Diagnosis Of Severe Dysplasia Research Articles

The role of immunocytochemical biomarkers in diagnostics of precancerous pathology of cervix

The last decades showed the worldwide tendency to finding consensus between diagnostics improvement and constant increase of cost of medical services in conditions of restricted financing. The aim of the article was to analyze the diagnostic value of p16 and Ki-67 biomarkers in diagnostics of precancerous diseases of cervix. Data of 80 patients with cervical dysplasia of varying degree who received excisional treatment were analyzed. It was shown that cytological study has a high sensitivity (79.17%) for the diagnosis of CIN 2-3, but low specificity (53.57%). The p16 immunocytochemical biomarker has a high sensitivity for the diagnosis of CIN 2 (0.92; 95% CI: 0.76-0.98) with good specificity (0.78; 95% CI: 0.67-0.82), for the diagnosis of CIN 3 both sensitivity (0.93; 95% CI: 0.82-0.98) and specificity (0.93; 95% CI: 0.82-0.98) is high. The immuno­cytochemical biomarker Ki-67 has a high sensitivity for CIN 2 (0.92; 95% CI: 0.65-0.99), but insufficient specificity (0.62; 95% CI: 0.54-0.64), for the diagnosis of CIN 3 the sensitivity is very high (0.96; 95% CI: 0.80-0.99) as well as specificity (0.78; 95% CI: 0.69-0.81). The combined use of p16 and Ki-67 biomarkers can significantly increase the diagnostic accuracy of the diagnosis of high-grade precancerous pathology of cervix and justify timely surgical intervention. Such an approach for the differential diagnosis of severe dysplasia, on the one hand, may contribute to a decrease in the risk of developing cervical cancer, and on the other hand, it will allow to avoid unnecessary operations and preserve reproductive function of women, reduce the economic costs of treatment.

INCIDENCE OF ORAL DYSPLASIA AND FOCAL INVASION FOLLOWING EXCISION

<h3>Background</h3> Dysplasia is defined as the presence of cells of an abnormal type within any tissue, which may signify a stage preceding the development of cancer. It can be categorized as mild/moderate/severe and carcinoma in situ. <h3>Objective</h3> To determine the incidence of oral dysplasia and the incidence of focal invasion following surgical excision of severe dysplasia and carcinoma in situ. <h3>Methods</h3> Histopathology reports for all patients diagnosed with dysplasia of the oral cavity at the Norfolk and Norwich University Hospital between the periods of May 2017 to May 2019 were analyzed. Data on site of lesion, grade of dysplasia, and presence of focal invasion were recorded. <h3>Results</h3> A total of 130 patients had 150 biopsies with a diagnosis of dysplasia. Eighty-two had mild (55%), 27 had moderate (18%), and 41 had severe or carcinoma in situ (27%). Patients with a diagnosis of severe dysplasia or carcinoma in situ (n = 41) had excision of the lesion, of which 9 (21.9%) showed focal invasion, changing their diagnosis to oral squamous cell carcinoma. Of these, 3 underwent further surgery following our local multidisciplinary team meeting. <h3>Conclusions</h3> Histopathology is essential in the management of these cases, as it defines the treatment modality required. If invasion is identified on histopathologic examination following excision, further excision may be required to deem the procedure as curative and reduce risk of recurrence. Hence all patients with a diagnosis of carcinoma in situ should be told of the risk of invasion and need for further surgery.

Fluorescence diagnosis of pre-invasive cervical pathology

Results of local fluorescence spectroscopy in 185 women with underlying and pre-invasive disease of cervix and high-risk HPV infection are represented. Fluorescence study was performed 2h after intravenous injection of fotoditazin in a dose of 1 mg/kg (wavelength 636.5 nm). Accumulation of the photosensitizer was estimated by diagnostic parameter (DP) value, calculated as mean value of fluorescence scaled to each type of tissue. For normal tissues DP accounted for 0.6±0.4, showing accumulation of the photosensitizer. According to the study the medication did not also accumulate in retention cysts (DP 0.3±0.1), explaining low efficiency of photodynamic therapy for this pathology. The accumulation of fotoditazin depends significantly on type of pathologic tissue. In patients with inflammation, leukoplakia and CIN I accumulation of the photosensitizer in pathologic foci was negligible: DP accounted for 1.7±0.2, 1.8±0.2 and 2.1±0.3, respectively. In sites of endometriosis and CIN II DP was significantly higher and accounted for 8.3±2.1 and 14.1±4.1, respectively. The greatest accumulation of the photosensitizer was registered in sites of CIN III, squamous cell carcinoma and adenocarcinoma. Though DP value for these pathologies had almost no difference and accounted for 23.1±4.7, 22.7±1.8 and 23.3±1.4, respectively. For fluorescence diagnosis of severe dysplasia in 48% of patients borders of fluorescence regions were beyond lesions detected for extended colposcopy with additional areas of fluorescence. Targeted biopsy of these regions proved pathology in all patients: CIN II, CIN III, mild dysplasia or CIS. Thus, local spectroscopy allows to diagnosis multifocal lesions on cervix, to define correctly borders of lesion and consider excisional biopsy in-time.

Grading und Staging von urothelialen Harnblasenkarzinomen

In a retrospective study, staging and grading of 2085 primary and recurrent urinary bladder carcinomas were determined according to WHO and UICC rules. Of the carcinomas 51% were papillary, 23% solid and 26% partly papillary and partly solid. 46.2% of carcinomas were correspondent to malignancy grade I, 37.7% to grade II and 16.1% to grade III. The depth of invasion was the greater the less the degree of differentiation. The uncorrected recurrence rate of carcinoma was 14.9%, 28% of the recurrences showed an increase in malignancy grade and (or) depth of invasion. The recurrence rate fell within the first three years from 76.8% to 8.2%. In addition, there was a high degree of coincidence between carcinoma grade III and severe urothelial dysplasia. The diagnosis of severe dysplasia is an indication for frequent cystoscopic and bioptic checks. Since the biological significance of urinary bladder carcinoma depends not only on the degree of malignancy but also on the depth of invasion and the readiness of carcinoma towards invasion, it is necessary for successful prospective studies, designed to evaluate the course of urinary bladder carcinoma and their therapeutic response, to incorporate exact staging and grading.

Gastric Cancer Risk in Patients With Premalignant Gastric Lesions: A Nationwide Cohort Study in the Netherlands

A cascade of precursor lesions (eg, atrophic gastritis, intestinal metaplasia, and dysplasia) precedes most gastric adenocarcinomas. Quantification of gastric cancer risk in patients with premalignant gastric lesions is unclear, however. Consequently, endoscopic surveillance is controversial, especially in Western populations. To analyze current surveillance practice and gastric cancer risk in patients with premalignant gastric lesions, all patients with a first diagnosis between 1991 and 2004 were identified in the Dutch nationwide histopathology registry (PALGA); follow-up data were evaluated until December 2005. In total, 22,365 (24%) patients were diagnosed with atrophic gastritis, 61,707 (67%) with intestinal metaplasia, 7616 (8%) with mild-to-moderate dysplasia, and 562 (0.6%) with severe dysplasia. Patients with a diagnosis of atrophic gastritis, intestinal metaplasia, or mild-to-moderate dysplasia received re-evaluation in 26%, 28%, and 38% of cases, respectively, compared with 61% after a diagnosis of severe dysplasia (P < .001). The annual incidence of gastric cancer was 0.1% for patients with atrophic gastritis, 0.25% for intestinal metaplasia, 0.6% for mild-to-moderate dysplasia, and 6% for severe dysplasia within 5 years after diagnosis. Risk factors for gastric cancer development were increasing severity of premalignant gastric lesions at initial diagnosis (eg, severe dysplasia, hazard ratio 40.14, 95% confidence interval 32.2-50.1), increased age (eg, 75-84 years, hazard ratio 3.75, 95% confidence interval 2.8-5.1), and male gender (hazard ratio 1.50, 95% CI 1.3-1.7). Patients with premalignant gastric lesions are at considerable risk of gastric cancer. As current surveillance of these patients is inconsistent with their cancer risk, development of guidelines is indicated.

A CASE OF COMPLETE GARDNER SYNDROME

We experienced a case of complete-type Gardner syndrome in which a giant desmoid tumor was associated with polyposis coli and an osteoma. A 36-year-old woman had undergone excision of abdominal desmoid tumor four times, which ended up in repeated recurrence. When the patient was admitted to the hospital for the 4th operation, she was pointed out having polyposis coli. As the polyposis was tubular adenoma, she was strictly followed on an ambulant basis. And on this 5th admission, a pathological diagnosis of severe dysplasia was made. Excision of the abdominal tumor and colectomy were carried out. There is an agreement for the treatment of polyposis coli that colectomy or colorectal excision should be performed at the age raging from 15 to 20 for its possible malignant change. In this case the operative procedure was selected by entertaining a significantly delayed timing for operation and better postoperative quality of life. No polyposis lesion was left in the remnant rectum, however, further careful observation would be mandatory.

Expression Pattern of Metalloproteinases and Their Inhibitors Changes with the Progression of Human Sporadic Colorectal Neoplasia

Several studies have implicated the extracellular matrix-degrading metalloproteinases (MMPs) as essential agents in tumor cell invasion and metastasis. In the present study, we have investigated the patterns of expression of a number of MMPs and their specific tissue inhibitors (TIMP-1 and TIMP-2) in human colonic tissue samples that represent various stages of progression from adenomas showing different degrees of dysplasia to adenocarcinomas. We assessed levels of mRNA by Northern blot analysis and the results were measured semiquantitatively by densitometry. In total, we analyzed nine adenomas of varying size and with varying degrees of dysplasia, three adenomas with adenocarcinoma (malignant polyps), and five adenocarcinomas. Although expression of MMP and TIMP mRNA was highly intercorrelated, transcripts for stromelysin 3 and TIMP-2 (high) showed the strongest relation to the neoplastic process. Detection of stromelysin 3 mRNA accompanied a diagnosis of severe dysplasia or malignancy, whereas levels of TIMP-2 (high) mRNA transcripts permitted finer distinctions on the neoplastic continuum. These data indicate changes within extracellular matrix acquired during the process of malignant transformation of human sporadic colorectal neoplasia.