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1.
Zhonghua Bing Li Xue Za Zhi ; 50(4): 339-343, 2021 Apr 08.
Artigo em Chinês | MEDLINE | ID: mdl-33831991

RESUMO

Objective: To study the thickness of cervical squamous epithelia and its correlation with cervical precancerous lesions. Methods: We selected 495 HE slides of 209 cervical biopsies from January 2020 to June 2020 in the Department of Pathology, the First and Seventh Medical Center of the PLA General Hospital, including 173 slides with low grade squamous intraepithelial lesion (LSIL) and 214 slides with high grade squamous intraepithelial lesion (HSIL). Artificial intelligence labeling software was used to assist in measuring the epithelial thickness of normal cervical squamous epithelium, LSIL and HSIL of each slide. The thickest, thinnest, and middle widths of epithelial thickness were measured, respectively. Average epithelial thickness was defined as the sum of the above three widths divided by 3. The correlation statistical analysis was performed by combining the data of age and pathological diagnosis. Results: The average thickness of normal cervical squamous mucosa was (245.83±91.40) µm, which was (222.42±81.22) µm and was (195.95±66.59) µm in LSIL and HISL epithelial respectively (F=27.09, P<0.01). The average cell layers of normal cervical squamous epithelium was (15.5±4.2) layers, which of LSIL was (14.8±4.8) layers, and that of HSIL was (15.8±4.8) layers. The differences among normal, LSIL and HSIL were not statistically significant (P>0.05). Further statistical analysis was stratified by age (≤30 years, 31-40 years, 41-50 years, 51-60 years, and >60 years), the results of Pearson correlation analysis showed that the thickness of normal cervical squamous epithelial gradually thinned with age (correlation coefficient r=-0.141 9, P<0.05), while LSIL and HSIL epithelial thickness had significant correlation with age (P>0.05). In the subgroup of ≤50 years old, the epithelial thickness of normal squamous epithelium was the thickest, followed by LSIL, and HSIL epithelial thickness was the thinnest. The differences were statistically significant (P<0.05). While in the subgroup of >50 years, the differences were not statistically significant (P>0.05). Conclusions: The cervical squamous epithelium gradually becomes thinner with the degree of precancerous lesions increasing among patients of ≤50 years old. However, after age of 50 years, with the onset of menopause, the normal mucosal epithelium is becoming atrophy, so that mucosal thickness is no longer correlated with the extent of the lesion. In addition, it is suggested that the cervical vinegar white test performance during colposcopy is related to the protein changes in the mucosal epithelial cells, but not directly related to the thickness of the epithelial layer.


Assuntos
Carcinoma de Células Escamosas , Neoplasia Intraepitelial Cervical , Lesões Pré-Cancerosas , Neoplasias do Colo do Útero , Adulto , Inteligência Artificial , Neoplasia Intraepitelial Cervical/diagnóstico , Feminino , Humanos , Pessoa de Meia-Idade , Gravidez
2.
Georgian Med News ; (311): 147-151, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33814409

RESUMO

Apoptosis plays one of the major roles in the progression of human cancers including cervical carcinoma. The aim of our study was to analyse the expression of Cas3, Bax and their correlation with the proliferation index and ER expression status during the progression of cervical intraepithelial neoplasia (CIN). Study included altogether 140 specimens, divided into two major groups, such as: cervical lesions without co-infections and with co-infections. Standard immunohistochemistry was used to detect antigens: Ki67, Cas3, Bax and ER. The study results showed that the expression of Cas3 is significantly decreased whilst the expression of Bax is significantly increased during the progression of CIN in both groups with and without co-infections. The expression of Bax negatively correlates with the expression of Cas3 (r=-42.4, p<0.05) and ER (r=-33.4, p<0.05) and positively correlates with the expression of proliferation marker Ki67 (r=56.3, p<0.05). The results indicate that the deregulated apoptosis measured as increased expression of Bax and Cas3 loss, as well as the increase in proliferation index measured as Ki67 expression is significantly related to the progression of CIN into cervical carcinoma. Therefore, the measuring of mentioned protein expression could be used as the markers of the CIN progression.


Assuntos
Proteínas Associadas a CRISPR , Neoplasia Intraepitelial Cervical , Infecções por Papillomavirus , Neoplasias do Colo do Útero , Biomarcadores Tumorais/genética , Neoplasia Intraepitelial Cervical/genética , Feminino , Humanos , Imuno-Histoquímica , Neoplasias do Colo do Útero/genética , Proteína X Associada a bcl-2/genética
4.
Ceska Gynekol ; 86(1): 11-15, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33752403

RESUMO

OBJECTIVE: The aim of this study was to compare TFF3, AIF-1, S100-A11 and DKK1 serum levels in patients with cervical dysplasia, and in healthy female controls. METHODS: The first group included 59 patients with a histological dia-gnosis of precancerous disease CIN 1. The second group included 198 patients with a histological dia-gnosis of precancerous disease CIN 2 or CIN 3. The control group was comprised of 90 patients who underwent elective total hysterectomy for nonmalignant disorders. In all patients, preoperative serum samples were taken and separated; the sera were all stored at -80°C until the analysis for TFF3, AIF-1, S100-A11 and DKK1. RESULTS: The serum levels of S100-A11 (P < 0.0001) and AIF-1 (P < 0.0001) were statistically significantly higher in patients with mild precancerous lesions (CIN 1) than in controls. The levels of TFF3 and DKK1 were not statistically significantly different in patients with CIN 1 and in the control group. The serum levels of S100-A11 (P < 0.0001) and AIF-1 (P < 0.0001) were statistically significantly higher in patients with severe precancerous lesions (CIN 2/3) than in controls. TFF3 and DKK1 levels were not statistically significantly different in patients with CIN 2/3 compared to controls. CONCLUSION: S100-A11 and AIF-1 represent potential bio-markers in patients with cervical dysplasia.


Assuntos
Neoplasia Intraepitelial Cervical , Lesões Pré-Cancerosas , Neoplasias do Colo do Útero , Biomarcadores , Feminino , Humanos
5.
Georgian Med News ; (310): 157-164, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33658425

RESUMO

Stem cells represent the small subpopulation of healthy and cancerous tissues, which are characterised with increased proliferation and self-renewal properties. From the many different markers of stem cells, we have investigated the stem cell index during the progression of cervical intraepithelial neoplasia (CIN), based on the immunohistochemical expression of CD44 in total of 140 tissue samples from uterine cervix. In addition, we have performed the profound correlation analysis of CD44 with different epithelial-mesenchymal, proliferation, apoptosis and hormonal markers at both protein and mRNA level. The results of our study indicated that, stem cell index based on the CD44 detection is significantly increased with the progression of cervical intraepithelial neoplasia. In addition, CD44 expression significantly correlates with the epithelial-mesenchymal transition, proliferation-apoptotic features and ER status in both protein and mRNA level. Two, groups of cervical intraepithelial lesions as well as carcinoma can be identified based on the expression of CD44, Ki67, Cas3 and ER. To the best of our knowledge we are first to demonstrate such findings in CIN and cervical carcinoma and identified characteristics could be used for the early assessment of CIN patient prognosis and for the relevant clinical management.


Assuntos
Neoplasia Intraepitelial Cervical , Neoplasias do Colo do Útero , Biomarcadores Tumorais , Feminino , Humanos , Células-Tronco
6.
Acta Obstet Gynecol Scand ; 100(3): 394-402, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-33566361

RESUMO

INTRODUCTION: Human papillomavirus (HPV) testing as the primary cervical cancer screening method is implemented in several countries. We report data from the first round of a large Danish pilot implementation of HPV-based screening. Our aim was to compare colposcopy referrals, detection of high-grade cervical intraepithelial neoplasia (CIN) and cervical cancer, and positive predictive value (PPV) of colposcopy referral in HPV vs cytology-based screening. MATERIAL AND METHODS: From May 2017 to October 2018, women aged 30-59 years attending cervical cancer screening in the uptake area of the Department of Pathology, Vejle Hospital, Region of Southern Denmark were screened by primary HPV testing (n = 16 067) or primary cytology (n = 23 981) depending on municipality of residence. In the HPV group, women with HPV16/18, or other high-risk HPV types and abnormal cytology, were referred to immediate colposcopy. Women with other high-risk HPV types and normal cytology were invited for repeat screening with HPV test and cytology after 12 months. From a nationwide pathology register, we obtained information on screening results and subsequent histological diagnoses during up to 2.9 years after the first screen. PPVs included diagnoses within 1 year after referral. RESULTS: In the HPV group, 3.7% were referred to immediate colposcopy and 2.8% were referred at the 12-month repeat screening. The total referral to colposcopy was higher in the HPV (6.6%) than cytology group (2.1%) (age-adjusted relative referral = 3.05, 95% confidence interval [CI] 2.75-3.38). The detection of CIN3+ was higher in the HPV (1.5%) than the cytology group (0.8%) (age-adjusted relative detection = 1.88, 95% CI 1.56-2.28). The probability of CIN3+ among women referred to colposcopy (= PPV) was lower in the HPV (21.1%; 95% CI 18.7%-23.7%) than the cytology group (34.6%; 95% CI 30.7%-38.9%). In the HPV group, the PPV was lower among women referred at repeat screening (12.1%) than among women referred immediately (27.8%). CONCLUSIONS: Compared with cytology-based screening, HPV-based screening provided a 90% increased CIN3+ detection at the cost of a threefold increase in colposcopy referrals, when considering complete data from the prevalence round. Our findings support implementation of HPV-based screening in Denmark, but modifications of screening algorithms may be warranted to decrease unnecessary colposcopy referrals.


Assuntos
Neoplasia Intraepitelial Cervical/diagnóstico , Técnicas Citológicas , Programas de Rastreamento/métodos , Infecções por Papillomavirus/diagnóstico , Neoplasias do Colo do Útero/diagnóstico , Adulto , Neoplasia Intraepitelial Cervical/virologia , Colposcopia , Dinamarca , Feminino , Humanos , Pessoa de Meia-Idade , Infecções por Papillomavirus/virologia , Valor Preditivo dos Testes , Encaminhamento e Consulta , Sistema de Registros , Neoplasias do Colo do Útero/virologia , Esfregaço Vaginal
7.
APMIS ; 129(4): 195-203, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33445208

RESUMO

In the high-income countries, the amount of cervical adenocarcinomas is on the rise. The pap smear sampling has a low sensitivity and a low specificity for endocervical malignancies, and there are only a few cytomorphological features, that are specifically associated with glandular atypia. In this study, 298 pap smears of 60 patients with endocervical adenocarcinoma or adenocarcinoma in situ (AIS) and 30 patients with high-grade intraepithelial lesion (HSIL) in histology were reviewed. The pap smear type (screening/clinical), the HPV status and the time from sampling to the histological confirmation of diagnosis were recorded for each case. Despite that no cytomorphological features could be associated with adenocarcinoma statistically, 70% of the pap smears were initially correctly diagnosed as an endocervical glandular lesion. Palisading cell borders, nuclear pleomorphism and the lack of single atypical cells present simultaneously were found to be associated with adenocarcinoma and AIS with the corresponding ORs of 5.89 (95% CI 1.96-17.70), 3.71 (95% CI 1.14-12.02) and 10.76 (95% CI 1.20-59.50). This combination of features was seen in smears taken up to 5 years before the histological diagnosis. Of all our screening samples, 10.9% were HPV-positive. There were no HPV-negative samples among patients with adenocarcinoma.


Assuntos
Adenocarcinoma/diagnóstico , Neoplasias do Colo do Útero/diagnóstico , Esfregaço Vaginal , Adulto , Idoso , Idoso de 80 Anos ou mais , Neoplasia Intraepitelial Cervical/diagnóstico , Feminino , Humanos , Pessoa de Meia-Idade , Adulto Jovem
8.
Int J Clin Oncol ; 26(4): 770-776, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33394202

RESUMO

BACKGROUND: Cervical intraepithelial neoplasia (CIN) is a precancerous lesion that may progress to invasive cervical cancer without intervention. We aim to examine the prognostic outcomes and risk factors for recurrence after laser vaporization for CIN 3, CIN 2 with high-risk human papillomavirus (HPV) infection, and CIN 1 persisting for more than 2 years. METHODS: Between 2008 and 2016, a total of 1070 patients underwent cervical laser vaporization using a carbon dioxide laser. We performed a retrospective review of their medical records to assess their clinical characteristics, pathologic factors, and prognostic outcomes. RESULTS: The mean patient age was 34 years (range 18-64 years). The preoperative diagnosis was CIN 1 in 27 patients, CIN 2 in 485 patients, and CIN 3 in 558 patients. Over a median follow-up period of 15 months, the 2-year recurrence rate was 18.9%, and the 5-year recurrence rate was 46.5%. The 2-year retreatment rate was 12.6%, and the 5-year retreatment rate was 30.5%. We diagnosed 9 patients with invasive cancer after treatment; all patients underwent combined multidisciplinary treatment, and there were no deaths during follow-up. The recurrence-free interval was correlated with patient age (hazard ratio [HR], 1.028; 95% CI 1.005-1.051; P = 0.0167), body mass index (HR, 1.052; 95% CI 1.008-1.098; P = 0.0191), and glandular involvement (HR, 1.962; 95% CI 1.353-2.846; P = 0.0004). CONCLUSIONS: Cervical laser vaporization is effective and useful for patients with CIN who wish to preserve fertility. However, patients with glandular involvement, older age, and higher body weight require close follow-up for recurrence.


Assuntos
Neoplasia Intraepitelial Cervical , Terapia a Laser , Infecções por Papillomavirus , Neoplasias do Colo do Útero , Adolescente , Adulto , Idoso , Neoplasia Intraepitelial Cervical/cirurgia , Feminino , Seguimentos , Humanos , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/cirurgia , Papillomaviridae , Prognóstico , Estudos Retrospectivos , Fatores de Risco , Neoplasias do Colo do Útero/cirurgia , Adulto Jovem
9.
Arch Virol ; 166(3): 853-862, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33486629

RESUMO

The aim of this study was to describe the distribution of human papillomavirus (HPV) genotypes among cervical cancers and pre-cancers in Shaanxi province of western China. A total of 17,341 women who were screened for cervical cancer from January 2014 to December 2016, using HPV genotyping and ThinPrep cytologic test were included. The prevalence and attribution of HPV genotypes were stratified by cervical lesion and age group. Of the subjects, 26.3% were infected with HPV, 28.0% of whom had multiple infections. The crude HPV prevalence increased from atypical squamous cells of undetermined significance/low-grade squamous intraepithelial lesions (ASCUS/LSIL, 64.3%) to high-grade squamous intraepithelial lesions (HSIL, 79.8%) and to invasive cervical cancer (ICC, 89.7%, P < 0.001). The three most prevalent genotypes were HPV 16 (8.0%), 58 (4.2%), and 52 (4.0%), and HPV 16, 31 and 33 were positively correlated with increased severity of cervical lesions. Additionally, the divalent vaccine genotypes HPV 16 and 18 accounted for 68.2% of ICC cases. Although 78.5% of ICC and 60.3% of HSIL cases were attributed to 9-valent vaccine genotypes, the other genotypes not covered by any vaccine still resulted in increases in coverage, with 1.5% for ICC, 5.3% for HSIL, and 13.5% for ASCUS/LSIL. HPV prevalence in western China was consistent with other regions of China. Early vaccination with 9-valent HPV vaccine is recommended in this locality for females younger than 26 years with no prior infection, while divalent the vaccine is more appropriate for women between 26 and 45 years, considering the efficacy, safety and cost-effectiveness of vaccines.


Assuntos
Neoplasia Intraepitelial Cervical/epidemiologia , Papillomavirus Humano 16/isolamento & purificação , Papillomavirus Humano 18/isolamento & purificação , Papillomavirus Humano 31/isolamento & purificação , Infecções por Papillomavirus/epidemiologia , Neoplasias do Colo do Útero/epidemiologia , Adulto , Neoplasia Intraepitelial Cervical/virologia , China/epidemiologia , Feminino , Genótipo , Papillomavirus Humano 16/genética , Papillomavirus Humano 18/genética , Papillomavirus Humano 31/genética , Humanos , Pessoa de Meia-Idade , Infecções por Papillomavirus/prevenção & controle , Infecções por Papillomavirus/virologia , Vacinas contra Papillomavirus/uso terapêutico , Prevalência , Neoplasias do Colo do Útero/prevenção & controle , Neoplasias do Colo do Útero/virologia , Vacinação
10.
Rio de Janeiro; s.n; 2021. ilus.
Tese em Português | Coleciona SUS | ID: biblio-1148238

RESUMO

Introdução: O pênfigo paraneoplásico é uma doença autoimune caracterizada pela produção de autoanticorpos por células tumorais neoplásicas. O primeiro sinal da doença são úlceras orais em 45% dos casos. Sua persistência e progressão são características de malignidade, reconhecida ou oculta. O difícil manejo dessa complicação, devido à doença de base não controlada, leva à piora dos sintomas e perda da qualidade de vida do doente. Objetivos: Relato de uma patologia rara, pouco relacionada a neoplasias sólidas, refratária a maioria dos tratamentos e com alta taxa de morbimortalidade. Métodos: Relato de caso de uma paciente com diagnóstico de carcinoma epidermoide de colo do útero, estadio IVa, com doença fora de controle e manifestações de pênfigo paraneoplásico cutâneo e mucoso. Resultados: A paciente apresentou o pênfigo paraneoplásico como complicação do câncer, com dificuldade de diagnóstico pela raridade da doença. Atualmente, sintomática com pouca resposta à corticoterapia. Conclusões: A raridade de algumas doenças torna o atraso no diagnóstico uma dificuldade ao tratamento. Assim como, o padrão de apresentação e a pouca experiência com patologias raras leva, muitas vezes, ao subdiagnóstico e subtratamento de nossos doentes, com perda da qualidade de vida


Background: Paraneoplastic pemphigus is an autoimmune disease characterized by autoantibody production by malignant tumor cells. The first sign of the disease is oral ulcer in 45% of cases. Their persistence and progression are features of malignancy, recognized or hidden. The difficult management of this complication due to uncontrolled underlying disease leads to the worsening of symptoms and loss of the patients' quality of life. Objective: Report a rare pathology, uncommonly related to solid neoplasms, refractory to most procedures and with high rates of morbidity and mortality. Methods: Case report of a patient diagnosed with squamous cell carcinoma of the cervix, stage IVa, with disease out of control and manifestations of skin and mucous paraneoplastic pemphigus. Results: The patient presented paraneoplastic pemphigus as a complication of the cancer, with a difficult diagnosis because of the rarity of the disease. Currently, symptomatic with little response to corticosteroid therapy. Conclusions: The uncommonness of some diseases makes the delay in diagnosing an obstacle to treatment. The presentation pattern and the little experience in rare diseases often lead to the underdiagnosis and undertreatment of our patients and loss of quality of life.


Assuntos
Humanos , Feminino , Adulto , Carcinoma de Células Escamosas/complicações , Pênfigo , Neoplasia Intraepitelial Cervical/complicações , Neoplasias
11.
Future Oncol ; 17(10): 1197-1207, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33331168

RESUMO

Aims: To evaluate the efficacy of TruScreen (TS01) for high-risk human papillomavirus (HR-HPV) women compared with other methods in reducing colposcopy referral rates in hospitals. Methods: A single-center, prospective, case-control study was conducted from December 2019 to June 2020. Results: Among 139 (46.2%) HR-HPV-positive patients, 58 were CIN1, 52 were CIN2-3 and 29 had cervical cancer (n = 29). The sensitivity and specificity of detecting CIN2+ by TS01, colposcopy and HPV16/18 testing were 96.3% and 46.4%, 85.2% and 40.5% and 59.3% and 74.1%, respectively. The highest sensitivity was 96.3% at HPV16/18 and TS01 (each positive results), and the highest specificity was 83.6% at HPV16/18 and TS01 (both positive) for CIN2+ compared with the other methods. Conclusion: TS01 is a noninvasive screening method and can be used to diagnose cervical lesions quickly. It is especially suitable as triage tool for HR-HPV-positive women facing SARS-CoV-2 exposure and infection risks in hospital.


Assuntos
/epidemiologia , Neoplasia Intraepitelial Cervical/diagnóstico , Detecção Precoce de Câncer/métodos , Infecções por Papillomavirus/complicações , Neoplasias do Colo do Útero/diagnóstico , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Colposcopia , Feminino , Humanos , Pessoa de Meia-Idade , Estudos Prospectivos , Sensibilidade e Especificidade , Triagem/métodos , Adulto Jovem
12.
Zhonghua Liu Xing Bing Xue Za Zhi ; 41(12): 2135-2140, 2020 Dec 10.
Artigo em Chinês | MEDLINE | ID: mdl-33378829

RESUMO

Objective: To study the relations of human papillomavirus (HPV) infection, vaginal micro-environmental disorder with cervical lesion. Methods: A total of 1 019 women including 623 with normal cervical (NC), 303 with low-grade cervical lesion (CIN Ⅰ) and 93 with high-grade cervical lesion (CIN Ⅱ/Ⅲ) were enrolled in this study from the communities in Shanxi province, China. Case-control method was adopted, with NC as the control group and CIN as the case group. Related information was collected including demographic characteristics and relevant factors related to cervical lesions. HPV genotypes were detected by flow-through hybridization technology. Vaginal pH was detected by the pH test paper. Vaginal H(2)O(2) was detected by the combined detection kit of aerobic vaginitis and bacterial vaginosis. Vaginal cleanliness was detected by smear method. Results: Data from the unconditional logistic regression analysis showed that HPV infection (CINⅠ: aOR=1.39, 95%CI: 1.01-1.90; CINⅡ/Ⅲ: aOR=11.74, 95%CI: 6.96-19.80), H(2)O(2) (CINⅠ: aOR=2.09, 95%CI: 1.47-2.98; CINⅡ/Ⅲ: aOR=4.12, 95%CI: 2.01-8.43), cleanliness (CIN Ⅱ/Ⅲ: aOR=2.62, 95%CI: 1.65-4.14), and composite indicators (CINⅠ: aOR=1.67, 95%CI: 1.24-2.25; CINⅡ/Ⅲ: aOR=4.24, 95%CI: 2.30-7.81) all had increased the risk of cervical lesion and the trend on the severity (P<0.001) of cervical lesions. Additionally, we observed a synergic effect between HPV infection and vaginal micro-environmental composite indicator in CINⅡ/Ⅲ. With or without HPV infection, the ORs value of CINⅠ caused by vaginal micro-environment disorder remained close. Conclusions: Results from our study revealed that vaginal micro-environmental composite indicator could increase the risk for cervical lesion, in particular with the high-grade ones which all posed stronger risks when combined with HPV infection. However, the role of vaginal micro-environment disorder in the occurrence of CIN Ⅰ should not be ignored.


Assuntos
Neoplasia Intraepitelial Cervical , Infecções por Papillomavirus , Microambiente Tumoral , Vagina , Neoplasia Intraepitelial Cervical/epidemiologia , China/epidemiologia , Feminino , Humanos , Infecções por Papillomavirus/epidemiologia , Vagina/microbiologia , Vagina/virologia , Esfregaço Vaginal
13.
Zhonghua Fu Chan Ke Za Zhi ; 55(11): 784-790, 2020 Nov 25.
Artigo em Chinês | MEDLINE | ID: mdl-33228350

RESUMO

Objective: To evaluate the value of p16INK4a detected by p16INK4a immunostaining as a new generation of cervical cytology for primary screening and secondary screening in population-based cervical cancer screening, and in improving cytological diagnosis. Methods: Between 2016 and 2018, 5 747 non-pregnant women aged 25-65 years with sexual history were recruited and underwent cervical cancer screening via high-risk (HR)-HPV/liquid-based cytological test (LCT) test in Shenzhen and surrounding areas. All slides were immuno-stained using p16INK4a technology, among them, 902 cases were offered p16INK4a detection during primary screening, and the remaining 4 845 cases were called-back by the virtue of abnormal HR-HPV and LCT results for p16INK4a staining. Participants with complete LCT examination, HR-HPV test, p16INK4a staining and histopathological examination results were included in this study. The performance of p16INK4a in primary and secondary screening, and in assisting cytology to detect high grade squamous intraepithelial lesion [HSIL, including cervical intraepithelial neoplasia (CIN) Ⅱ or Ⅲ] or worse [HSIL (CIN Ⅱ)+ or HSIL (CIN Ⅲ)+] were analyzed. Results: (1) One-thousand and ninety-seven cases with complete data of p16INK4a and histology were included. Pathological diagnosis: 995 cases of normal cervix, 37 cases of low grade squamous intraepithelial lesion (LSIL), 64 cases of HSIL and one case of cervical cancer were found. Among them, 65 cases of HSIL (CIN Ⅱ)+ and 34 cases of HSIL (CIN Ⅲ)+ were detected. The positive rate of p16INK4a in HSIL (CIN Ⅱ)+ was higher than that in CINⅠ or normal pathology (89.2% vs 10.2%; P<0.01). (2) p16INK4a as primary screening for HSIL (CIN Ⅱ)+ or HSIL (CIN Ⅲ)+ was equally sensitive to primary HR-HPV screening (89.2% vs 95.4%, 94.1% vs 94.1%; P>0.05), but more specific than HR-HPV screening (89.8% vs 82.5%, 87.7% vs 80.2%; P<0.05). p16INK4a was equally sensitive and similarly specific to cytology (≥LSIL; P>0.05). (3) The specificity of LCT adjunctive p16INK4a for detecting HSIL (CIN Ⅱ)+ or HSIL (CIN Ⅲ)+ were higher than that of LCT alone or adjunctive HR-HPV (P<0.01), while the sensitivity were similar (P>0.05). (4) p16INK4a staining as secondary screening: p16INK4a was significantly more specific (94.1% vs 89.7%, 91.9% vs 87.4%; P<0.01) and comparably sensitive (84.6% vs 90.8%, 88.2% vs 91.2%; P>0.05) to cytology for triaging primary HR-HPV screening. HPV 16/18 to colposcopy and triage other HR-HPV with p16INK4a was equally sensitive (88.2% vs 94.1%; P=0.500) and more specific (88.3% vs 83.0%; P<0.01) than HPV 16/18 to colposcopy and triage other HR-HPV with LCT≥ atypical squamous cells of undetermined significance (ASCUS), and the referral rate decreased (14.0% vs 19.4%; P=0.005). Conclusions: For primary screening, p16INK4a is equally specific to cytology and equally sensitive to HR-HPV screening. p16INK4a alone could be an efficient triage after primary HR-HPV screening. In addition, p16INK4a immunostaining could be used as an ancillary tool to cervical cytological diagnosis, and improves its accuracy in cervical cancer screening.


Assuntos
Neoplasia Intraepitelial Cervical/diagnóstico , Inibidor p16 de Quinase Dependente de Ciclina/análise , Inibidor p16 de Quinase Dependente de Ciclina/imunologia , Detecção Precoce de Câncer/métodos , Imuno-Histoquímica/métodos , Infecções por Papillomavirus/diagnóstico , Neoplasias do Colo do Útero/diagnóstico , Adulto , Idoso , Biomarcadores Tumorais/análise , Neoplasia Intraepitelial Cervical/metabolismo , Neoplasia Intraepitelial Cervical/virologia , Inibidor p16 de Quinase Dependente de Ciclina/fisiologia , Detecção Precoce de Câncer/estatística & dados numéricos , Feminino , Papillomavirus Humano 16 , Papillomavirus Humano 18 , Humanos , Pessoa de Meia-Idade , Papillomaviridae/genética , Papillomaviridae/isolamento & purificação , Infecções por Papillomavirus/metabolismo , Infecções por Papillomavirus/virologia , Gravidez , Sensibilidade e Especificidade , Neoplasias do Colo do Útero/metabolismo , Neoplasias do Colo do Útero/virologia , Esfregaço Vaginal
14.
BMC Infect Dis ; 20(1): 808, 2020 Nov 05.
Artigo em Inglês | MEDLINE | ID: mdl-33153446

RESUMO

BACKGROUND: Although more than 10 years have passed since HPV vaccination was implemented, first as an interim programme (Emergent vaccine promotion programme) in November 2010, followed by incorporating into the National Immunization Programme in April, 2013 and suspended in June 2013, limited studies have investigated the HPV vaccine effectiveness against high-grade cervical lesions in Japan. METHODS: We collected the matched data of the results of cervical biopsy and history of vaccination from the Japan Cancer Society database. The subjects were women aged 20 to 29 years screened for cervical cancer between April, 2015 and March, 2017, and with information on HPV vaccination status. We estimated the relative risk of developing high-grade cervical lesions in vaccinated subjects using Poisson regression as compared to unvaccinated subjects. RESULTS: Among the 34,281 women screened, 3770 (11.0%) were vaccinated. The prevalence of CIN2+ was statistically significantly lower in the vaccinated women as compared to the unvaccinated women (Vaccine Effectiveness (VE) =76%; RR = 0.24, 95% CI:0.10-0.60). High VE against CIN3+ was also observed (91%; RR = 0.09, 95% CI:0.00-0.42). CONCLUSION: Women aged 20-29 years who received at least one dose of HPV vaccine had a significantly lower risk of high-grade cervical lesions than those not vaccinated. In Japan, HPV vaccination should be resumed in order to reduce the incidence of cervical cancer.


Assuntos
Neoplasia Intraepitelial Cervical/prevenção & controle , Papillomaviridae/imunologia , Infecções por Papillomavirus/prevenção & controle , Vacinas contra Papillomavirus/imunologia , Neoplasias do Colo do Útero/prevenção & controle , Vacinação , Adulto , Neoplasia Intraepitelial Cervical/classificação , Neoplasia Intraepitelial Cervical/virologia , Estudos Transversais , Feminino , Humanos , Programas de Imunização , Incidência , Japão/epidemiologia , Infecções por Papillomavirus/epidemiologia , Vacinas contra Papillomavirus/administração & dosagem , Prevalência , Resultado do Tratamento , Neoplasias do Colo do Útero/classificação , Neoplasias do Colo do Útero/virologia , Adulto Jovem
15.
Medicine (Baltimore) ; 99(46): e23155, 2020 Nov 13.
Artigo em Inglês | MEDLINE | ID: mdl-33181688

RESUMO

BACKGROUND: There are currently no available standard drugs treating human papillomavirus (HPV) infection, especially for patients with low-grade cervical lesion. Several therapies are explored but the results are inconclusive. The objective of this study was to evaluate the efficacy of reported non-invasive treatments in patients with HPV infection and cervical lesions by meta-analysis. METHODS: A comprehensive search of prospective and randomized studies published from April 2000 to April 2020 was conducted in electronic databases. The statistical analyses of the pooled risk ratios (RRs) and the corresponding 95% confidence intervals (95% CIs) were performed using the Revman 5.2 software. RESULTS: Twelve articles including 12 randomized controlled studies and 1 prospective controlled randomized pilot study were enrolled. Therapeutic medications included biological and herbal regimen, interferon regimen and probiotics. The meta-analysis showed the experimental treatments had a statistically significant improvement in HPV clearance rate compared with the controls (RR = 0.71, 95% CI [0.63, 0.80], P < .00001); subgroup analyses stratified by regimen categories were consistent with results in the overall group. Treatment using biological and herbal regimen, interferon regimen or probiotics also resulted in a beneficial outcome in regression rate of cervical lesions compared with the controls (RR = 0.55, 95% CI [0.39, 0.79], P = .001). The trend was more favorable in the probiotics than that in the biological and herbal regimen (RR 0.48 vs 0.72). CONCLUSION: Treatment of biological and herbal regimen, interferon regimen and probiotics benefit patients who have HPV infection and cervical lesions. Both the clearance of HPV and regression of cervical lesions are significant. More studies with less heterogeneity are needed to draw a concrete conclusion.


Assuntos
Produtos Biológicos/farmacologia , Neoplasia Intraepitelial Cervical/terapia , Interferons/farmacologia , Infecções por Papillomavirus/terapia , Preparações de Plantas/farmacologia , Antivirais/farmacologia , Neoplasia Intraepitelial Cervical/virologia , Feminino , Humanos , Infecções por Papillomavirus/complicações , Resultado do Tratamento
16.
N Z Med J ; 133(1524): 50-63, 2020 10 30.
Artigo em Inglês | MEDLINE | ID: mdl-33119570

RESUMO

BACKGROUND: Most cervical cancers are associated with human papillomavirus (HPV) types 16 and 18. In 2008, New Zealand commenced a quadrivalent HPV (virus-like particles of types 6, 11, 16 and 18) vaccination programme. AIM: Document trends in number of colposcopy referrals and number and grade of cervical abnormalities diagnosed in women (20-24 years) referred to three large colposcopy clinics over time. METHOD: Retrospective analysis of colposcopy clinic data. RESULTS: The dataset included 5,012 episodes from 4,682 women. In Auckland (2013-2017), there was a 38% decrease in colposcopy referrals and 55% decrease in cervical intraepithelial neoplasia grade 2 (CIN2) or worse diagnoses. In Waikato (2011-2017), there was an 8% decrease in referrals and 22% reduction in CIN2 or worse diagnoses. In Canterbury (2011-2017), there was a 24% decrease in referrals and 49% reduction in CIN2 or worse diagnoses. Across all centres, the decrease in cervical intraepithelial neoplasia grade 3 (CIN3) or worse diagnoses was marked and more consistent than in CIN2 diagnoses. However, while the proportion of biopsies reported as CIN3 or worse decreased in non-Maori (24% in 2013 vs 16% in 2017, nptrend z=-4.24, p>|z| <.001), there was no change in Maori women (31% in 2013 vs 29% in 2017, nptrend z=-0.12, p>|z| =.90). CONCLUSIONS: We observed a decreased number of CIN diagnoses in young women over time, with a particularly large drop in the number of CIN3/AIS/CGIN diagnoses. However, compared to non-Maori, Maori women having biopsies are more likely to have CIN3 or worse and there was a smaller reduction in the total number of Maori women diagnosed with CIN2 or worse.


Assuntos
Neoplasia Intraepitelial Cervical/epidemiologia , Vacinas contra Papillomavirus , Neoplasias do Colo do Útero/epidemiologia , Biópsia , Neoplasia Intraepitelial Cervical/diagnóstico , Colposcopia/tendências , Feminino , Humanos , Povos Indígenas , Gradação de Tumores , Nova Zelândia/epidemiologia , Grupo com Ancestrais Oceânicos , Infecções por Papillomavirus/prevenção & controle , Estudos Retrospectivos , Neoplasias do Colo do Útero/diagnóstico , Adulto Jovem
17.
Zhonghua Fu Chan Ke Za Zhi ; 55(10): 708-715, 2020 Oct 25.
Artigo em Chinês | MEDLINE | ID: mdl-33120484

RESUMO

Objective: Evaluation of the clinical value of the BioPerfectus multiplex real time (BMRT)-HPV for cervical cancer screening. Methods: Physician-collected specimens of 1 495 women who were positive of Cobas 4800 HPV (Cobas-HPV), HPV genotyping based on SEQ uencing (SEQ-HPV), and (or) cytology ≥low grade squamous intraepithelial lesion (LSIL) in the primary screening of Chinese Multiple-center Screening Trial (CHIMUST), and 2 990 women selected from those who were negative of primary screening in the same project through nested control randomization with age-matching were tested for BMRT-HPV, which reported type-specific viral loads/10 000 cells in each specimen. With comparing to Cobas-HPV results and taking cervical histopathological diagnosis as the endpoint, the concordance of high-risk (HR)-HPV subtypes among the three assays was explored ,and the sensitivity and specificity of BMRT-HPV for cervical cancer screening were evaluated. Results: (1) The overall agreenment of HR-HPV subtypes between BMRT-HPV and Cobas-HPV, or SEQ-HPV test sample was 94.8%, 94.4%, with Kappa values 0.827, 0.814. (2) The sensitivity and specificity for cervical intraepithelial neoplasia (CIN) Ⅱ+ of BMRT-HPV, Cobas-HPV and SEQ-HPV were 92.62%, 94.26%, 93.44% and 84.67%, 83.25%, 82.76%, respectively. There were no significant difference in sensitivity among the three HPV assays (all P>0.05), but the specificity of BMRT-HPV for CIN Ⅱ+ was higher than those of Cobas-HPV and SEQ-HPV (P<0.01). The sensitivity for CIN Ⅲ+ of three HPV assays were all 100.00%, and the specificity for CIN Ⅲ+ of BMRT-HPV was higher than those of Cobas-HPV and SEQ-HPV (83.40% vs 81.95%, 83.40% vs 81.50%; P<0.01). The number of pathological examinations of colposcopy for cervical biopsy detected in 1 case of CIN Ⅱ+ or CIN Ⅲ+ in BMRT-HPV was less than those in Cobas-HPV and SEQ-HPV (P<0.01). When using HPV 16/18 + cytology ≥atypical squamous cell of undetermined signification (ASCUS) to triage HPV positive women among three assays, there was no different in the sensitivities of detecting CIN Ⅱ+ and CIN Ⅲ+ (P>0.05). The specificity BMRT-HPV was slightly higher than those in Cobas-HPV or SEQ-HPV (all P<0.05), and the colposcopy referral rate was lower than those in Cobas-HPV and SEQ-HPV (all P<0.05). Conclusions: BMRT-HPV is as sensitive as Cobas-HPV or SEQ-HPV for primary cervical cancer screening, and has higher specificity. Therefore it could be used as a primary screening method for cervical cancer, which is worthy of clinical application.


Assuntos
Neoplasia Intraepitelial Cervical/diagnóstico , Papillomaviridae/isolamento & purificação , Infecções por Papillomavirus/diagnóstico , Neoplasias do Colo do Útero/diagnóstico , Adulto , Idoso , Idoso de 80 Anos ou mais , Neoplasia Intraepitelial Cervical/virologia , DNA Viral/análise , DNA Viral/genética , Detecção Precoce de Câncer , Feminino , Papillomavirus Humano 16/genética , Papillomavirus Humano 18/genética , Humanos , Programas de Rastreamento/métodos , Papillomaviridae/genética , Infecções por Papillomavirus/virologia , Valor Preditivo dos Testes , Gravidez , Sensibilidade e Especificidade , Neoplasias do Colo do Útero/virologia , Esfregaço Vaginal/métodos
18.
BMC Infect Dis ; 20(1): 801, 2020 Oct 29.
Artigo em Inglês | MEDLINE | ID: mdl-33121447

RESUMO

BACKGROUND: According to the 2006 American Society for Colposcopy and Cervical Pathology guidelines, positive CIN2 p16 in women over the age of 25 should be managed with excisional treatment. However, excisional treatment is associated with physical, psychological and obstetric morbidity and can have a negative impact on sexual function. In our study we sought to identify a clear management strategy, addressing the impact of routine use of p16 immunohistochemistry in this population and identify appropriate criteria for patient selection with the aim of reducing over-treatment. METHOD: We studied the medical records of 130 patients who had undergone laser therapy for CIN2. Each patient underwent colposcopy, biopsy and HPV test and were tested for p16 protein,. Patients were divided based on HPV infection into: single infections, multiple infections. All patients underwent ZTA laser therapy with follow-up (2-year follow-up). STATISTICAL ANALYSIS: Contingency tables were created to evaluate the correlation between single, multiple and CIN2+ infections. Values with p < 0.05 were considered statistically significant. RESULTS: Single infections had a histological regression of 61.8% (21/34) and a histological persistence rate of 35.3% (12/34), which was greater than the multiple infection rate. The common characteristic that the women with persistence and progression had was the dimension of the lesion and the genotype 16. Ten cases of histological persistence and the only case of progression had one lesion greater than three quarters of the cervix. CONCLUSIONS: With the progress of our understanding of the natural history of infection from human papillomavirus and the increasing use of colposcopy, thanks to the addition of HPV genotyping and the technique of immunohistochemistry, conservative management of these lesions is now possible.


Assuntos
Neoplasia Intraepitelial Cervical/complicações , Neoplasia Intraepitelial Cervical/terapia , Tratamento Conservador/métodos , Inibidor p16 de Quinase Dependente de Ciclina/metabolismo , Papillomaviridae/genética , Infecções por Papillomavirus/complicações , Neoplasias do Colo do Útero/complicações , Neoplasias do Colo do Útero/terapia , Adulto , Neoplasia Intraepitelial Cervical/virologia , Colposcopia , Inibidor p16 de Quinase Dependente de Ciclina/imunologia , Progressão da Doença , Feminino , Seguimentos , Genótipo , Humanos , Imuno-Histoquímica , Terapia a Laser , Infecções por Papillomavirus/virologia , Estudos Retrospectivos , Resultado do Tratamento , Neoplasias do Colo do Útero/virologia
19.
Anticancer Res ; 40(11): 6273-6284, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-33109565

RESUMO

BACKGROUND/AIM: To determine the differential protein profiles of cervical cancer cell lines in order to find potential targets that can be used as biomarkers in low-grade squamous intraepithelial lesions (LSIL) diagnosis. MATERIALS AND METHODS: Proteomic analysis was performed on cervical cancer cell lines by 2D electrophoresis and liquid chromatography-mass spectrometry. Biomarker validation was performed in histological samples by immunofluorescence. RESULTS: Aldo-keto reductase C1 (AKR1C1) and transketolase-like 1 (TKTL1) proteins were selected as biomarkers and their expression was increased in samples with LSIL diagnosis. TKTL1 in combination with AKR1C1 increased sensitivity and specificity to 75% and 66%, respectively, with an area under curve of 0.76 in receiver operating characteristics curve analysis. CONCLUSION: AKR1C1 and TKTL1 showed potential as biomarkers for diagnosis of LSIL in Mexican women, with similar sensitivity and specificity to the biomarkers used in clinical trials for diagnosis of LSIL.


Assuntos
20-Hidroxiesteroide Desidrogenases/metabolismo , Neoplasia Intraepitelial Cervical/diagnóstico , Neoplasia Intraepitelial Cervical/metabolismo , Lesões Intraepiteliais Escamosas/diagnóstico , Lesões Intraepiteliais Escamosas/metabolismo , Transcetolase/metabolismo , Adulto , Área Sob a Curva , Linhagem Celular Tumoral , Neoplasia Intraepitelial Cervical/patologia , Feminino , Humanos , México , Gradação de Tumores , Proteínas de Neoplasias/metabolismo , Mapas de Interação de Proteínas , Curva ROC , Lesões Intraepiteliais Escamosas/patologia
20.
BMC Infect Dis ; 20(1): 642, 2020 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-32873233

RESUMO

BACKGROUND: Evidence suggested that vaginal microbiome played a functional role in the progression of cervical lesions in female infected by HPV. This study aimed at evaluating the influence of common vaginal infection on the carcinogenicity of high risk HPV (hr-HPV). METHODS: From January 15, 2017 to December 31, 2017, 310,545 female aged at least 30 years old had been recruited for cervical cancer screening from 9 clinical research centers in Central China. All the recruited participants received hr-HPV genotyping for cervical cancer screening and vaginal microenvironment test by a high vaginal swab. Colposcopy-directed biopsy was recommended for female who were infected with HPV 16 and HPV 18, and other positive hr-HPV types through test had undertaken triage using liquid-based cytology, cases with the results ≥ ASCUS among them were referred to colposcopy directly, and cervical tissues were taken for pathology examination to make clear the presence or absence of other cervical lesions. RESULTS: Among 310,545 female, 6067 (1.95%) were tested with positive HPV 16 and HPV 18, 18,297 (5.89%) were tested with other positive hr-HPV genotypes, cervical intraepithelial neoplasia (CIN) 1, CIN 2, CIN 3 and invasive cervical cancer (ICC) were detected in 861 cases, 377 cases, 423 cases, and 77 cases, respectively. Candida albicans and Gardnerella were not associated with the detection of cervical lesions. Positive trichomonas vaginitis (TV) was correlated with hr-HPV infection (p < 0.0001). Co-infection with TV increased the risk of CIN 1 among female infected with hr-HPV (OR 1.18, 95% CI: 1.42-2.31). Co-infection with TV increased the risk of CIN 2-3 among female infected with HPV 16 (OR 1.71, 95% CI: 1.16-2.53). CONCLUSIONS: Co-infection of TV and HPV 16 is a significant factor for the detection of cervical lesions.


Assuntos
Neoplasia Intraepitelial Cervical/epidemiologia , Coinfecção/complicações , Papillomavirus Humano 16/genética , Papillomavirus Humano 18/genética , Infecções por Papillomavirus/complicações , Vaginite por Trichomonas/complicações , Trichomonas vaginalis/isolamento & purificação , Neoplasias do Colo do Útero/epidemiologia , Adulto , Neoplasia Intraepitelial Cervical/diagnóstico , Neoplasia Intraepitelial Cervical/virologia , China/epidemiologia , Coinfecção/diagnóstico , Colposcopia , Estudos Transversais , Citodiagnóstico , Detecção Precoce de Câncer/métodos , Feminino , Genótipo , Humanos , Pessoa de Meia-Idade , Infecções por Papillomavirus/diagnóstico , Infecções por Papillomavirus/patologia , Infecções por Papillomavirus/virologia , Fatores de Risco , Vaginite por Trichomonas/diagnóstico , Vaginite por Trichomonas/parasitologia , Neoplasias do Colo do Útero/diagnóstico , Neoplasias do Colo do Útero/virologia
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