National Cancer Institute®
Last Modified: September 1, 2002
UI - 12039126
AU - Sellors JW; Jeronimo J; Sankaranarayanan R; Wright TC; Howard M;
TI - Blumenthal PD Assessment of the cervix after acetic acid wash: inter-rater agreement using photographs.
SO - Obstet Gynecol 2002 Apr;99(4):635-40
AD - Program for Appropriate Technology in Health (PATH), Seattle, Washington, USA. email@example.com
OBJECTIVE: To estimate the inter-rater agreement on the assessment of cervical photographs after acetic acid wash, using visual inspection with acetic acid categories. METHODS: Three raters individually assessed 144 photographs as negative, positive, or suspicious for cancer. The inter-rater agreement was analyzed using the unweighted and weighted kappa coefficient. To explore the reasons for concordancy and discordancy, photographs were compared on histologic evidence of cervical intraepithelial neoplasia and on testing for oncogenic types of human papillomavirus. RESULTS: Overall raw agreement among the three raters was 66.7% (96 of 144) with a kappa of 0.57 (95% confidence interval 0.48, 0.66). Pair-wise agreement using unweighted and weighted kappa was moderate to substantial: 0.54-0.60 and 0.56-0.63, respectively. There was concordance on negative in 25.7% (37 of 144) and on positive or suspicious for cancer in 41.0% (59 of 144). Cervical intraepithelial neoplasia II or III was not present on biopsy if photographs were concordant-negative, and the human papillomavirus test was less likely to be positive (relative risk 0.3; 95% confidence interval 0.2, 0.6) in concordant-negatives compared with concordant-positives, including suspicious for cancer. Cervical intraepithelial neoplasia II or III was more common in photographs that were concordant-positive, including suspicious for cancer, compared with discordants (relative risk 3.4, 95% confidence interval 1.5, 7.6). CONCLUSION: Based on photographs of the cervix taken after acetic acid wash, the level of agreement among raters using visual inspection with acetic acid categories was moderate to substantial, consistent with other commonly used tests.
UI - 12039132
AU - Solomon D; Schiffman M; Tarone R
TI - ASCUS LSIL Triage Study (ALTS) conclusions reaffirmed: response to a
SO - Obstet Gynecol 2002 Apr;99(4):671-4
AD - Division of Cancer Prevention, National Cancer Institute, Maryland, USA. firstname.lastname@example.org
UI - 12121440
AU - Ahmed SM; Al H; Reid WM; Johnson MA; Poulter LW
TI - The cellular response associated with cervical intraepithelial neoplasia in HIV+ and HIV- subjects.
SO - Scand J Immunol 2002 Aug;56(2):204-11
AD - Department of Immunology, Royal Free and University College Medical School, London, UK. email@example.com
This study investigates local alterations in T-cell and macrophage subsets that occur in cervical epithelial neoplasia (CIN), in the presence and absence of human immunodeficiency virus (HIV) infection. Ectocervical biopsies from 10 women with CIN who were infected with HIV, and 10 women with CIN but no HIV infection were studied by immunocytochemistry. Significantly increased proportions of activated CD8+ T cells were seen in all CIN biopsies, and these proportions were further increased in the presence of HIV infection. Levels of CD8+TIA-1+ cells were particularly increased in the CIN+HIV+ group. There was a lack of expression of CD28 on the CD8+ cells of the epithelium of CIN+HIV+ samples. A significant reduction in the proportion of epithelial inductive D1+ macrophages and an increase in D1+D7+-suppressive cells were observed in the CIN+HIV+ cohort. The lack of expression of CD28 on the CD8+ cells of the epithelium of CIN+HIV+ samples in combination with the reduced CD4+ T-cell numbers seen in the presence of HIV infection may contribute to the development of higher grade CIN in this susceptible group. This may be aggravated by the reduction in the D1+ epithelial inductive macrophages, which might reflect recruitment of more suppressive D1+D7+ cells. This would further compromise the ability of the local T-cell system to respond to antigens and thus contribute to the development of neoplasia at this site. These results suggest that the increase in activated CD8+ T cells is a consequence rather than a cause of CIN.
UI - 11852544
AU - Comar M; Wiesenfeld U; Variola F; Campello C
TI - HPV-direct in situ PCR: an advanced molecular tool in the screening of cervical cancer.
SO - Ann Ig 2001 Nov-Dec;13(6):581-6
AD - Dip. di Scienze di Medicina Pubblica, UCO Igiene e Medicina Preventiva, Universita degli Studi di Trieste, IRCCS Burlo Garofolo, Trieste.
UI - 11981939
AU - Arbyn M; Temmerman M
TI - Parliament calls for organised cervical cancer screening and HPV research.
SO - Eur J Obstet Gynecol Reprod Biol 2002 Mar 10;101(2):101-2
UI - 11858896
AU - Erzen M; Mozina A; Bertole J; Syrjanen K
TI - Factors predicting disease outcome in early stage adenocarcinoma of the uterine cervix.
SO - Eur J Obstet Gynecol Reprod Biol 2002 Mar 10;101(2):185-91
AD - Unit of Gynaecological Pathology and Cytology, Department of Obstetrics and Gynaecology, University Medical Centre, Ljubljana, Slajmerjeva 3, 1105, Ljubljana, Slovenia. firstname.lastname@example.org
CONTEXT: Adenocarcinoma (AC) and adenosquamous carcinoma (ASC) comprise the second principal histological types of cervical carcinoma. As compared with the squamous cell cancer (SCC), these lesions are far less frequent, and their epidemiology, natural history and prognostic determinants are less well understood. OBJECTIVE: Patients with an early stage AC of the uterine cervix diagnosed in our clinic were subjected to detailed analysis for the prognostic determinants. STUDY SUBJECTS: A series of 94 women with early stage (adenocarcinoma in situ (AIS) to IIB) cervical ACs or ASCs diagnosed and treated in our department during 1995-1999 and subsequently followed-up for a mean of 43.1 +/- 16.2 (S.D.) months. MAIN OUTCOME MEASURES: Patients were examined by colposcopy, Papanicolaou (PAP) smear and biopsy. The stage of the disease (FIGO) and tumour histology in operative specimens were recorded, and univariate (Kaplan-Meier) and multivariate survival analysis (Cox) were run to explore the factors predicting disease outcome. RESULTS: Mean age of the women was 44.2 +/- 2.5 (S.D.) years (range 24-81 years), which is significantly (P=0.000) lower than that (49.9 +/- 14.2) of 464 SCC patients in our material. Minority of the women (38.2%) reported any clinical symptoms, but these correlated with the stage (P=0.041). Screening history was acceptable (i.e. screening interval 3 to 4 years) in 56 women, whereas 28 (29.8%) had no previous PAP smear taken. Interpretation errors were established in 17 (23.6%) and sampling errors in 6 (8.3%) of the 72 smears available for re-screening. No colposcopic lesions were found in 29 (30.9%) women. Follow-up data were available from 72 patients, of whom the disease progressed in four (one died), whereas 68 patients are alive and well at the moment. Patient's age (P=0.000), screening history (P=0.0127), FIGO stage (P=0.001), mode of therapy (P=0.0187), and presence of co-existent squamous cell lesions (P=0.0184) were significant prognostic indicators in univariate survival analysis. Cox's multivariate survival analysis disclosed FIGO stage (P=0.001) and screening history (P=0.006) as the only significant independent predictors of the disease outcome. CONCLUSIONS: The present data emphasise the importance of early cervical AC as a disease of younger women, making early detection of its precursors (AIS) by regular PAP smear screening mandatory in prevention of disease progression. This can only be achieved by increasing the sensitivity of the PAP smear in detecting abnormal glandular cells in asymptomatic women.
UI - 11858897
AU - Kodama J; Mizutani Y; Hongo A; Yoshinouchi M; Kudo T; Okuda H
TI - Optimal surgery and diagnostic approach of stage IA2 squamous cell carcinoma of the cervix.
SO - Eur J Obstet Gynecol Reprod Biol 2002 Mar 10;101(2):192-5
AD - Department of Obstetrics and Gynecology, Okayama University Medical School, 2-5-1 Shikata-cho, 700-8558, Okayama, Japan. email@example.com
BACKGROUND: Most patients with International Federation of Gynecology and Obstetrics (FIGO) stage IA2 squamous cell carcinoma of the cervix, opt for radical surgery at present. Objective: To review surgical and diagnostic approaches in such patients. STUDY DESIGN: Our patient population consisted of 394 patients with a diagnosis of stage I squamous cell cervical carcinoma (with depth of stromal invasion 10mm or less) according to the 1995 FIGO definition. Biopsy and surgical specimen slides were reassessed retrospectively in all cases. The findings of T2-weighted MR imaging were available from the individual medical charts. RESULTS: None of the patients with stromal invasion of 5mm depth or less showed pelvic lymph node metastasis. However, metastasis to the parametrial connective tissue was found in one case with stage IA1 exhibiting marked lymph-vascular space involvement. There were no deaths due to disease in cases with stromal invasion of 5mm depth or less. The lesions were detected in all 20 cases exhibiting stromal invasion of greater than 5mm in depth. In contrast, the lesions were not detected with T2 imaging in four of six cases (67%) with stage IA2. CONCLUSION: Simple or modified radical hysterectomy with pelvic lymph node dissection may be sufficient for cases of stage IA2 cervical squamous cell carcinoma where lymph-vascular space involvement is absent. T2-weighted MR imaging with no detectable tumor would prove beneficial in the selection of these patients.
UI - 11985563
AU - Smith JH
TI - Bethesda 2001.
SO - Cytopathology 2002 Feb;13(1):4-10
AD - Department of Histopathology, Royal Hallamshire Hospital, Sheffield, UK. John.Smith@sth.nhs.uk
The Bethesda system (TBS) for reporting cervical/vaginal cytological diagnoses was originally developed in 1988 at a National Cancer Institute (NCI) workshop convened to consider the benefits of increased standardization in the diagnostic reports provided by cytology laboratories. It rapidly gained acceptance in laboratory practice in the USA and beyond and three years later the NCI sponsored another workshop to assess the use of TBS in practice and consider areas for improvement. Subsequently an illustrated guide was published.
UI - 12073052
AU - Scheungraber C; Muller B; Kohler C; Possover M; Leistritz S; Schneider
TI - A; Durst M Detection of disseminated tumor cells in patients with cervical cancer.
SO - J Cancer Res Clin Oncol 2002 Jun;128(6):329-35
AD - Klinik fur Frauenheilkunde und Geburtshilfe der Friedrich-Schiller-Universitat Jena, Abteilung Frauenheilkunde, Germany.
PURPOSE: Detection of disseminated tumor cells in a cohort of patients presenting the entire spectrum of invasive cervical cancer. METHODS: Disseminated tumor cells were detected in blood samples taken at different times during surgery or in bone marrow aspirates by a HPV type-specific nested PCR enzyme immunoassay (n-PCR-EIA). A group of 24 patients with HPV-positive cervical cancers representing early and late stages were evaluated, and 15 patients with breast cancer and without HPV-related genital disease served as controls. RESULTS: Disseminated tumor cells were detected in blood samples and/or bone marrow aspirates of 6 of 24 patients. A significant association was found between detectable disseminated tumor cells and recurrent disease ( P=0.013) and between disseminated tumor cells and survival of the patients ( P=0.0054). There was also a clear association between the presence of disseminated tumor cells and tumor size and/or positive lymph node status which, however, was not statistically significant. There was no evidence of increased shedding of tumor cells during surgery. CONCLUSION: Detection of disseminated tumor cells in blood or bone marrow may prove to be of prognostic value, particularly for early-stage cervical cancers.
UI - 12174401
AU - Wismer BA; Moskowitz JM; Min K; Chen AM; Ahn Y; Cho S; Jun S; Lew A; Pak
TI - YM; Wong JM; Tager IB Interim assessment of a community intervention to improve breast and cervical cancer screening among Korean American women.
SO - J Public Health Manag Pract 2001 Mar;7(2):61-70
AD - Center for Family and Community Health, School of Public Health, University of California, Berkeley, California, USA.
Breast and cervical cancer screening practices are suboptimal among Korean American women. A community intervention program was launched in 1996 to improve breast and cervical cancer screening among Korean American women in Alameda County, California. After 18 months, interim program assessment revealed that mammograms improved, but Pap smears, breast self-examinations, and clinical breast examinations did not change significantly. However, results were similar for the control county probably because the program was not implemented fully. Several strategies for improving program implementation are discussed including recommendations for researchers planning community intervention projects.
UI - 12163690
AU - Ziegler RG; Weinstein SJ; Fears TR
TI - Nutritional and genetic inefficiencies in one-carbon metabolism and cervical cancer risk.
SO - J Nutr 2002 Aug;132(8 Suppl):2345S-2349S
AD - Epidemiology and Biostatistics Program, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD 20892, USA. firstname.lastname@example.org
Folate deficiency has long been postulated to play a role in the etiology of cervical cancer, the third most frequent cancer among women worldwide. In a large, multiethnic community-based case-control study of invasive cervical cancer in five U.S. areas, we assessed accepted and postulated risk factors with an in-home interview and successfully obtained blood samples, at least 6 mo after completion of cancer treatment, from 51 and 68%, respectively, of interviewed cases and controls. Cases with advanced disease (6%) and/or receiving chemotherapy (4%) were excluded, leaving 183 cases and 540 controls. Serum and red blood cell folate were measured with both microbiologic and radiobinding assays. For all four folate measures, risk was moderately, but nonsignificantly, elevated for women in the lowest quartile, compared to the highest [fully adjusted relative risks (RR), including serologic human papillomavirus (HPV)-16 status = 1.2-1.6]. However, for women in the upper three homocysteine quartiles (>6.31 micro mol/L), risk of invasive cervical cancer was substantially and significantly elevated (fully adjusted RR, including serologic HPV-16 status = 2.4-3.2; P for trend = 0.01). This strong relationship suggests that circulating homocysteine may be 1) an especially accurate indicator of inadequate folate, 2) an integratory measure of insufficient folate in tissues or 3) a biomarker of disruption of one-carbon metabolism. The contribution of common polymorphisms in one-carbon pathway genes, as well as inadequate vitamin B-6, vitamin B-12 and/or riboflavin, to elevated homocysteine, inefficient one-carbon metabolism and increased cervical cancer risk merits further exploration.
UI - 11942715
AU - Lee J; Seow A; Ling SL; Peng LH
TI - Improving adherence to regular pap smear screening among Asian women: a population-based study in Singapore.
SO - Health Educ Behav 2002 Apr;29(2):207-18
AD - Department of Community, Occupational and Family Medicine, Faculty of Medicine, National University of Singapore. email@example.com
This study addresses the issue of adherence to regular screening for cervical cancer in Asian women and factors that would promote this. A community-based cross-sectional survey was carried out among 726 women (30-59 years) in Singapore. Although the overall screening prevalence was 62.4%, only 42% reported having regular smears. Women in the irregular group were more likely to have a Pap smear as part of postnatal or family planning visits, whereas the primary reason for attendance among the regular group was likely to be screening or a health checkup. Chief barriers to regular screening were low perceived susceptibility (46.5%) and low accessibility (37.1%). One third of women who have ever had a smear do not return for regular screening. Appropriate windows of opportunity in contact between women and the health care services should be used to convey the importance of adherence to screening.
UI - 11998209
AU - Mubiayi N; Bogaert E; Boman F; Leblanc E; Vinatier D; Leroy JL; Querleu
TI - D [Cytological history of 148 women presenting with invasive cervical cancer]
SO - Gynecol Obstet Fertil 2002 Mar;30(3):210-7
AD - Clinique de gynecologie-obstetrique et neonatologie, hopital Jeanne-de-Flandre, CHRU de Lille, 59037 Lille, France. firstname.lastname@example.org
OBJECTIVES: The aim of this study was to analyse the cytological history of women presenting with invasive cervical cancer. MATERIAL AND METHODS: Retrospective study of 148 patients treated for invasive cervical cancer in three hospitals of the North Pas de Calais in France. RESULTS: The average age of patients was 49 (26-86). Squamous carcinomas represented 81% of cases (120/148), adenocarcinomas 17% (25/148) and adenosquamous carcinomas 2% (3/148). 36.5% of patients (54/148) had never had a Pap smear. 34.5% (51/148) had had an occasional Pap smear (the last one dated of more than three years). 8.1% (12/148) were lost for follow up after a positive Pap smear. 3.4% (5/148) were treated for cervical dysplasia less than three years before the diagnosis of the cervical cancer. 17.5% (26/148) had had a Pap smear reported as negative less than three years before the diagnosis of the cervical cancer. In this last group, squamous carcinomas represented 57.7% of cases (15/26), adenocarcinomas 38.5% (10/26) and adenosquamous carcinomas 3.8% (1/26). 18 Pap smears of 26 reported as negative less than three years before the diagnosis of the cancer were reviewed. These Pap smears came from 11 patients presenting with squamous carcinoma and seven other presenting with adenocarcinoma. After review, 15 Pap smears were reported as false negatives and two as true negatives. The review was not possible in one case. CONCLUSION: In this study, the failures of cervical cancer screening were essentially attributed to the lack or the insufficiency of screening and the existence of false negatives of the cytology.
UI - 12043504
AU - Sahraoui S; Bouras N; Acharki A; Benider A; Tawfiq N; Jouhadi H; Kahlain
TI - A [Adenocarcinoma of the cervix uteri: a retrospective study of 83 cases]
SO - Gynecol Obstet Fertil 2002 Apr;30(4):291-8
AD - Centre d'oncologie, CHU Ibn Rochd, Casablanca, Maroc. email@example.com
The frequency of the adenocarcinoma of cervix uteri is increasing. AIM OF THE STUDY: To define the characteristics of the entity. PATIENTS AND METHODS: Between 1986 and 1992, 83 adenocarcinoma of cervix uteri, were treated at the Ibn Rochd Oncology Centre in Casablanca. It's a retrospective study with univariate analysis of the prognostic factors. This analysis was done for patients who were followed until the death or have 5 years or more follow up and the survival was calculated according the Kaplan & Meier method at 5 years. The local and regional recurrence factors were evaluated statically according the chi 2 and those for survival rate according the Logrank test. RESULTS: The frequency increased during the period with 2.1% in 1986 and 8.2% in 1992. The median of aged was 49 years. Fifty one patients have localised stage. Combined radiotherapy and surgery was performed in 66 cases and 17 received radiation alone. The loco-regional control was obtained in 83% among 73 available patients for results. The univariate analysis showed that the histological type was not a significant factor. However, age, tumor size, stage, histological grade and lymph node involvement were significant factors. These factors, the degree of differentiation and the lymph node involvement were significant for the 5-years survival. CONCLUSION: The prognosis factors of the cervix uteri adenocarcinoma are, size tumor more than 4 cm, lymph node involvement, microscopic involvement to the parameters and positives excision merges.
UI - 12043507
AU - Tranbaloc P
TI - [In situ adenocarcinoma of the uterus cervix: difficulties of its cytohistological diagnosis]
SO - Gynecol Obstet Fertil 2002 Apr;30(4):308-15
AD - Centre de pathologie, 19, rue de Passy 75016, Paris, France. firstname.lastname@example.org
In situ adenocarcinoma is regarded as the precursor of invasive adenocarcinoma. It is asymptomatic and early diagnosis relies solely on cytopathologist. It is usually discovered on a cone for squamous CIN. When diagnosis is made by biopsy, conisation is required to exclude invasive adenocarcinoma. Lesion is histologically characterised by epitheliomatous transformation of endocervical glands without invasion of the chorion. By the appearance of glandular cells, different histological varieties are described. They have no influence on the prognosis. Several benign lesions may mimic adenocarcinoma: tubal metaplasia, glandular atypia due to inflammation or irradiation, mesonephric remnants and microglandular hyperplasia. Precursor lesions (atypical hyperplasia, glandular dysplasia, CIGNI and II) are badly morphologically defined. Preferential location of in situ adenocarcinoma is the transformation zone. Because of this topography, if the surgical margins are disease free, conisation alone may be adequate therapy. HPV infection (mainly HPV 18) are incriminated in its pathogenesis.
UI - 12196621
AU - Cardin VA; Grimes RM; Jiang ZD; Pomeroy N; Harrell L; Cano P
TI - Low-income minority women at risk for cervical cancer: a process to improve adherence to follow-up recommendations.
SO - Public Health Rep 2001 Nov-Dec;116(6):608-16
AD - University of Texas School of Public Health, PO Box 20186, Houston, TX 77225, USA.
OBJECTIVE: The Houston Department of Health and Human Services (HDHHS) has a centralized process for notifying and setting up follow-up appointments for women with abnormal Pap smears who are clients of HDHHS health centers. Faculty and a student from the University of Texas School of Public Health and HDHHS personnel jointly conducted a study to evaluate the process and performance of the system. METHODS: The study examined two subpopulations: women with atypical squamous cells of undetermined significance or low-grade squamous intraepithelial lesions (ASCUS/LGSIL) and women with high-grade squamous intraepithelial lesions or atypical glandular cells of undetermined significance (HGSIL/AGCUS). A retrospective study was conducted of data on women attending eight Records of 1,216 women referred for evaluation of abnormal Pap smears were reviewed. Process effectiveness was measured by the number of successful contacts made and the number of appointments set up. Performance was measured by compliance with referral appointments. Predictors included race/ethnicity, age, co-existence of a sexually transmitted disease, number of prior referrals, type of patient visit, and health center attended. RESULTS: HDHHS staff successfully notified 95.6% of women with ASCUS/LGSIL and 97.9% of women with HGSIL/AGCUS. Using performance criteria as outcome measures, high-risk women requiring targeted interventions were identified. Overall, 84.2% of women scheduled appointments. Among those with ASCUS/LGSIL, women identified as African American were 53% less likely to accept an appointment and 45% less likely to show up for the appointment than those identified as Hispanic or "other." Age and type of patient visit appeared to be significantly associated with patient compliance behavior. CONCLUSION: The study describes the effectiveness of a centralized patient follow-up process for women at risk for cervical cancer.
UI - 10097694
AU - Alvarez-Santin C; Sica A; Rodriguez M; Feijo A; Garrido G
TI - Microglandular hyperplasia of the uterine cervix. Cytologic diagnosis in cervical smears.
SO - Acta Cytol 1999 Mar-Apr;43(2):110-3
AD - Department of Pathology, Facultad de Medicina, Universitad de la Republica, Montevideo, Uruguay.
OBJECTIVE: To identify cytomorphologic features specific to microglandular hyperplasia (MGH) in cervical cytologic smears. STUDY DESIGN: Twenty-four cervical smears from 24 patients obtained before the histologic diagnosis of MGH made on colposcopically directed biopsies during a period of two years (1995-1997) were evaluated. RESULTS: Of cases with MGH, 13/24 (54%) showed the presence of bidimensional or tridimensional cellular clusters made up of cubic or cylindrical glandular cells with vacuolated cytoplasm; cells with dense cytoplasm, basaloid in appearance, corresponding to immature squamous metaplasia; and subcylindrical reserve cells with small, round nuclei and scant cytoplasm. Clusters showed microlumina or fenestrated spaces, preserved polarity and absence of nuclear peripheral dispersion. In the control group these cellular clusters were found in 6/100 (6%). Statistical analysis (chi 2) showed a strong, highly significant association (P < 0.001) of the cytologic parameters selected and the histologic diagnosis of MGH. CONCLUSION: Until now, no specific cytologic parameters were described for MGH. This study underscored the value of cytomorphologic parameters described for typical cellular clusters showing microlumina or fenestrated spaces with shared party walls and an admixture of glandular cells, and immature squamous metaplastic and subcylindrical reserve cells in the cytologic diagnosis of MGH.
UI - 10833984
AU - Costa S; Sideri M; Syrjanen K; Terzano P; De Nuzzo M; De Simone P;
TI - Cristiani P; Finarelli AC; Bovicelli A; Zamparelli A; Bovicelli L Combined Pap smear, cervicography and HPV DNA testing in the detection of cervical intraepithelial neoplasia and cancer.
SO - Acta Cytol 2000 May-Jun;44(3):310-8
AD - Department of Obstetrics and Gynecology, University of Bologna, Italy.
OBJECTIVE: The sensitivity of the Pap smear (PAP) continues to be the subject of debate. During the past several years, cervicography (CER) and HPV DNA testing have been suggested as optional tools in the screening of cervical cancer precursors. STUDY DESIGN: The performance characteristics of PAP, CER and HPV DNA testing (hybrid capture test [HCT]) in all potential combinations were evaluated in a series of 1,030 women (aged 16-70, median, 33), subjected to colposcopy (COLPO) as the reference tool. RESULTS: Of the 992 evaluable cases, 402/992 (41%) had positive COLPO (i.e., an abnormal transformation zone). Of them, 298 women underwent directed punch biopsy, while of the COLPO negative patients, 18/93 positive by at least one of the three tests had endocervical curettage. Of the 402 COLPO positive women, 146 (36%) remained negative on all tests, whereas 256 (64%) had at least one positive test. There were 84 cervical intraepithelial neoplasia (CIN) 2 and 3 lesions and 6 invasive carcinomas. Of the former, 10 were detected by PAP alone, 4 by CER alone and 3 by HCT alone. Three of the 6 carcinomas were HCT negative. The predictive value (PPV) of a positive test was 45% for PAP, 51% for CER and 48% for HCT. The combinations of PAP with CER (for PAP negative cases) and PAP with HCT were more sensitive for CIN 2 and 3 (95% and 94%, respectively) as compared with PAP alone but were associated with a significant decrease in specificity (44% and 46% vs. 57%, respectively). However, both combinations retained a PPV (43%) similar to that of PAP alone (45%). CONCLUSION: The potential combinations of PAP with CER and with HCT were more sensitive in detecting CIN 2 and 3 as compared with PAP alone and retained a PPV similar to that of PAP.
UI - 11410098
AU - Moscicki AB; Hills N; Shiboski S; Powell K; Jay N; Hanson E; Miller S;
TI - Clayton L; Farhat S; Broering J; Darragh T; Palefsky J Risks for incident human papillomavirus infection and low-grade squamous intraepithelial lesion development in young females.
SO - JAMA 2001 Jun 20;285(23):2995-3002
AD - Department of Pediatrics, University of California, San Francisco, USA.
CONTEXT: Low-grade squamous intraepithelial lesions (LSILs) have been described as a benign cytological consequence of active human papillomavirus (HPV) replication. Several studies have reported that certain behavioral and biological risks exist for LSIL, suggesting that HPV alone is not sufficient for the development of LSIL. However, because most of these studies have been cross-sectional, it is not known whether behavioral and biological risks are simply risks for HPV infection itself. OBJECTIVE: To prospectively examine risks of incident HPV infection in HPV-negative females and of incident LSIL development in females with HPV infection. DESIGN: Prospective cohort study conducted between 1990-2000, with a median follow-up of 50 months. SETTING AND PARTICIPANTS: Females aged 13 to 21 years who attended 2 family planning clinics in the San Francisco bay area; 496 had prevalent HPV infection and 105 were HPV-negative. MAIN OUTCOME MEASURE: Incident development of HPV infection and LSIL, analyzed by various demographic, behavioral, and clinical risk factors. RESULTS: Fifty-four incident HPV infections occurred in the 105 females who were HPV-negative at study entry (median duration of follow-up for those who remained HPV-negative was 26 months). Multivariable analysis showed that risks of HPV included sexual behavior (relative hazard [RH], 10.10; 95% confidence interval [CI], 3.24-31.50 per new partner per month), history of herpes simplex virus (RH, 3.54; 95% CI, 1.37-9.10), and history of vulvar warts (RH, 2.73; 95% CI, 1.27-5.87). Current use of oral contraceptives had a significantly protective effect (RH, 0.49; 95% CI, 0.28-0.86). Among the 496 individuals who were HPV-positive at baseline or in follow-up, there were 109 incident cases of LSIL during the follow-up interval, with a median follow-up time of 60 months for those who never developed LSIL. Human papillomavirus infection was the most significant risk factor for development of LSIL. The multivariable model showed the following risks for LSIL: HPV infection for less than 1 year (RH, 7.40; 95% CI, 4.74-11.57); HPV infection for 1 to 2 years (RH, 10.27; 95% CI, 5.64-18.69); HPV infection for 2 to 3 years (RH, 6.11; 95% CI, 1.86-20.06); and daily cigarette smoking (RH, 1.67; 95% CI, 1.12-2.48). CONCLUSION: Our results indicate distinct risks for HPV and LSIL. In addition, most women with HPV infection in our study did not develop LSIL within a median follow-up period of 60 months. These findings underscore the hypothesis that certain biological risks thought to be associated with LSIL are, in fact, risks for acquisition of HPV. Cigarette smoking was a risk specific to LSIL, supporting the role of tobacco in neoplastic development.
UI - 11530126
AU - Belinson JL; Pretorius RG; Zhang WH; Wu LY; Qiao YL; Elson P
TI - Cervical cancer screening by simple visual inspection after acetic acid.
SO - Obstet Gynecol 2001 Sep;98(3):441-4
AD - Department of Gynecology and Obstetrics, The Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA. email@example.com
OBJECTIVE: To estimate the sensitivity and specificity of visual inspection using acetic acid as a primary screen for cervical intraepithelial neoplasia (CIN). METHODS: Visual inspection was done on 1997 women aged 35-45 years in a screening trial in rural China. Each women had colposcopy and at least five cervical biopsies (directed biopsy of lesions, one biopsy at 2, 4, 8, or 10 o'clock at the squamocolumnar junction in each normal quadrant, and an endocervical curettage). RESULTS: Forty-three women had biopsy-proven CIN II, 31 had CIN III, and 12 had invasive cancer. In two women only the endocervix was positive (one with CIN II and one with CIN III). Visual inspection yielded normal results in 1445 women (72%), low-grade intraepithelial neoplasia in 525 (26%), high-grade in 21 (1%), and cancer in six (0.3%). With abnormal visual inspection defined as low-grade intraepithelial neoplasia or worse, the sensitivity for detecting biopsy proven CIN II or worse was 71% (61 of 86, 95% confidence interval [CI] 60%, 80%); the specificity was 74% (1420 of 1911, 95% CI 72%, 76%); the sensitivity was 65% for smaller lesions (37 of 57, 95% CI 51%, 77%), and 89% for larger lesions (24 of 27, 95% CI 71%, 98%) (P =.03). CONCLUSION: The sensitivity of visual inspection equaled or exceeded reported rates for conventional cervical cytology. Visual inspection and colposcopy have similar specificity profiles for CIN II and greater. The benefit of an inexpensive point-of-care diagnosis and treatment algorithm will be a powerful incentive to pursue visual inspection for cervical cancer screening in developing countries.
UI - 11797876
AU - Paul C
TI - Should the law require doctors to make records available for audit of cervical screening?
SO - N Z Med J 2001 Nov 9;114(1143):499-500
AD - Department of Preventive and Social Medicine, University of Otago Medical School, Dunedin. firstname.lastname@example.org
UI - 11809252
AU - Conley LJ; Ellerbrock TV; Bush TJ; Chiasson MA; Sawo D; Wright TC
TI - HIV-1 infection and risk of vulvovaginal and perianal condylomata acuminata and intraepithelial neoplasia: a prospective cohort study.
SO - Lancet 2002 Jan 12;359(9301):108-13
AD - Division of HIV/AIDS Prevention, Surveillance, and Epidemiology, National Center for HIV, STD, and TB Prevention, Centers for Disease Control and Prevention, Public Health Service, US Department of Health and Human Services, Atlanta, GA, USA.
BACKGROUND: Information about vulvovaginal and perianal condylomata acuminata and intraepithelial neoplasia in women infected with HIV-1 is needed to develop guidelines for clinical care. Our aim was to investigate the incidence of these lesions in HIV-1-positive and HIV-1-negative women and to examine risk factors for disease. METHODS:In a prospective cohort study, 925 women had a gynaecological examination twice yearly-including colposcopy and tests for human papillomavirus DNA in cervicovaginal lavage-for a median follow-up of 3.2 years (IQR 0.98-4.87). FINDINGS: Vulvovaginal and perianal condylomata acuminata or intraepithelial neoplasia were present in 30 (6%) of 481 HIV-1-positive and four (1%) of 437 HIV-1-negative women (p<0.0001) at enrollment. Women without lesions at enrollment were included in an incidence analysis. 33 (9%) of 385 HIV-1-positive and two (1%) of 341 HIV-1-negative women developed vulvovaginal or perianal lesions, resulting in an incidence of 2.6 and 0.16 cases per 100 person-years, respectively (relative risk 16, 95% CI 12.9-20.5; p < 0.0001). Risk factors for incident lesions included HIV-1 infection (p = 0.013), human papillomavirus infection (p=0.0013), lower CD4 T lymphocyte count (p = 0.0395), and history of frequent injection of drugs (p=0.0199). INTERPRETATION: Our results suggest that HIV-1-positive women are at increased risk of development of invasive vulvar carcinoma. Thus, we recommend that, as part of every gynaecological examination, HIV-1-positive women should have a thorough inspection of the vulva and perianal region, and women with abnormalities-except for typical, exophytic condylomata acuminata-should undergo colposcopy and biopsy.
UI - 11876385
AU - Yuan CC; Wang PH; Ng HT; Tsai LC; Juang CM; Chiu LM
TI - Both TPA and SCC-Ag levels are prognostic even in high-risk stage Ib-IIa cervical carcinoma as determined by a stratification analysis.
SO - Eur J Gynaecol Oncol 2002;23(1):17-20
AD - Department of Obstetrics and Gynecology, Taipei Veterans General Hospital and National Yang-Ming University School of Medicine, Taiwan.
OBJECTIVE: To determine the prognostic values of tissue polypeptide antigen (TPA), squamous cell carcinoma antigen (SCC-Ag), and carcinoembryonic antigen (CEA) in the sera of cervical carcinoma patients, especially in those with a poor prognosis. METHODS: In this retrospective study, the preoperative serum SCC-Ag, TPA, and CEA were analyzed in 779 patients with cervical squamous cell carcinoma of stage Ib-IIa who received radical hysterectomy and pelvic lymph node dissection (RAH-PLND) between 1984 and 1994. RESULTS: Due to poor predictive value and poor correlation between serum CEA and clinico-pathological factors, CEA was abandoned in this study. Elevated TPA and SCC-Ag levels, pelvic lymph node metastasis (PLNM), lymphvascular space involvement (LVSI) and deep stromal invasion (DSI) were associated with poor survival time by univariate analysis. The correlation study showed that elevated serum TPA was significantly related to PLNM, LVSI, and DSI (p = 0.004, 0.008, and 0.021, respectively), and SCC-Ag was related to PLNM and bulky tumor size (p = 0.001 and 0.02, respectively). In the multivariate analysis, only PLNM and LVSI remained independently significant indicating poor survival. Further stratification studies by PLNM and LVSI showed that elevated TPA levels could even indicate higher recurrence rates in patients with PLNM (p = 0.045), as well as SCC-Ag in patients with LVSI (p = 0.038). CONCLUSIONS: The results suggest that both elevated TPA and SCC-Ag levels depicting poor prognosis in stage Ib-IIa cervical SCC, especially indicates a group of high-risk patients who may need more aggressive therapy.
UI - 11876400
AU - Pete I; Szirmai K; Csapo Z; Szantho A; Fule T; Gallai M; Kovalszky I
TI - Detection of high-risk HPV (16, 18, 33) in situ cancer of the cervix by PCR technique.
SO - Eur J Gynaecol Oncol 2002;23(1):74-8
AD - National Institute of Cancer, Gynecol. Dept., Budapest, Hungary.
OBJECTIVE: The purpose of this study was to collect data about the incidence of high-risk HPV (16, 18, 33) types in in situ cervical cancers, and to evaluate the reliability of the morphological signs of HPV infection by comparing the presence of these signs to the PCR-proven HPV virus infection. METHODS: Fifty patients who underwent conisation at the Department of Obstetrics and Gynecology of Semmelweis University, Budapest, Hungary because of in situ cervical cancer were examined retrospectively for the presence of HPV infection by the PCR technique. The direct and indirect morphological signs of HPV infection identified in the histological and cytological samples were compared to the actual results of virus DNA amplification by PCR in the identical histological sections. The evaluation of the cytological smears and the histological sections was accomplished independently by two different pathologists. RESULTS: E6 open reading frame of HPV 16, 18 or 33 was detected by PCR in 56% (28 cases) of the histological sections of the 50 examined patients with in situ cancer. In 92% (26 patients) of the 28 HPV positive patients one HPV type was detected, while in one of the remaining two cases two HPV types (16/33), or all three types could be detected. The direct morphological signs for HPV infection proved to be 75% sensitive and 50% specific when compared to the results of PCR. Their predictive value for HPV infection was 65%. For the indirect HPV signs the sensitivity was 64% and specificity 31%. The predictive value, prognosticating the presence of HPV 16, 18, 33 infection was 54% in the same sections. Using significance analysis no significant relationship (p = 0.7728) could be detected between the positivity of indirect signs and the presence of HPV 16, 18, 33 infection, while in case of direct signs the relationship was almost significant (p = 0.0675). The joint testing of the direct and indirect signs did not improve the results (p = 0.1338). During the review of the cytological smears the specificity of the cytology in predicting true HPV infections was found to be 68% and sensitivity was 20%. The predictive value was only 50%. A significance analysis was not accomplished by this diagnostic method because of the missing data (see text). CONCLUSION: The method of Nawa et al. seems to be a reliable approach for the detection of HPV DNA in paraffin-embedded material. The three main types of HPV (16, 18, 33) are probably represented in lower percentages in CIN III in Hungary, but a larger survey is needed to obtain reliable data. The direct and indirect morphological signs of HPV infection failed to show a significant relationship with the PCR proven presence of HPV 16, 18, 33.