Detection Of Pre-invasive Lesions Research Articles

CYTOLOGICAL, HPV GENOME, AND HISTOPATHOLOGICAL CORRELATION OF CERVICAL SMEARS IN FEMALES 30 YEARS AND ABOVE

Objectives: The objectives of the study were to evaluate the patterns of cervical smear cytology in relation to human papillomavirus (HPV) and to correlate with histopathological diagnosis in females of 30 years and above. Methods: The 2-year prospective study was done in the Department of Pathology in 100 patients who attended the Gynaecology OPD of Govt. Medical College, Patiala. The cervical brushings obtained were subjected to cytological examination by liquid-based cytology through SurePath method and for HPV evaluation by BD Onclarity HPV assay. The cytological findings were further correlated with histopathological examination. Results: Majority of the females were in the age group of 30−45 years (62%). There was high incidence of dysplasia and malignancy in those who were of parity 3, 4, and above. The most common presenting symptom was discharge per vaginum (DPV) seen in 28% of cases. Maximum cases on cytology were diagnosed as NILM (including inflammatory pathology, 49%) followed by LSIL as 14% and malignant as 13%. Overall HPV genome was detected in 54% of the samples, the cases diagnosed as dysplasia and malignancy showed 68.42% and 100% presence of HPV, respectively. This was found to be statistically significant (p<0.05). Conclusion: Pap smear along with HPV evaluation is an effective screening method for the detection of pre-invasive lesions and cancers of cervix that are potentially curable.

A retrospective analysis of clinical profile of patients with cancer cervix in a rural medical college in Karnataka

Cancer cervix is most common cause of cancerous deaths in females especially in developing countries. The pre-invasive stage of cervical cancer lasts for a long period and a small proportion progresses to an invasive lesion. In Indian set up, majority of the patients are presenting with an invasive lesion. To describe the clinical profile of patients presented with cervical cancer and to describe various treatments received by those patients.: The present study is a retrospective observational study done on confirmed cases of carcinoma cervix who attended rural medical college in Karnataka. Clinical records of the patients, who presented between November 2019 and November 2020 and were diagnosed with cervical cancer, were retrieved. The data related to demographic and clinical variables like age, socioeconomic status, education, symptoms, clinical staging, treatment and histopathology report were recorded. Data collected were entered in Microsoft Excel Office 2007and data analysed. Data were presented using descriptive statistics. The data was expressed in the form of frequencies and percentagesA total of 30 patients with the median age of 46 years were studied. Most common presentation was post coital bleeding (40%) followed by white discharge per vagina in 33%. Majority were under low socioeconomic status (70%). 60% presented in stage II and 30% in stage I. Chemoradiation was treatment of choice in 60% followed by surgery in 33% and 7% were lost to follow up. On histopathology, majority had squamous cell carcinoma (70%).The appropriate management of Cervical intraepithelial neoplasia(CIN) can prevent invasive cervical cancer. In this study most of them presented in advanced stage which could have been prevented with the regular screening and awareness among women in the reproductive age group. : Detection of pre invasive lesions or in situ cases remains important key to decreasing cervical cancer morbidity and mortality.

Ovarian cancer: screening and future directions.

Ovarian cancer carries a lifetime risk of approximately 2% for women and is the leading cause of death from any gynecologic malignancy. Currently, no screening program for ovarian cancer exists for the general population in the UK. This review focuses on the evidence surrounding the efficacy of current markers and discusses future improvements in screening for this disease. One-off cancer antigen 125 (CA125) measurements for detecting ovarian cancer have been well researched. However, studies have highlighted low positive predictive values (5%) and high false positive rates leading to patient anxiety and unnecessary invasive follow-up. Commonly, in the UK, CA125 is combined with transvaginal ultrasound, but there is little evidence that this approach can decrease mortality from ovarian cancer. Recently the Risk of Ovarian Cancer Algorithm, involving a combination of serial CA125 measurements and age, has been shown to detect more early stage cancers. Nevertheless, these measures are not robust in decreasing mortality from ovarian cancer and are costly to implement. Newer markers, such as human epididymis protein 4, have shown greater specificity. Its combination with CA125 and menopausal status in the Risk of Ovarian Malignancy Algorithm can predict the risk of malignancy but provides no additional benefit as a screening tool. Advanced techniques are emerging, including ultrasound molecular imaging techniques using microbubbles targeted to kinase domain receptors, and fallopian tube cytology. To reduce mortality from ovarian cancer, detection of pre-invasive lesions is imperative as ovarian cancer may develop in the fallopian tube and spread to the peritoneal cavity before being detected systemically. It seems that screening tools for ovarian cancer are currently not worthwhile for implementation into a national program. An emphasis on reducing false positives rates, associated anxiety and subsequent overdiagnosis is needed.

Pap screening as preventive tool against cervical cancer: a report of carcinoma in-situ in a woman with family history of cancer in Ilorin

The incidence of cervical cancer in the developed countries has significantly reduced as a result of well-organized and coordinated Pap screening program, which is aimed at detection of pre-invasive lesions that are then promptly treated. We report a 45-year old woman whose immediate elder sister had breast carcinoma, and she presented for routine breast and cervical cancer screening. Pap smears on 2 occasions revealed a high grade squamous intraepithelial lesion (HSIL). Histopathological evaluation of the cervix after hysterectomy revealed carcinoma in-situ. We discussed the need for early screening for malignancies in persons with significant family history of cancer.Keywords: Pap smear, Cervical cancer, Ilorin

Squamous cell carcinoma antigen reproducible marker and its clinicopathological correlation with preinvasive and invasive cervical cancer

Background: Squamous cell carcinoma antigen (SCC-Ag) is a serologic tumor marker detected in SCC of the cervix. The aim of this study is clinical features and their histopathological correlation between preinvasive and invasive cervical cancer and its association with SCC-Ag levels. Materials and Methods: This case–control study was carried out over a period of 1 year in the Department of Obstetrics and Gynaecology, with collaboration of pathology and medicine. After informed consent and ethical clearance, totally 3200 women were recruited. Out of these, 76 women who were histopathological proven, 30 preinvasive, and 46 of invasive cervical malignancy (International Federation of Gynecology and Obstetrics Stage I–IV) enrolled for study. 15 healthy cytology negative were considered as controls. Per speculum, per vaginam examination was done in every women and pap smear was obtained. Pretreatment 5 ml venous blood samples were drawn into sterile vials. SCC-Ag levels were measured by enzyme-linked immunosorbent assay (ELISA) technique using ELISA Kit as per producer protocol. Results: Among preinvasive group, 35.46% women complained white discharge per vaginam. Blood mixed discharge and postcoital bleeding were observed in 3.4% and 0.71%, respectively. In malignant group, foul smelling discharge and postmenopausal bleeding were reported in 1.68% and 1.87% women, respectively. Serum SCC-Ag levels were increased from controls to cases. In controls, 0.27 ± 0.12 ng/ml, preinvasive 0.85 ± 0.37 ng/ml and in invasive malignancy Stage I, II, III, IV, 2.10 ± 0.55 ng/ml, 3.15 ± 0.84 ng/ml, 4.12 ± 0.89 ng/ml, and 2.71 ± 1.05 ng/ml, respectively. Moderately differentiated and poorly differentiated SCC were reported in 80.43% and 19.56%, respectively. Expired patients had significantly (P < 0.01) higher premean SCC Ag level as compared to those who remain alive. Conclusion: Serum SCC-Ag is not only useful in the detection of preinvasive lesions and early invasive cases of cervical cancer but also a definite indicator for advanced Stage malignancy. Its value was quite high in late stages of cervical malignancy, thus it can be used as reproducible marker in cervical cancer.

Abstract PR01: Transformation of the fallopian tube secretory epithelium leads to high-grade serous ovarian cancer in BRCA/P53 models

Abstract PR01: Transformation of the fallopian tube secretory epithelium leads to high-grade serous ovarian cancer in BRCA/P53 models

Asymptomatic pancreatic lesions: New insights and clinical implications

Despite great efforts in experimental and clinical research, the prognosis of pancreatic cancer (PC) has not changed significantly for decades. Detection of pre-invasive lesions or early-stage PC with small resectable cancers in asymptomatic individuals remains one of the most promising approaches to substantially improve the overall outcome of PC. Therefore, screening programs have been proposed to identify curable lesions especially in individuals with a familial or genetic predisposition for PC. In this regard, Canto et al recently contributed an important article comparing computed tomography, magnetic resonance imaging, and endoscopic ultrasound for the screening of 216 asymptomatic high-risk individuals (HRI). Pancreatic lesions were detected in 92 of 216 asymptomatic HRI (42.6%). The high diagnostic yield in this study raises several questions that need to be answered of which two will be discussed in detail in this commentary: First: which imaging test should be performed? Second and most importantly: what are we doing with incidentally detected pancreatic lesions? Which ones can be observed and which ones need to be resected?

The Changing Face of Cervical Cancer Screening in the United States

With the introduction of widespread Pap smear screening starting in the 1940s, the United States has seen at least a 50% reduction in the incidence and mortality of invasive cervical cancer. In light of the ease of sampling, the long pre-malignant phase of cervical cancer, and well-tolerated treatment options for pre-invasive disease, cervical cancer screening has served as a model for screening for other malignancies. For some women, it also serves as the cornerstone for annual routine visits with gynecologists. Both patients and gynecologists have been taught that a yearly Pap test is important, and it can serve as the backbone of care. Unfortunately, however, access to screening and treatment for cervical cancer continues to be an issue for some women in the United States. Approximately 60% of women with invasive cancer had not undergone a Pap test in the 5 years preceding their diagnosis or have never undergone a Pap test. 1 The long history of Pap tests has also taught us a number of lessons. We have learned that cytologic screening is hardly perfect. In a study by Nanda et al. 2 the sensitivity of a single test was 51%, and this was subsequently confirmed in a pooled analysis of European and Canadian studies by Cuzick et al. 3 One way to compensate for this poor sensitivity is by using serial screening; the sensitivity of cytology increases to 76% with 2 consecutive annual Pap tests and 88% with 3 consecutive tests. Just adding tests and procedures, however, is not always the answer, and most recently the pendulum has swung in the other direction. We now understand the risk of overtreating pre-invasive disease and the potential impact of overtreatment on preterm labor and neonatal morbidity and mortality. In many adolescents and young women, abnormal Pap tests and underlying disease will resolve spontaneously. Therefore, in 2009, the American College of Obstetricians and Gynecologists recommended that screening for cervical cancer start at age 21. 4 Another lesson learned is the role of human papillomavirus (HPV) in cervical cancer. High-risk (HR) HPV DNA testing has become a mainstay of cervical cancer screening over the past 10 years. Experts now recognize that more than 99% of all invasive cervical cancers are associated with 14 different HR HPV types. Currently, HR HPV testing is recommended for women with equivocal Pap tests (ASC-US) and atypical glandular Pap tests (AGC). Most importantly, it is also widely recommended in conjunction with Pap testing in women older than 30 years of age. In keeping with the lesson of not overtreating and overscreening, after negative Pap and HPV test results, an individual woman can increase her screening interval to every 3 years. Another benefit of HR HPV testing is its much higher sensitivity than Pap testing (96% vs. 53% in pooled estimates). Since 2005, 7 randomized controlled trials 5–11 have been published that evaluated HPV testing in the screening setting. These studies have largely shown improvements in the detection of pre-invasive lesions either alone or in conjunction with Pap testing. Of particular note, a recently published trial from Finland showed

DUAL DIGITAL VIDEO-AUTOFLUORESCENCE IMAGING FOR DETECTION OF PRE-NEOPLASTIC LESIONS

Summary Aim: The incorporation of autofluorescence (AF) to white light bronchoscopy has led to improved sensitivity for the detection of pre-neoplastic lesions in the airways. However, AF has difficulty distinguishing benign epithelial changes such as bronchitis, previous biopsy, and airway fibrosis from pre-invasive lesions, which necessitates extensive biopsy. This frequently results in longer procedural time and need for additional sedation that may compromise patient safety, increase the risk of bronchospasm, and bleeding from multiple endobronchial biopsies. We postulate that dual imaging with simultaneous video and AF bronchoscopy of the tracheobronchial tree could improve the low specificity observed with AF in the detection of pre-invasive lesions, leading to targeted biopsy, good correlation with pathological diagnosis and shorter procedural time. Methods: Forty-eight patients with known or suspected of lung cancer underwent video and AF bronchoscopy, which were provided as real-time dual images with SAFE 3000 (Pentax, Tokyo) between March and August 2006. Biopsy specimens were taken from all suspicious areas with two random specimens from normal areas. Values were expressed as median and range, and p < 0.05 was considered statistically significant. Results: Twenty-five suspicious sites were detected by dual imaging bronchoscopy, and 126 endobronchial biopsies were evaluated, of which 22 (17.5%) were graded as moderate dysplasia and worse. Sensitivity and specificity of dual imaging for the detection of high-grade dysplasia were 86% and 94%, respectively, with good correlation between bronchoscopic assessment and pathology (r = 0.77, p < 0.0001). However, there were three random biopsy specimens obtained from normal or abnormal sites that showed severe dysplasia in two and moderate dysplasia in one. Median time taken for airway examination was 4 min (range, 4—4.8), and 5 min (range, 4—5) for biopsy, giving a total procedural time of 9 min (range, 8—10). There were no procedurerelated complications noted.

Dual digital video-autofluorescence imaging for detection of pre-neoplastic lesions

The incorporation of autofluorescence (AF) to white light bronchoscopy has led to improved sensitivity for the detection of pre-neoplastic lesions in the airways. However, AF has difficulty distinguishing benign epithelial changes such as bronchitis, previous biopsy, and airway fibrosis from pre-invasive lesions, which necessitates extensive biopsy. This frequently results in longer procedural time and need for additional sedation that may compromise patient safety, increase the risk of bronchospasm, and bleeding from multiple endobronchial biopsies. We postulate that dual imaging with simultaneous video and AF bronchoscopy of the tracheobronchial tree could improve the low specificity observed with AF in the detection of pre-invasive lesions, leading to targeted biopsy, good correlation with pathological diagnosis and shorter procedural time. Forty-eight patients with known or suspected of lung cancer underwent video and AF bronchoscopy, which were provided as real-time dual images with SAFE 3000 (Pentax, Tokyo) between March and August 2006. Biopsy specimens were taken from all suspicious areas with two random specimens from normal areas. Values were expressed as median and range, and p<0.05 was considered statistically significant. Twenty-five suspicious sites were detected by dual imaging bronchoscopy, and 126 endobronchial biopsies were evaluated, of which 22 (17.5%) were graded as moderate dysplasia and worse. Sensitivity and specificity of dual imaging for the detection of high-grade dysplasia were 86% and 94%, respectively, with good correlation between bronchoscopic assessment and pathology (r=0.77, p<0.0001). However, there were three random biopsy specimens obtained from normal or abnormal sites that showed severe dysplasia in two and moderate dysplasia in one. Median time taken for airway examination was 4 min (range, 4-4.8), and 5 min (range, 4-5) for biopsy, giving a total procedural time of 9 min (range, 8-10). There were no procedure-related complications noted. Dual imaging that allows simultaneous real-time assessment of the lesion with video and AF bronchoscopy not only achieves satisfactory sensitivity for the detection of pre-neoplastic lesions, importantly it improves specificity by allowing targeted biopsy, which has led to a marked decrease in procedural time and better patient safety.

Narrow Band Imaging in the Airway: Where Do We Stand?

Narrow Band Imaging in the Airway: Where Do We Stand?

Results of Two Years Expenience with Fluorescence Bronchoscopy in Detection of Preinvasive Bronchial Neoplasia

The aim of the study was to determine whether use of fluorescence bronchoscopy improves the detection of preinvasive neoplastic bronchial lesions. The data of all patients who underwent fluorescence bronchoscopy and in whom bronchial biopsies were taken, were analyzed. Most patients were at risk for preinvasive lesions. A total of 174 bronchoscopies were performed in 95 patients. Of the 681 representative biopsies, 31 were found to be moderate dysplastic, 39 were found to be severe dysplastic and 9 exhibited carcinoma in situ. These 79 preinvasive lesions were found in 34 patients. The respective results of fluorescence bronchoscopy in addition to conventional bronchoscopy and of conventional bronchoscopy alone for detection of preinvasive lesions were: sensitivity 85% (67/79) and 59% (47/79); specificity 60% (351/581) and 85% (493/581); positive predictive values of 23% (67/297) and 35% (47/135); negative predictive values of 97% (351/363) and 94% (493/525). A separate analysis of only the first bronchoscopy of each patient showed similar results. Results of fluoresence bronchoscopy were better in the second part of the patient group. We conclude that after a learning period fluorescence bronchoscopy can increase the yield of finding preinvasive neoplastic lesions when used in addition to conventional bronchoscopy.