Factors associated with HPV persistence after treatment for high-grade cervical intra-epithelial neoplasia with large loop excision of the transformation zone (LLETZ).

BACKGROUND AND OBJECTIVE: Human Papillomavirus (HPV) persistence after high-grade cervical intra-epithelial neoplasia (CIN) removal may be associated with residual lesions or risk of disease recurrence. Knowledge regarding the factors associated with HPV persistence following CIN treatment is still limited. The main purpose of this longitudinal study was to assess the association between characteristics of the patients and their cervical lesions with high-risk HPV-type persistence, detected by commercially available Hybrid Capture II (HC II), after CIN 2 and 3 treatment with large loop excision of the transformation zone (LLETZ). STUDY DESIGN: For this cohort study, a total of 94 women submitted to LLETZ between March 2001 and September 2002 were included. Only women with at least one follow-up visit at 6 or 12 months and confirmed CIN 2 or 3 in the cone specimen were considered. In each visit women answered to a questionnaire and undertook Pap smear and HC II specimens collection. McNemar's, chi-square and Fisher tests were used for univariate analysis. Generalized Estimating Equations (GEE) were used for multivariate analysis. All calculations were performed within 95% confidence intervals (95% CI). RESULTS: Histological evaluation showed 12 (13%) women with CIN, 2 and 82 (87%) with CIN 3 and conization margins were compromised in 27 (29%) cases. Eighty-seven (92%) women showed positive HC II tests prior to LLETZ. Of women initially HPV negative, none had a positive HC II during follow-up. The proportion of positive HPV tests was reduced from 92% to 20%(P < 0.01) at the first visit and to 22% (P < 0.01) at the second visit after LLETZ. Multivariate analysis showed that smoking and age above 35 years (irrespective of margin status) were strongly associated with positive HPV during follow-up. CONCLUSION: HPV persistence following LLETZ was associated with smoking and with the interaction between age and conization margins.

Persistence of human papillomavirus DNA in cervical lesions after treatment with diathermic large loop excision.

OBJECTIVE: The aim of this study was to identify human papillomavirus (HPV) in cervical intraepithelial neoplasia (CIN) lesions and to evaluate the persistence of viral DNA after diathermic large loop excision (DLLE) treatment. STUDY DESIGN: Biopsies from 36 patients with low- and high-grade CIN lesions were studied before and after DLLE treatment looking for HPV sequences. DNA was extracted to perform a radioactive polymerase chain reaction (PCR) using GP 5,6 generic primers. PCR products were analyzed by the single-stranded conformational polymorphism (SSCP) which is a simultaneous detection and typing method. Dot-blot hybridization with generic and type-specific biotinylated oligonucleotide probes was applied in some cases. RESULTS: HPV DNA was found in all pretreatment samples, and the viral type was identified in 80% of them, HPV 16 being the most prevalent. The viral type coincided with that detected in the first biopsy in all except one case. Seventy five percent of the patients (27 cases) were negative for CIN at follow up, but 50% of them remained HPV DNA positive. CONCLUSION: DLLE treatment was effective in removing the CIN lesion but not the HPV. This fact points out the need to asses the presence of HPV in DNA during the follow-up, since viral persistence has been considered a high risk factor for recurrence and/or malignant transformation.

[Diathermic loop treatment of subclinical cervical infection by human papilloma virus (HPV). Short-term effectiveness]. / Tratamiento de la infección cervical subclínica por el virus del papiloma humano (VPH) con asa diatérmica. Eficacia a corto plazo.

Multiple modalities of treatment have been employed since cervical subclinical papillomavirus (SPI) were discovered, with various degrees of success. The objective of this report is to assess the efficacy of the removal of cervical SPI by mean of LEEP in office conization. During the period from January 1992 and December 1993, 49 patients with histologically proven HPV infection were treated at the Private Colposcopic Clinic with LEEP. Patients ages ranged from 20 to 49 years old with average 36.1 years, mostly were parous woman. Satisfactory specimens suitable for histologic examination was obtained and in all cases margins of excisions appeared histologically clear of HPV infections patients discomfort was none or minimal in 45 patients (91.8%) and moderate in 4 (8.1%). There were 5 cases (10.2%) of postoperative haemorrhage and 3 cases (6.1%) of minimal cervical infections. The mean base of cone biopsy was 1.43 cm, and ranged from 1.0 to 3.0 cm. The overall cure rate of LEEP was 98% because there was only one confirmed case of treatment failures by loop conization. We concluded that this term results are satisfactory.

Epithelial alterations adjacent to invasive squamous carcinoma of the vulva.

The slides of 64 vulvectomy specimens from vulvar squamous carcinoma were reviewed in order to study the histopathologic changes adjacent to the neoplasia. Normal epithelium was found in 7 cases (11%) and epithelial alterations adjacent to carcinoma in 59 (89%). The epithelial alterations found were: nonneoplastic epithelial disorder (NNDV) in 38 cases (59%) and vulvar intraepithelial neoplasia (VIN) in 19 (30%). The distribution of NNDV was: 20 cases of epithelial hyperplasia (EH) (31%), 6 of lichen sclerosus (9%) and 12 of the mixed type (19%). Sixteen cases of VIN 3 (25%) were undifferentiated, and three cases were differentiated VIN. Eighteen of 19 VIN cases were associated with NNDV, and 8 cases of undifferentiated VIN were associated with human papillomavirus infection. There was no apparent relationship between the associated lesions and tumor size, depth of invasion, lymph node metastases and clinical stage. Nevertheless, we found a significantly higher frequency of associated lesions in poorly differentiated tumors (P > .01). The most important finding was a high association between EH (50%) and VIN (30%) with carcinoma. VIN cases were almost always (95%) associated with EH.

[Electrosurgery resection of intraepithelial lesions of lower female genital tract]. / Resección electroquirúrgica de las lesiones intraepiteliales del tracto genital femenino inferior.

Twenty patients bearing lesions caused by human papillomavirus and intraepithelial neoplasia of the lower genital tract and treated with electrosurgical excision of the lesions are presented. The technique used, the benefits of the histopathologic assessment of the specimen, and the changes that this procedure produces in the specimen tissue are analyzed. In general terms, the pre and postoperative diagnosis were concordant and the early and late morbidity was found to be not significative. The efficacy of this therapy in the long term remains to be evaluated.

Nuevo enfoque terapeútico de la verruga plana / New therapeutic approach of the flat wart

Se propone el ensayo teraprútico para la Verruga Plana, afección viral producida por el Papiloma Virus Tipo 3,10,28 y que pertenece al género de los Papovavirus, utilizando el Ig. Parvum; considerado como un inmunopotenciador siguiendo una dosificación y técnica que nuestro juicio está exenta de riesgo y efectos colaterales y con resultado muy promisor