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1.
Gene ; 723: 144142, 2020 Jan 10.
Artigo em Inglês | MEDLINE | ID: mdl-31589957

RESUMO

DNA methylation is an epigenetic alteration that may lead to carcinogenesis by silencing key tumor suppressor genes. Hypermethylation of the paired box gene 1 (PAX1) promoter is important in cervical cancer development. Here, PAX1 methylation levels were compared between Uyghur and Han patients with cervical lesions. Data on PAX1 methylation in different cervical lesions were obtained from the Gene Expression Omnibus (GEO) database, whereas data on survival and PAX1 mRNA expression in invasive cervical cancer (ICC) were retrieved from the Cancer Genome Atlas (TCGA) database. MassARRAY spectrometry was used to detect methylation of 19 CpG sites in the promoter region of PAX1, whereas gene mass spectrograms were drawn by Matrix-Assisted Laser Desorption/Ionization Time-of-Flight Mass Spectrometry. Human papillomavirus (HPV) 16 infection was detected by polymerase chain reaction. PAX1 methylation in high-grade squamous intraepithelial lesion (HSIL) and ICC was significantly higher than in normal tissues. PAX1 hypermethylation was associated with poor prognosis and reduced transcription. ICC-specific PAX1 promoter methylation involved distinct CpG sites in Uyghur and Han patients HPV16 infection in HSIL and ICC patient was significantly higher than in normal women (p < 0.05). Our study revealed a strong association between PAX1 methylation and the development of cervical cancer. Moreover, hypermethylation of distinct CpG sites may induce HSIL transformation into ICC in both Uyghur and Han patients. Our results suggest the existence of ethnic differences in the genetic susceptibility to cervical cancer. Finally, PAX1 methylation and HPV infection exhibited synergistic effects on cervical carcinogenesis.


Assuntos
Carcinoma de Células Escamosas/virologia , Metilação de DNA , Papillomavirus Humano 16/patogenicidade , Fatores de Transcrição Box Pareados/genética , Infecções por Papillomavirus/diagnóstico , Lesões Intraepiteliais Escamosas Cervicais/virologia , Neoplasias do Colo do Útero/virologia , Carcinoma de Células Escamosas/genética , China/etnologia , DNA Viral/genética , Bases de Dados Factuais , Regulação para Baixo , Epigênese Genética , Feminino , Regulação Neoplásica da Expressão Gênica , Papillomavirus Humano 16/genética , Humanos , Infecções por Papillomavirus/genética , Prognóstico , Regiões Promotoras Genéticas , Lesões Intraepiteliais Escamosas Cervicais/genética , Análise de Sobrevida , Neoplasias do Colo do Útero/genética
2.
J Clin Pathol ; 73(1): 30-34, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31315894

RESUMO

AIMS: The purpose of the present study was to elucidate the presence of human herpesvirus 6A (HHV-6A), HHV-6B and HHV-7 in samples of the uterine cervix through detection of viral DNA. We analysed normal tissues, samples with low-grade squamous intraepithelial lesions (LSILs) and high-grade squamous intraepithelial lesions (HSILs). We correlated the presence of HHV-6 and HHV-7 with the finding of human papillomavirus (HPV) in mucosal samples. METHODS: Cervical samples were examined and grouped as follows: group 1 (n=29), normal cytology; group 2 (n=61), samples with LSIL; group 3 (n=35), samples with HSIL. Molecular biology examinations were performed in all samples to detect HHV-6, HHV-7 and HPV DNA and to typify HHV-6 species. RESULTS: Group 1: normal cytology and HPV (-): HHV-6: 6.8% (2/29), HHV-7: 79.3% (23/29); group 2: LSIL and HPV (-): HHV-6: 93.1% (27/29), HHV-7: 96.5% (28/29); LSIL and HPV (+): HHV-6: 0% (0/32), HHV-7: 90.6% (29/32); group 3: HSIL and HPV (-): HHV-6: 20% (2/10), HHV-7: 70% (7/10); HSIL HPV (+): HHV-6: 12% (3/25), HHV-7: 68% (17/25). HHV-6A DNA was not detected in any samples. CONCLUSIONS: (1) Both HHV-6 and HHV-7 infect the mucosal cells of the cervix with higher prevalence of HHV-7. (2) The higher prevalence of HHV-6 in LSIL HPV (-) samples compared with those with normal cytology indicates that it constitutes a possible risk factor for atypia production. (3) The presence of HHV-7 in all samples questions its role in the production of atypia. (4) The finding of HHV-6 and HHV-7 suggests that the cervical mucosa is a possible transmission pathway for these viruses.


Assuntos
Neoplasia Intraepitelial Cervical/diagnóstico , DNA Viral/genética , Herpesvirus Humano 6/genética , Herpesvirus Humano 7/genética , Técnicas de Diagnóstico Molecular , Infecções por Roseolovirus/diagnóstico , Lesões Intraepiteliais Escamosas Cervicais/diagnóstico , Neoplasias do Colo do Útero/diagnóstico , Adolescente , Adulto , Argentina , Neoplasia Intraepitelial Cervical/genética , Neoplasia Intraepitelial Cervical/virologia , Feminino , Testes de DNA para Papilomavírus Humano , Humanos , Pessoa de Meia-Idade , Papillomaviridae/genética , Infecções por Papillomavirus/diagnóstico , Infecções por Papillomavirus/genética , Infecções por Papillomavirus/virologia , Valor Preditivo dos Testes , Prognóstico , Estudos Retrospectivos , Infecções por Roseolovirus/genética , Infecções por Roseolovirus/transmissão , Infecções por Roseolovirus/virologia , Lesões Intraepiteliais Escamosas Cervicais/genética , Lesões Intraepiteliais Escamosas Cervicais/virologia , Neoplasias do Colo do Útero/genética , Neoplasias do Colo do Útero/virologia , Adulto Jovem
3.
Jpn J Clin Oncol ; 49(9): 877-880, 2019 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-31613356

RESUMO

We developed an HPV16 E7-expressing Lactobacillus-based therapeutic vaccine, IGMKK16E7, to elicit mucosal E7-specific TH1 cellular immune responses. This study aims to examine the safety and clinical efficacy of IGMKK16E7 on HPV16-positive high-grade squamous intraepithelial lesion (HSIL). This is a multicenter, placebo-controlled, double-blind randomized phase I/II trial to test the safety and efficacy of IGMKK16E7 against HPV16-positive HSIL. The groups will include placebo, low-dose (0.5 g/day), middle-dose (1 g/day), and high-dose (1.5 g/day) IGMKK16E7. The target sample size will be 41 patients per group, and our data on our former agent, GLBL101c, were used to calculate sample size for 70% power and an α level = 0.05. The primary endpoint is IGMKK16E7 safety and pathological regression at week 16, and the secondary endpoints are cytological regression and HPV16 E7 immunological response. This study protocol has been approved by the Japanese Pharmaceuticals and Medical Devices Agency. Patient enrollment will begin in May 2019.


Assuntos
Papillomavirus Humano 16 , Imunoterapia , Proteínas E7 de Papillomavirus/imunologia , Infecções por Papillomavirus/terapia , Vacinas contra Papillomavirus/uso terapêutico , Lesões Intraepiteliais Escamosas Cervicais/terapia , Adulto , Neoplasia Intraepitelial Cervical/prevenção & controle , Neoplasia Intraepitelial Cervical/virologia , Método Duplo-Cego , Feminino , Humanos , Imunidade nas Mucosas , Lactobacillus/genética , Pessoa de Meia-Idade , Lesões Intraepiteliais Escamosas Cervicais/imunologia , Lesões Intraepiteliais Escamosas Cervicais/virologia , Resultado do Tratamento , Neoplasias do Colo do Útero/prevenção & controle , Neoplasias do Colo do Útero/virologia , Adulto Jovem
4.
BMC Infect Dis ; 19(1): 740, 2019 Aug 22.
Artigo em Inglês | MEDLINE | ID: mdl-31438877

RESUMO

BACKGROUND: Women living with HIV (WLWH) have high rates of persistent high-risk human papillomavirus (hrHPV) infections and cervical cancer. We aimed to assess the distribution of hrHPV genotypes, risk factors of type-specific hrHPV persistence, and high-grade squamous intraepithelial lesions or worse (≥HSIL) in WLWH in Denmark. METHODS: From the prospective Study on HIV, cervical Abnormalities and infections in women in Denmark (SHADE) we identified WLWH with a positive hrHPV test during the study period; 2011-2014. HIV demographics were retrieved from the Danish HIV Cohort Study and pathology results from the The Danish Pathology Data Bank. Logistic regression was used to identify risk factors associated with persistent hrHPV infection (positivity of the same hrHPV type in two samples one-two years after the first hrHPV positive date) and ≥ HSIL. RESULTS: Of 71 WLWH, 31 (43.7%) had persistent hrHPV infection. Predominant hrHPV genotypes were HPV58, 52, 51, and 35 and most frequently observed persistent genotypes were HPV52, 33 and 31. CD4 < 350 cells/µL predicted genotype-specific hrHPV persistence (adjusted OR 4.36 (95%CI: 1.18-16.04)) and ≥ HSIL was predicted by prior AIDS (adjusted OR 8.55 (95% CI 1.21-60.28)). CONCLUSIONS: This prospective cohort study of well-treated WLWH in Denmark found a high rate of persistent hrHPV infections with predominantly non-16/18 hrHPV genotypes. CD4 count < 350 cells/µL predicted hrHPV persistence, while prior AIDS predicted ≥HSIL.


Assuntos
Colo do Útero/virologia , Infecções por HIV/complicações , Infecções por HIV/epidemiologia , Papillomaviridae/isolamento & purificação , Infecções por Papillomavirus/epidemiologia , Adulto , Contagem de Linfócito CD4 , Colo do Útero/patologia , Estudos de Coortes , Dinamarca/epidemiologia , Feminino , Genótipo , HIV , Infecções por HIV/virologia , Humanos , Pessoa de Meia-Idade , Papillomaviridae/genética , Infecções por Papillomavirus/complicações , Infecções por Papillomavirus/diagnóstico , Infecções por Papillomavirus/virologia , Sistema de Registros , Fatores de Risco , Lesões Intraepiteliais Escamosas Cervicais/complicações , Lesões Intraepiteliais Escamosas Cervicais/diagnóstico , Lesões Intraepiteliais Escamosas Cervicais/epidemiologia , Lesões Intraepiteliais Escamosas Cervicais/virologia , Neoplasias do Colo do Útero/complicações , Neoplasias do Colo do Útero/diagnóstico , Neoplasias do Colo do Útero/epidemiologia , Neoplasias do Colo do Útero/virologia
5.
Virol J ; 16(1): 76, 2019 06 03.
Artigo em Inglês | MEDLINE | ID: mdl-31159808

RESUMO

BACKGROUND: Stratified mucin-producing intraepithelial lesion (SMILE) is a rare precursor lesion in the uterine cervix that is considered a variant of adenocarcinoma in situ (AIS). Although human papillomavirus (HPV) is thought to be related to the development of SMILE, there is little information available on the detection of HPV integrated into the lesion. CASE PRESENTATION: A 30-year-old female underwent a routine uterine cervical cancer screening, and her Pap smear indicated the possible existence of atypical glandular cells. A cervical biopsy with endocervical curettage was performed. The histopathological analysis showed that she had SMILE and high-grade squamous intraepithelial lesion (HSIL) on her cervix. The lesion was found to be positive for HPV genotypes 52 and 68 by multiplex PCR. In situ hybridization with HPV RNA probes revealed that these HPV types were involved in the onset of HSIL and SMILE, respectively. CONCLUSIONS: Rare, high-risk HPV genotypes may contribute to the development of SMILE, and their detection can be useful for preventing the progression to carcinoma and ensuring adequate patient management.


Assuntos
Neoplasia Intraepitelial Cervical/virologia , Mucinas/biossíntese , Papillomaviridae/genética , Infecções por Papillomavirus/diagnóstico , RNA Viral/isolamento & purificação , Lesões Intraepiteliais Escamosas Cervicais/virologia , Neoplasia Intraepitelial Cervical/patologia , Colposcopia , Detecção Precoce de Câncer , Feminino , Humanos , Hibridização in Situ Fluorescente , Reação em Cadeia da Polimerase Multiplex , Papillomaviridae/isolamento & purificação , Sondas RNA , Lesões Intraepiteliais Escamosas Cervicais/patologia , Neoplasias do Colo do Útero/patologia , Neoplasias do Colo do Útero/virologia
6.
Acta Cytol ; 63(5): 417-423, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31195388

RESUMO

INTRODUCTION: A causal link between infection with a high-risk strain of human papilloma virus (hrHPV) and the development of cervical squamous cell carcinoma (SCC) is well established. However, a small number of SCCs are hrHPV-negative by either HPV co-DNA testing and/or HPV-in situ hybridization (HPV-ISH) at the time of diagnosis. These apparently hrHPV-negative lesions are poorly understood, specifically whether hrHPV-positive precursor lesions exist, which would be detected through hrHPV-based screening. METHODS: A search of the pathology archives at the Johns Hopkins Hospital identified women with a diagnosis of hrHPV-negative cervical SCC on surgical specimen. All prior pathologies, including cervical cytology and surgical pathology specimens, and associated hrHPV DNA test results, p16 immunohistochemistry, and HPV-ISH were reviewed. RESULTS: A total of 25 women were identified having a surgical specimen diagnosed as SCC with either negative or equivocal HPV-ISH. Fifteen had a Pap test in the 6 months preceding a diagnosis of SCC, with cytology diagnoses as follows: high-grade squamous intraepithelial lesion n = 14/15; atypical squamous cells, cannot exclude high-grade squamous intraepithelial lesion n = 1/15. hrHPV co-testing was performed for 5 of these 15 women and was negative in 2/5 cases. Cervical biopsy was performed for 24 women. HPV-ISH testing, performed on 14 of the biopsy specimens, was negative for 11/14 patients. Of 15 specimens stained for p16, 14 were positive. CONCLUSION: A subset of patients exist in whom hrHPV is not detectable at or near the time of progression to SCC. Additional research is necessary to further describe this population and determine whether maintaining cytological screening would provide benefit.


Assuntos
Células Escamosas Atípicas do Colo do Útero/patologia , Carcinoma de Células Escamosas/patologia , Teste de Papanicolaou , Lesões Intraepiteliais Escamosas Cervicais/patologia , Neoplasias do Colo do Útero/patologia , Esfregaço Vaginal , Adulto , Idoso , Idoso de 80 Anos ou mais , Células Escamosas Atípicas do Colo do Útero/virologia , Baltimore , Biópsia , Carcinoma de Células Escamosas/cirurgia , Carcinoma de Células Escamosas/virologia , DNA Viral/genética , Bases de Dados Factuais , Feminino , Testes de DNA para Papilomavírus Humano , Humanos , Hibridização In Situ , Pessoa de Meia-Idade , Invasividade Neoplásica , Papillomaviridae/genética , Valor Preditivo dos Testes , Prognóstico , Reprodutibilidade dos Testes , Lesões Intraepiteliais Escamosas Cervicais/cirurgia , Lesões Intraepiteliais Escamosas Cervicais/virologia , Neoplasias do Colo do Útero/cirurgia , Neoplasias do Colo do Útero/virologia , Adulto Jovem
7.
Gynecol Oncol ; 154(2): 360-367, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31160073

RESUMO

OBJECTIVES: There is growing interest in using human papillomavirus (HPV) genotyping as a risk-based triage approach for women with atypical squamous cells-undetermined significance (ASC-US) and low-grade squamous intraepithelial lesions (LSIL) cytology. METHODS: This analysis includes 2807 subjects with ASC-US or LSIL cytology, ≥21 years, from the baseline phase of the Onclarity HPV trial. All women were referred to colposcopy/biopsy. Hierarchical-ranked prevalence and risk values, associated with high-grade cervical disease, were calculated based on extended genotyping. RESULTS: HPV 16 carried the highest risk for cervical intraepithelial neoplasia grade 2 or worse (≥CIN2) in both the ASC-US and LSIL populations. Risk of ≥CIN3 and ≥CIN2 associated with the other 13 genotypes varied somewhat for women with ASC-US and LSIL, however, HPV 31, 18, 33/58, 51 and 52 appear to comprise an intermediate risk band. Risk associated with HPV 35/39/68, 45, and 56/59/66, in either cytology population, was relatively low and beneath the benchmark threshold risk for immediate colposcopy. Restricting the analysis to women 21-24 years, ≥25 years, or ≥30 years produced similar results. CONCLUSIONS: HPV genotyping identified multiple risk bands for ≥CIN3 and ≥CIN2 in the ≥21 year-old ASC-US and LSIL populations. These results support a 1-year follow-up period to preclude immediate colposcopy for ASC-US or LSIL women positive for the lowest-risk HPV genotypes.


Assuntos
Células Escamosas Atípicas do Colo do Útero/virologia , Programas de Rastreamento/estatística & dados numéricos , Papillomaviridae/genética , Infecções por Papillomavirus/epidemiologia , Lesões Intraepiteliais Escamosas Cervicais/virologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Colposcopia/estatística & dados numéricos , Estudos Transversais , Feminino , Genótipo , Humanos , Programas de Rastreamento/instrumentação , Pessoa de Meia-Idade , Papillomaviridae/isolamento & purificação , Infecções por Papillomavirus/genética , Fatores de Risco , Estados Unidos/epidemiologia , Adulto Jovem
8.
Gynecol Oncol ; 154(2): 354-359, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31176553

RESUMO

BACKGROUND AND AIM: Age-specific type-distribution of high-risk human papillomavirus (hrHPV) in cervical precancerous lesions is subject to change in the HPV vaccination era. Knowing the pre-vaccination type-distribution helps to anticipate changes induced by mass vaccination and optimize screening. METHODS: We recruited 1279 women referred to colposcopy for abnormal cytology into a population-based study on HPV type distribution in diagnostic cervical samples (ISRCTN10933736). The HPV genotyping findings were grouped as: HPV16/18+, other hrHPV+ (HPV31/33/35/39/45/51/52/56/58/59/66/68), non-vaccine targeted hrHPV+ (HPV35/39/51/56/59/66/68), low-risk HPV, and HPV negative. We estimated the HPV group-specific prevalence rates according to diagnostic histopathological findings in the age groups of <30 (n = 339), 30-44.9 (n = 614), and ≥45 (n = 326). RESULTS: Altogether 503 cases with high grade squamous intraepithelial lesion or worse (HSIL+) were diagnosed. More than half, 285 (56.7%) of HSIL+ cases were associated with HPV16/18: 64.3% (101/157) in women <30 years (reference group), 58.4% (157/269) in women 30-44.9 years (risk ratio (RR) 0.91, 95% confidence interval (95% CI) 0.78-1.06), and 35.1% (27/77) in women ≥45 years of age (RR 0.55, 95% CI 0.39-0.75). Conversely, other hrHPV's were associated with 191 (38.0%) of HSIL+: 31.9% (50/157) in women <30, 36.8% (99/269) in women 30-44.9 years, 54.6% (42/77) and in women ≥45 (RR 1.71, 95% CI 1.26-2.33). The proportion of non-vaccine targeted hrHPV and HPV negative HSIL+ increased with advancing age. CONCLUSIONS: Pre-vaccination HPV type distribution in HSIL+ was distinctly polarised by age with HPV16/18 attributed disease being markedly more prevalent in women aged <30. In the older women the other hrHPV types, however, dominated suggesting a need for more age-dependent screening strategies.


Assuntos
Células Escamosas Atípicas do Colo do Útero/virologia , Papillomaviridae/classificação , Infecções por Papillomavirus/epidemiologia , Lesões Intraepiteliais Escamosas Cervicais/virologia , Adulto , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , Colposcopia/métodos , Feminino , Humanos , Programas de Rastreamento/estatística & dados numéricos , Pessoa de Meia-Idade , Papillomaviridae/isolamento & purificação , Vacinas contra Papillomavirus/imunologia , Prevalência , Lesões Intraepiteliais Escamosas Cervicais/epidemiologia , Vacinação/estatística & dados numéricos , Adulto Jovem
9.
Acta Cytol ; 63(5): 391-400, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31216550

RESUMO

OBJECTIVE: The exfoliative cell analyzer, LC-1000 (Sysmex Corporation, Japan), is a medical device that presents the cell proliferation index and 23 research parameters as indicators of cellular proliferative potential. The objective was to evaluate the clinical usability of qualitative assessment by LC-1000 compared with cytology, the human papillomavirus (HPV) test, and histology as gold standard. STUDY DESIGN: Women that visited 3 sites between July 2015 and March 2017 were registered. The primary endpoint in this study was the comparison between LC-1000 measurement and HPV test for sensitivity and specificity for cervical intraepithelial neoplasia 2+ (CIN2+). A tree model algorithm was newly constructed by a statistical method and its relationship with histological results was evaluated. RESULTS: The sensitivity and specificity of LC-1000 were 78.3 and 74.1%, while those of the HPV test were 94.7 and 85.4%, respectively. A tree model comprising five categories was constructed. The proportion of advanced lesions was higher with the change in the rank classification results from 1 to 5. The positive predictive values of CIN2+ in the categories 4 and 5 were high. Despite the small number of subjects, cancer was undetected in categories 1 and 2. In addition, the comparison with follow-up results in 19 women assessed as CIN1 showed that the rate of progression in the categories 3-5 was 50% (7/14); progression in the categories 1 and 2 was 0% (0/5). CONCLUSIONS: LC-1000 may be useful for cervical cancer screening as an index to qualitatively evaluate CIN and cancer based on the changes in characteristics of cells.


Assuntos
Adenocarcinoma in Situ/patologia , Carcinoma/patologia , Proliferação de Células , Neoplasia Intraepitelial Cervical/patologia , Citodiagnóstico/instrumentação , Detecção Precoce de Câncer/instrumentação , Lesões Intraepiteliais Escamosas Cervicais/patologia , Neoplasias do Colo do Útero/patologia , Adenocarcinoma in Situ/virologia , Automação Laboratorial/instrumentação , Biópsia , Carcinoma/virologia , Neoplasia Intraepitelial Cervical/virologia , DNA Viral/genética , Árvores de Decisões , Diagnóstico Diferencial , Detecção Precoce de Câncer/métodos , Desenho de Equipamento , Feminino , Testes de DNA para Papilomavírus Humano , Humanos , Japão , Teste de Papanicolaou , Papillomaviridae/genética , Valor Preditivo dos Testes , Reprodutibilidade dos Testes , Lesões Intraepiteliais Escamosas Cervicais/virologia , Neoplasias do Colo do Útero/virologia , Esfregaço Vaginal
10.
Acta Cytol ; 63(5): 371-378, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31067531

RESUMO

BACKGROUND: AgNOR pleomorphism has been widely used for its diagnostic importance in differentiating premalignant and malignant lesions of different human neoplasms. However, an evaluation of its potential for discriminating cases of high-risk squamous intraepithelial lesions of the cervix (SIL) has been rarely attempted. AIM: The tumor marker potential of AgNOR pleomorphism counts was assessed by correlating high and low mean counts in low-grade SIL (LSIL) cases with persistence or regression of the lesion and HPV positivity. MATERIALS AND METHODS: The 115 LSIL cases selected for the study were registered from the ongoing cervical cancer screening of the rural population of Lucknow West. Silver nitrate staining for AgNOR counts and HPV DNA testing were done in all 115 cases. RESULTS: The AgNOR counts in the 115 LSIL cases revealed low counts in 92 and high counts in 23 cases. Follow-up, available in 107 cases, revealed persistence of the lesion in 21 of the 23 cases with high counts and in 4 of the 84 cases with low counts. HPV positivity showed a strong correlation with high counts. Persistence of LSIL was also more frequent with high AgNOR counts and in HPV-positive cases. CONCLUSIONS: The study showed a correlation of high mean AgNOR counts with HPV positivity and persistence of LSIL.


Assuntos
Antígenos Nucleares/análise , Biomarcadores Tumorais/análise , Detecção Precoce de Câncer/métodos , Coloração pela Prata , Lesões Intraepiteliais Escamosas Cervicais/metabolismo , Neoplasias do Colo do Útero/química , Esfregaço Vaginal , DNA Viral/genética , Diagnóstico Diferencial , Estudos de Viabilidade , Feminino , Testes de DNA para Papilomavírus Humano , Humanos , Índia , Gradação de Tumores , Teste de Papanicolaou , Papillomaviridae/genética , Valor Preditivo dos Testes , Medição de Risco , Fatores de Risco , Lesões Intraepiteliais Escamosas Cervicais/patologia , Lesões Intraepiteliais Escamosas Cervicais/virologia , Neoplasias do Colo do Útero/patologia
11.
Asian Pac J Cancer Prev ; 20(4): 1031-1036, 2019 Apr 29.
Artigo em Inglês | MEDLINE | ID: mdl-31030470

RESUMO

Objective: To determine the factors associated with the increased risk of developing high-grade squamous intraepithelial lesions (HSIL) of the uterine cervix in women younger than 30 years compared with those aged ≥ 30 years who also had HSIL. Methods: Patients with HSIL who underwent loop electrosurgical excision procedure (LEEP) between January 2006 and July 2017 at Chiang Mai University Hospital were retrospectively reviewed. We analyzed the factors associated with the development of HSIL by comparing two age groups between women aged < 30 years and those aged ≥ 30 years. The factors analyzed included the well-recognized risk factors for cervical cancer, i.e. age at sexual debut, number of sexual partners, use of oral contraceptive (OC) pills, smoking history, sexually transmitted diseases and HIV status. Univariate and multivariate logistic regressions were used to assess factors associated with the increased risk of developing HSIL in women younger than 30 years compared with those aged ≥ 30 years. Results: During the study period, there were 345 patients with HSIL, 30 were < 30 years (case group) and 315 aged ≥ 30 years (control group). By multivariate analyses , early sexual debut(OR, 2.86; 95% CI, 1.01-8.13; P=0.047), multiple sexual partners (OR, 2.94; 95% CI, 1.23-7.02; P=0.015), history of genital warts (OR, 20.46; 95% CI, 2.27-183.72; P=0.007) and history of smoking (OR, 2.95; 95% CI, 1.10-7.93; P=0.032) were significantly associated with the development of HSIL in women younger than 30 years when compared with those aged ≥ 30 years. The OC use, HIV status and underlying diseases were not significantly different in both groups. Conclusion: Early age at sexual debut, multiple sexual partners, history of genital warts and smoking are significant risk factors for developing HSIL in women younger than 30 years. Cervical cancer screening should be considered in young women with such factors.


Assuntos
Neoplasia Intraepitelial Cervical/patologia , Condiloma Acuminado/complicações , Infecções por Papillomavirus/complicações , Lesões Intraepiteliais Escamosas Cervicais/patologia , Neoplasias do Colo do Útero/patologia , Adulto , Neoplasia Intraepitelial Cervical/epidemiologia , Neoplasia Intraepitelial Cervical/virologia , Feminino , Seguimentos , Humanos , Papillomaviridae/isolamento & purificação , Infecções por Papillomavirus/virologia , Prognóstico , Estudos Retrospectivos , Fatores de Risco , Comportamento Sexual , Lesões Intraepiteliais Escamosas Cervicais/epidemiologia , Lesões Intraepiteliais Escamosas Cervicais/virologia , Neoplasias do Colo do Útero/epidemiologia , Neoplasias do Colo do Útero/virologia , Adulto Jovem
12.
Asian Pac J Cancer Prev ; 20(4): 1265-1269, 2019 Apr 29.
Artigo em Inglês | MEDLINE | ID: mdl-31030504

RESUMO

Introduction: India fights massive cervical cancer burden. This article highlights an innovative feasible approach enabling tertiary hospitals to contribute to cancer prevention without compromising their primary mandate to provide treatment. Methodology: Since 1979, National Institute of Cancer Prevention and Research (NICPR) support a tertiary hospital in cervical cancer screening through a satellite clinic. Record review of 5328 attendees of this clinic between January-December 2016 was done. Pap-smear testing and reporting were performed by trained NICPR personnel. Patients' demographics, reproductive history, Pap-test date, cytology results were recorded and results were communicated to respective units for further management. Results: Among 5328 women screened, 2% (96/5328) had abnormal cytology, which included malignancy(33%; 32/96), Atypical Squamous Cells-Undetermined Significance(ASC-US) (20%; 19/96), Atypical Glandular Cells(AGC) (23%; 22/96) with complaints of pain in lower abdomen 65.6%(59/90), white discharge per vaginum 46.7%(42/90) and backache 23.3%(21/90). In which, Muslims- 67% (65/96), illiterates- 58% (56/96). Age>35(p<0.001), parity>3(p<0.05), illiteracy (p<0.05), Muslim women (p<0.05) had positive association with abnormal cytology. Conclusion: Awareness about cervical cancer screening is the immediate need in resource-limited countries. Government hospitals in such countries should house dedicated preventive oncology unit for cancer screening.


Assuntos
Células Escamosas Atípicas do Colo do Útero/patologia , Detecção Precoce de Câncer/normas , Infecções por Papillomavirus/complicações , Serviços Preventivos de Saúde/normas , Lesões Intraepiteliais Escamosas Cervicais/diagnóstico , Atenção Terciária à Saúde/normas , Neoplasias do Colo do Útero/diagnóstico , Adulto , Células Escamosas Atípicas do Colo do Útero/virologia , Feminino , Seguimentos , Humanos , Índia , Teste de Papanicolaou , Papillomaviridae , Infecções por Papillomavirus/virologia , Prognóstico , Estudos Retrospectivos , Lesões Intraepiteliais Escamosas Cervicais/epidemiologia , Lesões Intraepiteliais Escamosas Cervicais/virologia , Centros de Atenção Terciária/normas , Neoplasias do Colo do Útero/epidemiologia , Neoplasias do Colo do Útero/virologia , Esfregaço Vaginal
13.
Int J STD AIDS ; 30(6): 586-595, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30813859

RESUMO

Cervical cancer is a leading cause of death among women in low- and middle-income countries, and women living with HIV are at high risk for cervical cancer. The objective of this study was to estimate the prevalence and correlates of cervical cancer and pre-cancer lesions and to examine cervical cancer knowledge among women living with HIV receiving antiretroviral therapy in rural Andhra Pradesh, India. We conducted cytology-based screening and administered a standardized questionnaire among 598 HIV-infected women. We found 5 (0.8%), 39 (6.5%), 29 (4.9%), and 4 (0.7%) had atypical squamous cells of undetermined significance (ASCUS), low-grade squamous intraepithelial lesion (LSIL), high-grade squamous intraepithelial lesion (HSIL), and squamous cervical carcinoma (SCC), respectively. In multivariable logistic regression analysis, ASCUS/LSIL was independently associated with age >16 years old at first sexual encounter and smokeless tobacco use. We found no factors associated with HSIL/SCC. In total, 101 women (16.9%) had heard of cervical cancer and 28 (27.7%) of them correctly identified HIV infection as a risk factor. In light of the high prevalence of pre-cancer lesions and low level of cervical cancer knowledge in our study population, focused interventions are needed to improve cervical cancer literacy and prevention among rural women living with HIV.


Assuntos
Carcinoma de Células Escamosas/diagnóstico , Neoplasia Intraepitelial Cervical/diagnóstico , Infecções por HIV/complicações , Conhecimentos, Atitudes e Prática em Saúde/etnologia , Papillomaviridae/isolamento & purificação , Infecções por Papillomavirus/diagnóstico , População Rural/estatística & dados numéricos , Lesões Intraepiteliais Escamosas Cervicais/diagnóstico , Neoplasias do Colo do Útero/diagnóstico , Adolescente , Adulto , Carcinoma de Células Escamosas/epidemiologia , Carcinoma de Células Escamosas/virologia , Neoplasia Intraepitelial Cervical/epidemiologia , Neoplasia Intraepitelial Cervical/virologia , Feminino , Infecções por HIV/etnologia , Humanos , Índia/epidemiologia , Pessoa de Meia-Idade , Teste de Papanicolaou , Infecções por Papillomavirus/epidemiologia , Infecções por Papillomavirus/virologia , Prevalência , Fatores de Risco , Lesões Intraepiteliais Escamosas Cervicais/epidemiologia , Lesões Intraepiteliais Escamosas Cervicais/virologia , Inquéritos e Questionários , Neoplasias do Colo do Útero/epidemiologia , Neoplasias do Colo do Útero/virologia , Esfregaço Vaginal , Adulto Jovem
14.
Gynecol Oncol ; 153(2): 266-270, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30827725

RESUMO

OBJECTIVE: To estimate the prevalence of high-grade anal dysplasia in women with high-grade dysplasia or carcinoma of the cervix, vagina or vulva. METHODS: In this cross-sectional study, participants underwent anal cytology, anal HPV testing with Cervista HPV16/18 and high-resolution anoscopy (HRA). Patients with HSIL (high-grade squamous cell intraepithelial lesion) or greater on anal cytology or anal biopsy were referred to a colorectal surgery specialist for further evaluation. RESULTS: Seventy-five women were enrolled in the study, including 47 with cervical (cervix group), 10 with vaginal (vagina group), 15 with vulvar (vulva group), 1 with cervical and vaginal, and 2 with vulvar and vaginal disease. The median age in the cervix group (40 years (range 26-69)) was substantially younger than in the vagina (60 years (38-69)) and the vulva (59 years (36-75)) groups. Anal HSIL based on composite endpoints of the most severe cytology or histology result was diagnosed in 6 patients (8.0%). Anal cytology revealed HSIL in 2 (2.7%), atypical squamous cells of undetermined significance (ASCUS) in 12 (16.0%), low-grade squamous cell intraepithelial lesion (LSIL) in 2 (2.7%), and was normal in 59 (78.7%) patients. Anal HPV16/18 test was positive in 15 (20.0%), negative in 48 (64.0%) and insufficient in 12 (16.0%) patients. Of the 6 women with high-grade anal dysplasia, three (50%) had a positive anal HPV16/18 test. No case of anal cancer was observed. CONCLUSION: Our results suggest that the prevalence of anal HSIL is elevated among women with HPV-related lower genital tract dysplasia or cancer. To further support the inclusion of this high-risk group into screening guidelines for anal dysplasia, further studies are necessary to determine what screening strategy is suited to this population.


Assuntos
Canal Anal/patologia , Neoplasias dos Genitais Femininos/epidemiologia , Papillomaviridae/isolamento & purificação , Infecções por Papillomavirus/epidemiologia , Lesões Intraepiteliais Escamosas Cervicais/epidemiologia , Adulto , Fatores Etários , Idoso , Canal Anal/diagnóstico por imagem , Canal Anal/virologia , Estudos Transversais , Endoscopia Gastrointestinal , Feminino , Neoplasias dos Genitais Femininos/patologia , Neoplasias dos Genitais Femininos/virologia , Genitália Feminina/patologia , Genitália Feminina/virologia , Humanos , Pessoa de Meia-Idade , Infecções por Papillomavirus/diagnóstico por imagem , Infecções por Papillomavirus/patologia , Infecções por Papillomavirus/virologia , Projetos Piloto , Prevalência , Fatores de Risco , Lesões Intraepiteliais Escamosas Cervicais/patologia , Lesões Intraepiteliais Escamosas Cervicais/virologia
15.
Ginekol Pol ; 90(2): 66-71, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30860271

RESUMO

OBJECTIVES: The paper assess the relevance of HR HPV E6/E7 mRNA test in women with abnormal Pap results. MATERIAL AND METHODS: Between 2013-2014, 125 women were subjects to the enhanced diagnostics due to abnormal Pap results. According to The Bethesda system, if ASC-US, AGC, LSIL, ASC-H, HSIL or cancer cells were present, the result was abnormal. The patients underwent the enhanced diagnostics which included the following procedures: Pap smear collection for molecular assessment of HR HPV E6/E7 mRNA test, the colposcopic examination and biopsy of clinically suspicious areas. RESULTS: High-grade squamous intraepithelial lesions constituted the most frequent cervical pathology in women with abnormal Pap test results, as well as with the positive results of HR HPV E6/E7 mRNA test. Test sensitivity in patients with the histopathological diagnosis of high-grade squamous intraepithelial lesion was estimated at 86.1%. CONCLUSIONS: HR HPV E6/E7 mRNA test identifying neoplastic lesions and cervical cancer is characterised by a high relevance which is reflected by means of sensitivity and specificity. In fact, test sensitivity and specificity increased with the age in the group of patients up to 50 years old.


Assuntos
Papillomaviridae/genética , Infecções por Papillomavirus , RNA Mensageiro/análise , RNA Viral/análise , Lesões Intraepiteliais Escamosas Cervicais , Neoplasias do Colo do Útero , Adolescente , Adulto , Feminino , Humanos , Pessoa de Meia-Idade , Proteínas Oncogênicas Virais/genética , Infecções por Papillomavirus/diagnóstico , Infecções por Papillomavirus/virologia , Proteínas Repressoras/genética , Sensibilidade e Especificidade , Lesões Intraepiteliais Escamosas Cervicais/diagnóstico , Lesões Intraepiteliais Escamosas Cervicais/virologia , Neoplasias do Colo do Útero/diagnóstico , Neoplasias do Colo do Útero/virologia , Virologia , Adulto Jovem
16.
Acta Cytol ; 63(1): 50-55, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30721904

RESUMO

OBJECTIVES: The aim of this work was to study the spectrum of epithelial abnormalities on Pap smears of HIV-positive women categorized as per the Bethesda System of Reporting Cervical Cytology, to correlate them with CD4 lymphocyte counts, and to compare them with the spectrum of abnormalities seen in a HIV-negative control group. Study Design and Methodology: The present study was a 6-year retrospective study conducted in the Department of Pathology at Kasturba Medical College, Mangalore, which included 150 Pap smears from HIV-positive and HIV-negative women, respectively. The Pap-stained slides of the cases were retrieved and studied. The data collected were tabulated and analyzed. A statistical study was performed using SPSS software. The χ2 test was used to analyze the data and a p value < 0.05 was considered to be significant. RESULTS: Pap smear abnormalities were twice as high in HIV-infected women (12%) as compared with HIV-negative women (6%; p = 0.006, RR = 2). Negative for intraepithelial lesion/malignancy was the most common finding (88%), which was further subdivided into inflammatory, atrophic smear, non-specific, candidiasis, and bacterial vaginitis groups. The percentage of epithelial abnormalities was 12%, including: atypical squamous cells of undetermined significance, 5.55%; atypical squamous cells, cannot exclude HSIL, 16.66%; low-grade squamous intraepithelial lesion, 5.55%; high-grade squamous intraepithelial lesion (HSIL), 61.11%, and squamous cell carcinoma, 11.11%. The highest incidence of intraepithelial lesions in HIV-positive females was in the age group of 34-49 years. CD4 cell counts fell in the range of 200-500 cells/mm3 in most of the HIV-positive patients (68.75%), but was not found to be statistically significant. CONCLUSION: Routine Pap smear examination is advocated in women with HIV as the prevalence of epithelial cell abnormalities was found to be 12%, which was twice as high as compared to the HIV-negative control group. Although there was no correlation of epithelial cell abnormalities with CD4 counts, a higher rate of the cases with epithelial abnormalities were observed to have CD4 cell counts of 200-500 cells/mm3.


Assuntos
Células Escamosas Atípicas do Colo do Útero/patologia , Células Escamosas Atípicas do Colo do Útero/virologia , Infecções por HIV/patologia , Infecções por HIV/virologia , Teste de Papanicolaou , Lesões Intraepiteliais Escamosas Cervicais/patologia , Lesões Intraepiteliais Escamosas Cervicais/virologia , Neoplasias do Colo do Útero/patologia , Neoplasias do Colo do Útero/virologia , Esfregaço Vaginal , Adulto , Idoso , Contagem de Linfócito CD4 , Feminino , Infecções por HIV/epidemiologia , Infecções por HIV/imunologia , Humanos , Incidência , Índia/epidemiologia , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Prevalência , Estudos Retrospectivos , Fatores de Risco , Lesões Intraepiteliais Escamosas Cervicais/epidemiologia , Centros de Atenção Terciária , Neoplasias do Colo do Útero/epidemiologia , Adulto Jovem
17.
Asian Pac J Cancer Prev ; 20(1): 81-85, 2019 Jan 25.
Artigo em Inglês | MEDLINE | ID: mdl-30678384

RESUMO

Background: One of the features of cervical cancer screening using the combination of cytology and human papillomavirus (HPV) testing is the triage for atypical squamous cells of undetermined significance (ASC-US). The effectiveness of the triage has been recognized widely. However, there are few reports evaluating this triage process in Japan. Material and Methods: We retrospectively examined the results of cytology and HPV co-testing for cervical cancer screening in the Oyama area of Tochigi Prefecture between 2012 and 2014. Women who were ASC-US/HPV positive and had cytologic abnormalities [low-grade squamous intraepithelial lesions (LSIL) or worse] were examined by colposcopy. The results of the colposcopy testing were evaluated. In addition, we also examined the results of those who underwent co-testing a year after a ASC-US/HPV-negative result. Results: A total of 21,342 women received their first screening test during the study period, with 542 (2.5%) found to have ASC-US. Of the ASC-US-positive women, 289 (53.3%) were also HPV positive. The prevalence of CIN+ (cervical intraepithelial neoplasia or higher) in the ASC-US/HPV-positive group was 63.2%, with 81.8%, 16.4% and 4.8%. showing CIN 1, CIN 2 and CIN 3+, respectively. The prevalence of CIN+ in the LSIL group was 66.8%, with the majority having a low risk CIN 1 (76.6%) compared to CIN 2 (18.6%), and CIN 3+ (4.8%). No significant difference was observed between the LSIL and ASC-US/ HPV-positive groups. The prevalence of women diagnosed with CIN in the ASC-US/HPV-negative group, following co-testing a year after colposcopy was low (3%). Conclusions: The ASC-US/HPV-positive group was comparable to the LSIL group in terms of prevalence of CIN+ lesions. Furthermore, low CIN prevalence after one year in the ASCUS/ HPV-negative group provides confirmation that the screening interval could be extended. The application of HPV triage (which is routine in other countries) to identify these groups would be of benefit in Japan.


Assuntos
Células Escamosas Atípicas do Colo do Útero/patologia , Neoplasia Intraepitelial Cervical/diagnóstico , Detecção Precoce de Câncer , Infecções por Papillomavirus/complicações , Lesões Intraepiteliais Escamosas Cervicais/diagnóstico , Triagem , Neoplasias do Colo do Útero/diagnóstico , Células Escamosas Atípicas do Colo do Útero/virologia , Neoplasia Intraepitelial Cervical/virologia , Feminino , Seguimentos , Humanos , Japão , Papillomaviridae , Infecções por Papillomavirus/virologia , Prognóstico , Estudos Retrospectivos , Lesões Intraepiteliais Escamosas Cervicais/virologia , Neoplasias do Colo do Útero/virologia
18.
PLoS One ; 14(1): e0211260, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30699172

RESUMO

BACKGROUND: High-risk human papillomavirus (HR-HPV) has been demonstrated to be the necessary cause of cervical carcinoma. High-risk HPV detection has a prognostic significance for the women who are at increased risk of disease progression. HPV genotyping in cervical cancer precursor lesions is crucial for prevention and management of cervical cancer. This study was designed to investigate the distribution of HR-HPV genotypes among a group of patients with high-grade squamous intraepithelial lesions and higher, of the cervix, in Botswana. MATERIALS AND METHODS: 185-archived residual formalin-fixed paraffin-embedded cervical biopsies collected between the years, 2006 and 2008 were studied. These tissues were diagnosed with HSIL (n = 146) and squamous cell carcinoma (n = 39). DNA was extracted using the Abbott m2000 analyser (Abbott Laboratories, Illinois) using reagents provided by the manufacturer. HPV genotyping was done using the Abbott RealTime HR-HPV PCR, which qualitatively detects 14 HR-HPV (reported as HPV 16, 18 & Other HR-HPV). RESULTS: DNA was successfully extracted from 162/185 (87.6%) tissues as indicated by a positive ß-globin test. 132/162 (82%) tested positive for HR-HPV The HPV 16 prevalence was 50% (66/132), HPV 18 at 15.2% (20/132) and other Group 1 HR-HPV plus HPV 66 and 68 had a prevalence of 56.1% (74/132). Other HR-HPV types were common in HSIL than in carcinoma, while HPV 16 was more prevalent in carcinomas than other HR-HPV genotypes. CONCLUSION: In this study, HPV 16 and other HR-HPV genotypes were commonly associated with HSIL but HPV 18 was uncommon among Botswana women. Our data highlights the need for multivalent HPV vaccines with cross coverage for other high risk HPV other than HPV 16 and 18.


Assuntos
Alphapapillomavirus/classificação , Carcinoma de Células Escamosas/virologia , Técnicas de Genotipagem/métodos , Infecções por Papillomavirus/epidemiologia , Lesões Intraepiteliais Escamosas Cervicais/virologia , Adulto , Alphapapillomavirus/genética , Biópsia , Botsuana , Carcinoma de Células Escamosas/patologia , Progressão da Doença , Feminino , Humanos , Infecções por Papillomavirus/diagnóstico , Inclusão em Parafina , Prevalência , Prognóstico , Lesões Intraepiteliais Escamosas Cervicais/patologia , Fixação de Tecidos
19.
Int J Gynecol Pathol ; 38(5): 493-497, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30312218

RESUMO

Human papillomavirus (HPV) type 6 is historically classified as low-risk HPV type and associates with low-grade squamous intraepithelial lesions of the anogenital tract. Rare squamous carcinomas have been reported in association with these HPV types but the mechanism(s) behind this carcinogenic sequence have been unclear. We report 4 cases of low risk anogenital HPV infections-3 cervical (immature low-grade squamous intraepithelial lesion with metaplastic phenotype) and one anal (exophytic condyloma) lesion-that manifested with high-grade squamous intraepithelial lesion/squamous cell carcinoma. Two were associated with invasion one of which metastasized to a regional node. Two cases exhibited strong p53 positivity in the high-grade squamous intraepithelial lesion/squamous cell carcinoma component analogous to that seen in HPV-negative differentiated intraepithelial lesions of the external genitalia. This series of cases adds to the literature on low risk HPV-associated cervical squamous carcinomas. It underscores the similarities between the baseline cyto-morphology and benign mimics (low-grade squamous intraepithelial lesions), the subtle cytologic and immunohistochemical (MIB1) features heralding biologic aggressiveness, and in some potential pathways (p53) not usually involved in HPV-related anogenital neoplasia.


Assuntos
Neoplasias do Ânus/patologia , Carcinoma de Células Escamosas/virologia , Papillomavirus Humano 6/isolamento & purificação , Lesões Intraepiteliais Escamosas Cervicais/virologia , Neoplasias do Colo do Útero/virologia , Adulto , Carcinoma de Células Escamosas/patologia , Feminino , Humanos , Pessoa de Meia-Idade , Lesões Intraepiteliais Escamosas Cervicais/patologia , Neoplasias do Colo do Útero/patologia
20.
J Clin Lab Anal ; 33(3): e22708, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30390349

RESUMO

BACKGROUND: Human papillomavirus (HPV) infection can lead to the development of cervical cancer. This study assessed the genotype distribution of HPV of high-grade squamous intraepithelial lesion (HSIL) and invasive cervical cancer (ICC) in Ganzhou population. METHODS: A total of 935 females who got HPV testing from January 2016 to July 2018 in the maternal and child health hospital of Ganzhou were enrolled in the study, including 806 HSIL and 129 ICC. HPV detection and genotyping were tested by HPV Geno-Array test kit. RESULTS: The overall HPV-positive rate was 74.0% in Ganzhou. Among the HSIL and ICC patients, the positive rates of HPV detection were 75.6% and 64.3%. Among the HSIL individuals, the most prevalent hr-HPV genotype was HPV 16. And the 4 common subtypes in decreasing order were HPV 52, 58, 33, and 18. Of the ICC patients, the most frequently hr-HPV subtype was HPV 16 followed by 18, 52, 58, and 59. Among the squamous cell carcinoma (SCC) patients, for hr-HPV genotypes, HPV 16, 18, 52, 58, and 59 were five most common subtypes. In patients with adenocarcinoma (ADC), the most common hr-HPV genotype was HPV 18, followed by HPV 16, 52, 56, 68, 73. And, we found U-shaped and S-shaped curves in the HPV distribution of different age groups. CONCLUSION: The prevalence and distribution of HPV genotypes in Ganzhou differed from other regions of China and Western countries. These results can serve as valuable reference for HPV vaccination programs for Ganzhou women.


Assuntos
Papillomaviridae/genética , Infecções por Papillomavirus , Lesões Intraepiteliais Escamosas Cervicais , Neoplasias do Colo do Útero , Adulto , China/epidemiologia , Estudos Transversais , Feminino , Genótipo , Humanos , Pessoa de Meia-Idade , Infecções por Papillomavirus/epidemiologia , Infecções por Papillomavirus/virologia , Prevalência , Lesões Intraepiteliais Escamosas Cervicais/epidemiologia , Lesões Intraepiteliais Escamosas Cervicais/virologia , Neoplasias do Colo do Útero/epidemiologia , Neoplasias do Colo do Útero/virologia , Adulto Jovem
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