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Adverse Pregnancy Outcomes Following Cryotherapy, Thermal Ablation and Loop Electrosurgical Excision Procedure for cervical intraepithelial neoplasia Treatment: A Pilot Study among Zambian Women

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Open Journal of Obstetrics and Gynecology 2024年第1期14卷 7-17页

作者： Victoria Mwiinga-Kalusopa Johanna E. Maree Concepta Kwaleyela Patricia Katowa-Mukwato Department of Basic and Clinical Nursing University of Zambia Lusaka Zambia Department of Nursing Education University of Witwatersrand Johannesburg Gauteng South Africa School of Health Sciences Mulungushi University Kabwe Central Province Zambia

Background: cervical intraepithelial neoplasia treatments have become essential interventions to manage cervical lesions. Majority of the recipients of these treatments are women within the reproductive age group, who according to literature may be at risk of adverse pregnancy outcomes. This pilot study is part of a study investigating adverse pregnancy outcomes among women who received Cryotherapy, Thermal ablation and Loop Electrosurgical Excision Procedure compared to the untreated women in Zambia. Materials and Methods: This descriptive study analyzed records of 886 (n = 443 treated and n = 443 untreated) women aged 15 - 49 years. The women were either screened with Visual Inspection with Acetic Acid or treated for cervical intraepithelial neoplasia at the Adult Infectious Disease Centre between January 2010 and December 2020. Women meeting the criteria were identified using the Visual Inspection with Acetic Acid screening records and telephone interviews to obtain the adverse pregnancy outcome experienced. Data were analysed using STATA version 16 to determine the prevalence and obtain frequency distribution of outcomes of interest. Univariate and multivariable binary logistic regression estimated odds of adverse pregnancy outcomes across the three treatments. Results: The respondents were aged 15 to 49 years. Adverse pregnancy outcomes were observed to be more prevalent in the treatment group (18.5%) compared to the untreated group (5.4%). Normal pregnancy outcomes were lower in the treated (46.3%;n = 443) than the untreated (53.7%;n = 443). The treated group accounted for the majority of abortions (85.2%), prolonged labour (85.7%) and low birth weight (80%), whereas, the untreated accounted for the majority of still births (72.7%). Women treated with cryotherapy (aOR = 2.43, 95% CI = 1.32 - 4.49, p = 0.004), thermal ablation (aOR = 6.37, 95% CI = 0.99 - 41.2, p = 0.052) and Loop Electrosurgical Excision Procedure (aOR = 9.67, 95% CI = 2.17 - 43.1, p = 0.003)

关键词： Adverse Pregnancy Outcomes cervical intraepithelial neoplasia Cryothera-py Thermal Ablation Loop Electrosurgical Excision Procedure Pilot Repro-ductive Age

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Prevalence of HPV Infection And cervical intraepithelial neoplasia And Attitudes towards HPV Vaccination among Chinese Women Aged 18-25 in Jiangsu Province

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Chinese Journal of Cancer Research 2011年第1期23卷 25-32页

作者： Shang-ying Hu Ying Hong Fang-hui Zhao Adam K. Lewkowitz Feng Chen Wen-hua Zhang O.in-jing Pan Xun Zhang Cindy Fei Hui Li You-lin Qiao Department of Epidemiolo gy ＆ Biostotistics Institute of Basic Medical Sciences Chinese Academy of Medical Sciences School of Basic Medicine Peking Union Medicol Coflege Beijing 100730 China Department of Cancer Epidemiology Beijing 100021 China Department of Gynecological Oncology Beijing 100021 China Department of Pathology Cancer Institute/Hospital Chinese Academy of Medical Sciences Peking Union Medical College Beijing 100021 China Departmentof Gynecology and Obstetrics Affiliated Drum Tower Hospital Nanjing University MedicalSchool Nanjing 210008 China Mount Sinai School of Medicine New York City New York USA New York University School of Medicine New York City New York USA

Objective：Few data are available on the epidemiology of HPV and cervical cancer among Chinese women younger than 25 years *** study aimed to estimate the HPV infection rate and the prevalence of cervical intraepithelial neoplasia（CIN） in women aged 18-25,as well as their knowledge of and attitudes towards HPV ***：A population-based cervical cancer screening study was conducted on women aged 18-25 in Jiangsu province in *** provided socio-demographic,reproductive and behavioral information and completed a survey about their knowledge of and attitudes towards HPV *** then underwent a gynecologic exam to provide two cervical exfoliated cell samples for high risk HPV DNA testing and liquid-based cytology（LBC） as well as visual inspection with acetic acid（VIA）.Women testing positive for any test were referred to colposcopy and *** gold standard for diagnosis of cervical lesions was directed or random ***：Within the sample of 316 women,3.4% of them were diagnosed with CIN grade 2 or worse lesions and 17.1% were found to be positive for HPV *** these young women,extra-marital sexual behavior of them（OR=2.0,95%CI：1.1-3.8） or their husbands（OR=2.6,95%：1.4-4.7） were associated with an increased risk of HPV *** overall HPV awareness was low,after a brief educational intervention,98.4% reported they would electively receive HPV vaccination and would also recommend that their daughters be ***,most urban and rural women reported their ideal maximum out-of-pocket contribution for HPV vaccination to be less than 500 RMB and 50-100 RMB,***：Our study indicates cervical disease burden is relatively high among sampled Chinese women aged *** educational interventions for female adolescents and strategies to subsidize vaccine costs are definitely needed to ensure the effectiveness of vaccination campaigns in China.

关键词： cervical cancer cervical intraepithelial neoplasia Human papillomavirus Knowledge Attitude

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Predictors and clinical significance of the positive cone margin in cervical intraepithelial neoplasia III patients

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Chinese Medical Journal 2009年第4期122卷 367-372页

作者： SUN Xiao-guang MA Shui-qing ZHANG Jin-xia WU Ming Department of Obstetrics and Gynecology Peking Union MedicalCollege Hospital Chinese Academy of Medical Sciences & PekingUnion Medical College Beijing 100730 China

Background Conization is being widely accepted for diagnosis and treatment of cervical intraepithelial neoplasia （CIN）. There is controversy as to which factors are most predictive of a positive cone margin and the clinical significance of it. We conducted this study to identify the predictive factors and to evaluate the clinical significance of a positive cone margin in CIN III patients.Methods A retrospective review was conducted of 207 patients who had undergone conization due to CIN III from January 2003 to December 2005 at Peking Union Medical College Hospital. Of these, 67 had a subsequent hysterectomy Univariate and multivariate analysis were utilized to define the predictive factors for a positive cone margin, and to compare the pathologic results of conization with subsequent hysterectomy.Results One hundred and fifty-one （72.9%） were margin free of CIN I or worse, 37 （17.9%） had CIN lesions close to the margin and 19 （9.2%） had margin involvement. A total of 56 cases （27.1%） had positive cone margins （defined as the presence of CIN at or close to the edge of a cone specimen）. Univariate analysis showed that the parity, cytological grade multi-quadrants of CIN III by punch biopsy, gland involvement, as well as the depth of conization were significant factors correlated with a positive cone margin （P 〈0.05）. However the age, gravidity, grade of dysplasia in punch biopsy, as well as the cone methods were not significantly correlated （P 〉0.05）. Multivariate analysis revealed that the cytological grade （OR=1.92）, depth of conization （OR=2.03）, parity （OR=3.02） and multi-quadrants of CIN III （OR=4.60） were significant predictors with increased risk for positive margin. The frequency of residual CIN I or worse in hysterectomy specimens was found to be 55.6% （20/36） in patients who were margin free, 71.4% （15/21） in patients with CIN occurring close to margin, and 80.0% （8/10） in patients with margin involvement. The frequency of residual CIN III or worse was

关键词： conization cervical intraepithelial neoplasia factor analysis

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Gain of human telomerase RNA gene is associated with progression of cervical intraepithelial neoplasia grade Ⅰ or Ⅱ

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Chinese Medical Journal 2012年第9期125卷 1599-1602页

作者： LAN Yong-lian YU Lan JIA Chan-wei WU Yu-mei WANG Shu-yu Department of Reproduction and Genetics Beijing Obstetrics and Gynecology Hospital Capital Medical University Beijing 100026 China Department of Gynecological Oncology Beijing Obstetrics and Gynecology Hospital Capital Medical University Beijing 100026 China

Background The 3q26 chromosome region, where the human telomerase RNA gene （hTERC） is located, is a biomarker for cervical cancer and precancerous lesions. The aim of this study was to confirm the value of measuring hTERC gene gain in predicting the progression of cervical intraepithelial neoplasia grade Ⅰ or Ⅱ （CIN-Ⅰ and -Ⅱ, respectively） to CIN-Ⅲ and cervical cancer. Methods Liquid-based cytological samples from 54 patients with CIN-Ⅰ or CIN-Ⅱ lesions were enrolled in this study. Follow-up was performed with colposcopy and biopsy within 24 months after the diagnosis of CIN-Ⅰ or CIN-Ⅱ. Copy numbers of the hTERC gene were measured by fluorescence in situ hybridization with a dual-color probe mix containing the hTERC gene probe （labeled red） and the control, the chromosome 3 centromere-specific probe （labeled green）.Results All patients whose lesions progressed from CIN-Ⅰ or CIN-Ⅱ to CIN-Ⅲ displayed a gain of the hTERC gene, whereas patients where the hTERC gene was not amplified did not subsequently progress to CIN-Ⅲ or cervical cancer. The signal ratio pattern per cell was recorded as N：N （green： red）. The numbers of cells with the signal ratio pattern of 4：4 or N：≥5 in patients whose lesions progressed to CIN-Ⅲ were significantly higher than those whose lesions did not progress. Significantly, none of the patients with a 4：4 signal ratio pattern regressed spontaneously.Conclusions In conclusion, measurement of hTERC gene gain in CIN-Ⅰ or CIN-Ⅱ patients using liquid-based cytological samples could be a useful biomarker to predict the progression of such cervical lesions. In addition, a 4：4 or N：≥5 signal ratio pattern may indicate the unlikeness of spontaneous regression of CIN-Ⅰ or CIN-Ⅱ lesions.

关键词： in situ hybridization telomerase RNA cervical intraepithelial neoplasia human telomerase RNA gene

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The Role of IL-2, IL-4, IL-10 and IFN-γ Cytokines Expression in the Microenvironment of cervical intraepithelial neoplasia

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Advances in Reproductive Sciences 2022年第4期10卷 106-114页

作者： Yu Cai Jianjun Zhai Yumei Wu Rui Chen Xingyue Tian Department of Gynecology and Obstetrics Beijing Tongren Hospital Capital Medical University Beijing China Department of Gynecology and Oncology Beijing Obstetrics and Gynecology Hospital Capital Medical University Beijing China Department of Laboratory Medicine Beijing Tongren Hospital Capital Medical University Beijing China

Objective: To investigate the role of IL-2, IL-4, IL-10 and IFN-γ cytokines in the microenvironment of cervical intraepithelial neoplasia. Methods: 180 patients participating were enrolled in this trial, where 50 cases are in control group, 50 cases are in low-grade squamous intraepithelial lesion (LSIL) group, 50 cases are in high-grade squamous intraepithelial lesion (HSIL) group, and 30 cases have cervical carcinoma. ELISA methods are used to detect the expression of IL-2, IL-4, IL-10 and IFN-γ in the lavage fluid, and all data is analyzed using one-way analysis of variance. Results: The expression of IL-2 and IFN-γ in cervical lavage fluid gradually decreases with the aggravation of the lesion. The expression of IL-4 and IL-10 increases by the aggravation of pathological changes. There were statistically significant differences in IL-2 level among the four groups. IFN-γ levels are significantly different between the cervical cancer group and the other groups, also between HSIL and LSIL group, and between HSIL and the control group, but no statistically significant difference was observed in IFN-γ e between LSIL and the control group. The expressions of IL-4 and IL-10 between the cervical cancer group and the other groups were significantly different, and also between HSIL and the control group. But there was no statistically significant difference between LSIL and the control group, HSIL and LSIL. Conclusion: The cytokines of IL-2, IL-4, IL-10 and IFN-γ in the microenvironment of the cervix play an important role in the occurrence and development of cervical intraepithelial neoplasia. This study may provide the evidence for diagnosis and treatment of cervical intraepithelial neoplasia.

关键词： cervical intraepithelial neoplasia IL-2 Il-4 IL-10 IFN-γ Vaginal Lavage Fluid

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Value of frozen section examination in diagnosis and treatment of high-grade cervical intraepithelial neoplasia

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Chinese Medical Journal 2012年第14期125卷 2462-2465页

作者： REN Fang FENG Wei SHI Hui-rong WU Qing-hua CHEN Zhi-min Department of Obstetrics and Gynecology First Affiliated Hospitalof Zhengzhou University Zhengzhou Henan 450052 China

Background Invasive cancer of the cervix is considered a preventable disease because it has a long pre-invasive state, cervical cytology screening programs are currently available, and treatment of pre-invasive lesions is effective. We tested the accuracy of frozen section examination （FSE） of cone specimens to identify the endocervical margin and rule out invasion in patients with high-grade cervical intraepithelial neoplasia （CIN）. Methods For 320 consecutive patients with a preoperative biopsy result of CIN stage 2/3, cold-knife conization （CKC） was performed followed by FSE. The results from analyses of permanent paraffin sections （PS） were compared with the FSE findings. Results The accuracy of FSE was 87% （278/320）. For all of the seven patients with an invasive squamous cell carcinoma of the cervix identified by FSE, the diagnosis was confirmed by PS analysis. For one patient, the FSE result was cervicitis, whereas PS ananlysis showed microinvasive carcinoma. Appropriate surgery was performed for all patients based on the FSE and biopsy results. The FSE and PS results were not significantly different （P=-0.000）. Definitive examination of margin status using PS was concordant with FSE findings in all cases. Conclusions FSE is a rapid and reliable method for evaluating CKC specimens. It can identify frank invasion, permit adequate treatment in a one-stage procedure, and reliably detect clear resection margins. Since discrepancies do exist and may result in inappropriate treatment, further research is required to decrease these discrepancies and avoid missing even one case.

关键词： cervical intraepithelial neoplasia frozen section examination cold-knife conization, the upper endocervical margin, resection margin

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Distribution of High-Risk Human Papillomavirus Genotypes among Women with Colposcopic Diagnosis of cervical intraepithelial neoplasia in Bangladesh

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Journal of Cancer Therapy 2023年第6期14卷 277-290页

作者： Siddika Mosammat Shahida Mina Chowdhury Fatima Shajahan Jannat Ara Rifat Alfi Sharin Lubaba S. M. Shamsuzzaman Annekathryn Goodman Gynae Oncology Unit Department of Obstetrics and Gynaecology Dhaka Medical College Dhaka Bangladesh cervical Cancer UNFPA’s Support to 4th HPNSP through DGHS Dhaka Bangladesh Department of Obstetrics & Gynaecology Dhaka Medical College Hospital Dhaka Bangladesh Department of Obstetrics and Gynecology Khulna Medical College Hospital Khulna Bangladesh Department of Microbiology Dhaka Medical College Dhaka Bangladesh Massachusetts General Hospital Harvard Medical School Boston USA

Background: The incidence of cervical cancer is high in Bangladesh and there is a high prevalence of preinvasive lower genital tract disease among women of reproductive age. Persistent high-risk Human Papilloma Virus (HPV) infection is the main underlying cause of cervical cancer and its precursor, cervical intraepithelial neoplasia (CIN). Objective: The aim of the study was to identify the subtypes of high-risk HPV infection among women with the colposcopic diagnosis of cervical intraepithelial neoplasia in Bangladesh. Methods: This cross-sectional observational study was conducted in the colposcopy clinic of Dhaka Medical College Hospital over a six-month period. A total of 100 participants were enrolled. Married women, between 30 - 60 years of age with colposcopically diagnosed cervical intra epithelial neoplasia were enrolled. Women with chronic illness, pregnancy, and women unable to consent were excluded from this study. After counselling, colposcopically directed punch biopsies were taken from each CIN case concurrently with high-risk HPV testing by polymerase chain reaction (PCR). Results: The mean age of the patients was 38.69 (SD ±7.76) years. CIN 1 was diagnosed in 57% of participants, while 24% had CIN II and 19% had CIN III lesions. High-risk HPV was present in 52 patients. HPV 16 was the most common identified in 28 (53.84%) and HPV 18 was the second most common with 20 (38.46%) either singly or in combination with other high-risk subtypes. The other HPV strains, HPV 31, 33, 35, 52, 56 and 58, were also detected either as mono or co-infections. Out of the 52 HPV positive cases, 29 (55.8%) had mono infection and 23 (44.2%) had co-infection with several subtypes. The highest incidence (50%) of oncogenic HPV infections was present among women aged 35 - 45 years. Risk factors associated with HPV positive cases were high parity (P 0.05), early age at marriage (P = 0.754) and early age of first child. Conclusion: This study identified a high prevalence of HP

关键词： Bangladesh cervical Cancer cervical intraepithelial neoplasia Human Papillomavirus Infection High-Risk HPV

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Proliferative activity in cervical intraepithelial neoplasia and cervical carcinoma

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Chinese Medical Journal 1999年第4期 86-88页

作者：薛月珍丰有吉朱关珍张惜阴

Objective To detect the proliferative activity of cervical cells in cervical intraepithelial neoplasia (CIN) and cervical carcinoma by using proliferating cell nuclear antigen (PCNA) immunohistochemistry and mitotic index (MI).Methods Sixty specimens of CIN and cervical carcinoma from patients treated at the Obstetrics and Gynaecology Hospital, Shanghai Medical University, were analyzed. Among them, 8 were CIN Ⅰ Ⅱ, 16 CIN Ⅲ, 18 squamous carcinoma, and 18 adenocarcinoma. Serial 4μm sections were prepared for haematoxylin and eosin (HE) staining to observe mitotic figure and pathological grading and for immunohistochemical staining of PACN which was performed by murine monoclonal antibody PC 10 (DAKO PCNA).PCNA index (PI) and MI of CIN Ⅲ and cervical carcinoma were significantly higher than those of normal cervix and CIN Ⅰ Ⅱ. PI and MI increased with progress of disease. In addition, higher level of PI was correlated with higher level of MI, and higher levels of PI and MI were related with higher histological grade. However, there was no significant relationship between PI, MI, clinical staging, and lymph node *** and mitotic figure are useful for evaluating proliferative activity in CIN and cervical carcinoma, and could be used to distinguish CIN Ⅲ from CIN Ⅰ Ⅱ and evaluate the malignant potential of tumour tissues.

关键词： cervical intraepithelial neoplasia cervical carcinoma proliferating cell nuclear antigen mitotic figure

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Efficacy and Tolerability of Thermocoagulation Treatment of High-Grade cervical intraepithelial neoplasia

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Open Journal of Obstetrics and Gynecology 2021年第12期11卷 1691-1710页

作者： Beatriz Maykot Kuerten Paulo Sérgio Viero Naud Francisco Jose Cidral-Filho Armando José D’Acampora Department of Obstetrics and Gynecology Federal University of Santa Catarina Florianópolis Brazil Department of Obstetrics and Gynecology Federal University of Rio Grande do Sul Porto Alegre Brazil Experimental Neuroscience Laboratory (LaNEx) Postgraduate Program in Health Sciences University of Southern Santa Catarina Florianópolis Brazil Department of Clinical Surgery Federal University of Santa Catarina Florianópolis Brazil

Purpose: cervical cancer is still one of the main causes of cancer and mortality in women, especially in low- and middle-income countries, although it is a completely preventable disease through the detection and trea... 详细信息

Purpose: Cervical cancer is still one of the main causes of cancer and mortality in women, especially in low- and middle-income countries, although it is a completely preventable disease through the detection and treatment of pre-cancer lesions. We evaluated the efficacy and tolerability of thermocoagulation treatment of high-grade cervical intraepithelial neoplasia (CIN 2 and 3). Methods: We evaluated 115 women with high-grade cervical intraepithelial neoplasia, 54 with CIN 2 and 61 with CIN 3, confirmed by biopsy and without previous treatment, from January 2016 to December 2018, undergoing thermocoagulation treatment at the Lower Genital Tract Pathology and Colposcopy Service of the Hospital de Clinicas de Porto Alegre, Porto Alegre, Brazil. Results: The mean age was 33.11 years (SD = 9.83) for CIN 2 and 35.28 years (SD = 7.97) for CIN 3 patients. Treatment efficacy was 90.8% in CIN 2 and 94.9% in CIN 3 cases. Pain was the main symptom reported at the time of treatment, occurring more frequently in the CIN 3 group (49.1% versus 27.8% in the CIN 2 group). As the more important long-term complication, there were 3 cases of pelvic inflammatory disease in CIN 2 (5.6%) and 3 in CIN 3 group (5.0%). The percentage of residual lesion was very low in both groups, 5 in CIN 2 group (9.2%) and 2 in CIN 3 g

关键词： cervical intraepithelial neoplasia Thermocoagulation Efficacy Results Ablation Procedures Cancer Prevention

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The Prevalence of High Grade cervical intraepithelial neoplasia (CIN) in a Primary Human Papillomavirus (HPV) cervical Screening Programme Population with HPV Positive and Cytology Negative Smear Results

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Open Journal of Obstetrics and Gynecology 2020年第7期10卷 902-908页

作者： Simon G. Williams Ayesha Anwar Sachinta G. Wijesiri Sangeetha Palaparthy Emma Winter Specialty Trainee in O&G South Tyneside and Sunderland NHS Foundation Trust Sunderland UK Consultant Obstetrician and Gynaecologist North Cumbria Integrated Care NHS Foundation Trust Carlisle UK Specialty Trainee in O&G County Durham and Darlington NHS Foundation Trust Durham UK Specialty Trainee in O&G Queen Elizabeth University Hospital Glasgow UK Specialty Doctor in Gynaecology and Colposcopy Services North Cumbria Integrated Care NHS Trust Carlisle UK

High-risk HPV is found in 99.7% of cervical cancers. The causative role of HPV in cervical cancer has led to the inclusion of HPV testing as part of cervical screening. A pilot of HPV testing as primary screening was commenced in 2013 at six pilot sites in England. North Cumbria Integrated Care (NCIC) NHS Foundation Trust took part in the pilot, in which women with an HPV-positive/cytology-negative result were recalled at 12 months. Women with HPV type 16/18 found at initial screening and persisting at 12 months in spite of negative cytology were referred to Colposcopy services at 12 months. Women with smear positive for hrHPV other than 16/18 types were recalled twice at 12 and 24 months before referral to colposcopy. Persistent hrHPV positive/cytology negative smear at 12 and 24 months initiated a colposcopy referral. Objective: To assess the prevalence of high grade CIN and invasive cancer in patients referred to colposcopy services at NCIC NHS Foundation Trust with hrHPV positive/cytology negative smears. Method: The study was conducted at NCIC NHS Foundation Trust between January 2015 and December 2017. Data was collected retrospectively from the colposcopy data base (INFOFLEX). All patients with HPV positive/cytology negative smears seen in colposcopy clinic during the study period were included. Patients with high grade CIN, cervical glandular intraepithelial neoplasia (CGIN) or invasive cancer were recorded. Results: 763 women were included in the study. A total of 50 (6.6%) women had high grade CIN, CGIN or invasive cancer. 40 of these 50 women (80%) were treated by large loop excision of the transformation zone (LLETZ). <

关键词： cervical Screening cervical intraepithelial neoplasia cervical Cancer Human Papillomavirus Colposcopy

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