Premalignant Cervical Lesions Research Articles

Association between HIV Serostatus and premalignant cervical lesions among women attending a cervical cancer screening clinic at a tertiary care facility in southwestern Uganda: a comparative cross-sectional study

BackgroundUganda has approximately 1.2 million people aged 15–64 years living with human immunodeficiency virus (HIV). Previous studies have shown a higher prevalence of premalignant cervical lesions among HIV-positive women than among HIV-negative women. Additionally, HIV-infected women are more likely to have human papilloma virus (HPV) infection progress to cancer than women not infected with HIV. We determined the prevalence of premalignant cervical lesions and their association with HIV infection among women attending a cervical cancer screening clinic at Mbarara Regional Referral Hospital (MRRH) in southwestern Uganda.MethodsWe conducted a comparative cross-sectional study of 210 women aged 22–65 years living with HIV and 210 women not living with HIV who were systematically enrolled from March 2022 to May 2022. Participants were subjected to a structured interviewer-administered questionnaire to obtain their demographic and clinical data. Additionally, Papanicolaou smears were obtained for microscopy to observe premalignant cervical lesions. Multivariate logistic regression was performed to determine the association between HIV status and premalignant cervical lesions.ResultsThe overall prevalence of premalignant cervical lesions in the study population was 17% (n = 72; 95% C.I: 14.1–21.4), with 23% (n = 47; 95% C.I: 17.8–29.5) in women living with HIV and 12% (n = 25; 95% C.I: 8.2–17.1) in women not living with HIV (p < 0.003). The most common premalignant cervical lesions identified were low-grade squamous intraepithelial lesions (LSIL) in both women living with HIV (74.5%; n = 35) and women not living with HIV (80%; n = 20). HIV infection was significantly associated with premalignant lesions (aOR: 2.37, 95% CI: 1.27–4.42; p = 0.007).ConclusionPremalignant cervical lesions, particularly LSILs, were more common in HIV-positive women than in HIV-negative women, highlighting the need to strengthen the integration of cervical cancer prevention strategies into HIV care programs.

The Prevalence of Epstein - Barr Virus in Normal, Premalignant, and Malignant Uterine Cervical Samples in Iran.

It is suggested that Epstein-Barr virus (EBV) may play an important role in cervical cancer development. Most studies found a higher rate of EBV in cervical cancer samples in comparison to premalignant and normal groups. In this regard, this study aimed to investigate the prevalence of EBV in cervical samples. In total, 364 samples from 179 healthy subjects, 124 women with premalignant lesions, and 61 patients with cervical cancer were investigated using nested PCR. The mean age ± SE was 54.1 ± 13.4 in women with cervical cancer, 36.1 ± 9.4 among women with premalignant lesions and 36.6 ± 11.5 in healthy individuals. In total, 290 out of 364 samples were HPV positive and the following HPV genotypes were detected among them: HPV 16/18 was found in 43.1%, 23.9%, and 65.5%of normal, premalignant, and malignant samples, respectively, and other high-risk types were detected in 56.9% of normal, 76.1% of premalignant, and 34.5% of malignant samples. The prevalence of EBV was found to be 9.8%, 2.4%, and 2.8% in cervical cancer, premalignant lesions, and normal specimens, respectively, and the difference was statistically significant (P=0.028). The overall frequency of co-infection between EBV and HPV was shown to be 3.6%. The co-infection was more prevalent among HPV 16/18-infected samples than other high-risk HPVs (6.6% vs. 2.9%) although the difference was not reached a statistically significant difference (P=0.23). Our findings indicated that EBV could play an important role as a cofactor in the progression of cervical cancer. However, future studies with larger sample sizes and the expression analysis of EBV transcripts or proteins are mandatory.

Gastric-type glandular lesions of the female genital tract excluding the cervix: emerging pathological entities.

In the last two decades or so, a spectrum of benign, premalignant and malignant cervical glandular lesions exhibiting gastric differentiation has been described, with gastric-type adenocarcinoma representing the most common human papillomavirus (HPV)-independent cervical adenocarcinoma. More recently, limited literature has reported a variety of gastric-type glandular lesions at other sites within the female genital tract and, as in the cervix (the most common site for these lesions), a spectrum of benign, premalignant and malignant lesions has been proposed. We provide an update and review of the emerging spectrum of gastric-type glandular lesions at female genital tract sites other than the cervix. In the endometrium, putative gastric-type glandular lesions include mucinous metaplasia of gastric-type, atypical mucinous proliferation of gastric-type and gastric-type adenocarcinoma. Similarly in the vagina, gastric-type adenosis, atypical adenosis and adenocarcinoma have been described. There have also been occasional reports of gastric-type lesions involving the ovary and fallopian tube. We provide guidance on how to recognise gastric-type lesions morphologically and immunophenotypically and stress that sometimes these lesions occur at more than one site within the female genital tract (synchronous/multifocal gastric-type lesions of the female genital tract), sometimes in association with Peutz-Jeghers syndrome.

Colposcopic findings to study cervical changes in reproductive age group women using various contraceptives.

Colposcopy has a key role to play in see-and-treat programs for premalignant cervical lesions. The aim of the study/was to observe cervical changes with a colposcope using the Swede scoring system in fertile age group women using various contraceptives: conventional methods (barrier methods, coitus interruptus), oral contraceptives (OCPs), copper-T and bilateral tubectomy. The aim of the study was to observe and evaluate the colposcopic findings using the Swede scoring system for the diagnosis of premalignant/malignant lesions in reproductive age group women using various contraceptives. This was a prospective observational study, conducted among 200 women of reproductive age group using various contraceptives in a tertiary care institute in North India. PAP smear, direct visual examination, VIA (Visual Inspection with Acetic Acid) examination, colposcopic examination, and (biopsy if indicated) were done. The data were collected, and analysis was done using Microsoft Excel Office Software 2019 version 19.11 and epi info (CDC Atlanta) 7.23.1. Statistical analysis was done using percentages, mean, mode, median, standard deviation, Chi-square, Fisher's Test, and Anova Test. We found positive PAP (Papanicolaou test) smears in 61.50%, positive VIA examination in 9%, and positive findings in colposcopic examination in 28.50%, Swede score of 0-3 in 100% (0-91%, 1-2%, 2-6%, and 3-1%) and positive biopsy in 9% subjects. Malignant findings were observed in 1.00% of PAP smears. Colposcopic findings were CIN 1 (cervical intraepithelial neoplasia 1) in 8.5% and CIN 2 in 0.5% subjects. Swede score was zero in 91%, 1 in 2%, 2 in 6%, and 3 in 1% of subjects. HPE (histopathological examination) was chronic cervicitis in 8.50% and mild dysplasia/CIN 1 in 0.5%. No significant statistical associations between contraceptive choice and false-positive test results or disease prevalence was found in any group except Cu-T users p = 0.0184 (especially for CIN 2; p = 0.0109 and CIN 1 more in all groups than Cu-T users). Colposcopy had sensitivity 100%, specificity 91.46% (0/0 = 0%) PPV = 5.56%, NPV = 100%, Accuracy = 91.5% for detecting mild dysplasia/CIN-non-significant (p = 0.055). Our study had mainly low-grade lesions with 100% NPV. With increase in Swede Score, sensitivity increases but at the expense of specificity but it was statistically non-significant (p = 0.055). Our study may guide the rational use of colposcopy with Swede scoring for see-and-treat lesions, which is easy and with a low learning curve, as a tool for diagnosis but only in cases where indicated like unhealthy cervix because of the high rate of false-positive results. In low-grade lesions, it is highly useful to rule out the disease.

High Rate of Loss to Follow-Up Among Patients Undergoing Treatment for Premalignant Cervical Lesions at Mbarara Regional Referral Hospital, Southwestern Uganda: A Retrospective Cohort Study.

For a cervical cancer control program to be effective in reducing the incidence of the disease, there should be high compliance to treatment and follow-up of women diagnosed with precursor lesions. Screening programs in low-resource countries such as Uganda are challenged by poor adherenceto follow-up following treatment for premalignant cervical lesions. This study sought to describe the burden and factors associated with loss to follow-up among women undergoing treatment for premalignant cervical lesions at a tertiary hospital in southwestern Uganda. This was a retrospective cohort study. We reviewed the registers at the Mbarara Regional Referral Hospital (MRRH) cervical cancer clinic for a period of four years from January 2017 to December 2020. Data on age, district of residence, diagnosis, date of diagnosis, date and type of initial treatment, and date of follow-up visit were collected. We also captured data on whether patients returned on the scheduled follow-up date or within three months after the scheduled follow-up date. We defined loss to follow-up as failure to return for follow-up either on the scheduled date or within three months after the scheduled date. Out of the 298 patients who underwent treatment for premalignant cervical lesions in the study period, 227 (76.2%) did not return for follow-up at one year. At bivariate analysis, failure to attend the review visit at six weeks predicted the loss to follow-up at one year following treatment for premalignant lesions almost perfectly (risk ratio (RR)=2.84, 95% confidence interval (CI): 2.18-3.71, p<0.001). Negative HIV serostatus and receiving thermocoagulation slightly increased the risk of getting lost to follow-up, while being more than 45 years old reduced the odds.At multivariate analysis, treatment with thermocoagulation (adjusted risk ratio (aRR)=1.21, 95% CI: 1.07-1.36, p=0.03) was associated with loss to follow-up at one year. The proportion of women who did not return for follow-up at one year following treatment for premalignant cervical lesions at Mbarara Regional Referral Hospital is very high. There is a need to implement strategies such as telephone-aided reminders to prompt patients to return for follow-up following treatment for premalignant cervical lesions.

Potential diagnostic value of quantitative superb microvascular imaging in premalignant and malignant cervical lesions.

The purpose of this study was to assess the diagnostic efficacy of the vascular index (VI) on superb microvascular imaging (SMI) in distinguishing normal uterine cervical epithelium, high-grade cervical intraepithelial neoplasia (CIN), and cervical cancer. The retrospective study included women with pathology-confirmed CIN or cervical cancer, who underwent transvaginal ultrasound and SMI between April 2021 and October 2022. The SIM manifestations of normal cervix and cervical lesions were reviewed. SIM were measured and converted into vascular index (VI) which compared between cervical lesions and control groups. We have retrospectively compared ultrasound features of cervical lesions and characteristics of patients. Measurement reliability was evaluated by intra class correlation coefficient (ICC). A total of 235 consecutive females were enrolled, comprising 38 with high-grade CIN, 96 with cervical cancer, and 101 with a normal uterine cervix. The microvascular architecture exhibited significant variations between premalignant and malignant cervical lesions. Branch-like patterns were predominantly observed in high-grade CIN, while crab claw-like and fireball-like patterns were more commonly associated with cervical cancer. The median VI of cervical cancer (34.7 ± 10.3) was significantly higher than that of high-grade CIN (17.6 ± 4.2) (P < 0.001). Moreover, the VI values of cervical cancer differed significantly among different FIGO stages and pathological types (P < 0.001 and P = 0.003, respectively). The VI demonstrated superior diagnostic performance for cervical lesions compared to vascular patterns (AUC = 0.974 and 0.969, respectively). Using a cut-off value of 25.5, the VI yielded a sensitivity of 82.3% and a specificity of 99.3% for cervical lesion detection. The SMI parameter (VI) exhibited a significantly higher value in cervical cancer compared to high-grade CIN, with a high level of agreement among observers. These findings suggest that quantitative SMI holds promise as an imaging technique for the detection and characterization of cervical lesions.

Identification of cervical cancer stem cells using single-cell transcriptomes of normal cervix, cervical premalignant lesions, and cervical cancer.

Cervical cancer is the fourth leading cause of mortality among gynecological malignancies. However, the identification of cervical cancer stem cells remains unclear. We performed single-cell mRNA sequencing on ∼122,400cells from 20 cervical biopsies, including 5 healthy controls, 4 high-grade intraepithelial neoplasias, 5 microinvasive carcinomas of the cervix, and 6 invasive cervical squamous carcinomas. Bioinformatic results were validated by multiplex immunohistochemistry (mIHC) in cervical cancer tissue microarrays (TMA) (n=85). We identified cervical cancer stem cells and highlighted the functional changes in cervical stem cells during malignant transformation. The original non-malignant stem cell properties (characterized by high proliferation) gradually diminished, whereas the tumor stem cell properties (characterized by epithelial-mesenchymal transformation and invasion) were enhanced. The mIHC results of our TMA cohort confirmed the existence of stem-like cells and indicated that cluster correlated with neoplastic recurrence. Subsequently, we investigated malignant and immune cell heterogeneity in the cervical multicellular ecosystem across different disease stages. We observed global upregulation of interferon responses in the cervical microenvironment during lesion progression. Our results provide more insights into cervical premalignant and malignant lesion microenvironments. This research was supported by the Guangdong Provincial Natural Science Foundation of China (2023A1515010382), Grant 2021YFC2700603 from the National Key Research & Development Program of China and the Hubei Provincial Natural Science Foundation of China (2022CFB174 and 2022CFB893).

A STUDY OF CERVICAL LESIONS IN CORRELATION WITH HUMAN PAPILLOMAVIRUS ANALYSIS BY IMMUNOHISTOCHEMICAL ASSAY

Background: It has become clear that human papillomavirus (HPV) plays a critical role in the pathogenesis of nearly all cervical squamous cell carcinomas. Because HPV causes a variety of cervix lesions, including benign, premalignant, and malignant lesions, early detection of this infection benefits the patient. Objective: The goal of this study is to identify neoplastic and non-neoplastic cervix lesions, to study neoplastic and non-neoplastic cervix lesions caused by HPV in correlation with HPV analysis by immunohistochemistry (IHC), and to understand the significance of HPV in screening cervical lesions. Methods: The current study evaluated and compared HPV cocktail expression in 100 samples collected from 100 cases with cervical lesions. A semi-quantitative method was used to determine the positivity of the HPV cocktail. Comparison of expression of HPV cocktail IHC and histopathology was carried out. Results: Of the 100 cases, 30 were carcinoma cervix (CC), 4 were carcinoma in situ (CIS), 22 were squamous intraepithelial lesions (SIL), 20 were chronic cervicitis, 16 were chronic cervicitis with Koilocytic change, 7 were Koilocytic change, and 1 was Inflammatory polyp. SIL and CIS have a mean age of 46.8 and 44.5 years, respectively. There was a 42% incidence of carcinoma cases seen in the fourth decade, with a mean age of 45.9 years. The most common complaint presented by CC patients is AUB, with postmenopausal bleeding being the most common complaint. Seven patients with Squamous cell carcinoma present with postmenopausal bleeding. There were neoplastic lesions in 56% of the cases and non-neoplastic lesions in 44% of the cases. Premalignant cervix lesions include low grade squamous intra epithelial lesion, high grade squamous intra epithelial lesion, and CIS, which account for 46.42% of all cases. Non-neoplastic lesions such as chronic cervicitis account for 45.55% of all cases, followed by chronic cervicitis with Koilocytic change (36.36%), Koilocytic change (15.91%), and Polyp (2.27%). There were 28 Squamous cell carcinomas and 2 Adenocarcinomas among the 30 cases of CC. Squamous cell carcinoma accounted for 93.33% of all cases, while adenocarcinoma accounted for 6.67%. Moderately differentiated squamous cell carcinomas account for 86.66% of the cases, followed by well differentiated squamous cell carcinomas and poorly differentiated squamous cell carcinomas, which account for 6.66% of the cases. 26 (86.6%) of 30 squamous cell carcinomas tested positive for IHC. All two Adenocarcinoma cases (100%) and all CIS cases (100%) were positive. Out of the 22 SIL cases, 18 (81.81%) were positive. Out of 16 cases of chronic cervicitis with Koilocytic change, 14 (87.5%) were positive. Out of 20 chronic cervicitis cases, 12 (60%) were positive. 5 (71.43%) of the 7 cases of Koilocytic change were positive. Cervical lesions (benign, premalignant, and malignant) have a significant correlation with HPV cocktail IHC (p=0.01). Conclusion: The expression of the HPV cocktail was associated with clinical and histopathologic parameters in benign, premalignant, and malignant cervical lesions. Periodic follow-up allows patients to be better managed by providing vital data on the incidence of HPV infection in various cervical lesions. Low-grade SILs and high-grade SILs with HPV +ve infection can be monitored by HPV once a year instead of every 6 months. Patients over the age of 30 years with HPV-positive non-neoplastic cervical lesions can be monitored once every three years rather than annually. HPV is a biomarker for a better prognosis in cervical cancer, regardless of age, International Federation of Obstetricians and Gynecologists stage, or histologic type. HPV-positive tumors have a better prognosis.

Abstract 1978: Community Genomic Health Promotion Program evaluates precision DNA methylation biomarkers for use in self-testing and collection kits in urine, to increase cervical cancer screening rates among Latina women

Abstract Cervical cancer incidence is 32% higher among Latina women in the United States (US) and 78% higher among women in Puerto Rico compared to non-Latina White (NLW) women, yet it is largely preventable through screening. Latina women with public insurance or uninsured are significantly less likely to have had a Pap test, undergo fewer Pap and high-Risk Human Papilloma Virus (HPV) testing than NLW and Black women, and are less likely than women of other races/ethnicities to return for recommended follow-up after an abnormal Pap test. Utilizing the PRECEDE-PROCEED model, Community Based Participatory Research strategies and the NIH I-Corps hypothesis-driven research method of customer discovery, we implemented the Community Genomic Health Promotion Program in Federally Qualified Health Centers to evaluate cervical cancer screening needs in six rural municipalities in Puerto Rico. We recently validated in clinical liquid cytology samples that the CervicalMethDx test, a precision DNA methylation test, can identify HPV positive women most likely to be diagnosed with Cervical Intraepithelial Neoplasia (CIN) grades 2 and 3. We hypothesized that a molecular pathology test which identifies advanced premalignant cervical lesions in urine, can be distributed by commercial channels targeting populations with low screening rates. The CervicalMethDx quantitative Methylation Specific PCR (qMSP) test was used to quantify ZNF516, FKBP6 and INTS1 promoter DNA methylation in well-characterized, discarded, liquid cytology clinical samples from Puerto Rico. We then tested the CervicalMethDx test concordance on paired cytobrush (n=82) and urine samples (n=82) from Chile. The CervicalMethDx test correctly classified 86% of discarded liquid cytology clinical samples from HPV-positive women, when comparing DNA methylation in CIN2/CIN3 samples (n=47) to samples with a cervical pathology diagnosis of No Intraepithelial Lesions or Malignancy (n=18), with 83% Sensitivity, 94% Specificity, Area Under the Curve (AUC) of 0.88, and 98% positive predictive value (PPV). The concordance of the CervicalMethDx test in paired brush and urine samples was moderate (rho=0.45). The Wilcoxon signed-rank test showed no statistically significant differences for the CervicalMethDx test in paired brush and urine samples (p=0.14) These encouraging preliminary results show the successful identification of advanced premalignant cervical lesions in liquid cytology media and urine samples from Latina women. The data suggests that urine should be explored as a biofluid for cervical cancer screening. Future research may lead to expanded screening options, enabling women with low access to health care (public insurance or uninsured) to collect a specimen at home, and either send it to a testing facility or perform the test at home. Citation Format: Carmen Ili, Priscilla Brebi, Jaime López, Fernando T. Zamunér, Ana Purcell-Wiltz, Amanda García-Negrón, Keilyn Vale-Lassalle, Keerthana Gosala, Mirla Otero-García, Camila Rivero-Maldonado, Teresa Torres-Rivera, Adriana Pérez-Vicente, Ashley Ramos-López, David Sidransky, Mariana Brait, Rafael E. Guerrero-Preston. Community Genomic Health Promotion Program evaluates precision DNA methylation biomarkers for use in self-testing and collection kits in urine, to increase cervical cancer screening rates among Latina women [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 1978.

MORPHOMETRIC ANALYSIS OF PAP SMEARS AND CERVICAL BIOPSIES.

Background: In women malignant lesions of the cervix are the most frequent cause of mortality and morbidity and cervical cancer is the third most common cause of cancer deaths worldwide.Cervical cancer incidence is progressively reducing due to the routine use of Pap smears and cervical biopsy. Aim of the study is to use Image Morphometric Software in order to create macro-images to analyze a large number of cells at a given time. A one Methods: year retrospective study was conducted in the Department of Pathology, Dr PSIMS &amp; RF and data pertaining to all pap smears and their corresponding biopsies were reviewed. Each case was analysed with respect to age, and symptoms of the patient. A total of 30 patients aged bet Results: ween 35 and 70 years for whom both cervical biopsy and pap smears were done were studied over a period of 1 year. Based on Age, Symptoms, both pap smears and cervical biopsies were taken and studied . Among the biopsies studied 60% were diagnosed as Chronic Cervicitis aged between 35 to 45 years, distribution of lesions include : Endocervical Polyp (20%) aged between 45 to 50 years, Moderate Dysplasia (10%) aged between 55 to 60 years, Moderately differentiated Squamous Cell Carcinoma (10%) aged between 60 to 70 years. Among pap smears 60% inammatory smears, 20% polypoidal endocervicitis, 10% ASCUS, 10% LSIL. Testing cervical epithelium by Pap smear is a very si Conclusion: mple useful, economical and safe tool for early detection of premalignant and malignant cervical lesions. Gold standard is histopathological examination. The correlation studies are very important tools that can be used in the quality assurance of cytology laboratories.

The Correlation of Papanicolaou Smears and Clinical Features to Identify the Common Risk Factors for Cervical Cancer: A Retrospective and Descriptive Study from a Tertiary Care Hospital in Trinidad.

Background: Cervical cancer, the fourth most frequent cancer in women, is associated with the human papillomavirus (HPV). This study identifies risk factors and clinical findings for abnormal cervical cytology and histopathology in the Trinidad and Tobago populations. Some risk factors include early age of first coitus, a high number of sexual partners, high parity, smoking, and using certain medications, such as oral contraception. This study aims to identify the significance of Papanicolaou (pap) smears and the common risk factors that contribute to the development of premalignant and malignant cervical lesions. Method: A three-year retrospective, descriptive study of cervical cancer was conducted at the Eric Williams Medical Sciences Complex. The subject population included 215 female patients aged 18 years and older with the following documented abnormal cervical cytology: (ASCUS), ASC-H, LSIL, HSIL, Atypical Glandular cells, HPV, Adenocarcinoma, and Invasive Squamous Cell Carcinoma. Histopathology records were analysed for thirty-three of these patients. Patients' information was recorded on data collection sheets adapted from the North Central Regional Health Authority's cytology laboratory standardised reporting format request form. Results and Findings: The data were analysed via Statistical Package for Social Sciences (SPSS) software edition 23 using frequency tables and descriptive analysis. The mean sample age of the population was 36.7 years, the first age of coitus was 18.1 years, the number of sexual partners was 3.8, and the number of live births was 2. LSIL was the most popular abnormal finding, 32.6%, followed by HSIL, 28.8%, and ASCUS, 27.4%. Most histopathological reports resulted in CIN I and II. Conclusions: The significant risk factors observed for cytology abnormalities and premalignant lesions were early age of coitus, a high number of sexual partners, and no use of contraception. Patients mostly presented as asymptomatic despite obtaining abnormal cytology results. Hence, regular pap smear screening should continue to be highly encouraged.

Economic burden of cervical cancer and premalignant lesions associated with human papilloma virus: a societal perspective

ABSTRACT Background Cervical cancer is one of the most common cancers in women, the cause of which is mostly human papilloma virus (HPV). The aim of this study was to determine the economic burden of cervical cancer and premalignant lesions associated with HPV infection from a societal perspective. Methods The study is a partial economic evaluation (cost of illness), which was conducted cross-sectionally in the referral university clinic in Fars province in 2021. The prevalence-based and bottom-up approaches used to calculate the costs, the indirect costs were calculated by human capital approach. Results The mean cost of premalignant lesions associated with HPV infection was USD 2,853 per patient, which 68.57% was direct medical costs. In addition, the mean cost of cervical cancer was USD 39,327 per patient, the largest share of which (57.9%) was related to indirect costs. The mean annual cost of cervical cancer patients in the country was estimated at USD 40,884,609 as well. Conclusion Cervical cancer and premalignant lesions associated with HPV infection imposed a significant economic burden on the health system and patients. The results of the present study can help health policymakers with efficient and equitable prioritization and allocation of resources.

Knowledge, Attitude and Practice on Cervical Cancer Screening Among Female Reproductive Health Clients in Zewditu Memorial Hospital, Addis Ababa, Ethiopia

<i>Background: </i>Cervical cancer is the most common gynaecologic malignancy among women. In general, poor level of awareness, lack of effective screening program, overshadowed by other health concerns (such as AIDS, TB, cardiovascular and mental health), and lack of attentiveness to women’s health are a few of the possible factors for the noticed higher incidence rate of cervical cancer in Ethiopia.<i> Objective: </i>To assess the level of knowledge, attitude, and practice on cervical cancer screening among reproductive health clients aged 18-49 of Zewditu Memorial Hospital, Addis Ababa, Ethiopia. <i>Methods:</i> The study design was a cross-sectional descriptive study, conducted on 237 women who were enrolled with a simple random sampling method from March to October 2020. A structured pretested questionnaire was carried out to gather data and the collected data were entered into SPSS version 23 for analysis. Descriptive analysis using frequency, percentages, mean, and SD with bivariate analysis and multiple regressions was done. <i>Result: </i>About three-quarters (75.1%) of the participants heard about cervical cancer and out of the total participants 59% of them were found to have adequate knowledge, 58.2% with a positive attitude, and 51% of the participants were screened for cervical cancer. Lack of information about cervical cancer was the most reported reason for not attending cervical cancer screening. <i>Conclusion and recommendation:</i> The study showed more than half of the respondents had adequate knowledge, attitude, and practice on cervical cancer and screening for a premalignant cervical lesion. But still, there is a need to promote cervical cancer screening among women by informing them on their susceptibility to cervical cancer and encouraging a belief that active and regular screening can detect cervical cancer at the precancerous stage, hence enabling the early treatment and prevention of cancer development.

Prevention Strategies and Early Diagnosis of Cervical Cancer: Current State and Prospects.

Cervical cancer ranks third among all new cancer cases and causes of cancer deaths in females. The paper provides an overview of cervical cancer prevention strategies employed in different regions, with incidence and mortality rates ranging from high to low. It assesses the effectiveness of approaches proposed by national healthcare systems by analysing data published in the National Library of Medicine (Pubmed) since 2018 featuring the following keywords: "cervical cancer prevention", "cervical cancer screening", "barriers to cervical cancer prevention", "premalignant cervical lesions" and "current strategies". WHO's 90-70-90 global strategy for cervical cancer prevention and early screening has proven effective in different countries in both mathematical models and clinical practice. The data analysis carried out within this study identified promising approaches to cervical cancer screening and prevention, which can further enhance the effectiveness of the existing WHO strategy and national healthcare systems. One such approach is the application of AI technologies for detecting precancerous cervical lesions and choosing treatment strategies. As such studies show, the use of AI can not only increase detection accuracy but also ease the burden on primary care.

Prevalence of premalignant cervical lesions among women in community-based screening program using visual inspection with acetic acid in Metro Manila

BACKGROUND: Cervical cancer remains a health-care burden in our country. Majority of women afflicted with this cancer are diagnosed in advanced stage. Several groups like the Philippine Society for Cervical Pathology and Colposcopy (PSCPC) have put forth efforts to decrease and eventually eliminate cervical cancer through improvement in level of awareness on the disease and community-based cervical cancer screening programs using visual inspection using acetic acid (VIA). Data on the prevalence of premalignant lesions using this screening method are limited in our country. Thus, the initiative of the society (PSCPC) to embark on this study.OBJECTIVE: The objective of this study was to determine the prevalence of premalignant cervical lesions among women screened in community-based screening program using VIA in Metro Manila.METHODOLOGY: A retrospective cross-sectional study with collection of data from medical records of cervical screening programs done by the PSCPC from March 2017 to December 2019 was done. VIA was done for screening. All VIA-positive women underwent colposcopy and those with abnormal findings had colposcopically guided cervical punch biopsy.RESULTS: A total of 1072 women were screened with a positivity rate of 14.6%. One hundred and fifty-six women were VIA positive and 79 of these women underwent colposcopically guided biopsy. Premalignant cervical lesions were seen in 21 women. The prevalence rate of premalignant cervical lesions in VIA-positive women was 13.5%. The prevalence of premalignant cervical lesions among all women screened was 2%. Risk factors associated with premalignant lesions were early coitarche and smoking.CONCLUSION: The prevalence of premalignant cervical lesions among women who underwent community-based cervical cancer screening using VIA is lower compared to other studies at 2%.

Determining the relationship between serum acute phase reactants and cervical premalignant lesions: a cohort study.

Acute phase reactants play a role in the progression and prognosis of many malignant and premalignant tumors. This study investigated the diagnostic value of certain reactants as markers for cervical premalignant lesions. Despite advanced screening and vaccination programs, cervical cancer remains a serious health problem worldwide. We aimed to determine the possible relationship between premalignant cervical disease and serum acute phase reactant levels. This study included 124 volunteers who underwent cervical cancer screening. We divided the patients into three groups according to cervical cytology and histopathological findings as follows: no cervical lesion, low-grade neoplasia, or high-grade neoplasia. We included women aged 25-65 years with benign smear or colposcopy results, low- and high-grade squamous intraepithelial lesions. The benign group was based only on cytology findings, whereas the other groups were based on histopathology findings. Demographic data and serum albumin, fibrinogen, ferritin, and procalcitonin levels were evaluated in the three groups. We found significant differences among the three groups in terms of age, albumin level, albumin/fibrinogen ratio, and procalcitonin level. The regression analysis revealed lower serum albumin levels in the low- and high-grade squamous intraepithelial lesion groups compared with the benign group. This is the first study to evaluate the importance of serum inflammatory markers in cervical intraepithelial lesions. Our results indicate that serum albumin level, albumin/fibrinogen ratio, procalcitonin level, and neutrophil values differ among cervical intraepithelial lesions.

Prognostic Value of Endocervical Curettage at the Time of Colposcopic Assessment of the Uterine Cervix: Cross-Sectional Analytical Research

Objective: This study aimed to investigate the necessity and diagnostic value of endocervical curettage (ECC) in cervical preneoplastic and neoplastic lesions. Material and Methods: A total of 296 patients who were admitted to the gynecologic oncology outpatient clinic at a single tertiary care center and who simultaneously underwent colposcopic biopsy and ECC between 2018 and 2020 were included in the study. Hematoxylin-Eosin (H&E), p16, and ki-67-stained preparations obtained from biopsy and curettage samples of the patients were analyzed by light microscope. Demographic data of the patients were obtained from the hospital system. Results were statistically and comparatively analyzed. Results: Cervical premalignant/malignant lesion was detected in 125 out of 296 patients and premalignant/malignant lesion was detected in 42 patients on ECC. Out of these 42 patients, 19 were diagnosed by ECC material alone. It was striking that all of the 5 HPV-18- positive patients were diagnosed with ECC material. When conization materials of CIN 2-3 patients were assessed with ECC results, it was observed that adenocarcinoma and glandular involvement were remarkably significant in ECC-positive patients. Conclusion: Our study involves important findings in the determination of the role of ECC in diagnosing cervical premalignant lesions. ECC simultaneously performed with colposcopic biopsy for appropriate women increases the diagnosticity of colposcopic biopsy procedure and gives information about glandular involvement. Moreover, it can decrease the risk of recurrence and minimize surgical margins.

Cytological characteristics of premalignant cervical epithelial lesions in postmenopausal women based on endocrine indices and parakeratosis.

To identify useful cytological findings for detecting premalignant lesions in postmenopausal women, cervicovaginal smear samples were analyzed and compared between women with or without premalignant lesions based on endocrine indices and presence of parakeratosis (PK). The cervicovaginal smear samples of postmenopausal women with premalignant lesions (n = 94) and those who were without (n = 344), who were diagnosed between 2012 and 2014 were retrieved and analyzed. Women cytologically diagnosed with malignancy or those with suspicion of malignancy were excluded from this study. Cytological endocrine indices, such as the maturation index (MI) and eosinophilic index (EI) and the prevalence of PK were compared between the groups and analyzed using the 2 × 2 χ2 test. The association of endocrine indices combined with the presence of PK and histological findings was also evaluated. Postmenopausal women with premalignant lesions had higher endocrine indices (EI of ≥11%; 65% vs. 43%, P < 0.01, f = 0.18) and a higher prevalence of PK positivity (PK ≥ 1; 46% vs. 7%, P < 0.01, f = 0.44) than those without lesions. Further analysis indicated that the combination of high EI and the presence of PK in postmenopausal women with cytological premalignant cases was highly associated with histological squamous intraepithelial lesions (SIL) (86% in women with premalignant lesions vs. 53% in those without; P = 0.01, f = 0.34). Our research demonstrated that high EI and PK positivity were correlated with SIL in postmenopausal women. These cytological findings could provide potential diagnostic clues for detecting dysplasia.

Comparison of Visual Inspection Methods Using Either Acetic Acid Solution or Lugol’s Iodine Solution with Colposcopy in Screening of Cervical Cancer: A Cross Sectional Study

Background & Objective: We compared two different methods of visual inspection of the cervix, including Visual inspection of the cervix with acetic acid (VIA) and Visual inspection of the cervix with Lugol's iodine (VILI) in terms of sensitivity and specificity in diagnosis of pre-malignant cervical lesions in comparison to colposcopy guided biopsy.Materials & Methods: In this cross-sectional study, a total number of 200 women who were referred to the colposcopy clinic of Arash women’s hospital (Tehran, Iran) for cervical cancer screening, underwent VIA, VILI, and colposcopy guided biopsy during 2018-2019.Results: The calculated sensitivity and specificity of VIA and VILI in this population were (100% and 69.5%) and (100% and 60%), respectively, whereas the sensitivity and specificity of both VIA and VILI tests in combination were 100% and 77.2%. The positive and negative predictive values were 32.7% and 100%, respectively, when combined form of VIA and VILI was applied in this population.Conclusion: VIA and VILI alone or in combination could be used as screening tests to evaluate the presence of cervical cancer and in case of positive results, supplementary tests such as colposcopy guided biopsy could be performed for definite diagnosis.

Frequency of cervical premalignant lesions in the gynecologic patients of a tertiary hospital in Mogadishu, Somalia

BackgroundCervical cancer is the fourth most common cancer worldwide and is the most frequently diagnosed cancer in 23 countries and the most common cause of death in 36 countries, mostly from Sub-Saharan African countries. Cervical screening is a key element to reduce the incidence and mortality of cervical cancer. Cancer screening is low in Sub-Saharan Africa. This study aims to provide information about cervical premalignant lesions frequency in Somalia.MethodsThe pathology results of cervicovaginal smear samples obtained from patients aged 25–65 years who applied to the gynecology outpatient clinic between October 5 and December 5, 2021 were analyzed retrospectively. SPSS 22.0 was used for the statistical analysis of the data.ResultAmong the 497 results, 63 premalignant lesions were detected. The rate of premalignant lesions (63/497) was found to be 12.3%. The most common premalignant lesion was atypical squamous cells of undetermined significance (ASC-US).ConclusionIn this study, the frequency of cervical premalignant lesions in Somalia was found to be higher than in the literature. Vaccination, screening, and early diagnosis are the most important components in the fight against cervical cancer. Access to vaccination, screening, and early diagnosis, which are the most important components in the fight against cervical cancer in Somalia, will be possible with the cooperation of the national health system and international organizations.