear, Abnormal, and Oral Contraceptive Pill (OCP).

Is the Physiological Composition of the Vaginal Microbiome Altered in High-Risk HPV Infection of the Uterine Cervix?

Background: Cervical cancer is the fourth most common malignancy and fourth leading cause of cancer death in women worldwide. More than 99.7% of cases are caused by human papillomavirus (HPV), while HPV types 16 and 18 cause over 70% of all cervical cancer cases. In this preliminary study, we aimed to investigate the presence of HPV infection and diversity of bacteria associated with bacterial vaginosis. Methods: Cervical swabs (n = 21) taken from women aged 21–47 years, in seventeen cases, with different degrees of cervical abnormality, and from four healthy women, were tested for the presence of HPV DNA, as well as the bacterial strains associated with bacterial vaginosis, using the real-time PCR method. Results: HPV16 was the dominant genotype in 53% (9/17) of patients with confirmed precancerous lesions (ASCUS, LSIL, and HSIL). In specimens with confirmed cytological abnormalities and hrHPV infection, we detected a wide diversity of microbes, while the most common species were Gardnerella vaginalis, Atopobium vaginae, Prevotella bivia, Ureaplasma parvum, Ureaplasma urealyticum, Leptotrichia amnionii, Bacteroides ureolyticus, and Sneathia sanguinegens. The presence of pathogens did not differ, depending on the degree of precancerous lesions or HPV type. Conclusion: In our work, HPV16 dominated in patients with cervical precancerous lesions. We also suggest an increased bacterial diversity of the vaginal microbiome in patients with cervical lesions, for which the HPV virus is largely responsible.

Clinical Performance of the RealTime High Risk HPV Assay on Self-Collected Vaginal Samples within the VALHUDES Framework.

ABSTRACTThe VALHUDES framework (NCT03064087) was established to evaluate the clinical accuracy of HPV testing on self-samples compared with HPV testing on matched clinician-taken cervical samples. Women referred to colposcopy due to previous cervical abnormalities were recruited at five Belgian colposcopy centers. A total of 486 pairs of matched cervical samples and vaginal self-samples were included in the analysis (228 collected with Evalyn Brush and 258 with Qvintip). The dry vaginal brushes were transferred into 20 mL ThinPrep PreservCyt solution. All specimens were tested with the Abbott RealTime High Risk HPV assay (Abbott RT). Testing on vaginal and cervical specimens was considered the index and comparator tests, respectively, and colposcopy and histology as the reference standard. The clinical sensitivity for CIN2+ of Abbott RT (cutoff ≤32 cycle number [CN]) on vaginal self-samples (Evalyn Brush and Qvintip combined) was 8% lower than on the cervical clinician-collected samples (ratio = 0.92 [95% CI, 0.87 to 0.98]), while the specificity was similar (ratio = 1.04 [95% CI, 0.97 to 1.12]). Sensitivity (ratio = 0.95 [95% CI, 0.89 to 1.02]) and specificity (ratio = 1.11 [95% CI, 0.995 to 1.23]) on Evalyn Brush samples was similar to cervical, while on Qvintip samples, the sensitivity was 12% lower than cervical samples (ratio = 0.88 [95% CI, 0.78 to 0.998]) with similar specificity (0.99 [95% CI, 0.90 to 1.10]). Exploratory cutoff optimization (cutoff ≤35 CN) resulted in an improvement of the relative sensitivity (self-sampling versus clinician sampling: ratio = 0.96 [95% CI, 0.91 to 1.02]) but yielded a loss in relative specificity (ratio = 0.92 [0.85 to 1.00]). The clinical accuracy of Abbott RT differed from the self-sampling device. However, after cutoff optimization, the sensitivity on self-samples taken with either of two vaginal brushes became similar to clinician-collected samples.IMPORTANCE Self-samples are becoming a crucial part of HPV-based cervical cancer screening programs to reach nonattendee women and increase screening coverage. Therefore, the VALHUDES framework was established to validate and evaluate HPV tests and devices on self-samples. Here, in the present manuscript, we evaluated the accuracy of the RealTime High Risk HPV assay (Abbott RT) on two different vaginal devices to detect cervical intraepithelial neoplasia grade two or higher (CIN2+). The study results demonstrated that the Abbott RT assay is similarly accurate on vaginal self-samples as on matched clinician-taken cervical samples after adjusting cutoff values. Moreover, we observed that some vaginal devices perform better than others in CIN2+ detection. We also underline the necessity of standardization and validation of general workflow and sample handling procedures for vaginal self-samples.

Evaluation of Urine and Vaginal Self-Sampling versus Clinician-Based Sampling for Cervical Cancer Screening: A Field Comparison of the Acceptability of Three Sampling Tests in a Rural Community of Cuenca, Ecuador.

Self-sampling methods for HPV testing have been demonstrated to be highly sensitive and specific. The implementation of these methods in settings with a lack of infrastructure or medical attention has been shown to increase the coverage of cervical cancer screening and detect cervical abnormalities in the early stages. The aim of this study is to compare the acceptability of urine and vaginal self-sampling methods versus clinician sampling among rural women. A total of 120 women participated. Each participant self-collected urine and vaginal samples and underwent clinician sampling for Pap smear and HPV testing. After the sample collection, a questionnaire to qualify the device, technique, and individual acceptability was applied, and the additional overall preference of three sample tests was evaluated. Results: The characteristics of the participants were as follows: median age of 35 years; 40.8% were married; 46.7% had a primary level of education; median age of sexual onset of 17.6 years. Compared with clinician sampling, both vaginal self-sampling, OR 20.12 (7.67–52.8), and urine sampling, OR 16.63 (6.79–40.72), were more comfortable; granted more privacy: vaginal self-sampling, OR 8.07 (3.44–18.93), and urine sampling, OR 19.5 (5.83–65.21); were less painful: vaginal self-sampling, OR 0.07 (0.03–0.16), and urine sampling, OR 0.01 (0–0.06); were less difficult to apply: vaginal self-sampling, OR 0.16 (0.07–0.34), and urine sampling, OR 0.05 (0.01–0.17). The overall preference has shown an advantage for vaginal self-sampling, OR 4.97 (2.71–9.12). No statistically significant preference was demonstrated with urine self-sampling versus clinician sampling. Conclusions: Self-sampling methods have a high acceptance in rural communities. Doubts on the reliability of self-sampling often appear to be a limitation on its acceptability. However, the training and education of the community could increase the uptake of these methods.

SELLA TURCICA BRIDGING IN PATIENTS WITH GORLIN-GOLTZ SYNDROME AND ITS IMPLICATIONS

Patients with Gorlin-Goltz syndrome, also called nevoid basal cell carcinoma syndrome (NBCCS), can present sella turcica bridging (STB), which has been associated with the development of dental and cervical vertebral anomalies. In our clinical cases series, we analyzed skull and cervical spine x-rays of 7 patients with NBCCS and STB. Three patients had STB associated with dental (agenesis, tooth impaction, hyperdontia, diastemata, microdontia, gyroversion, and supernumerary teeth) and cervical (rudimentary cervical discs and ossification of the nuchal ligament) anomalies, 3 had STB associated with dental alterations (tooth impaction, gyroversion, and agenesis), and 1 had STB associated with cervical abnormality (partial fusion of the vertebrae). The pathogenic mutation of genes (PTCH1, PTHC2, or SUFU) involved in the main pathway related to embryonic development, sonic hedgehog, promotes accumulate changes in the neural crest cells of patients with NBCCS, which phenotypically express as STB and dental and cervical vertebrae anomalies.

Long-term human papillomavirus vaccination effectiveness and immunity in Rwandan women living with and without HIV: a study protocol

IntroductionProphylactic human papillomavirus (HPV) vaccines have been shown to be highly effective in protecting women against cervical infections, high-grade abnormalities and cancer caused by the targeted HPV types. However, the...

Clinical Correlation between Cervical Cancer Screening Using Pap Smear Test

Objective: The study's objective is to evaluate the effectiveness of the Pap smear screening procedure for identifying precancerous lesions. Study Design: Prospective study Place and Duration: Department of Pathology, Nishtar Medical University Multan, From 1st October, 2021 to 31 March, 2022. Methods: There were 162 females had age 18-50 years were presented in this study. All of the women were given a complete physical examination, including a speculum exam and a vaginal exam, and their medical histories were recorded. Women's cervical cancer screenings often involved a Pap smear. Using an Ayre spatula, a smear was collected and spread over a labelled glass slide before being stored in 95% ethyl alcohol and delivered to the Pathology Department for cytopathological testing. SPSS 24.0 was used to analyze all data. Results: Among 162 females, 45 (27.8%) had age 18-30 years, 73 (45.1%) were aged between 31-40 years and 44 (27.2%) patients had 41-50 years. Mean BMI of the females was 22.4 ±6.52 kg/m2. Frequency of smokers was 4 (2.5%). Most common complaint was vaginal discharge, followed by irregular menstrual cycle and abdominal pain. We found that 63 (32.7%) cases had no pathology, frequency of inflammatory was 49 (30.2%) cases, atypical squamous cells of undetermined significance (ASUS) was 28 (17.3%), low-grade squamous intraepithelial lesions (LSILs) was 8 (4.9%) and high-grade squamous intraepithelial lesions (HSILs) was 5 (3.1%). As per HPV, low risk and high risk virus was found in 11 (6.8%) cases. Conclusion: The Pap smear is an easy, quick, and inexpensive way to check for cervical epithelial precancerous abnormalities. It has the potential to be employed as a routine screening tool, leading to better treatment outcomes and lower death rates. Increased detection of these lesions is facilitated by the Pap test and the HPV-PCR test. Keywords: Cervical Cancer, Pap smear Test, HPV, Pathology

Effectiveness of human papillomavirus vaccine against cervical precancer in Japan: Multivariate analyses adjusted for sexual activity.

Japanese girls aged 12–16 years are offered free human papillomavirus (HPV) vaccination and cervical cancer screening is conducted with cytology and not HPV testing from the age of 20 years. So far, no study has analyzed the effect of HPV vaccination against cervical precancers considering HPV infection status and sexual activity. We aimed to analyze the vaccine effectiveness (VE) against HPV infection and cytological abnormalities, adjusted for sexual activity. This study comprised women aged 20–26 years who underwent cervical screening in Niigata. We obtained HPV vaccination status from municipal records and a questionnaire along with information concerning sexual activity. Of 5194 women registered for this study, final analyses included 3167 women in the vaccinated group (2821 vaccinated women prior to sexual debut) and 1386 women in the unvaccinated group. HPV 16/18 (0.2% vs 3.5%), 31/45/52 (3.4% vs 6.6%), and 31/33/45/52/58 (5.0% vs 9.3%) positive rates were significantly lower in the vaccinated group (P < 0.001). No women vaccinated before sexual debut had HPV 16/18‐related cytological abnormalities. VE for HPV 16/18 infection and high‐grade cytological abnormalities in women vaccinated prior to sexual debut were 95.8% (95% CI 81.9–99.0%; P < 0.001) and 78.3% (95% CI 11.3–94.7%; P = 0.033), respectively, in multivariate analyses adjusted for age and number of sexual partners. However, analyses of all vaccinated women did not show significant effectiveness against cytological abnormalities. Our results showed the effectiveness of HPV vaccine against high‐grade cervical cytological abnormalities and the importance of the vaccination before sexual debut.

A comparison of high-grade cervical abnormality risks in women living with and without human immunodeficiency virus undergoing routine cervical-cancer screening

As the US moves increasingly towards using human papillomavirus (HPV) testing with or without concurrent cytology for cervical cancer screening, it is unknown what the corresponding risks are following a screening result for women living with HIV (WLWH), which will dictate the optimal clinical follow-up. Therefore, using medical records data from Kaiser Permanente Northern California, which introduced triennial HPV and cytology co-testing in women aged 30–64 years in 2003, we compared risks of cervical intraepithelial neoplasia grade 2 (CIN2) or more severe diagnoses (CIN2+) in women not known to have HIV (HIV[−] women) (n = 67,488) frequency matched 111:1 on age and year of the first co-test to the 608 WLWH (n = 608). WLWH were more likely to test HPV positive (20.2% vs. 6.5%, p < 0.001) and have non-normal cytology (14.1% vs. 4.1%, p < 0.001) than HIV[−] women. Five-year CIN2+ risks for all WLWH and HIV[−] women were 3.5% (95%CI = 2.0–5.0%) and 1.6% (95%CI = 1.5–1.8%) (p = 0.01), respectively. Five-year CIN2+ risks for WLWH with positive HPV and non-normal cytology, positive HPV and normal cytology, negative HPV and non-normal cytology, and negative HPV and normal cytology were 24.9% (95%CI = 13.4–36.4%), 3.0% (95%CI = 0.0–7.4%), 3.6 (95%CI = 0.0–9.8%) and 0.3% (95%CI = 0.0–0.8%), respectively. Corresponding 5-year CIN2+ risks for HIV[−] women were 26.6% (95%CI = 24.6–28.7%), 8.5% (95%CI = 7.2–9.9%), 1.9% (95%CI = 1.0–2.8%), and 0.5% (95%CI = 0.4–0.6%), respectively. Thus, in this healthcare setting, the main cause in overall CIN2+ risk differences between WLWH and HIV[−] women was the former was more likely to screen positive and once the screening result is known, it may be reasonable to manage both populations similarly.

Multiple High-Risk HPV Types Contribute to Cervical Dysplasia in Ugandan Women Living With HIV on Antiretroviral Therapy.

Cervical cancer mortality remains high in sub-Saharan Africa, especially among women living with HIV (WLWH). Characterization of prevalent high-risk human papillomavirus (hrHPV) types and immune function in WLWH with cervical abnormalities despite antiretroviral therapy (ART) can inform prevention strategies. Kampala, Uganda. From 2017 to 2020, we enrolled Ugandan women with cervical dysplasia detected with visual inspection with acetic acid (VIA). WLWH were required to be on ART >3 months with plasma HIV RNA <1000 copies/mL. Biopsies from VIA-positive lesions underwent histopathologic grading and cervical swab specimens were tested for hrHPV. Clinical correlations were evaluated with Poisson regression to estimate adjusted prevalence ratios (aPR). One hundred eighty-eight WLWH and 116 HIV-seronegative women participated. Among WLWH, median ART duration was 6 years and median CD4 667 cells/µL. Cervical intraepithelial neoplasia (CIN) grade 2/3 was found in 29% of WLWH versus 9% of HIV-seronegative women. In women with CIN1 or without histopathology-confirmed dysplasia, hrHPV (aPR [95% confidence interval]: 2.17 [1.43 to 3.29]) and multiple hrHPV (aPR 3.73 [1.07 to 13.1]) were more common in WLWH, as were vaccine-targeted and vaccine-untargeted hrHPVtypes. Differences in hrHPV prevalence by HIV serostatus were not observed in women with CIN2/3 (interaction P < 0.01). Among WLWH, low CD4/8 ratio was associated with hrHPV while detectable plasma HIV RNA (20-1000 copies/mL) was associated with CIN2/3 or invasive cancer. Despite ART, WLWH with cervical VIA abnormalities remain at elevated risk for multiple hrHPV and high-grade dysplasia. Cervical cancer prevention and research tailored for WLWH are warranted in the ART era.

P-466 Decellularization of whole organ human cervix: Physio and biochemical aspects of decellularized extracellular matrix

Abstract Study question Can the whole organ-cervix be decellularized while maintaining its fiber ultrastructure and extracellular matrix (ECM) functionality? Summary answer Cervix after decellularization could maintain the physical properties, ECM was found to be intact and functional. What is known already ECM-rich bioscaffolds are obtained from the process that utilizes the decellularization of tissues and organs. Cervical bioengineering is needed for clinical cervicovaginal reconstruction and tissue constructs can help women with cervical abnormalities. Study design, size, duration Human cervices were obtained from hysterectomized samples from 3 women undergoing surgery for complete hysterectomy during January 2021 to December 2021 Participants/materials, setting, methods Human cervices were obtained from hysterectomized samples from 3 women undergoing surgery and were subjected to whole organ decellularization. Various physical, chemical methods were employed to remove cellular remnants for a period of 10 days via perfusion of ionic and detergent solutions. Validation of complete decellularization was done via hematoxylin and eosin (H&amp;E) staining, DNA quantification. ECM functionality was observed. Main results and the role of chance Well-organized ECM was obtained. Effective complete decellularization was dictated and verified by cervical tissue density, histopathological studies, DNA quantification and biochemical tests. H&amp;E staining reflected the absence of any nuclear material in the endocervical and ectocervical tissues. Tissue microarchitecture and descending uterine artery were intact and could be helpful in the nutrient and gas exchange. DNA was found to be around 70 ng/mg tissue weight. Cell-free tissue-derived scaffolds were obtained along with a combination of growth factors and proteins. Limitations, reasons for caution Acellular cervical scaffold as a whole organ with vasculature intact for site-specific transplantation is a bigger question and still unaddressed. Wider implications of the findings Our study creates numerous prospects for in-vitro and in-vivo whole cervix tissue engineering. Site-specific tissue holds a promising avenue for the reconstruction of cervical abnormalities. Trial registration number Not applicable