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1.
Prim Care ; 48(4): 583-595, 2021 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-34752271

RESUMO

Declining cervical cancer rates in the United States highlights the value of prevention and early detection of premalignant cervical disease afforded by the human papillomavirus vaccine and Pap smear. The availability of in-office loop electrosurgical excision procedure affords clinicians with a cost-effective and preferred tool for the excision of high-grade lesions of the cervix with minimal risk for severe adverse outcomes. The most recent American Society for Colposcopy and Cervical Pathology guidelines recommend a risk-based approach for the detection, treatment, and surveillance of cervical disease and specifically focus on the risk of developing cervical intraepithelial neoplasia 3 or worse histology.


Assuntos
Neoplasia Intraepitelial Cervical , Neoplasias do Colo do Útero , Neoplasia Intraepitelial Cervical/diagnóstico , Neoplasia Intraepitelial Cervical/cirurgia , Colposcopia , Eletrocirurgia , Feminino , Humanos , Gravidez , Neoplasias do Colo do Útero/diagnóstico , Neoplasias do Colo do Útero/cirurgia , Esfregaço Vaginal
2.
BMC Infect Dis ; 21(1): 1158, 2021 Nov 15.
Artigo em Inglês | MEDLINE | ID: mdl-34781884

RESUMO

BACKGROUND: Human papillomavirus (HPV) infection is the main cause of cervical cancer. Characteristics of HPV infections, including the HPV genotype and duration of infection, determine a patient's risk of high-grade lesions. Risk quantification of cervical lesions caused by different HPV genotypes is an important component of evaluation of cervical lesion. Data and evidence are necessary to gain a deeper understanding of the pathogenicity of different HPV genotypes. The present study investigated the clinical characteristics of patients infected with single human papillomavirus (HPV) 53. METHODS: This retrospective study analyzed the clinical data of patients who underwent cervical colposcopy guided biopsy between October 2015 and January 2021. The clinical outcomes and the follow-up results of the patients with single HPV53 infection were described. RESULTS: 82.3% of the initial histological results of all 419 patients with single HPV53 infection showed negative (Neg). The number of patients with cervical intraepithelial neoplasia (CIN)1, CIN2, CIN3, vaginal intraepithelial neoplasia (VaIN)1, CIN1 + VaIN1, CIN1 + VaIN2, and CIN2 + VaIN2 was 45, 10, 2, 9, 6, 1, and 1, respectively. Cancer was not detected in any patient. When the cytology was negative for intraepithelial lesion or malignancy (NILM), atypical squamous cells of undetermined significance (ASC-US) or low-grade squamous intraepithelial lesion (LSIL), we observed a significant difference in the distribution of histological results (P < 0.05). 95 patients underwent follow-up with cytology according to the exclusion criteria. No progression of high-grade lesions was observed during the follow-up period of 3-34 months. CONCLUSIONS: The lesion caused by HPV53 infection progressed slowly. The pathogenicity of a single HPV53 infection was low.


Assuntos
Alphapapillomavirus , Neoplasia Intraepitelial Cervical , Infecções por Papillomavirus , Neoplasias do Colo do Útero , Neoplasia Intraepitelial Cervical/epidemiologia , Colposcopia , Feminino , Humanos , Papillomaviridae/genética , Infecções por Papillomavirus/epidemiologia , Gravidez , Estudos Retrospectivos , Neoplasias do Colo do Útero/epidemiologia , Esfregaço Vaginal
3.
Pan Afr Med J ; 40: 55, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34795834

RESUMO

Introduction: histologic interpretation of hematoxylin and eosin-stained cervical biopsies is subject to substantial discordance among pathologists. Immunohistochemical staining for p16INK4a can reduce inter-observer disagreement. We did a cross-sectional study to evaluate the utility of p16INK4a staining in the assessment of cervical biopsies in Nairobi, Kenya. Methods: hematoxylin and eosin-stained sections from 91 colposcopic biopsies diagnosed as negative for dysplasia or as cervical intraepithelial neoplasia (CIN) grade 1-3 from 2011-2013 in Nairobi, Kenya, were reviewed and immunostained for p16INK4a. Agreement in interpretation of cervical biopsies was compared between primary and consensus review results. Results: on primary evaluation, 16 cases were negative for squamous dysplasia; 23 were CIN 1; 37 CIN 2; and 15 CIN 3. On consensus review, 32 cases were negative for dysplasia; 19 were CIN 1; 16 CIN 2 and 24 CIN 3. Agreement was moderate between primary and consensus histology review results for the diagnosis of low-grade versus high-grade squamous intraepithelial lesions (Kappa = 0.568). None of the cases negative for dysplasia were positive for p16INK4a expression, but in primary and consensus review results, 17% and 5% cases of CIN 1; 49% and 69% of CIN 2, and 80% and 96% of CIN 3 were p16INK4a positive, respectively. Conclusion: there was significant variability in the interpretation of cervical biopsies on hematoxylin and eosin between primary and consensus review assessments. 75% of CIN 1 cases that were upgraded to CIN 2 during consensus review expressed p16INK4a. These findings demonstrate the role of p16INK4a in increasing diagnostic accuracy and as a marker of high-grade CIN 2/3.


Assuntos
Neoplasia Intraepitelial Cervical/diagnóstico , Inibidor p16 de Quinase Dependente de Ciclina/genética , Displasia do Colo do Útero/diagnóstico , Neoplasias do Colo do Útero/diagnóstico , Adulto , Idoso , Biópsia , Neoplasia Intraepitelial Cervical/genética , Colposcopia , Estudos Transversais , Amarelo de Eosina-(YS) , Feminino , Hematoxilina , Humanos , Quênia , Pessoa de Meia-Idade , Displasia do Colo do Útero/genética , Neoplasias do Colo do Útero/genética , Adulto Jovem
4.
Zhonghua Fu Chan Ke Za Zhi ; 56(10): 691-696, 2021 Oct 25.
Artigo em Chinês | MEDLINE | ID: mdl-34823318

RESUMO

Objective: To screen out high risk factors of cervical intraepithelial neoplasia (CIN) of grade Ⅱ or worse (CIN Ⅱ+) by analyzing related factors for CIN Ⅱ+ detection in grade 1 abnormal colposcopic finding (G1) of cervix and provide reference for individual management of colposcopic performance. Methods: A retrospective study was performed on patients who were reffered to colposcopy for abnormal results of cervical cancer screening and only had G1 colposcopic findings of cervix at the First Affiliated Hospital of Nanjing Medical University, from April 2017 to January 2021. The factors influencing the detection of CIN Ⅱ+ were analyzed by univariate and multivariate analysis. Results: (1) A total of 403 patients were included in this study whose median age was 38 years old (range: 22-67 years old), and utimately 108 had high-grade squamous intraepithelial lesion, 1 had adenocarcinoma in situ and 1 had adenocarcinoma. The overall detection rate of CIN Ⅱ+ was 27.3% (110/403). (2) Univariate analysis showed that the detection rate of CIN Ⅱ+, in patients ≥50 years old was higher than that in patients <50 years old (38.3% vs 25.4%; χ²=4.328, P=0.037), and in HPV 16 positive cases was higher than that in non-HPV 16 positive cases (41.8% vs 21.8%; χ²=16.080, P<0.01); as the cytological severity (χ²=6.775, P=0.009) and the number of involving quadrants (χ²=31.117, P<0.01) increased, the risk of CIN Ⅱ+ detection increased; but the types of colpolscopic signs were not related to detection of CIN Ⅱ+(χ²=0.323, P=0.851). Multivariable analysis showed that the age of ≥50 years old (OR=2.504, 95%CI: 1.299-4.830, P=0.006), HPV 16 positive type (OR=3.353, 95%CI: 2.004-5.608, P<0.01) and the increase of involving quadrants (OR=1.899, 95%CI: 1.518-2.376, P<0.01) were independent risk factors. (3) The detection rate of CIN Ⅱ+ was highest in the women with HPV 16 positive type and four quadrants of G1 (73.7%), while lowest in the women with non-HPV 16 positive type and one quadrant of G1 (10.4%). Conclusions: The age of ≥50 years old, HPV 16 positive type and the increase of involving quadrants are independent risk factors of detecting CIN Ⅱ+ in G1 colposcopic findings. So the key point of the individual management of G1 groups with different risk stratification is to adequately biopsy in high-risk group to avoid miss diagnosis of CIN Ⅱ+.


Assuntos
Neoplasia Intraepitelial Cervical , Infecções por Papillomavirus , Neoplasias do Colo do Útero , Adulto , Idoso , Neoplasia Intraepitelial Cervical/diagnóstico , Neoplasia Intraepitelial Cervical/epidemiologia , Colo do Útero , Colposcopia , Detecção Precoce de Câncer , Feminino , Humanos , Pessoa de Meia-Idade , Papillomaviridae , Infecções por Papillomavirus/diagnóstico , Infecções por Papillomavirus/epidemiologia , Gravidez , Estudos Retrospectivos , Neoplasias do Colo do Útero/diagnóstico , Neoplasias do Colo do Útero/epidemiologia , Adulto Jovem
5.
Mymensingh Med J ; 30(4): 1100-1106, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34605483

RESUMO

Cancer of the uterine cervix is one of the leading causes of mortality and morbidity among women in poor countries. It is the most common reproductive cancer among women in Bangladesh and most women are diagnosed at advanced stage when appropriate treatment is not possible. But this cancer is preventable through proper screening and simultaneous treatment of premalignant lesions. The same day "Screen and Treat" approach is an endeavour to reach the goal especially at low resource settings. Ablation of precancerous lesions by thermo-coagulation is a promising mode of complete cure as this method is easy to apply, effective and relatively cheaper than other procedures. To avoid the issue of overtreatment, an intermediate approach- colposcopy can be used. Aim of this study was to diagnose premalignant lesions of cervix during screening procedure and to treat the lesions by thermo-coagulation at the same sitting. This prospective study was carried out at Upzilla Health Complex (UHC), Rangunia, from 3rd February 2018 to 6th February 2018 in a campaign of cervical cancer screening program by visual inspection of cervix with 5.00% acetic acid (VIA). About 1000 women attending the outpatient department were enrolled in this study by consecutive sampling technique according to inclusion and exclusion criteria. Informed consent was taken after explaining the screening method, thermo-coagulation procedure and follow up schedule. VIA was found positive in 22 cases. Colposcopy was done in VIA positive cases by Gynocular colposcope. Punch biopsy was taken when colposcopy revealed positive in 12 women. Then thermo-coagulation was done. Histopathology report revealed, CIN1 (cervical intraepithelial neoplasia 1)- in 6 cases (50.00%); CIN 2 (cervical intraepithelial neoplasia 2)- in 01 case (8.33%); Chronic cervicitis with squamous metaplasia- in 05 cases (41.67%). Sensitivity and specificity of colposcopy was calculated considering colposcopy directed biopsy as gold standard, which was 100.00% and 75.00% respectively in CIN-1. While in CIN-2 it was 100.00% and 95.20% respectively. VIA is an effective screening tool for cancer cervix. Main advantage is the "screen and treat" approach can be attempted for at risk women in low resource setting by thermo-coagulation which is accepted by women while guaranteeing satisfactory cure rates. Thus, reduces loss to follow-up and have an impact on cervical cancer control.


Assuntos
Neoplasia Intraepitelial Cervical , Neoplasias do Colo do Útero , Ácido Acético , Neoplasia Intraepitelial Cervical/diagnóstico , Neoplasia Intraepitelial Cervical/cirurgia , Colposcopia , Detecção Precoce de Câncer , Feminino , Humanos , Programas de Rastreamento , Gravidez , Estudos Prospectivos , Neoplasias do Colo do Útero/diagnóstico , Neoplasias do Colo do Útero/cirurgia
6.
N Z Med J ; 134(1543): 69-78, 2021 10 08.
Artigo em Inglês | MEDLINE | ID: mdl-34695078

RESUMO

AIM: The aim of this study was to examine the demographic factors associated with attendance at colposcopy clinics among Pacific women following a high-grade cytology in New Zealand. METHODS: A retrospective cohort study was undertaken of Pacific women following high-grade cytology between January 2010 and December 2015. Univariate and multivariate binary logistic regression was undertaken to assess whether socioeconomic deprivation, age and Pacific ethnicity were associated with colposcopy attendance. RESULTS: Colposcopy attendance for Pacific women was 84.9% at 90 days and 93.5% at 180 days following referral. Pacific women residing in the most deprived areas were less likely to attend at both 90 days (OR=0.37 95% CI: 0.21-0.67) and 180 days (OR=0.19 95% CI: 0.60-0.63). Older women were more likely to attend their colposcopy appointment at 90 days when compared to the reference group aged <24-years-old. There was no association between Pacific ethnicity and attendance when adjusting for deprivation and age. CONCLUSIONS: The overall attendance rates for Pacific women were higher than expected. Despite Pacific women engaging with cervical screening, Pacific women living in the most deprived areas were less likely to be seen by colposcopy services following a high-grade cytology. Targeted interventions are required to improve service utilisation and reduce health inequities.


Assuntos
Colposcopia , Programas de Rastreamento/estatística & dados numéricos , Grupo com Ancestrais Oceânicos , Neoplasias do Colo do Útero/diagnóstico , Adulto , Fatores Etários , Idoso , Instituições de Assistência Ambulatorial , Neoplasia Intraepitelial Cervical/diagnóstico , Feminino , Humanos , Modelos Logísticos , Pessoa de Meia-Idade , Análise Multivariada , Nova Zelândia , Estudos Retrospectivos , Classe Social , Neoplasias do Colo do Útero/prevenção & controle , Adulto Jovem
7.
Zhonghua Fu Chan Ke Za Zhi ; 56(8): 569-575, 2021 Aug 25.
Artigo em Chinês | MEDLINE | ID: mdl-34420289

RESUMO

Objective: To investigate the application value of vaginoscopy in the diagnosis and treatment of vaginal squamous intraepithelial lesions post hysterectomy. Methods: From May 2017 to June 2020, patients with high-risk (HR)-HPV infection and (or) cytological abnormalities after hysterectomy in Obstetrics and Gynecology Hospital Affiliated to Fudan University were examined by colposcopy, and those who were not satisfied with exposure under colposcopy were further examined by vaginoscopy. The role of vaginoscopy in the detection and treatment of occult vaginal squamous intraepithelial lesions was analyzed. Results: A total of 153 patients with HR-HPV infection and (or) cytological abnormalities, and inadequate colposcopy were enrolled in this study. The average age was (49.8±8.1) years. All cases were successfully performed vaginoscopy with no vaginal perforation, no bladder and intestinal injury. During vaginoscopy, 11 (7.2%, 11/153) cases with unclear high-grade squamous intraepithelial lesion (HSIL) boundary under colposcopy were found with clear HSIL boundary, and new HSIL was found in 23 (15.0%, 23/153) cases. According to colposcopy, there were 89 cases of normal or inflammation, 45 cases of vaginal low-grade squamous intraepithelial lesion (LSIL) and 19 cases of vaginal HSIL. According to vaginoscopy, there were 56 cases of normal or chronic inflammation, 55 cases of vaginal LSIL, 40 cases of vaginal HSIL (including 2 cases of vaginal HSIL could not exclude cancer) and 2 cases of vaginal carcinoma. There were significant difference between colposcopy and vaginoscopy (P<0.01). The missed diagnosis rate of vaginal apex blind curettage under colposcopy was 54.8%. For the 40 cases with vaginal HSIL under vaginoscopy, 15 cases were completely curettaged with vaginal endoscopic claw forceps, and 22 cases were vaporized by Versapoint. Among the 37 cases of vaginal HSIL treated by vaginoscopy, 34 cases were followed up for 6 months with 31 cases of vaginal HSIL cured. The cure rate was 91.2% (31/34), the positive rate of HR-HPV decreased from 100.0% (34/34) to 79.4% (27/34). Conclusion: For patients with inadequate exposure of vaginal apex during colposcopy posthysterectomy, vaginoscopy is helpful to detect the occult lesions in the vaginal apex, and it could also be used for the treatment of vaginal squamous intraepithelial lesions.


Assuntos
Neoplasia Intraepitelial Cervical , Lesões Intraepiteliais Escamosas , Neoplasias do Colo do Útero , Adulto , Neoplasia Intraepitelial Cervical/diagnóstico , Neoplasia Intraepitelial Cervical/cirurgia , Colposcopia , Feminino , Humanos , Pessoa de Meia-Idade , Gravidez , Esfregaço Vaginal
8.
Int J Gynaecol Obstet ; 155(2): 275-281, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34382217

RESUMO

OBJECTIVE: To develop an in-depth understanding of HPV self-testing cervical screening clinical pathways for never-/under-screened Maori women. METHODS: Based on a community-based cluster randomized controlled trial in Aotearoa (New Zealand), a Kaupapa Maori (by Maori, for Maori) qualitative study enrolled Maori women who met the eligibility criteria of the HPV trial intervention (aged 25-69 years, no screen in >4 years). In total, 28 were recruited (22 had a negative test, six had a positive test and colposcopy). They were asked about their clinical pathway. RESULTS: The HPV self-test was seen as empowering and promoting bodily autonomy, although some women expressed fears or misconceptions about this new technology. While those with a negative test were relieved, for the six women who had a positive test, there were many fears, compounded by seeking out information on the Internet. When attending colposcopy, the importance of support and responsive care was emphasized. CONCLUSION: HPV self-testing has the potential to improve access to cervical screening and reduce inequities for Maori. Care must be taken in the delivery of screening and colposcopy results. Primary care and colposcopy services need to take special care with never-/under-screened Maori women to provide sensitive, responsive care, and mitigate trauma.


Assuntos
Infecções por Papillomavirus , Neoplasias do Colo do Útero , Colposcopia , Procedimentos Clínicos , Detecção Precoce de Câncer , Feminino , Humanos , Programas de Rastreamento , Grupo com Ancestrais Oceânicos , Papillomaviridae , Infecções por Papillomavirus/diagnóstico , Gravidez , Autoteste , Neoplasias do Colo do Útero/diagnóstico , Esfregaço Vaginal
9.
Arch Gynecol Obstet ; 304(5): 1253-1258, 2021 11.
Artigo em Inglês | MEDLINE | ID: mdl-34432109

RESUMO

OBJECTIVES: To assess the effectiveness of colposcopy in detecting cervical lesions and to grade them according to Reid score and Swede score, and compare it with histopathology results. METHODS: This study was conducted on 130 patients in a tertiary care centre, who were subjected to pap smear and colposcopy. The cervical lesions were graded according to Reid score and Swede score, and a biopsy was obtained from the lesion. Histopathology results were correlated with colposcopy findings, and the scores were compared. RESULTS: The colposcopic findings using Reid score and Swede score correlated with histopathology results in the study population. The association between colposcopic impression and histopathology result was highly significant (p < 0.001), using both Reid score and Swede score. The sensitivity, specificity, PPV and NPV of Reid score (overall) was 86.2%, 80.20%, 55.56% and 95.3%, respectively. The diagnostic accuracy was 81.54%. At score > 5, specificity increased to 99% and diagnostic accuracy was 92.31%. The overall sensitivity, specificity, PPV, NPV and diagnostic accuracy of Swede score was 89.7%, 49.5%, 33.8%, 94.3% and 48.46%, respectively. As the cut off value increased, the sensitivity decreased. But the specificity, PPV, NPV and diagnostic accuracy increased and was statistically significant. The specificity and PPV was 100% at score > 8. CONCLUSION: As the cut off value increased, the diagnostic accuracy of both the Scores increased, and was more accurate in detecting high-grade lesions.


Assuntos
Neoplasia Intraepitelial Cervical , Neoplasias do Colo do Útero , Neoplasia Intraepitelial Cervical/diagnóstico , Colposcopia , Feminino , Humanos , Teste de Papanicolaou , Gravidez , Sensibilidade e Especificidade , Neoplasias do Colo do Útero/diagnóstico
11.
JCO Glob Oncol ; 7: 1251-1259, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-34351814

RESUMO

PURPOSE: Belize has one of the highest cervical cancer burdens among Latin American and Caribbean countries, despite the implementation of national policies to increase access to prevention and treatment services. This study evaluates the policies, infrastructure, and workforce of the cervical cancer management system in Belize to inform capacity building efforts. METHODS: In 2018, health facility assessments were conducted across all six districts of Belize at the national pathology facility and 12 public facilities identified as critical to cervical cancer control. Human and infrastructure resource availability and existing policies related to cervical cancer screening and treatment services were assessed through a structured instrument. RESULTS: The public cervical cancer screening workforce in Belize consists of 75 primary care nurses and physicians-one per 1,076 screening-eligible women, with 44% conducting rural outreach. All districts have at least one screening facility, but 50% perform screening services only once per week. Colposcopy and loop electrical excision procedures are available in three and four districts, respectively; radical hysterectomy and chemotherapy are available in two districts; and radiation therapy is unavailable. Of essential pathology equipment, 38.5% were present and functional, 23% were present but nonfunctional, and 38.5% were unavailable. Additionally, 35% of supplies were unavailable at the time of assessment, and 75% were unavailable at least once in the 12 months before assessment. CONCLUSION: Public-sector cervical cancer management services differ among districts of Belize, with tertiary service availability concentrated in the largest district. Screening, outreach, and pathology are limited mostly by resource availability. This study characterizes the current capacity of services in Belize and pinpoints health system components for future investment and capacity-building efforts.


Assuntos
Neoplasias do Colo do Útero , Belize , Colposcopia , Atenção à Saúde , Detecção Precoce de Câncer , Feminino , Humanos , Gravidez , Neoplasias do Colo do Útero/diagnóstico , Neoplasias do Colo do Útero/epidemiologia , Neoplasias do Colo do Útero/prevenção & controle
12.
Klin Lab Diagn ; 66(7): 417-421, 2021 Jul 16.
Artigo em Inglês | MEDLINE | ID: mdl-34292684

RESUMO

The investigation aims - a quantitative assessment of cervical surface changes with digital analysis and computer technologies in dysplasia. Colposcopy was made in 90 women from 21 to 52 years (avr. age 33,9±8,13 y.o.) with mild epithelial dysplasia (CIN1), moderate dysplasia (CIN2), severe dysplasia (CIN3). The algorithm detected indicators which provide the cervical dysplasia classification on pre cytological and pre molecular-genetic patients investigations. The outcome of an algorithm was the identification of the cervix surface condition severity by an objective quantification. The cervical dysplasia type (CIN) was classified as IndGV values. The mild dysplasia (CIN1) had IndGV=8,5, moderate dysplasia (CIN2) - IndGV=13, severe dysplasia (CIN3) - IndGV=15,6. The cervical affected surface area (IndInt) equalled 0,17 in CIN1, 0,19 in CIN2, 0,22 in CIN3. A change severity has a direct relation with a grey color value. It demonstrates quantify classification in digital analysis. The algorithm is used in real-time mode and no requires considerable material outlays. This makes it possible to use an algorithm after clinical examination and predict patient management.


Assuntos
Neoplasia Intraepitelial Cervical , Infecções por Papillomavirus , Neoplasias do Colo do Útero , Adulto , Neoplasia Intraepitelial Cervical/diagnóstico , Colposcopia , Feminino , Humanos , Hiperplasia , Gravidez
13.
BMC Infect Dis ; 21(1): 691, 2021 Jul 17.
Artigo em Inglês | MEDLINE | ID: mdl-34273957

RESUMO

BACKGROUND: Female genital schistosomiasis (FGS) is a neglected tropical gynaecological disease that affects millions of women in sub-Saharan Africa (SSA). FGS is caused by Schistosoma haematobium, a parasitic carcinogen involved in the pathogenesis of squamous cell carcinoma of the bladder. Cervical cancer incidence and mortality are highest in SSA, where pre-cancerous cervical dysplasia is often detected on screening with visual inspection with acetic acid (VIA). There are no studies evaluating the association between VIA positivity and FGS diagnosed by genital PCR. METHODS: Women were recruited from the Bilharzia and HIV (BILHIV) study in Zambia a community-based study comparing genital self-sampling to provider obtained cervicovaginal-lavage for the diagnosis of FGS in women aged 18-31. FGS was defined as positive Schistosoma DNA from any genital PCR. Urogenital schistosomiasis diagnostics included urine circulating anodic antigen, urine microscopy and portable colposcopy. Participants were offered cervical cancer screening using VIA at Livingstone Central Hospital. Associations of PCR confirmed FGS and other diagnostics with VIA positivity were assessed using multivariable logistic regression. RESULTS: VIA results were available from 237 BILHIV participants. A positive Schistosoma PCR in any genital specimen was detected in 14 women (5.9%), 28.6% (4/14) of these women had positive VIA compared to 9.0% without PCR evidence of schistosome infection (20/223). Schistosoma PCR positivity in any genital specimen was strongly associated with VIA positivity (OR: 6.08, 95% CI: 1.58-23.37, P = 0.02). CONCLUSIONS: This is the first study to find an association between FGS and positive VIA, a relationship that may be causal. Further longitudinal studies are needed.


Assuntos
Esquistossomose Urinária/epidemiologia , Displasia do Colo do Útero/epidemiologia , Adolescente , Adulto , Animais , Neoplasia Intraepitelial Cervical/diagnóstico , Neoplasia Intraepitelial Cervical/epidemiologia , Neoplasia Intraepitelial Cervical/parasitologia , Colposcopia/métodos , Testes Diagnósticos de Rotina/métodos , Detecção Precoce de Câncer/métodos , Feminino , Genitália Feminina/parasitologia , Genitália Feminina/patologia , Humanos , Incidência , Microscopia/métodos , Reação em Cadeia da Polimerase , Schistosoma haematobium/genética , Schistosoma haematobium/isolamento & purificação , Esquistossomose Urinária/diagnóstico , Esquistossomose Urinária/parasitologia , Manejo de Espécimes , Urinálise/métodos , Displasia do Colo do Útero/diagnóstico , Displasia do Colo do Útero/parasitologia , Neoplasias do Colo do Útero/diagnóstico , Neoplasias do Colo do Útero/epidemiologia , Neoplasias do Colo do Útero/parasitologia , Adulto Jovem , Zâmbia/epidemiologia
14.
Eur J Obstet Gynecol Reprod Biol ; 264: 56-59, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34273753

RESUMO

PURPOSE: The aim of this study is to present a single department's experience on cervical cancer cases following previous excision of cervical intraepithelial neoplasia (CIN) and to discuss potential pathogenesis. METHODS: Nine cervical cancer cases meeting the inclusion criteria, with available pathological and follow-up data, were considered eligible for this study. RESULTS: The majority (7/9) have had clear excisional margins. The interval between initial treatment and cancer diagnosis ranged from 7 to 17 years. In all cases cancer diagnosis was "unexpected", as the prior cytological and/or colposcopic evaluation was not suggestive of significant cervical pathology. All cancers were squamous, and 5/9 at stage I. CONCLUSION: The long interval between initial CIN treatment and final diagnosis as well as the normal post-treatment follow-up may suggest a 'de novo' underlying but 'hidden' carcinogenesis process. It might be that dysplastic cells entrapped within crypts (or normal metaplastic affected by the same predisposing factors) continue undergoing their evolution, undetectable by cytology and colposcopy until they invade stroma and surfaces (endo- and/or ectocervical) approximately a decade later. Heavy cauterisation of cervical crater produced post excision might be a potential culprit of this entrapment.


Assuntos
Neoplasia Intraepitelial Cervical , Neoplasias do Colo do Útero , Neoplasia Intraepitelial Cervical/cirurgia , Colposcopia , Feminino , Humanos , Margens de Excisão , Gravidez , Neoplasias do Colo do Útero/diagnóstico , Neoplasias do Colo do Útero/cirurgia
15.
BMC Cancer ; 21(1): 804, 2021 Jul 13.
Artigo em Inglês | MEDLINE | ID: mdl-34253177

RESUMO

BACKGROUND: In the absence of practical and reliable predictors for whether the endocervical curettage (ECC) procedure should be performed, decisions regarding patient selection are usually based on the colposcopists' clinical judgment instead of evidence. We aimed to develop and validate a practical prediction model that uses available information to reliably estimate the need to perform ECC in patients suspected of having cervical lesions. METHODS: In this retrospective study, 2088 patients who underwent colposcopy, colposcopically directed biopsy (CDB) and ECC procedures between September 2019 and September 2020 at the Second Hospital of Shanxi Medical University were included. The data were analyzed with univariate and multivariable logistic regression. Least absolute shrinkage and selection operator (LASSO) was used to select predictors for ECC positivity. The ECC prediction model was presented as a nomogram and evaluated in terms of discrimination and calibration. Furthermore, this model was validated internally with cross-validation and bootstrapping. RESULTS: Significant trends were found for ECC positivity with increasing age (P = 0.001), menopause (P = 0.003), Human papillomavirus (HPV) status (P < 0.001), severity of ThinPrep Cytological Test (TCT) (P < 0.001), original squamous epithelium ectopia (P = 0.037) and colposcopy impression (P < 0.001) by multivariable logistic regression analysis. The ECC prediction model was developed based on the following predictors: age, menopause, symptom of contact bleeding, severity of TCT, HPV status, cervix visibility, original squamous epithelium ectopia, acetowhite changes and colposcopic impression. This model had satisfactory calibration and good discrimination, with an area under the receiver operator characteristic curve (AUC) of 0.869 (95% confidence interval 0.849 to 0.889). CONCLUSIONS: A readily applicable clinical prediction model was constructed to reliably estimate the probability of ECC positivity in patients suspicious of having cervical lesions, which may help clinicians make decisions regarding the ECC procedure and possibly prevent adverse effects.


Assuntos
Biópsia/métodos , Colposcopia/métodos , Curetagem/métodos , Neoplasias do Colo do Útero/cirurgia , Adulto , Tomada de Decisões , Feminino , Humanos , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Neoplasias do Colo do Útero/patologia
17.
Femina ; 49(7): 425-432, 20210731. ilus
Artigo em Português | LILACS | ID: biblio-1290592

RESUMO

As células glandulares atípicas representam 0,2% a 2,1% dos resultados dos testes de Papanicolaou. Mesmo com essa baixa prevalência, tem um significado importante no diagnóstico do câncer cervical e endometrial, tendo em vista que tais células e subcategorias, associadas à idade da paciente, podem prenunciar um número expressivo de doença intraepitelial, doença invasiva do endocérvix, endométrio e até neoplasias anexiais. E não se pode esquecer do importante número de resultados histológicos benignos, identificados no seguimento dessas pacientes, muitas vezes assintomáticas.(AU)


Atypical glandular cells represent 0,2% to 2,1% of Pap test results even with this low prevalence has an important significance in the diagnosis of cervical and endometrial cancer, considering that such cells and subcategories associated with the patient's age can predict a significant number of intraepithelial disease, invasive disease of the endometrium, endocervix and even adnexial neoplasms; no forgetting the important number of benign histological results, identified in the follow up of these patients, often asymptomatic.(AU)


Assuntos
Humanos , Feminino , Neoplasias do Colo do Útero/patologia , Colo do Útero/cirurgia , Carcinoma Endometrioide/patologia , Conização , Adenocarcinoma in Situ/cirurgia , Adenocarcinoma in Situ/patologia , Colposcopia , Citodiagnóstico/métodos
18.
PLoS One ; 16(7): e0253493, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34197472

RESUMO

OBJECTIVE: To validate the colposcopy indication proposed by the 2019 ASCCP Risk-Based Management Consensus Guidelines for abnormal cervical cancer screening tests (the 2019 ASCCP guidelines). METHODS: Clinical data of 1404 patients who underwent colposcopy in single center in China were reviewed. Based on history and current cervical screening (HPV & cytology), corresponding recommendations were given according to the 2019 ASCCP guidelines. The agreement and discrepancy of colposcopy indication were analyzed between the Chinese consensus and the 2019 ASCCP guidelines. RESULTS: Colposcopy indication was matched in about 80% patients. The left 20% were recommended with follow-up by the 2019 ASCCP guidelines. The discrepancy mainly focused on patients having a current result of HPV-positive NILM without unknown history. The ratio of observed CIN3+ in our database over estimated CIN3+ by the 2019 ASCCP guidelines was 6.2 (31/5). The ratio was even higher in patients with HPV16/18-positive NILM (7, 28/4), compared with those with other types of high-risk HPV-positive NILM (3, 3/1). The 2019 ASCCP guidelines had a relatively high sensitivity (83.1%), a low specificity (21.5%), a low positive predictive value (14.1%) and a high negative predictive value (89.1%) for prediction of CIN 3+. CONCLUSIONS: We could try to apply the 2019 ASCCP guidelines in Chinese population. The classification of HR-HPV was strongly recommended during risk assessment. For patients with HPV16/18 infection, colposcopy should be recommended. Perspective multi-center randomized controlled trial with reliable follow-up should be performed in the future to confirm the feasibility.


Assuntos
Neoplasia Intraepitelial Cervical/diagnóstico , Colposcopia/normas , Detecção Precoce de Câncer/métodos , Guias como Assunto , Neoplasias do Colo do Útero/diagnóstico , Adulto , Neoplasia Intraepitelial Cervical/patologia , China , Feminino , Papillomavirus Humano 16/isolamento & purificação , Papillomavirus Humano 18/isolamento & purificação , Humanos , Programas de Rastreamento/métodos , Infecções por Papillomavirus/patologia , Estudos Retrospectivos , Risco , Neoplasias do Colo do Útero/patologia
19.
BMC Womens Health ; 21(1): 257, 2021 06 24.
Artigo em Inglês | MEDLINE | ID: mdl-34167543

RESUMO

BACKGROUND: Colposcopy offers an accurate way to the diagnose of cervical precancerous lesions. However, the diagnostic accuracy of colposcopy is unsatisfied. This study was to evaluate colposcopic accuracy according to the 2011 International Federation of Cervical Pathology and Colposcopy (IFCPC) terminology. METHODS: A retrospective cohort study was performed in 1,838 patients who underwent colposcopy in Shandong Qianfoshan Hospital, Cheeloo College of Medicine, Shandong University from October 2013 to April 2018. Using conization or cervical biopsy pathology as the gold standard, the agreement between colposcopic diagnosis and pathologic diagnosis was calculated, and correlations between variables were analyzed. RESULTS: As an authoritative and widely used terminology for colposcopy diagnosis, the 2011 IFCPC terminology has certain clinical practicality and diagnostic accuracy. However, some signs such as mosaic, punctation, sharp border, inner border sign and ridge sign had high specificity but unsatisfactory sensitivity, which limited the diagnostic value. Therefore, we discussed the Lugol's staining, a very common sign in colposcopy, and analyzed the diagnostic significance of bright yellow staining in low-grade squamous intraepithelial lesion (LSIL) and mustard yellow staining in high-grade squamous intraepithelial lesion (HSIL). The results showed that mustard yellow may be a valuable indicator in the diagnosis of HSIL. CONCLUSION: The 2011 IFCPC colposcope terminology has standardized interpretations of the colposcopic findings and improved the accuracy of colposcopy diagnosis. The aceto-white epithelium still has important diagnostic value; however, the value of a few signs is needed to be discussed and new signs are expected to be discovered. Although the significance of Lugol's staining was diminishing, mustard yellow might be a valuable indicator for the diagnosis of HSIL.


Assuntos
Colposcopia , Neoplasias do Colo do Útero , Colposcópios , Feminino , Humanos , Gravidez , Estudos Retrospectivos , Neoplasias do Colo do Útero/diagnóstico
20.
Eur J Obstet Gynecol Reprod Biol ; 262: 228-231, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34087721

RESUMO

OBJECTIVES: In 2018, an inquiry into the Irish Cervical Cancer screening programme (CervicalCheck) was initiated, following publicised cases of non-disclosure regarding internal audit results of cytology screening in women diagnosed with cervical cancer. The inquiry attracted widespread media coverage and the government offered women free, out of programme screening. We investigated whether the controversy led to an increase in referrals based on clinical suspicion and the impact on waiting times for abnormal cytology. STUDY DESIGN: A retrospective cross-sectional analysis was performed, including all colposcopy referrals to The National Maternity Hospital, Dublin, before (March 2016-2018) and after (March 2018-2020) the media coverage. Chi-squared (χ2) and independent one-tailed t-tests were used to perform between-group analyses. RESULTS: Post-controversy, suspicious cervix referrals increased (10.1 %-14.2 %; p = 0.037 × 10-27), as did colposcopic impression of CIN (p = 0.000000016). While an increase in CIN1 histology (18.5 %-30.3 %) was diagnosed, a decrease in high-risk CIN2 (10 % to 8.6 %), CIN3 (6.2 % to 2.9 %), AIS (1.2 % to 0.3 %) and invasive cancer (2.8 % to 1.2 %; p = 0.0058 × 10-9) were diagnosed. Across all grades of cytological abnormality, significantly fewer patients were reviewed in the recommended waiting time post-controversy. Half of delayed abnormal cytology referrals had high-grade changes. CONCLUSIONS: This study highlights the profound impact that the CervicalCheck Controversy had on the women attending colposcopy and clinicians performing the screening tests, and the direct impact on women with confirmed cytological abnormalities. The increase in suspicious cervix referrals reflects a lack of confidence in both clinical practice and screening test results. The importance of public trust in the effective delivery of screening services cannot be ignored. Increased resources are required to ensure all women are seen within recommended time frames. Heightened anxiety and increased surveillance does not necessarily lead to better clinical outcomes for patients but can result in unnecessary distress for low-risk patients and delays to diagnosis for high-risk patients with concerning abnormalities.


Assuntos
Neoplasia Intraepitelial Cervical , Neoplasias do Colo do Útero , Estudos de Coortes , Colposcopia , Estudos Transversais , Detecção Precoce de Câncer , Feminino , Humanos , Irlanda , Gravidez , Estudos Retrospectivos , Esfregaço Vaginal
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