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Cervical cancer is a prevalent disease affecting the cervix cells in women and is one of the leading causes of mortality for women globally. The Pap smear test determines the risk of cervical cancer by detecting abnormal cervix cells. Early detection and diagnosis of this cancer can effectively increase the patient's survival rate. The advent of artificial intelligence facilitates the development of automated computer-assisted cervical cancer diagnostic systems, which are widely used to enhance cancer screening. This study emphasizes the segmentation and classification of various cervical cancer cell types. An intuitive but effective segmentation technique is used to segment the nucleus and cytoplasm from histopathological cell images. Additionally, handcrafted features include different properties of the cells generated from the distinct cervical cytoplasm and nucleus area. Two feature rankings techniques are conducted to evaluate this study's significant feature set. Feature analysis identifies the critical pathological properties of cervical cells and then divides them into 30, 40, and 50 sets of diagnostic features. Furthermore, a graph dataset is constructed using the strongest correlated features, prioritizes the relationship between the features, and a robust graph convolution network (GCN) is introduced to efficiently predict the cervical cell types. The proposed model obtains a sublime accuracy of 99.11% for the 40-feature set of the SipakMed dataset. This study outperforms the existing study, performing both segmentation and classification simultaneously, conducting an in-depth feature analysis, attaining maximum accuracy efficiently, and ensuring the interpretability of the proposed model. To validate the model's outcome, we tested it on the Herlev dataset and highlighted its robustness by attaining an accuracy of 98.18%. The results of this proposed methodology demonstrate the dependability of this study effectively, detecting cervical cancer in its early stages and upholding the significance of the lives of women. [ABSTRACT FROM AUTHOR]

Background: The coronavirus 2019 (COVID-19) pandemic impacted cancer health care in several countries, with delays in the detection and treatment of breast and cervical cancer. The objective of this study is to analyze and compare the screening, diagnosis and treatment of breast and cervical cancer in the pre-COVID period and during the COVID-19 period. Methods: Cross-sectional study with secondary data collected from the Mortality Information System (SIM), Hospital Information System (SIH), Ambulatory Information System (SIA) and the Oncology Panel (PO) of breast cancer notifications with ICD C50.0 to C50.9 and cervix ICD C53.0 to C53.9, The analyzed period before the pandemic was from March 1 to October 1, 2019, and during the pandemic from March 1 to October 1, 2020. The period from 2013 to 2022 was also analyzed with the same information, including the number of diagnoses, treatments, and deaths from breast cancer and cervical cancer. The study population consisted of Brazilian women aged 25 to 70 years. In order to compare categorical variables between periods, the Chi-Square or Fisher's Exact tests, and Mann-Whitney U tests were applied, and the Poisson Regression model was applied to model the number of reported cases of COVID-19 and the amount of procedures. Results: There was a decrease in the number of mammograms and cytopathological exams during COVID-19, as well as a decrease in cases of breast and cervical cancer. The Poisson regression showed that the increase in the number of COVID-19 cases caused a decrease in the number of breast cytopathological examinations, cervical-vaginal cytopathological examinations/microflora and screening, diagnosis, initiation of treatment for breast cancer and deaths from this disease. Meanwhile, in some regions of Brazil, as the number of Covid-19 increased, there was a significantly increase in the number of mammograms performed and cervical cancer diagnoses. Conclusions: The COVID-19 period in 2020 significantly impacted screening, diagnosis, treatment for breast and cervical cancer. [ABSTRACT FROM AUTHOR]

Perinatal care provides important health care opportunities for many individuals at risk for cervical cancer. Pregnancy does not alter cervical cancer screening regimens. ASCCP risk-based management has a colposcopy threshold of a 4% immediate risk of cervical intraepithelial neoplasia (CIN) 3 or cancer, but the actual risk can be considerably higher based on current and past screening results. Improving cervical cancer outcomes with diagnosis during pregnancy rather than postpartum and facilitating further evaluation and treatment postpartum for lesser lesions are the perinatal management goals. Although colposcopy indications are unchanged in pregnancy, some individuals with lower risk of CIN 2--3 and reliable access to postpartum evaluation may defer colposcopy until after delivery. Cervical intraepithelial neoplasia diagnosed in pregnancy tends to be stable, with frequent regression postpartum, though this is not universal. Colposcopic inspection during pregnancy can be challenging. Although biopsies in pregnancy are subjectively associated with increased bleeding, they do not increase complications. Endocervical curettage and expedited treatment are unacceptable. Treatment of CIN 2--3 in pregnancy is not recommended. Excisional biopsies in pregnancy are reserved for suspicion of malignancy that cannot be confirmed by colposcopic biopsy and when excisional biopsy results would alter oncologic or pregnancy care. Surveillance of high-grade lesions in pregnancy uses human papillomavirus-based testing, cytology, and colposcopy, with biopsy of worsening lesions every 12--24 weeks from diagnosis until postpartum evaluation. Mode of delivery does not definitively affect persistence of CIN postpartum. Postpartum care may involve a full colposcopic evaluation or expedited excisional procedure if indicated. [ABSTRACT FROM AUTHOR]

Background: This study aimed to measure the accuracy of optical coherence tomography (OCT) in the early diagnosis of high-grade cervical lesions and assess its diagnostic value in the triage of high-risk HPV infection. Method: From Jan 2019 to Jan 2021, women who visited the gynecology clinics of 2 hospitals for colposcopy were invited to participate in this study. Women aged 35 to 64 years old who were sexually active and had an intact cervix with a diameter of more than or equal to 2 cm were included in this study. Additionally, individuals with abnormal cytology, positive HPV test results, or other clinically suspicious symptoms or signs were referred. All participants were examined before colposcopy using OCT. Biopsy and/or ECC were conducted under colposcopy. We used the results of histopathology as the gold standard and assessed the accuracy of OCT. Results: Overall, 883 women were included in the analysis. Approximately 13.25% of women were ASCUS+ in cytological assessments, and 22.31% were positive for high-risk HPV. Nearly 15.18% of women were positive in OCT. Of them, 27 women were diagnosed with CIN2, and 33 were diagnosed with CIN3+ lesions. Among HPV-positive women, the detection rates for CIN2+ and CIN3+ were much lower for those who were negative in OCT, compared with NILM cytology (CIN2+: 20.0% vs. 30.0%, P=0.002, and CIN3+: 18.2% vs. 27.3%, P=0.013). Among women who were positive for HPV16/18, the detection rate for CIN2+ was much lower for negative OCT, compared with NILM cytology (8.3% vs.15.0%, P=0.005). Compared to HPV and cytological tests, HPV combined with OCT had higher specificity for detecting CIN2+ and CIN3+ (96.1% vs. 93.2%, P=0.002; 93.8% vs. 91.3%, P=0.013). OCT triage after HPV genotyping had the highest AUC for detecting CIN2+ and CIN3+ cases among patients with high-risk HPV infection (0.921, 0.920). Conclusion: OCT is an accurate test for the early diagnosis of high-grade cervical lesions and has great diagnostic value in the triage of patients with high-risk HPV infection. [ABSTRACT FROM AUTHOR]

Background: Recent publications underscore the need for updated recommendations addressing less radical surgery for <2 cm tumors, induction chemotherapy, or immunotherapy for locally advanced stages of cervical cancer, as well as for the systemic therapy for recurrent or metastatic cervical cancer. Aim: To summarize the current evidence for the diagnosis, treatment, and follow-up of cervical cancer and provide evidence-based clinical practice recommendations. Methods: Developed according to AGREE II standards, the guidelines classify scientific evidence based on the Agency for Health Technology Assessment and Tariff System criteria. Recommendations are graded by evidence strength and consensus level from the development group. Key Results: (1) Early-Stage Cancer: Stromal invasion and lymphovascular space involvement (LVSI) from pretreatment biopsy identify candidates for surgery, particularly for simple hysterectomy. (2) Surgical Approach: Minimally invasive surgery is not recommended, except for T1A, LVSI-negative tumors, due to a reduction in life expectancy. (3) Locally Advanced Cancer: concurrent chemoradiation (CCRT) followed by brachytherapy (BRT) is the cornerstone treatment. Low-risk patients (fewer than two metastatic nodes or FIGO IB2-II) may consider induction chemotherapy (ICT) followed by CCRT and BRT after 7 days. High-risk patients (two or more metastatic nodes or FIGO IIIA, IIIB, and IVA) benefit from pembrolizumab with CCRT and maintenance therapy. (4) Metastatic, Persistent, and Recurrent Cancer: A PD-L1 status from pretreatment biopsy identifies candidates for Pembrolizumab with available systemic treatment, while triplet therapy (Atezolizumab/Bevacizumab/chemotherapy) becomes a PD-L1-independent option. Conclusions: These evidence-based guidelines aim to improve clinical outcomes through precise treatment strategies based on individual risk factors, predictors, and disease stages. [ABSTRACT FROM AUTHOR]

The history of colposcopy, a common medical procedure, is entwined with that of Nazi medicine and the death camp Auschwitz. This article explores that history and focuses on the actions of Hans Hinselmann, often referred to as the "father of colposcopy." The centennial anniversary of Hans Hinselmann's initial publication describing colposcopy is approaching. In the 100 years since the inventor's seminal paper, colposcopy has become indispensable in the diagnosis and management of cervical cancer. It remains central in diagnosing precancerous and cancerous cervical lesions and has dramatically reduced cervical cancer incidence and mortality since the mid-20th century. Previous descriptions of colposcopy's development in medical literature obscure the dark history of its earliest days, arising within the center of German Nazism. The pioneers of colposcopy benefited from the Nazi government's public health focus and exploited the environment fostered by the Nazi medical establishment. They made use of the apparatus of the Auschwitz concentration camp to position colposcopy for expanded postwar adoption, ultimately accomplishing Hinselmann's stated goal that colposcopy become a routine part of gynecologic examination and care. This historical exposition clarifies the Nazi past of colposcopy, highlights the important role that unethical treatment of victims of Auschwitz played in cementing this procedure within standard cervical cancer screening programs globally, and offers steps to reckon with this tragic legacy. [ABSTRACT FROM AUTHOR]

Cervical cancer ranks among the leading causes of mortality in women worldwide, underscoring the critical need for early detection to ensure patient survival. While the Pap smear test is widely used, its effectiveness is hampered by the inherent subjectivity of cytological analysis, impacting its sensitivity and specificity. This study introduces an innovative methodology for detecting and tracking precursor cervical cancer cells using SIFT descriptors in video sequences captured with mobile devices. More than one hundred digital images were analyzed from Papanicolaou smears provided by the State Public Health Laboratory of Michoacán, Mexico, along with over 1800 unique examples of cervical cancer precursor cells. SIFT descriptors enabled real-time correspondence of precursor cells, yielding results demonstrating 98.34% accuracy, 98.3% precision, 98.2% recovery rate, and an F-measure of 98.05%. These methods were meticulously optimized for real-time analysis, showcasing significant potential to enhance the accuracy and efficiency of the Pap smear test in early cervical cancer detection. [ABSTRACT FROM AUTHOR]

Purpose: To assess the diagnostic potential of whole-tumor histogram analysis of multiple non-Gaussian diffusion models for differentiating cervical cancer (CC) aggressive status regarding of pathological types, differentiation degree, stage, and p16 expression. Methods: Patients were enrolled in this prospective single-center study from March 2022 to July 2023. Diffusion-weighted images (DWI) were obtained including 15 b-values (0 ~ 4000 s/mm2). Diffusion parameters derived from four non-Gaussian diffusion models including continuous-time random-walk (CTRW), diffusion-kurtosis imaging (DKI), fractional order calculus (FROC), and intravoxel incoherent motion (IVIM) were calculated, and their histogram features were analyzed. To select the most significant features and establish predictive models, univariate analysis and multivariate logistic regression were performed. Finally, we evaluated the diagnostic performance of our models by using receiver operating characteristic (ROC) analyses. Results: 89 women (mean age, 55 ± 11 years) with CC were enrolled in our study. The combined model, which incorporated the CTRW, DKI, FROC, and IVIM diffusion models, offered a significantly higher AUC than that from any individual models (0.836 vs. 0.664, 0.642, 0.651, 0.649, respectively; p < 0.05) in distinguishing cervical squamous cell cancer from cervical adenocarcinoma. To distinguish tumor differentiation degree, except the combined model showed a better predictive performance compared to the DKI model (AUC, 0.839 vs. 0.697, respectively; p < 0.05), no significant differences in AUCs were found among other individual models and combined model. To predict the International Federation of Gynecology and Obstetrics (FIGO) stage, only DKI and FROC model were established and there was no significant difference in predictive performance among different models. In terms of predicting p16 expression, the predictive ability of DKI model is significantly lower than that of FROC and combined model (AUC, 0.693 vs. 0.850, 0.859, respectively; p < 0.05). Conclusion: Multiple non-Gaussian diffusion models with whole-tumor histogram analysis show great promise to assess the aggressive status of CC. [ABSTRACT FROM AUTHOR]

BACKGROUND: Cervical malignancy is considered among the most perilous cancers affecting women in numerous East African and South Asian nations, both in terms of its prevalence and fatality rates. OBJECTIVE: This research aims to propose an efficient automated system for the segmentation of cancerous regions in cervical images. METHODS: The proposed techniques encompass preprocessing, feature extraction with an optimized feature set, classification, and segmentation. The original cervical image undergoes smoothing using the Gaussian Filter technique, followed by the extraction of Local Binary Pattern (LBP) and Grey Level Co-occurrence Matrix (GLCM) features from the enhanced cervical images. LBP features capture pixel relationships within a mask window, while GLCM features quantify energy metrics across all pixels in the images. These features serve to distinguish normal cervical images from abnormal ones. The extracted features are optimized using Genetic Algorithm (GA) as an optimization method, and the optimized sets of features are classified using the Co-Active Adaptive Neuro-Fuzzy Inference System (CANFIS) classification method. Subsequently, a morphological segmentation technique is employed to categorize irregular cervical images, identifying and segmenting malignant regions within them. RESULTS: The proposed approach achieved a sensitivity of 99.09%, specificity of 99.39%, and accuracy of 99.36%. CONCLUSION: The proposed approach demonstrated superior performance compared to state-of-the-art techniques, and the results have been validated by expert radiologists. [ABSTRACT FROM AUTHOR]

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This study addresses the critical issue of cervical cancer, which stands as the fourth most prevalent cancer among women. With early detection being pivotal for successful treatment, the research focuses on evaluating the effectiveness of deep learning-based models in cervical cancer detection. Leveraging the widely employed Papanicolaou (Pap) smear test, the study proposes a transfer learning approach, incorporating contrast limited adaptive histogram equalization for image enhancement. Convolutional neural network models, including AlexNet, visual geometry group (VGGNet)-16, and VGGNet-19, are employed to accurately distinguish between cancerous and non-cancerous cervical cell images. The evaluation metrics encompass accuracy, precision, sensitivity, specificity, F1-score, and the matthew correlation coefficient (MCC). Notably, the findings reveal the exceptional performance of the VGGNet-19 model, achieving an accuracy of 98.71%, sensitivity of 98.33%, and specificity of 99% for a single smear cell. This research marks a significant advancement in the application of deep learning for precise cervical cancer detection. The promising results underscore the potential of these models to enhance early diagnosis and contribute to improved treatment outcomes, thereby addressing a crucial aspect of women's health. [ABSTRACT FROM AUTHOR]

Background: Infection with human papillomavirus (HPV) is one of the more common sexually transmitted diseases in Germany. Vaccination against HPV was introduced in Germany in 2007. In this study, we sought to detect a population-based decline in the incidence of cervical cancer in women under age 30 who were eligible for vaccination in the first 11 years after its introduction. Methods: Data on new diagnoses of HPV-associated cervical cancer from 2004 to 2018 were obtained from the cancer registries of the German federal states (Bundesländer) through the German Center for Cancer Registry Data (ZfKD). Trends in the incidence of invasive and in situ cervical cancer were determined with log-linear joinpoint regression and age--period--cohort models. Results: The incidence of cervical cancer, which had been rising in the previous decades, has been falling since 2010, with a marked decline among women in all age groups eligible for vaccination (e.g., from 70.0 to 41.8 cases per 100 000 persons per year from 2010 to 2018 in women aged 24 to 26). Women born in 1992 were the first to become eligible for vaccination and have a 24% lower incidence than the reference cohort of women born in 1989 (relative risk 0.76, 95% confidence interval [0.68; 0.86]). Larger effects were found in later birth cohorts, in which vaccination was more widespread. Conclusion: Eleven years after the introduction of HPV vaccination, a drop in the incidence of cervical cancer was observable at the population level in the birth cohorts eligible for vaccination. [ABSTRACT FROM AUTHOR]

Background: CD46 has been revealed to be a key factor in malignant transformation and cancer treatment. However, the clinical significance of CD46 in cervical cancer remains unclear, and this study aimed to evaluate its role in cervical cancer diagnosis and prognosis evaluation. Methods: A total of 180 patients with an initial diagnosis of cervical cancer were enrolled at Taizhou Hospital of Zhejiang Province, China. The plasma levels of soluble CD46 (sCD46) and the expression of membrane-bound CD46 (mCD46) were detected by enzyme-linked immunosorbent assay (ELISA) and immunohistochemistry (IHC), respectively. Results: CD46 was found to be significantly upregulated in cervical cancer tissues vs. normal tissues, while no CD46 staining was detected in paired adjacent noncancerous tissues. CD46 staining was more pronounced in cancer cells than in stromal cells in situ (in tissues). Moreover, the plasma levels of sCD46 were able to some extent discriminate between cancer patients and healthy women (AUC=0.6847, 95% CI:0.6152-0.7541). Analysis of Kaplan-Meier survival curves revealed that patients with low CD46 expression had slightly longer overall survival (OS) than patients with high CD46 expression in the tumor microenvironment, but no significant difference. Univariate Cox regression analysis revealed that CD46 (P=0.034) is an independent risk factor for OS in cervical cancer patients. Conclusion: The present study demonstrated that cervical cancer patients exhibit aberrant expression of CD46, which is closely associated with a poor prognosis, suggesting that CD46 plays a key role in promoting cervical carcinogenesis and that CD46 could serve as a promising potential target for precision therapy for cervical cancer. [ABSTRACT FROM AUTHOR]

Background: Persistent infections with high-risk human papillomavirus (hrHPV) can cause cervical squamous intraepithelial lesions (SIL) that may progress to cancer. The cervicovaginal microbiome (CVM) correlates with SIL, but the temporal composition of the CVM after hrHPV infections has not been fully clarified. Methods: To determine the association between the CVM composition and infection outcome, we applied high-resolution microbiome profiling using the circular probe-based RNA sequencing technology on a longitudinal cohort of cervical smears obtained from 141 hrHPV DNA-positive women with normal cytology at first visit, of whom 51 were diagnosed by cytology with SIL six months later. Results: Here we show that women with a microbial community characterized by low diversity and high Lactobacillus crispatus abundance at both visits exhibit low risk to SIL development, while women with a microbial community characterized by high diversity and Lactobacillus depletion at first visit have a higher risk of developing SIL. At the level of individual species, we observed that a high abundance for Gardnerella vaginalis and Atopobium vaginae at both visits associate with SIL outcomes. These species together with Dialister micraerophilus showed a moderate discriminatory power for hrHPV infection progression. Conclusions: Our results suggest that the CVM can potentially be used as a biomarker for cervical disease and SIL development after hrHPV infection diagnosis with implications on cervical cancer prevention strategies and treatment of SIL. [ABSTRACT FROM AUTHOR]

We have been encouraging practicing gynecologists to adopt molecular diagnostics tests, PCR, and cancer biomarkers, as alternatives enabled by these platforms, to traditional Papanicolaou and colposcopy tests, respectively. An aliquot of liquid-based cytology was used for the molecular test [high-risk HPV types, (HR HPV)], another for the PAP test, and one more for p16/Ki67 dual-stain cytology. A total of 4499 laboratory samples were evaluated, and we found that 25.1% of low-grade samples and 47.9% of high-grade samples after PAP testing had a negative HR HPV-PCR result. In those cases, reported as Pap-negative, 22.1% had a positive HR HPV-PCR result. Dual staining with p16/Ki67 biomarkers in samples was positive for HR HPV, and 31.7% were also positive for these markers. Out of the PCR results that were positive for any of these HR HPV subtypes, n 68.3%, we did not find evidence for the presence of cancerous cells, highlighting the importance of performing dual staining with p16/Ki67 after PCR to avoid unnecessary colposcopies. The encountered challenges are a deep-rooted social reluctance in Mexico to abandon traditional Pap smears and the opinion of many specialists. Therefore, we still believe that colposcopy continues to be a preferred procedure over the dual-staining protocol. [ABSTRACT FROM AUTHOR]

The aim of this study was to identify biomarkers associated with immunity and prognosis in patients with cervical cancer. Data from patients with cervical squamous cell carcinoma (CESC) were retrieved from the UCSC Xena database and subjected to analysis. Gene sets representing 22 types of immunocytes were acquired, and immunocytes relevant to prognosis were identified. Weighted gene co-expression network analysis (WGCNA) was utilized to identify gene modules associated with prognosis-related immunocytes and to construct immune-related gene markers. Differentially expressed genes were then screened, and the association between immune score and biological function of immune-related gene markers was analyzed. Furthermore, tissue samples from cervical cancer patients in Northeast China were collected to validate the expression of two genes using real-time PCR and immunohistochemistry. This study identified 10 immunocytes significantly correlated with overall survival time in patients. Six gene modules were identified as significantly associated with prognosis-related immunocytes, with gene module 6 showing relevance to all prognosis-related immunocytes. Gene module 6 was related to all prognosis-related immunocytes. Moreover, two genes (including PLA2G2D and CHIT1) were found to be significantly associated with overall survival in cancer patients. Patients with CESC were classified into high and low immune score groups based on the median score of gene markers. Correlation analysis of the immune score and biological function was performed. Immunohistochemistry and real-time PCR results revealed high expression of CHIT1 and PLA2G2D in CESC tumor tissues. PLA2G2D and CHIT1 show promise as biomarkers for evaluating immune infiltration and prognosis in patients with cervical cancer. [ABSTRACT FROM AUTHOR]

Objective: The objective of this study was to delineate the profile of peripheral blood lymphocytic indices in patients afflicted with high-grade squamous intraepithelial lesions (HSIL) and cervical neoplasms, and to elucidate the correlation of these hematologic markers with the clinicopathological spectra in individuals diagnosed with cervical carcinoma. Methods: We adopted a retrospective case-control modality for this investigation. An aggregate of 39 HSIL patients and 42 cervical carcinoma patients, who were treated in our facility from July 2020 to September 2023, were meticulously selected. Each case of cervical malignancy was confirmed through rigorous histopathological scrutiny. Concomitantly, 31 healthy female individuals, who underwent prophylactic health evaluations during the corresponding timeframe, were enlisted as the baseline control group. We systematically gathered and analyzed clinical demographics, as well as the neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR), from peripheral blood samples. Pearson's correlation coefficient was deployed to dissect the interrelation between peripheral NLR and PLR concentrations and the clinicopathological features in the cervical cancer group. Results: Inter-group comparative analysis unveiled statistically substantial variances in the PLR and NLR values among the tripartite clusters (F = 36.941, 14.998, P < 0.001, respectively). Although discrepancy in NLR (P = 0.061) and PLR (P = 0.759) measures between the groups of cervical carcinoma and HSIL was not statistically appreciable, these indices were markedly elevated in the cervical carcinoma faction as juxtaposed with the normative control group (t = 5.094, 5.927; P < 0.001 for both parameters). A discernible gradation in peripheral blood PLR and NLR concentrations was noted when stratified by clinical stage and the profundity of myometrial invasion in cervical cancer subjects (P < 0.001). The correlation matrix demonstrated a positive liaison between peripheral blood PLR and the clinical gradation, as well as the invasiveness of the neoplastic cells into the muscularis propria (P < 0.05); a similar trend was observed with the NLR values (P < 0.05). Conclusion: Augmented NLR and PLR levels in peripheral blood specimens are indicative of HSIL and cervical malignancy. These hematological parameters exhibit a pronounced interconnection with clinical staging and muscular wall penetration depth, serving as potential discriminative biomarkers for the diagnosis and prognosis of cervical cancer. [ABSTRACT FROM AUTHOR]

Background: Cancer has surpassed infectious diseases and heart ailments, taking the top spot in the disease hierarchy. Cervical cancer is a significant concern for women due to high incidence and mortality rates, linked to the human papillomavirus (HPV). HPV infection leads to precancerous lesions progressing to cervical cancer. The cervix's external os, near the vagina, hosts various microorganisms. Evidence points to the link between vaginal microbiota and HPV-induced cervical cancer. Cervical cancer onset aligns with an imbalanced Th1/Th2 immune response, but the role of vaginal microbiota in modulating this imbalance is unclear. Methods: In this study, we collected vaginal samples from 99 HPV-infected patients across varying degrees of lesions, alongside control groups. These samples underwent bacterial DNA sequencing. Additionally, we employed Elisa kits to quantify the protein expression levels of Th1/Th2 cytokines IL2, IL12, IL5, IL13, and TNFa within the centrifuged supernatant of vaginal-cervical secretions from diverse research subjects. Subsequently, correlation analyses were conducted between inflammatory factors and vaginal microbiota. Results: Our findings highlighted a correlation between decreased Lactobacillus and increased Gardenerella presence with HPV-induced cervical cancer. Functionally, our predictive analysis revealed the predominant enrichment of the ABC transporter within the vaginal microbiota of cervical cancer patients. Notably, these microbiota alterations exhibited correlations with the production of Th1/Th2 cytokines, which are intimately tied to tumor immunity. Conclusions: This study suggests the potential involvement of vaginal microbiota in the progression of HPV-induced cervical cancer through Th1/Th2 cytokine regulation. This novel insight offers a fresh perspective for early cervical cancer diagnosis and future prevention strategies. [ABSTRACT FROM AUTHOR]

Cervical cancer is a significant concern for women, necessitating early detection and precise treatment. Conventional cytological methods often fall short in early diagnosis. The proposed innovative Heap Optimizer-based Self-Systematized Neural Fuzzy (HO-SsNF) method offers a viable solution. It utilizes HO-based segmentation, extracting features via Gray-Level Co-Occurrence Matrix (GLCM) and Local Binary Pattern (LBP). The proposed SsNF-based classifier achieves an impressive 99.6% accuracy in classifying cervical cancer cells, using the Herlev Pap Smear database. Comparative analyses underscore its superiority, establishing it as a valuable tool for precise cervical cancer detection. This algorithm has been seamlessly integrated into cervical cancer diagnosis centers, accessible through smartphone applications, with minimal resource demands. The resulting insights provide a foundation for advancing cancer prevention methods. [ABSTRACT FROM AUTHOR]

The longer-term impact of introducing human papillomavirus (HPV) testing into routine cervical cancer screening on precancer and cancer rates by histologic type has not been well described. Calendar trends in diagnoses were examined using data from Kaiser Permanente Northern California, which introduced triennial HPV and cytology co-testing in 2003 for women aged ≥30 years. We examined trends in cervical precancer (cervical intraepithelial neoplasia grade 3 [CIN3] and adenocarcinoma in situ [AIS]) and cancer (squamous cell carcinoma [SCC] and adenocarcinoma [ADC]) diagnoses per 1000 screened during 2003–2018. We examined ratios of squamous vs. glandular diagnoses (SCC:ADC and CIN3:AIS). CIN3 and AIS diagnoses increased approximately 2% and 3% annually, respectively (p trend < 0.001 for both). While SCC diagnoses decreased by 5% per annually (p trend < 0.001), ADC diagnoses did not change. These patterns were generally observed within each age group (30–39, 40–49, and 50–64 years). ADC diagnoses per 1000 screened did not change even among those who underwent co-testing starting in 2003–2006. SCC:ADC decreased from approximately 2.5:1 in 2003–2006 to 1.3:1 in 2015–2018 while the CIN3:AIS remained relatively constant, ∼10:1. Since its introduction at KPNC, co-testing increased the detection of CIN3 over time, which likely caused a subsequent reduction of SCC. However, there has been no observed decrease in ADC. One possible explanation for lack of effectiveness against ADC is the underdiagnosis of AIS. Novel strategies to identify and treat women at high risk of ADC need to be developed and clinically validated. • Following the introduction of 3-yearly co-testing, the detection of CIN3 and AIS increased. • Following the introduction of 3-yearly HPV and Cytology co-testing, diagnoses of cervical squamous cell carcinoma decreased. • Following the introduction of 3-yearly HPV and Cytology co-testing, diagnoses of cervical adenocarcinoma did not change. [ABSTRACT FROM AUTHOR]

Hypoxia and Ferroptosis are associated with the malignant behaviour of cervical cancer. Endothelial PAS domain‐containing protein 1 (EPAS1) contributes to the progression of cervical cancer. EPAS1 plays important roles in hypoxia and ferroptosis. Using the GEO dataset, machine‐learning algorithms were used to screen for hypoxia‐ and ferroptosis‐related genes (HFRGs) in cervical cancer. EPAS1 was identified as the hub gene. qPCR and WB were used to investigate the expression of EPAS1 in normal and cervical cancer tissues. The proliferation, invasion and migration of EPAS1 cells in HeLa and SiHa cell lines were detected using CCK8, transwell and wound healing assays, respectively. Apoptosis was detected by flow cytometry. A dual‐luciferase assay was used to analyse the MALAT1‐miR‐182‐5P‐EPAS1 mRNA axis and core promoter elements of the super‐enhancer. EPAS1 was significantly overexpressed in cervical cancer tissues. EPAS1 could increase the proliferation, invasion, migration of HeLa and SiHa cells and reduce the apoptosis of HeLa and SiHa cell. According to the double‐luciferase assay, EPAS1 expression was regulated by the MALAT1‐Mir‐182‐5p‐EPAS1 mRNA axis. EPAS1 is associated with super‐enhancers. Double‐luciferase assay showed that the core elements of the super‐enhancer were E1 and E3. EPAS1, an HFRG, is significantly overexpressed in cervical cancer. EPAS1 promotes malignant behaviour of cervical cancer cells. EPAS1 expression is regulated by super‐enhancers and the MALAT1‐miR‐182‐5P‐ EPAS1 mRNA axis. EPAS1 may be a target for the diagnosis and treatment of cervical cancer. [ABSTRACT FROM AUTHOR]

This study undertakes a comprehensive analysis of cervical cancer diagnosis using machine learning (ML) techniques. We start by introducing the critical importance of early and accurate diagnosis of cervical cancer, a significant health issue globally. The objective of this research is to compare the effectiveness of three ML algorithms: K-nearest neighbors (KNN), linear support vector machine (SVM), and Naive Bayes classifier, in predicting biopsy results for cervical cancer. Our methodology involves utilizing a substantial dataset to train and test these algorithms, focusing on performance measures like accuracy, precision, recall, F1 score, and the area under the receiver operating characteristic curve (AUC). The findings reveal that KNN demonstrates superior performance, with high precision, recall, accuracy, and F1 score, alongside a notable AUC. This suggests KNN's potential utility in clinical applications for cervical cancer prognosis. Meanwhile, linear SVM and Naive Bayes exhibit certain limitations, indicating a need for further optimization. This study highlights the promising role of ML in enhancing medical diagnostic processes, particularly in oncology. [ABSTRACT FROM AUTHOR]

Introduction: Screening programs has conventional cytology such as Conventional Pap Smear (CPS) have successfully reduced cervical cancer, but newer tests like Manual Liquid-based cytology (MLBC) and Human Papillomavirus testing might enhance screening. Materials and Methods: This was a cross sectional study conducted on 175 samples was processed for CPS and MLBC. Cytobrush was used for LBC which was suspended and detached in the preservative fluid and processed by manual method. Histopathological correlation and HPV DNA testing was also done. Results: MLBC showed higher specimen adequately, cellularity, clean background and uniform distribution of cells than CPS. Conclusion: MLBC showed improved specimen adequately, better cytomorphological features and higher detection of epithelial cell abnormality. [ABSTRACT FROM AUTHOR]

Objectives: The spread of technology and the internet in society has not only been apparent in the information and communication sectors but has also affected all fields. One of the active areas where the Internet is used is in healthcare. This study aims to investigate the relationship between women's online health information-seeking behavior, e-health literacy levels, and cyberchondria severity levels with cervical cancer screening. Materials and Methods: This research, conducted using a quantitative correlational screening model and a cross-sectional method, involved face-to-face interviews with 370 women aged 30 to 65, who applied to a gynecology clinic in Ankara City Hospital. A four-part questionnaire was used, which included women's sociodemographic data, questions aimed at understanding online health information-seeking behavior, the eHealth Literacy Scale (eHEALS), and the Short Form Version of the Cyberchondria Severity Scale (CSS-12). Results: A low positive correlation was found between participants' e-health literacy and cyberchondria scale scores. However, no significant relationship was observed between online health information-seeking behavior, e-health literacy, cyberchondria severity levels, and participation in screenings. Conclusion: In this study, it was observed that despite high rates of online health information-seeking behavior among women, it is not sufficient to encourage cervical cancer screenings. [ABSTRACT FROM AUTHOR]

Background: Cancer/testis antigen-45A1 (CT45A1) is overexpressed in various types of cancer but is not expressed in healthy women. The role of CT45A1 in cervical cancer has not yet been described in the literature. Purpose: The aim of this research was to study the role of CT45A1 in cervical cancer progression and drug resistance, elucidate the mechanisms underlying CT45A1-mediated tumorigenesis and investigate CT45A1 as a biomarker for cervical cancer diagnosis, prognostic prediction, and targeted therapy. Methods: The CT45A1 levels in the tumors from cervical cancer patients were measured using immunohistochemical staining. The role and mechanisms underlying CT45A1-mediated cervical cancer cell tumor growth, invasion, and drug resistance were studied using xenograft mice, cervical cancer cells, immunohistochemistry, RNA-seq, real-time qPCR, Chromatin immunoprecipitation and Western blotting. Results: CT45A1 levels were notably high in the tumor tissues of human cervical cancer patients compared to the paracancerous tissues (p < 0.001). Overexpression of CT45A1 was closely associated with poor prognosis in cervical cancer patients. CT45A1 promoted cervical cancer cell tumor growth, invasion, neovascularization, and drug resistance. Mechanistically, CT45A1 promoted the expression of 128 pro-tumorigenic genes and concurrently activated key signaling pathways, including the oncogenic SRC, ERK, CREB, and YAP/TAZ signaling pathways. Furthermore, CT45A1-mediated tumorigenesis and drug resistance were markedly inhibited by the small molecule lycorine. Conclusion: CT45A1 promotes cervical cancer cell tumorigenesis, neovascularization, and drug resistance by activating oncogenic SRC and downstream tumorigenic signaling pathways. These findings provide new insight into the pathogenesis of cervical cancer and offer a new platform for the development of novel therapeutics against cervical cancer. [ABSTRACT FROM AUTHOR]

Background: Cervical cancer is currently the second leading cause of cancer death among women from developing countries (1). However, there is a lack of effective treatment methods, and the existing treatments often result in significant adverse reactions and high chances of recurrence, which ultimately impact the prognosis of patients. As a result, the application of nanotechnology, specifically nanoparticle-based approaches, in the diagnosis and treatment of cervical cancer has gained significant attention. This study aims to examine the current research status and future development trends of nanotechnology in relation to cervical cancer using a bibliometric perspective. Methods: A bibliometric analysis was performed to gather relevant research papers from the Web of Science database. VOSviewer and CiteSpace were utilized to conduct quantitative analysis and identify hot topics in the field, focusing on countries, institutions, journals, authors, and keywords. Result: A total of 997 eligible literature were retrieved. From January 1, 2014 to September 20, 2023, the overall number of publications showed an upward trend. The paper mainly comes from China (n=414). The main institution is the Chinese Academy of Sciences (n=62), and 60% of the top 10 institutions in the number of documents issued are from China. First authors Ma, Rong (n=12) and Alifu, Nuernisha (n=12). The journal with the highest publication volume is ACS Applied Materials&INTERFACES (n=35), and the journal with the highest citation frequency is BIOMATERIALS (n=508). "Nanoparticles (n=295)", "cervical cancer (n=248)", and "drug delivery (n=218)" are the top three most frequently occurring keywords. In recent years, photothermal therapy and indocyanine green have become research hotspots. Conclusion: The application of nanotechnology in the field of cervical cancer has garnered considerable attention. Nanoparticles-based methods for diagnosis, administration, and treatment have proven to be instrumental in enhancing the sensitivity of cervical cancer detection, improving the accuracy and efficiency of administration, and reducing drug toxicity. Enhancing treatment efficacy and improving patient prognosis have emerged as current research priorities and future directions. [ABSTRACT FROM AUTHOR]

Cervical cancer continues to pose a significant global health burden, despite advancements in screening and early detection. In recent years, the integration of Artificial Intelligence (AI) technologies has emerged as a promising approach to enhance cervical cancer detection and diagnosis. The challenges associated with existing screening methods; AI-based approaches that have been developed to address these challenges are explored. Through a systematic review of the literature, we highlight the strengths and limitations of different AI algorithms and methodologies employed in cervical cancer detection, the role of machine learning, deep learning, and other AI techniques in improving the accuracy and efficiency of screening programs, as well as their potential impact on reducing disparities in cervical cancer outcomes. The integration of AI technologies into existing screening frameworks, including the use of automated systems for image interpretation, decision support tools for healthcare providers, and mobile health applications for patient education and engagement and the regulatory and ethical considerations surrounding the deployment of AI in cervical cancer detection are discussed. Review highlights future directions and emerging trends in AI-driven cervical cancer detection, the transformative potential of AI technologies in revolutionizing the future of cervical cancer detection and the importance of collaborative efforts among researchers, healthcare providers, policymakers, and industry stakeholders to realize this vision. [ABSTRACT FROM AUTHOR]

Introduction: Cervical cancer is the third leading cause of death from malignancies worldwide, affecting mainly low- and middle-income countries. By 2020 an incidence of 604,000 new cases was estimated. Objective: To characterize the main hospital indicators of the Cervical Cancer Early Diagnosis Program. Methods: An observational, descriptive and cross-sectional study was carried out to characterize the main hospital indicators of the Program in the Neck Pathology Service of the General Hospital Dr. Bruno Zayas Alfonso of Santiago de Cuba, from January 2020 to December 2022. The study population consisted of 443 women. The data collected were analyzed using descriptive statistic techniques, expressed in frequency and percentages. Results: Of the women studied, 60.9 %had cervical intraepithelial lesion of high degree of malignancy, with 32.6 % positive for cervical cancer. The overall percentage of useless cytological tests was 2.07 and no cells from the processing zone was 4.01, both quality indicators. There was a high significance in terms of the overall coverage rate of women at risk (K=0.615), showing that the results of the cytology largely reflect the diagnosis of histology, with a good agreement. Conclusions: Cervical-vaginal cytology remains the most valuable diagnostic method for detecting cervical intraepithelial neoplasm and early-stage carcinoma in large populations [ABSTRACT FROM AUTHOR]

Cervical cancer is the fourth most common cancer among women worldwide. It is believed that Human Papilloma Virus (HPV) is responsible for 100% of cervical cancers. 200 HPV genotypes have been identified to date, of which 13--15 are high-risk HPV genotypes infecting the genital area. 218 females suffering from high-risk HPV infection and showing a negative cytology test were selected in a retrospective cross-sectional study and divided into two groups: 1. HPV 16/18 (121 women) and 2. Other highrisk HPV (OHrHPV) (97 women). The demographic and clinical data were collected from Motahari clinic, Shiraz University of Medical Sciences, between September 2020 and January 2023. The collected data were analyzed using IBM SPSS software version 26. Data analysis was carried out using chi-square, t-test, and Mann-Whitney, and p < 0.05 was defined as being statistically significant for all the aforementioned tests. The mean age for the HPV 16/18 and OHrHPV groups were 35.27 ± 7.698 and 36.58 ± 8.756, respectively. The most prevalent HPV genotype was HPV type 16 (n = 96) in the population, followed by HPV type 18 (n = 25) and HPV type 31 (n = 17). The HPV 16/18 group had 15 high-grade colposcopy results, while only four similar results were observed in the OHrHPV group (p value = 0.031). The most prevalent HPV genotype in patients with cervical intraepithelial neoplasia (CIN) 2 and CIN3 was HPV16. The cytology test failed to identify over 4% of the lesions in the OHrHPV group. Direct referral for colposcopy in the OHrHPV group results in the identification of missed diagnosed lesions and lost to follow-up patients. [ABSTRACT FROM AUTHOR]

The cytological diagnosis of atypical squamous cells that cannot exclude high-grade squamous intraepithelial lesions (ASC-H) is subjective and entails great variation in the risk of HSIL+. Therefore, we retrospectively analyzed the clinicopathological outcomes of patients with ASC-H cytology from January 2018 to June 2021 to determine associated predictors for diagnosing HSIL+ and explore their appropriate clinical management. Overall, 279 patients with ASC-H cytology were enrolled, 64.9% (181/279) of whom were histopathologically confirmed as HSIL+. Further analysis showed that only human papillomavirus (HPV) positivity was an independent risk factor for HSIL+ in ASCH patients. Additionally, no significant difference was observed in the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of the three HPV testing methods (hybrid capture (HC) II, HPV E6E7 mRNA and HPV genotyping testing) for detecting HSIL+ (p > 0.05). The perfect agreement between colposcopy and final histology was 40.5%, with a κ value of 0.145. The sensitivity, specificity, PPV and NPV of colposcopy for detecting HSIL+ were 32.6%, 91.8%, 87.9% and 42.3%, respectively. After cervical conization, none of the patients diagnosed with normal/benign histopathology by cervical biopsy was reclassified to HSIL+, while 39.5% (17/43) of the low-grade squamous intraepithelial lesion (LSIL) patients were reclassified as HSIL. During follow-up, ASC-H patients diagnosed with LSIL had a high rate of normalization (70%) and a low rates of persistence (20%) and progression (10%). In four ASC-H patients younger than 30 years old with HSIL (cervical intraepithelial neoplasia (CIN) 2), two normalized and two persisted during followup. In conclusion, ASC-H patients should be directly referred for colposcopy and undergo biopsy irrespective of their age, menopausal status and HPV status. Relatively conservative management might be more suitable for ASC-H patients with LSIL- or ASC-H patients younger than 30 years with HSIL (CIN2). [ABSTRACT FROM AUTHOR]

We aimed to explore the diagnostic value of multi-slice spiral computed tomography dynamic enhanced scanning (MSCT) for the lymph node metastasis of cervical cancer and the causes for missed diagnosis. A total of 283 patients with cervical cancer treated from March 2019 to March 2022 were selected. Lymph node metastasis was observed by MSCT. The results were compared with those of surgical and pathological examinations to analyze the diagnostic value of MSCT. The patients with confirmed lymph node metastasis were divided into a missed diagnosis group (n = 41) and a nonmissed diagnosis group (n = 128). The factors for missed diagnosis by MSCT were explored by multivariate logistic regression analysis. A back propagation (BP) neural network model was constructed and evaluated. Results: The positive coincidence rate of MSCT diagnosis was 92.75%, the negative coincidence rate was 71.72%, and the total coincidence rate was 81.98%. The area under the receiver operator characteristic curve of MSCT was 0.741 (95% confidence interval: 0.723-0.826), indicating a high diagnostic value. A high degree of differentiation, negative Ki-67 expression, and interstitial infiltration depth of

Background Screening can reduce cancer mortality, but uptake is suboptimal and characterized by disparities. Home-based self-sampling can facilitate screening for colorectal cancer (with stool tests, eg, fecal immunochemical tests) and for cervical cancer (with self-collected human papillomavirus tests), especially among patients who face barriers to accessing health care. Additional data are needed on feasibility and potential effects of self-sampling tools for cancer screening among underserved patients. Methods We conducted a pilot randomized controlled trial with patients (female, ages 50-65 years, out of date with colorectal and cervical cancer screening) recruited from federally qualified health centers in rural and racially segregated counties in Pennsylvania. Participants in the standard-of-care arm (n   =   24) received screening reminder letters. Participants in the self-sampling arm (n   =   24) received self-sampling tools for fecal immunochemical tests and human papillomavirus testing. We assessed uptake of screening (10-week follow-up), self-sampling screening outcomes, and psychosocial variables. Analyses used Fisher exact tests to assess the effect of study arm on outcomes. Results Cancer screening was higher in the self-sampling arm than the standard-of-care arm (colorectal: 75% vs 13%, respectively, odds ratio = 31.32, 95% confidence interval = 5.20 to 289.33; cervical: 79% vs 8%, odds ratio = 72.03, 95% confidence interval = 9.15 to 1141.41). Among participants who returned the self-sampling tools, the prevalence of abnormal findings was 24% for colorectal and 18% for cervical cancer screening. Cancer screening knowledge was positively associated with uptake (P  < .05). Conclusions Self-sampling tools can increase colorectal and cervical cancer screening among unscreened, underserved patients. Increasing the use of self-sampling tools can improve primary care and cancer detection among underserved patients. Clinical Trials Registration Number STUDY00015480. [ABSTRACT FROM AUTHOR]

Simple Summary: Poor survival rates of squamous cell carcinomas (SCCs) are due in part to a limited number of reliable biomarkers and molecular targets. NAD+ metabolism plays a relevant role in SCC chemoprevention and therapy and is found dysregulated in several tumors. Therefore, the aim of our study was to identify new biomarkers based on NAD+ metabolism-related gene (NMRG) expression. Our findings indicate that NAD+ metabolism-related gene profiles can be an important source of SCC biomarkers and potential therapeutic targets. These findings agree with SCC preclinical and clinical studies using NAD+ precursors. Further in-depth studies on identified NMRGs may provide additional insights into SCC pathogenesis and improve therapeutic choice. Poor survival rates of squamous cell carcinomas (SCCs) are associated with high recurrence, metastasis, and late diagnosis, due in part to a limited number of reliable biomarkers. Thus, the identification of signatures improving the diagnosis of different SCC types is mandatory. Considering the relevant role of NAD+ metabolism in SCC chemoprevention and therapy, the study aimed at identifying new biomarkers based on NAD+ metabolism-related gene (NMRG) expression. Gene expression of 18 NMRGs and clinical-pathological information for patients with head and neck SCC (HNSCC), lung SCC (LuSCC), and cervix SCC (CeSCC) from The Cancer Genome Atlas (TCGA) were analyzed by several bioinformatic tools. We identified a 16-NMRG profile discriminating 3 SCCs from 3 non-correlated tumors. We found several genes for HNSCC, LuSCC, and CeSCC with high diagnostic power. Notably, three NMRGs were SCC-type specific biomarkers. Furthermore, specific signatures displayed high diagnostic power for several clinical-pathological characteristics. Analyzing tumor-infiltrating immune cell profiles and PD-1/PD-L1 levels, we found that NMRG expression was associated with suppressive immune microenvironment mainly in HNSCC. Finally, the evaluation of patient survival identified specific genes for HNSCC, LuSCC, and CeSCC with potential prognostic power. Therefore, our analyses indicate NAD+ metabolism as an important source of SCC biomarkers and potential therapeutic targets. [ABSTRACT FROM AUTHOR]

This study presents an approach to optimize cervical cancer classification using Support Vector Machines (SVM) and an improved Genetic Algorithm (GA) on Pap smear images. The proposed methodology involves preprocessing the images, extracting relevant features, and employing a genetic algorithm for feature selection. An SVM classifier is trained using the selected features and optimized using the genetic algorithm. The performance of the optimized model is evaluated, demonstrating improved accuracy and efficiency in cervical cancer classification. The findings hold the potential for assisting healthcare professionals in early cervical cancer diagnosis based on Pap smear images. [ABSTRACT FROM AUTHOR]

Background: Squamous cell carcinoma (SqCC) is the most prevalent subtype of carcinoma of the uterine cervix. It is well-known for its local infiltration and a high frequency of lymphonodal invasion, but distant hematogenous metastases are uncommon. Case Report: This case report highlights the rare occurrence of gastric perforation resulting from metastatic uterine cervical SqCC. A 56-year-old woman, initially treated for cervical cancer, presented with severe abdominal pain and vomiting. Emergency laparotomy revealed a prepyloric stomach perforation. Subsequent subtotal gastrectomy confirmed high-grade malignancy with atypical cells infiltrating the stomach. The literature on gastric metastasis from cervical cancer is limited, making this case noteworthy. Surgical intervention and postoperative therapy were recommended, although the patient's deteriorating health delayed the planned treatment. Conclusion: While only three similar cases have been reported, emphasizing the need for early radical treatment and postoperative care, this case underlines the complexity and lack of standardized protocols in managing such rare metastatic scenarios. [ABSTRACT FROM AUTHOR]

Purpose: Reducing time between cancer screening, diagnosis, and initiation of treatment is best achieved when services are available in the same hospital. Yet, comprehensive cancer centers are typically unavailable in low- and middle-income countries (LMICs), where resources are limited and services scattered. This study explored the impact of establishing an in-house pathology laboratory at the largest public cancer hospital in Tanzania on the downstaging of cervical cancer. Methods: We examined clinical datasets of 8,322 cervical cancer patients treated at the Ocean Road Cancer Institute (ORCI). The first period included patients treated from 2002 to 2016, before establishment of the pathology laboratory at ORCI; the second period (post-pathology establishment) included data from 2017 to 2020. Logistic regression analysis evaluated the impact of the pathology laboratory on stage of cervical cancer diagnosis. Results: Patients treated during the post-pathology period were more likely to be clinically diagnosed at earlier disease stages compared to patients in the pre-pathology period (pre-pathology population diagnosed at early disease stage: 44.08%; post-pathology population diagnosed at early disease stage: 59.38%, p < 0.001). After adjustment for age, region of residence, and place of biopsy, regression results showed patients diagnosed during the post-pathology period had higher odds of early stage cervical cancer diagnosis than patients in the pre-pathology period (OR 1.35, 95% CI (1.16, 1.57), p < 0.001). Conclusions: Integrated and comprehensive cancer centers can overcome challenges in delivering expedited cervical cancer diagnosis and treatment. In-house pathology laboratories play an important role in facilitating timely diagnosis and rapid treatment of cervical and possibly other cancers in LMICs. [ABSTRACT FROM AUTHOR]

Colposcopy imaging is pivotal in cervical cancer diagnosis, a major health concern for women. The computational challenge lies in accurate lesion recognition. A significant hindrance for many existing machine learning solutions is the scarcity of comprehensive training datasets.

Introduction: Behind breast, colorectal, and lung cancers, cervical cancer is the fourth most common cancer affecting females. Despite, it is a preventable form of cancer both the incidence and mortality figures reflect it as a major reproductive health problem. Late-stage cervical cancer diagnosis is associated with complicated clinical presentation which can result in short survival time and increased mortality. Several factors contribute to the late-stage presentation of cervical cancer patients. In Ethiopia nationally summarized evidence on the level and the factors contributing to late-stage cervical cancer diagnosis is scarce. Therefore, this systematic review and meta-analysis aimed to assess the pooled prevalence of late-stage cervical cancer diagnosis and its determinants in Ethiopia. Method: A systematic review and meta-analysis were conducted using PRISMA guidelines. Comprehensive literature was searched in PubMed, Embase, Google Scholar, and African Online Journal to retrieve eligible articles. A weighted inverse variance random effect model was used to estimate pooled prevalence. Cochrane Q-test and I2 statistics were computed to assess heterogeneity among studies. Funnel plot and Egger's regression test were done to assess publication bias. Result: Overall, 726 articles were retrieved and finally 10 articles were included in this review. The pooled prevalence of late-stage cervical cancer diagnosis in Ethiopia was 60.45% (95%CI; 53.04%-67.85%). Poor awareness about cervical cancer and its treatment (AOR = 1.55, 95% CI: (1.03 – 2.33, longer delay to seek care (AOR = 1.02, 95% CI: (1.01 – 1.03)) and rural residence (AOR = 2.07, 95% CI:(1.56 – 2.75)) were significantly associated to late-stage diagnosis. Conclusion: In Ethiopia, six in every ten cervical cancer cases are diagnosed at the late stage of the disease. Poor awareness about cervical cancer and its treatment, long patient delay to seek care, and rural residence were positively associated with late–stage diagnosis. Therefore intervention efforts should be made to improve public awareness about cervical cancer, minimize patient delay to seek care, and expand screening services specifically in the rural residing segment of the population to detect the disease early and improve survival. [ABSTRACT FROM AUTHOR]

Introduction: Cervical cancer threatens women's health seriously. In recent years, the incidence of cervical cancer is on the rise, and the age of onset tends to be younger. Prevention, early diagnosis and specific treatment have become the main means to change the prognosis of cervical cancer patients. Metabolomics research can directly reflect the changes of biochemical processes and microenvironment in the body, which can provide a comprehensive understanding of the changes of metabolites in the process of disease occurrence and development, and provide new ways for the prevention and diagnosis of diseases. Objectives: The aim of this study is to review the metabolic changes in cervical cancer and the application of metabolomics in the diagnosis and treatment. Methods: PubMed, Web of Science, Embase and Scopus electronic databases were systematically searched for relevant studies published up to 2022. Results: With the emergence of metabolomics, metabolic regulation and cancer research are further becoming a focus of attention. By directly reflecting the changes in the microenvironment of the body, metabolomics research can provide a comprehensive understanding of the patterns of metabolites in the occurrence and development of diseases, thus providing new ideas for disease prevention and diagnosis. Conclusion: With the continuous, in-depth research on metabolomics research technology, it will bring more benefits in the screening, diagnosis and treatment of cervical cancer with its advantages of holistic and dynamic nature. [ABSTRACT FROM AUTHOR]

Cancer of the cervix has a progressive character and is one of the most significant public health problems in many countries. Our research aimed to translate EORTC QLQ CX 24 (European Organization for Research and Treatment of Cancer; Quality of life questionnaire-cervical cancer 24) from English to Serbian, to create essential cultural adaptations and to analyze psychometric properties of the translation in a model of female inpatients with cancer of the cervix. The QLQ CX 24 was translated and adapted according to internationally established guidelines, and then tested on a sample of 100 Serbian females with cancer of the cervix. The testing was repeated three times on the same patients. We calculated the internal consistency (Cronbach's alpha), criterion validity, convergent validity, and discriminative validity of the QLQ CX 24. We used factor analysis to discover the original construct. The Serbian translation of QLQ CX 24 showed good internal consistency, showed satisfactory reliability, and temporal stability. In the first, when was rated by the investigators Cronbach's alpha was 0.607, and one month later when the questionnaire also was rated by investigators Cronbach's alpha was 0.696. When the scale was rated by females themselves Cronbach's alpha was 0.802. Divergent as well as convergent validity tests had good results. The factorial analysis exposed six domains. The Serbian translation of QLQ CX 24 is a trustworthy and appropriate specific instrument for measuring the quality of life in females with cervical cancer. [ABSTRACT FROM AUTHOR]

There are a large number of gynaecological cancers with rare histologies, for which the available data are limited and usually retrospective. Because of their rarity and poor prognosis, the management of these cancers must be centralized in expert centres, for both histological diagnosis and treatment. With the exception of sarcomas, most endometrial or cervical cancers with rare histologies respond to the same radiation treatment modalities than cancers with more common histologies, although there are some specificities regarding treatments such as neuroendocrine carcinomas (chemotherapy with platinum and etoposide, major role of surgery). For localized or locally advanced ovarian cancer, external beam radiotherapy has a role in the management of hypercalcaemic small cell carcinoma of the ovary. This article summarizes the current role of external beam radiotherapy and brachytherapy in the management of cancers of the uterine cervix, uterine corpus and ovaries, with rare or very rare histologies, and with localized or locally advanced stages. [ABSTRACT FROM AUTHOR]

To quantify the accuracy of ChatGPT in answering commonly asked questions pertaining to cervical cancer prevention, diagnosis, treatment, and survivorship/quality-of-life (QOL). ChatGPT was queried with 64 questions adapted from professional society websites and the authors' clinical experiences. The answers were scored by two attending Gynecologic Oncologists according to the following scale: 1) correct and comprehensive, 2) correct but not comprehensive, 3) some correct, some incorrect, and 4) completely incorrect. Scoring discrepancies were resolved by additional reviewers as needed. The proportion of responses earning each score were calculated overall and within each question category. ChatGPT provided correct and comprehensive answers to 34 (53.1%) questions, correct but not comprehensive answers to 19 (29.7%) questions, partially incorrect answers to 10 (15.6%) questions, and completely incorrect answers to 1 (1.6%) question. Prevention and survivorship/QOL had the highest proportion of "correct" scores (scores of 1 or 2) at 22/24 (91.7%) and 15/16 (93.8%), respectively. ChatGPT performed less well in the treatment category, with 15/21 (71.4%) correct scores. It performed the worst in the diagnosis category with only 1/3 (33.3%) correct scores. ChatGPT accurately answers questions about cervical cancer prevention, survivorship, and QOL. It performs less accurately for cervical cancer diagnosis and treatment. Further development of this immensely popular large language model should include physician input before it can be utilized as a tool for Gynecologists or recommended as a patient resource for information on cervical cancer diagnosis and treatment. • ChatGPT provides correct and comprehensive cervical cancer prevention and survivorship counseling. • ChatGPT performs far less accurately for questions regarding cervical cancer diagnosis and treatment. • While ChatGPT has potential, it requires further development before it can be utilized as a resource for patients. [ABSTRACT FROM AUTHOR]

To compare radical hysterectomy case volume, cancer stage, and biopsy-to-treatment time of invasive cervical cancer diagnosed before and after onset of the COVID-19 pandemic. In a multi-institution retrospective cohort study conducted at 6 large, geographically diverse National Cancer Institute-designated cancer centers, patients treated for newly diagnosed invasive cervical cancer were classified into 2 temporal cohorts based on date of first gynecologic oncology encounter: (1) Pre-Pandemic: 3/1/2018–2/28/2020; (2) Pandemic & Recovery: 4/1/2020–12/31/2021. The primary outcome was total monthly radical hysterectomy case volume. Secondary outcomes were stage at diagnosis and diagnosis-to-treatment time. Statistical analyses used chi-squared and two sample t -tests. Between 3/1/2018–12/31/2021, 561 patients were diagnosed with cervical cancer. The Pre-Pandemic and Pandemic & Recovery cohorts had similar age, race, ethnicity, smoking status, and Body Mass Index (BMI). During Pandemic & Recovery, the mean monthly radical hysterectomy case volume decreased from 7[SD 2.8] to 5[SD 2.0] (p = 0.001), the proportion of patients diagnosed with Stage I disease dropped from 278/561 (49.5%) to 155/381 (40.7%), and diagnosis of stage II-IV disease increased from 281/561 (50.1%) to 224/381 (58.8%). Primary surgical management was less frequent (38.3% Pandemic & Recovery versus 46.7% Pre-Pandemic, p = 0.013) and fewer surgically-treated patients received surgery within 6 weeks of diagnosis (27.4% versus 38.9%; p = 0.025). Lower radical hysterectomy case volume, a shift to higher cervical cancer stage, and delay in surgical therapy were observed across the United States following the COVID-19 outbreak. Decreased surgical volume may result from lower detection of early-stage disease or other factors. • A decline in monthly radical hysterectomy case volume was observed after the outbreak of the COVID-19 pandemic • After the outbreak of the COVID-19 pandemic, a shift to higher stages at the time of cervical cancer diagnosis was observed • Delays in delivery of surgical and radiation-based therapy were seen for patients with cervical cancer after the pandemic • There may be long-term implications of these findings on patient outcomes and quality of surgical training post-pandemic [ABSTRACT FROM AUTHOR]

Traditional cervical cancer diagnosis mainly relies on human papillomavirus (HPV) concentration testing. Considering that HPV concentrations vary from individual to individual and fluctuate over time, this method requires multiple tests, leading to high costs. Recently, some scholars have focused on the method of cervical cytology for diagnosis. However, cervical cancer cells have complex textural characteristics and small differences between different cell subtypes, which brings great challenges for high-precision screening of cervical cancer. In this paper, we propose a high-precision cervical cancer precancerous lesion screening classification method based on ConvNeXt, utilizing self-supervised data augmentation and ensemble learning strategies to achieve cervical cancer cell feature extraction and inter-class discrimination, respectively. We used the Deep Cervical Cytological Levels (DCCL) dataset, which includes 1167 cervical cytology specimens from participants aged 32 to 67, for algorithm training and validation. We tested our method on the DCCL dataset, and the final classification accuracy was 8.85% higher than that of previous advanced models, which means that our method has significant advantages compared to other advanced methods. [ABSTRACT FROM AUTHOR]

Background: The aim of the study is to analyze the morphological characteristics of p16INK4a/Ki-67 dual stained cells (DS) in cytology, to expand understanding of potential diagnostic value of integration of biomarkers in cytology and contribute to the existing knowledge on their utility in cervical cancer screening. Materials and Methods: In our study included a total 162 woman, who had previous abnormal Pap screening results and were enrolled in an opportunistic screening program. For these participants 162 pap /p16INK4a/Ki-67 co- tests results and 29 histopathology results were available. Results: In our study, sensitivity, specificity, PPV, NPV and accuracy of p16INK4a/Ki-67 DS of cervical smear, with abnormal morphology of stained cells to detect histologic high-grade cervical intraepithelial neoplasia (CIN2+) were 91%, 94%, 93%, 94% and 93%, respectively(p<0.01). There occur 1 error. Conclusions: Our study reveals that p16INK4a/Ki-67 DS cytology is superior in detecting CIN2+ to compare pap test, but morphologic categorization of p16INK4a/Ki-67 DS cytology is not superior over morphologic non-categorization of DS cytology in detecting high grade precancerous lesion during cervical cancer screening. [ABSTRACT FROM AUTHOR]

T2-weighted magnetic resonance imaging (MRI) and diffusion-weighted imaging (DWI) are essential components of cervical cancer diagnosis. However, combining these channels for the training of deep learning models is challenging due to image misalignment. Here, we propose a novel multi-head framework that uses dilated convolutions and shared residual connections for the separate encoding of multiparametric MRI images. We employ a residual U-Net model as a baseline, and perform a series of architectural experiments to evaluate the tumor segmentation performance based on multiparametric input channels and different feature encoding configurations. All experiments were performed on a cohort of 207 patients with locally advanced cervical cancer. Our proposed multi-head model using separate dilated encoding for T2W MRI and combined b1000 DWI and apparent diffusion coefficient (ADC) maps achieved the best median Dice similarity coefficient (DSC) score, 0.823 (confidence interval (CI), 0.595–0.797), outperforming the conventional multi-channel model, DSC 0.788 (95% CI, 0.568–0.776), although the difference was not statistically significant (p > 0.05). We investigated channel sensitivity using 3D GRAD-CAM and channel dropout, and highlighted the critical importance of T2W and ADC channels for accurate tumor segmentation. However, our results showed that b1000 DWI had a minor impact on the overall segmentation performance. We demonstrated that the use of separate dilated feature extractors and independent contextual learning improved the model's ability to reduce the boundary effects and distortion of DWI, leading to improved segmentation performance. Our findings could have significant implications for the development of robust and generalizable models that can extend to other multi-modal segmentation applications. [ABSTRACT FROM AUTHOR]

Purpose: Cervical cancer (CC) patients are more likely to develop second primary malignancies (SPMs) than general population. With the advancement in cancer therapy, CC patients are achieving long-term survival, leading SPMs to our attention. Our study aims to establish diagnostic and prognostic nomograms for CC patients with second primary malignancies (CCSPMs) to help make personalized follow-up plans and treatments. Methods: Data of CCSPMs between 2000 and 2019 was extracted from SEER. The proportions and the median interval time of CCSPM onset were calculated. 11 related clinical characteristics, including age, race, marital status, grade, FIGO stage, radiotherapy, chemotherapy, and surgery, were further explore. Logistic and Cox regressions were employed to predict risk factors for CCSPMs diagnosis. Finally, two nomograms were developed to predict the probability occurrence and prognosis of CCSPMs, respectively. Results: For diagnostic nomogram construction, 59,178 CC patients were randomly divided into training (n = 41,426) and validation cohorts (n = 17,752). For prognostic nomogram construction, 3527 CCSPMs patients were randomly divided into training (n = 2469) and validation cohorts (n = 1058). The diagnostic nomogram consisting of above 11 independent risk factors (all P < 0.05), had high accuracy (AUCtraining = 0.851 and AUCvalidating = 0.845). The prognostic nomogram integrated with eight independent prognostic factors such as treatments, FIGO stage and TNM stage performed well in predicting 5-year OS (AUCtraining = 0.835 and AUCvalidating = 0.837). Conclusion: Our diagnostic and prognostic nomograms could facilitate clinicians to quantify individual SPMs risk and survival probabilities and optimize the surveillance recommendations and personalized clinical decision-making. [ABSTRACT FROM AUTHOR]