High Squamous Intraepithelial Lesion Research Articles

Poor Acceptance of the Revised Classification of Premalignant Anal Lesions Following the LAST Standardized Project.

The Lower Anogenital Squamous Terminology (LAST) Project recommended unified classification for HPV-associated squamous lesions of the lower anogenital tract, using a 2-tiered nomenclature in 2013. Adherence to the new nomenclature worldwide is unknown. This study aims to assess the trend of the use of the two-tiered High Squamous Intraepithelial Lesion and Low Squamous Intraepithelial Lesion (HSIL/LSIL) as opposed to the traditional three-tiered Anal Intraepithelial Neoplasia (AIN I/II/III) classification as suggested by the LAST Project. A literature search on full-text English language studies of premalignant anal lesion was performed on PubMed from 2002-2022. The studies were categorized by continent, and the prevalence of HSIL/LSIL classification vs AIN I/II/III was calculated. 546 studies and 251 studies were identified using the AIN I/II/II and the HSIL/LSIL classification respectively. Global trend suggested a statistically significant downward trend in the use of the two-tiered nomenclature system in publications globally. Regional trend including North America, Europe, and other (Asia and Latin America) showed variance in adoption of the two-tiered nomenclature system. Despite multidisciplinary collaborative effort, adherence to the recommendations to use the two-tiered system for HPV-associated premalignant anal lesions continues to be suboptimal. Further efforts are needed to identify the cause of poor adherence to be able to create strategies that reinforces unification of terminology and integration of LAST the recommendations.

Deep Learning in High-Resolution Anoscopy: Assessing the Impact of Staining and Therapeutic Manipulation on Automated Detection of Anal Cancer Precursors.

High-resolution anoscopy (HRA) is the gold standard for detecting anal squamous cell carcinoma (ASCC) precursors. Preliminary studies on the application of artificial intelligence (AI) models to this modality have revealed promising results. However, the impact of staining techniques and anal manipulation on the effectiveness of these algorithms has not been evaluated. We aimed to develop a deep learning system for automatic differentiation of high-grade squamous intraepithelial lesion vs low-grade squamous intraepithelial lesion in HRA images in different subsets of patients (nonstained, acetic acid, lugol, and after manipulation). A convolutional neural network was developed to detect and differentiate high-grade and low-grade anal squamous intraepithelial lesions based on 27,770 images from 103 HRA examinations performed in 88 patients. Subanalyses were performed to evaluate the algorithm's performance in subsets of images without staining, acetic acid, lugol, and after manipulation of the anal canal. The sensitivity, specificity, accuracy, positive and negative predictive values, and area under the curve were calculated. The convolutional neural network achieved an overall accuracy of 98.3%. The algorithm had a sensitivity and specificity of 97.4% and 99.2%, respectively. The accuracy of the algorithm for differentiating high-grade squamous intraepithelial lesion vs low-grade squamous intraepithelial lesion varied between 91.5% (postmanipulation) and 100% (lugol) for the categories at subanalysis. The area under the curve ranged between 0.95 and 1.00. The introduction of AI to HRA may provide an accurate detection and differentiation of ASCC precursors. Our algorithm showed excellent performance at different staining settings. This is extremely important because real-time AI models during HRA examinations can help guide local treatment or detect relapsing disease.

ACCEPTANCE AND OUTCOMES OF CERVICAL CANCER SCREENING AMONG WOMEN OF NORTH INDIA

Cervical cancer is one of the preventable cancer, still it is fourth leading cause of death of women worldwide and second leading cause of death of women in India. Screening for cervical cancer using high performance test and vaccination against HPV(Human papilloma virus) are recommended by WHO as global strategy to eliminate cervical cancer. The very rst indigenous vaccine CERVAVAC is also launched in India in year 2023,however data from nationally representative survey(NFHS-5) showed very low awareness and acceptance of cervical cancer screening among women. Present study is a descriptive cross sectional study done in camp based settings (25-30 women in each camps) from November 2021 to november 2022 at peripheral health centers of Lucknow district of state Uttar Pradesh of North India. Aim of the study was to assess the acceptance and outcomes of cervical cancer screening among ASHA(accredited social health activist) from health centers and women visiting peripheral health centers. Result showed that total 43% women accepted screening(41.4% ASHA, 31.4% women visiting health center). On bivariate analysis education level(p=0.003 ), employment status (p<0.001)and knowledge of cervical cancer(p=0.02) found to be predictors of cervical cancer screening. Liquid based cytology test was carried to screen those who were willing and it was found that as per Bethesda system of classication among those who opted for screening(N=110), 4(3.1%) were having ASCUS (Atypical squamous cells of undetermined signicance), 2(1.5%) had LSIL (low squamous intraepithelial lesions), 4(3.1%) reported to have HSIL (High squamous intraepithelial lesion), 9 (7.7%) had non neoplastic inammation, 93(84.6%) were negative for any neoplastic or non- neoplastic lesion. All Positive screened participants were referred to higher centre for further management.

Higher clearance rates of multiple HPV infections may explain their lower risk of HSIL: A retrospective study in Wenzhou, China.

Persistent human papilloma virus (HPV) infection is known to be associated with cervical lesions.The chief object of the study is to investigate if the pathogenicity of multiple HPV infections is different from a single infection. Furthermore, we would like to corroborate the discrepancy with clearance rates.Between August 1, 2020, and September 31, 2021, 5089 women underwent a colposcopy-directed biopsy in our hospital. We divided the 2999 patients who met the criteria into multiple and single HPV infection groups. The HPV genotypes were identified using the flow cytometry fluorescence hybridization technology. Binary logistic regression and survival analysis were used to perform statistics.Among HPV-positiveindividuals, 34.78% (1043/2999) were positive for 2 or more HPV types. After adjusting for the main factors, compared with single infection, multiple infections were associated with a significantly decreased risk of high squamous intraepithelial lesions (HSIL) (odds ratio [OR]: 0.570; 95% confidence interval [CI]: 0.468-0.694). In the mean time, the clearance rates of multiple infections were significantly higher (OR: 2.240; 95%CI: 1.919-2.614). When analyzing specific types covered by the 9-valent HPV vaccine, consistency between the lower risk of HSIL and the higher clearance rate was found in the most groups.Compared with a single infection, multiple HPV infections have a lower risk of HSIL, which may be related to its higher clearance rate. It suggests that aggressive treatment of multiple HPV infections early in their detection may be beneficial.

Assessment of high-risk human papillomavirus infections and associated cervical dysplasia in HIV-positive pregnant women in Germany: a prospective cross-sectional two-centre study.

Invasive cervical cancer (ICC) is associated in nearly 100% with persistent high-risk Human Papillomavirus (HR-HPV) infection. ICC is still one of the leading causes for cancer mortality in women worldwide. The immunosuppressive influence of Human Immunodeficiency Virus (HIV) and the immunocompromised period of pregnancy due to tolerance induction against the hemiallogeneic fetus, are generally risk factors for acquisition and persistence of HR-HPV infections and their progression to precancerous lesions and HPV-associated carcinoma. Overall, 81 pregnant women living with HIV (WLWH) were included. A medical history questionnaire was used to record clinical and HIV data. Participants received cervicovaginal cytological smear, colposcopy and HPV testing. HPV test was performed using BSGP5+/6+ PCR with Luminex read-out. The HR-HPV genotypes 16, 18, 31, 33, 45, 52, 58 were additionally grouped together as high-high-risk HPV (HHR-HPV) for the purpose of risk-adapted analysis. HR-HPV prevalence was 45.7%. Multiple HPV infections were detected in 27.2% of participants, of whom all had at least one HR-HPV genotype included. HR-HPV16 and HR-HPV52 were the most prevalent genotypes and found when high squamous intraepithelial lesion (HSIL) was detected by cytology. HIV viral load of ≥ 50 copies/ml was associated with higher prevalence of HR-HPV infections. Whereas, CD4 T cells < 350/µl showed association with occurrence of multiple HPV infections. Time since HIV diagnosis seemed to impact HPV prevalence. Pregnant WLWH require particularly attentive and extended HPV-, colposcopical- and cytological screening, whereby clinical and HIV-related risk factors should be taken into account.

HPV-genotyping versus conventional cervical cytology as a screening method to detect dysplastic cervical epithelial changes

The world health organization (WHO) called for coordinated global action in 2018 to eliminate cervical cancer, ensuring that every woman is screened and treated for precancerous lesions (World Health Organization. Cervical cancer: an NCD we can overcome. Geneva, 2018. http://www.who.int/director-general/speeches/detail/cervical-cancer-an-ncd-we-can-overcome.tegy). Cytology-based screening has been for decades the conventional method of screening. Ancillary techniques have been added like immunocytochemistry with P16/Ki67 and L1-Capsid, but these methods require maintenance of complex infrastructure and highly trained personnel as well as relatively short screening intervals. HPV-based screening method to detect high-risk groups is a faster and automated method, which does not need morphologically highly qualified personal with high social costs. In the study, we have focused on the distribution of cervical lesions in the age groups with concordance of detection HPV high-risk subtypes (HPV-HR) and on the safety of the screening method. In the Institute for Pathology and Cytology-Schuettorf-Leer-Germany 146.800 samples of women from the age of and above 35 years were analyzed between the beginnings of 2020 until the beginning of 2021. 63.710 cases under 35 years old were analyzed. The samples were processed for both conventional cytological techniques and for molecular detection and subtyping of HPV-HR according to the advice and measurements of BD-manufacture. In this study, we have studied the histopathological results (Table 2) after colposcopy according to the age subgroups. The histopathological results were subdivided into no dysplasia, cervical intraepithelial neoplasia I (CIN I), cervical intraepithelial neoplasia II (CIN II), cervical intraepithelial neoplasia III (CIN III), squamous cell carcinoma (Sq.c.c), adenocarcinoma in situ (AIS), endometrial carcinoma, endocervical adenocarcinoma and cases without biopsy during the colposcopy (COB). We have used the muenchener classification III (Table 3) as a subgrading system for the cytological specimens. The frequency of detecting HPV56/59/66 is higher as detecting HPV-16 and HPV18 in age groups under 35 years old, 41–50 years old and 51–60 years old. HPV16 is detected higher in age groups 35–40 years old and above 60 years. The incidence of high squamous intraepithelial lesions (CIN II and III) is 0.92% in age group 35–40 years, 0.54% in age under 35 years, 0.59% in age group 41–50 years old, 0.35% in age group 51–60 years old and 0.15% in age group above 60 years old. There is no significance (p value = 0.4060). Low grade cervical lesions (CIN I) were 0.13% (< 35 Ys), 0.35% (35–40 Ys), 0.36% (41–50 Ys), 0.25% (51–60 Ys) and 0.098% (> 60Y s), which was statistically significant (p value = 0.04,0.60). Without dysplasia 0.19% (< 35 Ys), 0.5% (35–40 Ys), 0.56% (41–50 Ys), 0.51 (51–60 Ys) and 0.26% (> 60 Ys). There is no significance between occurrence of cervical dysplasia and without dysplasia despite of detection of HPV-HR subtypes (p value = 0.1754). The only use of HPV-subtyping is not a secure method and a protective way for women. There are worldwide many HPV-positive cases, which have been psychologically impaired with higher costs, although they have no cervical epithelial changes during the HPV-infection. There are many HPV-negative cases, in some studies up to 13% of cases, which develop cervical cancer. We have the opinion and are convinced that the screening should be both morphologically via cytological examination and may be with adding immunocytochemistry to detect the really dysplastic cervical lesions. HPV-subtyping may be added every three years to detect the concomitant subtype.

Cervical cancer classification using efficient net and fuzzy extreme learning machine

Cervical cancer is the most common and deadly malignancy affecting women worldwide. The prediction and treatment of this malignancy are necessary in order to avoid serious complications. In recent days, deep learning has enhanced the accuracy of cervical cancer prediction in its early stages. In this study, a deep learning based EN-FELM approach is proposed to detect and classify the cervical cells. Initially, the pap smear images are pre-processed to eliminate the background distortions. The EfficientNet is a reversed bottleneck MBConv used for feature extraction. Consequently, fuzzy extreme learning machine (FELM) is used to classify the healthy, benign, low squamous intraepithelial lesions (LSIL) and high squamous intraepithelial lesions (HSIL). The proposed model acquires the best classification accuracy on Herlev and SIPaKMeD datasets range of 99.6% and 98.5% respectively. As a result, the classification using FELM produces more efficient and accurate result which is significantly high compared to the traditional classifiers. The proposed EN-FELM improves the overall accuracy of 0.2%, 0.13% and 14.6% better than Autoencoder, LSTM and KNN with CNN respectively.

Effectiveness of Different Testing Strategies Applied for Cervical Cancer Screening in Shuangliu District, Chengdu City

To evaluate the clinical value of different combination strategies of high-risk HPV (hr-HPV) testing and Thinprep cytology test (TCT), a cervical cytology test, for cervical cancer screening, especially for high or higher-grade squamous intraepithelial lesion (HSIL+) in Shuangliu District, Chengdu City. The study is a population-based randomized clinical trial. Women aged 35 to 65 years meeting the inclusion criteria were enrolled for the study. At the baseline screening conducted in the first year, the participants were randomly assigned to either cytology test or hr-HPV testing at a ratio of 1∶2. If the paticipants had positive results for the baseline hr-HPV test, they would then undergo either cytology test or colposcopy by random assignment. After 24 months, all participants were called back, and combined screening of cytology test and hr-HPV test were performed. Women who had negative results at baseline screening and who entered and completed the third-year follow-up were selected as the subjects of the study. Based on the aforementioned testing findings, the related data were extracted and four different screening protocols were simulated: 1) combined TCT and hr-HPV screening, with referral for colposcopy when there was positive results for either one of the two; 2) combined TCT and hr-HPV screening, with referral for colposcopy when both tests had positive results at the same time; 3) TCT was done for preliminary screening and those who were found to be positive would then undergo hr-HPV test for triage purpose, with subsequent referral made for colposcopy if the hr-HPV results were positive; 4) hr-HPV was done for preliminary screening and those who were found to be positive would then undergo TCT, with subsequent referral made for colposcopy if TCT results were positive. With the detection of HSIL+ on histological examination as the endpoint event, the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and area under curve ( AUC) of different combination screening models were calculated. A total of 3102 women were screened, and 2967 women were included in the statistical analysis in this study. Among the 2967 women, 979 were randomized to cytology and 1988 to hr-HPV genotyping. For prescreening, the positive rate of the cytology group was 5.6% (55/979), with of HSIL+ positive rate being 0.2% (2/979), while the positive rate of the hr-HPV group was 7.5% (149/1988), with HSIL+ positive rate being 0.9% (18/1988). After 24 months, 2456 women were called back and were given cervical cytology test and hr-HPV test at the same time. Among them, the positive rate of the cytology group was 3.2% (78/2456), while the positive rate of hr-HPV group was 8.7% (215/2456). The overall positive rate of HSIL+ was 0.69%(17/2456). Women with a negative baseline hr-HPV had a lower incidence of HSIL+ lesions in the long term. The strategy of cervical cytology screening combined with hr-HPV test for triage purpose is the best method, with a sensitivity of 88.9%, a specificity of 58.3%, a PPV of 44.4%, a NPV of 93.3%, and an AUC of 0.736, P=0.039 (95% CI: 0.555-0.917). This randomized clinical trial from Shuangliu District, Chengdu City shows that the sensitivity of hr-HPV testing is better than that of cytology test, and the prevalence of HSIL+ in women with negative baseline hr-HPV results is lower than that of women with negative baseline cytology results. The screening program of TCT for prescreening plus subsequent hr-HPV test for triage purpose shows better value for the detection of HSIL+.

Cytological screening and Seroincidence of IgM with possible risk factors associated with naturally selected high risk group for Oncogenic Human Papilloma Virus Infection in Daura, Katsina State

Cervical cancer is the second most common cancer among women in the developing countries and the seventh commonest cancer in the developed countries. Human papillomavirus (HPV) is now known to be the main factor in the aetiology of cervical cancer with over 99.7% of cases being associated with previous high risk HPV infection. The aim of the research is to determine the risk factors and incidence of oncogenic human papilloma virus among women of reproductive age in Daura. This was a cross-sectional prospective study involving a total of 120 women. Questionnaires were administered to collect data such as socio-demographic and possible risk factors. Endocervical swab and serum samples were then collected from the participants. Samples were analyzed by Enzyme Linked immunosorbent Assay and Pap smear respectively. The findings of this research revealed and overall high seroincidence of 36.6% as well as significant difference between seroincidence rate of pregnant and non-pregnant women. The findings also revealed that 10-20 age groups had the higher seroincidence rate of (50.0%) with no statistical significant difference between age groups. None of the sociodermographic factors involved in the research show significant association with HPV infections. The result by type of marriage shows that similar seroincidence rate was obtained in both monogamy and polygamy forms of marriage (36.7%). The study also reveals that risk factors like sexual partners, HIV status and sexual debut are significantly associated with HPV infection (P&lt;0.05). Sixty (60) participants show normal cytole under microscope with prevalence of 50.0% and those with abnormal cytole had prevalence of (16.7%) while lowest prevalence of (3.3%) was obtained from participants with high squamous intraepithelial lesions. These results demonstrate a high seroincidence of HPV infection among women in the study area. We recommend improved education regarding HPV and cervical cancer among the populace and increasing cervical cancer screening particularly to attendees of antenatal care to prevent HPV related morbidity and mortality.&#x0D; Keywords: HPV; Cervical cancer; Endocervical swab; Seroincidence

Gynaecological cytology in women under the age of 30—the impact of P16/KI67 dual-staining cytology

Abstract Background The HPV detection test is not recommended as a primary screening of cervical lesions, before the age of 30, because the high rate of HPV infections with a high rate of spontaneous resolution in this age group. This study aims to evaluate the performance of p16/Ki67 dual staining in detecting high-grade squamous cervical lesions in these women. Methods Cervical-vaginal samples from 67 women HPV positives under the age of 30 and cervical biopsies of 41 of these women. Results of p16/Ki67 dual staining, cytology and histology were analysed. In 53 of the women, 159 results of p16/Ki67 dual staining, HPV test and cytology, obtained in 3 follow-up medical visit, were compared. Results The p16/ki67 dual staining was positive in 23.9% and negative in 76.1% of all 67 women. All women with high squamous intraepithelial lesion cytology, 39.1% with low squamous intraepithelial lesion cytology, 17.4% with negative for intraepithelial lesion cytology and 10% with atypical squamous cells cytology, were p16/Ki-67 dual staining positives. In the 41 women with histological diagnosis, p16/ki67 dual staining showed a sensitivity of 87.5% and a specificity of 96% to detect HSIL. When comparing, the tests differ significantly (P &amp;lt; 0.001), p16/ki67 dual staining was positive in 24% of positive cytology and in 19.5% of positive HPV tests. Conclusions Our results demonstrate that p16/Ki67 dual stain has good sensitivity and specificity to detect HSIL and can be useful on women under the age of 30, avoiding excessive diagnosis and reducing colposcopy referrals. Further studies are required in a large number of women.

Quality of Actions to Control Cervical Cancer in Bahia, Brazil.

Objective:To assess the quality of the actions to control cervical cancer (CC) and its correlates. Methods:This is a cross-sectional study conducted from January to March 2019 in 19 municipalities in Bahia, Brazil, with a sample of 241 doctors and nurses from primary health care (PHC). Three dependent variables were chosen- “Performance of educational, promotion, prevention, and monitoring actions” (D1); “Access to diagnostic tests” (D2); “Non-occurrence of high grade cervical squamous intraepithelial lesions (HSIL)” (D3). Poisson regression with robust variance was used, adopting hierarchical input variables to estimate the prevalence ratios and confidence intervals of 95%. Results:The following prevalence rates were found: D1 39.8% (95% CI: 33.8-46.2); D2 73.9% (95% CI: 67.9-79.1); and D3 46.4% (95% CI: 39.9-53.0). These dimensions remained associated with the dependent variables: D1- having professional training courses on the topic; consideration to ensure that collection takes place appropriately by a professional; and women having access to medical transport; D2- nurses treating low-grade lesions; D3- recording the Papanicolaou in electronic medical records; D1 and D2- professionals joining the service through public tender; D1 and D3- working in the PHC (≥ 2 years); D2 and D3- recording Papanicolaou in physical records; and performance of Papanicolaou by residents. Conclusion:Better trained professionals and professionals working in stable work arrangements are associated with comprehensive actions to control CC. Such strategies indicate that investments in work management result in a more organized PHC and more solution-centered work processes. Therefore, working in the PHC for a longer time and nurses performing more clinical actions (collection and treatment) are favored by such organizational actions. Investments in diagnostic support contribute to perceptions of more comprehensive actions to control CC.

Should the management of high grade cervical squamous intraepithelial lesion (HSIL) be different in HIV-positive women?

BackgroundThis study compares the management and outcome of high grade squamous intraepithelial lesions (HSIL) in HIV-positive and -negative women and identifies risk factors for treatment failure.MethodsThis retrospective, controlled study includes 146 HIV-positive women, matched for HSIL, age and year of diagnosis, with 146 HIV-negative women. Differences were analysed using parametric and non-parametric tests and Kaplan–Meier survival curves. A binary logistic regression was used to assess risk factors for treatment failure.ResultsPersistence of cervical disease was observed most frequently in HIV-positive women (42 versus 17%) (p < 0.001) and the cone biopsy margins were more often invaded in HIV-positive-women than in HIV-negative ones. (37 versus 16%; p < 0.05).HIV-positive women, with successful cervical treatment had better HIV disease control: with significantly longer periods of undetectable HIV viral loads (VL) (19 versus 5 months; p < 0.001) and higher CD4 counts (491 versus 320 cells/mm3; p < 0.001). HIV-positive women with detectable VL at the time of dysplasia had 3.5 times (95% IC: 1.5–8.3) increased risk of treatment failure. Being treated through ablative therapy was associated with a 7.4, four-fold (95% IC: 3.2–17.3) increased risk of treatment failure compared to conizationConclusionHIV-positive women have a higher risk of treatment failure of HSIL than do HIV-negative women, especially when ablative therapy is used and in women with poor control of their HIV infection. The management and the follow- up of HSIL’s guidelines in this high-risk population should be adapted consequently: for HIV-positive women with uncontrolled viral load, excisional treatment should be the preferred therapy, whereas for women with undetectable viral load, CD4 + lymphocytes higher than 500 cells/mm3 and with a desire of pregnancy, ablative therapy may be considered.

Risk factors for ≥high-grade anal intraepithelial lesions in MSM living with HIV and the response to topical and surgical treatments.

BackgroundThe objective of this study in MSM living with HIV was to determine the incidence of HSIL and ASCC, related factors, and the response to treatment.Patients and methodsData were gathered in 405 consecutive HIV-infected MSM (May 2010-December 2018) at baseline and annually on: sexual behavior, anal cytology, and HPV PCR and/or high-resolution anoscopy results. They could choose mucosectomy with electric scalpel (from May 2010) or self-administration of 5% imiquimod 3 times weekly for 16 weeks (from November 2013). A multivariate logistic regression model was developed for ≥HSIL-related factors using a step-wise approach to select variables, with a significance level of 0.05 for entry and 0.10 for exit, applying the Hosmer-Lemeshow test to assess the goodness of fit.ResultsThe study included 405 patients with a mean age of 36.2 years; 56.7% had bachelor´s degree, and 52.8% were smokers. They had a mean of 1 (IQR 1–7) sexual partner in the previous 12 months, median time since HIV diagnosis of 2 years, and mean CD4 nadir of 367.9 cells/uL; 86.7% were receiving ART, the mean CD4 level was 689.6 cells/uL, mean CD4/CD8 ratio was 0.77, and 85.9% of patients were undetectable. Incidence rates were 30.86/1,000 patient-years for ≥high squamous intraepithelial lesion (HSIL) and 81.22/100,000 for anal squamous cell carcinoma (ASCC). The ≥HSIL incidence significantly decreased from 42.9% (9/21) in 2010 to 4.1% (10/254) in 2018 (p = 0.034). ≥HSIL risk factors were infection with HPV 11 (OR 3.81; 95%CI 1.76–8.24), HPV 16 (OR 2.69, 95%CI 1.22–5.99), HPV 18 (OR 2.73, 95%CI 1.01–7.36), HPV 53 (OR 2.97, 95%CI 1.002–8.79); HPV 61 (OR 11.88, 95%CI 3.67–38.53); HPV 68 (OR 2.44, CI 95% 1.03–5.8); low CD4 nadir (OR1.002; 95%CI 1–1.004) and history of AIDS (OR 2.373, CI 95% 1.009–5.577). Among HSIL-positive patients, the response rate was higher after imiquimod than after surgical excision (96.7% vs 73.3%, p = 0.009) and there were fewer re-treatments (2.7% vs 23.4%, p = 0.02) and adverse events (2.7% vs 100%, p = 0.046); none developed ASCC.ConclusionsHSIL screening and treatment programs reduce the incidence of HSIL, which is related to chronic HPV infection and poor immunological status. Self-administration of 5% imiquimod as first-line treatment of HSIL is more effective than surgery in HIV+ MSM.

Specific distribution of human papillomavirus type in patients of different reproductive age with low and high-grade squamous intraepithelial lesion

The purpose of this work was to study the characteristics of human papillomaviruses spread in reproductive age patients with low and high degree squamous intraepithelial lesions of the cervix in Yekaterinburg. Material and Methods. In with study 140 female patients of reproductive age with histologically confirmed low and high grade intraepithelial lesions were retrospectively included. HPV-genotyping by polymerase chain reaction was carried out in combination with liquid-based cytology BDSurePath. Formed 4 groups: LSIL, age from 18 to 30 years; LSIL, age from 31 to 44; HSIL, ages 18 to 30; HSIL, ages 31 to 44. Results. Analysis of the obtained data demonstrated that HPV 16 prevails in intraepithelial squamous cell lesions of the cervix of low and high degree in women of reproductive age in Yekaterinburg. In women aged 18-30 years, compared with the older reproductive age (31-44 years), multiple infections with 3, 4 or more HPV genotypes are more often recorded, regardless of the degree of damage. In addition to HPV 16, low-grade lesions in young women are most often associated with HPV 31, 51, and 52, and high-grade lesions with types 31, 33 and 52. HPV 33 is characteristic of a high degree of intraepithelial squamous cell lesions, especially in patients of older reproductive age. With intraepithelial squamous lesions of low and high degree, regardless of age, an equally high concentration of HPV DNA is observed.

Role of PAP Smear Cytology and p16 Immunocytochemistry for Detection of Cervical Lesions of Cervix: A Hospital-Based Study

Pap-smear-based cytology is used widely in detecting cervical precancerous lesions and still needs further standardization. Co-expression of p16 can be used as an additional biomarker for detection of cervical lesions. The aim of the study was to assess the diagnostic value of Pap smears and detection of the p16 proteins in women with cervical lesions. Totally 66 cases of cervical smear were taken, out of whom 14 samples were cytologically normal, 16 samples were inflammatory, 15 samples had low squamous intraepithelial lesions (LSIL), 11 samples had high squamous intraepithelial lesions (HSIL) and 10 samples had cervical squamous cell carcinoma (SCC). The expression of p16 was evaluated by immunohistochemical method. The immunostaining results of p16 were classified into four categories: negative, 1+, 2+ and 3+. There was a significant increase in the expression of p16 (P < 0.001) from cytologically normal to SCC. The expression of p16 (P = 0.01) was significantly increased in inflammatory, LSIL, HSIL and squamous cell carcinoma, and the results were compared with those of Pap smear cytology. The result of p16 was compared with that of Pap smear cytology and can improve the diagnostic accuracy of cervical lesions. p16 expressions increase from inflammatory to LSIL, HSIL and SCC.

AgNOR Count in Cervical Swab Under Cytological Normal and Other Pathologic Conditions: A Tumour Prolifirative Marker

To study the argyrophilic nucleolar organizer regions (AgNOR) as a cell proliferative marker in cervical smears and to assess its counts with the severity of the lesions on Papanicolaou (PAP)-stained cervical smears. The present study was a prospective experimental study which was carried out in 50 samples of women attending at Acharya Harihar Regional Cancer Centre, a span of 1 year. The Student’s unpaired ‘t’ test was used to analyse the data. There was a progressive rise in the AgNOR counts with the severity of the lesions [normal cytology < inflammatory < low squamous intraepithelial lesion < high squamous intraepithelial lesion < malignant of cervix, i.e. 1.68 < 2.50 < 4.09 < 5.94 < 8.60, respectively]. Each lesion had a significant AgNOR value which helped in differentiating it from its precursor lesion. The AgNOR counts have been immensely helpful as they behave as a cell proliferative marker, aiding the diagnosis which is made through the cervical PAP-stained smears and letting the cytopathologist understand the exact stage of the cervical lesion.

CERVICAL SMEAR ABNORMALITIES IN HIV INFECTED WOMEN ATTENDING A RURAL HOSPITAL ART CENTER IN TAMILNADU

INTRODUCTION: Cervical cancers are the most common form of cancer encountered in Indian women. Studies from India had reported HIV positive women are 10-11 times more prone for cervical carcinomas than HIV negative women with a recent rise in incidence observed. India started a free antiretroviral therapy (ART) program in 2004 with services extended to rural General Hospitals. Cancer cervix can be diagnosed at a preinvasive stage with repeatative papanicolaou smear (cytological screening) and can be readily preventable. AIM: Our aim is to determine the prevalence of PAP smear abnormalities among HIV infected women from rural areas coming for ART initiation and the relationship between immunological status and smear abnormalities. METHODS: As per the Indian National ART program all HIV positive women of reproductive age should undergo PAP smear examination before initiation of ART. All consenting women &gt;18 years of age with history of penetrative vaginal intercourse undergo PAP smear examination. In this observational cohort from 25th June 2011 to 15th January 2012 conducted in Melur ART centre and the cytological reports and the patient clinical and immunological status data was analyzed by using SPSS 17 version. RESULTS: 102 PAP smears were obtained and classified according to Bethesda classification. Five patients (4.90%) were abnormal. Squamous cell carcinoma was observed in 1 (0.98%) patient with a CD4 count of 580 cells/mm3. High squamous intraepithelial lesions were observed in 2 patients (1.96%) with CD4 counts of 208 &amp; 633 cells/mm3 respectively. Low squamous intraepithelial lesion were observed in 2 patients (1.96%) with CD4 counts of 50 and 385 respectively cells/mm3. Immunological status (CD4 count) correlated with grade of the initial lesion (p=0.10). All the patients with PAP smear abnormalities were referred to Madurai Medical College Hospital for further treatment and follow-up. CONCLUSION: In our observational study increasing cytological abnormalities in the HIV Infected women were noted. Accordingly, all ART centre and HIV treatment programs should institute comprehensive reproductive health care services for this high-risk groups, including routine Papanicolaou smear screening

Classification of adeno carcinoma, high squamous intraephithelial lesion, and squamous cell carcinoma in Pap smear images based on extreme learning machine

ABSTRACT Cervical cancer is a malignant tumour that attacks the female genital area originating from epithelial metaplasia in the squamous protocol junction area. One method of diagnosis of cervical cancer is to do a Pap smear examination by taking a cervical cell smear from the woman’s cervix and observing its cell development. However, examination of cervical cancer from Pap smear results usually takes a long time. This is because medical practitioners still rely on visual observations in the analysis of the results of Pap smear so that the results are subjective. Therefore, we need a programme that can help the classification process in establishing a diagnosis of cervical cancer with high accuracy results. In this study, a cervical cancer classification program was developed using a combination of the Grey Level Co-occurrence Matrix (GLCM) and Extreme Learning Machine (ELM) methods. There are three classes of cervical cell images classified, namely adenocarcinoma, High Squamous Intraepithelial Lesion (HSIL) and Squamous Cell Carcinoma (SCC). From the results of the training program obtained an accuracy 100% and from the testing program obtained an accuracy of 80%.

Cervical cancer screening abnormalities in immunosuppressed renal transplant women: case-control study in Southern Brazil.

To evaluate the prevalence of cervical pre-malignancies in the cervical cytology of female renal transplant recipients (RTR) and compare to immunocompetent patients. A prospective case-control study of 165 RTR (cases) and 372 immunocompetent women (controls) was carried out from May 2015 to August 2016. The participants completed a questionnaire with demographic characteristics, habits, reproductive history, and information about the renal transplant. Cervical cytology samples were collected at their visit for cervical cancer screening. Relevant medical history was obtained from medical records and previous cervical cytology results were retrieved: from the time of kidney transplantation to the beginning of this study for RTR and all collected throughout life for controls. The mean age was similar between groups (42.6 ± 11.4 vs. 41.8.2 ± 11.1years, p = 0.447). Considering cervical cytology collected since the kidney transplant, RTR had three times higher rates of abnormal cervical cytology test (24.8% of RTR vs. 6.3% for controls), and the abnormalities were more frequent (p < 0.001) for low squamous intraepithelial lesion (LSIL) (n = 23, 13.9%) and high squamous intraepithelial lesion (HSIL) (n = 9, 5.5%). Cervical cytology collected during the study had normal results in 152 RTR (92.1%) vs. 326 controls (93.9%) (p > 0.05). When the altered results were broken down, a higher frequency of LSIL could be seen in RTR (3.6% vs 0.0%, p = 0.008). RTR had significantly higher rates of cervical cytology abnormalities comparing to the control group and most of it was composed of LSIL.

Large pelvic mass arising from the cervical stump: A case report

A large cervical cyst with a cervical high-grade squamous intraepithelial lesion arising from the cervical stump is rare. After supracervical hysterectomy, there is a risk of various lesions occurring in the cervical stump. We review the types and characteristics of cervical stump lesions and compare total hysterectomy with subtotal hysterectomy. Gynecologists should choose the most suitable surgical method based on both the patient's condition and wishes. If the cervix is retained, patients require a close follow-up. A 57-year-old woman was admitted to the Gynecology Department for a large pelvic mass. Her chief complaint was abdominal distention for two months. She had undergone subtotal supracervical hysterectomy for leiomyoma 14 years prior. Abdominal ultrasonography detected a 9.1 cm × 8.5 cm × 8.4 cm anechoic mass with silvery fluid in the pelvic cavity and high-risk human papilloma virus 53 (HPV53) was positive. The admission diagnosis we first considered was a pelvic mass mimicking carcinoma of the cervical stump. We performed a laparotomy and a rapid frozen biopsy was suggestive of a fibrous cyst wall coated with a high squamous intraepithelial lesion. The pelvic mass was removed, and a bilateral adnexectomy was implemented. Final pathology confirmed that the pelvic mass was a large inflammatory cyst with a cervical high-grade squamous intraepithelial lesion. After successful intervention, the patient was discharged one week after surgery and there was no recurrence of the vaginal stump at 43 mo. When addressing benign uterine diseases, gynecologists should pay adequate attention to retaining the cervix. If the cervix is retained, patients require a close follow-up.