Uterine Cervical Neoplasm Research Articles

The Effect of an Educational Program Based on Protection Motivation Theory (PMT) in Adopting Preventive Behaviors from Uterine Cervical Neoplasm among Women Referring to Health Centers in Torbat Heydariyeh City

Introduction: One of the cancers that endangers women's health is cervical cancer which can be fatal due to the lack of significant symptoms. This study was conducted with the aim of determining the effectiveness of an educational program based on Protection Motivation Theory (PMT) in adopting preventive behaviors from uterine cervical neoplasm among Women Referring to Health Centers in Torbat Heydariyeh city. Methods: A quasi-experimental study was conducted on 200 women with average age of 30/62 (intervention 100 and control 100) referred to Torbat Heydariyeh city health centers by random cluster sampling method from October 2019 to May 2020.The data collection tools were researcher-made questionnaires based on PMT, and its validity and reliability were reviewed and confirmed. Pre-test was also performed for both groups. Based on the results of the pre-test, need assessment was done. The educational intervention was performed for case group as lecture, pamphlet, Power Point presentation and question and answer in three 90-minute sessions. Post-test was performed after three month using the same questionnaire for both groups. The collected data were analyzed by independent t-test, paired t-test, and Pearson and chi square using SPSS software v22. Results: Before the intervention, there was no significant difference between control and experimental groups(p<0/05)regarding the mean score of constructs of the PMT. After the intervention, however, there was a significant difference in the mean scores of all the constructs of PMT in the two groups (self-efficacy p=0/001, response cost p=0/001, response efficiency p=0/001, perceived vulnerability p=0/007, fear p=0/001, perceived intensity p=0/01, motivation p=0/002 and behavior p=0/001). Conclusion: The study results revealed effectiveness of educational intervention based on PMT in promoting Pap smear screening behavior. The rate of doing pap smear test in the experimental group increased to 56% in the intervention group. Therefore, the authors recommend designing educational interventions based on this theory to promote public health, especially for women.

Japan Society of Gynecologic Oncology 2022 guidelines for uterine cervical neoplasm treatment.

The Japan Society of Gynecologic Oncology (JSGO) Guidelines 2022 for the Treatment of Uterine Cervical Cancer are revised from the 2017 guideline. This guideline aimed to provide standard care for cervical cancer, indicate appropriate current treatment methods for cervical cancer, minimize variances in treatment methods among institutions, improve disease prognosis and treatment safety, reduce the economic and psychosomatic burden of patients by promoting the performance of appropriate treatment, and enhance mutual understanding between patients and healthcare professionals. The guidelines were prepared through the consensus of the JSGO Guideline Committee, based on a careful review of evidence gathered through the literature searches and the medical health insurance system and actual clinical practice situations in Japan. The guidelines comprise seven chapters and 5 algorithms. The main features of the 2022 revision are as follows: 1) added discussed points at the final consensus meeting; 2) revised the treatment methods based on the International Federation of Gynecology and Obstetrics 2018 staging system; 3) examined minimally invasive surgery based on Laparoscopic Approach to Cervical Cancer trial; 4) added clinical question (CQ) for treatments of rare histological types, gastric type, and small-cell neuroendocrine carcinoma; 5) added CQ for intensity-modulated radiation therapy; 6) added CQ for cancer genomic profiling test; and 7) added CQ for cancer survivorship. Each recommendation is accompanied by a classification of recommendation categories based on the consensus reached by the Guideline Committee members. Here, we present the English version of the JSGO Guidelines 2022 for the Treatment of Uterine Cervical Cancer.

Uterine Cervical Neoplasm Diagnosed by Flexible Magnifying Endoscopy with Narrow Band Imaging.

When detected early, uterine cervical cancer is one of the most successfully treatable forms of cancer. The diagnostic accuracy of the standard method, the Pap smear test followed by colposcopy, remains unsatisfactory. To improve detection of early-stage cervical cancer, new diagnostic tools for uterine cervical intraepithelial neoplasm (CIN) need to be developed. Magnifying endoscopy with narrow- band imaging (ME-NBI), which allows the visualization of the micro-structure as well as micro-vascularity of the mucosal surface, has excellent diagnostic ability for early gastrointestinal neoplasms. In our previous investigation, ME-NBI was efficacious for diagnosis of CIN. We herein report two notable cases of CIN3 that were diagnosed by ME-NBI that were not detected by colposcopy. These cases illustrate the usefulness of ME-NBI for diagnosis of early-stage uterine cervical neoplasms.

Effect of vitamin E supplementation on uterine cervical neoplasm: A meta-analysis of case-control studies.

Several epidemiological studies have suggested that vitamin E could reduce the risk of uterine cervical neoplasm. However, controversial data were presented by different reports. Hence, we conducted a meta-analysis to assess the relationship between vitamin E and the risk of cervical neoplasia. We performed a comprehensive search of the PubMed, Embase and Cochrane databases through December 31, 2016. Based on a fixed-effects or random-effects model, the odds ratio (OR) and 95% confidence intervals (CIs) were calculated to assess the combined risk. Subgroup analyses and meta-regression were done to assess the source of heterogeneity. Subgroup analyses were performed according to survey ways, types of cervical neoplasia, study populations. A protocol was registered with PROSPERO (No. CRD42016036672). In total, 15 case-control studies were included, involving 3741 cases and 6328 controls. Our study suggested that higher category of vitamin E could reduce the cervical neoplasia risk (OR = 0.58, 95% CIs = 0.47–0.72, I2 = 83%). In subgroup-analysis, both vitamin E intake and blood levels of vitamin E had a significant inverse association with the risk of cervical neoplasm. Additionally, we found the same relationship between vitamin E and cervical neoplasia among different populations and types of cervical neoplasia. Meta-regression showed that none of the including covariates were significantly related to the outcomes. No evidence of publication bias was observed. In conclusion, vitamin E intake and blood vitamin E levels were inversely associated with the risk of cervical neoplasia.

TLR9 gene polymorphism -1486T/C (rs187084) is associated with uterine cervical neoplasm in Mexican female population.

The aim of this work was to evaluate the association of single nucleotide polymorphisms in TLR9 (-1486 T/C [rs187084], -1237T/C [rs5743836] and G2848A [rs352140]) with HPV infection, squamous intraepithelial lesions, and uterine cervical neoplasm in a Mexican population. Additionally, the peripheral expression of TLR9 was evaluated to evaluate the differences in the TLR9 expression associated with every genotype in the locus -1486 of the TLR9 gene. The serum concentration of TLR9 was evaluated in a randomly selected subsample. Genotyping was performed using predesigned 5' endonuc lease assays and the association of the polymorphisms with the diagnosis groups were assessed by performing multinomial regression models. The relative expression of TLR9 in peripheral blood mononuclear cells was evaluated by real-time polymerase chain reaction and the association of the level of TLR9 expression with the diagnosis was evaluated by performing multinomial regression models. The serum concentration of TLR9 was evaluated in a subsample of patients diagnosed with uterine cervical neoplasm by ELISA. The results showed that genotype TT in the -1486 locus of TLR9 was significantly associated with HPV infection (OR=3.25, 95% CI 1.12-9.46), squamous intraepithelial cervical lesion (OR=3.76, 95% CI 1.36-10.41), and uterine cervical neoplasm (OR=5.30, 95% CI 1.81-15.55). Moreover, the highest level of TLR9 expression was significantly associated with a greater risk for developing squamous intraepithelial cervical lesion and uterine cervical neoplasm. The serum TLR9 concentration was higher in patients with uterine cervical cancer than in controls. Our findings indicate that genotype TT in the -1486 locus of the TLR9 gene could comprise a risk genotype for HPV infection, squamous intraepithelial cervical lesion, and uterine cervical neoplasm in Mexican female population. Further studies with larger samples are needed to evaluate if the peripheral expression of TLR9 could be used as a biomarker of uterine cervical neoplasm progression.

Knowledge, attitudes and practices of prevention for cervical cancer and breast cancer among medical students.

Objective To assess the knowledge, attitudes and practices of medical students for health promotion, primary prevention and early detection of breast neoplasm and uterine cervical neoplasm, as well as to make recommendations for improving the Public Health curriculum at the Universidad de los Andes. Methodology This study utilized a survey of medical knowledge, attitudes and practices applied to fifth year Colombian medical students attending the Universidad de los Andes in the first semester of 2013. Results 64/76 students answered the surveys (response rate 84.2 % ): 62.5 % (40/64) and 37.5 % (24/64) response rates from students in their ninth and tenth semesters, respectively; and 64.1 % (41/64) and 35.9 % (23/64) response rates from female and male students, respectively. Knowledge: clinical breast exam (CBE), breast self-examination (BSE) and mammography were recommended by 95.3 % (61/64) of students, 96.9 % (62/64) of medical students and 90.7 % (58/64) of students, respectively. Attitude: the most effective tests to reduce mortality in women aged ≥ 50 years were the Papanicolaou test according to 90.6 % (58/64) of students and mammography according to 82.8 % (53/64) of students. Practice: 55.0 % (35/64) of students had received training in the guidelines and protocols for breast neoplasm and uterine cervical neoplasm screening. Discussion To promote early detection of cervical and breast cancer, knowledge, attitudes and practices must be improved to enhance clinical practices (e.g. Papanicolaou test) and medical student training guidelines or protocols for these two cancers. Overall, with induced demand and support from research communities and institutions seeking to make these improvements, we collaborate to decrease missed opportunities in medical research and Public Health.

Divergent expression of L-type amino acid transporter 1 during uterine cervical carcinogenesis

L-type amino acid transporter 1 (LAT1) is a Na⁺-independent neutral amino acid transporter that has an essential role in cell proliferation. Although LAT1 expression is observed in various tumor cell lines and immunohistochemical expression of LAT1 has been investigated in carcinomas of various organs, LAT1 expression in uterine cervical neoplasm has not been reported. Therefore, in the present study, we immunohistochemically analyzed LAT1 expression along with the well-known markers of cervical carcinogenesis Ki-67 and p16 in normal uterine cervical mucosa (49 specimens) as well as cervical intraepithelial neoplasia (17 mild or moderate dysplasias and 19 severe dysplasias or carcinomas in situ) and invasive carcinomas (17 squamous cell carcinomas and 9 adenocarcinomas). LAT1 expression was limited to the basal layer of normal squamous epithelium, and it was significantly decreased in cervical intraepithelial neoplasia (P < .001), generally paralleled by increased expression of Ki-67 and p16. Interestingly, in invasive squamous cell carcinoma, LAT1 expression again increased especially at the invasive fronts (P < .001), whereas Ki-67 and p16 expressions were almost unchanged relative to noninvasive neoplasia. Although virtually no LAT1 expression was demonstrated in normal uterine cervical glands, LAT1 expression was observed in some adenocarcinomas (P < .001). The present study suggests that LAT1 expression decreases because of human papillomavirus infection as reflected by p16 overexpression in cervical intraepithelial neoplasia, whereas LAT1 expression in invasive carcinoma is associated with acquired malignant potential.

Análise de um programa municipal de prevenção do câncer cérvico-uterino

Trata-se de um estudo descritivo-exploratório com objetivo de analisar o programa de prevenção do câncer cérvico uterino no município de Igarapava/SP. No ano de 2006, a rede pública municipal realizou uma cobertura de 14,9% da população feminina na faixa etária de 25 a 59 anos, metade da razão mínima esperada para os municípios, sendo a faixa etária predominante das coletas de 20 a 34 anos (43,2%). Um total de 6,3% não compareceu no serviço de saúde a fim de receber o resultado. Quanto aos resultados das coletas, 51.6% (774) estavam dentro dos limites de normalidade e 47,9% (719) apresentaram alguma alteração, sendo 0,1% compatível com NIC II e III.

As políticas públicas e a atenção ao câncer do colo do útero no Estado de Mato Grosso - uma abordagem crítica

Este estudo faz um levantamento de dados secundários, e aborda as condições atuais da atenção à saúde da mulher com câncer do colo do útero no Estado de Mato Grosso, com o objetivo precípuo de iniciar um diálogo entre estes números com o direito fundamental do ser humano: a saúde. O direito à saúde está explicitado nas políticas públicas de atenção à saúde da população através dos princípios de resolutividade, integralidade e equidade tais como são descritos na Lei Orgânica da Saúde que instituiu o Sistema Único de Saúde (SUS) no Brasil. A baixa motivação das mulheres no cuidado com sua saúde, está relacionada tanto às questões de ordem psicológicas e culturais, como também a precária noção de direitos sanitários e de cidadania, revelados por uma quase ausência de atos que responsabilizem legal e eticamente os serviços e profissionais de saúde em relação aos casos não resolvidos pelo sistema. O estudo aponta para a necessidade de se incrementar a participação social dos usuários, como um dos caminhos para melhorar a qualidade da atenção à saúde, reforçando os princípios constitucionais e estimulando a cidadania ativa da população.

Altered plasma phospholipid fatty acids and nutritional status in patients with uterine cervical cancer

Little is known about the fatty acid status of uterine cervical neoplasm patients. Therefore, the aim of this study was to investigate the changes in the plasma phospholipid fatty acid (FA) profile along with nutrition status of cervical cancer patients. A controlled cross-sectional study with uterine cervical cancer patients virgin of treatment was conducted. Nutritional status, nutrient intake and plasma phospholipid FA were evaluated. Patients had lost weight in relation to their weight 6 months prior (5.1+/-8.8%) (p<0.01). Compared to the control group and their usual intake, patients ingested less energy (p<0.01). Patients also ingested less protein (p<0.01) and 18:3n-3 FA (p<0.05), compared to the control group. Patients plasma concentrations of 18:0, 24:0 FA and the 18:0/18:1 FA ratio were higher (p<0.001), and 16:0 (p=0.001) and 18:2n-6 (p=0.02) concentrations were lower than that of the control group. The weight loss and low nutrient intake among patients suggest the importance of nutrition intervention at an early stage of the diagnosis and plasma 18:0/18:1 FA ratio may be an indirect marker of FA metabolism disregulation in these patients.

Expression of p21Cip1/Waf1 and p27Kip1 in Small Cell Neuroendocrine Carcinoma of the Uterine Cervix

Small-cell neuroendocrine carcinoma of the uterine cervix (SCCC), a rare but malignant cervical neoplasm, has a highly aggressive phenotype that requires more intensive treatment than other cervical tumors. Immunohistochemical methods were used to compare the expression of p21Cip1/Waf1 and p27Kip1 in SCCC and squamous cell carcinoma, the most common type of cervical cancer. In SCCC, p21 expression was significantly reduced compared with squamous cell carcinoma, whereas expression of p27 was similar in both carcinomas. Reduced expression of p21 could be a helpful diagnostic marker and may contribute to the invasive phenotype of SCCC.

Clinical Significance of p27 and Skp2 Protein Expression in Uterine Cervical Neoplasm

The loss of p27 indicates a poor prognosis in various solid tumors, and a decrease in p27 level is the result of increased degradation by Skp2. We evaluated the relationship of p27 and Skp2 protein expression to various clinicopathologic factors in 332 cases of untreated uterine cervical neoplasm using tissue microarray method. After immunohistochemical staining, 313 and 300 tumor samples were retrieved for interpretation for p27 and Skp2, respectively. High p27 protein expression (nuclear staining in more than 30% of the tumor cells) was seen in 39.9% (125/313 cases), including 32 cervical intraepithelial neoplasia (CIN) III (55.2%), 58 microinvasive squamous cell carcinoma (SCC) (56.9%), 21 invasive SCC (17.1%), 11 adenocarcinoma (55.0%), and 3 cases of other tumors (30.0%). High Skp2 protein expression was noted in 28.3% (85/300 cases), including 14 cervical intraepithelial neoplasia III (25.0%), 18 microinvasive SCC (18.75%), 45 invasive SCC (37.8%), 6 adenocarcinoma (30.0%), and 2 cases of other tumors (22.2%). Low p27 protein expression was correlated with large tumor size (P < 0.005), depth of invasion in squamous lesion (P < 0.0005), high stage (P < 0.0005), and poor survival (P < 0.005). High Skp2 protein expression was correlated with large tumor size (P < 0.05), depth of invasion in squamous lesion (P < 0.05), and high stage (P < 0.005), but not with patient survival. There was no significant correlation between p27 and Skp2 protein expression. Only tumor stage had prognostic significance in the multivariate analysis (P = 0.041). Patients with low p27 protein expression had worse prognosis, indicating that p27 may participate in the progression of cervical squamous cell lesions.

Human papillomavirus genotyping by oligonucleotide microarray and p16INK4A expression in uterine cervical intraepithelial neoplasm and in invasive carcinoma in Korean women

For evaluating the diagnostic significance of p16(INK4A) over-expression in the uterine cervical intraepithelial neoplasm and in invasive carcinoma, human papillomavirus (HPV) was detected and genotyped by oligonucleotide microarray in archival tissues of 117 cervical specimens, including 47 invasive squamous cell carcinomas (SCC), 30 cases of cervical intraepithelial neoplasia (CIN), 20 adenocarcinomas, and 20 cases of non-neoplastic cervix. The expression of p16(INK4A) protein was immunohistochemically studied in these cases and in five HPV-positive and one HPV-negative cervical cancer cell lines. HPV was detected in 50% of CIN, 61.7% of SCC, and 45.5% of adenocarcinomas. p16(INK4A) expression was seen in all 20 cases of adenocarcinoma, 78.7% (37/47) of SCC, and 96.7% (29/30) of CIN, but not in any cases of the non-neoplastic cervix. There was no difference in p16(INK4A) expression between the HPV-positive and HPV-negative cervical lesions. All HPV-positive and -negative cervical cancer cell lines expressed p16(INK4A) protein. In conclusion, the presence of p16(INK4A) expression in cervical squamous and glandular epithelium indicates the existence of dysplasia or malignancy in the uterine cervix, regardless of HPV infection.

Cyclooxygenase-2 and c-erbB-2 expression in uterine cervical neoplasm assessed using tissue microarrays

Objectives Cyclooxygenase-2 (COX-2) and c-erbB-2 are involved in the pathogenesis of solid organ tumors. Chemotherapeutic agents targeting COX-2 and c-erbB-2 are used to treat colon and breast cancers. This study evaluated the significance and relationship of COX-2 and c-erbB-2 protein expression in untreated uterine cervical neoplasm. Methods This study included 332 patients with uterine cervical neoplasm. We constructed tissue microarray blocks that included two cores from each donor tumor and immunostained them with primary anti-cyclooxygenase-2 and anti-c-erbB-2 monoclonal antibodies. The clinical features and survival data were compared. Results Three hundred and eighteen tumor samples (95.8%) could be interpreted after immunohistochemical staining. COX-2 protein expression was noted in 140 cases of uterine cervical neoplasm (44.0%): In 26.7% of the cervical intraepithelial neoplasia III (16/60 cases), 37.9% of the microinvasive squamous cell carcinoma (39/103 cases), 51.6% of the invasive squamous cell carcinoma (64/124 cases), and 76.2% of the adenocarcinomas (16/21 cases) ( P < 0.005). By contrast, except for one case of adenoid cystic carcinoma, none of the uterine cervical neoplasm expressed c-erbB-2 protein. COX-2 protein expression correlated with histology ( P < 0.005) and stage ( P < 0.05), but was not associated with patient survival. Conclusion COX-2 may participate in the progression of cervical squamous cell lesions, while the contribution of c-erbB-2 to cervical carcinogenesis is probably small.

Human Papillomavirus Infection and Polymorphism of p53 codon 72 in the Uterine Cervical Neoplasia

Objective : The uterine cervical neoplasia is one of the most frequent gynecologic tumor in Korean women. Though the precise pathogenic mechanisms were not elucidated, human papillomaviruses (HPVs) has been considered as a strong candidate for the cause of uterine cervical neoplasm. Methods : About 100 subtypes of HPV were known, and they were divided into two groups as “high-risk HPVs” and “low-risk HPVs” according to their oncogenic potentialities. It was known that arginine (Arg) residue at codon 72 of p53 tumor suppressor gene could be used as a marker for the risk of cervical epithelial neoplasia associated human appilloma virus infection. But the notions are still controversal. Studies to date have focused mainly on Caucasians despite marked ethnic variations in both the p53 polymorphism and the different genotypes of human papillomavirus associated with cervical neoplasia. In this study, the p53 codon 72 status in 125 Korean women with cervical neoplasia and 200 Korean healthy women was determined. In addition, the different genotypes of human papillomavirus associated with cervical neoplasia was also determined by DNA Chip. Results : The most frequent subtypes of HPV associated with uterine cervical neoplasia in Korean women were 16 (25.6%), 58 (16%), other type (10.4%), 52 (10%) and 18 (4.8%) in order of frequency. The polymorphic rate of p53 codon 72 in 200 Korean women was Arg/Ar (47%), Arg/Pro (43%) and Pro/Pro (10%) respectively. The polymorphic rate of p53 codon 72 in HPV associated uterine cervical neoplasia was Arg/Ar (55.5%), Arg/Pro (38.9%) and Pro/Pro (5.50%) respectively, which was not statistically significant compared to the normal control. In 16/18 genotypes associated cervical neoplasia, the polymorphic rate of p53 codon 72 was 44.8% (Arg/Arg), 42.1% (Arg/Pro) and 13.1% (Pro/Pro) respectively, while in 58/52/other type/33/35/40/44 genotypes, it was 36.5% (Arg/Arg), 50% (Ar/Pro), and 13.5% (Pro/Pro) respectively. There was no statistical significance between two groups. Conclusion : Above results showed that the genotypes of HPV associated with uterine cervical neoplasia in Korean women were different from those of Western countries, and there was not significant difference between the polymorphism of p53 codon 72 and genotypes of HPV associated with uterine epithelial neoplasia.

Use of Monoclonal Antibody MIB-1 in Differential Diagnosis of Uterine Cervical Glandular Neoplasm

This study was undertaken to evaluate the significance of MIB-1 immunoreactivity in the discrimination of differential diagnosis of benign cervical lesion, endocervical glandular dysplasia, and endocervical adenocarcinoma on formalin-fixed, paraffinembedded tissue. Fifty-two cases were selected from the pathology files of Korea University Hospital from 1994 to 1998 and were composed of 25 cases of endocervical adenocarcinoma, including three cases in which squamous cell carcinoma coexists; six cases of endocervical glandular dysplasia associated with squamous cell carcinoma or cervical intraepithelial neoplasia (CIN); and 21 cases of chronic endocervicitis. Immunohistochemical staining for MIB-1 was performed after microwave treatment on formalin-fixed, paraffin-embedded tissue sections. MIB-1 expression was evaluated according to the labeling indexes. The labeling indexes were calculated for 52 specimens by means of image analysis (Quantification of Proliferation Index). The results are as follows; There was diffuse strong MIB-1 reactivity in endocervical adenocarcinoma (labeling index 37.6-61.4%, mean 54.9%), moderate spotty reactivity in endocervical glandular dysplasia (labeling index 27.9-42.6%, mean 35.1%), and minimal to focal reactivity in chronic endocervicitis (labeling index 0-24.4%, mean 5.2%). Significant differences in MIB-1 labeling indexes existed among the chronic endocervicitis group, the endocervical glandular dysplasia group, and endocervical adenocarcinoma group. In conclusion, MIB-1 immunostaining is of value in the differential diagnosis among benign cervical lesions, endocervical glandular dysplasia, and endocervical adenocarcinoma.

妊婦の子宮頚癌スクリーニングにおけるサイトピックの有用性の検討 綿棒採取との比較

妊婦の子宮頸癌スクリーニングにおけるサイトピックの有用性について, 綿棒との比較検討を行った. 1992年1月から1997年12月末までに当院を受診した妊婦4749人のうち, 子宮膣部擦過細胞診にてクラスIIIaと診断された症例は83例であり, このうち十分な精査を行い得た53例にっいて解析を行った. 綿棒にて細胞診採取を行った29例中 (綿棒採取群) 組織診との結果が一致した症例は12例 (41.4%) であった. 一方サイトピックにて細胞診採取を行った24例中 (サイトピック採取群) 組織診との結果が一致した症例は18例 (75%) であり, 綿棒採取群と比較して組織診との一致率は有意に高率であった (p=0.0140, x2検定). 特に上皮内癌以上の症例における一致率は綿棒採取群で33.3%にとどまったのに対し, サイトピック採取群では100%と高率であった. 以上のことから, 妊婦における子宮頸癌スクリーニングにおいては綿棒よりもサイトピックの方が病変をより正確に反映する可能性が示唆された.

Problematic Uterine Smooth Muscle Neoplasms

A recent trend in the classification of uterine smooth muscle neoplasms (USMNs) into clinically benign and clinically malignant groups has been to move from exclusive reliance upon mitotic index (MI) to an approach that incorporates additional histopathologic characteristics. In furtherance of this goal, we assessed a variety of histopathologic features of 213 problematic smooth muscle neoplasms for which we had > or = 2 years of clinical follow-up data or for which there was an unfavorable outcome. One hundred and thirteen of these patients have had a minimum follow-up of 5 years, and 48 have been followed for > or = 10 years. Cases eliminated from the study group included USMNs with a significant myxoid or epithelioid component and cases of intravenous leiomyomatosis. USMNs, whether cellular or not, with no cytologic atypia and with a mitotic index (MI = number of mitotic figures [mf]/10 high-power fields [hpf]) of < 5 mf/10 hpf (usual leiomyomas) were also excluded unless they had unusual features or were associated with an adverse clinical outcome. Fifty-six patients were initially treated by myomectomy or another form of local tumor removal; the remainder had a hysterectomy. From a wide variety of light microscopic features assessed, the important predictors that emerged, using a variety of data exploratory techniques, were MI, the degree of cytologic atypia, and the presence or absence of coagulative tumor cell necrosis (CTCN). Stratification of the USMNs with respect to these three features resulted in a five-group classification of USMNs with the following major characteristics. Group 1: Of the 89 USMNs with an MI in the range 5 < or = MI < 20 without CTCN and with no more than mild atypia, 88 were clinically benign. One patient with a tumor in this group died of metastatic disease 96 months after her uterine cervical primary neoplasm was removed. Combining our data with that in the literature, the failure rate in this group is approximately 1/200 (0.5%). This low failure rate warrants the use of the label "leiomyoma with increased mitotic index" for USMNs with these histologic features. Two patients whose USMNs were characterized by mild atypia, no necrosis, and MI < 5 developed identical-appearing pulmonary metastases and were judged in retrospect to have the syndrome "benign metastasizing leiomyoma." Group 2: USMNs with no CTCN and diffuse moderate to severe atypia fell into two groups based on the MI. For those patients whose neoplasms had an MI > or = 10 mf/10 hpf, four of 10 failed.(ABSTRACT TRUNCATED AT 400 WORDS)

Long-term Mass Screening in Uterine Cervical Carcinoma Eradication Strategy

Results of the Tochigi Cancer Detection Center screening of a total of 252,453 women for uterine cervical neoplasm, conducted over fifteen years, are reported. Among the women, 16,454 (6.5%) were referred for precision reexamination and 14,129 (85.9%) responded. Eighty-nine patients with unmistakably invasive carcinomas at International Federation of Gynecology and Obstetrics (FIGO) Stage Ib or more, 81 with microinvasive carcinomas at Stage Ia and 192 with carcinomas in situ were found, all of them receiving appropriate treatment. The cervical neoplasm detection rate decreased from 26.2 per 10,000 to 6.9 per 10,000 during the 15 years (average rate, 0.15%) with a relatively increasing trend of early stage carcinoma (microinvasive and in situ carcinomas) (62.9-84.0%) over frank carcinoma (37.1-16.0%). During the same period, the ratio of the uterine carcinoma mortality rate to that of all carcinomas decreased from 5.0 to 2.7%. The mean ages (years) of patients with frankly invasive (53.4), microinvasive (48.2) and in situ (45.6) carcinomas, however, remained constant over the 15 years. Five-year actuarial survival rates were 86.6% for frank, 98.8% for microinvasive and 98.8% for in situ carcinomas. Among rechecked women, all frank carcinoma patients were rescreened after more than one-and-a-half years of their last check. These results suggest that long-term mass screening and yearly checks would be of value both for detecting uterine carcinoma earlier and for reducing its mortality rate.