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Abramson Cancer CenterNCI CANCERLIT® Search: Diagnosis-Histopathology-Pathogenesis of Cervical Cancer - April 2002
National Cancer Institute®
Last Modified: April 1, 2002
Table of Contents
1
UI - 11868960
AU - Gupta A; Kumar A; Stewart DE
TI -
Cervical cancer screening among South Asian women in Canada: the role of
education and acculturation.
SO - Health Care Women Int 2002 Feb;23(2):123-34
AD - Children's Hospital of Eastern Ontario, Ottawa, Canada.
Cervical cancer screening by Papanicolaou (Pap) smear lowers the
incidence and provides early detection of cervical cancer and is a
preventative health care measure that should be available on a regular
basis to all women at risk. As the population of ethnic women increases,
it is important to assess whether these women are aware of and are
utilizing this health service. A self-administered questionnaire was
completed by 124 South Asian women, aged 18 to 60 years. Sixty-two South
Asian students were selected from a university setting and 62 Tamil
women were selected from a community center for South Asian women. This
study examined the knowledge and use of Pap smears in South Asian women
in Canada, and whether their level of acculturation or formal education
influenced whether they know about and receive Pap smears. Low level of
knowledge about the Pap test and a low prevalence of Pap testing
behaviour was significantly correlated (p < 0.001) with a low level of
formal education, education taking place outside of Canada, and a low
index of acculturation. South Asian students were significantly more
acculturated than Tamil women (p < 0.001). In conclusion, there was a
low level of knowledge and prevalence of cervical cancer screening among
South Asian women. This study highlights the need for educational
interventions in Canada directed to ethnic women especially from South
Asia.
2
UI - 11547588
AU - Gomez-Jauregui J
TI -
[Costs and quality of the timely detection of cervix uteri cancer at a
public clinica and at a non-government organization]
SO - Salud Publica Mex 2001 Jul-Aug;43(4):279-88
AD - Centro de Investigacion en Sistemas de Salud, Instituto Nacional de
Salud Publica, Avenida Universidad 655, colonia Santa Maria
Ahuacatitlan, 62508 Cuernavaca, Morelos, Mexico. jesica@datasys.com.mx
OBJECTIVE: To compare the costs and quality of cervical cancer screening
between a non-governmental organization (NGO) and a Ministry of Health
clinic. MATERIAL AND METHODS: A quantitative and qualitative
healthcare clinics in Cuernavaca, Morelos, Mexico. Cervical cancer
screening production processes were compared along four components: a)
Pap smear collection; b) its transportation to the cytology center; c)
analysis and interpretation; and d) notification of results. The
framework developed by Bruce was used for assessing the quality of care.
The framework includes users' perceptions on information received and
waiting times, as well as providers' perceptions of space and equipment
availability. RESULTS: The unitary cost of the production process in the
public clinic ($144 pesos or US$15.5) was 26% higher than in the NGO
($114 pesos or US$12.3). Women attending NGO services reported a higher
satisfaction with the quality of care than those who attended the public
clinic. The waiting time prior to screening and the time each woman has
to wait to receive test results were the main sources of insatisfaction.
CONCLUSIONS: Analysis of costs and quality of care results suggest that
NGOs should be considered as an alternative in the provision of cervical
cancer screening. The English version of this paper is available at:
http://www.insp.mx/salud/index.html
3
UI - 11725731
AU - Hessling JJ; Raso DS; Schiffer B; Callicott J Jr; Husain M; Taylor D
TI -
Effectiveness of thin-layer preparations vs. conventional Pap smears in
a blinded, split-sample study. Extended cytologic evaluation.
SO - J Reprod Med 2001 Oct;46(10):880-6
AD - Laboratory Corporation of America, 2039 Willow Springs Drive,
Burlington, NC 27215, USA.
OBJECTIVE: To further evaluate the effectiveness of the AutoCyte PREP
thin-layer slide preparation (TriPath Imaging, Inc., Burlington, North
Carolina) as compared to conventional Pap smears. STUDY DESIGN: A
split-sample, blinded evaluation of matched thin-layer preparations and
conventional smears from 2,438 patients was performed. This material was
enriched by including 260 cases of high grade squamous intraepithelial
lesions (HSILs) and cancer cases from an earlier study. Many of these
cases were difficult to diagnose, containing very few abnormal cells on
one or both matching slides. The preparations were evaluated multiple
times by both thin-layer-inexperienced and -experienced cytology
professionals to better compare performance related to preparation
quality alone. RESULTS: The initial evaluations of the slides by
personnel with only brief training in thin-layer interpretation
demonstrated equivalent performance for the two preparations. The
reevaluation study by cytology professionals with several months of
thin-layer experience demonstrated a statistically significant
improvement in detection of both LSIL and HSIL lesions using AutoCyte
PREP slides. There was also a statistically significant improvement in
the number of satisfactory samples using the AutoCyte PREP method.
CONCLUSION: The study demonstrated that the AutoCyte PREP thin-layer
slide preparation is at least equivalent to conventional Pap smears in
the detection of LSIL and HSIL, even when evaluated by cytology
professionals who have been newly trained in the thin-layer method and
that, with increased experience, the thin-layer AutoCyte PREP slide
preparation method showed a statistically significant improvement in
disease detection.
4
UI - 11781515
AU - Zaino RJ
TI -
The fruits of our labors: distinguishing endometrial from endocervical
adenocarcinoma.
SO - Int J Gynecol Pathol 2002 Jan;21(1):1-3
5
UI - 11781519
AU - Pirog EC; Isacson C; Szabolcs MJ; Kleter B; Quint W; Richart RM
TI -
Proliferative activity of benign and neoplastic endocervical epithelium
and correlation with HPV DNA detection.
SO - Int J Gynecol Pathol 2002 Jan;21(1):22-6
AD - Department of Pathology, Weill Medical College of Cornell University,
New York, New York 10021, USA.
Recent studies have indicated that the use of the MIB-1 immunostaining
may be useful in distinguishing endocervical neoplasia from benign
nonneoplastic lesions. We sought to investigate this finding further
with a specific emphasis on the common benign processes that may result
in a nonspecific increase of MIB-1 staining. In this study we quantified
the MIB-1 immunostaining in the mucinous endocervical epithelium (n=45)
and in tubal metaplasia (n=28) during the proliferative and secretory
phases (hormonal influence), in the mucinous endocervical epithelium in
cases of cervicitis (inflammation) (n=10), in cases with a history of a
recent biopsy (regeneration) (n=15), endocervical polyps (benign growth)
(n=8), in the endocervical glands adjacent to a squamous intraepithelial
lesion (human papilloma virus [HPV] infection) (n=63), and in in situ
and invasive cervical adenocarcinomas (n=30). All cases with increased
MIB-1 staining were subsequently tested for the presence of HPV DNA. The
range of MIB-1 staining in the benign endocervical epithelium was from
0% to 48% and in the neoplastic epithelium from 25% to 84%. MIB-1
staining below 10% always reflected a benign process and MIB-1 staining
higher than 50% was always associated with a neoplasia. Rare benign
cases (tubal metaplasia during the proliferative phase, glands adjacent
to squamous intraepithelial lesions, and cases with a history of a
recent biopsy) had increased MIB-1 index, which overlapped with the
neoplastic cases. In conclusion, MIB-1 is a useful marker of
endocervical neoplasia, although in rare cases an overlap between benign
and neoplastic cases may exist.
6
UI - 11801869
AU - O'Meara AT
TI -
Changing the face of cervical cancer: ongoing efforts.
SO - Curr Opin Obstet Gynecol 2002 Feb;14(1):1-3
7
UI - 11801877
AU - Sheets EE
TI -
Management of adenocarcinoma in situ, micro-invasive, and early stage
adenocarcinoma of the cervix.
SO - Curr Opin Obstet Gynecol 2002 Feb;14(1):53-7
AD - Harvard Medical School, Brigham and Women's Hospital, Department of
Obstetrics and Gynecology, Boston, Massachusetts 02115, USA.
esheets@partners.org
The incidence of glandular neoplasms of the uterine cervix has been
steadily increasing over the past two decades. Given the fact that these
lesions are more difficult to diagnosis and are relatively infrequent,
less is known about them compared with their squamous counterparts. In
addition, because these lesions tend to arise in women of childbearing
age, there is a particular need to understand whether the in-situ and
early invasive forms of adenocarcinoma are amenable to conservative
treatment measures that spare fertility like their squamous
counterparts. Recent publications have addressed the underlying causes
of the increasing incidence, the pros and cons of conservative
management, and the difficulties in definitively identifying each
glandular subtype. The most difficult diagnostic lesions are
adenocarcinoma in situ cases and early invasive adenocarcinomas.
8
UI - 11836911
AU - Rodney P; Rodney ZK; Nu S; Hemans-Richards JE
TI -
Cervical cancer and black women: an analysis of the disparity in
prevalence of cervical cancer.
SO - J Health Care Poor Underserved 2002 Feb;13(1):24-37
9
UI - 11888862
AU - Jacqueme B; Coudert C; Mabriez JC; Bonnier P; Piana L
TI -
[Antecedents of cytological screening among patients treated for
invasive cervical neoplasm]
SO - Bull Cancer 2002 Feb;89(2):234-40
AD - Echelon local du Service medical du regime general de
l'Assurance-Maladie des Bouches-du-Rhone, 56, chemin Joseph-Aiguier,
13009 Marseille, France.
OBJECTIVE: The aim of this study is to evaluate if the seriousness of
invasive neoplasms of the uterin cervix actually observed is related to
the apparition of rapid onset cases. Population: 219 invasive cancers of
the cervix treated from 1988 to 1999 in a gynecological oncologic
department. METHODS: prognostic factors of cancers have been studied and
compared to those of cases treated between 1975 and 1980 in the same
department. The existence of cytological screenings has been searched
and results have been analysed. RESULTS: Cervical cancers treated during
the last 12 years have more serious prognostic factors than those
treated during the former period. This evolution is shown by a
progression of advanced stages of + 10.2%, an increase of lymph node
invasion in proximal stages of + 13,4% and the doubling of number of
adenocarcinomas. Though no change of the natural history of cancers has
been proved. Only 42% of patients had profited of a cervical screening
and cancers diagnosed at "stage I" are statistically more numerous in
this group. Improvement should be brought up in the quality of samplings
and of the care of abnormal results of cytological screening.
10
UI - 11902526
AU - Arbyn M; Temmerman M
TI -
Belgian Parliament calls for organised cervical cancer screening and HPV
research throughout Europe.
SO - Lancet Oncol 2002 Feb;3(2):74
AD - European Network of Cervical Cancer Screening, Scientific Institute of
Public Health, Brussels, Belgium.
11
UI - 11917572
AU - Simsir A; Brooks S; Cochran L; Bourquin P; Ioffe OB
TI -
Cervicovaginal smear abnormalities in sexually active adolescents.
Implications for management.
SO - Acta Cytol 2002 Mar-Apr;46(2):271-6
AD - Departments of Pathology and Gynecologic Oncology, University of
Maryland Medical System, Baltimore, Maryland, USA. simsia01@med.nyu.edu
OBJECTIVE: To assess the prevalence and spectrum of Pap smear (PS)
abnormalities in sexually active adolescents in comparison to adult
women in order to determine whether management of adolescents should
differ from that of adults. STUDY DESIGN: Five hundred twenty-four
adolescents who had an initial PS at our institution from January to
cervical biopsy. Initial PS results were compared with those of adult
women. The chi 2 test was used to calculate the statistical significance
of differences between the two groups. The qualified atypical squamous
cells of undetermined significance (ASCUS) cytologic diagnosis in
adolescents was correlated with follow-up data. RESULTS: The overall
prevalence of squamous intraepithelial lesions (SILs) in adolescents was
29% as compared to 23% in adults. Almost all initial squamous lesions
were ASCUS and low grade squamous intraepithelial lesion (LSIL); only
one case of high grade squamous intraepithelial lesion (HSIL) was
detected. On follow-up 18% and 2.4% of adolescents developed LSIL and
HSIL, with a LSIL/HSIL ratio of 8/1 as compared to 5/1 in adults. The
average time from initial PS to detection of HSIL was 20 months. All
patients with HSIL except one had had one or more previous abnormal PSs.
The positive predictive values (PPVs) for subsequent dysplasia for ASCUS
favor reactive (ASCUS.R), ASCUS not otherwise specified (ASCUS.NOS) and
ASCUS favor dysplasia (ASCUS.D) in adolescents were .13, .17 and .31,
respectively. ASCUS.NOS (P = .01) and ASCUS.D (P = .007) were strong
indicators of dysplasia as compared to ASCUS.R. CONCLUSION: PS
abnormalities are more common in sexually active adolescents, with a
significantly higher prevalence of LSIL over HSIL as compared to adult
women. Given the natural history of HPV infection, we recommend
follow-up with cytology rather than colposcopy/biopsy for adolescents
with ASCUS and LSIL PSs. Qualification of ASCUS is useful in determining
which adolescents are at the highest risk of cervical dysplasia.
12
UI - 11917574
AU - Morimura Y; Nishiyama H; Hashimoto T; Takano Y; Yamada H; Yanagida K;
TI -
Sato A
Diagnosing endometrial carcinoma with cervical involvement by cervical
cytology.
SO - Acta Cytol 2002 Mar-Apr;46(2):284-90
AD - Department of Obstetrics and Gynecology, Fukushima Medical University, 1
Hikarigaoka, Fukushima, 960-1295, Japan.
OBJECTIVE: To assess the relationship of a cervical cytologic diagnosis
based on number, size and degeneration of malignant clusters and
necrotic background to cervical involvement of endometrial carcinoma.
STUDY DESIGN: Cervical smears of 53 women with endometrial carcinoma
were evaluated for cervical involvement. The cytologic diagnosis was
compared with actual involvement, and accuracy was calculated.
Retrospectively, cytologic features, including number, size and
degeneration of malignant clusters and necrotic background, were
analyzed in involved and noninvolved cases. RESULTS: Cervical
involvement was confirmed in 15 patients (28.3%). The number and size of
malignant clusters in the involved cases were significantly larger than
those in the noninvolved cases (P < .001 and < .01, respectively). The
proportion of degenerated malignant cells and necrotic background in
involved cases were significantly higher than those in noninvolved cases
(P < .05). Cytologic diagnosis had a sensitivity and specificity of
62.5% and 86.8%, respectively. CONCLUSION: Cervical smears of involved
cases revealed a large number and large size of malignant clusters.
These findings support cytologic diagnosis based on number, size and
degeneration of malignant cells and necrotic background. Cervical
cytology is useful to exclude cervical involvement because of its high
specificity and can help detect cervical involvement because of its
moderately high sensitivity.
13
UI - 11917576
AU - Tench WD
TI -
Validation of AutoPap primary screening system sensitivity and high-risk
performance.
SO - Acta Cytol 2002 Mar-Apr;46(2):296-302
AD - Laboratory Services, Palomar Medical Center, 555 East Valley Parkway,
Escondido, California 92025, USA.
OBJECTIVE: To confirm or deny the reported sensitivity of the AutoPap
Primary Screening System (AutoPap) (TriPath Imaging Inc., Burlington,
North Carolina, U.S.A) in a moderate-sized laboratory and to determine
performance characteristics for the "clinically high risk" (CHR) patient
population. STUDY DESIGN: Archives were searched for low and high grade
squamous intraepithelial lesion (LSIL, HSIL), adenocarcinoma in situ
(AIS) and cancer (Ca) with follow-up biopsies demonstrating a lesion of
at least the reported Pap smear's severity. Smears fulfilling these
criteria and a matched normal, control slide from the same day of
preparation were subjected to evaluation on the AutoPap. Two hundred
eighty-three smears from 254 patients were enrolled in the study,
including 80 LSIL, 178 HSIL, 5 AIS and 20 Ca. Specific criteria
established CHR status. Fisher's exact test was applied to determine
AutoPap performance differences for non-CHR and CHR populations.
RESULTS: AutoPap successfully classified as "Review" all cases as
follows: 91.2% LSIL (73/80), 96.6% HSIL (172/178), 100% AIS (5/5), and
100% Ca (20/20). Fisher's exact P values, pLSIL = 1.00 and pHSIL+ =
.411, confirmed statistically equivalent performance. CONCLUSION: The
results confirmed the sensitivity data reported in the Food and Drug
Administration-approved labeling of the AutoPap and indicated no
statistically significant differences in performance characteristics in
a CHR population when compared to patients without CHR status for all
grades of abnormality examined.
14
UI - 11917577
AU - Luthra UK; Chishti M; Dey P; Jolly SV; Abdulla M; Das DK; Sugathan TN;
TI -
Ajrawi MT; George J; George SS; Aziz AA; al-Juwaiser A; Karim FA; Mallik
MK; Sheikh ZA; Khan S
Performance of monolayered cervical smears in a gynecology outpatient
setting in Kuwait.
SO - Acta Cytol 2002 Mar-Apr;46(2):303-10
AD - Department of Pathology, Faculty of Medicine, Kuwait University, Kuwait.
OBJECTIVE: To compare ThinPrep (TP) Papanicolaou smears (Cytyc Corp.,
Box-borough, Massachusetts, U.S.A.) with matching conventional
Papanicolaou (CP) smears for specimen adequacy, cytologic quality,
diagnostic accuracy and screening time. STUDY DESIGN: In this
prospective study of 1,024 women a split-sample, matched-pair design in
favor of CP slides based on single-blind criteria was followed with a
smear on a glass slide for CP and the remaining material collected in
Preserv-Cyt solution (Cytyc) for a TP smear. A Cytobrush (Medscand,
Hollywood, Florida, U.S.A.) was used for smear preparation for CP. TP
smears were processed in ThinPrep 2000 (Cytyc). Smears were stained with
Papanicolaou stain and were interpreted according to the Bethesda
system. RESULTS: The number of satisfactory but limited (SBL) cases with
TP were 77 (7.5%) as compared to 127 (12.4%) with the CP method. This
reduction in SBL smears with the TP method and consequent increase in
satisfactory smears were highly significant (P < .001) by McNemar's
test. As regards unsatisfactory smears in discordant pairs, although the
number of unsatisfactory smears was higher with TP (41 cases) as against
CP (27 cases), the difference was not statistically significant (P <
.05). The split-sample method showed a high correlation between the CP
and TP diagnoses. TP smears had a significant advantage over CP smears
in the reduction in the number of ASCUS and AGUS cases (14 vs. 29) (P <
.05) and increased the pickup rate of LSIL, 6 vs. 1. Time taken to
screen the TP smears was half that of CP smears. No cases of LSIL or
HSIL were missed on TP smears. CONCLUSION: The liquid-based processor
significantly improved the adequacy and quality of smears, resulting in
fewer recall cases for SBL smears, leading to more definitive diagnoses
in atypical cases, increasing the pickup rate of LSILs and reducing the
screening time. A machine handling multiple specimens automatically
would decrease cost and be an asset to a cytopathology laboratory.
15
UI - 11917578
AU - Heber E; Schwint AE; Sartor B; Nishihama S; Sanchez O; Brosto M; Itoiz
TI -
ME
AgNORs as an early marker of sensitivity to radiotherapy in gynecologic
cancer.
SO - Acta Cytol 2002 Mar-Apr;46(2):311-6
AD - Department of Radiobiology, National Atomic Energy Commission, Avenida
del Libertador 8250 (1429), Buenos Aires, Argentina.
OBJECTIVE: To evaluate the changes induced in silver-stained nucleolar
organizer regions (AgNORs) by the first fraction of a radiotherapy
protocol for gynecologic cancer on exfoliated cytologic samples to
predict the therapeutic success of the full protocol. STUDY DESIGN:
Thirteen gynecologic cancer patients who were scheduled for radiotherapy
were included in the study. Cell smears were taken from the affected
area before and after the first fraction of a radiotherapy protocol and
silver stained for AgNORs. AgNORs per nucleus were counted under a light
microscope. Local disease control by the full radiotherapy protocol was
assessed at one year by the Papanicolaou technique. RESULTS: Local
success of radiotherapy was greater for lesions with higher pretreatment
AgNOR counts and for lesions that underwent a greater percentage
reduction in AgNOR counts after the first fraction. We correlated local
success of the full radiotherapy protocol with a predictive index based
on AgNOR counts obtained before and after the first fraction.
CONCLUSION: A predictive index based on AgNOR counts can predict, as
early as after the first fraction, the local control of disease by a
full radiotherapy protocol. Knowledge of the probability of success long
before the protocol is completed would allow reevaluation of therapeutic
options.
16
UI - 11875704
AU - Vassilakos P; Petignat P; Boulvain M; Campana A
TI -
Primary screening for cervical cancer precursors by the combined use of
liquid-based cytology, computer-assisted cytology and HPV DNA testing.
SO - Br J Cancer 2002 Feb 1;86(3):382-8
AD - Institute of Pathology, University Hospitals of Geneva, 1211 Geneva 14,
Switzerland. vassilakospierre@swissonline.ch
Primary screening for cervical cancer precursors has considerably
evolved with the introduction of new technology to improve the early
detection of disease. The objective of this study was to elaborate a
diagnostic pathway integrating liquid-based and computer-assisted
cytology and human papillomavirus DNA testing to focus screening on
women at risk which may be more cost-effective for the healthcare
system. A single laboratory analysis was conducted during a 5-month
period using liquid-based cytology followed by human papillomavirus DNA
testing for women with an abnormal result or with previous abnormal
cytology. Human papillomavirus prevalence was estimated by testing 909
consecutive unselected samples. All slides were then rescreened using
automated cytologic testing and triaged into a high- or low-score group
according to computer results. Of the 8676 slides scanned, 352 had a
test result of atypical squamous cells of undetermined significance or
worse. Two hundred and ninety-seven (84.3%) samples with an atypical
squamous cells of undetermined significance or worse result and 100% of
those with detection of high-grade squamous intraepithelial lesions and
carcinomas (HSIL+) were triaged into the high-score group. The
combination of instrument scores and human papillomavirus results
indicated that 51.0% of high score/human papillomavirus-positive cases
should be considered as ASCUS+, while 99.6% of low-score/human
papillomavirus negative cases remained negative in the final cytologic
diagnosis, representing 49.0% of all cases. Of the screened women 89.5%
should test negative for human papillomavirus and be reported as such in
the final cytologic diagnosis. In conclusion, preliminary results
suggest that this diagnostic pathway has the potential to improve
primary cervical cancer screening and cost-effectiveness. By using a
combination of testing methods to focus screening and clinical attention
to cases at risk, it would be possible to lengthen screening intervals
for 90% of women and to archive without further review all
low-score/human papillomavirus-negative slides, representing 50% of the
screening workload. Copyright 2002 The Cancer Research Campaign
17
UI - 11919069
AU - Hewitt M; Devesa S; Breen N
TI -
Papanicolaou test use among reproductive-age women at high risk for
cervical cancer: analyses of the 1995 National Survey of Family Growth.
SO - Am J Public Health 2002 Apr;92(4):666-9
AD - Institute of Medicine, National Cancer Policy Board, 2101 Constitution
Avenue, Washington, DC 20418, USA. mhewitt@nas.edu
OBJECTIVES: This study assessed the relationship between risk factors
for cervical cancer and Papanicolaou (Pap) test use within the past year
among reproductive-age women. METHODS: The 1995 National Survey of
Family Growth, a demographic and reproductive health survey of 10 847
women aged 15 to 44, was analyzed with multiple logistic regression.
RESULTS: Of the women, 62% reported having had a Pap test within the
past year. Use was significantly higher among women with risk factors
and among African American women. Use was significantly lower among
uninsured, poor, and foreign-born women and among women with lower
educational attainment and of "other" race/ethnicity. CONCLUSIONS:
Strategies to improve Pap test use include (1) educational campaigns
that inform women of cervical cancer risk factors and encourage
screening and (2) increased support for programs that expand access to
Pap tests.
18
UI - 11905599
AU - Ferenczy A; Franco E
TI -
Persistent human papillomavirus infection and cervical neoplasia.
SO - Lancet Oncol 2002 Jan;3(1):11-6
AD - McGill University and the Sir Mortimer B Davis Jewish General Hospital,
Montreal, Quebec, Canada. aferen@po-box.mcgill.ca
The development of cervical cancer is preceded by precursor lesions
(cervical intraepithelial neoplasia). Evidence-based epidemiological and
molecular data suggest that persistent infections with human
papillomavirus (HPV) types that carry ahigh oncogenic risk are the
intermediate endpoints, leading to both intraepithelial and invasive
cervical neoplasia. Integration of highly oncogenic HPVs into host-cell
chromosomes is followed by binding of HPV E6 and E7 oncoproteins to
tumour-suppressor genes p53 and RB, respectively. This process results
in impaired tumour-suppressor-gene function, involving DNA repair,
decreased apoptosis, and eventual cell immortalisation. Mutations
causing chromosomal alterations, loss of heterozygosity, and
proto-oncogene and telomerase activation in immunopermissive individuals
have important roles in virus-induced cervical carcinogenesis. The
so-called non-European variants of HPV 16 and 18 may increase the
degradation potential of p53. HPV 16 is polymorphic and, although the
evidence is controversial, the Arg/Arg genotype of p53 could have
greater susceptibility to HPV-E6 degradation than the other genotypes.
The coincident interplay between the non-European genomic variants of
HPV 16/18 and p53 Arg/Arg may explain, at least in part, the persistence
of HPV infection and tumour progression in women with cervical
neoplasia. Further epidemiological and molecular research is needed, to
gain insight into HPV-mediated cervical carcinogenesis. The evidence
highlights the need to develop appropriate prophylactic HPV vaccines and
diagnostic and screening tests.
19
UI - 11818119
AU - Dehbashi S; Honarvar M; Riaz Montazer N
TI -
Comparison of cotton swab-spatula and cytobrush-spatula for cervical
cytology.
SO - Int J Gynaecol Obstet 2002 Feb;76(2):185-7
AD - Department of Obstetrics and Gynecology, Shiraz University of Medical
Sciences, Zand Ave., Post 71348, Shiraz, Iran.
20
UI - 11818123
AU - Hurtig AK; San Sebastian M
TI -
Gynecologic and breast malignancies in the Amazon basin of Ecuador,
1985-1998.
SO - Int J Gynaecol Obstet 2002 Feb;76(2):199-201
AD - Instituto de Epidemiologia y Salud Comunitaria, 'Manuel Amunarriz',
Quito, Apdo. 17-10-7410, Ecuador. sandyura@ecuanex.net.ec
21
UI - 11920531
AU - Denny L; Kuhn L; Pollack A; Wright TC Jr
TI -
Direct visual inspection for cervical cancer screening: an analysis of
factors influencing test performance.
SO - Cancer 2002 Mar 15;94(6):1699-707
AD - Department of Obstetrics and Gynecology, Faculty of Health Sciences,
University of Cape Town, Cape Town, South Africa.
BACKGROUND: The authors evaluated direct visual inspection of the cervix
after the application of 5% acetic acid (DVI) as a cervical cancer
screening test for use in low-resource settings. METHODS: Four tests
were used to screen 2754 previously unscreened women: DVI with and
without x4.5 magnification and differentiating between all lesions and
well-circumscribed lesions; testing for high-risk types of human
papillomavirus DNA using the Hybrid Capture II assay, cervical cytology,
and Cervicography. Women with positive results on any of the four
screening tests were referred for colposcopy and histologic sampling.
All women were tested for N. gonorrhea, C. trachomatis, T. vaginalis,
and human immunodeficiency virus 1. RESULTS: Histologically confirmed
carcinoma was diagnosed in 21 women (0.8%), high-grade squamous
intraepithelial lesions (SILs) were diagnosed in 96 women (3.5%), and
low-grade SILs were diagnosed in 102 women (3.7%). The estimated
sensitivity of DVI when performed without magnification for high-grade
SILs was 70%, with an estimated specificity of 79%. Magnification did
not significantly improve sensitivity for high-grade SILs (74% with
magnification) but significantly reduced specificity (77%). Restricting
the definition of a positive DVI test to a well-defined acetowhite
lesion reduced sensitivity and significantly improved specificity.
Infection with T. vaginalis, N. gonorrhea, and C. trachomatis did not
alter sensitivity or specificity. CONCLUSIONS: This study confirmed the
utility of DVI as a primary screening test. Evaluation of the clinical
effectiveness of screening with this low-cost and simple test in
low-resource settings is necessary. Copyright 2002 American Cancer
Society.
22
UI - 11915180
AU - Szumera A; Okon K
TI -
Karyometric features differentiate early invasive cervical squamous cell
carcinoma from preinvasive carcinoma.
SO - Pol J Pathol 2001;52(4):193-7
AD - Department of Pathomorphology, Jagiellonian University Medical College,
Krakow.
The aim of the study was to investigate whether karyometric features
reflect phenotypic change from preinvasive to early invasive squamous
cell carcinoma of the cervix uteri. The material for the study was
obtained from 12 patients diagnosed in the Chair of Pathomorphology.
Each specimen contained both preinvasive and microinvasive lesions. The
system of image acquisition and analysis consisted of a microscope
coupled with a CCD camera and a PC computer. The software based on
AnalySIS 3.0 system (Soft Imaging Systems GmbH) automatically detected
cell nuclei and measured the preselected parameters. In each case 250
cell nuceli from both preinvasive and invasive components were analyzed.
Significant differences in basic karyometric parameters were found both
within individual cases and especially between groups studied. The
present findings confirm the presence of early cytological changes at
the onset of invasion. From the practical viewpoint the results suggest
that karyometric features measured by image analysis might be used as a
diagnostic tool, especially in cases where the diagnosis of
microinvasion is difficult.
23
UI - 11915184
AU - Chosia M
TI -
New educational methods in cytopathology: a transnational training
program in cervical cytology--CYTOTRAIN CD-ROM.
SO - Pol J Pathol 2001;52(4):219-20
AD - Department of Pathomorphology, Pomeranian Medical Academy, Szczecin.
Among the reasons for the low effectiveness of preventive measures for
early detection of cancers and preinvasive states of the uterine cervix
there is insufficient training of people performing cytological
screening. In order to decrease the rate of false negative diagnosis it
is necessary to improve the organisation of permanent professional
training of cytopathologists and cytotechnicians.
24
UI - 11818093
AU - Sun CA; Liu JF; Wu DM; Nieh S; Yu CP; Chu TY
TI -
Viral load of high-risk human papillomavirus in cervical squamous
intraepithelial lesions.
SO - Int J Gynaecol Obstet 2002 Jan;76(1):41-7
AD - School of Public Health, National Defense Medical Center, Taipei,
Taiwan. sunca@ndmctsgh.edu.tw
OBJECTIVES: This case-control study was conducted to investigate the
role of viral load of high-risk human papillomaviruses (HPVs) in the
development of cervical squamous intraepithelial lesions (SILs) and
invasive cancers. METHODS: A total of 30 female cases who had
histological evidence of low-grade SIL (n=10) or high-grade SIL and
above (n=20) were identified as the case group at the Tri-Service
addition, 80 female controls who had normal cervical cytology were
enrolled and individually matched on age (+/-5 years) and date of
recruitment to each case. Cervical swabs collected from study subjects
were tested for the positivity and viral load of high-risk HPVs by
Hybrid Capture II assay. Additionally, subjects completed a risk factor
questionnaire. RESULTS: Among sex behavioral factors studied, younger
age at first intercourse was associated with a significantly elevated
risk of cervical SIL and invasive cancers. With respect to HPV
infection, high-risk HPV DNA was present in 70% (21/30) of case and 21%
(17/80) of control subjects, resulting in an odds ratio (OR) of 6.6 [95%
confidence interval (C.I.)=2.6-17.0]. Moreover, women who had a high
viral load were at significantly greater risk for cervical SIL and
invasive cancers than those who were infected with a low viral load
(OR=18.0, 95% C.I.=3.0-108.5). CONCLUSIONS: Among the variables tested,
infection with a high viral load of high-risk HPVs is the strongest
determinant for cervical SIL and cervical cancers in Taiwan.
25
UI - 11818094
AU - Milojkovic M
TI -
Residual and recurrent lesions after conization for cervical
intraepithelial neoplasia grade 3.
SO - Int J Gynaecol Obstet 2002 Jan;76(1):49-53
AD - Department of Gynecology and Obstetrics, Clinical Hospital Osijek,
Osijek, Croatia. milojkovic_os@altavista.com
OBJECTIVES: To evaluate the importance of regular and long-term
follow-up of patients who had conization for cervical intraepithelial
neoplasia grade 3 (CIN 3); and to assess the risk of residual/recurrent
lesions of the cervix uteri. METHODS: Retrospective analysis of 934
patients with CIN 3 who underwent conization over the period 1 January
involved resection margins and 896 (95.9%) patients who had free
resection margins. RESULTS: Twenty-three out of 934 (2.5%) patients had
another operation (reconization in 17 and hysterectomy in six) whereas
one patient had a biopsy. Residual or recurrent lesion after conization
was found in 23 patients out of 934 (2.5%). Three patients had invasive
cervical cancer (0.3%), 19 had CIN 3 (2.0%) and one patient had CIN 1
(0.1%). One of the 24 patients (4.2%) was diagnosed with no lesion after
repeated operation. Eleven patients out of 38 (28.9%) with involved
resection margins during the first conization had residual/recurrent
disease, compared with eight out of 896 patients (0.9%) who had free
resection margins. CONCLUSION: Another operation is recommended only in
cases when, on the basis of cytological, colposcopical and histological
findings, the gynecologist suspect the residual/recurrent lesions.
26
UI - 11818095
AU - Gichangi P; De Vuyst H; Estambale B; Rogo K; Bwayo J; Temmerman M
TI -
HIV and cervical cancer in Kenya.
SO - Int J Gynaecol Obstet 2002 Jan;76(1):55-63
AD - Department of Obstetrics and Gynecology, University of Nairobi, Nairobi,
Kenya.
OBJECTIVES: To determine the effect of the HIV epidemic on invasive
cervical cancer in Kenya. METHODS: Of the 3902 women who were diagnosed
with reproductive tract malignancies at Kenyatta National Hospital (KNH)
from 1989 to 1998, 85% had invasive cervical cancer. Age at presentation
and severity of cervical cancer were studied for a 9-year period when
national HIV prevalence went from 5% to 5-10%, to 10-15%. RESULTS: There
was no significant change in either age at presentation or severity of
cervical cancer. Of the 118 (5%) women who were tested for HIV, 36 (31%)
were seropositive. These women were 5 years younger at presentation than
HIV-negative women. CONCLUSIONS: A two- to three-fold increase in HIV
prevalence in Kenya did not seem to have a proportional effect on the
incidence of cervical cancer. Yet, HIV-positive women who presented with
cervical cancer were significantly younger than HIV-negative women.
27
UI - 11925972
AU - Anonymous
TI -
Evaluation of cervical cytology.
SO - Evid Rep Technol Assess (Summ) 1999 Jan;(5):1-6
28
UI - 11920489
AU - Lin SS; Clarke CA; Prehn AW; Glaser SL; West DW; O'Malley CD
TI -
Survival differences among Asian subpopulations in the United States
after prostate, colorectal, breast, and cervical carcinomas.
SO - Cancer 2002 Feb 15;94(4):1175-82
AD - Northern California Cancer Center, Union City, California.
BACKGROUND: Information is limited for Asian subgroups regarding
survival after diagnosis of the common cancers amenable to routine
screening. The authors examined survival after carcinomas of the
prostate, colon/rectum, breast, and cervix separately for Chinese,
Japanese, Filipinos, and non-Hispanic whites in the United States.
METHODS: Using data from the Surveillance, Epidemiology, and End Results
program, the authors compared the distributions of stage at diagnosis
and computed 5-year cause specific survival probabilities, overall and
by stage of disease, for cancer patients whose diagnosis was in
1988-1994 and who were observed through 1997. RESULTS: Among males,
Filipinos were more likely to be diagnosed with advanced stage
colorectal and prostate carcinomas than other Asians and non-Hispanic
whites; they also experienced worse survival after these cancers. This
survival deficit occurred across all stages of colorectal carcinoma and
remained apparent within distant stage prostate carcinoma. Among
females, Chinese were less likely to receive diagnoses of early stage
colorectal carcinoma than Japanese and Filipinas. In addition, their
survival was consistently lower across more advanced stages of disease.
Chinese also experienced somewhat worse survival after diagnosis of
early stage cervical carcinoma. Japanese were more likely to be
diagnosed with early stage carcinomas but also tended to experience
better survival after prostate, colorectal, and breast carcinomas
regardless of stage. CONCLUSIONS: Chinese, Japanese, and Filipinos
experienced unequal survival after these screenable carcinomas,
indicating that certain groups may benefit from more aggressive
screening efforts. The heterogeneity of cancer outcomes observed within
the community classified as Asian reinforces the need for cancer
statistics to be reported for disaggregated subgroups. Copyright 2002
American Cancer Society. DOI 10.1002/cncr.10319
29
UI - 11904594
AU - Georgakoudi I; Sheets EE; Muller MG; Backman V; Crum CP; Badizadegan K;
TI -
Dasari RR; Feld MS
Trimodal spectroscopy for the detection and characterization of cervical
precancers in vivo.
SO - Am J Obstet Gynecol 2002 Mar;186(3):374-82
AD - G.R. Harrison Spectroscopy Laboratory, Massachusetts Institute of
Technology, Cambridge 02139, USA. ireneg@mit.edu
OBJECTIVE: The objective of this study was to assess the potential of 3
spectroscopic techniques (intrinsic fluorescence, diffuse reflectance,
and light scattering) individually and in combination (trimodal
spectroscopy) for the detection of cervical squamous intraepithelial
lesions. STUDY DESIGN: The study was conducted with 44 patients who
underwent colposcopy for the evaluation of an abnormal Papanicolaou
smear. Fluorescence and reflectance spectra were collected from
colposcopically normal and abnormal sites and analyzed to extract
quantitative information about tissue biochemistry and morphologic
condition. This information was compared with histopathologic
classification, and diagnostic algorithms were developed and validated
with the use of logistic regression and cross-validation. RESULTS:
Diagnostically significant differences exist in the composition of
fluorescing biochemicals, the scattering properties, and the epithelial
cell nuclear morphology of cervical squamous intraepithelial lesions and
non-squamous intraepithelial lesions. Trimodal spectroscopy is a
superior tool for the detection of cervical squamous intraepithelial
lesions than any 1 of the techniques alone. CONCLUSION: Trimodal
spectroscopy has the potential to improve the in vivo detection of
precancerous cervical changes.
30
UI - 11936077
AU - Yamamoto S
TI -
Uterine cancer incidence in the world.
SO - Jpn J Clin Oncol 2002 Jan;32(1):37
31
UI - 11920583
AU - Ueda M; Terai Y; Yamashita Y; Kumagai K; Ueki K; Yamaguchi H; Akise D;
TI -
Hung YC; Ueki M
Correlation between vascular endothelial growth factor-C expression and
invasion phenotype in cervical carcinomas.
SO - Int J Cancer 2002 Mar 20;98(3):335-43
AD - Department of Obstetrics and Gynecology, Osaka Medical College,
Takasuki, Osaka, Japan. gyn017@poh.osaka-med.ac.jp
The correlation between vascular endothelial growth factor (VEGF)-C gene
expression and in vitro invasive activity and matrix metalloproteinase
(MMP)-2 or 9 gene expression and proteolytic activity in 11 cervical
carcinoma cell lines, was investigated. Immunohistochemical expression
of VEGF-C in 52 cervical carcinoma tissues was also correlated with
tumor aggressiveness with respect to clinicopathologic features, tumor
vascularity, MMP-2 expression and patient outcome. Expression of VEGF-C
mRNA differed remarkably among the cell lines and there was a
statistical correlation between VEGF-C gene expression and the number of
invaded tumor cells (p = 0.0009) and MMP-2 gene expression and activity
(p < 0.05). Anti-VEGF-C antibody inhibited the invasive and proteolytic
activity of tumor cells in a concentration-dependent manner. VEGF-C or
MMP-2 expression in clinical tissue samples was well correlated with
depth of myometrial invasion, endometrial invasion, pelvic lymphnode
metastasis and tumor vascularity (p < 0.05) and there was a close
relation between VEGF-C and MMP-2 expression (p < 0.0001) in cervical
carcinomas. Overall survival rates for 14 patients with strong VEGF-C
staining tumors were lower than those for 38 patients with weak VEGF-C
staining tumors (p = 0.0132) and VEGF-C tissue status emerged as an
independent prognostic parameter (p = 0.0232). These results suggest
that VEGF-C expression is closely related to invasion phenotype and
affects the patient's survival in cervical carcinomas. Copyright 2002
Wiley-Liss, Inc.
32
UI - 11920594
AU - Cheng Q; Lau WM; Tay SK; Chew SH; Ho TH; Hui KM
TI -
Identification and characterization of genes involved in the
carcinogenesis of human squamous cell cervical carcinoma.
SO - Int J Cancer 2002 Mar 20;98(3):419-26
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