-
[show abstract]
[hide abstract]
ABSTRACT: To investigate the distribution and viral load of the most prevalent high risk human papillomavirus (HPV) types 16, 18, 31, 33, and 45 and low risk HPV types 6 and 11 in a variety of cervical lesions.
One hundred and seventy six cytological specimens from women with different cervical lesions were investigated. For an accurate standardisation of the sample, cervical cells were counted and a volume of the cell suspension processed by polymerase chain reaction-enzyme linked immunosorbent assay (PCR-ELISA). Semiquantitative determinations were achieved in relation to an external reference titration curve.
HPV DNA was detected in 60.2% of the samples. HPV-16 was the prevalent genotype (57.6%), followed by HPV-33, HPV-31, HPV-6, HPV-18, and HPV-45. HPV-11 was not detected. HPV-16 showed a pronounced increase in prevalence with the evolution of cervical disease. Semiquantitative evaluation of the results showed that only HPV-16 DNA could reach very high values (> 1000 genome copies/cell) and a very high HPV-16 load correlated with the severity of cervical disease.
Only HPV-16 load appears to be associated with the severity of cervical disease.
Journal of Clinical Pathology 05/2001; 54(5):377-80. · 2.31 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Most studies of cervical conization have considered the frequency of complications and the outcome of follow-up. The determinants of cone margin positivity have been inadequately described. In a series of CIN patients undergoing conization-equivalent electrosurgical procedure, we evaluated the factors associated with (i) any cone margin involvement, and (ii) endocervical margin involvement (with or without other locations) as contrasted with all other conditions.
Study population included 718 patients. Potential determinants of margin involvement were or were treated as categorical. Univariate analysis was based on the chi-square test. Multivariate associations were estimated by multiple logistic regression models.
Cone margin involvement was observed in a total of 195 patients (27%). In univariate analysis, the frequency was positively related to histologic grade, time period, lesion size, and cone width and depth. In multivariate analysis, histology diagnosis and time period retained a strong association. The effect of lesion size was of borderline significance. The endocervical location emerged as a multivariate determinant of margin positivity. The effect of cone width and depth was not confirmed. Endocervical margin involvement was observed in 98 cases (14%). In univariate analysis, the frequency was positively associated with histologic grade, time period, and age, and inversely related to the visibility of the squamous-columnar junction. Multivariate analysis confirmed the strong effect of histology diagnosis and time period. The association with age and visibility of the squamous-columnar junction was weaker.
Histology diagnosis and time period were the strongest determinants of cone margin involvement. Endocervical margin positivity was also related to patient age and visibility of the squamous-columnar junction. Cone width and depth had no protective effect.
Acta Obstetricia Et Gynecologica Scandinavica 08/2000; 79(7):586-92. · 1.77 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: To evaluate the accuracy of cytologic screening in pregnancy through routine colposcopy and to confirm the safety of conservative management of cervical intraepithelial neoplasia (CIN) in pregnancy.
In total, 3,658 pregnant women, screened for cervical cancer with either cytology or colposcopy, were prospectively evaluated. Patients with abnormal findings underwent colposcopically directed biopsy and, in case of CIN, repeat cytology and colposcopy. Biopsy was repeated in case of suspected progression of the lesion. Suspected microinvasion was the only reason for diagnostic conization during pregnancy. After delivery, excisional treatment provided a final specimen from all patients. Diagnostic methods were compared.
Comparison between cytology and colposcopy showed 97.1% concordance with a few false positives (2.5%) and false negatives (0.2%). Abnormal cytology and colposcopy, as compared with histology, showed similar concordances, but the risk of underestimation by cytology was significantly higher (P < .05). Initial and final histology of the 63 cases of CIN and microinvasive carcinoma showed 88.9% concordance. Progression of the lesion was not observed.
These data do not justify combined use of cytology and colposcopy to improve screening for cervical cancer in pregnancy. Delayed treatment of CIN after delivery is safe.
The Journal of reproductive medicine 09/1998; 43(8):647-53. · 0.87 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: The conservative management of cervical intraepithelial neoplasia (CIN) essentially depended on the introduction and improvement of colposcopy. This technique, allowing to locate the lesion, to estimate its extension and to perform multiple punch biopsies, becomes discriminant in therapeutic choice. Whether colposcopy reveals endocervical involvement or abnormal transformation zone (ANTZ) may be only partially explored, excisional conization should be preferred to ablative therapy since the former advantageously can verify histopathologic diagnosis, confirm completely excision of lesion and rule out invasive carcinoma. The literature shows that cases of invasive lesions can be underestimated and therefore inadequately treated by ablative therapy, emphasizing colposcopy and punch biopsy limitations about suspect and diagnosis of microinvasion. We analyzed data concerning preliminary diagnostic investigations and results of 346 CO2 laser excisional conizations performed between 1984 and 1993. Histopathologic diagnosis on punch biopsy, performed in 111 cases of ANTZ1 and in 235 cases of ANTZ2, shows an agreement with cone biopsy in 30.8% of the cases of CIN1, of 40.9% in cases of CIN2 and of 66.3% in cases of CIN3. Whereas the lesion is overestimated in 30.6% of cases, in which it is likely that punch biopsy has removed the epicenter of the lesion or the lesion in toto, we had an underestimation in 15% of cases, particularly in 4 cases of CIN2, in 38 cases of CIN3 and in all microinvasive processes. The rate of invasive lesions previously ignored and detected only by histopathologic diagnosis on cone biopsy is 2.9%. In only one of these cases colposcopy, even if attributing to each of these the higher grading, shows the suspicion of invasion, whereas the detection of invasive processes is missed in every case by punch biopsy.(ABSTRACT TRUNCATED AT 250 WORDS)
Minerva ginecologica 10/1994; 46(9):455-9.
-
S Costa,
M Sideri,
K Syrjänen,
P Terzano,
M De Nuzzo, P De Simone,
P Cristiani,
A C Finarelli,
A Bovicelli,
A Zamparelli,
L Bovicelli
[show abstract]
[hide abstract]
ABSTRACT: The sensitivity of the Pap smear (PAP) continues to be the subject of debate. During the past several years, cervicography (CER) and HPV DNA testing have been suggested as optional tools in the screening of cervical cancer precursors.
The performance characteristics of PAP, CER and HPV DNA testing (hybrid capture test [HCT]) in all potential combinations were evaluated in a series of 1,030 women (aged 16-70, median, 33), subjected to colposcopy (COLPO) as the reference tool.
Of the 992 evaluable cases, 402/992 (41%) had positive COLPO (i.e., an abnormal transformation zone). Of them, 298 women underwent directed punch biopsy, while of the COLPO negative patients, 18/93 positive by at least one of the three tests had endocervical curettage. Of the 402 COLPO positive women, 146 (36%) remained negative on all tests, whereas 256 (64%) had at least one positive test. There were 84 cervical intraepithelial neoplasia (CIN) 2 and 3 lesions and 6 invasive carcinomas. Of the former, 10 were detected by PAP alone, 4 by CER alone and 3 by HCT alone. Three of the 6 carcinomas were HCT negative. The predictive value (PPV) of a positive test was 45% for PAP, 51% for CER and 48% for HCT. The combinations of PAP with CER (for PAP negative cases) and PAP with HCT were more sensitive for CIN 2 and 3 (95% and 94%, respectively) as compared with PAP alone but were associated with a significant decrease in specificity (44% and 46% vs. 57%, respectively). However, both combinations retained a PPV (43%) similar to that of PAP alone (45%).
The potential combinations of PAP with CER and with HCT were more sensitive in detecting CIN 2 and 3 as compared with PAP alone and retained a PPV similar to that of PAP.
Acta cytologica 44(3):310-8. · 0.49 Impact Factor
