Search

Objective: The aim of this study was to calculate the validity parameters of the Digene Hybrid Capture 2 (HC2) high-risk human papillomavirus DNA test with and without cytology in the follow-up examinations after laser treatment of the transformation zone or large loop excision of the transformation zone (LLETZ) for cervical intraepithelial neoplasia (CIN)., Methods: We performed a standardized follow-up examination in 113 postlaser and 153 post-LLETZ patients in our colposcopy clinic. Routine cytology, HC2 tests, and colposcopically-guided cervical biopsies were performed and sensitivity, specificity, and positive and negative predictive values were calculated using the histological cervical biopsy result as the criterion standard., Results: After a median follow-up time of 25.5 months, the overall posttreatment recurrence/persistence rate of CIN 2 or higher (CIN 2+) was 24% after laser and 12.4% after Post-LLETZ treatment. Hybrid Capture 2 alone had a sensitivity/NPV of 70/88% in post-laser and 70/93% in post-LLETZ patients. Cytology alone had a sensitivity/NPV for CIN 2+ of 48/84% in post-laser and 58/91% in post-LLETZ patients. Combined testing of HC2 with cytology had a sensitivity/NPV of 81/92% in postlaser and 88/95% in post-LLETZ patients., Discussion: In this test of cure study, combined testing of cytology with HC2 resulted in a high sensitivity and NPV. Hybrid Capture 2 and cytology-negative women may safely return to routine recall. Cytology alone is not an adequate follow-up strategy in postlaser patients.

Purpose: To assess the present state of diagnosis, therapy and follow-up of cervical intraepithelial neoplasia (CIN) in Austria., Material and Methods: 100 questionnaires were sent to all departments of Gynecology and Obstetrics in Austria. The anonymous questionnaire consisted of 22 multiple choice questions. It was possible to choose one or more answers by ticking applicable boxes, with the option in individual cases of giving additional information in the form of free text., Results: 55 (55%) departments returned their answered questionnaires, indicating growing consciousness of quality control in medicine. It was found that in the collection of cytologic specimens 67% of the departments used a wooden spatula and cotton swabs. Management of patients with Pap smears indicating low grade squamous intraepithelial lesion (LSIL) and abnormal colposcopy, in 36 (65%) departments consisted of punch biopsy for histological diagnosis. After 3 recurrent Pap smears indicating LSIL, 76% of the hospitals treated such patients by conization, regardless of the histological grade of the lesion. Following inadequate resection of CIN III by conization, operative management of patients was the most commonly used regimen., Conclusion: We regard the results of this survey as a basis for the development of further quality management strategies in the prevention, diagnosis and therapy of cervical intraepithelial neoplasia in Austria.

Background: Angiogenesis (the formation of new blood vessels) appears to be required for the growth of invasive tumors, but little information exists about its role in the development of preinvasive lesions. We examined microvessel density and expression of vascular endothelial growth factor in specimens of cervical intraepithelial neoplasia (CIN), a preinvasive lesion of the uterine cervix, to determine whether a connection could be established between these parameters of angiogenesis and the grade of dysplasia (i.e., tissue abnormality)., Methods: Sections of biopsy specimens from 83 patients with grades I-III CIN were examined retrospectively. Microvessels were localized by use of a polyclonal antibody directed against factor VIII-related antigen; vascular endothelial growth factor was detected by means of a monoclonal antibody. Reported P values are two-sided., Results: Highest microvessel densities and highest expression of vascular endothelial growth factor were found in a narrow border region between CIN lesions and the underlying stroma. A significant correlation was observed between high vascular endothelial growth factor expression and high microvessel density (Kendall's tau = 0.27; 95% confidence interval [CI] = 0.03-0.50; P = .018). Mean microvessel density values +/- standard deviations for CIN I, CIN II, and CIN III lesions were 19.4 +/- 5.8, 21.9 +/- 7.0, and 34.1 +/- 14.8, respectively (Kendall's tau = 0.46; 95% CI = 0.30-0.61; P<.0001). Corresponding values for vascular endothelial growth factor expression were 8.3 +/- 3.5, 8.4 +/- 2.0, and 12.2 +/- 3.6, respectively (Kendall's tau = 0.41; 95% CI = 0.20-0.60; P<.0001)., Conclusions: Our results are consistent with the idea that progression of cervical dysplasia is dependent on angiogenesis.

The expression of specific CD44 splice variants in malignant tumors has been shown to be associated with metastasis and poor prognosis. In previous studies we have detected aberrant expression of the transmembranous cell adhesion molecule CD44 in cervical cancer. Therefore, we now focus on its role in intraepithelial dysplastic lesions of the cervix. Forty-five cervical intraepithelial neoplasias (CIN), grades I to III, were investigated immunohistochemically for three different splice variants of CD44 (v5, v6, and v7-8). A negative correlation of CD44v5 (Kendall correlation coefficient r = -0.25, P < 0.05) expression with the grade of CIN was found. In normal squamous epithelium of the cervix, the staining reaction of CD44v5 was confined to the basal and the parabasal cell layers. In dysplastic lesions a diffuse and weaker staining pattern of the entire epithelium was observed. Our data suggest a loss of CD44v5 epitope during dysplastic transformation. It seems that expression of CD44 splice variants is not a continuous process in the natural history of cervical cancer, and the pattern of CD44 splice variant expression is changed during carcinogenesis.

Objective: To determine the incidence of cervical smears indicating cervical intraepithelial neoplasia during the 1980s and to compare two quinquennia., Design: A retrospective epidemiologic analysis was performed, based on a large collection of 238,261 cervical smears obtained from Austrian women screened between 1980 and 1989. After application of strict epidemiologic criteria to avoid bias of changes in socio-economic status and methodological changes in cytology, 12,604 women were eligible for further analysis. We calculated incidences and relative risks of cytologically indicated cervical intraepithelial neoplasia, comparing the time periods of 1980 to 1984 and 1985 to 1989 for different age cohorts., Results: We found a statistically significant increase in the incidence of cervical cytology indicating cervical intraepithelial neoplasia in the second time period for patients between 21 and 40 years of age. Women older than 40 years showed a significant decrease of this incidence., Conclusions: In Austrian women between the ages of 21 and 40 years an unidentified risk factor or a pattern of risk factors during the period prior to 1985 resulted in an increase of cervical intraepithelial neoplasia during the last years studied. This increasing incidence of cervical intraepithelial neoplasia indicates the importance of regular cytological screening. The significant decrease of the cervical intraepithelial neoplasia incidence in women older than 40 years provides an argument for increasing screening intervals in these women.

The aim of the present study was to evaluate the effect of age and human papillomavirus (HPV) infection associated cellular changes on the predictive value of cervical cytology. In a group of 671 women with Papanicolaou smears suggesting low grade squamous intraepithelial lesion (LSIL), a high grade squamous intraepithelial lesion (HSIL) or invasive cervical cancer, cervical cytology was correlated with the histological finding. Predictive values were calculated and related to severity of the lesion, age and HPV associated changes. The predictive values of Papanicolaou (cervical) smears suggesting LSIL, HSIL and invasive carcinoma were 40%, 86%, and 78%, respectively. A poor predictive value of smears suggesting LSIL was found among older women. HPV associated changes were diagnosed in 80% of women < or = 25 years of age, 66% in the age group 26 to 35 years, 51% in the age group 36 to 45 years and 38% in women aged > or = 46 years (P = 0.03). The presence of HPV associated cellular changes led to a significantly higher number of overdiagnoses (9% with HPV infection compared to 4% without HPV infection) and HPV negative cases were more frequently associated with underdiagnosis (15% without HPV infection compared to 8% with HPV infection, P = 0.0011). This result remained significant after adjustment for age (P = 0.004). Cellular changes associated with HPV infection most frequently occurred in young women. HPV infection should therefore be acknowledged as source of overdiagnosis in the cytological evaluation of SIL especially in young women.

The objective was to investigate a possible correlation between expression of carcino-embryonic antigen (CEA) and human papilloma virus (HPV) infection in moderate cervical intraepithelial neoplasia (CIN II). We examined the correlation of the incidence in different cases and the topographical correspondence. CEA was detected by immunohistochemistry and HPV infection was diagnosed by in situ hybridization (including typing of 6/11, 16/18, 31/33) and well-established histologic criteria. Samples from 32 women were examined. In 29 cases (91%) CEA was expressed, mainly in the superficial layer of the epithelium. Twenty-three tissue samples (72%) showed HPV infection. There was topographical correspondence of the two markers (mainly in superficial cell layers) but no correlation concerning the incidence of HPV infection or particular HPV subtypes. The highest prevalence of HPV was found in dysplasias of the large-cell reserve cell type.

The influence of cold knife conisation on further progression of pregnancy was analysed in 28 patients, who underwent the operation during pregnancy. 13 women were operated on within the first 16 weeks of gestation (group I) and were compared to 15 patients, where conisation was done in the 17th week or later (group II). In the first group, deliveries were found in the 39th week of pregnancy compared to 34 weeks in the second group (p.05). A statistical significant difference concerning the further duration of pregnancy after conisation was found: 25 weeks in group I vs. 11 weeks in group II (p. 0012). There was no difference, however, in radicality whether conisation was done in early or late pregnancy. Our final conclusion is, that a preterm delivery occurs significantly more often in women who underwent conisation after 16th week of gestation.

The aim of the study was, to evaluate the possible curative effect of punch biopsy on low grade cervical intraepithelial dysplasia (CIN I) as indicated by the literature. After a three-month interval, 115 women with PAP-smears indicating CIN I were subsequently controlled by cytologic cervical smears. Additional colposcopically directed punch biopsies were taken in 26 patients at the first examination. The remission rate was similar in patients with or without punch biopsy (54% to 49%), as well as the progression rate (8% to 7%). In addition we performed in-situ hybridisation in all biopsy specimens for the detection of human papillomavirus (HPV)-DNA. On comparing the progression and remission rate of women with HPV-positive and HPV-negative dysplastic tissue, we found no difference between these two groups. Punch biopsy does not seem to have a therapeutic effect either in HPV positive or HPV negative CIN I.