Diagnosis Of Cervical Dysplasia Research Articles

Evaluation of risk factors for anal human papillomavirus infection in heterosexual women diagnosed with human papillomavirus associated cervical dysplasia

Background/Aim: Cervical dysplasia is a well-recognized precursor to cervical cancer, and human papillomavirus (HPV) infection is the primary causative agent in its development. The intricate relationship between cervical and anal HPV infections remains understudied. There have been no established risk factors determined for anal HPV infection in women without a history of anal intercourse. This study aims to address this critical knowledge gap by evaluating the risk factors for anal HPV infection in a homogeneous population of heterosexual women with HPV-associated cervical dysplasia. Methods: This retrospective cohort study was carried out in a single tertiary center and comprised women between the ages of 30 and 65. Women diagnosed with either low-grade squamous intraepithelial lesion (LSIL) or high-grade squamous intraepithelial lesion (HSIL) and without a history of anal intercourse were included in the analysis. Participants without a histological or colposcopic diagnosis were excluded from the analysis. Women with a history of prior cervical therapeutic intervention, previous cervical or genital dysplasia, known immunosuppressive disorders, current immunosuppressive medication use, a past cancer diagnosis, or a history of HPV vaccination were also excluded. Anal sampling was performed for HPV infection within the first year after the initial diagnosis of cervical dysplasia. Patient characteristics including smoking status were extracted from patient files. Results: Overall, 186 women who met the inclusion criteria were tested for active anal HPV infection of the anal canal. Active anal HPV infection was found in 96 (51.6%) of the patients. In women with active anal HPV infection, 31 (32.3%) were found to have only HPV 16/18 genotypes, and 22 had HPV16/18 along with other high-risk types. When risk factors were analyzed, only current smoking was found to be associated with anal HPV infection in this group of women. Overall, 40.6% of the women with active anal HPV infection were smokers; however, only 25.6% of the women without anal HPV infection were current smokers (P=0.029). Conclusion: Women had a high risk of active anal HPV infection during the diagnosis of cervical intraepithelial neoplasia. Current smoking was the only identifiable risk factor for anal HPV infection in women without anal intercourse history.

(067) False Positive Pap Smear as The First Sign of Genitourinary Syndrome of Menopause

Abstract Introduction Around 2010, we started to realize in our centers that we were receiving an increasing number of perimenopausal women with abnormal Pap smears (cervical dysplasia), going from ASCUS to low-grade squamous intraepithelial lesions or high-grade squamous intraepithelial lesions with or without positive HPV. With no previous history of cervical abnormality and almost all of them in a long-term stable sexual relationship with a maximum of 1 or 2 sexual partners. After talking with our pathologist, we asked if vaginal atrophy could produce such results. He answered affirmatively and provided us with a few recent articles that describe such findings. As an advocate for hormone replacement therapy, we decided to start using local vaginal estrogen for several months and then repeat the Pap smears. We were able to confirm that inclusively with those cases diagnosed with high-grade squamous intraepithelial lesions, the next Pap smear after the treatment with local estrogens was totally normal. The situation has been repeated in more than 96% of cases in around 1500 patients in the same conditions for the last 12 years. Objective Describe these new findings confirmed by a few articles in the pathology field and two articles on estrogen use, in women ranging between the ages of 30-70 years. Methods Prospective follow-up of perimenopausal patients with positive Pap smears and very low risk for STDs placed on local and/or systemic vaginal estrogen. A Pap smear was conducted at 4 months and then 1 year after, which was followed by the regular scheme of Pap smear follow-ups. Results 96.7% of all those patients with the described characteristics were successfully treated with local estrogens. During the study, we realized that the high number of patients who entered after the initial diagnosis of cervical dysplasia in the regular guidelines of colposcopies, biopsies, LEEP excisions, cryotherapy, and due to the persistence of the findings in more than 50% of those cases (because of the persistence of cervicovaginal atrophy) they finished having cone biopsies and/or hysterectomies. Conclusions We describe the early finding of another sign of genitourinary syndrome of menopause: false positive cervical dysplasias, secondary to cervicovaginal atrophy, due to the decrease in the level of estrogens that characterized the perimenopause. Also, how the management of local estrogens prevents a great number of interventions and patient procedures, saving billions of dollars per year, taking into account that the number of Pap smears in the named population is around 50-60% of all Pap smears practiced in the total population of women. Disclosure No

Computer-aided diagnosis of cervical dysplasia using colposcopic images.

Backgroundcomputer-aided diagnosis of medical images is becoming more significant in intelligent medicine. Colposcopy-guided biopsy with pathological diagnosis is the gold standard in diagnosing CIN and invasive cervical cancer. However, it struggles with its low sensitivity in differentiating cancer/HSIL from LSIL/normal, particularly in areas with a lack of skilled colposcopists and access to adequate medical resources.Methodsthe model used the auto-segmented colposcopic images to extract color and texture features using the T-test method. It then augmented minority data using the SMOTE method to balance the skewed class distribution. Finally, it used an RBF-SVM to generate a preliminary output. The results, integrating the TCT, HPV tests, and age, were combined into a naïve Bayes classifier for cervical lesion diagnosis.Resultsthe multimodal machine learning model achieved physician-level performance (sensitivity: 51.2%, specificity: 86.9%, accuracy: 81.8%), and it could be interpreted by feature extraction and visualization. With the aid of the model, colposcopists improved the sensitivity from 53.7% to 70.7% with an acceptable specificity of 81.1% and accuracy of 79.6%.Conclusionusing a computer-aided diagnosis system, physicians could identify cancer/HSIL with greater sensitivity, which guided biopsy to take timely treatment.

A pilot study of a collaborative screening program for HPV-related dysplasia and malignancy in gynecologic oncology patients (376)

<b>Objectives:</b> Human papillomavirus (HPV)-related dysplasia or malignancy is associated with a significantly increased risk of second site dysplasia or malignancy. However, screening for additional potential sites of HPV-related pathology is not routinely performed. The primary objective of this study was to determine the feasibility and acceptability of concurrent anal, cervical, or vulvovaginal screening in patients with a history of HPV-related gynecologic high-grade dysplasia or malignancy. The secondary objective was to assess patient knowledge regarding HPV screening and risks. <b>Methods:</b> Women with a diagnosis of cervical high-grade dysplasia or cancer and vulvovaginal high-grade dysplasia or cancer were enrolled during a one-year pilot period. Clinical data on all enrolled subjects were obtained using electronic medical records. All enrolled subjects completed a baseline HPV-knowledge survey. Subjects with cervical dysplasia or malignancy underwent vulvar examination with acetic acid and anoscopy. Subjects with vulvovaginal dysplasia or malignancy underwent a Pap test if indicated and anoscopy. Gynecologic oncologists were trained in anoscopy by colorectal surgery colleagues. Appropriate referrals were made for abnormal findings on screening exams. Feasibility was assessed by compliance using study acceptance rate, screening procedure adherence, and referral adherence. Acceptability was assessed using an acceptability Likert scale completed by subjects after screening procedures were performed. Descriptive statistics were used to assess the data. <b>Results:</b> A total of 103 women with a diagnosis of high-grade vulvovaginal or cervical dysplasia or carcinoma were approached regarding study enrollment; of these, 74 (71.8%) enrolled. Thirty-three (44.5%) had a primary diagnosis of cervical dysplasia or malignancy, and 43 (58.1%) had a primary diagnosis of vulvovaginal dysplasia or malignancy. About 50/74 (68%) were White, and 17/74 (23%) were Black. The median score on the HPV knowledge assessment was 8.1 ± 1.6 (max score of 10). Fifty-two patients (69%) reported that their provider discussed a possible diagnosis of HPV with them; 56 patients (75%) believed that HPV caused ovarian cancer. All enrolled subjects completed screening procedures, and 73/74 (98.6%) patients rated the procedure as acceptable (score of 5/5). On exam, 14 (18.9%) subjects had abnormalities noted; seven (9.5%) were referred for colorectal surgical evaluation, and 6/7 (85.7%) were compliant with their referral appointments. <b>Conclusions:</b> Screening exams for other HPV-related dysplasias and malignancies, including Pap tests, vulvovaginal inspection, and anos- copy, can be performed by gynecologic oncologists and are acceptable to patients with abnormal findings in almost one in five women. Improvements in communication and patient education regarding HPV should be the focus of future research efforts.

The effect of cervical conization on women’s sexual function and psychological health (341)

Objectives: Diagnosis of cervical dysplasia and subsequent conization of the uterine cervix might affect women’s sexual health. The study objective was to assess the effect of cervical conization on women’s sexual function and psychological wellbeing using structured questionnaires. Methods: Patients undergoing conization of the cervix completed questionnaires before and 6-12 months after conization. Assessment of sexual distress and function was done using the female sexual distress scale-revised (FSDS-r) and the female sexual function inventory (FSFI), respectively. Risk for anxiety and depression was assessed using the Hospital Anxiety and Depression Scale (HADS). Results: From October 2018 to March 2021, 55 patients undergoing cervical conization were recruited. No significant differences were found in FSDS-r scores before and after conization. An equal number of patients indicated having sexual distress (29 patients, 53%, before and after conization, p=1.0). No significant changes were noticed on any FSDS domains or the total FSDS score before and after conization (26.8 vs 26.0, p=0.461). The percent of patients that indicated an overall sexual dysfunction, increased from 49 percent before conization, to 59 percent after conization (p=0.388). A high percentage of patients indicated signs of anxiety on the HADS questionnaire, both before and after conization (49% and 47%, respectively). The median anxiety and depression scores did not change after conization (p=1.0). Conclusions: A high percentage of patients undergoing conization suffer from sexual distress, sexual dysfunction, and general anxiety, both before and after conization. The conization procedure itself did not seem to affect questionnaire scores. Gynecologists should be aware of the psychological and sexual effects of the diagnosis and treatment of cervical pre-cancerous lesions; patients should be counseled accordingly. Objectives: Diagnosis of cervical dysplasia and subsequent conization of the uterine cervix might affect women’s sexual health. The study objective was to assess the effect of cervical conization on women’s sexual function and psychological wellbeing using structured questionnaires. Methods: Patients undergoing conization of the cervix completed questionnaires before and 6-12 months after conization. Assessment of sexual distress and function was done using the female sexual distress scale-revised (FSDS-r) and the female sexual function inventory (FSFI), respectively. Risk for anxiety and depression was assessed using the Hospital Anxiety and Depression Scale (HADS). Results: From October 2018 to March 2021, 55 patients undergoing cervical conization were recruited. No significant differences were found in FSDS-r scores before and after conization. An equal number of patients indicated having sexual distress (29 patients, 53%, before and after conization, p=1.0). No significant changes were noticed on any FSDS domains or the total FSDS score before and after conization (26.8 vs 26.0, p=0.461). The percent of patients that indicated an overall sexual dysfunction, increased from 49 percent before conization, to 59 percent after conization (p=0.388). A high percentage of patients indicated signs of anxiety on the HADS questionnaire, both before and after conization (49% and 47%, respectively). The median anxiety and depression scores did not change after conization (p=1.0). Conclusions: A high percentage of patients undergoing conization suffer from sexual distress, sexual dysfunction, and general anxiety, both before and after conization. The conization procedure itself did not seem to affect questionnaire scores. Gynecologists should be aware of the psychological and sexual effects of the diagnosis and treatment of cervical pre-cancerous lesions; patients should be counseled accordingly.

The Role of p16/Ki-67 Immunostaining, hTERC Amplification and Fibronectin in Predicting Cervical Cancer Progression: A Systematic Review.

Simple SummaryHuman papillomaviruses (HPV) are common sexually transmitted infections and they are responsible for cervical cancer (CC), as well as for several other anogenital cancers. CC is the fourth leading cause of death in women with cancer, although it could be preventable by enforcement of optimal screening programs. The Pap smear is the standard screening test for CC and precancerous lesions, and a combination of Pap smear and HPV testing is generally recommended as a triage step before colposcopy. However, these tests cannot predict lesion progression, which is why several adjunctive biomarkers have been studied. Our aim was to summarize current scientific data on the role of these biomarkers, with a view to determining which biomarkers could help to more accurately establish the need for colposcopy and at the same time, to limit the number of unnecessary colposcopy referrals.Human papillomaviruses (HPVs) are common sexually transmitted infectious agents responsible for several anogenital and head and neck cancers. Cervical cancer (CC) is the fourth leading cause of death in women with cancer. The progression of a persistent HPV infection to cancer takes 15–20 years and can be preventable through screening. Cervical cytology (Pap smear) is the standard screening test for CC and precancerous lesions. For ASC-US and ASC-H lesions, a combination of Pap smear and HR-HPV analysis is recommended as a triage step before colposcopy. However, these tests cannot predict progression to CC. For this purpose, we summarized current scientific data on the role of p16/Ki-67 immunohistostaining, telomerase and fibronectin in predicting progression to CC. p16 and p16/Ki-67 dual staining (DS) were more specific than HR-HPV DNA testing for the detection of CIN2+/CIN3+ in women with ASC-US and LSIL. Similarly, hTERC FISH analysis significantly improved the specificity and positive predictive value of HPV DNA testing in differentiating CIN2+ from CIN2 cytological samples. In conclusion, p16 IHC, p16/Ki-67 DS and hTERC FISH amplification are all valid adjunctive biomarkers which significantly increase the sensitivity and specificity of cervical dysplasia diagnosis, especially when combined with HPV DNA testing. However, considering the global socioeconomic background, we can postulate that p16 and p16/ Ki-67 IHC can be used as a next step after positive cytology for ASC-US or LSIL specimens in low-income countries, instead of HPV DNA testing. Alternatively, if HPV DNA testing is covered by insurance, p16 or p16/Ki-67 DS and HPV DNA co-testing can be performed. In middle- and high-income countries, hTERC amplification can be performed as an adjunctive test to HPV DNA testing in women with ASC-US and LSIL.

Avoidable bilateral salpingo-oophorectomy at hysterectomy: a large retrospective study.

Evaluate the proportion of justified bilateral salpingo-oophorectomy (BSO) at hysterectomy, based on pathologic diagnosis, and determine prevalence of avoidable BSO based on pre- and intraoperative considerations and pathologic diagnosis. Retrospective review of hysterectomies at seven Ontario, Canada hospitals from 2016 to 2019. Surgeries completed by oncologists or for invasive placentation were excluded. Patient, case, and surgeon characteristics were recorded along with pathologic diagnoses. Avoidable BSO criteria were: preoperative diagnosis of cervical dysplasia or benign diagnosis other than endometriosis, gender dysphoria, risk reduction or premenstrual dysphoric disorder; age < 51 years; absence of intraoperative endometriosis and adhesions; unjustified pathology (where "justified" pathology was endometriosis or (pre)malignant diagnosis except for cervical dysplasia). Patients with avoidable BSO were compared to those having at least one criterion for BSO. Binary logistic regression identified factors most strongly associated with avoidable BSO. Four thousand one hundred ninety-one hysterectomies were completed with 1,422 (33.9%) patients having concomitant BSO. Pathologic diagnosis justified BSO in most patients (1,035/1,422, 72.8%) with endometrial cancer being most common (439/1,422, 30.9%). When preoperative characteristics, intraoperative findings, and pathologic diagnoses were considered, 79 of 1,422 (5.6%) BSOs were avoidable. Compared to cases with at least one criterion for BSO, avoidable BSOs were more frequently completed by generalists (OR 1.80, 95% CI 1.10-2.99, P = 0.021), for preoperative diagnoses of abnormal uterine bleeding/menorrhagia (OR 3.82, 95% CI 2.35-6.30, P = 0.001) and fibroids (OR 4.25, 95% CI 2.63-6.92, P < 0.001). Pathologic diagnosis justified most BSOs at hysterectomy. BSO was avoidable in 5.6% of patients, underscoring the need to standardize practice of BSO.

The Diagnosis of Cervical Dysplasia in a University Hospital Using Pap Smear and Colposcopy in the Western Region of Saudi Arabia: A Correlational Study.

ObjectivesTo assess the diagnostic performance of Pap smear screening with or without human papillomavirus (HPV) testing and colposcopy in detecting preinvasive lesions of the cervix among women with reference to histopathological findings.Materials and methodsWe performed a retrospective study in a tertiary care center of the clinical and pathological records of women with evocative symptomatology. The diagnostic performance of Pap smear screening and colposcopy was analyzed. The sensitivity and specificity of Pap smear screening and colposcopy in detecting preinvasive lesions of the cervix were calculated in 388 patients.ResultsThe mean age was 45.12 years, and the most frequent gynecological symptoms included abnormal bleeding (17.2%) and postcoital bleeding (10.9%). Histopathology showed abnormal results in 26.5% of the 388 patients, including cervical intraepithelial neoplasia 1 (CIN 1; 20.4%), CIN 2 (2.8%), CIN 3 (1.3%), and SCC (1.3%). Both Pap smear screening and colposcopy were highly sensitive in detecting CIN 1+ (94.2%vs.93.2%, respectively) and CIN 2+ (100.0% vs.95.8%, respectively) intraepithelial lesions; however, Pap smears had very low specificity in detecting both CIN 1+ (8.1% vs.73.7%, respectively) and CIN 2+ (8.0% vs. 59.3%, respectively) compared with colposcopy. When combined with HPV status, the specificity of Pap smear increased considerably.ConclusionIt has become a high priority to improve the efficiency of cervical cancer (CC) screening programs by optimizing the practice of Pap smear screening, increasing the test specificity, and implementing systematic cytology-HPV co-testing.

The Effect of Cervical Conization on Women's' Sexual Function and Psychological Health, A Prospective Observational Study

Diagnosis of cervical dysplasia and subsequent conization of the uterine cervix might affect women's' sexual health. To assess the effect of cervical conization on women's sexual function and psychological wellbeing. Patients undergoing conization of the cervix were assessed before, and 6 months after conization. Assessment of sexual distress and function was done using the female sexual distress scale-revised (FSDS-r) and the female sexual function inventory (FSFI), respectively. Risk for anxiety and depression, was assessed using the Hospital Anxiety and Depression Scale (HADS). FSDS-r, FSFI and HADS scores before and after conization RESULTS: From October 2018 to March 2021, 55 patients undergoing cervical conization were recruited. No significant differences were found in FSDS-r scores before and after conization. An equal number of patients indicated having sexual distress (29 patients, 53%, before and after conization, P=1.0). No significant changes were noticed on any FSDS domains or the total FSDS score before and after conization, (26.8 vs. 26.0, p=0.461). The percent of patients that indicated an overall sexual dysfunction, increased from 49 percent before conization, to 59 percent after conization, P=0.388. A high percent of patients indicated signs of anxiety on the HADS questionnaire, both before and after conization (49% and 47%, respectively). The median anxiety and depression scores did not change after conization, p=1.0. A high percent of patients undergoing conization suffer from sexual distress, sexual dysfunction and general anxiety, both before and after conization. The conization procedure itself did not seem to effect questionnaire scores. This was a prospective cohort, with comprehensive assessment of female sexual and psychological wellbeing after conization. Not all subjects reported sexual intercourse prior to questionnaire completion. Gynecologists should be aware of the psychological and sexual effect of the diagnosis and treatment of cervical pre-cancerous lesions, patients should be counselled accordingly. Michaan N, Loboda N, Ochshorn I, et al., The Effect of Cervical Conization on Women's' Sexual Function and Psychological Health, A Prospective Observational Study. J Sex Med 2022;19:257-262.

Justifying Bilateral Salpingo-Oophorectomy at Hysterectomy: A Large Retrospective Study

<h3>Study Objective</h3> Evaluate proportion of patients with justified bilateral salpingo-oophorectomy (BSO) at hysterectomy based on pathologic diagnosis and determine rate and predictors of avoidable BSO based on preoperative considerations, surgical characteristics and pathologic diagnosis. <h3>Design</h3> Multicenter retrospective analysis. <h3>Setting</h3> 7 Ontario, Canada hospitals (4 academic, 3 community). <h3>Patients or Participants</h3> Patients with concomitant BSO at hysterectomy. <h3>Interventions</h3> All hysterectomies with concomitant BSO from July 2016 to December 2019. Cases by gynecologic oncologists were excluded. <h3>Measurements and Main Results</h3> Demographics, surgical factors, surgeon characteristics and pathologic diagnoses were recorded. BSO was considered justified if pathologic diagnosis was endometriosis or any (pre)malignant diagnosis except for gestational trophoblastic neoplasia or cervical cancer/dysplasia. Criteria for avoidable BSO included: age ˂51 years, preoperative diagnosis of cervical dysplasia or benign diagnosis other than gender dysphoria, risk reduction or premenstrual dysphoric disorder, absence of intraoperative endometriosis and adhesions, and unjustified final pathology. Those with avoidable BSO were compared to patients with at least one criterion for BSO. Multivariate analyses identified factors most strongly associated with avoidable BSO. During the study period, 4191 hysterectomies were completed with 1422 (33.9%) having concomitant BSO. Final pathologic diagnosis justified BSO in 72.8% (1035/1422). The most common pathologic diagnoses were endometrial cancer (439/1422, 30.6%), endometrial hyperplasia (275/1422, 19.3%) and endometriosis (200/1422, 14.1%). The remaining cases were unjustified, with 42/1422 (3%) BSOs deemed avoidable. Compared to cases with at least one criterion for BSO, avoidable BSOs were more frequently completed by generalists (OR 2.01, 95% CI 1.04 to 4.08, p=0.044) and for preoperative diagnoses of abnormal uterine bleeding (OR 3.75, 95% CI 1.96 to 7.43, p<0.001) and/or fibroids (OR 3.26, 95% CI 1.70 to 6.23, p<0.001). <h3>Conclusion</h3> Final pathologic diagnosis justified most BSOs at hysterectomy. Ovarian preservation may have been possible in 3% of women, underscoring the need to standardize practice with respect to BSO among gynecologic surgeons.

Rural-urban differences in HPV testing for cervical cancer screening.

Rural preventable cancer disparities are often attributed in part to lower screening rates secondary to compromised health care access. When considering higher cervical cancer incidence and mortality, existing analyses primarily consider differences in Pap testing rather than the preferred method of HPV testing, which is more sensitive in identifying severe cases of cervical dysplasia. Logistic regression using data from the 2016 and 2018 Behavioral Risk Factor Surveillance System was used to examine urban and rural rates of cervical cancer screening according to national guidelines. Propensity score weighting was used to account for baseline sociodemographic differences between rural and urban populations in the 2016 landline sample. In 2016 and 2018, rural women were less likely than urban women to have current cervical cancer screening. This disparity was explained by sociodemographic variables in 2016. Among women with current cervical cancer screening, rural women were significantly less likely than urban women to undergo HPV testing in both 2016 and 2018. Rural women with current cervical cancer screening were significantly less likely than their urban counterparts to have HPV testing. It is possible that updates to preventive care guidelines may be slower to reach rural providers, rural patients may be unaware that HPV testing was completed, or rural practice configuration may complicate the integration of HPV testing into clinical practice. Failure to undergo HPV testing may lead to delayed cervical dysplasia diagnosis, missed opportunities for early intervention, and contribute to rural/urban disparities in cervical cancer incidence and mortality.

A Spatial Regulated Patch-Wise Approach for Cervical Dysplasia Diagnosis

Cervical dysplasia diagnosis via visual investigation is a challenging problem. Recent approaches use deep learning techniques to extract features and require the downsampling of high-resolution cervical screening images to smaller sizes for training. Such a reduction may result in the loss of visual details that appear weakly and locally within a cervical image. To overcome this challenge, our work divides an image into patches and then represents it from patch features. We aggregate patch patterns into an image feature in a weighted manner by considering the patch--image label relation. The weights are visualized as a heatmap to explain where the diagnosis results come from. We further introduce a spatial regulator to guide the classifier to focus on the cervix region and to adjust the weight distribution, without requiring any manual annotations of the cervix region. A novel iterative algorithm is designed to refine the regulator, which is able to capture the variations in cervix center locations and shapes. Experiments on an 18-year real-world dataset indicate a minimal of 3.47%, 4.59%, 8.54% improvements over the state-of-the-art in accuracy, F1, and recall measures, respectively.

Attitude and Acceptability of the Self-Sampling in HPV Carrier Women.

The descriptive, cross-sectional design included a convenience sample of Mexican women with a previous diagnosis of cervical dysplasia. Women (n = 61) were young adults (M = 27 years, SD = 6.92) reporting single marital status (55%) and sexually active (93%). Mean age at onset of sexual activity was 17 years; a majority of women (78.8%) had more than one sexual partner in their lifetime with 56.6% reporting between two and five partners. All (100%) of the women indicated that they would "choose self-sampling for HPV detection" and would recommend it to other women. Concerning "attitudes toward HPV," the women responded that it is necessary to comply with HPV treatment and understand that preventative measures can avoid HPV transmission. Women reported high acceptability for self-sampling and positive attitudes toward HPV diagnostic procedures. Women indicated substantial interest in learning more about HPV, its transmission, preventive measures, routine testing, and recommended self-sampling for HPV detection.

Prevalence of high-risk human papilloma virus infection and abnormal cytology of the anal transformation zone in women with cervical dysplasia. Bogotá, Colombia, 2017-2019.

To determine the prevalence of anal infection caused by high risk human papilloma virus (HR-HPV) and of abnormal anal cytology in women with confirmed cervical dysplasia. Cross sectional study that included patients between 30 and 65 years of age with a new diagnosis of cervical dysplasia by histopathology attended in two lower genital tract colposcopy and pathology units (one public and one private institution), conducted between December 2017 and April 2019. Women with human immunodeficiency virus (HIV) infection, immune compromise (use of steroids, transplant, chemo therapy), pregnancy or anorectal malformations were excluded. Consecutive sampling. Socio demographic variables, intercourse type, degree of cervical dysplasia, positive results of HR HPV Polymerase Chain Reaction test in anal canal and HR - HPV type indentified (16-18 or others) were evaluated. Descriptive statistics were used. Of 188 candidates, 100 were included in the analysis. A 32 % prevalence of high-risk HPV infection and a 2.8 % prevalence of abnormal cytology in the anal canal (ASCUS) were found. Of the HR-HPV infections in the anal canal, 68.8 % corresponded to HR-HPV genotypes different from 16 or 18. Prevalence of HR HPV infection in women with lower genital tract dysplasia was 32%. It is important to determine the usefulness of screening for anal mucosa compromise by HPV virus associated with a high risk of cancer in women with cervical dysplasia. Studies are needed on the prognosis of anal HR-HPV infection in women with cervical dysplasia.

Application of p16, p63, cyclin D1 immunostaining and nuclear morphometric analysis for assessment of cervical dysplasia

Background/Aim. Human papilloma virus (HPV) infection is the main etiological factor for the development of cervical precancerous dysplastic squamous intraepithelial lesions (SIL). The virus oncoproteins affect several proteins included in cell proliferation. The aim of this study was to evaluate application of immunohistochemical markers related to proteins of the cell cycle and, also, application of nuclear morphometric analysis for assessment of cervical dysplasia. Methods. Retrospective study included 78 women with detection of presence of high-risk HPV by polymerase chain reaction (PCR), with histopathology diagnosis low-grade SIL (LSIL) or high-grade SIL (HSIL). Immunohistochemical staining for p16, p63, cyclin D1 and morphometric analysis of the nuclear surface area were performed. The control group consisted of ten women without SIL and without HPV infection. This study was conducted in accordance with the Helsinki Declaration. Results. Comparing immunohistochemical expression of p16 and p63, highly statistically significant differences (p &lt; 0.001) were established among the control, LSIL and HSIL groups, while cyclin D1 showed significant statistical difference (p &lt; 0.05). Great variations were observed in nuclear morphology and nuclear surface area that had highly statistically significant differences (p &lt; 0.001) among the control, LSIL and HSIL groups. Conclusion. This study demonstrated that immunohistochemical analysis of p16, p63 and cyclin D1 are important for diagnosis of dysplastic changes in cervical epithelium. Also, morphometric analysis of the nuclear surface area demonstrated a high significance for diagnosis of cervical dysplasia.

Prognostic relevance of Ki-67 and P16/INK4a markers in histological diagnosis of cervical dysplasia

Purpose of the study. To determine the quantitative parameters of the molecular markers Ki‑67 and p16/INK4a at CIN 1–3 and to establish the possibility of using them to improve the quality of diagnosis by histological samples.Patients and methods. Biopsy material of the cervix was studied in 71 patients who were carriers of HPV infection. Immunohistochemical method (IHC) in biopsy specimens determined the expression of Ki‑67 and p16/INK4a markers.Results. According to the results of a standard histological examination, the distribution of patientsinto groups occurred as follows: CIN 1–18, in CIN 2–39, in CIN 3–14 patients. It was found that the expression of the studied markers is associated with the severity of dysplastic changes in the tissue of the cervix. By the studied marker, the most characteristic molecular profiles for the degrees of dysplasia were determined: CIN1 – Ki‑67–15–25%, p16/INK4a 10–15%; CIN2 – Ki‑67–70–80%, p16/INK4a – 65–70%; CIN3 – Ki‑67–85–90%, p16/INK4a – 90–95%. Heterogeneity was revealed in the expression of these markersin the CIN 2 group: in 7 cases (22,6%), the molecular profile corresponded to CIN 1, in 1 case (3,6%) to CIN 3. Clinical examples of using the IHC profile to clarify the degree of CIN are given.Conclusion. The use of an IHC study with Ki‑67 and p16/INK4a, in addition to the standard histological examination, makes it possible to objectify the initial diagnosis of the degree of CIN, as well as to identify patients with a high and low risk of developing severe injuries. This is especially true for the CIN2 group, the most problematic in terms of histological evaluation and tactics of clinical management of patients. The use of IHC in the initial diagnosis will contribute to: improving the information content of multiple aimed and loop excisional biopsies; reduction in relapse due to inadequate treatment; eliminating the unreasonable use of such a traumatic method as conization (especially in women of childbearing age).

A comprehensive study on the multi-class cervical cancer diagnostic prediction on pap smear images using a fusion-based decision from ensemble deep convolutional neural network

The diagnosis of cervical dysplasia, carcinoma in situ and confirmed carcinoma cases is more easily perceived by commercially available and current research-based decision support systems when the scenario of pathologists to patient ratio is small. The treatment modalities for such diagnosis rely exclusively on precise identification of dysplasia stages as followed by The Bethesda System. The classification based on The Bethesda System is a multiclass problem, which is highly relevant and vital. Reliance on image interpretation, when done manually, introduces inter-observer variability and makes the microscope observation tedious and time-consuming. Taking this into account, a computer-assisted screening system built on deep learning can significantly assist pathologists to screen with correct predictions at a faster rate. The current study explores six different deep convolutional neural networks- Alexnet, Vggnet (vgg-16 and vgg-19), Resnet (resnet-50 and resnet-101) and Googlenet architectures for multi-class (four-class) diagnosis of cervical pre-cancerous as well as cancer lesions and incorporates their relative assessment. The study highlights the addition of an ensemble classifier with three of the best deep learning models for yielding a high accuracy multi-class classification. All six deep models including ensemble classifier were trained and validated on a hospital-based pap smear dataset collected through both conventional and liquid-based cytology methods along with the benchmark Herlev dataset.

Age-related Features of the Cytological Diagnosis of Cervical Dysplasia of Different Degrees

Age-related Features of the Cytological Diagnosis of Cervical Dysplasia of Different Degrees

Long-term observational approach in women with histological diagnosis of cervical low-grade squamous intraepithelial lesion: an Italian multicentric retrospective cohort study

ObjectiveTo evaluate the risk of progression to high-grade squamous intraepithelial lesion (HSIL) (CIN2-3) or invasive cancer in women with histopathological diagnosis of low-grade squamous intraepithelial lesion (LSIL) (CIN1), managed in...

The impact of a cervical dysplasia diagnosis on individual cancer prevention habits over time: a bicentric case-control study.

Annual cervical cancer screening is recommended in Germany as a part of the statutory preventive care. Abnormal results can provoke psychological distress and anxiety, compromising women's adherence. Little is known about how a cervical dysplasia impacts adherence follow-up visits and prevention habits over time. To optimize care strategies, this study aims to identify women at risk for nonadherence to follow-up visits after a screening event. Between November 2015 and May 2017, participants with an abnormal Pap smear at the Heidelberg and Leipzig University Hospitals received a four-part questionnaire (sociodemographic data, PHQ-D, self-designed fear and prevention habit questions) at the first consultation (T1) and subsequently after 3 (T2) and 6 (T3) months; healthy controls completed the questionnaire at T1. 132 women with an abnormal Pap smear [with conization: S1 (n = 68, 51.5%), without intervention: S2 (n = 64, 48.5%)] and healthy controls (K, n = 101) generally adhered to gynecological checkups, except S1 6 months after the first diagnosis (S1/T3 - 0.47, signed rank p < 0.0005). Knowledge of primary prevention information, i.e., HPV vaccination, was significantly higher among K (K 58%, S1 29%, S2 44%, Chi-squared p = 0.01) as was vaccine uptake (K 39% versus S1/S2 7% and 17%, respectively, Chi-squared p = 0.0004). Fear of upcoming Pap smears rose significantly over time (S1/T1-S1/T2-S1/T3, Wilcoxon signed-rank test p < 0.001) and was higher among those with conization at T2 (Chi-square test, p = 0.01) and partially accompanied by panic disorders at T1 (Chi-square test p = 0.035). Realization of general preventive habits rose significantly among women without an operative procedure (S2) over the study. This study advances the understanding of non-participation in follow-up visits after a dysplasia diagnosis, identifying post-conization women as a special risk group for decreased adherence.