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Cervical cancer is one of the most common malignant cancers in women worldwide. The 5-year survival rate is 65%; nevertheless, it depends on race, age, and clinical stage. In the oncogenesis of cervical cancer, persistent HPV infection plays a pivotal role. It disrupts the expression of key proteins as Ki-67, p16, involved in regulating the cell cycle. This study aimed to identify the potential role of testin in the diagnosis of cervical precancerous lesions (CIN). The study was performed on selected archival paraffin-embedded specimens of CIN1 (31), CIN2 (75), and CIN3 (123). Moderate positive correlation was observed between testin and Ki-67 as well as testin and p16 expression in all dysplastic lesions (r = 0.4209, r = 0.5681; p < 0.0001 for both). Statistical analysis showed stronger expression of the testin in dysplastic lesions vs. control group (p < 0.0001); moreover, expression was significantly higher in HSIL than LSIL group (p < 0.0024). In addition, a significantly stronger expression of testin was observed in CIN3 vs. CIN1 and CIN3 vs. CIN2. In our study, expression of Ki-67, p16, and testin increased gradually as the lesion progressed from LSIL to HSIL. The three markers complemented each other effectively, which may improve test sensitivity and specificity when used jointly.

Infections with multiple human papilloma virus (HPV) types have been reported, but their role in cervical carcinogenesis has not been fully elucidated. In this study, 236 cases with multiple HPV infection were examined and compared to 180 cases with single HPV infection. HPV genotyping was performed with cervico-vaginal swab specimens using multiplex (real-time) polymerase chain reaction (PCR). In multiple HPV infection, the most prevalent HPV genotype was HPV 53, followed by HPV 16, 58, 52, and 68. HPV 33, 35, 39, 51, 52, 53, 58, and 68 were high-risk-HPV (HR-HPV) genotypes that were more frequently detected in multiple HPV infection compared to that in single HPV infection. The association between multiple HPV infection and high-grade SIL (HSIL) was significantly stronger compared to that of single HPV infection and HSIL (p = 0.002). Patients with multiple HPV infection displayed persistent and longer duration of the HPV infection compared to patients with single HPV infection. Multiple HPV infections have distinct clinicopathologic characteristics. Since it is associated with persistent HPV infection, HSIL, and different HR-HPV strains in contrast to single HPV infection, the presence of multiple HPV infection should be reported; close follow up is warranted.

Background: Cervical cancer is one of the commonest malignancies and a leading cause of morbidity and mortality among women. The aim of this study was to evaluate the diagnostic value of Papanicolaou (PAP) smear and visual inspection with acetic acid as methods of cervical cancer screening.Materials and Methods: This was a observational cross-sectional study conducted from the period of 2068.11.01 to 2069.11.01. The study population consisted of women with histologically confirmed cervical intraepithelial neoplasia or invasive carcinoma who had undergone prior PAP smear.Results: During the study period 160 patients underwent both PAP smear and cervical biopsy. Of these patients, 49 had a histological diagnosis of cervical intraepithelial neoplasia or invasive carcinoma. The histopathological and cytological diagnoses were compared. Visual inspection with acetic acid status was available for 31 of the 49 cases. The sensitivity of PAP smear was 61%, specificity 97%, positive predictive value 91%, negative predictive value 85% and diagnostic accuracy 86% for detection of cervical neoplasia. Visual inspection with acetic acid had a sensitivity of 74%, specificity 48%, Positive predictive value 64%, Negative predictive value 60% and diagnostic accuracy of 63%. Combining the two procedures increased sensitivity by 26%, Negative predictive value by 11% and diagnostic accuracy by 2 per cent.Conclusion: PAP smear has a higher specificity, Positive predictive value, Negative predictive value and diagnostic accuracy but lower sensitivity than visual inspection with acetic acid. Visual inspection with acetic acid by itself is not an effective screening method. A combination of PAP smear and visual inspection with acetic acidcan ensure adequate screening of cervical neoplasia.

Aim: To evaluate the results of colposcopy-guided biopsy in patients diagnosed with low- and high-grade cervical intraepithelial neoplasia (CIN) identified by Pap smear test. Methods: A total of 102 patients with low- and high-grade CIN diagnosed by Pap smear test, who underwent colposcopy-guided biopsy in the gynecology and obstretrics outpatient clinics at Haseki Tranining and Research Hospital, were included in this retrospective study. Results: One hundred and two patients were included in our study. Colposcopy-guided biopsy results of patients with low-grade and high-grade CIN were as follows: acanthosis and chronic cervicitis-36 (50%) and five (16%), CIN I - 28 (38%) and nine (30%), and CIN II-III - 8 (11%) and 16 (53%), respectively. The specificity and sensitivity of colposcopy-guided biopsy in detecting CIN II-III in patients with high-grade CIN were 67% and 80%, respectively, and the positive predictive value was 50%. Conclusion: Considering the fact that smear is a screening test, the diagnosis of low-grade and high-grade CIN should be confirmed with colposcopy-guided biopsy. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the spontaneous progression of cervical intraepithelial neoplasia grade 2 (CIN2) in accordance with Chlamydia trachomatis (chlamydia) serology.Methods: A prospective observational study included women diagnosed with CIN2 by cervical biopsy and managed conservatively for 24 months at Hospital del Mar, Barcelona, between December 2011 and October 2013. Serum anti-chlamydia immunoglobulin G (IgG), previous cytology, and high-risk human papillomavirus (HPV) genotyping were recorded at baseline. The outcome was regression, persistence, or progression of CIN2.Results: Overall, 93 women aged 18-56 years were enrolled. Spontaneous regression was observed for 61 (66%) women, and 21 (23%) progressed to CIN3. Eight (9%) women had chlamydia seropositivity at baseline. Multivariate analysis showed that anti-chlamydia IgG seropositivity (odds ratio [OR], 19.1; 95% confidence interval [CI], 1.9-189.7), previous high-grade squamous intraepithelial lesion cytology (OR, 5.0; 95% CI, 1.7-14.6), and HPV16 (OR, 4.8; 95% CI, 1.7-13.7) increased the risk of CIN2 persistence or progression.Conclusion: Women with CIN2 and chlamydia IgG seropositivity had increased risk of progression to CIN2+ and immediate treatment may be recommended for these women. Larger clinical studies are needed to confirm the results, but chlamydia serology might be introduced into CIN2 management to better individualize treatment. [ABSTRACT FROM AUTHOR]

Objective: There are currently three licensed human papillomavirus (HPV) vaccines that protect against cervical cancer. Here we compare the prevalence of bi-, quadri-, and nonavalent vaccine-related HPV genotypes in a multi-ethnic sample of non-Hispanic white, non-Hispanic black, Hispanic, and Asian women. Design: Patients in this analysis (n = 419) represent a subset of women with a previous abnormal Pap test participating in a clinical trial. HPV genotyping was conducted using the Roche Linear Array. Prevalent HPV genotypes were grouped according to their inclusion in each of the vaccines: bivalent (16, 18), quadrivalent (16, 18, 6, 11), and nonavalent (16, 18, 31, 33, 45, 52, 58, 6, 11). Results: The prevalence of HPV genotypes covered by the bi-/quadrivalent vaccines was lowest among non-Hispanic black (15%) and Hispanic women (20%), compared to non-Hispanic white (38%) and Asian women (38%). Across all racial/ethnic groups, a large proportion of infections (38%–49%) were with genotypes included in the nonavalent vaccine. However, the prevalence of HPV genotypes not covered by any vaccine was significantly higher among non-Hispanic black (36%) and Hispanic women (42%), compared to non-Hispanic white (24%) and Asian women (16%) (p < 0.001). Racial/ethnic differences in HPV genotype prevalence were observed when controlling for demographic and sexual behavior characteristics, as well as when restricting the analysis to women with CIN 2+. Conclusion: Our data suggest racial/ethnic differences in the prevalence of vaccine-related HPV genotypes. In particular, non-Hispanic black and Hispanic women had the lowest prevalence of HPV genotypes covered by the bi-/quadrivalent vaccines. While a large proportion of their infections were covered by the nonavalent vaccine, non-Hispanic black and Hispanic women also had the highest prevalence of HPV genotypes not covered by any vaccine. [ABSTRACT FROM AUTHOR]

Background: Most endocervical adenocarcinomas are human papillomavirus (HPV)-related cancers associated with p16 immunostaining. Ovarian metastasis from cervical cancer is a rare phenomenon, the mechanism of dissemination remains unclear. The diagnosis of metastasis may be difficult to establish when the ovarian neoplasm presents features consistent with primary tumor. Immunohistochemical expression of p16 in ovarian tumors can guide the diagnosis of metastasis from HPV-related cervical cancer, but p16 positivity is nonspecific. Identical HPV genotype in the paired endocervical and ovarian tumors is a better marker for cervical origin, which may also be confirmed by identical HPV integration site.Case Presentation: Two women presented with HPV18 cervical adenocarcinoma. No signs of disease were visible on MRI after treatment. After several years of follow-up, mucinous ovarian tumors were discovered in both patients. Molecular analyses showed that the ovarian lesions were HPV18-positive; indicating a primary cervical origin. A third woman was diagnosed with grade 1 ovarian endometrioid carcinoma with no peritoneal carcinomatosis. Final histological examination and HPV genotyping revealed HPV18-related in situ endometrioid adenocarcinoma in the endocervix and HPV18-related invasive endometrioid adenocarcinoma in the endometrium and both ovaries. Additional molecular analyses performed in two patients identified the same HPV integration sites in both the ovarian and cervical tumors, confirming that the ovarian mass was a metastasis from the cervical adenocarcinoma.Conclusion: We report three new cases of ovarian neoplasia in which the diagnosis of metastasis from cervical cancer was supported by the same HPV genotype and the same integration site in the paired cervical and ovarian tumors. To our knowledge, this is the first report of molecular evidence of the cervical origin of an ovarian metastasis. HPV screening should be performed in ovarian tumors for all patients with history of cervical neoplasia. [ABSTRACT FROM AUTHOR]

Human papillomavirus (HPV) is essential in cervical carcinogenesis, however, less is known about the carcinogenic potential of individual HPV types. Our aim was to examine the risk of cervical intraepithelial neoplasia grade 3 or worse (CIN3+) after persistence of 13 individual oncogenic HPV types. Liquid‐based cervical samples (n = 40,399) collected in 2002–2005 were tested for HPV by hybrid capture 2 and genotyped with INNO‐LiPAv2. Persistence was defined as having the same genotype twice 1–4.5 years apart. The absolute risk of CIN3+ was estimated by the Aalen‐Johansen estimator and Cox proportional hazard regression was used to compare the rates of CIN3+ according to HPV type adjusting for age and time between HPV tests. Of 2,875 oncogenic HPV‐positive women, 874 had persistence of one or more types and 761 persisted for one oncogenic HPV type only. Persistent HPV16 infection was associated with the highest risk of CIN3+, with an 8‐year absolute risk of 55% (95% CI: 45%–66%), followed by HPV33 (33% (95% CI: 20%–50%)), HPV18 (32% (95% CI: 20%–48%)) and HPV31 (31% (95% CI: 21%–46%)). Other HPV types, including HPV52 and HPV45, were also associated with high risks. Persistent HPV56 had the lowest 8‐year absolute risk of CIN3+ (3% (95% CI: 0.4%–20%)). In Cox analyses, a similar pattern remained after adjustment for age and time between tests. Our results add knowledge about the varying carcinogenic potential of individual persistent oncogenic HPV types, which may have implications for the clinical use of HPV testing. What's new? While the critical role of human papilloma virus (HPV) infection in cervical cancer is well established, less is known about the cancer risk associated with individual HPV subtypes. Here the authors performed a large population‐based study including 40,000 Danish women. They show large differences in absolute risk for high‐grade cervical intraepithelial neoplasia (CIN3+) development linked to persistent infection with 13 oncogenic HPV types. They suggest that these differences may inform clinical use of type‐specific HPV testing in the future. [ABSTRACT FROM AUTHOR]

Aim of the study To evaluate the diagnostic capacity of tele-cervicography for the detection of cervical neoplasia as an adjunctive test with Papanicolaou (Pap) smears. Material and methods : Pap smear and tele-cervicography were performed on each subject. Histologic results were obtained for all patients. Results : Of the 863 females who had a tele-cervigram, 252 (29.2%) had a positive result. Of the 60 histologically confirmed cases of high-grade squamous intraepithelial lesions (HSILs), 56 (93.3%) were detected by tele-cervicography, including 16 (26.7%) with a positive grade of 1 and 40 (66.7%) with a positive grade of 2. With the positive threshold of tele-cervicography set as any positive grade (P0 to P3), the overall sensitivity was 94.0% (95% CI: 88.0–97.3%), the specificity was 80.9% (95% CI: 80.0–81.5%), and the positive likelihood ratio was 4.94 (95% CI: 4.23–5.77) for the detection of HSILs or cancer. The combination of tele-cervicography with Pap smear testing for the detection of HSILs or cancer resulted in an increase in sensitivity from 84.6% (Pap only: cutoff = atypical squamous cells of undetermined significance or more severe) to 98.3% (Pap plus tele-cervicography: cutoff = P0 or more severe). Conclusions : The sensitivity of tele-cervicography was higher than that of cytology for the detection of cervical neoplasia, and combining the two tests increased the sensitivity. Tele-cervicography can be considered a useful complementary tool to cytology.

Carsten Rygaard Department of Pathology, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark Aim of database: To monitor and improve the quality of the Danish national cervical cancer screening program, an annual report is published, including nine quality indicators. Study population: The screening target group consisted of 1.5 million Danish women aged 23–64 years, but in the calculation of quality indicators, the dataset varies according to indicators being Danish women, cervical cancer cases, or cytology samples. Main variables: The variables include the number of cytology samples per pathology laboratory, participation rate, percentage of unsatisfactory samples, diagnostic sensitivity and specificity, percentage of samples answered within ≤ 10 days, percentage of atypical squamous cells of undetermined significance samples in women aged >30 years with human papillomavirus-triage, coverage, percentage of non-normal samples not followed up according to recommendations, number of incident cervical cancers, incidence of cervical cancer in the past 5 years, and upcoming percentage of incident cervical cancers undergoing audit. Descriptive data: Annual reports have been published since 2009. Better fulfillment of quality standards has been seen for the size of pathology departments, percentage of unsatisfactory samples, percentage of atypical squamous cells of undetermined significance with human papillomavirus-triage, and a slight decrease in the percentage of non-normal samples not followed up within the recommended time intervals. Stable patterns have been observed for participation rate, coverage, and number of incident cervical cancer cases. With a coverage of 75%, and with presently 16% of non-normal samples not followed up in a timely manner, there is definitely a scope for improvement in the screening program. Conclusion: The database has pinpointed the strengths and weaknesses of the national cervical cancer screening program. Measures to enhance participation rate/coverage and to improve follow-up of non-normal cytology samples are warranted. Keywords: screening, cervical cancer, cytology

Objective To compare the diagnostic accuracy of the classic Meisels cytologic criteria and the Schneider secondary criteria relative to the hybrid capture method for diagnosing HPV infection. Methods This was a retrospective study performed at a public university hospital. A total of 41 patients with a cytologic diagnosis of HPV infection and 40 HPV-negative patients were selected for review of the cervical-vaginal smears seeking to classical and secondary criteria. A single pathologist reviewed the slides in search of the criteria. The classical and secondary cytologic criteria were compared with the hybrid capture for diagnosing HPV infection. Bartleti test was applied for the age analysis, and Fisher's exact test was used to compare proportions. The tests were considered significant when the probability of rejecting the null hypothesis was less than 5% (p < 0.05). Results The Meisels criteria were less sensitive (34.0%) than the secondary Schneider criteria (57.5%) when compared with the hybrid capture (p < 0.0001), although the specificity of the former criteria was non-significantly higher (91.2% and 67.7%, respectively). In cases of moderate or intense inflammation, the sensitivity and specificity of the Schneider criteria were decreased, 33.3% and 50.0% respectively (p = 0.0115). Conclusions Compared with hybrid capture for diagnosis of HPV infection, the sensitivity of the secondary Schneider criteria was higher than the classical Meisels criteria.Moderate or intense inflammation reduces the sensitivity and specificity of the secondary Schneider criteria for diagnosing HPV infection using the hybrid capture as the gold standard.

Introduction: Sexually Transmitted Diseases (STDs) are very common in the sexually active young Indian women particularly in rural areas because of poor genital hygiene. Aim: The present study was carried out to compare the prevalence of different STDs in the urban and rural population of Lucknow, Uttar Pradesh. Materials and Methods: The present prospective observational study was conducted in 2369 rural women attending camps in 126 villages of West Lucknow between May 2013 and March 2017 undergoing cervical cancer screening and in 38,478 urban women attending Gynaecology Outpatient Department (OPD) of KG Medical University, Lucknow, Uttar Pradesh, India, between April 1971 to November 2005 in which the data were collected retrospectively. Statistical analysis was performed with SPSS version 18.0 and the results were subjected to chisquare test. Results: The incidence of Candida albicans was higher in rural women (4.7%) as against 1.1% seen in urban cohorts. The trend was reverse with Trichomonas vaginalis, the incidence being high (2.9%) in the Urban women than 1.0% in the rural group. The viral STDs were rarely seen in both the groups ranging from 0.1% to 0.6%. Association of Squamous Intraepithelial Lesions (SILs) of the cervix with non-viral STDs was more pronounced in rural women than in their urban counterparts while this was very high with viral STDs in both the groups. All the STDs except HSV were commonly seen in younger sexually active women between 21-30 years. Leucorrhoea was commonly associated with all STDs in both groups but the incidence was almost double in rural women. Conclusion: All the STDs examined were commonly seen in younger women between 21-30 years mostly with symptoms of leucorrhoea. Hence, cytological screening is felt mandatory in such women to rule out any STD infection.

Objectives: The objective of this study was to evaluate the frequency of human papillomavirus (HPV) in the oral cavity of women with and without abnormal cervical cytology and to determine whether there is an association of oral HPV infection with infection of the cervix or with cervical cancer precursor lesions.Methods: The present study was conducted among 406 women, aged 18-82 years, who attended the Prevention Department of Barretos Cancer Hospital (HCB), Brazil due to a previous altered cervical cytology result. Oral rinse, cervical cytology and biopsy were collected at the same day. The participants also answered a questionnaire about socioeconomic characteristics and risk factors for cervical cancer. Molecular screening for HPV16, HPV18 and 12 other high-risk HPV types was performed on cervical and oral rinse specimens using Cobas 4800 (Roche Molecular Systems, USA).Results: HPV was detected in the oral rinse of 3.9% of participants. Infection of the oral cavity with a non-HPV16 or 18 type was most frequent (81.2%), followed by HPV16 (18.7%). Infection with HPV in the cervix and oral cavity was present in 11 (2.7%) of participants. There were no differences observed in the smoking status (p value 0.62), mean age of first sexual intercourse (p value 0.25), mean age of the first oral sex (p value 0.90) or mean lifetime number of sexual partners (p value 0.08) between the participants with oral HPV infection or not.Conclusion: The presence of HPV infection in the oral cavity was low in the group of women with abnormal cervical cancer screening findings and a high rate of cervical HPV infection. [ABSTRACT FROM AUTHOR]

Background: Cervical cancer is the fourth most common cancer in women, and we recently reported human leukocyte antigen (HLA) alleles showing strong associations with cervical neoplasia risk and protection. HLA ligands are recognized by killer immunoglobulin-like receptors (KIRs) expressed on a range of immune cell subsets, governing their proinflammatory activity. We hypothesized that the inheritance of particular HLA-KIR combinations would increase cervical neoplasia risk.Methods: Here, we used HLA and KIR dosages imputed from single-nucleotide polymorphism genotype data from 2143 cervical neoplasia cases and 13858 healthy controls of European decent.Results: The following 4 novel HLA alleles were identified in association with cervical neoplasia, owing to their linkage disequilibrium with known cervical neoplasia-associated HLA-DRB1 alleles: HLA-DRB3*9901 (odds ratio [OR], 1.24; P = 2.49 × 10-9), HLA-DRB5*0101 (OR, 1.29; P = 2.26 × 10-8), HLA-DRB5*9901 (OR, 0.77; P = 1.90 × 10-9), and HLA-DRB3*0301 (OR, 0.63; P = 4.06 × 10-5). We also found that homozygosity of HLA-C1 group alleles is a protective factor for human papillomavirus type 16 (HPV16)-related cervical neoplasia (C1/C1; OR, 0.79; P = .005). This protective association was restricted to carriers of either KIR2DL2 (OR, 0.67; P = .00045) or KIR2DS2 (OR, 0.69; P = .0006).Conclusions: Our findings suggest that HLA-C1 group alleles play a role in protecting against HPV16-related cervical neoplasia, mainly through a KIR-mediated mechanism. [ABSTRACT FROM AUTHOR]

Introduction: Sexually Transmitted Diseases (STDs) are very common in the sexually active young Indian women particularly in rural areas because of poor genital hygiene. Aim: The present study was carried out to compare the prevalence of different STDs in the urban and rural population of Lucknow, Uttar Pradesh. Materials and Methods: The present prospective observational study was conducted in 2369 rural women attending camps in 126 villages of West Lucknow between May 2013 and March 2017 undergoing cervical cancer screening and in 38,478 urban women attending Gynaecology Outpatient Department (OPD) of KG Medical University, Lucknow, Uttar Pradesh, India, between April 1971 to November 2005 in which the data were collected retrospectively. Statistical analysis was performed with SPSS version 18.0 and the results were subjected to chisquare test. Results: The incidence of Candida albicans was higher in rural women (4.7%) as against 1.1% seen in urban cohorts. The trend was reverse with Trichomonas vaginalis, the incidence being high (2.9%) in the Urban women than 1.0% in the rural group. The viral STDs were rarely seen in both the groups ranging from 0.1% to 0.6%. Association of Squamous Intraepithelial Lesions (SILs) of the cervix with non-viral STDs was more pronounced in rural women than in their urban counterparts while this was very high with viral STDs in both the groups. All the STDs except HSV were commonly seen in younger sexually active women between 21-30 years. Leucorrhoea was commonly associated with all STDs in both groups but the incidence was almost double in rural women. Conclusion: All the STDs examined were commonly seen in younger women between 21-30 years mostly with symptoms of leucorrhoea. Hence, cytological screening is felt mandatory in such women to rule out any STD infection. [ABSTRACT FROM AUTHOR]

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Background Prevention of cervical cancer is based upon the accurate diagnosis and grading of cervical lesions identified during screening. The pathological classification of cervical intraepithelial neoplasia (CIN) is problematic, as it relies on subjective criteria and is known to have high interobserver variability and low reproducibility. These limitations can result in either over or under treatment of patients. Biomarkers to improve CIN diagnosis have not overcome all these challenges. Main body Here we review the use of a promising optical imaging method using eosin-based fluorescence spectroscopy. This technique is able to perform fluorescent analysis of cervical biopsies directly from hematoxylin and eosin (H&E) stained tissues. Eosin is a brominated derivative of fluorescein. Fluorescence characteristics of protein–eosin complexes can demonstrate tissue changes associated with dysplasia and cancer. In this article we review the progress made towards developing eosin-based fluorescence spectroscopy. We describe the various morphologies seen among the CIN grades with this optical method and highlight the progress made to quantitate the spectral image characteristics. Conclusion Eosin-based fluorescence spectroscopy can be used to directly examine H&E stained tissue slides. Relevant areas can be imaged and spectral analysis done to obtain objective data to identify and grade cervical lesions. [ABSTRACT FROM AUTHOR]

Background: The interactions of oral contraceptive (OC) use, risk of human papillomavirus (HPV) infection and associated cellular atypia are complex. We investigated the association between history of OC-use, and cytological or histopathological abnormalities in a cohort of non-HPV vaccinated originally 16-17-year-old women participating the PATRICIA trial for 4 years.Methods: The total number of hepatitis A-virus (control) vaccine recipients participating in the clinical PATRICIA trial in Finland was 2399. Nine-hundred and ninety-nine women returned questionnaires on living conditions-life habits and sexual health after completing the study. Mean age at answering the questionnaire at the end of the clinical trial was 22 years. Age at sexual debut varied between 12 and 16 years for majority of the women. Cervical cytological samples were obtained every 6 months throughout the PATRICIA trial. The relative risk of cervical atypia associated with time since start of oral contraceptives use was calculated as odds ratio (OR) with 95% confidence interval (CI) using logistic regression.Results: Compared to never-users, the smoking and age-at-sexual-debut adjusted relative risk of cervical intraepithelial neoplasia grade 1 (CIN1) in women who had started the use of oral contraceptives for more than 1 year was low (OR 0.2, 95% CI: 0.1-0.7). Risk of cytological atypia was also reduced (OR 0.6) albeit not significantly (95% CI: 0.3-1.3).Conclusions: Use of oral contraceptives does not increase the risk of cervical atypia but when established might instead be protective. [ABSTRACT FROM AUTHOR]

Comparative analysis of the results of the adjuvant therapy in 60 patients with HPV-associated cervical neoplasms. It is established that the use of local immunomodulatory therapy with Polyoxidonium before conducting destructive methods of treatment improves the state of local immunity, promotes the normalization of microflora of the vagina and elimination of human papillomavirus, increases the effectiveness of therapy, reduces the recurrence of the process.

The authors have made a complex analysis of the molecular biological factors associated with cervical intraepithelial neoplasia. They have revealed that infection by oncogenic human papillomavirus types is associated with suppressed apoptosis and enhanced cellular proliferative activity, which can be effectively used in the diagnosis and prediction of cervical neoplasias to optimize management tac- tics and to improve the results of treatment.

Background: Hospital-based registries are important tools for policy formulations and region-specific data creation, particularly in case of cervical cancer, which is preventable by an effective screening program. Objective: To study the epidemiological characteristics and trends in cervical neoplasia in an urban population over a decade. Materials and Methods: Data were collected from the histopathological records of patients from January 2000 to December 2009. Results: A total of 1315 gynecological malignancies were reported with cancer cervix being the most common (70.4%) with a progressive increase in the number from 56 in 2000 to 157 in 2009. Squamous cell cancer was the predominant variant with majority in advanced stage. The mean age was 50.1 years with doubling of cases in the ≤35-year category. Of 742 colposcopic biopsies performed, cervical intraepithelial neoplasia (CIN) 1 was diagnosed in 34.9%, CIN 2 in 11.8%, CIN 3 in 7.8%, and microinvasive cancer in 0.8% cases. Conclusion: Though screening programs are in place, their effectiveness can be judged only by such reporting systems that aid in modifying the current cancer control strategies.

The article provides an overview of the scientific data on the effectiveness of Polyoxidonium® in gynecological practice with the influence of the drug on the local and systemic immunity and effectiveness in the treatment of inflammatory diseases of the female genital organs being the focus. A comparative analysis of the results of complex therapy in 15 patients with cervical neoplasia (CIN I-II), associated with human papilloma virus was made. It was found that the use of immunomodulatory therapy in the complex anti-inflammatory therapy improves the parameters of local immunity, increases the effectiveness of the therapy, and helps to reduce the recurrence of the process.

Introduction: Cervical cancer is the third most common cancer in India. In women, it is the second most common after breast carcinoma. Human cancers arise from a protracted sequence of multiple genetic and epigenetic alterations which involve the growth regulatory genes like p53. Aim: This study aimed at correlation of immunopositivity of p53 with the histopathological type and grade of carcinoma cervix. Materials and Methods: A total of 100 cases of cervical biopsy/ hysterectomy specimens of carcinoma cervix received at the Department of Pathology, SMSMC Jaipur from January 2016 to September 2017 were examined for gross and microscopic features. Immunohistochemistry was used to study the p53 expression as proliferative index in cervical intraepithelial neoplasia, invasive squamous cell carcinoma as well as adenocarcinoma of the uterine cervix. Results: The demographic profile of SCC and CIN in this study was in concordance with that described by epidemiological studies in India with larger group of patients presenting with advanced stage tumors. Increased expression of p53 was found in increasing grades of CIN and SCC. The p53 positivity showed a statistically significant association with squamous cell carcinoma (SCC) histologic type (P = 0.005). Conclusion: The expression of p53 is greater in the malignant cervical neoplasms than pre-malignant cervical lesions, suggesting that p53 overexpression can be used as an early diagnostic tool and also as a prognostic indicator. [ABSTRACT FROM AUTHOR]

Objective Cervical cancer is a global public health challenge. Since 1999, platin based chemoradiation (CRT) is the standard treatment for those patients with locally advanced disease. However, this population still has a dismal prognosis and, alternatives approaches such as adjuvant chemotherapy are controversial, especially because of increased toxicity. Neoadjuvant chemotherapy (NACT) could be an option for more intensive treatment with manageable toxicity. Methods A phase II, prospective, non-randomized trial was conducted at a reference center in Recife, Brazil. Locally advanced cervical cancer patients (Ib2–IVa) were treated with neoadjuvant cisplatin 35 mg/m 2 and gemcitabine 1000 mg/m 2 D1 and D8, for 2 cycles. Then, they received CRT (50.4 Gy) with weekly cisplatin 40 mg/m 2 followed by brachytherapy. Response rate (RR) and toxicity were the primary endpoints. Progression-free survival (PFS) and overall survival (OS) were secondary endpoints. Results Between Sep/2013 and Oct/2015, 50 patients were initiated on NACT and CRT. RR was 81% at the end of treatment. Hematological and gastrointestinal toxicity were most common. Grade 3/4 toxicity was 20% during NACT and 44% during CRT. Late adverse events were present in 20% of patients. PFS at 1 and 3-years were 73.4% (IC 58.7–83.6) and 53.9% (IC 36.9–68.3), respectively; and, OS at 1 and 3-years were 93.9% (IC 82.4–98.0) and 71.3% (IC 53.3–83.3), respectively. Conclusion In our hands NACT in locally advanced cervical cancer patients did not show a meaningful improvement in ORR. Nevertheless, we believe it should be further explored in prospective trials. [ABSTRACT FROM AUTHOR]

Objective: To identify the barriers to early detection of cervical cancer. Method: Integrative literature review in databases such as Science Direct, Medline, SciELO and Scopus, published during the past six years, written in English, Portuguese and Spanish. Results: Socio-cultural aspects, prevention strategies employed and the difficulty in accessing care barriers were found in the review; also, the lack of acceptance of HPV vaccines and non-attendance to Pap test affect the appearance of numerous cases of pre-neoplastic lesions. Conclusions: It is evident that there is a need to strengthen actions of education, information and support to nursing professionals, to help reduce the incidence of this disease, which represents an important challenge to health care personnel. [ABSTRACT FROM AUTHOR]

Objective This study evaluated the safety and immunogenicity of qHPV vaccine in SLE. Methods Subjects: 34 women ages 19–50 years (yrs.) with mild to moderate SLE & minimally active or inactive SLE received qHPV vaccine at the standard dosing schedule. Exclusion criteria: active SLE disease (SELENA-SLEDAI > 2), history of severe SLE disease, deep venous thrombosis, on >400 mg/day of hydroxychloroquine, on >15 mg/day of prednisone, or active infections. Patients were monitored for adverse events (AE), SLE flare, generation of thrombogenic antibodies and thrombosis. Antibody (Ab) levels to HPV 6, 11, 16 & 18 were measured by HPV competitive Luminex Immunoassay and Geometric Mean Titers (GMTs) were calculated for each HPV type. Seroconversion was assessed for those seronegative at baseline. Results The women in the study: African-American (79%), mean age = 38.1 years, mean age at diagnosis of SLE = 28.6 years, 35.3% had a history of smoking, 91% had 4 or more sexual partners, 50% had a history of sexually transmitted diseases, and 27.3% used condoms on a regular basis. Vaccine site reactions (VSRs) occurred in 62%, all mild. Ninety-seven percent experienced at least 1 non vaccine adverse event (nvAE) with a total of 493 nvAEs in 33 patients, of which 90% were mild and none were related to vaccine or SLE. There were 9 serious AEs, none were related to vaccine or SLE, all resolved. No patient experienced an SLE flare, thrombosis, or generation of thrombogenic antibodies. Seroconversion rate was 100% with mean GMTs comparable to Gardasil® package insert data. Conclusion In this SLE vaccine study, qHPV vaccine was generally safe, well tolerated, and highly immunogenic. This clinical trial is registered on Clinical Trials.gov under number, NCT01741012 and was conducted under the FDA IND BB14113. [ABSTRACT FROM AUTHOR]

Introduction: Conservative treatments including cold knife cone biopsy (CKC) or loop electrosurgical excision procedure (LEEP) are fertility-preserving alternatives to hysterectomy. The risks of persistent cervical neoplasia in women with negative surgical margins following conservative treatment of adenocarcinoma-in-situ (AIS) are uncertain. This study aims to investigate the risk of persistent or recurrent cervical neoplasia [AIS, adenocarcinoma and/or high-grade cervical squamous intraepithelial neoplasia (CIN)] and compliance with follow-up recommendations in conservatively treated women with AIS and negative histopathological margins.Material and Methods: A retrospective, population-based study of Western Australian women treated by CKC or LEEP for AIS between 2001 and 2012. Histopathology reports were reviewed for demographic information, treatment procedures and clinicopathological factors. Primary outcomes were the diagnosis of cervical neoplasia during follow-up (defined as <12 months) and surveillance (≥12 months) periods.Results: The cohort comprised 360 women, with 175 (48.6%) initially treated by CKC and 185 (51.4%) treated by LEEP. The median patient age at time of excisional treatment was 30.0 years (range 18-64 years) and the median follow-up time was 3.9 years (range six months to 12.2 years). During the follow-up and surveillance periods, seven (1.9%) women were diagnosed with CIN 2/3, 10 (2.8%) with AIS, and one (0.3%) with cervical adenocarcinoma, despite their initial excision specimens having negative histological margins.Conclusion: In this study, there was a low but significant risk of persistent or recurrent cervical neoplasia in women who had initial conservative management of AIS with negative histopathological margins. [ABSTRACT FROM AUTHOR]

Tumor Necrosis Factor (TNF) plays an essential role in various inflammatory, immune and cancerous processes. TNF-inhibitors have been widely used to treat inflammatory diseases. Infections is the most common side effect of these biological drugs. Conflicting data exist on the risk of cancer following anti-TNFα therapy. Furthermore, the percentage of women with inflammatory disease is rather high. Thus, this study focused on the gynecological side effects of TNF-inhibitors. [ABSTRACT FROM AUTHOR]

The second leading cause of death in women worldwide is the cervical cancer, being an important public health issue. The aim of the paper was to evaluate the prevalence of cervical neoplasia and the treatment used for this pathology. We included a total of 111 cases diagnosed with cervical neoplasia. The cervical cancers are found more frequently in women on perimenopause and menopause. In our study, the stage I or the carcinoma in situ were treated by conization or hysterectomy. The type of interventions for the other stages (I B, II A and II B) were radical hysterectomy and bilateral adnexectomy. In 79 (71.17%) cases the intervention was radical Wertheim hysterectomy (with pelvic lymphadenectomy). We also identified 3 (2.70%) cases of stage IIIA, IIIB or IV where it was performed an exploratory laparotomy. Cervical cancer can be detected relatively easily by screening, indicated especially at the women at high risk, through a gynecological examination, vaginal cytology and HPV genotyping. The prognosis is favorable in cases detected in the early stages, and unfavorable in the advanced ones, so, it is dependent on the breakthrough stage, the woman's age, histopathological form and the combination of therapeutic approach to the task. [ABSTRACT FROM AUTHOR]

Introduction: Preventive screening for cervical cancer is the best available strategy to reduce the incidence and mortality from this neoplasm. However, the low proportion of women who undergo routine screening is a pending concern for healthcare systems worldwide., Objective: To estimate the prevalence and factors associated with preventive cervical cancer screening in a Peruvian region., Methods: Cross-sectional, multicenter study. It enrolled 1146 women users of healthcare centers in a Peruvian sanitary region. The dependent variable was the performance of cervical cancer preventive screening with Papanicolaou or visual inspection with acetic acid in the last two years. The independent variables were sociodemographic and socio-sanitary factors, knowledge about cervical cancer and human papillomavirus, attitudes and information towards screening tests. To evaluate the association between the variables, crude and adjusted prevalence ratios were calculated with generalized linear models of Poisson., Results: The overall prevalence of preventive screening was 50.5%. This was associated with being tested, having a higher education level and urban area of residence, using contraceptive methods, having health insurance, being recommended by healthcare personnel to be screened, and being concerned about developing cervical cancer. It was also associated with responding that this cancer is preventable, being aware of cervical cancer or human papillomavirus, and believing it can cause cervical cancer. In contrast, considering preventive screening risky was associated with not having the test., Conclusions: The proportion of women with preventive cervical cancer screening is low. In addition, certain associated modifiable factors were identified, which could improve preventive screening behaviors and rates., Competing Interests: This work is licensed under a Creative Commons Attribution 4.0 International License., (This work is licensed under a Creative Commons Attribution 4.0 International License.)

The results of the genital human papillomavirus (HPV) detection in 439 cervical samples by cervical cytology were compared with sequencing analysis and a newly developed HPV genotyping 9G membrane test. The excellent sensitivity and specificity of the HPV genotyping 9G membrane test was assured by a signal to noise ratio of more than 300 and a target hybridization to non-target hybridization ratio of 300 ~ 400 at 25 °C. The final results can be obtained in 29 min by simple loading of the hybridization and washing solutions and scanning the membranes without any drying steps or special handling. The 100% identical results of the HPV genotyping 9G membrane test with sequencing results in 439 clinical samples demonstrate significant clinical application for this test. HPV genotyping 9G membrane tests can identify and discriminate five HR-HPV genotypes which are prevalent in almost 87% of cervical cancer cases. Its simple handling makes the HPV genotyping 9G membrane test a very convenient platform for accurate HPV genotyping.

Purpose: Women with human papilloma virus (HPV) associated cervical neoplasia have a higher risk of developing breast cancer than the general female population. The purpose of this study was to (i) identify high risk for cancer HPVs in cervical neoplasia and subsequent HPV positive breast cancers which developed in the same patients and (ii) determine if these HPVs were biologically active.Methods: A range of polymerase chain reaction (PCR) and immunohistochemical techniques were used to conduct a retrospective cohort study of cervical precancers and subsequent breast cancers in the same patients. Results: The same high risk HPV types were identified in both the cervical and breast specimens in 13 (46%) of 28 patients. HPV type 18 was the most prevalent. HPVs appeared to be biologically active as demonstrated by the expression of HPV E7 proteins and the presence of HPV associated koilocytes. The average age of these patients diagnosed with breast cancer following prior cervical precancer was 51 years, as compared to 60 years for all women with breast cancer (p for difference = 0.001). Conclusions: These findings indicate that high risk HPVs can be associated with cervical neoplasia and subsequent young age breast cancer. However these associations are unusual and are a very small proportion of breast cancers. These outcomes confirm and extend the observations of 2 similar previous studies and offer one explanation for the increased prevalence of serious invasive breast cancer among young women.

Bacterial vaginosis is one of the most frequent disorders of vaginal ecosystem in women during their reproductive life. The first concept in the pathogenesis of bacterial vaginosis points out that the unfamiliar initial influence on vaginal ecosystem decreases lactobacillus concentration, which results in the increase of vaginal secretion pH and multiplication of Gardnerela vaginalis and other anaerobes. The aim of this study was to compare the frequency of cervical neoplasia in women with and without bacterial vaginosis. The research included 158 patients, between 18 and 51 years of age, at the Clinic of Gynecology and Obstetrics in Niš. Clinical processing of patients consisted of cytological, colposcopic and pathohistological examinations. Bacterial vaginosis was, beside clue cell detection with native preparation, diagnosed by the application of other Amsel’s criteria: presence of characteristic vaginal secretion, positive amino test, values of vaginal secretion pH over 4.5. The results showed that 23.42% of the patients had bacterial vaginosis. The greatest percent of the patients with bacterial vaginosis (24.32%) was between 20 and 34 years of age. In the examined population, 7.59% of the patients had positive pathohistological finding. The number of normal pathohistological findings was statistically significantly lower in the patients with bacterial vaginosis (75.68%) than in those without bacterial vaginosis (97.52%), (χ2=16.28, p