High-grade squamous intraepithelial lesion could be managed conservatively in women up to 25 years: results from a retrospective cohort study.

OBJECTIVE: The aim of this study was to compare histologic findings and clinical outcomes of women up to 25 years with a high-grade squamous intraepithelial lesion (HSIL) compared to women older than 25 years. MATERIALS AND METHODS: Sixty-three women up to 25 years and 245 women older than 25 years with HSIL, diagnosed from June 1991 to September 2008, were examined and treated following the official Spanish guidelines. Colposcopic and histologic findings and needs for treatment were recorded, and patients were followed up for a minimum of 12 months. RESULTS: A total of 308 patients were evaluated; 63.49% of women up to 25 years and 77.10% of women older than 25 years with HSIL had cervical intraepithelial neoplasia (CIN) 2+ histology (p = .04). Also, 74.60% of women up to 25 years and 99.24% of women older than 25 years underwent an excisional procedure (p < .001). No significant or clinical differences were found in the 1-year follow-up outcomes (82.54% vs 78.37% had normal results; p = ns). CONCLUSIONS: Women up to 25 years have less CIN 2+ histologic findings and less need for conization compared to older women. Our findings support the feasibility to design an adequate protocol for these younger women, which would be less aggressive and would, consequently, minimize obstetric long-term secondary effects.

Incidence of human papillomavirus infection in male sexual partners of women diagnosed with CIN II-III.

INTRODUCTION: Human papillomavirus (HPV) infection is a very common sexually transmitted disease which has been strongly related to cervical cancer and cervical intraepithelial neoplasia (CIN), penile cancer and intraepithelial and infiltrating anal squamous cell carcinoma. OBJECTIVES: To describe the HPV status of male sexual partners of women diagnosed with CIN II/III and to evaluate the practical usefulness of the HPV detection in urine as a reliable marker of genital high-risk HPV infection in men. METHODS: Ninety-one heterosexual male partners (mean age 32.7) were included in the study. A panel of epidemiological data was recorded. Peniscopy was performed at the first visit and after 6 months. Urine samples and anal and penile scrapings were obtained and Hybrid Capture II test for high-risk HPV was performed. Physical examination disclosed clinically or peniscopic lesions in only 5.4% patients. HPV was isolated in 12.9% and 6.2% of penile and anal scrapings respectively whereas HPV detection was positive in 28% of urine samples. Overall, 41% of the evaluated patients presented at least one finding diagnostic of HPV infection. CONCLUSION: HPV detection in male partners of women with CIN is a frequent event, and urine HPV detection by Hybrid Capture test is a sensitive method for its detection. The determination of HPV in urine samples seems to be a simple method to investigate the subrogated genital HPV infection in men.

PCR study of a series of ASCUS cases HPV-positive by HCII.

Most guidelines currently recommend the testing of human papillomavirus (HPV) in ASCUS cases. The most used method for this purpose is Hybrid Capture II (HCII), but PCR techniques with GP5+/6+ primers can be also applied. Furthermore, the HCII high-risk probe test for detection of HPV shows cross-reactivity with low-risk HPV. Although this cross-reactivity has been studied in screening populations, it has received little attention in ASCUS cases. To compare the performance of the HCII high-risk probe test and PCR for the detection of HPV in ASCUS cases. We randomly selected 83 ASCUS cases that were positive for high-risk HPV by HCII and applied the PCR test using MYO9-11 and GP5+/6+ primers to samples from these cases. Our results show cross-reactivity with low-risk HPV in 25.3% (21/83) of the HCII+ PCR+ cases. Regarding the follow-up our results emphasize the importance of HPV typing, especially for HPV 16 infection. We propose the use of PCR techniques using GP5+/6+ consensus primers for the screening of HPV in ASCUS.

Estudio comparativo de la determinación de HPV entre HC2 y Cervista™ / Comparative study of HC2 and Cervista™ for the detection of HPV

Antecedentes. La determinación del virus del papiloma humano (VPH) en muestras ginecológicas es en la actualidad un elemento clave para la toma de decisiones en patología cervical. El método más contrastado clínicamente es la captura de híbridos de segunda generación (HC2). Métodos. Estudio comparativo de los resultados obtenidos, mediante HC2 y Cervista™, para la detección de VPH de alto riesgo (VPH-AR) en muestras ginecológicas. Resultado. La comparación de resultados muestra una concordancia del 96,4%, con una sensibilidad de Cervista™ para CIN2+ del 98,3% y una especificidad del 98,4%. Conclusiones. Creemos que Cervista™ es un buen método para la detección de VPH-AR, aplicable tanto en el cribado como en la clínica(AU)

Introduction. HPV detection in gynaecological samples currently provides key data in cervical pathology for diagnostic and management decisions. At present HC2 is the most clinically proven method for this purpose. Methods. Comparative study of HPV-HR detection between HC2 and Cervista™. Results. The concordance between the two methods is 96.4%. The sensitivity of Cervista™ for CIN2+ is 98.3% and specificity exceeds 98.4%. Conclusions. We conclude that Cervista™ is an appropriate method for the detection of HPV-HR in gynecological samples for screening and clinical purposes(AU)

La carga viral no es un factor pronóstico en LSIL / Viral load is not a prognostic factor in LSIL

Objetivo. Estudiar el valor de la carga viral para predecir la persistencia y/o la progresión en LSIL. Diseño del estudio. Estudio prospectivo. Todos los casos diagnosticados como LSIL en el año 2006, y seguidos a los 6, 12 y 24 meses después del diagnóstico. Método. Citología líquida (ThinPrep®, Hologic, Malborough, MA, EE. UU.) para realizar el estudio citológico. Test de captura de híbridos (HCII-HR, Quiagen, Hilden, Alemania), utilizando el test para determinar la presencia de VPH de alto riesgo. Resultados. De los 102 casos, 87 fueron HPV positivos (85,3%). La persistencia o progresión se observó en el 54% de los casos en el primer control, en el 42,4% en el segundo control y en el 33,3% en el tercer control. No se demostró lesión en el seguimiento en el 46% de los casos en el primer control, en el 57% de los casos en el segundo control y en el 66,7% de los casos en el tercer control. Diecinueve casos progresaron a HSIL: 11 detectados en el primer control, 6 en el segundo y 2 en el tercero. La sensibilidad para HSIL nunca superó el 89%, con una especificidad siempre menor del 40%. Conclusiones. La determinación de la carga viral mediante HC2 en LSIL no es útil para predecir su comportamiento(AU)

Objective. To study the HPV viral load (VL) in the prediction of the persistence and/or progression in LSIL cases. Study design. Prospective study. 102 consecutive cases diagnosed as LSIL in 2006 with follow-ups at 6, 12 and 24 months subsequent to diagnosis. Method. Liquid based cytology (ThinPrep®, Hologic, Malborough, MA, USA), for the cytological study. Hybrid Captute II Test (HCII-HR, Quiagen, Hilden, Germany), for the determination of the presence or absence of High-Risk HPV. Results. 87 of the 102 cases studied were HR-HPV positive (85.3%). The presence or progression was detected in 54%, 42% and 33.35% of the cases in the first, second and third controls respectively. No lesion was demonstrated in 46%, 57% and 66.7% of the cases at first, second and third controls respectively. 19 cases progressed to HSIL; 11 of which were detected on the first control, 6 on the second and 2 on the third. The sensitivity of the VL for detecting HSIL never exceeded 89%, with a specificity always inferior to 40%. Conclusion. The VL determined by the HC2 method is not a useful indicator of prognosis in the follow-up of LSIL cases(AU)

Detection of HPV by in situ hybridization in thin-layer (ThinPrep) cervicovaginal samples.

We have studied an automated in situ hybridization (ISH) method as a possible alternative approach for detecting high-risk human papillomavirus (HPV) in monolayer (ThinPrep) cervico-vaginal samples, comparing the results with those obtained by polymerase chain reaction (PCR) using consensus primers and studying the relationship between the ISH staining pattern and the viral integration in HPV 16-positive cases. Eighty atypical squamous cells of undetermined significance (ASCUS) and low-grade squamous intraepithelial lesion (LSIL) cases were used for our purposes. The patients were monitored through periodic cytologies. ISH with was performed with an automated Ventana System, analysis by PCR was performed with consensus primers and integration of HPV16 was performed by realtime PCR analyzing E2 and E6 genes. Additionally, 27 HSIL cases were also studied to observe the ISH staining patterns. HPV infection was detected by ISH in 21.7% of the ASCUS cases and 55.8% of the LSIL cases. Two distinct staining patterns were observed: multipunctated (MP) and diffuse (DI). In some cases, a mixed pattern (MP + DI) was observed and these cases were considered as MP. The MP pattern increased with the degree of lesion and seemed to have a prognostic value in ASCUS/LSIL cases. The lesion in MP pattern cases persisted throughout the entire study in 77% of cases, whereas in cases with a DI staining pattern, only 41% of them showed persistence of the lesion (p <0.001). No correlation was found between HPV integration and the ISH staining pattern. Given the lower sensitivity and negative predictive value of ISH and its incapacity to demonstrate the integration of high-risk HPV in ASCUS and LSIL cases using liquid-based cytology, we do not recommend this technique for the triage of ASCUS and LSIL cases.

The value of p16 in ASCUS cases: a retrospective study using frozen cytologic material.

This study scans the efficacy of p16 immunostain on gynecological cytologies for the detection of high-grade lesions in ASCUS cases. This is a retrospective study that evaluates p16 immunostaining using frozen material from 109 cases diagnosed as ASCUS and followed for an average of 16 months. The diagnosis of ASCUS was made using liquid-based cytology (Thin Prep, Hologic, Marlborough, MA). High-risk HPV using Hybrid Capture II was performed. The immunohistochemical evaluation of p16 immunoreactivity was done following Wentzensen criteria. In the series p16 immunoreactivity showed a sensitivity and negative predictive value for HSIL, of 82.3 and 94.5% with specificity and positive predictive value of 100%. The sensitivity was similar to that found using the HC-II, though the specificity was much higher. The use of p16 immunostain in cytologic specimens applying the Wentzensen criteria helps to focus the attention in positive cells evaluating the cell changes, helps to detect some cells suspicious or diagnostic of HSIL, and could help to reclassify the ASCUS cases.