High CIN Research Articles

CONIZACIÓN LEEP EN NIE DE ALTO GRADO EN UNA INSTITUCIÓN PRIVADA DE SALUD

SUMMARY Background: The cervical conizacion of the uterine cervix is considered the treatment of election of high degree intraepithelial neoplasias. Objective: To analyze the results of treatment of this pathology by Leep Conization. Method: The antecedents and biopsies of 145 patients with histological diagnosis of intraepithelial II and III neoplasia, treated with cervix Conization Leep at Lower Genital Tract Unit of Davila Clinic from June first 2002 to May 31 2008 are reviewed. Results: There was a colpo-biopsy correlation of 80% (116/145) for high degree CIN. There was positive edge in 75 patients (51.7%) and negative in 70 (48.3%). A second treatment in 5 patients were necessary (3.4%); in 3 cases by recurrences and 2 by invasive lesions. 89% remain in control, verifying itself that the totality of these has had a satisfactory considered treatment. Conclusion: Our results confirm that the high degree cervical lesions must preferably be treated by excision methods, being the Leep Conization the method of election by their facility of accomplishment, low cost and can be made without great infrastructure requirements.

Ki67 predicts progression in early CIN: validation of a multivariate progression-risk model.

This study of early CIN biopsies (25 CIN1 and 65 CIN2) with long follow-up was done to validate, in a new group of patients, the value of Ki67 immuno-quantitative features to predict high CIN grade in a follow-up biopsy (often denoted to as “progression”), as described in a previous study. Each biopsy in the present study was classified with the previously described Ki67-model (consisting of the stratification index and the % positive nuclei in the middle third layer of the epithelium) as “low-risk” or “high-risk”, and matched with the follow-up outcome (progression-or-not). Furthermore, it was studied whether subjective evaluation of the Ki67 sections by experienced pathologists, who were aware of the prognostic quantitative Ki67 features, could also predict the outcome. Thirdly, the reproducibility of routine use of the quantitative Ki67-model was assessed. Fifteen cases progressed (17%) to CIN3, 2/25 CIN1 (8%) and 13/65 CIN2 (20%), indicating that CIN grade (as CIN1 or CIN2) is prognostic and that the percentage of CIN1 and CIN2 cases with progression in the present study is comparable to many previous studies. However, the quantitative Ki67 model had stronger prognostic value than CIN grade as none of the 40 “Ki67-model low-risk” patients progressed, in contrast to 15 (30%) of the 50 “Ki67-model high-risk” patients (p < 0.001). In multivariate analysis, neither CIN grade nor any of the other quantitative Ki67 features added to the abovementioned prognostic Ki67-model. Subjective analysis of the Ki67 features was also prognostic, although quantitative assessments gave better results. Routine application of the quantitative Ki67-model in CIN1 and CIN2 was well reproducible. In conclusion, the results confirm that quantitative Ki67 features have strong prognostic value for progression in early CIN lesions.

A real time optoelectronic device as an adjunct to the Pap smear for cervical screening: A multicenter evaluation

We report on the results from a multicenter trial for a real time optoelectronic device as an adjunct to the Pap smear for cervical screening. TruScreen (Polartechnics Limited, Sydney, Australia) is an automated device which measures the response to optical and electrical stimulation of the cervix and returns a screening result in real time. Analysis was performed on a group of 651 subjects recruited at 10 centers. Cytology and histology analyses were performed by centralized laboratories, with the cytology classification performed according to the Bethesda 2001 system. The sensitivities for histologically confirmed CIN 2/3 lesions by TruScreen, Pap, and TruScreen/Pap combined were 70% (95% CI: 67–74), 69% (CI: 65–72), and 93% (CI: 91–95), respectively. For histologically reported CIN 1, the sensitivities of the TruScreen, Pap, and combined test were 67% (CI: 63–70), 45% (CI: 41–49), and 87% (CI: 84–89). The improvement in sensitivity for the combined test compared to the Pap smear alone was significant (P = 0.002). Because TruScreen and cytology detect partly different but overlapping groups of CIN cases, the adjunctive combination provides very high CIN detection rates.