Cervical Intraepithelial Neoplasia Research Articles

Cervical cancer screening: a comparative study of TruScreen vs. Pap Smear

ObjectivesThis study aimed to evaluate the potential of real-time optoelectronic device (TruScreen™; TS; TruScreen Group Limited, New Zealand) as an alternative or adjunct to Pap Smear (Liquid Based Cytology (LBC)) for cervical cancer screening.MethodWe conducted a prospective observational pilot study involving 507 women who were routinely followed at gynecology clinics. All participants underwent TS and LBC examinations after study enrolment. Those with abnormal findings were referred for colposcopy and cervical biopsy within one month.ResultsOverall, 507 women fulfilled the eligibility criteria and were included in this study, of which 30 women (5.9%) had abnormal TS findings and underwent colposcopy. Thirteen women (43.3%) had low-grade lesions, and only one (3.3%) had a high-grade lesion. Regarding biopsy findings, three women had cervical intraepithelial neoplasia (CIN) 1, two women had ‘CIN2 + , and one had glandular hyperplasia. The TS yielded a sensitivity of 83.3% (95% CI: 35.9–99.6%) and a specificity of 95% (95% CI: 92.7- 96.8%) for the detection of cervical abnormality, compared to 66.7% (95% CI: 22.3–95.7%) and 98.2% (95%: CI 96.6%-99.2%) of the Pap smear, respectively. The difference between both screening tools was not statistically significant (p = 0.91). The sensitivity (100%, 95% CI 15.6–100%) and specificity (95.6%, 95% CI 93.4–97.2%) of TS and Pap smear for ‘CIN2 + lesions were notably high.ConclusionTS demonstrated potential as a screening tool for cervical neoplasms in this preliminary study. The tool did not require cervical samples, laboratory equipment, or highly trained personnel. While our findings suggest the potential for real-time and accurate screening, further research with a larger sample size is necessary to confirm its reliability and practicality.

The Risk of Developing Cervical Cancer in the Elderly; Who Benefits From Screening After the Age of 60?

Population-based cervical cancer screening in the Netherlands ends at age 60. This retrospective cohort study aims to identify a subgroup of people over 60 years who are at increased cervical cancer risk, and may benefit from extended screening. People with a cervix, aged 59-61 with an abnormal exit smear (index smear), conducted as part of the screening program between 2000 and 2004, were identified from the Dutch nationwide pathology databank. A 1:3 matching was obtained with people without an abnormal screening smear at the same age. Incidence rate ratios (IRR) were calculated for the risk of developing cervical cancer or cervical intraepithelial neoplasia (CIN) later in life. Up to 22 years of follow-up was obtained. A total of 10,368 people were identified. The IRR for CIN and cervical cancer was increased for people with an abnormal index smear. This risk was highest for people with a high-grade index smear, compared with a normal index smear; IRR of high-grade CIN of 104.05 (95% CI = 38.18-353.18) and IRR for cervical cancer of 18.58 (95% CI = 5.31-61.07). The majority (82%) of people with an abnormal index test showed normal cytology or histology preceding their CIN or cervical cancer. People with a cervix with abnormal cytology in their exit screening smear 59-61 years showed a 19 times increased lifelong risk of cervical cancer and more than 100 times increased risk for CIN. Because this increased risk was not limited to a specific timeframe, prolonged screening or adjusted diagnostic follow-up for this specific group should be considered.

Participation and relative cost of attendance by direct-mail compared to opt-in invitation strategy for HPV self-sampling targeting cervical screening non-attenders: A large-scale, randomized, pragmatic study.

Broad accessibility to cervical cancer screening and high participation rate is essential to reduce cervical cancer incidence. HPV self-sampling is an alternative to clinician collected cervical samples to increase accessibility and screening coverage. To inform on deployment strategies of HPV self-sampling, this large-scale, randomized, pragmatic study compared two invitation modalities; direct-mail and opt-in. The study included screening non-attenders from the Capital Region of Denmark randomly allocated (1:4) to a direct-mail or opt-in invitation for cervical screening by HPV self-sampling. Primary endpoint was screening participation; secondary endpoints were HPV prevalence and histology outcome. Adherence to follow-up and cost were also evaluated. After exclusion of hysterectomized/non-accessible women, 49,393 women were invited: 9639 by direct-mail, and 39,754 by the opt-in offer. A direct-mail invitation for HPV self-sampling yielded a significant higher participation than an opt-in invitation. HPV self-sample participation for direct-mail was 25.2% (n = 2426), opt-in participation was 20.2% (n = 8047), adjusted OR = 1.27, 95% CI 1.20-1.34. Participation increased with age (p < .0001) for both strategies and decreased with screening history of non-attendance (p < .0001). Interaction between invitation strategy and age/screening history was found; more women below 50 years of age participated by direct-mail compared to opt-in (p < .0001) and higher participation by direct-mail group was found in women with a short history of non-attendance (p < .0001). Participation of long-term unscreened women was similar between arms. The relative cost was ≈14 HPV self-sample kits distributed per additional participant by direct-mail over opt-in. HPV prevalence, adherence to follow-up, and detection of high-grade cervical intraepithelial neoplasia was similar between invitation strategies.

EXPRESS: Utility of serum NAMPT concentrations in clinical management of HPV infected patients.

The expression of nicotinamide-phosphoribosyl transferase (NAMPT) was demonstrated to increase in various dysplastic and malignant conditions, usually consistent with the severity of the disease. This study was conducted to a assess the utility of eNAMPT in management of cervical dysplasia in HPV infected women. Circulating eNAMPT concentrations in high-risk HPV infected women that were diagnosed with HSIL or invasive cancer (CIN2+ lesions) and that were revealed to have no cervical dysplasia or LSIL were evaluated and compared. 159 high risk HPV infected patients that cervical biopsies were taken under colposcopy guidance between February 2022 and February 2023 were included in this case-control study. Study group composed of consecutively enrolled 84 women with histological diagnosis of HSIL or cervical cancer (CIN2+ lesions) and control group composed of consecutively enrolled 75 women with LSIL or normal cervical biopsies. Circulating eNAMPT concentrations of cases with CIN2+ lesions and cases with LSIL or normal cervical biopsies were compared. No significant difference was found between median peripheral venous blood eNAMPT concentration of cases with histologic diagnosis of CIN2+ lesions and cases with LSIL or normal cervical biopsies (9.4ng/mL (0.19-192) vs. 8.9ng/mL(0.19-176.9); p=0.07, respectively). Multivariate linear regression analysis revealed no independent predictor of circulating eNAMPT concentrations among possible predictor variables. In conclusion, circulating eNAMPT concentrations of cases with CIN2+ lesions and cases with LSIL or normal cervical biopsies were found to be similar. Further research that evaluate cervical fluid eNAMPT concentrations might define novel non-invasive tools in cervical dysplasia management.

Effect of vaccination against HPV in the HPV-positive patients not covered by primary prevention on the disappearance of infection

An undeniable risk factor for cervical cancer and intraepithelial neoplasia is persistent infection with HPV – types 16,18, 31, 45, 52 and others. Changes in sexual behavior may, in the coming decades, influence the epidemiology of HPV-related lesions. For those diseases, vaccination against HPV may be the only effective mean of prevention. Our study aims to show the results and changes in the smear for HPV DNA in patients after receiving a vaccination course with a 9-valent HPV vaccine in women with HPV infection. Out of 320 subjects with HPV- positive result 250 (78.1%) decided to be vaccinated against HPV, and 70 (21.9%) did not. All patients included in the analysis had not been vaccinated with any commercially available HPV vaccines in the past. In the vaccinated group, the rate of HPV disappearance was significantly higher over the follow-up period than in the control group. This applies especially to the complete disappearance of the HPV - in 72.4% vaccinated women compared to 45.7% unvaccinated. This effect is especially visible when analyzing the disappearance of HPV genotypes covered by the 9-valent vaccine. The proportion of negative HPV outcome differed significantly between vaccinated patients with LEEP (81.1%), vaccinated patients without LEEP (59.8%), non-vaccinated patients with LEEP (57.1%), and non-vaccinated patients without LEEP (34.3%), and the differences were statistically significant (p < 0.001). Vaccination in patients with histopathologically confirmed HSIL will probably reduce the occurrence of different HPV-related lesions.

Development and implementation of a novel metric score (SciMet) for scientific publications.

Development and implementation of a novel metric score (SciMet) for scientific publications.

The effects of human papillomavirus vaccination in Japan

ABSTRACT Human papillomavirus (HPV) is a prevalent virus responsible for nearly all cervical cancer cases, a major health issue worldwide, including in Japan. With over 12,000 cases of cervical cancer and 4,213 related deaths annually in Japan, effective prevention through vaccination is essential. The 9-valent HPV (9vHPV) vaccine provides broader protection against high-risk HPV types (HPV-31, -33, -45, -52, -58) compared to the bivalent and quadrivalent (4vHPV) vaccines. This study evaluates the public health impact of both girls-only and gender-neutral vaccination strategies using 9vHPV and 4vHPV vaccines in Japan. A dynamic transmission model, calibrated with Japanese population data, was used to project cervical cancer and genital wart outcomes over 100 years. Vaccination scenarios included no vaccination, girls-only and gender-neutral vaccination with both 4vHPV and 9vHPV vaccines. Results show that switching to the 9vHPV vaccine significantly reduces cervical cancer incidence and mortality compared to 4vHPV, particularly in gender-neutral strategies. The 9vHPV vaccine was projected to prevent an additional 857,549 cases of cervical intraepithelial neoplasia (CIN2/3) and 43,799 cervical cancer deaths in a girls-only vaccination strategy compared to the 4vHPV vaccine, over a 100-y period. Gender-neutral vaccination with the 9vHPV further amplifies these benefits, with a faster reduction in HPV-related diseases for both genders. Even under conservative assumptions of 20-y vaccine protection, 9vHPV outperformed 4vHPV in all scenarios. These findings support switching to the 9vHPV vaccine and expanding the National Immunization Program to include boys to achieve long-term HPV control, reduce HPV-related cancers, and improve public health outcomes in Japan.

The triage role of cytological DNA methylation in women with non-16/18, specifically genotyping high-risk HPV infection.

To evaluate cytological DNA methylation testing methods for risk stratification in women with non-16/18 HPV, focusing on high-risk HPV (hrHPV) genotyping. This study compared the triage performance of liquid-based cytology (LBC) testing, hrHPV genotyping, and PAX1/JAM3 gene methylation (CISCER) testing. The absolute risks of cervical intraepithelial neoplasia grade 2 or worse (CIN2+), grade 3 or worse (CIN3+), and colposcopy referral rates were calculated. The CISCER test showed a CIN3+ risk of 39.1% for positive and 0.9% for negative results. In comparison, LBC ≥ ASCUS and HPV33/35 genotyping had CIN3+ risks of 9.8% and 19.3%, respectively, for positive result. The colposcopy referral rates were 17.4% for CISCER+, 61.9% for LBC ≥ ASCUS, and 8.9% for HPV33/35+ genotyping. The CIN3+ risks were 40.0% and 50.0% when CISCER+ was combined with LBC ≥ ASCUS and HPV33/35+, respectively. The CIN3+ risks were 0.0% and 1.0% when CISCER- was combined with LBC with no intraepithelial lesions or malignancy (NILM) and non-HPV33/35, respectively. Our analysis of CIN2+ patients yielded similar results. DNA methylation testing outperformed LBC in triaging women with non-16/18 hrHPV infections, significantly reducing unnecessary colposcopy referrals, particularly when combined with HPV33/35 genotyping.

Cervical cancer screening data from the case-based national electronic registry in Bangladesh

BackgroundThe Government of Bangladesh established a visual inspection with acetic acid (VIA)-based cervical cancer screening programme at 600 primary, secondary and tertiary health facilities following a pilot programme in 2005. An aggregated data collection system was initiated using District Health Information System 2 (DHIS2) software in 2013 and a case-based electronic data registry system was developed utilising its “tracker” component since January 2018. The purpose of this study is to review the cervical cancer surveillance situation based on the data of the national cervical cancer screening, treatment and follow-up through the DHIS2-based electronic registry.MethodsWomen aged 30 to 60 were enrolled in the DHIS2 electronic registry in health facilities of all tiers including the community clinics and screened for cervical cancer using the VIA method at Upazila Health Complexes and upper tiers. The VIA-positive women were referred for colposcopy in the nearest colposcopy centres. The screen-positive women were offered treatment and followed up at certain intervals following the national standard protocol. During each encounter, required data were captured in DHIS2. Anonymised data from the DHIS2 covering January 2018 to May 2023 were extracted and analysed for this study.ResultsA total of 1,562,963 women were enrolled in 497 screening facilities and 6398 community clinics. Among them, 1,557,002 (99.6%) availed VIA tests, and primary health facilities performed 74.4% enrolments and 72% VIA tests. Among screened women, 51,913 (3.3%) were VIA positive, of which only 20,954 (40.4%) attended for colposcopy. Among colposcopy-positive women, 6.3% (1,327) and 6.2% (1,302) women had cervical intraepithelial neoplasia (CIN) II/III and cervical carcinoma, respectively. Among women who received treatment for cervical precancer, 81.6% (5062) had thermal ablation, and 17.6% (1089) had loop electrosurgical excision procedure. Histopathology reports (n = 3079) revealed 16.1% (n = 495) of women had squamous cell carcinoma, 4.0% (n = 123) had micro-invasive squamous cell carcinoma, 11.7% (n = 36) had CIN II, and 8.1% (n = 250) had CIN III.ConclusionsThe National Cervical Cancer Screening and Treatment Programme for women in Bangladesh using a DHIS2-based electronic case-based tracking system is effective in understanding the screening situation and can be a valuable lesson for other countries.

Vascular Remodeling Across the Spectrum of Cervical Intraepithelial Neoplasia and Squamous Cell Carcinoma: A Digital Pathology-Based Morphometric and Immunohistochemical Analysis

Vascular Remodeling Across the Spectrum of Cervical Intraepithelial Neoplasia and Squamous Cell Carcinoma: A Digital Pathology-Based Morphometric and Immunohistochemical Analysis

Analysis of the triage value of multigene methylation testing for CIN2 + in hrHPV-positive patients

ObjectiveTo assess the triage value of multigene methylation testing for cervical intraepithelial neoplasia 2 and above (CIN2+) in high-risk human papillomavirus (hrHPV) positive patients.Methods634 hrHPV-positive cases were selected from the gynecology outpatient clinic at Hainan Women and Children’s Medical Center between July 2022 and April 2024. Out of these, 274 patients were excluded based on the inclusion and exclusion criteria. A total of 360 patients were evaluated for hrHPV, cytology, histopathology, and DNA methylation across multiple loci. These patients were categorized into five groups based on their histopathological diagnoses: control group, CIN1 group, CIN2 group, CIN3 group, and cervical cancer (CC) group. The triage value of multigene methylation testing for CIN2 + in hrHPV-positive patients was evaluated by calculating the positivity of candidate gene methylation, sensitivity, specificity, area under the curve (AUC), and other performance indicators.ResultsAmong the 17 candidate genes (ST6GALNAC5, PAX1, AJAP1, CDKN2A, ZNF671, GATA4, MAL, POU4F3, RXFP3, JAM3, MIR124, LHX8, SOX1, ASTN1, SOX17, DLX1, and ITGA4), ITGA4 methylation testing demonstrated the highest diagnostic efficacy for detecting CIN2 + lesions, with an AUC of 0.866 (95% confidence interval [CI]: 0.806–0.925). This method exhibited a sensitivity of 75.32% (95% CI: 0.647–0.836) and a specificity of 96.45% (95% CI: 0.936–0.981). The combined methylation test, which included all candidate genes, showed a higher specificity of 97.87% (95% CI: 0.954–0.990) compared to any individual gene methylation test. However, its sensitivity was lower, at 72.73% (95% CI: 0.619–0.814). Furthermore, the diagnostic accuracy of combining HPV16/18 testing with all candidate gene methylation tests for the diagnosis of CIN2 + was significantly greater than when HPV16/18 testing was combined with cytology. This combined approach had an AUC of 0.907 (95% CI: 0.858–0.955), a sensitivity of 72.73% (95% CI: 0.619–0.814), and a specificity of 98.58% (95% CI: 0.964–0.995).ConclusionMultigene methylation testing is an efficient triage test for CIN2 + in hrHPV-positive patients and has potential value in clinical practice. Combined HPV16/18 and multigene methylation testing for the triage of CIN2 + is significantly better than combined HPV16/18 and cytology testing.

Outcomes associated with large loop excision of the cervical transformation zone in women 60–64 years of age: A population‐based register study from Denmark

AbstractIntroductionFor women treated for cervical dysplasia at 60–64 years in Denmark, we reported the frequency of abnormalities before and after treatment of cervix uteri (most frequently performed as large loop excision of the cervical transformation zone, LLETZ) using population‐based real‐world data.Material and MethodsWe conducted a retrospective cohort study based on national data from the Danish Pathology Data Bank and identified women who underwent a LLETZ in 2010–2016 at the age of 60–64. Women were managed according to nationwide evidence‐based recommendations proposed by the Danish professional organizations. We retrieved information on all LLETZ specimens, cervical histology, cytology, and human papillomavirus (HPV) tests in the period of 2 years prior to the procedure to 2 years thereafter. We reported the frequencies of abnormalities before, at, or after the procedure.ResultsOf the 1014 women who had a LLETZ during the study period, 660 (65%) showed cervical intraepithelial neoplasia grade 1 or worse (CIN1+, including CIN1, CIN2, CIN3, cervical cancer, and CIN not otherwise specified) in their LLETZ specimen, with free resection margins in 255 (39%). Of the 1014 women, 551 (54%) had CIN2+ in a biopsy preceding the LLETZ and in 567 (56%) CIN2+ was found in their LLETZ specimen. In 37 (4%) women, the specimen showed cervical cancer; whereas in the pre‐LLETZ biopsies of these 37 women, cancer was detected in only 7 (1%). After LLETZ, 818 (81%) women underwent test‐of‐cure follow‐up which was positive in 406 women (40%). Furthermore, 408 (40%) women had new histological samples registered after LLETZ. These showed CIN2+ in 134 (13%) women, whereas a new cancer was diagnosed in 11 (1%) women.ConclusionsDue to persistent abnormal tests after LLETZ, an extended follow‐up is still required for a large proportion of the women in this age group.

No Increased Risk of Autoimmune Diseases Following HPV Vaccination: A Systematic Review and Meta-Analysis

Background: HPV vaccination reduces the risk of anogenital warts, high-grade cervical intraepithelial neoplasia (CIN2+), and cervical cancer. To enhance immunogenicity, HPV vaccines include adjuvants such as toll-like receptor agonists, which may theoretically trigger autoimmune responses. However, existing data on this risk remain conflicting. This systematic review and meta-analysis assess the association between HPV vaccination and autoimmune disease onset in post-licensure controlled studies. Methods: A comprehensive literature search was conducted in Scopus, PubMed/MEDLINE, ScienceDirect, and the Cochrane Library from inception to June 2024, following PRISMA guidelines. The study protocol was registered in PROSPERO (CRD42024606834). Results: A total of 356 studies were identified, including cross-reference reviews. Fourteen met inclusion criteria for qualitative and quantitative analysis, encompassing 8,088,838 patients, of whom 2,041,865 received the HPV vaccine. Conclusions: This meta-analysis found no significant association between HPV vaccination and autoimmune disease development. However, further large-scale observational studies are needed, particularly among male recipients, as current evidence is predominantly based on female populations. Future research should also evaluate risks for specific autoimmune disorders to refine the vaccine’s safety profile.

Analysis of human papillomavirus subtype distribution and cervical lesion characteristics in a cancer hospital in Shenzhen City

This study aims to retrospectively analyze the distribution of human papillomavirus (HPV) subtypes and cervical lesion characteristics in female patients at Shenzhen Cancer Hospital. Adopting a retrospective observation research method. Using convenience sampling, the study subjects were selected from women who visited the Shenzhen Hospital of the Chinese Academy of Medical Sciences Cancer Hospital from September 2020 to December 2023.HPV genotyping was performed on cervical exfoliated cells from 6 402 women using rapid nucleic acid hybridization. Additionally, thinprep cytologic test (TCT) was conducted on 845 HPV-positive samples. High-grade squamous intraepithelial lesions (HSIL) were further classified as cervical intraepithelial neoplasia grades 2 or 3 (CIN2/3) through histopathological examination via cervical biopsy or conization. Data were statistically analyzed using χ2 test and two-sided test. The results showed that HPV testing identified 1 205 HPV-positive cases, with an overall positivity rate of 18.8% (1 205/6 402). Among these, the positivity rate for high-risk(HR) HPV was 14.34%(918/6 402), low-risk(LR) HPV was 3.58%(229/6 402), and other HPV types accounted for 0.91% (58/6 402). The most prevalent high-risk HPV subtypes were HPV16, HPV52, HPV39, HPV58, and HPV53, with positivity rates of 3.16% (202/6 402), 2.92% (187/6 402), 1.34% (86/6 402), 1.30%(83/6 402), and 1.05%(67/6 402), respectively. HPV16 had the highest infection rate in cervical malignancies, CIN3, and CIN2/3 groups, with rates of 53.18%(92/173), 47.37%(27/57), and 34.78%(8/23), respectively. Conversely, HPV52 showed the highest infection rate in the atypical squamous cells(ASC), Low-grade squamous intraepithelial lesion(LSIL), and CIN2 groups, at 29.68%(19/64), 23.50%(43/183), and 37.93%(11/29), respectively. Among 845 HPV positive female patients, the pathological diagnosis was squamous cell carcinoma, accounting for 22.13% (187/845), and adenocarcinoma accounting for 1.42%(12/845). HPV infection rates increased with age: 16.39%(97/592) in the ≤30 age group, 14.46%(301/2 082) in the 31-40 group, 17.26%(318/1 842) in the 41-50 group, 23.98%(300/1 251) in the 51-60 group, and 29.76%(189/635) in those over 60. In conclusion,in the female patient population of the Shenzhen Hospital of the Chinese Academy of Medical Sciences Cancer Hospital, HPV16 is associated with cervical cancer and high-grade cervical lesions, while HPV52 is related to low-to moderate-grade cervical lesions. Enhancing HPV screening among adult women is essential for preventing cervical cancer and associated lesions.

The inferred modulation of correlated vaginal microbiota and metabolome by cervical differentially expressed genes across distinct CIN grades

BackgroundIn vitro studies have demonstrated the modulation of vaginal microbiota (VM) by cervical peptides which levels varied with the status of HPV infection and cervical intraepithelial neoplasia (CIN) grades. However, there is a deficiency in population-based studies investigating the modulation of VM compositions and metabolome by cervical differentially expressed genes (DEGs) across different grades of CIN.MethodsThis study included 43 HPV-positive women, classified into low-grade (CIN1, n = 23) and high-grade (CIN2 + , n = 20) groups. Vaginal swabs were collected for both microbiota and metabolome analysis. Cervical exfoliated cells were collected for RNA-Seq analysis.ResultsWe identified 258 differentially expressed genes (DEGs), among which 176 CIN1-enriched genes were linked to immune responses, cell chemotaxis, negative regulation of cell migration, and B cell differentiation, activation, and proliferation. Eighty-two genes upregulated in CIN2 + cohorts were associated with epidermis development and keratinization. Then, we identified 5,686 paired correlations between DEGs, VM, and metabolome, with 2,320 involving Lactobacillus. Further analysis revealed Lactobacillus as the primary determinant of metabolic profiles, followed by Gardnerella, Faecalibacterium, Aerococcus and Streptococcus, such as the notable positive correlation between Lactobacillus with D-lactic acid and DL-indole-3-lactic acid. Applying mediation analysis, we found that Lactobacillus mediated the association of 14 CIN1-enriched DEGs, such as COL4A2, CCBE1 and SPON1, with the production of 57 metabolites, including D-lactic acid, oleic acid and various amino acids. Additional analysis indicated significant mediation effects of 79 metabolites on the association of DEGs with the growth of Lactobacillus, Gardnerella, Fannyhessea and Aerococcus.ConclusionsOur findings provide valuable population-based evidence for the inferred modulation of correlated VM and metabolome by cervical DEGs across different CIN stages.

Concordance of Colposcopy-Directed Biopsy and Conization Results in Cervical Dysplasia

OBJECTIVE: Cervical cancer prevention requires proper management of women with cervical intraepithelial neoplasia (CIN). A colposcopy is key to diagnosing CIN in women with abnormal cytology. Colposcopy identifies lesions, assesses grading, and guides biopsies. Excisional procedures like cold knife conization remove affected tissue for pathological examination and treat the CIN lesions. Some studies evaluate the consistency of conization and colposcopy-directed biopsy results. This study aimed to review the data of patients who had undergone conization retrospectively and to assess the consistency in predicting malignancy between preoperative cytology, biopsy, and/or Human papillomavirus (HPV) findings and conization pathologies. STUDY DESIGN: This retrospective study included 114 women presenting to the gynecological oncology department between 2013 and 2024. The study included women with abnormal cytology and/or positive HPV 16/18 or persistent positivity for other high-risk HPV types. All of the women had undergone a colposcopy-directed biopsy and conization procedure. The kappa statistic (k) was used to assess the correlation between colposcopy-directed biopsy and conization findings. RESULTS: Among the patients, 46 (40.35%) had concordant colposcopy-directed biopsy and pathology results. The strength of agreement, as indicated by the Kappa statistic, was 0.237 (p&lt;0.001). Colposcopy sensitivity for detecting high-grade cervical pathology was 93.2%, and specificity was 40%. of 77 patients (67.5%), an agreement between colposcopy-directed biopsy and cervical pathology for low and high-grade lesions was observed. The strength of agreement with the Kappa statistic was 0.338 (p&lt;0.001). CONCLUSION: This study showed that with a sensitivity of over 90%, colposcopy-directed biopsy plays an important role in detecting high-grade cervical lesions.

Experiences of women living with HIV who underwent long loop excision of the transformation zone (LLETZ) in selected hospitals of Vhembe district, Limpopo province, South Africa

Background Cervical cancer poses a significant health threat, especially for women living with HIV, who are at increased risk of developing premalignant cervical lesions. Large Loop Excision of the Transformation Zone (LLETZ) is a standard treatment for cervical intraepithelial neoplasia (CIN) to prevent progression to malignancy. This study explores the experiences of HIV-positive women who underwent LLETZ in Vhembe District, South Africa, where access to such specialized treatments remains limited. Methods Using a qualitative, phenomenological approach, this study engaged seven HIV-positive women who underwent LLETZ, capturing their lived experiences through in-depth, unstructured interviews. Thematic analysis identified key themes and subthemes to elucidate their psychological, physical, and social encounters related to the procedure. Results Analysis revealed eight central themes: psychological and physical experiences, psychosocial and financial support, misconceptions, education, recommendations, and time-related factors. Participants reported anxiety, fear, and initial stress about the procedure, coupled with resilience and acceptance over time. Physical effects such as pain and bleeding were common, though recovery experiences varied. Social support from family and community played a critical role in coping, while financial constraints impacted access to and continuity of care. Misunderstandings about the LLETZ procedure underscored the need for enhanced patient education. Participants emphasized timely screening and support systems to improve treatment outcomes and reduce psychological distress. Conclusions The study highlights the multifaceted impact of LLETZ on HIV-positive women, including the psychological and financial burdens and the importance of clear communication and patient education. Improved support structures, timely result communication, and access to follow-up care are essential to enhance patient outcomes. Recommendations advocate for health system improvements, partner involvement, and proactive counselling to address the specific needs of HIV-positive women undergoing cervical cancer prevention treatments.

Safety of LEEP in Treating CIN 2-3 During Pregnancy.

Cervical intraepithelial neoplasia (CIN) 2-3, a premalignant lesion usually treated by Loop Electrosurgical Excision Procedure (LEEP) in nonpregnant women, is addressed differently in pregnant women. Data from 2006 to 2023 on 178 pregnant women with CIN 2-3 were provided by the Israeli Society of Colposcopy. Sixty-seven underwent LEEP within 15 weeks of gestation with only minor complications. Of the 57 continuing pregnancies, 53 (93%) delivered at term, 2 (3.5%) at 34-37 weeks, and 2 (3.5%) experienced missed abortions. One hundred eleven women were followed through pregnancy without LEEP. Of that group, 5 women were lost to follow-up. From 173 women on whom the authors have follow-up data, 9 (5.2%) were finally diagnosed with cervical cancer, 132 women (76.3%) remained CIN 2-3, and 32 women (18.5%) were CIN 1 or normal. Loop Electrosurgical Excision Procedure (LEEP) performed within the first 15 weeks of pregnancy in 67 women was safe. In 5.2% of pregnant women with CIN 2-3, the final diagnosis was invasive cancer.

Association between low-grade cervical cytology and histological cervical intraepithelial neoplasia concurrent vaginal intraepithelial neoplasia among outpatient colposcopy: A retrospective study.

There is evidence that cytological low-grade squamous intraepithelial lesion (LSIL) is associated with cervical intraepithelial neoplasia (CIN) in colposcopy, but its link to cervical intraepithelial neoplasia concurrent vaginal intraepithelial neoplasia (VaIN) remains unclear. A retrospective chart review was performed that encompassed patients who were pathologically diagnosed with CIN at a single center from 2017 to 2021. Demographics, referring cytology, HPV genotype, and histologic information were recorded. The primary outcome was CIN coexisted with VaIN. Among 5488 patients included in this study (mean age, 37.0 years [SD 10]; 1376 [25.4]) had low-grade cervical cytology positive. A total of 458 participants were classified as having histologically CIN concurrent VaIN. Compared with participants without LSIL cytology, those with LSIL cytology had a higher prevalence of histological CIN concurrent VaIN (38.1% [172] vs. 24.2% [1204]). After adjusting for potential confounders, we found an association between LSIL cytology and histological CIN concurrent VaIN (odds ratio [OR], 3.28; 95% confidence interval [CI], 1.84-5.82). In subgroup analyses, LSIL cytology was associated with histological CIN concurrent VaIN among participants sexual life year 10 to 19 years (OR, 5.35; 95% CI, 1.58-18.04), gravidity 1-2 fetus (OR, 5.49; 95% CI, 1.62-18.61), HPV33 positive (OR, 90.06; 95% CI, 2.27-3579.46), HPV52 positive (OR, 9.09; 95% CI, 1.96-42.12). In this cross-sectional study, LSIL cytology was associated with histological CIN concurrent VaIN in the outpatient colposcopy in adjusted models. This association may be important to consider in the colposcopy for the early detection of CIN concurrent VaIN.

Diagnostic accuracy of available methylation assays in advanced cervical intraepithelial neoplasia from high-risk HPV-positive women: A systematic review and network meta-analysis.

Diagnostic accuracy of available methylation assays in advanced cervical intraepithelial neoplasia from high-risk HPV-positive women: A systematic review and network meta-analysis.