Colposcopy Results Research Articles

A Parallel-Group, Randomized Trial Examining Impact of Colposcopy Results Delivery by a Nurse Liaison on Patient-Reported Outcomes and Adherence

ObjectivesCervical cancer is on the rise in Canada. Addressing patient anxiety and improving patient understanding of colposcopy and results may improve adherence. This randomized controlled trial examined the impact of colposcopy results delivery by a Nurse Liaison versus the referring primary care provider (PCP) on patient anxiety, and secondary outcomes including patient satisfaction, knowledge of diagnosis, and 9-month adherence to follow-up. MethodsPatients ≥18 years old presenting for initial appointment at the study colposcopy clinic were randomized 1:1 to an intervention group (Nurse Liaison) versus a control group (PCP). After receiving colposcopy results, participants completed online measures of anxiety (State-Trait Anxiety Inventory), health care satisfaction scales (Patient Satisfaction Questionnaire-18, Health Anxiety Inventory, Visit-Specific Satisfaction Questionnaire-9), self-reported colposcopy diagnosis, and demographics. Chart review at 9 months assessed adherence to recommended colposcopy follow-up. Groups were compared on continuous and categorical variables, controlling for diagnosis severity and trait anxiety. ResultsThe intervention group had significantly lower state anxiety with State-Trait Anxiety Inventory-state mean scores of 37.3 versus 40.7 in controls (P = 0.03). Intervention group participants were more likely to correctly report their diagnosis (84% vs. 66.3%, P = 0.003). Questionnaire responders were more likely to be in the intervention group and had a higher proportion of cervical intraepithelial neoplasia 2+ pathology. There were no differences in demographics, patient satisfaction, or adherence to follow-up between groups. ConclusionsDirect delivery of colposcopy results by a trained Nurse Liaison was associated with decreased patient anxiety around colposcopy results, and increased patient knowledge regarding diagnosis. This model may be considered to improve patient-centred care.

Diagnostic cervical excision in patients with HPV positivity, cytological abnormalities- and preoperative cervical stenosis

AimThere is currently no protocol for classifying patients with HPV persistence and preoperative stenosis of the cervical canal. This has a significant impact on cytology results, colposcopy results and the possibility of obtaining reliable cervical histology outcomes. Our analysis clearly shows that colposcopy and cytology underestimate the histological results in patients with limited visibility due to the presence of a type 3 transformation zone (TZ). Our analysis revealed a significant discrepancy between the colposcopy and cytology results and the histological outcomes. Insufficient colposcopy led to the underdiagnosis of dysplastic lesions in patients with a type 3 TZ and cervical stenosis. In the case of repeated cytological abnormalities and inadequate colposcopy examination, it is crucial to perform a diagnostic conization to exclude high-grade dysplastic changes and cervical carcinoma.MethodsWe conducted a retrospective analysis of 1,021 conizations performed in tertiary care hospital in Wolfsburg, Germany between 2014 and 2020. Of these surgical procedures, 89 were diagnostic conizations. In our analysis, we defined diagnostic conization as a procedure performed when there is HPV persistence and repeated cytologic abnormalities in combination with a type 3 TZ, and when it is not possible to retrieve a relevant cervical histology sample.ResultsIn this period, 8.7% of all conizations were diagnostic excisions. We found histological abnormalities in 48 of 89 patients (53.9%). The histological examination of the excised cone revealed high-grade cervical intraepithelial neoplasia (CIN/HSIL) in 9 patients (10.1%) and CIN 2+ (HSIL) in 23 out of the 89 patients (25.8%). Two cases of early-stage cervical carcinoma (FIGO IA1 and FIGO IA2) were confirmed (2.3%).ConclusionPatients with cervical stenosis, high-risk HPV persistence and repeated cytological abnormalities are at high risk of undetected high-grade cervical dysplasia. Histologic confirmation must be ensured in this patient consultation and this can be achieved by performing diagnostic excisions.

Examination of Colposcopy Results Performed at a Single Tertiary Level Center

Examination of Colposcopy Results Performed at a Single Tertiary Level Center

Clinical evaluation of an artificial intelligence-assisted cytological system among screening strategies for a cervical cancer high-risk population

BackgroundPrimary cervical cancer screening and treating precancerous lesions are effective ways to prevent cervical cancer. However, the coverage rates of human papillomavirus (HPV) vaccines and routine screening are low in most developing countries and even some developed countries. This study aimed to explore the benefit of an artificial intelligence-assisted cytology (AI) system in a screening program for a cervical cancer high-risk population in China.MethodsA total of 1231 liquid-based cytology (LBC) slides from women who underwent colposcopy at the Chinese PLA General Hospital from 2018 to 2020 were collected. All women had received a histological diagnosis based on the results of colposcopy and biopsy. The sensitivity (Se), specificity (Sp), positive predictive value (PPV), negative predictive value (NPV), false-positive rate (FPR), false-negative rate (FNR), overall accuracy (OA), positive likelihood ratio (PLR), negative likelihood ratio (NLR) and Youden index (YI) of the AI, LBC, HPV, LBC + HPV, AI + LBC, AI + HPV and HPV Seq LBC screening strategies at low-grade squamous intraepithelial lesion (LSIL) and high-grade squamous intraepithelial lesion (HSIL) thresholds were calculated to assess their effectiveness. Receiver operating characteristic (ROC) curve analysis was conducted to assess the diagnostic values of the different screening strategies.ResultsThe Se and Sp of the primary AI-alone strategy at the LSIL and HSIL thresholds were superior to those of the LBC + HPV cotesting strategy. Among the screening strategies, the YIs of the AI strategy at the LSIL + threshold and HSIL + threshold were the highest. At the HSIL + threshold, the AI strategy achieved the best result, with an AUC value of 0.621 (95% CI, 0.587–0.654), whereas HPV testing achieved the worst result, with an AUC value of 0.521 (95% CI, 0.484–0.559). Similarly, at the LSIL + threshold, the LBC-based strategy achieved the best result, with an AUC of 0.637 (95% CI, 0.606–0.668), whereas HPV testing achieved the worst result, with an AUC of 0.524 (95% CI, 0.491–0.557). Moreover, the AUCs of the AI and LBC strategies at this threshold were similar (0.631 and 0.637, respectively).ConclusionsThese results confirmed that AI-only screening was the most authoritative method for diagnosing HSILs and LSILs, improving the accuracy of colposcopy diagnosis, and was more beneficial for patients than traditional LBC + HPV cotesting.

Cervical Squamous Intraepithelial Lesions: A Comparison of Diagnostic Approaches

Aim. To compare the effectiveness of Papanicolaou test, screening for oncogenic human papillomavirus (HPV) strains, and colposcopy in diagnosis of cervical squamous intraepithelial lesions and cervical cancer.Materials and Methods. We conducted a retrospective study which included 101 patients aged 21-65 years (mean age 36.9 ± 8.2 years). All patients underwent cytological examination, screening for 14 high-risk HPV types, and colposcopy. The prognostic value of the methods was calculated using standard formulas for determining the sensitivity, specificity, and prognostic value of positive and negative results. Cervical biopsy was accepted as the gold standard.Results. Among the examined women (n = 101), high-risk HPV types were detected in 78 women (77.2%). According to the results of cytological examination, cervical intraepithelial neoplasia (CIN) I, CIN II, CIN III, and cancer were detected in 24 (23.8%), 24 (23.8%), 22 (21.7%), and 2 (2%) cases, respectively. Abnormal colposcopy results of the 1st and 2nd degree were found in 33 (32.7%) and 51 (50.5%) women, respectively. The highest sensitivity in the diagnosis of low-grade squamous intraepithelial lesion was demonstrated by colposcopy (81.3%), whilst HPV testing and cytological examination had lower sensitivity values (75.0% and 58.3%, respectively). However, HPV testing had the highest sensitivity (85.7%) in diagnosis of high-grade squamous intraepithelial lesion and cervical cancer, whereas colposcopy and Papanicolaou test were behind (82.9% and 63.6%, respectively).Conclusion. Detection of high-risk HPV types has a high sensitivity in detecting both low- and highgrade squamous intraepithelial lesions and cervical cancer.

Value of high‑risk human papillomavirus detection combined with colposcopy in the diagnosis of cervical cancer and precancerous lesions.

In the present study, the diagnostic value of high risk-human papillomavirus (HR-HPV) combined with colposcopy for the detection of cervical cancer and precancerous lesions was evaluated. A total of 397 patients with confirmed cervical disease were enrolled between August 2020 and December 2021. According to the pathological diagnosis, the patients were divided into cervical intraepithelial neoplasia grade I (CIN I; n=153 cases), CIN II (n=101 cases), CIN III (n=86 cases) and cervical cancer (n=57 cases) groups. The HR-HPV-positive rate of the patients with different lesion types was compared, and the consistency of colposcopy and pathological examination results were assessed. For cervical cancer and precancerous lesions, the diagnostic value and efficacy of HR-HPV testing, colposcopy and combined HR-HPV testing and colposcopy examination were compared using pathological examination results as the gold standard. The results of the present study demonstrated that in patients with cervical cancer, the positive rate of HR-HPV (100.00%; n=57/57) was higher than that in patients with precancerous lesions, and the positive rate of HR-HPV in patients with CIN I type (36.60%, n=56/153) was lower than that in patients with CIN II (83.17%, n=84/101) and CIN III (82.56%, n=71/86) types (P<0.05). There was no significant difference in the HR-HPV-positive rate between patients with CIN II and CIN III (P>0.05). Cohen's κ coefficient for colposcopy examination and pathological examination of patients with cervical cancer and precancerous lesions was 0.622, the diagnostic accuracy was 90.43% (n=359/397), the positive predictive value was 65.57% (n=40/61), and the negative predictive value was 94.94% (n=319/336). Receiver operating characteristic curve analysis demonstrated that the area under the curve of the combined examination in the diagnosis of cervical cancer and precancerous lesions was 0.904, which was higher than that of colposcopy (0.820) or HR-HPV testing (0.802) alone (P<0.05). The results of the present study indicated that HR-HPV detection combined with colposcopy has diagnostic value for cervical cancer and precancerous lesions.

Real-world effectiveness of cytology and HPV-based screening strategy in cervical cancer screening: A cross-sectional population-based study in Chengdu, China.

Cervical cancer poses a significant health challenge in developing countries, emphasizing the need for appropriate screening strategies to accelerate the elimination of this disease. This study summarized the results of a large-scale community-based cervical cancer screening program conducted in Chengdu, China, to understand the prevalence of HPV infection and cervical lesions in the population, and to compare the real-world effectiveness of two different screening methods implemented in the program. From January 2021 to December 2022, a total of 363,376 women aged 35-64 years in Chengdu received free screenings. Among these participants, 70.1% received cytology screening and 29.9% received HPV testing combined with 16/18 genotyping and cytology triage. Ultimately, 824 cases of high-grade lesions and cervical cancer were detected, with a total detection rate of cervical cancer and precancerous lesions of 226.8 per 100,000. The follow-up rate of patients with high-grade lesions and above was 98.9%, and the treatment rate was 86.6%. The overall high-risk HPV infection rate was 11.7%, with the HPV 16/18 infection rate of 1.4%. The rate of abnormal cytology results was 2.8%. The attendance rates for colposcopy and histopathology were 71.6% and 86.1%, respectively. By calculating the age-standardized rates to eliminate the different age composition between the two group, the HPV-based screening strategy had a higher rate of primary screening abnormalities (3.4% vs. 2.8%, P<0.001), higher attendance rates of colposcopy (76.5% vs. 68.9%, P<0.001) and histopathological diagnosis (94.1% vs. 78.0%, P<0.001), higher percentage of abnormal colposcopy results (76.0% vs. 44.0%, P<0.001), and higher detection rate of cervical precancerous lesions and cancer (393.1 per 100,000 vs. 156.4 per 100,000, P<0.001) compared to cytology screening. Our study indicates that the combination of HPV testing with 16/18 genotyping and cytology triage has demonstrated superior performance in cervical cancer screening compared to cytology alone in large-scale population.

Оценка эффективности применения активированной глицирризиновой кислоты у пациенток с ВПЧ-ассоциированными поражениями шейки матки с учетом уровня половых стероидных и гонадотропных пептидных гормонов

Background: the persistence of human papillomavirus (HPV) infection with oncogenic protein expression causes changes in the stratified squamous epithelium, which is the immediate cause of cervical cancer manifestation. The use of the activated glycyrrhizic acid (GA) for HPV-associated cervical lesions is pathogenetically justified. During an experimental study on a culture of human cervical adenocarcinoma cells (HeLa line), it was shown that the antiproliferative effect of GA is enhanced by low concentrations of estradiol and weakened by testosterone. Aim: to evaluate the efficacy of the activated GA in female patients with HPV-associated cervical pathology with respect to the level of sex steroid and gonadotropin-releasing hormones Patients and Methods: a prospective study was conducted with the inclusion of 51 female patients with HPV-associated cervical pathology (ASCUS — atypical squamous epithelial cells of undetermined significance, LSIL — low-grade squamous intraepithelial lesion, HSIL— high-grade squamous intraepithelial lesion according to the Bethesda classification) and the absence of clinical and/or laboratory signs of hyperandrogenism. The following studies were performed: clinical examination, colposcopy, microscopic examination, cytology and immunocytochemistry, as well as hormonal status was evaluated. All female patients received Epigen Intim spray 0.1%, 3 times a day, for 30 days from the moment of inclusion in the study. If indicated, cervical conization was also performed. The treatment efficacy was evaluated 90±7 days after the therapy initiation based on the liquid-based HPV-PAP test results with the determination of p16/Ki67 oncogenic protein co-expression in the cervical epithelium. Changes in the colposcopy results were also evaluated. Results: it was found that the level of estradiol in patients with HSIL was lower versus the patients with ASCUS and LSIL (32 [32.0; 36.0] pg/ml versus 40 [34.5; 45.5] and 40 [33.0; 44.0] pg/ml, respectively, but the difference did not reach statistical significance (p=0.453). 90 days after the follow-up start, according to the cytology results of the cervical epithelium, 50 (98.0%) patients showed the absence of cervical intraepithelial lesions and the absence of p16/Ki67 oncogenic protein co-expression, 48 (94.1%) patients showed no high-risk (HR) HPV DNA, whereas HPV-associated colposcopy signs (anogenital warts, chronic cervicitis signs) persisted only in 6 (11.8%) patients. Conclusion: the use of activated GA in female patients of reproductive age with HPV-associated cervical lesions without clinical and/or laboratory signs of hyperandrogenism allowed to achieve high efficiency indicators: 98.5% — according to the cytology results, 83.3% — in reducing the HR-HPV viral load, 85.7% — in terms of p16/Ki67 oncogenic protein co-expression. KEYWORDS: human papillomavirus, squamous intraepithelial lesion of the cervix, oncogenic protein co-expression, sex steroid hormones, activated glycyrrhizic acid FOR CITATION: Mandrykina Zh.A., Dobrokhotova Yu.E., Ibragimova D.M., Kazieva M.D., Filimonova M.S., Shimanovsky N.L., Akhmetgaliev A.R. Assessment of the activated glycyrrhizic acid efficacy in female patients with HPV-associated cervical lesions with respect to the level of sex steroid and gonadotropin-releasing hormones. Russian Journal of Woman and Child Health. 2024;7(2):127–134 (in Russ.). DOI: 10.32364/2618-8430-2024-7-2-7.

Rethinking the Risk: Evaluation of The Malignant Potential of Non-16 and 18 HPV Types via Colposcopic Results

Rethinking the Risk: Evaluation of The Malignant Potential of Non-16 and 18 HPV Types via Colposcopic Results

A research investigation into the micronuclei assay within urothelial cells as an innovative biomarker for the carcinogenesis of cervical cancer conducted at a tertiary care facility

Abstract Background: Cervical carcinoma ranks as the fourth most prevalent cancer in women worldwide, following breast, colorectal, and lung cancers. Screening is a crucial secondary prevention strategy, particularly in developing nations such as India, ensuring effective prevention and treatment. This study investigates the micronuclei assay in urothelial cells as a potential biomarker for cervical carcinoma screening, focusing on its correlation with colposcopic and histopathological observations. Materials and Methods: The prospective study was conducted from September 2016 to September 2017 at the Department of Pathology, Institute of Obstetrics and Gynecology, Madras Medical College, Chennai, Tamil Nadu, India. It involved 108 women who visited the colposcopic clinic. Urine samples were collected from 50 women with normal colposcopic findings and 58 with abnormal colposcopy results. Micronuclei scoring was performed on 1000 epithelial cells from the smears. Additionally, cervical biopsies were conducted for the 58 cases with abnormal colposcopic findings, and the resulting histopathological data were juxtaposed with the findings of the micronuclei assay. Results: The study’s findings demonstrated a sensitivity of 82.76% and a specificity of 90%, with positive predictive values of 90.75% and negative predictive values of 81.82%. Additionally, a statistically significant linear correlation was observed between the micronuclei assay and histopathological diagnosis, with a P value of less than 0.001. Conclusion: Therefore, the micronuclei assay offers a means to detect genotoxicity, monitor cervical carcinogenesis, and identify high-risk groups using simple, reliable, and cost-effective techniques suitable for large-scale screening programs.

Colposcopy-A Valuable Diagnostic Tool for Pregnant Women With Unexplained Vaginal Bleeding.

We aimed to examine the diagnostic value of colposcopy in a large cohort of pregnant women with unexplained vaginal bleeding during the second or third trimester. This retrospective study included women who underwent colposcopy due to vaginal bleeding in the second and third trimesters during 2012-2022 at a tertiary care hospital. Demographics, obstetric data, bleeding characteristics, colposcopy results, cervical cytology testing, a sonogram directed at the placenta, and birth details were collected. In total, 364 women were included. The mean maternal age was 29.7 years and the mean gestational age at examination was 30.7 weeks. Vaginal bleeding was mild in 80.8%, moderate in 14.6%, and severe in 4.7%. Only 3.3% had been vaccinated against human papilloma virus and 25.5% underwent a Pap smear study before pregnancy. Colposcopy diagnosed the bleeding source in 83 women (22.8%). The colposcopic examination revealed vaginal bleeding due to contact bleeding from ectropion in 46 (12.6%), a decidual/cervical polyp in 37 (10.2%), acetowhite epithelium in 12 (3.3%), herpes genetalis in 2 (0.5%), and bleeding from vaginal varices in 2 (0.5%). Of those who were recommended a follow-up examination after the postpartum period, only 49.1% completed such.Among women with compared to without postcoital bleeding ( N = 72), the risk of abnormal colposcopic findings was higher (24 [33.3%] vs 54 [19.7%], p = .017) and the rate of abnormal Pap smear was higher (7 [13.2%] vs 7 [3.2%], p = .008). Colposcopy can be a valuable diagnostic tool for women with unexplained vaginal bleeding in the second or third trimester.

Retrospective survey of colposcopy experience for wāhine Māori across two time periods (2016 and 2021) in Waitematā and Auckland districts, New Zealand.

To examine wāhine Māori experiences of colposcopy services in New Zealand based on surveys conducted in 2016 and 2021. The surveys included a total of 201 wāhine Māori who had attended one of the three colposcopy clinics in the Waitematā and Auckland districts. Participants were retrospectively surveyed about their experience via telephone using a pre-tested questionnaire. Pre-defined responses were analysed quantitatively, and narrative comments were analysed thematically. Response rates were 27.6% in 2016 and 34.2% in 2021. Prior to their appointment, most women reported receiving the information leaflet and a reminder. At the clinic visit, overall interaction with staff, comfort, listening and explanation of the procedure all scored highly, with maintenance or improvements from 2016 to 2021. Wāhine reported feeling culturally safe. Areas for improvement included content of information, access to Māori community liaison, appointment waiting time and delivery of colposcopy results. The findings indicated that wāhine Māori had overall excellent experiences of colposcopy services, maintained over a five-year period with some suggested improvements to context of information and communication. This provides reassurance for wāhine Māori in the diagnostic and treatment part of the cervical screening pathway ahead of the upcoming change to HPV primary screening.

B-208 Correlation Studies of Human Papillomavirus DNA on Roche Cobas vs Human Papillomavirus mRNA on Hologic Panther

Abstract Background Molecular testing, specifically HPV DNA has revolutionised the screening and management of cervical cancer. WHO in 2021 has recommended HPV DNA as the primary screening test and also the newer technology HPV mRNA as alternative assay. This evaluation aims to study the result concordance between HPV DNA and mRNA assay. Methods The evaluation was conducted on Roche Cobas 4800 (HPV DNA) and Hologic Panther (HPV mRNA) at NHGD IMH lab in 2021. Both instruments underwent precision studies and carryover test to ascertain its performance prior to the concordance study. 64 samples were used in the correlation against the reference method- HPV DNA testing on Roche Cobas 6800. Results Both Cobas 4800 and Hologic Panther demonstrated acceptable performance in precision, carryover and LoD (for Hologic only). However closer result agreement is observed in Roche 4800 results to the testing laboratory, Quest which is using Roche 6800. Conclusion The disconcordance between cobas 6800 vs cobas 4800 came from the negative samples in cobas 4800 in which their Ct value were found to be near to the detection limit. Similar to Cobas 4800, the discordance observed in Hologic came from the negative samples. However, HPV mRNA screening has been recognized for its higher specificity at baseline in the recent studies which improve clinical outcomes and reduce colposcopy referrals by 14%. Unfortunately, this could not be verified in our evaluation as colposcopy results for those HPV DNA positive sample were not available.

Effect of Pap Smear Cytology, HPV Genotyping on the Concordance of Colposcopy and Conization Results.

To evaluate the conization results performed due to human papillomavirus (HPV), smear, colposcopy results or clinician's decision and determine the factors that predict ≥CIN2. Retrospective comparative study. Place and Duration of the Study: Department of Gynaecology and Obstetrics, Dr. Abdurrahman Yurtaslan Ankara Oncology Training and Research Hospital, Ankara, Turkey, between January 2011 and December 2021. Women with known HPV results who underwent conization in the Gynaecology clinic were retrospectively included. Age, HPV genotypes, conization, and colposcopy results of the patients were recorded. Patients were divided into two groups as those with and without ≥CIN2 and compared in terms of clinicopathological features. Four hundred and twenty eight (82.8%) of the 517 patients were premenopausal and perimenopausal, and 89 (17.2%) of the patients with a median age of 42 years (range: 30-65 years) were postmenopausal. While 374 were HPV 16/18 positive, 143 were non-16/18 HPV positive. Conization result was normal in 202 (39.1%) patients, CIN1 in 129 (25.0%) patients, and CIN 2-3 in 186 (36.0%) patients. In the HPV 16/18 positive group, conization result was normal in 38.2% of patients, CIN1 in 20.9%, and CIN 2-3 in 40.9%; these rates were 41.3%, 35.7%, and 23.1% in the HPV-other group, respectively (p <0.001). In the logistic regression model, age, HPV type (16/18), and smear cytology results (≥ASC-US) were tested as independent factors predicting ≥CIN2. HPV 16/18 positivity and smear cytology result (≥ASC-US) were the factors predicting ≥CIN2. Smear and HPV genotyping can make an important contribution to detecting false <NIC2 results as a result of colposcopy. CIN, Colposcopy, Conization, Cervix, Cervical cancer, Neoplasia, HPV.

Histopathologic Follow-Up of Women with Inadequate ThinPrep™ Cervical Pap Tests and Positive High-Risk Human Papillomavirus Test Results

Introduction: We found only a few studies that had performed high-risk human papillomavirus (hrHPV) analyses of inadequate ThinPrep™ Papanicolaou (Pap) tests. Therefore, this study aimed to analyze unsatisfactory ThinPrep Pap tests using hrHPV tests. The colposcopic biopsy results of cases with an unsatisfactory ThinPrep Pap test and positive hrHPV results were revealed. Methods: Between January 1, 2018, and October 31, 2022, 965 (3.7%) of 25,958 liquid-based cytology specimens were evaluated as unsatisfactory. Ninety-five (9.8%) of 965 patients were positive for hrHPV. The colposcopic evaluation was performed in 28 (29.4%) of 95 patients, in whom 23 tests were adequate. Results: Twenty-three colposcopy biopsy results showed that 17 (73.9%) of 23 patients had benign biopsy results. High-grade squamous intraepithelial lesions were observed in three (13%) of the 23 patients, and low-grade squamous intraepithelial lesions were observed in two (8.6%) of the 23 patients. One of the 23 (4.3%) patients had keratinized squamous cell carcinoma of the cervix diagnosed histologically, although no tumor was visible upon gynecologic examination. Conclusion: For the management of unsatisfactory Pap tests, The American Society for Colposcopy and Cervical Pathology (ASCCP) recommends repeat cytology within 2–4 months. Evaluation of such patients using hrHPV tests may triage those with squamous intraepithelial lesions, even invasive cervical cancer. More studies with a larger number of cases are needed to analyze the hrHPV status and biopsy follow-up of cases with unsatisfactory cytology.

Determining the relationship between serum acute phase reactants and cervical premalignant lesions: a cohort study.

Acute phase reactants play a role in the progression and prognosis of many malignant and premalignant tumors. This study investigated the diagnostic value of certain reactants as markers for cervical premalignant lesions. Despite advanced screening and vaccination programs, cervical cancer remains a serious health problem worldwide. We aimed to determine the possible relationship between premalignant cervical disease and serum acute phase reactant levels. This study included 124 volunteers who underwent cervical cancer screening. We divided the patients into three groups according to cervical cytology and histopathological findings as follows: no cervical lesion, low-grade neoplasia, or high-grade neoplasia. We included women aged 25-65 years with benign smear or colposcopy results, low- and high-grade squamous intraepithelial lesions. The benign group was based only on cytology findings, whereas the other groups were based on histopathology findings. Demographic data and serum albumin, fibrinogen, ferritin, and procalcitonin levels were evaluated in the three groups. We found significant differences among the three groups in terms of age, albumin level, albumin/fibrinogen ratio, and procalcitonin level. The regression analysis revealed lower serum albumin levels in the low- and high-grade squamous intraepithelial lesion groups compared with the benign group. This is the first study to evaluate the importance of serum inflammatory markers in cervical intraepithelial lesions. Our results indicate that serum albumin level, albumin/fibrinogen ratio, procalcitonin level, and neutrophil values differ among cervical intraepithelial lesions.

Corelaţii citologice, colposcopice şi histopatologice în diagnosticul neoplaziilor intraepiteliale cervicale

Preinvasive cervical lesions have a long period of evolution towards cervical cancer, therefore their early detection and treatment, along with anti-HPV vaccination, are a necessity in preventing the occurrence of invasive cervical cancer. Genital HPV infection is the most common sexually transmitted infection. The objective of the study was to establish the prediction of the cervicovaginal cyto-tumor examination and the colposcopic examination for cervical dysplastic lesions and the histopathological examination of the fragments obtained by cervical biopsy, as well as the reevaluation of the histopathological diagnosis of certainty of dysplastic lesions, in the context of the increased incidence of cervical cancer in our country. Cervicovaginal cyto-tumor examination and colposcopic examination had a good correlation with the histopathological diagnosis of the biopsied cervical fragment in cases where they were concordant. In case of discordant cytological and colposcopic results, cervical biopsy with histopathological examination establishes the diagnosis of certainty. Since the incidence of cervical cancer is high in our country, the biopsy with histopathological examination is necessary to establish the diagnosis of dysplastic lesions and the subsequent therapeutic behavior.

HPV Pozitif Kadınlarda ASC-US ve LSIL Sitolojilerinin Klinik Veri ve Kolposkopi Sonuçlarının Karşılaştırılması

ABSTRACT&#x0D; Objective: The aim of our study is to compare the clinical data and colposcopy- directed biopsy (CDB) results of atypical squamous cell of undetermined significance (ASC-US) and low-grade squamous intraepithelial lesion (LSIL) cytology among high risk human papilloma virus (hrHPV) positive women.&#x0D; Materials and Methods: A total of 359 hrHPV-positive patients with ASC-US and LSIL cytology, between 20-67 years of age were included in the study. Participants’ age, education status, smoking status, colposcopy results, and number of CDBs were assessed and clinical data compared with histopathologic evaluation of biopsies statistically. &#x0D; Results: There were no statistically significant differences in terms of age, marital status, education status and smoking status of hrHPV + ASC-US and hrHPV + LSIL groups. Both groups were compared in terms of histopathologic results of CDBs and no statistically significant difference was observed between the groups. The number of CDB material and frequency of endocervical curettage were significantly higher in hrHPV + LSIL than hrHPV + ASC-US patients. There was no statistically significant difference between the two groups in terms of advanced treatment need. Control cytology performed during follow-up of both ASC-US and LSIL groups were resulted as benign.&#x0D; Conclusion: The approach to ASCUS and LSIL is similarly important in HPV positivity. Since our follow up period includes a sort period of 1 year, further studies need to be carried out in order to demonstrate longer term outcomes.

Could HPV Type 33 Be More Risky Than We Thought?

Objective: The distribution of human papilloma virus (HPV) genotypes varies by country and region. HPV is the most important risk factor for cervical cancer and HPV 16/18 is the most common genotype. Other high risk HPVs (hrHPVs) other than HPV 16 and 18 contribute significantly to invasive disease. In this study, we aimed to reveal the frequency of association of HPV 16, 18 and other high-risk-HPV types with CIN 2 + (CIN 2 and above) cervical lesions in patients with cervical intraepithelial neoplasia (CIN) and to support the literature especially on the management of high-risk-HPV types other than 16 and 18. Materials and Methods: This retrospective study, which was conducted on 264 patients and 202 patients after the exclusion criteria, was conducted in the gynecology oncology outpatient clinic of the tertiary care hospital between March 2020 and May 2022. HPV 16, HPV 18 and other high-risk-HPV types with negative cytology between the ages of 25-65 were compared by taking a biopsy accompanied by colposcopy performed by the same gynecologist. As a result of colposcopy, CIN2 + patients who underwent excisional procedure were distributed according to HPV type. During this procedure, the patients who were positive for more than one HPV type were considered positive for the group with all subtypes (For example, if the patient was type 31 and 33 positive, they were included in both the 31 and 33 positive groups). The genotype distribution in the high-risk-HPV group was examined. Results: Colposcopy results showed HPV 16 positivity in 43.3%, HPV 33 positivity in 30% and HPV 18 positivity in 10% of the patients with CIN2 + and above lesions. It was observed that the incidence of CIN2 + lesions in the patients with HPV 33 positive was higher than the incidence of a lower-grade lesion (such as CIN1, chronic cervicitis) (p < 0.05). While HPV 33 (r = 0.290, p < 0.000) results were positively correlated with CIN2 + and above lesions, there was a negative correlation with HPV 45 (r = - 0.172, p < 0.015) results (p < 0.05). It was observed that HPV 33 and HPV 45 positivity was a statistically significant variable in predicting the probability of CIN2 + lesions in colposcopy results. It was determined that a HPV 33 positive patient increased the probability of having a CIN2 + lesion by 4.999 times (p < 0.000). Conclusion: In the literature, the role of high-risk -HPV types other than HPV 16 and HPV 18 with negative cytology in the women at risk of cervical preinvasive lesions has still not been fully determined. According to the results of the stuy, especially in women infected with high-risk -HPV types other than HPV 16/18, the relationship between HPV 33 type and CIN 2 + lesions was found to be high, and it was seen that colposcopic biopsy should be performed immediately instead of follow-up after 1 year.

Co-Test im Zervixkarzinom-Screening: Die erste Runde

BackgroundIn 2020 guidelines for an organized screening program for cervical cancer with changes in primary screening and clinical management of conspicuous findings were introduced in Germany.ObjectiveDue to the data deficit, which stems from the central documentation only beginning after a 9-month delay, the results of the complete first screening round from a routine laboratory are evaluated.MaterialIn 2020 all co-test results of women aged 35 years and over were recorded in a pathology practice. The cytological control findings, human papillomavirus (HPV) tests, colposcopy and histological findings were documented.ResultsIn the primary screening a co-test was carried out for 63,615 women. Cytology findings requiring clarification by colposcopy (groups IIp–V of the Munich nomenclature III) were found in 1.96% and the HPV positive rate was 5.82% (1.28% HPV 16, 0.42% HPV 18). When cytologically negative and HPV positive women were examined by the required co-test 12 months later, these findings persisted in 40.6%, in 19.7% positive cytology findings were found. For 973 of the 1378 women positive for co-test, the results of colposcopy are known: 10.2% cervical intraepithelial neoplasia (CIN) 1, 7.8% CIN2, 8.5% CIN3 and 0.21% carcinoma. Of the 1081 women with positive cytology findings in primary screening 979 underwent colposcopy and 19.9% CIN1, 17% CIN2, 25.1% CIN3, 0.41% adenocarcinoma in situ (AIS) and 1.43% invasive carcinoma were diagnosed. Referral for colposcopy solely on persistent positive HPV test yielded CIN3 in 3.6% and for low-risk cytology a total of 6.6%.ConclusionOur data indicate an unfavorable benefit-cost ratio for negative and low-risk cytology. The central program evaluation will show to what extent algorithms should be adapted.