Had High-grade Squamous Intraepithelial Lesion Research Articles

Prevalence of anal high-risk human papillomavirus (HR-HPV) types in people living with HIV and a history of cancer.

Referral tertiary care hospital for adult patients with cancer. We reviewed data of patients from the AIDS Cancer Clinic on antiretroviral therapy in chronic control who were consecutively referred for high-resolution anoscopy (HRA), where they underwent anal evaluation, collection of specimens for anal cytology and anal human papillomavirus (HPV) followed by HRA with directed biopsy if needed. A total of 155 patients were included; 149 (96.1%) were men, all of them men who have sex with men (MSM); the median age was 39 (IQR 32-47) years; 105 (67.7%) with Kaposi sarcoma, 40 (25.8%) with non-Hodgkin lymphoma and 10 (6.4%) with other neoplasms; only 7 (4.5%) had active cancer. The prevalence of HR-HPV infection was 89% (n=138) (95% CI 83-93) with at least one HR-HPV infection, and 62% (96) had coinfection with at least two types; the median HR-HPV types of coinfection were 3 (IQR 2-4). The number of patients infected with HPV 16 was 64 (41.3%, 95% CI 33.8-49.3), HPV 18 was 74 (47.7%, 95% CI 39.9-55.7) and with both 35 (22.6%). Some 59 patients (38%) had high-grade squamous intraepithelial lesions (HSIL) and 49 (31.6%) had low-grade squamous intraepithelial lesions (LSIL). The prevalence of HR-HPV and HSIL among patients aged ≤35 and >35 years was the same. In this cohort of PLWHIV with a history of malignancy we found a high prevalence of HR-HPV 16 and 18 and anal HSIL, even in persons aged ≤35 years. These data highlight the importance of anal cancer screening in PLWHIV and history of malignancy.

Prevalence of high-risk human papillomavirus infection and genotype distribution among Kazakhstani women with abnormal cervical cytology

Aim This study aimed to identify the prevalence and distribution of high-risk human papillomavirus (HR-HPV) types among Kazakhstani women with abnormal cervical cytology. Methods A cross-sectional study was performed from May 2019 to June 2020. Cervical samples were collected from women in the different regions of Kazakhstan. Results A total of 316 patients’ samples were analysed for HR-HPV using real-time multiplex PCR. Cervical cytology abnormalities were reported according to the Bethesda classification. HPV detection by cytology showed a statistically significant association with HPV status and the number of HPV infection types (p < .05). Among women with abnormal cervical cytology, 62.4% were positive for HPV infection of those 79.4% had low-grade squamous intraepithelial lesions (LSIL), and 20.6% had high-grade squamous intraepithelial lesions (HSIL). Among patients with LSIL, 77.4% had HPV16 and 58.8% were infected with HPV18. Among patients with HSIL, 41.2% had HPV18 and 22.6% – HPV16. Conclusions There is a high prevalence of HR-HPV types among Kazakhstani women with abnormal cervical cytology. The most identified types were HPV16, 18, 31, 33 and 52. There is an emergency need to implement an HPV vaccination program to prevent cervical lesion development.

Human Papillomavirus Genotypes Infecting the Anal Canal and Cervix in HIV+ Men and Women, Anal Cytology, and Risk Factors for Anal Infection.

The incidence of anal intraepithelial neoplasias associated with HPV is rising worldwide. In the general population, this pathology is rare, but individuals living with HIV/AIDS are at a significantly higher risk. We aimed to study HPV infection and performed cytological screening to study the epidemiological and behavioral determinants in a group of men and women living with HIV from a region in Mexico with high HIV incidence. This was a cross-sectional study including adults living with HIV/AIDS performed in Merida (Mexico). We invited patients of public HIV/STD clinics and those affiliated with social organizations of people living with HIV to participate in the study. Participants responded to an instrument to assess their risky behaviors and clinical history. Swabs from the anal canal and cervix and anal cytology specimens were obtained by medical staff from women and by self-sampling from men. For the 200 participants, 169 men and 31 women, anal HPV PCR tests resulted in 59.8% positivity (62.6% of men and 45.2% of women), and 17 genotypes were identified. The most frequent high-risk (HR) types for the anal canal were: HPV33 (35.3%), HPV58 (20.6%), HPV66 (18.6%), HPV45 (17.6%), and HPV16 (14.7%). Multiple genotypes were found in over 80% of the participants. Receptive anal intercourse in the previous 12 months, inconsistent condom use, and detectable HIV titers (≥50 cc/mL) were associated with HPV infection (p < 0.05). Cytology (smears and liquid-based) identified that 34.6% of the participants had low-grade squamous intraepithelial lesions (LSILs), and 3.5% had high-grade squamous intraepithelial lesions (HSILs). Neither HPV nor lesions were associated with low CD4+ counts (<200 cells/mm3, p > 0.05). Of the women, 60% were infected in the cervix and 45% in the anal canal, with an agreement of at least one genotype in 90%. The HR-HPV types associated with HSILs were HPV66, 33, 52, 51, 45, 18, and 68.

Correlation Between hr-HPV Genotypes/Negative Cytology with Cervical Histology Findings

Abstract Introduction/Objective It is well established that the persistent of hr-HPV infection is necessary for the development of cervical dysplasia. Currently, routine cervical cancer screening include both high-risk human papilloma virus (hr- HPV) testing and cervical cytology tests. The guidelines for managing HPV-positive/cytology-negative results is cotesting at 1 year, and/or immediate colposcopy if HPV16 and/or HPV18 is positive. We analyzed the correlation between hr-HPV genotypes /negative cytology with cervical histology findings. Methods/Case Report Retrospective chart review was performed to identify all negative pap smears with positive hr-HPV and follow up colposcopy for patients who presented to our institution from January 2018 to December 2019. We calculated the distribution of HPV genotypes within low grade and high-grade cervical lesions among patients with HPV-positive/cytology-negative pap smears. Results (if a Case Study enter NA) 179 patients with HPV-positive/cytology-negative pap smears were included. The age range was 22-69 years old. Among these patients, 6.70% had low-grade squamous intraepithelial lesion (LGSIL) and 6.14% had high-grade squamous intraepithelial lesion (HSIL) on follow up biopsy. The detection rates of HPV genotypes among patients with LGSIL diagnosis were HPV16 (41.66%), HPV18 (16.66%) and other hr-HPV (41.66%). The detection rates of HPV genotypes among patients with HGSIL diagnosis were HPV16 (9.09), HPV18 (0%), other hr-HPV (72.72%), combined HPV16 + other hr-HPV (9.09), combined HPV18+ other hr-HPV (9.09%). Conclusion According to our data, patients with negative cytology and HGSIL on biopsy have higher association with other hr-HPV (not 16 or 18) than HPV 16 and 18. Patients with negative cytology and LGSIL on biopsy have higher association with HPV16 and other hr-HPV subtypes than HPV18. Thus, we recommend follow-up colposcopy even for patients with other hr-HPV infection.

Primary screening of cervical cancer by Pap smear in women of reproductive age group.

Cancer cervix is a major health problem responsible for causing a higher mortality rate in women worldwide; the exponential increase in such cases can be reduced by early screening of women. The cytology-based cervical screening had a higher success rate in reducing the incidence of cervical cancer. The present study aimed to evaluate the use of Pap smear screening to find cytological abnormalities and precancerous lesions. Sexually active women over 21 years of age were enrolled for the study. A detailed history was taken on the preformed proforma, and all were subjected to vaginal examination. Samples for Pap smear were taken with the help of Ayre spatula and immediately spread over a marked grease-free glass slide and dipped into 95% ethyl alcohol fixative for cytological examination. Most of the abnormality of the epithelial cells found was in the age range of 31-50 years, and most of them were multiparous. 47.92% of the women had a chief complaint of vaginal discharge, an irregular menstrual cycle in 11.07%, and abdominal pain in 7.83%, while 30.41% were asymptomatic. Women found negative for intraepithelial neoplasia were 82.94%, while 13.36% had an inflammatory smear. 0.92% atypical squamous cells of undetermined significance (ASCUS), 2.78% Low-grade squamous intraepithelial lesion (LSIL) were found, no woman had High-grade squamous intraepithelial lesion (HSIL). Pap smear is a simple, cost-effective, non-invasive, and easy to perform tool for early detection of precancerous lesions, and it is evident that every woman above the age of 25-30 years must be recommended for cervical screening.

Human papillomavirus-associated anal squamous intraepithelial lesions in men who have sex with men and transgender women living with and without HIV in Karachi Pakistan: implications for screening and prevention

BackgroundAnal squamous intraepithelial lesions (ASIL), strongly related to human papilloma virus (HPV) infection, is more prevalent among men who have sex with men (MSM). However, no such data are available for Pakistan yet, and neither HPV vaccination nor anal-cytology screening is implemented in Pakistan. The purpose of this first ever study was to assess the prevalence of HPV-related anal cytological abnormalities among MSM and transgender women living with and without HIV infection in Pakistan.MethodsWe conducted a cross-sectional study from March 2016 to November 2017 at sexual health centers run by the Perwaaz Trust and the National AIDS Control Program in Karachi. The study enrolled MSM and transgender women aged greater-than-and-equal-to-18-years who reported anal sex in the preceding 6 months. We collected two anal samples for liquid-based cytology and HPV type testing by PCR, and socio-demographic and behavioral data were collected through face-to face interviews. ASIL and its associations with biological and behavioral risk factors were analyzed through Cox regression for prevalence ratios (PR) and corresponding 95% confidence intervals (CIs).ResultsOut of 271 qualifying participants, 79% were MSM and 21% transgender women. The mean age was 28.8 (± 8) years. Almost 35% (93/271) of the study population had ASIL detected, ASIL was significantly more common among participants living with HIV than in HIV negative ((50/118) 42.4%; vs. (43/153) 28.1%) (p ≤ 0.001). Among ASIL, 66% (61/93) had low-grade squamous intraepithelial lesions (LSIL), and 3.6% (3/93) had high-grade squamous intraepithelial lesions (HSIL). The overall, HPV16 positivity was 35.5% (33/93) among all abnormal anal lesions and all 3 HSIL were HPV16 positive, however, HPV16 positivity could show its association with ASIL detection in univariate model only (PRcrude: 2.11(1.39–3.18)). Moreover, any HR-HPV type (PR 3.04; 95% CI 1.75–5.26), concurrent sexually transmitted infection (STI) (2.13; (1.28–3.55)) and HIV + /HPV + coinfection (1.75; (1.07–2.88)) remained independently associated with ASIL in the multivariate model.ConclusionsAbnormal anal cytology among MSM and transgender is prevalent enough to consider optimal screening regimens. Further studies are required to see if periodic anal cytology can be made part of HIV care and treatment programs among MSM in Pakistan.

Delays in LEEP associated with the COVID-19 pandemic and impact on resulting pathology

Objectives:Over the course of the past year, medical providers were forced to make difficult decisions in response to the global COVID-19 pandemic. Many clinics were closed for routine and follow-up visits in order to preserve personal protective equipment and to decrease exposure of patients and staff to the virus. The aim of this study was to assess the effect that the COVID-19 response had on scheduling a loop electrosurgical excision procedure (LEEP) and the potential impact on resulting pathology.Methods:A retrospective review of all patients who received a LEEP due to an abnormal cervical cancer screening test at a single inner-city academic institution was performed. Procedures scheduled from March 2020 (start of the COVID-19 pandemic) through July 2020 were included. Baseline patient characteristics (including race), time from colposcopy to LEEP, and pathology results were collected.Results:A total of 37 patients underwent a LEEP in this timeframe. Median age was 33 years (range, 22-63) and 6 patients (16%) were smokers. Median time between colposcopy and LEEP was 80 days (range, 0-303 days), with 25% having a delay of ≥131.5 days. Non-White patients (n=25, median 91 days) experienced numerically higher delays than White patients (n=12, median 34.5 days, p=0.077, Mann-Whitney U test). Expedited treatment (colposcopy and LEEP on same day) occurred in 0/25 non-White patients and in 3/12 White patients (p=0.028, Fisher exact test). On colposcopy, 31/37 patients (84%) had high grade squamous intraepithelial lesion (HSIL); the rest had low grade squamous intraepithelial lesion (LSIL) or lower. On LEEP, 1 patient had squamous cell carcinoma (3%) and 20 patients had HSIL (54%); the rest had LSIL or lower. From colposcopy to LEEP, 14/37 patients (37.8%) had discordant pathologies of which 2 patients (5%) had upgraded pathologies; these two patients underwent LEEP 136 days and 142 days after colposcopy and were upgraded to squamous cell carcinoma and HSIL, respectively. A total of 12 patients (32.4%) had downgraded pathologies.Conclusions:During the COVID-19 pandemic, a large proportion of inner-city patients experienced delays between colposcopy and LEEP, an effect which seemed more pronounced among non-White patients. The patients with upgraded interval pathologies had particularly long delays between the procedures. Additional study is needed to examine the potential negative ramifications of the COVID-19 pandemic on cervical cancer screening and healthcare disparities.

Abstract 39: Human Papillomavirus (HPV) DNA Testing Based Cervical Cancer Screening and Triage with CINtec PLUS Cytology Test in HPV Positive Women in Bogalay Township, Ayeyarwady Region, Myanmar

Abstract Purpose: This study aimed to conduct Human Papillomavirus (HPV) DNA testing based cervical cancer screening among married women in Bogalay Township, Ayeyarwady Region, Myanmar and to triage with CINtec PLUS Cytology test among women who have HPV infection. Methods: It was a prospective cross-sectional descriptive study. Total of asymptomatic 677 married women (median age-40-years;range 30-55) residing in Bogalay Township, Ayeyarwady Region, Myanmar were screened in 2020. HPV-DNA testing was performed using cobas HPV-DNA-test which detects 14-high-risk-HPV genotypes -16,-18,-31,-33,-35,-39,-45,-51,-52,-56,-58,-59,-66 and-68. Positive HPV cases were followed by liquid-based- cytology (LBC) and CINtec PLUS Cytology i.e, dual-immuno-biomarker technology to simultaneously detect p-16 and Ki-67 to provide a strong indicator of the presence of transforming HPV infections. Results: HPV was identified in 4.6% (31/677) of screened women in Bogalay Township, Ayeyarwady Region, Myanmar. Among HPV-positive-cases, HPV-16 was 22.6 % (7/31), HPV-18 was 6.5% (2/31) and other-HR-HPV-genotypes (HPV-31,-33,-35,-39,-51,-52,-56,-58,-59,-66and-68) were 70.9% (22/31). In cytological-diagnosis of HPV positive women, 87.1% had cervical cytological abnormalities comprising; 16.1% had high grade squamous intraepithelial lesion (HSIL), 48.4% had low grade squamous intraepithelial lesion (LSIL) and 22.6% had atypical squamous cells of undetermined significance (ASCUS). Only 12.9% were negative for intraepithelial lesion or malignancy (NILM). In CINtec-PLUS-Cytology, all HSIL (100%) cases, 66.7% of LSIL, 14.3% of ASCUS were positive with both p-16 and Ki-67 dual-immuno-biomarker but negative in NILM cases. Conclusion: This study highlighted that using HPV-DNA test in cervical cancer screening, the highest risk women can be determined. In triage with CINtec-PLUS-Cytology in HPV positive women, women who were more significantly at risk for cervical pre-cancer and cancer as well as women that require referral to colposcopy were identified. In LSIL and ASCUS cases, CINtec-PLUS-Cytology may reduce the number of women that require referral to colposcopy. This study pointed out CINtec-PLUS-Cytology was very useful to confirm the high-grade cervical lesions. Citation Format: Mu Mu Shwe, Khin Kay Thwe, Su Su Hlaing, Lynn Pa Pa Aye, Kham Mo Aung, Nu Lwin, Win Maw Tun, Zaw Than Htun. Human Papillomavirus (HPV) DNA Testing Based Cervical Cancer Screening and Triage with CINtec PLUS Cytology Test in HPV Positive Women in Bogalay Township, Ayeyarwady Region, Myanmar [abstract]. In: Proceedings of the 9th Annual Symposium on Global Cancer Research; Global Cancer Research and Control: Looking Back and Charting a Path Forward; 2021 Mar 10-11. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2021;30(7 Suppl):Abstract nr 39.

Loop Electrosurgical Excision Procedure in a Low-Resource Setting: Feasibility of Selective See-and-Treat Approach

To assess the correlation between cervical smear, colposcopic findings and loop electrosurgical excision procedure (LEEP) histopathology and thereby assess the feasibility of performing LEEP bypassing cervical biopsy in selected cases. This is a retrospective study of patients who underwent LEEP at our institution from 2014 to 2018. We traditionally follow a three-step approach for detection and treatment of pre-invasive lesions of cervix—(1) pap smear, (2) colposcopy of abnormal pap smear cases and directed biopsy, and (3) treatment of abnormal biopsies with LEEP. LEEP was performed for cervical intraepithelial neoplasia (CIN) 2, CIN3, persistent CIN1 cases. Swede score ≥ 6 or major lesion on International Federation for Cervical Pathology and Colposcopy (IFCPC) scoring on colposcopy was considered to be suggestive of high-grade lesion. Of the 123 patients who underwent LEEP, 80 patients had high-grade squamous intraepithelial lesion (HSIL) on cervical smear and swede score ≥ 6 on colposcopy. Seventy-seven (96.3%) of these patients had high-grade lesion on final histopathology. Avoiding cervical biopsy and proceeding with LEEP in these patients would reduce an additional procedure in 77 patients with overtreatment of only 3 patients (2.4%). Overtreatment rate was 3.2% when IFCPC scoring was used instead of Swede score. LEEP may be considered in patients with high-grade lesions on both colposcopy and cervical smear, bypassing cervical biopsy, thereby reducing the number of procedures performed. This reduces the financial burden for the individual and the healthcare facilities, also decreasing the anxiety and apprehension associated with multiple hospital visits and procedures.

Distribution of cervical lesions in high-risk HPV (hr-HPV) positive women with ASC-US: a retrospective single-center study in China

BackgroundTo investigate distributions of cervical lesions and factors associated with the severity of the cervical lesions in high-risk HPV (hr-HPV) positive women with atypical squamous cells of undetermined significance (ASC-US) cytology.MethodsClinical information of 250,000 women who underwent HPV and cytological test was collected from January 2012 to January 2019. The association between the severity of the cervical lesions and hr-HPV genotypes, hr-HPV viral load, and ages, were analyzed in hr-HPV-positive/ASC-US women.Results3459 hr-HPV-positive/ASC-US women were enrolled in this study. Overall, 43.51% of women with ASC-US had normal histological results, 34.35% had high-grade squamous intraepithelial lesion (HSIL), and 1.30% had cervical cancer. The rate of HSIL or worse (HSIL+) in women with single HPV16 infection (63.09%) was the highest, followed by HPV33 (57.50%), HPV51 (36.11%), HPV58 (36.11%), HPV52 (28.28%), HPV18 (26.37%), HPV66 (19.35%), HPV39 (18.92%), HPV53 (15.00%), and HPV56 (8.51%). Detection rate of HSIL+ in low, intermediate and high viral-load groups were 15.87% (n = 30), 34.91% (n = 74) and 40.68% (n = 214) (Cochran-Armitage Trend test χ2 = 35.03, p < 0.0001). Compared with the 51–60-year-old group (21.65%), the women in ≤ 30 (40.52%), 31–40 (39.67%), and 41–50 (34.22%) year-old groups had significantly higher risk of HSIL+. The women in ≤ 51–60 (2.68%) and > 60 (3.41%) year-old groups were at increased risk for cervical cancer, compared with the ≤ 30-year-old group (0.61%).ConclusionsASC-US women with HPV 16/18/33/51/52/58 single infection and multiple infections, as well as high HPV viral loads, have high risk of HSIL+.

Liquid-based cytology for the detection of cervical intraepithelial lesions in Jimma town, Ethiopia

BackgroundCervical cancer is the second leading type of female cancer in Ethiopia. Screening for cervical cancer is primarily conducted using visual inspection with 5% acetic acid (VIA). Liquid-based cytology (LBC) is not yet widely used in Ethiopia.MethodWomen aged 21–65 years were tested using LBC and VIA to detect cervical dysplasia. Logistic regression analysis was conducted to identify associated factors. Cohen’s Kappa test was conducted to test agreement between LBC and VIA.ResultsForty-two percent (n = 188) of 448 participants were 31 to 40 years of age and only two participants were above 60. Of the 448 participants, 419 (93.5%) were tested with LBC, 294 (65.6%) VIA and 272 (60.7%) with both LBC and VIA. Among women screened using LBC, 305 (72.8%) were negative for intraepithelial lesion or malignancy (NILM), 97 (23.2%) had low-grade squamous intraepithelial lesion (LSIL) and 17 (4.1%) had high-grade squamous intraepithelial lesion (HSIL). Presence of cervical lesions was generally lower in younger and older women. Majority, 39 (40%) of women with LSIL and 10 (59%) with HSIL were 41–50 years of age. Women aged 51–60 were more likely to have abnormal intraepithelial lesions compared to women aged 21–30 (AOR = 20.9, 95% CI = [7.2–60.9], p = 0.00). Out of 47 (10.8%) HIV-positive women, 14 (32.56%) had intraepithelial lesions of which 10 (23.3%) and 4 (9.3%) had LSIL and HSIL, respectively. Among women screened with VIA, 18 (6.1%) were positive; among the 272 (60.7%) women screened using both LBC and VIA, 6 (2.2%) were positive on both LBC and VIA tests. The level of agreement between the two tests was weak at a statistically significant level (kappa value = 0.155, p = 0.006).ConclusionLBC demonstrated high rates of cervical squamous intra-epithelial lesions in our study. VIA was a less reliable predictor of cervical squamous intra-epithelial lesions than LBC. Evaluating diagnostic accuracy of both LBC and VIA against a histological endpoint should be completed before adopting either or both screening modalities.

Cervical Cancer screening in a tertiary care centre by Pap smear and its clinical correlation

Introduction: Cervical cancer is one of the common cancers in women and is a major public health problem all over the world. It has significant contribution to high mortality and morbidity. Preinvasive lesions spontaneously regress to normal, remain stable for a long time or progress to higher degree of dysplasia followed by carcinoma cervix.&#x0D; Materials and Method This was a hospital based retrospective study where 456 patients’ records were reviewed. Pap smear was used as the screening tool for the detection of precancerous lesion among the women visiting Western Regional Hospital (WRH), Department of obstetrics and gynecology.&#x0D; Results: Among 456 patients screened, most of them were in the age group of 30-39 years (42.8%) and were of parity 3 (42.8%). Most of them had no risk factors for carcinoma cervix (54.4%). Early marriage accounted for the highest risk of developing precancerous lesion (32.7%). There were no carcinoma detected by Pap smear. The test was negative in 68.9%, Low-grade Squamous Intraepithelial Lesion (LSIL) was detected in 5.9% and 2.9% had High-grade Squamous Intraepithelial Lesion (HSIL). Pap smear was sent for screening purpose in asymptomatic women (37.1%) and among the symptomatic patients vaginal discharge was the most common indication of pap test (34.6%).&#x0D; Conclusion: A Pap smear is reliable, simple, non-invasive, cost effective, and easy screening tool for detection of precancerous lesions in a woman.

Human papillomavirus genotyping among women with cervical abnormalities in Ulaanbaatar, Mongolia

ObjectivesFew studies on human papillomavirus (HPV) have been conducted in Mongolia. This study was performed to evaluate the prevalent HPV genotypes and their associations with cytology and demographic and behavioral characteristics in Mongolian women with cervical abnormalities. MethodsExfoliated cell samples of 100 women who had a previous history of cervical abnormality were collected. Cytological interpretation was conducted microscopically and HPV genotyping was performed using the Roche Linear Array test. Study questionnaires were completed. ResultsOverall, 25 HPV genotypes were detected in 47% of participants, and the most prevalent were HPV 16, 52, 58, and 33. Cytological examination revealed 12% of participants had atypical squamous cells of undetermined significance (ASC-US), 8% had low-grade squamous intraepithelial lesions (LSIL), 7% had high-grade squamous intraepithelial lesions (HSIL), and 14% had squamous cell carcinoma (SCC), while 59% of women had a normal cytology. HPV 16 was the most common type among women with a normal cytology and cervical cancer. However, women with cervical abnormalities including LSIL and HSIL were predominantly infected with HPV 52. Moreover, women aged <35 years had a significantly higher risk of HPV infection than those in the other age groups (p<0.05). ConclusionsThe prevalent trend of HPV genotypes observed in this cohort differs from that reported previously in Mongolia. These data may contribute to developing an effective strategy for cervical cancer prevention in Mongolia.

A Review and Update on Papillary Immature Metaplasia of the Uterine Cervix: A Distinct Subset of Low-Grade Squamous Intraepithelial Lesion, Proposing a Possible Cell of Origin.

- Papillary immature metaplasia (PIM) is a known papillary cervical lesion associated with low-risk human papillomavirus (LR-HPV). - To evaluate additional clinicopathologic features and the HPV genotypes of PIM and discuss the presumptive cell of origin. - A total of 26 PIM cases were evaluated by p16INK4a, cytokeratin (CK) 7, and CK17 immunohistochemical stainings. Human papillomavirus genotyping was performed, by using HPV DNA Chip, HPV polymerase chain reaction (PCR), and real-time PCR. - Histologically, PIM forms either a papillary mass (n = 21 of 26, 81%) or a slightly elevated/flat plaque (n = 5, 19%). All cases contain variable amounts of mucinous epithelia within the lesions. Koilocytosis was identified in 15 of the 26 cases (58%). Sixteen cases (61%) were associated with LR-HPV (types 6, 11, or 42), but 3 cases (12%) with high-risk (HR) HPV (16, 16/18, and 33), 2 cases (8%) with mixed LR- and HR-HPV (6/16 and 11/58), while 2 cases (8%) were negative, but p16INK4a immunostaining showed nonblock positivity in all cases. Eight (31%) had high-grade squamous intraepithelial lesion (HSIL) in the adjacent mucosa, 4 (50%) of which showed direct continuity. Identical HPV subtypes were confirmed in separately microdissected cases from PIM and adjacent HSIL. Most lesions (n = 24, 92%) expressed CK17 (reserve cell marker) in a bottom-heavy pattern and CK7 (squamocolumnar junction [SCJ] marker) in a top-heavy pattern, while most cases of low-grade squamous intraepithelial lesion (LSIL) were negative for both markers. - Our results suggest that PIM is a distinct subset of LSIL showing a productive HPV infection, but PIM involves the transformation zone and is proximal to SCJ, while LSIL is mostly from ectocervix or distal to the SCJ.

Comparative Study of Precancerous Lesions of the Uterine Cervix Among Users and Non-Users of Combined Oral Contraceptive Pills in Jos, Nigeria

Combined oral contraceptive pills (COCP) use, is link to the development of precancerous cervical lesions. There are variations in reports across studied populations. Our study was a comparative, cross-sectional study. SPSS version 20 (IBM, Armonk, NY, USA) was used for data analysis and P-Value < 0.05 was considered statistically significant. The Prevalence of precancerous cervical lesions in the Exposed and Control groups were 16.4% (9/55) and 14.5% (8/55) respectively (P = of 0.79). In the exposed group, four out of the nine women that had abnormal cervical cytology results had high grade squamous intra-epithelial lesions (HGSIL) while only one out of 8 women that had abnormal cytology results in the control group had HGSIL. We found no significant difference in the prevalence of pre-cancerous cervical lesions between users and non-users of COCP. However, women who used COCP had higher cases of HGSIL when compared with the control group. Therefore, we suggest relatively short schedule of cervical cytology screening for this group of women relative to the general population.

Liver transplant recipients have a higher prevalence of anal squamous intraepithelial lesions

Background:Anal squamous intraepithelial lesions (ASIL) are precancerous lesions of anal squamous cell carcinoma, with a higher prevalence in immunosuppressed patients. There are some studies in kidney transplant recipients, but there is no information regarding prevalence in liver transplantation. Our aim was to evaluate the prevalence of ASIL in this setting.Methods:Prospective case–control study involving liver transplant recipients without any other known risk factor for ASIL (n=59), which were compared with a healthy control group (n=57). All were submitted to anal cytology and high-resolution anoscopy was performed in those with abnormal results.Results:Ten (17%) of liver transplant recipients had abnormal cytological results, seven patients had atypical squamous cells of undetermined significance (ASC-US), one patient had atypical squamous cells that cannot exclude high-grade (ASC-H) and two patients had high-grade squamous intraepithelial lesions (HSIL). In the control group, one patient (2%) had an ASC-US result (P=0.005). Anal squamous intraepithelial lesions were confirmed in 7 out of 10 of liver transplant patients and 0 out of 1 in the controls (P=0.013) by high-resolution anoscopy with biopsies. Current smoking was the only risk factor for abnormal cytology (odds ratio=5.87, 95% confidence intervals=1.22–28.12, P=0.027).Conclusions:Liver transplant patients have a higher risk of ASIL. Screening should be considered, especially in smokers.

Abstract 1866: Ultrahigh resolution optical coherence microscopy for label-free imaging of human cervical lesions ex vivo

Abstract Cervical cancer remains the fourth most common cause of cancer and the fourth leading cause of cancer death in women worldwide. In contrast to the decreasing prevalence in developed countries, incidence of cervical cancer remains high in developing countries, such as China, India and Chile. Effective screening of cervical cancer is crucial for early diagnosis of the disease. Ultrahigh resolution optical coherence microscopy (UHR OCM) is an emerging label free imaging technique that can be used to obtain three dimensional (3D) “optical biopsy” of biological samples with cellular resolution up to 2 mm beneath the tissue surface. The goal of this study is to assess the diagnostic value of UHR OCM for human cervical precancer and cancer screening and identify characteristic features in UHR OCM images that correlate with the gold standard histopathology. Six hundred and fifty eight (658) fresh cervical tissues from cervical biopsy, conization and panhysterectomy were obtained from 254 consenting volunteers. Multiple 3D UHR OCM images were obtained from each specimen before the sample was processed for standard histopathology evaluation. Of the 658 samples imaged, 474 had normal cervix or benign lesions, 110 had low grade squamous intraepithelial lesion (LSIL), 57 had high grade squamous intraepithelial lesions (HSIL) and 17 had invasive cancer. UHR OCM images were compared to histopathology slides obtained from the same specimens in order to identify diagnostic image features. Distinctive patterns for squamous epithelium, columnar epithelium, basement membrane, cervical inflammation and erosion, koilocytic cells, low grade and high grade squamous intraepithelial lesions and cervical cancer were clearly observed. Our results lay the foundation for future non-invasive optical evaluation of cervical tissue in vivo. This could lead to a less invasive and more effective screening strategy for cervical cancer based on OCM guided biopsies. Citation Format: Xianxu Zeng, Canyu Li, Xiaofang Wang, Jason Jerwick, Tao Xu, Yuan Ning, Linlin Zhang, Yutao Ma, Xiaoan Zhang, Chao Zhou. Ultrahigh resolution optical coherence microscopy for label-free imaging of human cervical lesions ex vivo [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2017; 2017 Apr 1-5; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2017;77(13 Suppl):Abstract nr 1866. doi:10.1158/1538-7445.AM2017-1866

HPV prevalence and type distribution in Cypriot women with cervical cytological abnormalities

BackgroundHuman papillomavirus (HPV) is the most common sexually transmitted agent, and it can cause cervical lesions and cancer in females. Currently, information regarding the prevalence of HPV in Cyprus is lacking. The aim of this study was to evaluate the HPV type-specific prevalence in 596 women, aged 19–65 years, with cytological abnormalities. Additionally, in a subset of 348 women for whom cytology results of the Pap test were available, the association between HPV infection and cervical disease was investigated.MethodsHPV detection and typing was carried out using PCR and restriction fragment length polymorphism analysis, respectively.ResultsOverall, the HPV prevalence was 72.8%, and it was shown to be age dependent, with a decreasing prevalence until the age of 45 years (p = 0.0018, χ2). Two hundred and fifty-eight women (59.4%) were infected with high-risk HPV, 151 (34.8%) with low-risk HPV, and 25 (5.8%) with HPV types of unknown risk. The most common high-risk HPV type was HPV16 (17.7%), followed by HPV31 (12.9%), HPV58 (7.1%), HPV68 (4.6%), HPV18 (4.1%), and HPV56 (3.7%). Among the women for whom cytology results were available, 268 (77%) were HPV positive, with a sample distribution as follows: 188 (74%) had atypical squamous cells of undetermined significance (ASCUS), 61 (85.9%) had low-grade squamous intraepithelial lesion (L-SIL), and 19 (82.6%) had high-grade squamous intraepithelial lesion (H-SIL). HPV16 was the most common type among women affected by L-SIL (19.7%) and H-SIL (15.8%), with HPV31 being the most common type in women affected by ASCUS (16.5%).ConclusionsThe present study provides the first epidemiological data related to HPV prevalence and type distribution in Cypriot women with cytological abnormalities.

Human papillomavirus infection in anal intraepithelial lesions from HIV infected Cuban men

BackgroundAn association between HPV infection and progression to anal squamous intraepithelial lesions (ASIL) has been established, specifically in high-risk populations such as HIV-infected men. In this population, anal cancer is one of the most common non-AIDS-defining malignancies.MethodsA cross-sectional study to detect anal lesions and HPV infection was performed. Anal mucosa samples were collected from 56 HIV-infected men from Cuba. The cytological diagnosis was done according to Bethesda 2001 System. HPV DNA detection was determined by qPCR for six high-risk HPV types and end point PCR for low-risk HPV types (6 and 11). The end point PCR with nucleotide sequencing technique was achieved to detect other genotypes of HPV not included in the qPCR in those samples negative for HPV- 6 and 11 or negative for the six genotypes identified in the qPCR.ResultsCytological diagnosis identified 53 of 56 (95%) men with abnormal anal cytology. Among those, 26% (14/53) had atypical squamous cells of undetermined significance (ASC-US), 4% (2/53) had atypical squamous cells of undetermined significance cannot exclude high-grade lesions (ASC-H), 64% (34/53) had low-grade squamous intraepithelial lesions (LSIL), and 6% (3/53) had high-grade squamous intraepithelial lesions (HSIL). HPV DNA was detected in 89% (50/56) of men and 79% had at least one of the high-risk HPV types. HPV- 16 was the most common genotype (52%), while HPV-18 was the most frequently detected genotype in men with HSIL. We found statistically significant differences in the HPV viral loads with respect to the cytology results (p = 0.0006) and that the practice of receptive anal sex was a risk factor for anal HPV infection (p = 0.032).ConclusionThis study shows a high prevalence of ASIL and high-risk HPV infections in the study group and is the first study showing the distribution of HPV genotypes in HIV infected Cuban men with abnormal anal cytology. This information may be of importance for local decision makers to improve prevention strategies, including the introduction of HPV vaccine in Cuba.

Cervical cytology as a diagnostic tool for female genital schistosomiasis: Correlation to cervical atypia and Schistosoma polymerase chain reaction.

Background:Female genital schistosomiasis (FGS) is a tissue reaction to lodged ova of Schistosoma haematobium in the genital mucosa. Lesions can make the mucosa friable and prone to bleeding and discharge. Women with FGS may have an increased risk of HIV acquisition, and FGS may act as a cofactor in the development of cervical cancer.Objectives:To explore cytology as a method for diagnosing FGS and to discuss the diagnostic challenges in low-resource rural areas. The correlation between FGS and squamous cell atypia (SCA) is also explored and discussed. Cytology results are compared to Schistosoma polymerase chain reaction (PCR) in vaginal lavage and urine and in urine microscopy.Materials and Methods:In a clinical study, 394 women aged between 16 and 23 years from rural high schools in KwaZulu-Natal, South Africa, underwent structured interviews and the following laboratory tests: Cytology Papanicolaou (Pap) smears for S. haematobium ova and cervical SCA, real-time PCR for Schistosoma-specific DNA in vaginal lavage and urine samples, and urine microscopy for the presence of S. haematobium ova.Results:In Pap smears, S. haematobium ova were detected in 8/394 (2.0%). SCA was found in 107/394 (27.1%), seven of these had high-grade squamous intraepithelial lesion (HSIL). Schistosoma specific DNA was detected in 38/394 (9.6%) of vaginal lavages and in 91/394 (23.0%) of urines. Ova were found microscopically in 78/394 (19.7%) of urines.Conclusion:Schistosoma PCR on lavage was a better way to diagnose FGS compared to cytology. There was a significant association between S. haematobium ova in Pap smears and the other diagnostic methods. In low-resource Schistosoma-endemic areas, it is important that cytology screeners are aware of diagnostic challenges in the identification of schistosomiasis in addition to the cytological diagnosis of SCA. Importantly, in this study, three of eight urines were negative but showed Schistosoma ova in their Pap smear, and one of them was also negative for Schistosoma DNA in urine. In this study, SCA was not significantly associated with schistosomiasis. HSIL detected in this young population might need future consideration.