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PubMed2005

Assessment of human papilloma viral load of archival cervical intraepithelial neoplasia by real-time polymerase chain reaction in a Turkish population.

The purpose of this study was to determine the existence, and viral load of human papilloma virus (HPV) subtypes 16 and 18 in paraffinized cervical intraepithelial neoplasia (CIN) samples by real-time polymerase chain reaction (RT-PCR). Overall 94 women were included. Of these patients 47 (50%) had CIN I, 27 (28.8%) had CIN II, and 20 (21.2%) had CIN III. HPV positivity for these three groups were 4.2%, 14.8% and 45%, respectively. HPV positivity in CIN III patients was significantly higher than CIN I (OR = 18.41, 95% CI 3.00-145.73; p < 0.001), and CIN II patients (OR = 4.70, 95% CI 1.00-23.76; p = 0.05). The difference between CIN I and II was not significant (p = 0.18). Viral loads were 10(2), and 10(4) copy/ml for two CIN I patients; 10(2), 10(3), and 10(5) for three CIN II patients; and 10(2), 10(3), 10(4), 10(4), 10(5), 10(5), and 10(6) copy/ml for eight patients with CIN III. Viral load of the remaining one patient could not be assessed. No significant variance was noted among the groups with respect to viral load (p = 0.73). RT-PCR had important advantages of detecting, typing, and quantifying at the same time. Although HPV positivity was increased significantly by the degree of lesions, this relation was not observed for viral load.

Adult↗
PubMed2005

[Cervical glandular intraepithelial neoplasia topography and the risk of conisation].

OBJECTIVES: The frequency of endocervical adenocarcinoma is increasing in comparison with squamous cell carcinoma and it presents a very difficult diagnostic and therapeutic problem. DESIGN: The aim of this study was: 1) Evaluation of topography of the cervical glandular intraepithelial neoplasia (CGIN) 2) An analysis of the Human Papillomavirus (HPV) infection rate in samples. MATERIALS AND METHODS: 360 amputated uterine cervix samples with histologically-proven diagnosis of cervical intraepithelial neoplasia (CIN-3) were evaluated. The coexistence of pre-invasive lesions in squamous epithelium and endocervical columnar cell were investigated. Moreover CGIN topography and retrospective histopathological analysis were determined. A polymerase chain reaction (PCR) was performed using commercially available PCR Human Papillomavirus Typing Set to detect HPV infection. RESULTS: Among 360 positive cervical intraepithelial glandular neoplasia samples (CIN-3) 71 (19.7%) showed coexisting glandular lesions (CGIN-1, 2, 3). The lesions in endocervical glandular cells of CIGN-type were distributed from the distance up to 14 mm from the surface of cervix. Most of them were located no deeper than 1 mm from the surface of canal epithelium. HPV DNA was found in more than 90 preneoplastic glandular proliferations. The frequency of oncogenic HPV-16 and 18 presence was higher than non-oncogenic HPV. CONCLUSIONS: 1. CIN-3 is associated in about 20% with cervical glandular intraepithelial neoplasia (CGIN). 2. Topography of CGIN is important in planning the management. 3. Most of CIGN are associated with HPV infection.

Carcinoma in Situ↗
PubMedDate not supplied

High-grade squamous intraepithelial lesion with endocervical cone margin involvement after cervical loop electrosurgical excision: what should a clinician do?

This study was undertaken to evaluate the incidence and severity of residual lesions in women featuring high-grade squamous intraepithelial lesion (HSIL) histology with endocervical cone margin involvement after the loop electrosurgical excision procedure (LEEP). The medical records of women undergoing LEEP at Chiang Mai University Hospital between October 2004 and February 2006 were retrospectively reviewed and 74 cases were identified. Nineteen women were excluded because of loss to follow-up. The remaining 4 were referred to other hospitals and 2 declined re-excision, leaving a study population of 55 women for analysis. Mean age+/-SD of the patients was 48.5+/-8.9 years. Residual lesions were noted in 26 (47.3%, 95%CI=33.7 to 61.2). Four (7.3%) had unrecognized invasive cervical carcinoma in subsequent specimens. In conclusion, approximately half of women with positive endocervical cone margins after LEEP for HSIL histology have residual disease. Repeat diagnostic excision is recommended for evaluation of lesions and severity.

Adult↗
PubMed1996

One-session management of cervical intraepithelial neoplasia: a solution for developing countries.

Six hundred thirty-nine patients with CIN on referral Pap were evaluated cytocolposcopically at the first visit and decided whether to be treated the same day or not. One hundred ninety-two patients (30%) were considered negative. Follow-up evidenced later appearance of CIN in five of them. One hundred fifty-three (24%) were candidates for delayed treatment due to conditions contraindicating same-day treatment. Two hundred ninety-four patients (46%) were randomly allocated in LEEP (149) or excisional laser (145) arms, and treated the same day under local anesthesia. Both arms were comparable. There were three microinvasive carcinomas diagnosed in the surgical specimen. LEEP was faster and produced less bleeding than laser, although required a mean of four slices to remove the lesion. Arterial hypertension after anesthetic infiltration was detected in 26% of cases. Two intraoperative and two delayed bleeders required surgery. The size of lesion and surgical defect were larger than those reported in the literature. Margins were involved in 8 patients (2.7%). Only 4.7% (7/149) of patients randomized to LEEP and 3.4% (5/145) with excisional laser had persistent or recurrent CIN on follow-up. Factors predisposing to failure included depth of surgical defect, grade of lesion, and operator's expertise. With this approach, 69% of patients referred for cytology of CIN were adequately managed in the first visit, which contrasts to classical management that reaches the state of treatment in 30% of patients. LEEP appears to be faster, less costly, and requires less expertise. Its use in conjunction with adequate screening is recommended for developing countries.

Conization↗
PubMed1996

[Atypical cervix uteri smears--consequences?].

Among 37,992 cervical smears (725 (1.9%)) were found to be atypical. All atypial smears were referred for colposcopically guided biopsies and cervical abrasio within three months. This is an expensive and cumbersome procedure. In order to obtain a more differentiated follow-up procedure the atypical smears were divided into two groups without knowledge of the later histological diagnosis on biopsy: "Atypia, probably reactive" and "atypia, probably CIN (cervical intraepithelial neoplasia)". In the latter group the subsequent biopsies showed significantly more CIN than in the former (60.4% against 15.7%). We find it useful to divide the atypical smears into two groups in our daily routine work with a different follow-up procedure: "Atypia, probably reactive" to be followed by a repeat smear and "atypia, probably CIN" to be followed by colposcopically guided biopsies and cervical abrasio.

Biopsy↗
PubMed1996

[Management of pregnant women with abnormal cervical smears. A series of 146 patients].

OBJECTIVES: Evaluation of the value of colposcopy and directed biopsy in the follow-up of pregnant women presenting with abnormal cervical smear. MATERIAL AND METHODS: Retrospective study of 146 patients examined by colposcopy during pregnancy between January 1985 and December 1994. RESULTS: Colposcopy was satisfactory in 86% of patients. Colposcopic impression was concordant with the final diagnosis, overestimated and underestimated in 69%, 18% and 13% of the cases, respectively. Directed biopsies were performed in 115 patients. In one case, bleeding necessitated vaginal packing for 24 hours. Directed biopsy correlated well with the final diagnosis in 87% of low grade CIN and in 90% of high grade CIN. In 4 patients, conisation was performed between 10 and 16 weeks of gestation without subsequent obstetrical complications. CONCLUSION: Colposcopy with directed biopsy is a reliable tool to evaluate abnormal smear during pregnancy.

Adolescent↗
PubMed1996

Cervical dysplasia treatment: key issues for developing countries.

Many developing countries face serious obstacles that have hindered establishment of successful cervical cancer control programs. Various countries are now seeking to strengthen cytology services and identify simple low-cost screening strategies; but any real gains in reducing cervical cancer incidence and mortality will also require effective treatment of women with preinvasive disease. Despite a trend toward conservative outpatient approaches for treating cervical dysplasia in industrialized countries, clinicians in many developing countries still rely primarily on invasive inpatient methods such as cone biopsy and hysterectomy. For women who could be treated with less invasive methods, these procedures tend to pose unnecessary risks and entail high costs that put them beyond the reach of many patients. Outpatient therapy, employing methods such as cryotherapy and the loop electrosurgical excision procedure (LEEP), combined with proper follow-up, is appropriate for dealing with visible lesions on the ectocervix when invasive cancer and endocervical involvement have been ruled out. Cryotherapy and LEEP hold out particular promise for developing countries because of their effectiveness, lack of side-effects, simplicity, and low cost. Cure rates range from 80% to 95%, depending on the method used and the severity of the lesions. However, each method has advantages and disadvantages that demand consideration. Various ways of reducing the number of follow-up visits, including the two-visit "see and treat" approach, are also available for use in areas where women's access to health services may be limited. A recent survey by the Program for Appropriate Technology in Health (PATH) affirmed the tendency to rely on cone biopsy and hysterectomy. It also found that in many places all degrees of preinvasive disease were treated, rather than only high-grade or severe conditions; that respondents in Latin America, the Caribbean, and Asia tended to use cryotherapy and LEEP more widely than other low-cost methods; that LEEP was preferred over cryotherapy in Latin America; and that colposcopes and other basic equipment needed to provide treatment were not consistently or widely available in some settings.

Colposcopy↗
PubMed1997

Overcoming unsatisfactory colposcopy. Use of osmotic dilators.

OBJECTIVE: To evaluate the usefulness of osmotic dilators as an alternative to diagnostic cone biopsy. STUDY DESIGN: Women who had an unsatisfactory colposcopic examination were offered repeat examination after use of osmotic dilators as part of an interventional, nonrandomized study. The physician selected the type, size and duration of use of the dilator. RESULTS: Twenty-nine of 32 women (91%) underwent a satisfactory repeat examination. Diagnostic cone biopsy was avoided in all women. Twenty-one women did not require further treatment, and four women had the lesion removed by the colposcopically directed biopsy. Six women underwent electrosurgery, and one woman underwent cryotherapy. CONCLUSION: The use of osmotic dilators can decrease the need for diagnostic cone biopsy.

Adult↗
PubMed1997

[Microinvasive cervical cancer].

While the rate of invasive carcinoma of the cervix is relatively constant among women under 40 years of age, the rate of microinvasive carcinoma (MIC) appears to increase steadily in this young age group. The definition of MIC is not universally established and if the probability of dissemination of the disease is low, it is not unconceivable and calls for an adequate surgical treatment that should respect the anatomic and functional integrity of these young women. The diagnosis of MIC relies primarily on conisation that is indicated in severe dysplasia and cervical neoplasia with no evidence of invasion on colposcopic directed biopsies. Conisation is the standard approach that requires a rigorous surgical technique and a thorough histological evaluation of the surgical sample by a skilled pathologist. This pathologic examination should be particularly attentive to the depth of stromal invasion, the width and volume of the lesion and the magnitude of LVI. While the dissemination within the parametrium cannot be well assessed, it appears that the likelihood of pelvic lymph node involvement approximates the depth of stromal invasion of the MIC with a threshold limit of 3 mm. LVI also carries the risk of poor prognosis, particularly in the early stages of the disease, and has been taken into consideration by the Society of Gynecologic Oncologists (SGO). The standard treatment of MIC is also conisation under the condition that the surgical limits are not diseased. If the depth of stromal invasion exceeds 3 mm or if LVI is reported by the pathologist, the lesion should then be treated like an invasive carcinoma of the cervix (i.e.: colpohysterectomy and pelvic lymphadenectomy). In some instances however (e.g.: early invasion with LVI), a laparoscopy directed pelvic lymphadenectomy could be suggested as a first line investigation associated with conisation. Since early invasive carcinoma of the cervix can now be defined and carries a reduced spreading potential we can propose an adequate treatment allowing functional integrity in these patients in a particularly young age group.

Biopsy↗