Screening Of Cervical Lesions Research Articles

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.

Overview of organisational methods of primary cervical lesion screening programmes that use human papillomavirus testing.

Many factors need to be considered when planning and managing a screening programme for the early detection of cervical cancer (CC). A non-systematic international review of the organisation of CC screening using high-risk human papillomavirus (HPV-HR) testing, aimed at identifying the organisational methods of these programmes, was conducted with a view to supporting the future of the French system in the context of the transition to HPV-HR testing. In countries where HPV testing has been implemented or planned, the initial reflection process has provided an opportunity to rethink the previous (cytological) screening organisation. Despite considerable differences between countries, a nationally or regionally centralised organisational model appears to be the preferred option in most countries. This model is based on a national/regional structure tasked with all invitations, reminders, follow-up and coordination, centralised laboratories integrating both biology and pathology laboratories, and a unified information system integrated with routine health management tools used by health practitioners and nurses. Besides quality considerations, grouped purchasing makes it possible to implement a public procurement policy that includes price negotiations with suppliers. Discussions around the introduction of HPV testing have resulted in most countries reviewing or creating information systems and quality assurance processes. While the WHO seems to recommend the systematic use of vaginal self-sampling, very few countries have considered this option. More and more countries are planning to implement vaginal self-sampling, but no clear organisational model has emerged from the countries where it has been implemented to date.

HMGB3 is a potential diagnostic marker for early cervical lesion screening

HMGB3 is a potential diagnostic marker for early cervical lesion screening

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.

Association of MicroRNA-10b Expression and P16 with Pathological Features in Various Stages of Cervical Precancerous Lesions.

Cervical cancer is the fourth most prevalent cancer for females with 14,100 new cases each year globally. Efficient screening and intervention at the precancerous stage is the key point to the prevention and treatment of cervical cancer. However, no widely recognized biomarkers have been discovered yet. We investigated the expression of miR-10b in cervical cells and its correlation with clinicopathological features in different pathological grades of cervical precancerous lesions. The expression of miR-10b in cervical cytology samples from 20 cases of LSIL, 22 cases of HSIL, 18 cases of early-stage cervical cancer, and 20 cases of cervicitis controls were assessed using qPCR. From the same cervical cytology samples, the human papillomavirus (HPV) load was assessed using semi-PCR and the lesion size, and gland involvement levels from the same subjects were assessed during the cervical examination. The correlation between miR-10b expression and different pathological grades of cervical lesions was analyzed. We also calculated the correlation between HPV load, lesion size, gland involvement, P16 expression, and different pathological grades. The expression of miR-10b exhibited a step-decreasing manner from cervicitis control (4.23(4.00,4.71)) to LSIL (2.67(2.52,2.90)), HSIL (1.49(1.30,1.80)) and cervical cancer group (0.65(0.55,0.80)). There is a significant difference (P<0.001) between cervicitis and HSIL, cervicitis and cervical cancer, ISIL and HSIL, as well as ISIL and cervical cancer but not between the cervicitis group and the LSIL group. In addition, more severe pathological grades were correlated with a bigger rate of gland involvement (P＜0.001). We also found that different pathological grades were correlated with the intensity of P16 expression (P=0.001), and the intensity of P16 expression is positively correlated with different pathological grades (P<0.05). Repressed expression of miR-10b is related to the progression of cervical precancerous lesions. Increased gland involvement rate and increased intensity of P16 expression are risk factors for developing cervical cancers. Our result showed that miR-10b may be a potential biomarker for the screening and ranking of cervical precancerous lesions.

Mass screening for cervical cancer using visual inspection methods with acetic acid and lugol: Experience from three campaigns in Senegal

Objectives: To take stock of 3 mass screening campaigns for cervical cancer by visual inspection methods using acetic acid and lugol. Material and Methods: This was a cross-sectional study carried out during the year 2013. It concerned 3 “fairground” campaigns of systematic mass screening by visual inspection methods using acetic acid (VIA) and at Lugol (IVL). The information was collected on a survey sheet containing the following parameters: patient characteristics, level of information on cervical cancer, clinical, paraclinical and therapeutic data. Data was captured and analyzed by SPSS software version 13.0. The statistical method used was the chi-square test with a significance level set at 5%. Results: During the study period, 311 patients participated in the survey and received systematic screening for precancerous cervical lesions by visual inspection methods with acetic acid and lugol. The patients were on average 41 years old, married (67.2%) with an average parity of 3 and never had a Pap smear screening (87.8%). Most of them (60.5%) had heard of cervical cancer from the media. The majority of patients (87.1%) had no knowledge of ways to prevent cervical cancer. Systematic screening for precancerous cervical lesions was most often performed by midwives (57.2%). It made it possible to find 44 positive IVAs (14.1%) and 75 positive IVLs (24.1%). Conclusion: Visual inspection methods with acetic acid and lugol, easily performed, inexpensive and with immediate results seem to be a reliable alternative to the cervico-uterine smear to effectively and on a larger scale detect precancerous lesions of the cervix.

Screening for Precancerous Cervical Lesions in Women of Reproductive Age in the Kara Region of Togo in 2022

Screening for Precancerous Cervical Lesions in Women of Reproductive Age in the Kara Region of Togo in 2022

Automated Segmentation of Cervical Cell Images Using IMBMDCR-Net

Early screening of cervical lesions is of great significance in pathological diagnosis. Owing to the complexity of cell morphological changes and the limitations of medical images, accurate segmentation of cervical cells is still a challenging task. In this paper, an isomorphic multi-branch modulation deformable convolution residual model is proposed to extract features for enhancing the segmentation of small cells and overlapping cytoplasmic boundaries. Then the regional feature extraction, boundary box recognition, and adding a single pixel-level mask at the last level are integrated and optimized based on the cascade regional convolution neural network (Cascade R-CNN) to complete the segmentation of cervical cells for getting better accuracy. The proposed framework was evaluated on the ISBI2014 cervical cell segmentation competition public dataset. Experimental results show that the average accuracy of the network model in cervical cell segmentation is 81.1%, and the accuracy of small targets is 77%. To some extent, it can assist pathologists in screening cervical cancer in the early phase.

Cytohistopathological Correlation of 884 Cervical Pap Smears as Bethesda System 2014: A Hospital-Based Study

Cervical carcinoma is most common in Indian women of which Rural women are predominantly affected. The most common etiological factor is human papillomavirus (HPV ). The present study aims to assess the diagnostic accuracy, sensitivity, specificity, and different patterns of cervical Pap smears by comparing histological findings. The index study is a retrospective cross-sectional analytical study. The data was collected at the pathology department from May 2017 to December 2019 according to hospital ethical protocol. Cervical Pap smears received by the pathology department underwent Pap staining. A total of 884 Pap smears were satisfactory and included in the study. The age of enrolled women was 46.4 ± 9.7 years. 800 cervical Pap smears were reported as negative for intraepithelial lesion (NILM), and 84 Pap smears were reported as abnormal. Abnormal pap smears included 64 (7.1%) atypical squamous cell-undetermined significance (ASC-US), 9 (1.01%) low-grade squamous intraepithelial (LSIL), 5 (0.56%) high-grade squamous intraepithelial lesion cannot be ruled out (ASC-H), 3 cases (0.33%) of high grade squamous intraepithelial lesion (HSIL), 2 cases (0.22%) of atypical glandular cell-not specific otherwise (AGC-NOS) and 1 case (0.11%) of squamous cell carcinoma. The cytohistological correlation was found in 56 patients, including 41.07% with chronic cervicitis, 26.75% with chronic cervicitis with squamous metaplasia, 5.35% with cervical polyps, 3.57% with CIN-1, 14.28% with carcinoma in situ, 7.14% with squamous cell carcinoma (keratinizing), 1.78% with squamous cell carcinoma (non-keratinizing) patients. Cytohistological correlation of 56 cases revealed sensitivity (83.33%), specificity (94.73%), PPV (88.23%), NPV (92.3%) and accuracy (91.07%). The cervical Pap test is cost-effective, almost as sensitive, and accurate as histology in screening for cervical lesions.

Diagnosis of Cervical Cancer and Pre-Cancerous Lesions by Artificial Intelligence: A Systematic Review.

The likelihood of timely treatment for cervical cancer increases with timely detection of abnormal cervical cells. Automated methods of detecting abnormal cervical cells were established because manual identification requires skilled pathologists and is time consuming and prone to error. The purpose of this systematic review is to evaluate the diagnostic performance of artificial intelligence (AI) technologies for the prediction, screening, and diagnosis of cervical cancer and pre-cancerous lesions. Comprehensive searches were performed on three databases: Medline, Web of Science Core Collection (Indexes = SCI-EXPANDED, SSCI, A & HCI Timespan) and Scopus to find papers published until July 2022. Articles that applied any AI technique for the prediction, screening, and diagnosis of cervical cancer were included in the review. No time restriction was applied. Articles were searched, screened, incorporated, and analyzed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. The primary search yielded 2538 articles. After screening and evaluation of eligibility, 117 studies were incorporated in the review. AI techniques were found to play a significant role in screening systems for pre-cancerous and cancerous cervical lesions. The accuracy of the algorithms in predicting cervical cancer varied from 70% to 100%. AI techniques make a distinction between cancerous and normal Pap smears with 80-100% accuracy. AI is expected to serve as a practical tool for doctors in making accurate clinical diagnoses. The reported sensitivity and specificity of AI in colposcopy for the detection of CIN2+ were 71.9-98.22% and 51.8-96.2%, respectively. The present review highlights the acceptable performance of AI systems in the prediction, screening, or detection of cervical cancer and pre-cancerous lesions, especially when faced with a paucity of specialized centers or medical resources. In combination with human evaluation, AI could serve as a helpful tool in the interpretation of cervical smears or images.

Spectrum of cervical cancer among women screened for cervical cancer in Nakuru County Referral Hospital Laboratory, Kenya

Abstract Introduction/Objective Cervical cancer is the leading cause of cancer-related deaths in Kenya and the second most common cancer among females. However, the prevalence of this type of cancer at Nakuru county is not known. We sought to establish the spectrum of this cancer among women who were attended at Nakuru county referral Hospital between 2015-2019. Methods/Case Report A retrospective descriptive cross-sectional study was carried out among women screened for cervical cancer between January 2015 and December 2019. One thousand and thirty-one (1031) records were retrieved. Data extracted were analyzed using SPSS version 21. Approval to conduct the study was obtained from the hospital institutional review board; Results (if a Case Study enter NA) Among the 1,031 women whose records were reviewed, 81 (7.9%) had lesions, while 950 (92.1%) had no lesions. Results for pre-cancerous and cancerous according to age group were as follows: 15 – 25 years (3.4%), 26 – 35 (6.3%), 36 – 45 (10.1%), 46 – 55 (5.2%), 56 – 65 (8.9%), 66 – 75 (15.1%), 76 years and above (4.5%). Those who had HSIL were 4.9%, LSIL 2.3%, ASC-H 0.4% and ISCC 0.2% respectively. Conclusion The percentage for pre-cancerous and Cancerous lesions of women of younger age group between 15–25 years was low at 3.4% while percentage for older age group for pre-cancerous and Cancerous lesions was at 10.1%, 8.9% and 5.2% respectively. This necessitates the need for increased campaigns for cytology screening for cervical lesions. This would reduce morbidity and mortality associated with cancer of the cervix.

Relationships Between HPV Infection and Cervical Lesions in Women from Southwest China

Objective: To analyze the infection status of human papillomavirus (HPV) in women from Southwest China and explore the correlation between different subtypes of HPV infection, the degree of cervical lesions and the age of patients, to provide reference for the early diagnosis and prevention of cervical cancer. Methods: The data of 1543 women from the department gynecology of the first affiliated hospital of Kunming medical university for colposcopy were enrolled in this study and the data were analyzed here. According to the cervical pathological results, women infecting HPV were divided into cervical intraepithelial neoplasia grade I group, cervical intraepithelial neoplasia grade II group, cervical intraepithelial neoplasia grade III group and cervical cancer group, cervicitis group. Results: 1339 cases (86.78%) were infected with HPV among 1543 specimens. Forty-eight HPV subtypes were detected, and the top five infection rates were HPV16, 18, 52, 58 and 33. Statistical difference between cervical pathology results between age group and HPV infection were detected at <I>P</I><0.05. Most cervical cancer lesions of HPV-infected women were over 50 years old. In addition, except for the cervical cancer group, and the proportion of HPV infection in each age group showed an "n" type distribution pattern in cervical pathology results. The majority patients with HPV infection were multiple infection (66.25%) and triple or more types of HPV infection (39.51%). The proportion of high-risk subtypes of HPV infection decreased gradually with the increase of age, while the proportion of low-risk subtypes increased with the increase of age. The high-risk subtype was significantly higher than the low-risk subtype in the cervical pathological HPV infection subtypes in each group, and the most high-risk subtypes were 16, 18 and 52. The HPV subtypes in the cervical cancer group were only high-risk subtypes, and subtypes 16 and 18 showed the highest frequency. Conclusions: The main types of HPV in Kunming were HPV subtypes 16, 18 and 52. Age was an important factor influencing the subtype of HPV infection as well as cervical pathology outcomes. To reduce clinical cervical cancer lesions, attention should be paid to the screening and protection of cervical cancer lesions in women aged more than 50 years old with HPV infection of HPV subtypes 16 and 18.

Study to determine efficacy of urinary HPV 16 & HPV 18 detection in predicting premalignant and malignant lesions of uterine cervix.

To evaluate clinical performance and diagnostic accuracy of urinary HPV for non-invasive screening of high-grade precancerous and cancerous cervical lesions in a visual inspection under acetic acid (VIA) -positive cohort. The study included 180 women aged 35-65 years, who were VIA positive in a colposcopy clinic. All participants had the initial stream of a random urine sample tested for the presence of high-risk HPV (hrHPV) types 16 and 18 and acetowhite lesions were biopsied per protocol. Concordance analysis was conducted to assess agreement between detection of hrHPV in urine and the presence of premalignant and malignant lesions in cervix on histopathology. Measures of diagnostic accuracy were estimated to evaluate the performance of urinary HPV against histopathology (reference standard). Substantial agreement between urinary HPV detection and histopathology was found (Cohen's κ is 0.696, P≤ 0.001), with an agreement in 88.9% of the cases and disagreement in 11.1%. The diagnostic performance of urinary HPV in predicting the presence of a high-grade precancerous or cancerous lesion was as follows: sensitivity 67%, specificity 97%, positive predictive value 89%, and negative predictive value 88.8%. HPV DNA detection from urine has good concordance with the histopathology for detection of precancerous and cancerous lesions of the cervix. Further studies on optimization of urine sampling and processing techniques are warranted.

Applicability of On-Site Evaluation of Cervical Cytology Smears Stained with Toluidine Blue to Reduce Unsatisfactory Results

Introduction: Carcinoma of the uterine cervix is a major health problem faced by Indian women. Screening techniques like visual inspection with acetic acid, Lugol’s iodine, Papanicolaou smear, and human papillomavirus DNA testing have been suggested. Pap smear is a simple, safe, cost-effective, and reliable technique used for screening cervical lesions. Rapid on-site evaluation (ROSE) using the 1% aq. toluidine blue staining method has been less studied in cervical cytology. Materials and Methods: Our study was a prospective study done over a period of 2 years. All the cervical cytology smears were reported as per the Bethesda system 2014. Rapid stain using aqueous toluidine blue (1%) and conventional Pap stain was done on the smears received. Results: We evaluated a total of 1,300 cases, with 97.6% satisfactory samples. The spectrum of cases included 96.3% of negative for malignancy cases (including bacterial vaginosis, trichomonas, candida, and atrophic smears), atypical squamous cell of undetermined significance and atypical squamous cells cannot exclude high-grade squamous intraepithelial lesion in 0.5% cases, low-grade squamous intraepithelial lesion and high-grade intraepithelial lesion in 0.3% cases, squamous cell carcinoma in 0.3% cases, and atypical glandular cells/adenocarcinoma in 0.2% cases. Turnaround time was within 48 h in 77% cases. With rapid stain, our unsatisfactory rate was reduced from 12% to approx. 2.4%. Conclusion: ROSE has been attempted on routine FNA cytology samples with success. However, the use of ROSE in cervical cytology has not been attempted to date. Lower unsatisfactory rate is an important indicator for the successful implementation of cervical cancer screening technique.

Cervical cancer prevention in countries with the highest HIV prevalence: a review of policies

IntroductionCervical cancer (CC) is the leading cause of cancer-related death among women in sub-Saharan Africa. It occurs most frequently in women living with HIV (WLHIV) and is classified as an AIDS-defining illness. Recent World Health Organisation (WHO) recommendations provide guidance for CC prevention policies, with specifications for WLHIV. We systematically reviewed policies for CC prevention and control in sub-Saharan countries with the highest HIV prevalence.MethodsWe included countries with an HIV prevalence ≥ 10% in 2018 and policies published between January 1st 2010 and March 31st 2022. We searched Medline via PubMed, the international cancer control partnership website and national governmental websites of included countries for relevant policy documents. The online document search was supplemented with expert consultation for each included country. We synthesised aspects defined in policies for HPV vaccination, sex education, condom use, tobacco control, male circumcision,cervical screening, diagnosis and treatment of cervical pre-cancerous lesions and cancer, monitoring mechanisms and cost of services to women while highlighting specificities for WLHIV.ResultsWe reviewed 33 policy documents from nine countries. All included countries had policies on CC prevention and control either as a standalone policy (77.8%), or as part of a cancer or non-communicable diseases policy (22.2%) or both (66.7%). Aspects of HPV vaccination were reported in 7 (77.8%) of the 9 countries. All countries (100%) planned to develop or review Information, Education and Communication (IEC) materials for CC prevention including condom use and tobacco control. Age at screening commencement and screening intervals for WLHIV varied across countries. The most common recommended screening and treatment methods were visual inspection with acetic acid (VIA) (88.9%), Pap smear (77.8%); cryotherapy (100%) and loop electrosurgical procedure (LEEP) (88.9%) respectively. Global indicators disaggregated by HIV status for monitoring CC programs were rarely reported. CC prevention and care policies included service costs at various stages in three countries (33.3%).ConclusionConsiderable progress has been made in policy development for CC prevention and control in sub Saharan Africa. However, in countries with a high HIV burden, there is need to tailor these policies to respond to the specific needs of WLHIV. Countries may consider updating policies using the recent WHO guidelines for CC prevention, while adapting them to context realities.

Cervical lesion image enhancement based on conditional entropy generative adversarial network framework.

Early screening and diagnosis of cervical precancerous lesions are very important to prevent cervical cancer. High-quality colposcopy images will help doctors make faster and more accurate diagnoses. To tackle the problem of low image quality caused by complex interference during colposcopy operation, this paper proposed a conditional entropy generative adversarial networks framework for image enhancement. A decomposition network based on Retinex theory is constructed to obtain the reflection images of the low-quality images, then the conditional generative adversarial network is used as the enhancement network. The low-quality images and the decomposed reflection images are both input the enhancement network for training, and the conditional entropy distance is used as a part of the loss of the conditional generative adversarial network to alleviate the over-fitting problem during the training process. The test results show that compared with published methods, the proposed method of this paper can significantly improve the image quality, and can enhance the colposcopy image while retaining image details.

Significance of Triple Detection of p16/ki-67 Dual-Staining, Liquid-Based Cytology and HR HPV Testing in Screening of Cervical Cancer: A Retrospective Study.

In addition to liquid-based cytology (LBC) and HR HPV testing, p16/ki-67 dual-staining is another method for cervical cancer screening. The combination of any two methods can improve the accuracy of screening, but some cervical lesions are still missed or misdiagnosed. In this retrospective study, the significance of LBC, HR HPV testing and especially p16/ki-67 dual-staining in cervical lesion screening was evaluated with reference to histological diagnosis. At the same time, we tried to explore the value of p16/ki-67 dual-staining combined with LBC and HR HPV testing (triple detection) in improving the diagnostic specificity of CIN2+ and reducing the missed diagnosis of CIN2+ lesions. We found that p16/ki-67 dual-staining was valuable in identifying cervical CIN2+ lesions and reducing the missed diagnosis of CIN2+ in HPV negative patients. More than 96% of CIN2+ patients were positive for two or three tests of triple detection. Whole positive triple detection can effectively predict high grade cervical lesions. In conclusion, the triple detection can distinguish almost all cervical CIN2+ lesions. Our data put forward and highlight the feasibility and significance of triple detection in cervical lesion screening.

Re-Evaluating the Predictive Values of Pap-smear for Diagnosis and LLETZ Margin Status for Management of Precancerous Cervical Lesions

Background: The incidence of HPV infection, precancerous cervical lesions and cervical cancer is relatively high in sub-Saharan African countries. There is significant variability among such countries and worldwide in the accuracy of screening for precancerous cervical lesions and test for cure after excision. Implementation and interval between these procedures also vary. Objective: The aim of this study was to determine the predictive values of Pap-smear for screening and LLETZ for proof-of-cure in a South African hospital setting. Patients and Methods: In the current study, the positive and negative predictive values of Pap-smear screening for the identification of low-grade and high-grade squamous epithelial cervical lesions (LSIL and HSIL, respectively) and Large Loop Excision of the Transformation Zone (LLETZ) procedures for the assessment of residual lesions were determined in a South African hospital setting. Patients referred to the hospital because of abnormal Pap-smear results were included. Results: Pap-smear screening was found to have a positive predictive value of over 90% for HSIL, indicating that this procedure is a reasonable low-cost method of screening for cervical cancer in this setting. Conversely, LLETZ displayed more modest PPV and NPV of 58% and 62%, respectively, for prediction of residual and completely excised lesions. Conclusion: Pap-smear testing had reasonable PPV (>90% for HSIL) to be effectively used as a low-cost screening method in a middle- to low-income South African hospital setting. The predictive values of LLETZ margin status was questionable, justifying careful follow-up after negative margin status. These results justify the consideration of post-LLETZ follow up pap-smear within 3–4 months for both positive and negative margin status, this may prevent under or over treatment of women with precancerous cervical lesions.

SPECTRUM OF CERVICAL LESIONS IN LIQUID BASED CYTOLOGY SMEAR IN A TERTIARY CARE CENTRE IN NORTH INDIA: A 3 YEAR RETROSPECTIVE STUDY

Cervical lesions are one of the most common cause of female morbidity, cervical cancer being the second most common malignancy only after breast in women in India as well as the world. The aim of this study was to analyse the spectrum of cervical lesions in Liquid based cytology and categorizing them according to the Bethesda System for Reporting Cervical cytology. This is a 3 year retrospective study . Total number of cases collected were 1228, of which majority were in the age group of 21-30 years comprising of 450 cases (36.6%) . The most common complain was whitish discharge followed by pain lower abdomen. Out of 1228 cases ,1131 (92.10%) were NILM, 11(0.89%) LSIL,10(0.80%) each of HSIL &amp;ASCUS,5(0.42%) Atypical endocervical cells(NOS), 4(0.35%) SCC and 2(0.16%) Atypical glandular cells(NOS) .55 cases (4.48%) were inadequate. Out of 1131cases of Negative for intraepithelial lesion or Malignancy, 1048 were non -neoplastic and 83 were associated with specic infection. Premalignant and malignant lesions of the cervix are very common, therefore proper screening and categorization of cervical lesion is necessary for treatment and follow up,thereby reducing the mortality and morbidity.

Support for lowering cervical cancer screening age to 25 for women living with HIV: retrospective cross-sectional programmatic data from Botswana

BackgroundWomen living with human immunodeficiency virus (HIV) tend to develop cervical cancer at a younger age than women without HIV. The World Health Organization’s (WHO) 2021 guidelines for screening and treatment of cervical pre-cancer lesions for cervical cancer prevention include a conditional recommendation for initiating screening at age 25 for women living with HIV (WLWH). This recommendation is based on low-certainty evidence, and WHO calls for additional data. We describe the association of age and HIV status with visual inspection with acetic acid (VIA) positivity and cervical intraepithelial neoplasia grade two or higher (CIN2+) in Botswana.MethodsThis was a retrospective cross-sectional study of 5714 participants aged 25 to 49 years who underwent VIA screening in a clinic mainly serving WLWH. VIA-positive women received cryotherapy if eligible or were referred for colposcopy and excisional treatment. Known cervical cancer risk factors, screening outcome, and histological results were extracted from the program database. We compared the proportions and association of VIA positivity and CIN2+ by age and HIV status.ResultsThe median age was 35 years [IQR 31–39], and 18% of the women were aged 25–29. Ninety percent were WLWH; median CD4 count was 250 cells/µL [IQR 150–428], and 34.2% were on anti-retroviral treatment (ART). VIA-positivity was associated with younger age (OR 1.48, CI 1.28, 1.72 for 25–29 years vs. 30–49 years), and HIV-positivity (OR 1.85, CI 1.51, 2.28). CIN2+ was only associated with HIV-positivity (OR 6.12, CI 3.39, 11.10), and proportions of CIN2+ were similar for both age groups in WLWH (69.1% vs. 68.3%).ConclusionsYounger WLWH in Botswana had a significant burden of CIN2+. This finding further supports lowering the screening age for WLWH from 30 to 25.