Cervical Biopsy Results Research Articles

Analysing the gene expression profiles of the orphan nuclear receptors NR4A1, NR4A2 and NR4A3 in premalignant lesions of the cervix and cervicitis

ObjectiveThe main objective of the present study was to evaluate the expression of nuclear orphan receptors in the development of Uterine Cervical Cancer (UCC). The principal cause of dysplastic changes in cervical epithelium is the presence of the human papilloma virus leading to the development of cervical intraepithelial neoplasia I (CIN I), high-grade lesions (CIN II and CIN III) and, finally, invasive cancer. Despite the existence of various treatments and vaccines, there is still a high mortality rate. There is evidence of the participation of a group of nuclear receptors called orphans in the development of various diseases, including cancer. Study designThe expression levels of the orphan receptors NR4A1, NR4A2, and NR4A3 were measured using real-time polymerase chain reaction (RT-PCR) in samples obtained through colposcopy from forty-five patients who attended the Medical Oncology Specialties Unit (UNEME) in Mexicali, B.C. ResultsForty-five cervical biopsy results were obtained, indicating cervicitis, CIN I, or CIN III, none of them CIN II. Our results showed that orphan receptors expressed in a specific manner depending on the degree of premalignant lesions. NR4A1 overexpressed in cervicitis (p < 0.05). NR4A3 was significantly expressed in CIN I (p < 0.05) and NR4A2 was expressed in both cervicitis and CIN III (p > 0.05). ConclusionOur data suggest, for the first time, that nuclear receptors might be involved in the various stages that precede the development of invasive UCC.

Chemotherapy for cervical cancer and contraception: discussion issues and clinical case

Cervical cancer occupies one of the leading places in the structure of oncological diseases of the Female Reproductive System. In the treatment of this pathology, along with the surgical method of treatment, chemotherapy and radiation therapy are used. According to clinical guidelines, in the presence of cervical cancer stages IIB–IIIA, it is allowed to carry out 2–4 cycles of neoadjuvant chemotherapy in order to create conditions for the possibility of performing extended hysterectomy according to Meigs. Pregnancy during chemotherapy is unique and extremely rare.The article presents a clinical case of pregnancy during chemotherapy (performed according to the scheme: taxanes and platinum-containing drugs) in a 27-year-old patient. According to the clinical picture and results of cervical biopsy, the diagnosis was made: invasive nonkeratinizing squamous cell carcinoma of the cervix IIB (cT2bNxM0) G2, right-sided parametric variant, nonspecific (with unspecified HPV status). Taking into account the presence of parametrial infiltration, the age of the patient, the oncological council prescribed from 2 to 4 cycles of chemotherapy according to the TC scheme (paclitaxel, carboplatin) with an interval assessment. After the second cycle of chemotherapy, an early pregnancy was diagnosed – a medical abortion was performed. Against the background of 3 cycles of chemotherapy, the conditions for surgical treatment were formed – surgical treatment was performed in the amount of extended hysterectomy according to Meigs (type III according to Piver/C2 Morrow) with transposition of the ovaries. The postoperative period was uneventful; the patient was discharged in a satisfactory condition.The described case of pregnancy on the background of chemotherapy is of scientific and practical interest, initiating a discussion on the need to counsel such patients regarding reliable contraception, taking into account the eligibility criteria, which will avoid undesirable outcomes during cancer treatment.

Reevaluation of negative cervical conizations: Frequency, diagnostic errors, risk factors and management

ObjectiveCervical conization is an effective treatment for precancerous lesions. However, in cases where no high-grade lesion is identified in the surgical specimen, managing these patients may be challenging due to the absence of established follow-up protocols for negative conizations. This study aimed to assess the negative conization rates at our institution by histopathological review, identify diagnostic errors, possible risk and recurrence factors and propose follow-up strategies for this group of patients. MethodsA retrospective study from January-2010 to December-2020 analyzed patients with negative conization including all surgical techniques and procedure indications. Biopsy and cervical conizations slides were reviewed and patients who kept a negative result underwent deeper levels sectioning of the paraffin blocks with immunohistochemical stains application: p16, Ki-67 and geminin. Data were compared with a control group composed by 29 women with CIN3. ResultsOut of 1022 conizations, 186 were negative (18.1%), with 151 cases selected for the study after excluding 35 patients. Following pathology review, 4 patients were excluded due to false-positive cervical biopsy results, 16 for false-negative conization results and 9 for hidden dysplasia identified after deeper sectioning. The remaining 122 patients were considered truly negative cones (11.9%) and exhibited IHC staining with p16 positive in 20.4% of cases, low Ki-67 expression, and low geminin score in most cases. Specimens with CIN 1 had higher prevalence of p16 staining, Ki-67 expression and geminin score when compared to absence of neoplasia, nevertheless geminin had no statistical difference. Older age, higher parity and IHC pattern with negative p16, low Ki-67 and geminin expressions were identified as risk factors for negative cones (p<0.05). Only 10 patients recurred for high-grade lesions, with no statistically significant risk factors identified. ConclusionsThe negative conization rate was 11.9%, with diagnostic errors identified across pre-surgical biopsy, cone specimen, and deeper levels. Risk factors included older age, higher parity, low expression of p16, Ki-67 and geminin (p<0.05). Recurrence represented 8.1% of the negative cones, without identification of statistically significant risk factors. Pathological review with deeper level sections and 2-year follow-up are recommended for patients with negative conizations.

Evaluation of concordance between loop electrosurgical excisional procedure and cervical colposcopic biopsy results

To evaluate the results of loop electrosurgical excisional procedures (LEEP) with colposcopic biopsy results of patients who presented to our hospital for vaginal smears. The LEEP reports of patients who presented to our gynecology clinic between January 2015 and December 2020 were retrospectively evaluated. The data were obtained from electronic patient records and the department of medical pathology archives. A total of 579 patients were evaluated with a mean age of 38.05±6.17 years. Colposcopy-guided biopsy was not taken from 102 patients. The results of the remaining 477 (82.4%) patients were: no dysplasia (n=12; 2.1%), Cervical intraepithelial neoplasia-I (CIN-I) (n=99; 17.1%), CIN-II (n=111; 19.2%), CIN-III (n=248; 42.8%), and cancer (n=7; 1.2%). Completed excision was performed in 87.0% of the patients using LEEP, the lesion was positive at the surgical margins in 10.9%, and the lesion could not be completely excised in 2.1%. The complication rate after LEEP was 3.1% including pelvic pain (n=5; 0.9%) and bleeding (n=13; 2%). The histopathologic results of LEEP were: benign (n=50; 8.6%), CIN-I (n=110; 19.0%), CIN-II (n=89; 15.4%), CIN-III (n=280; 48.4%), cancer (n=7; 1.2%), and metaplasia (n=37; 6.4%). The concordance between colposcopic biopsy and LEEP results was 85.9% for CIN-I, 71.2% for CIN-II, 98.4% for CIN-III, and 85.7% for cancer diagnoses. LEEP is a simple minimally invasive method used in the treatment of CIN, with low persistence, recurrence, and complication rates and increased human papillomavirus clearance in most patients. Our results support the consistency of cervical colposcopic biopsy and LEEP results.

The role of endocervical curettage in the diagnosis of cervical intraepithelial neoplasia in human papillomavirus positive patients.

The role of endocervical curettage (ECC) in the diagnosis of cervical intraepithelial neoplasia (CIN) is a controversial topic. Investigate the role of ECC in the diagnosis of CIN in human papillomavirus (HPV) positive patients. Retrospective. A tertiary training and research hospital. This study included patients who were referred for colposcopy between 2018-2022 because of abnormal screening results. ECC results, age, cytology, HPV status, and colposcopic impression of the patients were extracted from the medical records. Multinomial logistic regression analyses were performed to identify factors that could predict CIN on ECC. The likelihood of high-grade squamous intraepithelial lesions (HSIL) in ECC in patients with cervical biopsy results of normal and low-grade squamous intraepithelial lesion (LSIL). 2895 women. In patients with normal and LSIL cervical biopsy results, HSILs were detected in 6.7% of ECC results. There was no difference in the detection rates of CIN in ECC among groups with smear results negative for intraepithelial lesions or malignancy (NILM), atypical squamous cells of undetermined significance (ASC-US), and LSIL. The likelihood of HSIL being observed in ECC was 2.2 times higher in patients with HPV16. The probability of LSIL disanois was 2.3 times higher in women aged 50-59 years and 2.8 times higher in women ≥ 60 years compared to the reference group of <30 years. The probability of LSIL was 2.3 and HSIL by ECC was 2.2 times higher in both age categories (P<.012 and P=.032, respectively) than the reference group of <30 years. Regardless of colposcopic findings, ECC should be performed in patients with smear results of NILM who are positive for HPV16, in patients with smear results of ASC-US and LSIL who are positive for any oncogenic type of HPV and in patients 50 and above with any result of smear or any oncogenic HPV type. We did not have the components of the HPV types in mixed groups.

The role of cervical elastography in the differential diagnosis of preinvasive and invasive lesions of the cervix.

This study aims to evaluate the role of cervical elastography in the differential diagnosis of preinvasive and invasive lesions of the cervix. A total of 95 women participated in this prospective study and were divided into the following groups: 19 healthy subjects (group 1) with normal cervicovaginal smear (CVS) and negative human papillomavirus test (HPV DNA), 19 women with normal cervical biopsy and normal final pathological result of cervical biopsy (group 2), 19 women with low-grade squamous intraepithelial lesion (LSIL) (group 3), 19 women with high-grade squamous intraepithelial lesion (HSIL) (group 4), and 19 women with cervical cancer (group 5). Clinical, demographic, histopathological, and elastographic results were compared between these groups. Comparing groups, age (40.42 ± 8.31 vs. 39.53 ± 8.96 vs. 38.79 ± 9.53 vs. 40.74 ± 7.42 vs. 54.63 ± 12.93, p < 0.001 respectively), gravida (1.74 ± 1.33 vs. 2.16 ± 1.68 vs. 2.21 ± 1.96 vs. 2.53 ± 1.93 vs. 4.63 ± 2.17 p < 0.001 respectively), parity (1.37 ± 0.68 vs. 1.68 ± 1.20 vs. 1.58 ± 1.30 vs. 2.00 ± 1.67 vs. 3.37 ± 1.61, p < 0.001 respectively), and the proportion of patients at menopause (10.5% vs., 15.8% vs. 10.5% vs. 5.3% vs. 57.9%, p < 0.01 respectively), a statistically significant difference was found (Table1). However, no statistically significant difference was found in the number of abortions, BMI, mode of delivery, smoking, additional disease status, history of surgery, and family history (p > 0.05) (Table2. As a result of the applied roc analysis, mean cervical elastographic stiffness degree (ESD) was found to be an influential factor in predicting cervical cancer (p < 0.05). The mean cut-off value was 44.65%, with a sensitivity of 94.7% and a specificity of 96.1% (Table7). Measurement of ESD by elastography is a low-cost, easily applicable, and non-invasive indicator that can distinguish cervical cancer from normal cervical and preinvasive lesions. However, it is unsuitable for determining preinvasive cervical lesions from normal cervix.

Liquid-Based Cervical Cytology: Monitoring the Laboratory Quality Indicators.

Many developments in cervical cancer screening have happened in the past century, helping women in earlier detection of cervical cancer and its precursors. Cytology still holds the fort as being a specific test, though it suffers in sensitivity. As a part of the quality control program, the aim of the study is to determine the total number of abnormal liquid-based cervical cytology (LBC) at our center and correlate the abnormal LBC with histology and human papillomavirus (HPV) DNA test results. Retrospective analysis of 4286 LBC screening cases was carried out over a period of 5 years. For cytology-histology correlation, cervical biopsy and cytology test results were analyzed. The two-tier grading system for biopsy interpretation was used. HPV DNA test results wherever available were correlated. Of the 4286 LBC cases, 157 samples (3.7%) were unsatisfactory for evaluation, 3915 samples (91.3%) were negative for intra-epithelial lesion or malignancy, and 214 samples (5%) showed epithelial cell abnormality. ASC-US was reported in 60 cases (1.4%), ASC-H in 35 cases (0.8%), LSIL in 47 cases (1.1%), HSIL in 41 cases (1.0%), squamous cell carcinoma in a single case (0.02%), and atypical glandular cells in 30 cases (0.7%). The ASC/SIL ratio was 1.07:1. The CHC major discrepancy was calculated as 16.2%. The concordance of HSIL on cytology and biopsy as a measure of PPV is 94.4%. Of the epithelial cell abnormalities, 24 cases were positive for high-risk HPV (hrHPV). Molecular test results of 2737 samples showed HPV detected in 50 cases, of which 24 cases were positive for hrHPV. The study helped us to analyze the quality parameters of our cytopathology laboratory which are within the acceptable limits.

Predictors factors of the absence of high-grade intraepithelial lesion in excisional therapy specimen.

To identify predictive factors of the absence of high-grade intraepithelial lesion (HGSIL) in cervical excisional therapy specimen. Data from 835 women who underwent excisional therapy for a cervical intra epithelial lesion at the department of Gynaecology from two university hospitals, between January 2015 and December 2020 were reviewed. Demographic data, referral cytology, colposcopic findings, results of cervical biopsy and endocervical curettage were retrieved. Primary outcome was the absence of HGSIL on cervical excisional specimen analysis defined by the identification of no intraepithelial lesion or of low-grade lesion only. The absence of HGSIL on specimen was observed in 137 (16.4%) cases. Three factors were identified to have a significant and independent impact on the probability of the absence of HGSIL on specimen: age higher than 40 years (aOR: 1.8; 95%CI: 1.1-3.0; p=0.024), a small abnormal transformation zone (TZ) (aOR: 2.3; 95%CI: 1.4-3.7; p=0.001) and the result of the cervical biopsy at the time of colposcopic assessment not showing HGSIL (aOR: 8.6; 95%CI: 4.7-15.5; p < 0.001). No significant impact of the referral cytology nor of the colposcopic impression were observed. Although the result of cervical biopsy performed at the time of colposcopic assessment is the key risk factor for the absence of HGSIL on excisional specimen, age over 40 and a small abnormal TZ are the two other identified risk factors. Practitioners should consider these findings when deciding for excisional therapy.

SVM classifier of cervical histopathology images based on texture and morphological features.

Cervical histopathology image classification is a crucial indicator in cervical biopsy results. The objective of this study is to identify histopathology images of cervical cancer at an early stage by extracting texture and morphological features for the Support Vector Machine (SVM) classifier. We extract three different texture features and one morphological feature of cervical histopathology images: first-order histogram, K-means clustering, Gray Level Co-occurrence Matrix (GLCM) and nucleus feature. The original dataset used in our experiment is obtained from 20 patients diagnosed with cervical cancer, including 135 whole slide images (WSIs). Given an entire WSI, the patches on its tissue region are extracted randomly. We finally obtain 3,000 patches, including 1,000 normal, 1,000 hysteromyoma and 1,000 cancer images. Among them, 80% of the entire data set is randomly selected as training set and the remaining 20% as test set. The accuracy of SVM classification using first-order histogram, K-means clustering, GLAM and nucleus feature for extracting features are respectively 87.4%, 90.6%, 91.6% and 93.5%. The classification accuracy of the SVM combining the four features is 96.8%, and the proposed nucleus feature plays a key role in the SVM classification of cervical histopathology images.

The effect of adsorbent-antioxidant vaginal gel on high-risk HPV clearance

Background: The purpose of this study is to investigate the effect of an adsorbent-antioxidant vaginal gel, which contains micronized silicon dioxide and antioxidant deflamin, on high-risk human papillomavirus (hr-HPV) clearance within the follow-up periods specified in the guidelines. Methods: In the study, the data of 52 patients infected with hr-HPV using vaginal gel for 3 months and 115 patients who were not using vaginal gel were analyzed retrospectively. Demographic characteristics, Liquid-Based Cytology (LBC) at the time of presentation, colposcopy findings, and cervical biopsy results of both groups were investigated. After the LBC and hr-HPV results were evaluated at the end of the control period, both groups were compared in terms of hr-HPV clearance. The level of statistical significance was taken as 0.05 in all tests. Results: The two groups had similar demographic data, cytological findings, colposcopy findings, and cervical biopsy results (p &gt; 0.05). During similar follow-up periods (13.6 ± 3.2 vs. 14.1 ± 3.4 months; p &gt; 0.05), there was no significant difference in terms of hr-HPV clearance (46.2% vs. 51.3%; p &gt; 0.05). Furthermore, the initial and follow-up cytology results of the patients were similar (p &gt; 0.05). Conclusions: A significant effect of the absorbent antioxidant vaginal gel on hr-HPV clearance at approximately 1-year follow-up could not be demonstrated.Background: The purpose of this study is to investigate the effect of an adsorbent-antioxidant vaginal gel, which contains micronized silicon dioxide and antioxidant deflamin, on high-risk human papillomavirus (hr-HPV) clearance within the follow-up periods specified in the guidelines. Methods: In the study, the data of 52 patients infected with hr-HPV using vaginal gel for 3 months and 115 patients who were not using vaginal gel were analyzed retrospectively. Demographic characteristics, Liquid-Based Cytology (LBC) at the time of presentation, colposcopy findings, and cervical biopsy results of both groups were investigated. After the LBC and hr-HPV results were evaluated at the end of the control period, both groups were compared in terms of hr-HPV clearance. The level of statistical significance was taken as 0.05 in all tests. Results: The two groups had similar demographic data, cytological findings, colposcopy findings, and cervical biopsy results (p &gt; 0.05). During similar follow-up periods (13.6 ± 3.2 vs. 14.1 ± 3.4 months; p &gt; 0.05), there was no significant difference in terms of hr-HPV clearance (46.2% vs. 51.3%; p &gt; 0.05). Furthermore, the initial and follow-up cytology results of the patients were similar (p &gt; 0.05). Conclusions: A significant effect of the absorbent antioxidant vaginal gel on hr-HPV clearance at approximately 1-year follow-up could not be demonstrated.

Surgical outcomes of laparoscopic trachelectomy following supracervical hysterectomy: a multicenter study.

To evaluate the feasibility, safety, and surgical outcomes of laparoscopic trachelectomy after supracervical hysterectomy. This multicenter study was conducted at Tanta University, Benha University, and Aminah Laparoscopy Center (Benha, Egypt) from June 1, 2018 to October 31, 2021. Forty patients were recruited for this study and counseled on laparoscopic trachelectomy to treat their symptoms after supracervical hysterectomy. Furthermore, cervical biopsy was performed to detect and exclude any malignancy. Histopathological examination of cervical specimens was performed after surgery. Operative details and outcomes were recorded. The median age of the patients was 42 years (range, 38-47). The median body mass index was 25 years (range, 22- 28). The median interval between hysterectomy and the clinical presentation was 4.40 years (range, 3.58-5.25). Most patients presented with abnormal vaginal discharge (40%) and bleeding (25%). Moreover, a cervical biopsy result revealed stump carcinoma in three cases (7.5%) that were excluded. The median operative time was 210 minutes (range, 170-220). The median blood loss was 270 mL (range, 220-320). Additionally, histopathological examinations revealed that chronic non-specific cervicitis was present in 54.05% of trachelectomy specimens. There were no significant differences between symptomatic and asymptomatic patients regarding operative outcomes, except adhesions, which were more significantly increased in symptomatic patients (P=0.015). Minimal complications, both operative and postoperative, were related to the procedure. Although the operative time was long and adhesions were common during laparoscopic trachelectomy, the procedure was feasible and safe, with minimal complications.

Evaluation of the relationship between Doppler predictors with human papillomavirus types, smear and cervical biopsy results

Objectives: The study aims to investigate whether there is any difference between human papillomavirus (HPV) types, smear results, and colposcopic biopsy results in terms of iliac, uterine, and cervical artery pulsatility and resistive index values in high-risk HPV positive patients.Methods: Iliac, uterine, and cervical artery pulsatility and resistive index values were determined by pelvic Doppler ultrasonography in patients who applied for high-risk HPV positivity and underwent colposcopyguided cervical biopsy. Results: There was no difference between HPV types and Pap-smear results and the pulsatility and resistive indices of the iliac artery, uterine artery, and cervical artery. It was observed that the mean cervical artery pulsatility index of the patients whose colposcopic cervical biopsy result was cervical intraepithelial neoplasia (CIN) 1 was 1.61 ± 0.43 and the cervical artery pulsatility index of the patients with CIN 2-3 was 1.15 ± 0.28, and a statistically significant difference was found between them (p = 0.038). There was no difference between other Doppler indices and colposcopic cervical biopsy results. Conclusions: Doppler indices such as cervical artery pulsatility index may be helpful in the evaluation of cervical cancer precursor lesions.

Evaluation of the consistency ratios of cervical smear, cervical biopsy and conization results.

Possible discrepancies between the cervical smear, biopsy histology and loop electrosurgical excision procedure (LEEP) results of the same patient is a matter of debate in the literature. In this study, we investigate the degree to which these results differ, and the clinical reasons for these differences. With a retrospective design, cervical smear, cervical biopsy and LEEP results of patients were compared in terms of consistency. One hundred sixty-four patients who underwent till LEEP procedure due to pathologic initial smear and biopsy results between January 2015 and March 2020 were included in the study. Exact diagnosis discrepancy and high grade squamous intraepithelial lesion (HSIL) discrepancy were 78.9% and 50.0% between smear and cervical biopsy, 64.6% and 31.7% between cervical smear and LEEP and 43.8% and 28.1% between cervical biopsy and LEEP results, respectively. Age did not affect the consistency rates of pathologic results between smear-biopsy (p = 0.408) and biopsy-LEEP (p = 0.590). However, the probability of the consistency of smear and LEEP results exhibited a statistically significant linear relation with age (OR = 1.043, p = 0.015). HPV infections did not affect the discrepancy between smear-biopsy (p = 0.533), smear-LEEP (p = 1.000) and biopsy-LEEP (p = 0.529). Smear technique has a serious discrepancy and under-diagnosis problem when its results are compared with biopsy and LEEP. The consistency between smear and LEEP results appears to improve with age. When HSIL is evaluated in terms of detection, this discrepancy decreases. A smear test can detect HSIL and carcinoma with a higher accuracy than low-grade lesions.

Outcomes of women with positive oncogenic HPV and reflex cytology showing possible high-grade squamous intraepithelial lesion.

To examine outcomes in women following cervical screening detection of oncogenic human papillomavirus (HPV), with reflex cytology showing possible high-grade squamous intraepithelial lesion (pHSIL). A retrospective observational study of 523 women seen in the Royal Women's Hospital Colposcopy Clinic from 1 January 2018 to 31 July 2020. Two hundred eighty-two (53.9%) women had histology-confirmed HSIL, encompassing CIN2 or worse (CIN2+), including seven cancers (1.3%) and two adenocarcinoma in situ (AIS) (0.4%). In 81.2% (229/282) of women with CIN2+, this was detected on cervical biopsy at initial colposcopy, with another 8.9% (25/282) of CIN2+ detected at cervical excision following initial colposcopy and the remaining 9.9% (28/282) at follow-up colposcopy thereafter. When discordant cervical biopsy results were discussed at multidisciplinary meeting (MDM), 66.7% of women with pHSIL cytology upgraded to definite HSIL were found to have CIN2+, but only 20.8% when pHSIL cytology was retained and none when downgraded to low-grade (LSIL) or normal. No significant difference was found in the proportion of CIN2+ based on patient age above or below 40, HPV16 and/or 18 versus non 16/18, or whether discordant findings were reviewed at MDM. We propose a pathway for management of women with positive oncogenic HPV and reflex pHSIL cytology. MDM review is recommended when CIN2+ is not identified on cervical biopsy at initial colposcopy. Conservative management is safe with low risk of CIN2+ when LBC prediction of pHSIL is confirmed or downgraded at MDM with no high-grade change on colposcopy or repeat cytology.

Risks for cervical abnormalities in women with non-16/18 high-risk human papillomavirus infections in south Shanghai, China.

The study was aimed to analyze the prevalence characteristics of non-16/18 high-risk human papillomaviruses (HR-HPV) and the related risks for cervical abnormalities in south Shanghai. A total of 2291 HPV women who had been referred for a colposcopy due to HPV infection from @@@@@2016.12 to 2019.6 were enrolled. Combined with liquid-based thin-layer cell test (TCT) and pathological results of cervical biopsy, the infection spectrum and pathogenic risk of non-16/18 HR-HPV in local population were investigated. The results showed that the single HR-HPV infection rate was significantly higher than that of multiple infection, and the five most frequently detected types were HPV16, HPV52, HPV18, HPV53, HPV58 in the group. The total proportion of non-16/18 HR-HPV infection was 68.22%, more than twice of HPV16/18. In cases with high-grade cervical intraepithelial lesions (HSIL) or cervical cancer, non-16/18 HR-HPV infections account for 50.84% (single infection: 28.57%, multiple infection: 22.27%). The risk of cervical abnormalities caused by single HPV infection was ranked as HPV16 > HPV52 > HPV18 = HPV58 > HPV51 > HPV53 = HPV56 > others. Notably, among non-16/18 HR-HPV infected patients with HSIL/cancer lesions, the omission diagnostic rate of TCT was 62.81%. The infection rate of non-16/18 HR-HPV in whole study population was much higher than that of 16/18 type, and the infection rate of the former was also slightly higher in patients with HSIL and cancer. Due to the high omission diagnostic rate of TCT, we suggest patients with persistent non-16/18 HPV infection should undergo colposcopy biopsy to reduce missed detection of HSIL and cancers.

Analysis of colposcopic findings of high-risk HPV positive women with unsatisfactory cervical cytology

Aim: We aimed to analyze the colposcopic directed biopsy results of women with unsatisfactory cervical cytology and high-risk human papilloma virus (HPV) positivity, who were referred to the Gynecologic Oncology outpatient clinic from Cancer Early Diagnosis and Screening Centers.&#x0D; Materials and Methods: In this retrospective study, women with high-risk HPV subtypes who applied to our clinic between March 2015 and October 2017 with an inadequate cervical cytology underwent colposcopy-directed biopsy. Patients were grouped according to HPV types. The results of endocervical curettage, cervical biopsy, and cervical conization were analyzed.&#x0D; Results: Forty-six patients with unsatisfactory cervical cytology and high-risk HPV were included in this study during the 30-month period. Twenty-five (54.3%) of the patients had “non-16 non-18” HPV subtypes, while 21 (45.7%) had HPV 16 and/or HPV 18. Cervical biopsy results revealed high-grade squamous intraepithelial lesion (H-SIL) in 5 (10.9%) patients, low-grade squamous intraepithelial lesion (L-SIL) in 17 (37%), “HPV effect” in 4 (8.7%) and normal histopathology in 20 (43.5%) patients. The endocervical curettage revealed three (6.5%) women with H-SIL and seven (15.2%) with L-SIL. Seven (15.2%) patients underwent conization due to H-SIL and there were three H-SIL with negative margins and four L-SIL in the final histopathology report.&#x0D; Conclusion: Performing colposcopy seems to be crucial for women with inadequate cervical cytology and high-risk HPV regardless of HPV subtypes as there is an increased risk of H-SIL in this patient population.

Influence of the human immunodeficiency virus on cervical precancerous lesions

To study the influence of HIV status on the occurrence of cervical precancerous lesions (CPL). This analytical cross-sectional study was carried out between 1st December 2019 and 31st May, 2020. All women with documented HIV status screened for CPL with biopsies done were recruited. The main variables recorded included maternal age, educational level, number of sexual partners, age at first sexual intercourse, smoking, alcohol consumption, HIV status, CD4 count, cervical biopsy result. Fisher exact test and t-test were used for comparison. P<0.05 was considered statistically significant. Concerning women attending our screening units, CPL was more frequent amongst those living with HIV/AIDS (20/92 or 21.7%) than among those not living with HIV/AIDS (29/290 or 10.0%) (P=0.004). As regards women living with HIV/AIDS, those with a CD4 count ˂350/ml were more at risk of having a CPL (OR 21.39, 95%CI 5.60-81.56, P ˂0.001). High grade lesions (CIN 2, CIN 3) were more found amongst women living with HIV/AIDS (OR 3.83, 95%CI 1.09-13.45, P=0.033). More attention should be paid to women living with HIV/AIDS, especially those with CD4 count ˂350/ml who should be screened more often with biopsy frequently conducted if indicated.

Comparison of colposcopic biopsy results of cervical cytology-negative and HPV 16/18 or other high-risk HPV subtypes

Aim: This study aimed to compare the colposcopic biopsy results of patients with negative cervical cytology and positive human papillomavirus (HPV) tests and to investigate the necessity of colposcopy in patients with cytology-negative/other high-risk HPV (non-HPV 16/18) positive results. Materials and Methods: The study included 126 patients aged 30–65 years who underwent HPV DNA testing between 2016 and 2019 and who underwent colposcopic biopsy at our hospital because of their positive results. The patients were divided into three groups: HPV16/18 positivity, other high-risk HPV positivity, and unclassified HPV positivity. Cytology and colposcopy-guided cervical biopsy results were compared with the HPV types. Results: Approximately 44.4% of the patients had HPV 16/18 positivity, 23% had other high-risk HPV positivity, and 32.5% had unclassified HPV positivity. The cytology results revealed that 57.1% of patients were negative for intraepithelial lesions or malignancy (NILM), 22.2% had atypical squamous cells of undetermined significance, 17.5% had low-grade squamous intraepithelial lesions (LGSIL), and 2.4% had high-grade squamous intraepithelial lesions. Colposcopic biopsy results were normal in 15.1% of the patients, showed LGSIL in 15.9%, high-grade squamous intraepithelial lesions (HGSIL) in 10.3%, and cervical cancer in 0.8% of the patients. Evaluation of the biopsy results based on HPV type in the patients with NILM cytology revealed that 12.8% of those with HPV 16/18 positivity had LGSIL and 17.9% had HGSIL, whereas 7.1% of those with other high-risk HPV positivity had HGSIL and 7.1% had LGSIL. Conclusions: The possibility of detecting dysplasia in the colposcopic biopsies of patients who are NILM and HPV 16/18-positive is higher than in the colposcopic biopsies of patients with other high-risk HPV types; therefore, these patients should be evaluated using colposcopic biopsy. Colposcopic biopsy is unnecessary in the presence of NILM and other high-risk HPV types.

Comparison of Cervical Smear and Biopsy Results

Amaç:&#x0D; Serviks kanseri 20.yy başlarına kadar kadın genital organ kanserleri içinde ön sıralarda iken 1950'lerden sonra servikal kanser taramasının yaygınlaşmasına bağlı olarak insidans ve serviks kanserinden ölüm %50 oranında azalmıştır. Servik kanseri gelişiminde insan papilloma virüsü ile enfeksiyon en önemli etkendir. Servikal yayma ile tarama özellikle gelişmiş ülkelerde serviks kanseri ve öncül lezyonlarının erken tanısı için kullanılan önemli bir yöntemdir.&#x0D; Geraç ve Yöntem:&#x0D; Selçuk Üniversitesi Tıp Fakültesi Hastanesi Tıbbi Patoloji laboratuarında 2010-2018 yılları arasında incelenen ve raporlanan, öncesinde smear sonucu olan ve servikal biyopsi yapılan 223 hastanın sonuçları karşılaştırıldı.&#x0D; Bulgular: &#x0D; 223 hastanın yaş ortalaması 45 (26-83) dir. Biyopsi sonuçları 173 (%78) hastada kronik inflamasyon, 15 (%7) hastada düşük dereceli skuamöz intraepitelyal lezyon “HPV veya hafif displazi veya CIN 1, 21 (%9) hastada yüksek dereceli skuamöz intraepitelyal lezyon “Orta derecede displazi veya ağır displazi veya CIN 2 veya CIN 3 veya Karsinoma in situ ve 14 (%6) hastada malign/skuamöz hücreli karsinom olarak raporlanmıştır.&#x0D; Sonuç: &#x0D; Biyopsi ve smear sonuçları birlikte değerlendirildiğinde 141 (%63) hastada biyopsi ve smear sonuçlarının uyumlu olduğu, 82(%37) hastada ise biyopsi ve smear sonuçlarının farklı olduğu görüldü. Pap smear testinin uygulama kolaylığı ve düşük maliyeti, bu yöntemin yaygın olarak kullanılmasını sağlamıştır. Teknik nedenler ve değerlendirme hatalarına bağlı olarak yanlış negatif sonuçlar görülebilmektedir. Bizim serimizde %63 olguda korelasyon olduğu tesbit edilmiştir. Pap smear ile yanlış negatif oranları %1,1 ile %50 arasında değişiyor olsa da, bu test hala prekanseröz lezyonları tespit etmek için en etkili yöntem olarak kabul edilir.

Personalized Medicine and Cervical Screening: Development of Individualized Quantitative Risk Assessments for Cervical Adenocarcinoma and Adenocarcinoma in situ

Introduction: Cervical screening has decreased the incidence of cervical carcinoma around the world primarily by preventing cervical squamous carcinoma, with significantly less measurable protective benefits in prevention of cervical adenocarcinoma. In this study, we apply Bayesian modeling of cervical clinical, screening, and biopsy data from a large integrated health system to explore the feasibility of calculating personalized risk assessments on screened system patients for subsequent histopathologic diagnoses of invasive cervical adenocarcinoma (AdCa) or cervical adenocarcinoma in situ (AIS). Materials and Methods: Diagnoses of cervical AIS or AdCa rendered between 2005 and 2018 were identified in our large health system database with 1,053,713 cytology results, 354,843 high-risk (hr) human papillomavirus (HPV) test results, and 99,012 cervical histopathologic results. Using our continuously updated Bayesian cervical cancer screening model which includes clinical data, cervical screening results, and cervical biopsy results, we projected quantitative estimates of patients’ 5-year cumulative risk for cervical AIS or AdCa. Results: 161 patients were identified with AIS (ages 17–75, mean 37 years), and 99 patients had diagnoses of cervical AdCa (ages 26–91, mean 48 years). Quantitative Bayesian 5-year cumulative risk projections for diagnoses of cervical AdCa or AIS in patients with different cervical screening test and biopsy histories were determined. The highest patient risk projections for subsequent cervical AdCa and/or AIS histopathologic diagnoses were associated with prior cervical screening test results of HPV-positive atypical glandular cells. Prior squamous cytologic abnormalities were associated with lower risk estimates. Prior histopathologic diagnoses of squamous abnormalities also influenced quantitative risk. A prior histopathologic diagnosis of AIS was associated with a very low risk of subsequent AdCa, consistent with effective excisional treatment. AdCa risk was greatest in women aged 30–65 years with prior CIN3 biopsy results, whereas AIS risk was greatest in women <30. Conclusion: Prevention of cervical AdCa in screened patients remains a major challenge for cervical screening. Individualized risk projections for cervical glandular neoplasia reflecting patient age, prior cervical screening test results, and prior cervical biopsy history are feasible using Bayesian modeling of health system data.