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Significance of atypical squamous cells of undetermined significance on ThinPrep Papanicolaou smears

GYNECOLOGIC ONCOLOGY 2000年第1期79卷 44-49页

作者： Eltabbakh, GH Lipman, JN Mount, SL Morgan, A Univ Vermont Div Gynecol Oncol Coll Med Burlington VT 05401 USA Univ Vermont Dept Pathol Coll Med Burlington VT 05401 USA Univ Vermont Dept Biostat Coll Med Burlington VT 05401 USA

Objective. The aim of this study was to assess the prevalence and risk factors predictive of dysplasia among women seen in a gynecologic oncology service with the cytologic diagnosis of atypical squamous cells of undetermined significance (ASCUS) on Papanicolaou smears obtained by the ThinPrep method. Methods. Patients with ASCUS ThinPrep Papanicolaou smears seen at the Division of Gynecologic Oncology, University of Vermont, between 1997 and 1999 were identified. The cytologic smears were reviewed and subtyped into reactive or suggestive of squamous intraepithelial lesion (SIL). The charts of these patients were reviewed and the following information was abstracted: age, gravidity, parity, menopausal status, use of hormonal replacement therapy, smoking, history of pelvic cancer, history of radiation therapy, history of abnormal Papanicolaou smear and its treatment, history of human papillomavirus (HPV) infection, and follow-up information including results of repeat Papanicolaou smears, colposcopy, and biopsies. The prevalence of dysplasia was calculated. The demographic features of women with ASCUS, reactive, were compared with those with ASCUS, SIL, using a two-sample t test, chi(2), and Fisher's exact test. Risk factors predictive of dysplasia were calculated using the odds ratio and the 95% confidence interval. P < 0.05 was considered significant. Results. One hundred twenty-six patients with ASCUS on ThinPrep Papanicolaou smear were identified;63 patients had ASCUS, reactive, and 63 patients had ASCUS, SIL. The demographic features of both groups were similar. The overall prevalence of dysplasia was 15.9% and was significantly higher among women with ASCUS, SIL, than among women with ASCUS, reactive (25.4% versus 6.4%, P = 0.003). The type of ASCUS cytology (reactive versus SIL), smoking, and history of HPV were significant risk factors for dysplasia (P = 0.003, 0.037, and 0.042, respectively). Conclusions. The prevalence of dysplasia among women seen in a gyn

关键词：宫颈上皮内瘤样病变/病理学子宫颈/病理学子宫颈/病毒学乳头状瘤病毒科乳头状瘤病毒感染/病理学乳头状瘤病毒感染/病毒学试验预期值患病率预后危险因素肿瘤病毒感染/病理学肿瘤病毒感染/病毒学宫颈非典型增生/流行病学宫颈非典型增生/病理学宫颈非典型增生/病毒学宫颈肿瘤/病理学阴道涂片成年人女(雌)性人类

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Laminin-5 as a marker of invasiveness in cervical lesions

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JOURNAL OF THE NATIONAL CANCER INSTITUTE 1999年第21期91卷 1882-1887页

作者： Skyldberg, B Salo, S Eriksson, E Aspenblad, U Moberger, B Tryggvason, K Auer, G Karolinska Inst Dept Pathol & Oncol Div Cellular & Mol Tumor Pathol Stockholm Sweden Karolinska Inst Huddinge Hosp Dept Immunol Microbiol Pathol & Infect Dis Div Biomed Lab Technol S-10401 Stockholm Sweden Univ Oulu Dept Biochem Oulu Finland Bioctr Oulu Oulu Finland Karolinska Hosp & Inst Dept Women & Child Hlth Div Obstet & Gynecol Stockholm Sweden Karolinska Inst Dept Med Biochem & Biophys Stockholm Sweden

Background: Treatment decisions for cervical cancer, a common disease worldwide, depend on demonstrating whether or not tumor invasion of the surrounding tissue has occurred. Invasion can be difficult to assess by standard histopathologic methods, especially when limited amounts of tissue are available. Several studies of a variety of cancers have reported increased expression of laminin-5-an important attachment protein for epithelial cells-in invasive carcinomas. This study was designed to investigate whether the presence of laminin-5 is related to the invasive capacity of cervical lesions. Methods: We used immunohistochemical methods to stain archival, paraffin-embedded sections of cervical lesions with a polyclonal antibody specifically targeting the gamma 2 chain of human laminin-5 protein. The study sample included 23 lesions of mild and moderate dysplasia (cervical intraepithelial neoplasia [CIN] 1 and 2, respectively), 32 lesions of severe dysplasia or carcinoma in situ (CIN 3), 15 lesions of microinvasive cancer, and 20 lesions of frankly invasive cancer. Cellular proliferative activity was also investigated by the use of monoclonal MIB-1 (directed against the antigen Ki-67) and anticyclin A antibodies. Results: Invasiveness of cervical lesions was positively associated with immunohistochemical staining of the gamma 2 chain of laminin-5 (two-sided P = .001). All CIN 1 and CIN 2 lesions-except one CIN 2 lesion later shown to be invasive cancer-and 21 CIN 3 lesions tested negative for the gamma 2 chain of laminin-5. Eleven CIN 3 lesions and all invasive cancers tested positive for this protein. One lymph node metastasis and a pleural metastasis from one of the patients with invasive cancer showed strong immunohistochemical positivity. Proliferative activity increased with advancement of the lesion but was not confined to cells positive for the gamma 2 chain of laminin-5. Conclusions: These data suggest that antibodies directed against the gamma 2 chain of lam

关键词：细胞黏附分子/分析宫颈上皮内瘤样病变/化学宫颈上皮内瘤样病变/病理学免疫组织化学肿瘤侵润肿瘤标记生物学/分析宫颈非典型增生/化学宫颈非典型增生/病理学宫颈肿瘤/化学宫颈肿瘤/病理学女(雌)性人类

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GYNECOLOGIC DISEASE IN YOUNG, SEXUALLY ACTIVE WOMEN

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AMERICAN JOURNAL OF OBSTETRICS AND GYNECOLOGY 1976年第7期126卷 880-889页

作者： RODDICK, JW SO ILLINOIS UNIV SCH MEDDEPT OBSTET & GYNECOLSPRINGFIELDIL 62708

There has been a significant change in adolescent sexual behavior in the past decade. This report of 1,594 young, sexually active women, primarily from middle and upper socioeconomic backgrounds, identifies the obstetric and gynecologic problems characteristic of the group. While supposedly in a low-risk category these patients displayed a high incidence of cervical epithelial abnormality, problem pregnancy, and other obstetric and gynecologic abnormality. The incidence of veneral disease was somewhat lower than anticipated.

关键词：年龄因素子宫颈/病理学生殖器疾病女(雌)性/流行病学伊利诺伊收入性行为性传播疾病/流行病学宫颈非典型增生/流行病学宫颈非典型增生/病理学青少年成年人儿童女(雌)性人类

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Combined colposcopy, loop conization, and laser vaporization reduces recurrent abnormal cytology and residual disease in cervical dysplasia

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GYNECOLOGIC ONCOLOGY 2000年第1期78卷 47-51页

作者： Bar-Am, A Daniel, Y Ron, IG Niv, J Kupferminc, MJ Bornstein, J Lessing, JB Tel Aviv Sourasky Med Ctr Lis Matern Hosp Cerv Pathol Unit IL-64239 Tel Aviv Israel Tel Aviv Sourasky Med Ctr Lis Matern Hosp Dept Obstet & Gynecol IL-64239 Tel Aviv Israel Tel Aviv Univ Sackler Fac Med IL-69978 Tel Aviv Israel

Objectives. Loop electrosurgical excision of the transformation zone (LEETZ) was recently associated with relatively high failure rates. We evaluated whether the combination of LEETZ with laser vaporization is superior to LEETZ alone in reducing the rates of recurrent abnormal cytology and residual disease. Methods. The study population included 426 women with histologic diagnosis of cervical intraepithelial neoplasia (CIN) 2-3, of whom 289 (study group) were treated by LEETZ followed by laser vaporization of the crater base and walls and 137 (control group) were treated by LEETZ alone. All women were followed scrupulously at regular intervals for recurrent abnormal cytology and residual disease. The mean follow-up periods were 43 and 59 months for the study and control groups, respectively. Results. Both groups were derived from the same community and were similar in epidemiologic characteristics and disease severity. Although the incidence of positive surgical margins was similar in both groups (10.4 and 9.5% for the study and control groups, respectively), recurrent abnormal cytology (10.2% vs 5.5%, P = 0.07) and histologic residual disease (21.4% vs 0%, P = 0.05) were more frequent among women in the control group. This applied to women with both negative and positive surgical margins. Both study and control women with positive surgical margins, especially at the endocervix, were at higher risk for recurrence. Conclusion. The addition of laser vaporization to LEETZ may improve outcome of both women with positive margins and women with negative margins. Our results support conservative management for all treated women, regardless of cone margin status. (C) 2000 Academic Press.

关键词：宫颈上皮内瘤样病变/病理学宫颈上皮内瘤样病变/外科学子宫颈/病理学队列研究阴道镜检查电外科手术/方法肿瘤残余复发危险因素治疗结果宫颈非典型增生/病理学宫颈非典型增生/外科学宫颈肿瘤/病理学宫颈肿瘤/外科学青少年成年人女(雌)性人类中年人

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The significance of ASCUS cytology in HIV-positive women

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GYNECOLOGIC ONCOLOGY 1999年第1期75卷 118-121页

作者： Holcomb, K Abulafia, O Matthews, RP Chapman, JE Borges, A Lee, YC Buhl, A SUNY Hlth Sci Ctr Dept Obstet & Gynecol Div Gynecol Oncol Brooklyn NY 11203 USA

Objective. The aim of this study was to determine the incidence and severity of dysplasia associated with a cytologic diagnosis of atypical cells of undetermined significance (ASCUS) in women infected with the human immunodeficiency virus (HIV), Methods. A cross-sectional analysis of cervical cytology, colposcopic impression, and cervical biopsy results was performed on 261 HIV-positive women diagnosed with ASCUS. The prevalence and grade of histologically documented cervical intraepithelial neoplasia (CIN) was determined. Patients with CD4 counts above and below 200 cells/mm(3) were compared using chi(2) analysis to determine any effect: of worsening immunosuppression on the rates of associated dysplasia. Results. Seven hundred sixty-one Pap smears were performed during the study period. Two hundred nine (27%) were diagnosed as ASCUS. All patients (pts) received colposcopic evaluation. The incidence of human papilloma virus (HPV) effect, low-grade CIN (I), and high-grade CIN (II, III, and carcinoma in situ) documented by cervical biopsy, cervical conization or endocervical curettings was 40, 17, and 15%, respectively. No cases of invasive cancer were found. These results are similar to those of previous cytohistologic studies of ASCUS in HIV-untested populations. There was no significant difference in frequency or severity of CIN in pts with severe immunosuppression (P = 0.4). Conclusion. A cytologic diagnosis of ASCUS in HIV-positive women identifies a group at significant risk for histologic abnormalities. The majority of pts will be diagnosed with HPV or low-grade GIN. HIV infection and severe immunosuppression do not appear to increase the frequency or severity of CIN associated with ASCUS, Given the 32% risk of associated GIN, all HIV-positive women with ASCUS cytology should undergo colposcopic evaluation, (C) 1999 Academic Press.

关键词：宫颈上皮内瘤样病变/并发症宫颈上皮内瘤样病变/流行病学宫颈上皮内瘤样病变/病理学横断面研究 HIV血清阳性/并发症发病率疾病严重程度指数宫颈非典型增生/并发症宫颈非典型增生/流行病学宫颈非典型增生/病理学宫颈肿瘤/并发症宫颈肿瘤/流行病学宫颈肿瘤/病理学成年人女(雌)性人类

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Hypoxia-inducible erythropoietin signaling in squamous dysplasia and squamous cell carcinoma of the uterine cervix and its potential role in cervical carcinogenesis and tumor progression

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AMERICAN JOURNAL OF PATHOLOGY 2003年第6期162卷 1789-1806页

作者： Acs, G Zhang, PJ McGrath, CM Acs, P McBroom, J Mohyeldin, A Liu, SZ Lu, HS Verma, A Univ Penn Dept Pathol & Lab Med Med Ctr Philadelphia PA 19104 USA Huron Hosp Cleveland Clin Hlth Syst Dept Med Cleveland OH USA Walter Reed Army Med Ctr Dept Obstet & Gynecol Washington DC 20307 USA Uniformed Serv Univ Hlth Sci Dept Neurol Bethesda MD 20814 USA

Tissue hypoxia is a characteristic property of cervical cancers that makes tumors resistant to chemo- and radiation therapy. Erythropoietin (Epo) is a hypoxia-inducible stimulator of erythropoiesis. Acting via its receptor (EpoR), Epo up-regulates bcl-2 and inhibits apoptosis of erythroid cells and rescues neurons from hypoxic damage. In addition to human papillomavirus infection, increased bcl-2 expression and decreased apoptosis are thought to play a role in the progression of cervical neoplasia. Using reverse transcriptase-polymerase chain reaction and Western blotting we showed that HeLa and SiHa cervical carcinoma cells and human cervical carcinomas express EpoR, and that hypoxia enhances EpoR expression. Exogenous Epo stimulated tyrosine phosphorylation and inhibited the cytotoxic effect of cisplatin in HeLa cervical carcinoma cells. Using immunohistochemistry, we examined the expression of Epo, EpoR, p16, hypoxia-inducible factor (HIF)-1alpha, and bcl-2 in benign and dysplastic cervical squamous epithelia and invasive squamous;cell carcinomas (ISCCs). EpoR expression in benign epithelia was confined to the basal cell layers, whereas in dysplasias it increasingly appeared in more superficial cell layers and showed a significant correlation with severity of dysplasia. Diffuse EpoR expression was found in all ISCCs,. Expression of Epo and HIF-1alpha was increased in dysplasias compared to benign epithelia. Focal Epo and HIF-1alpha expression was seen near necrotic areas in ISCCs, and showed correlation in their spatial distribution. Significant correlation was found between expression of EpoR, and p16 and bcl-2 in benign and dysplastic squamous epithelia. Our results suggest that increased expression of Epo and EpoR may play a significant role in cervical carcinogenesis and tumor progression. Hypoxia-inducible Epo signaling may play a significant role in the aggressive behavior and treatment resistance of hypoxic cervical cancers.

关键词：癌鳞状细胞/遗传学癌鳞状细胞/代谢癌鳞状细胞/病理学细胞低氧细胞存活/药物作用周期素依赖激酶抑制剂p16/生物合成疾病恶化剂量效应关系药物红细胞生成素/遗传学红细胞生成素/代谢红细胞生成素/药理学基因表达调控肿瘤 HeLa细胞缺氧诱导因子1 α亚基免疫组织化学肿瘤分期原癌基因蛋白质c-bcl-2/生物合成 RNA 信使/遗传学 RNA 信使/代谢受体红细胞生成素/遗传学受体红细胞生成素/代谢重组蛋白质类逆转录聚合酶链反应信号传导转录因子/生物合成肿瘤细胞培养的/药物作用肿瘤细胞培养的/代谢宫颈非典型增生/遗传学宫颈非典型增生/代谢宫颈非典型增生/病理学宫颈肿瘤/遗传学宫颈肿瘤/代谢宫颈肿瘤/病理学女(雌)性人类

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Endocervical curettage when colposcopic examination is satisfactory and normal

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OBSTETRICS AND GYNECOLOGY 2000年第6期95卷 801-803页

作者： Williams, DL Dietrich, C McBroom, J Tripler Army Med Ctr Dept Obstet & Gynecol Gynecol Sect Honolulu HI 96859 USA

Objective: To estimate the incidence of endocervical dysplasia in women with cervical cytology of atypical squamous cells of undetermined significance (ASCUS) or low-grade squamous intraepithelial lesion (SIL) who have a satisfactory and normal colposcopic examination. Methods: An electronic colposcopy database was reviewed and women with satisfactory colposcopic examinations and original cervical cytology of ASCUS on two consecutive Papanicolaou smears, ASCUS favor SIL, or low-grade SIL were selected. Exclusion criteria were pregnancy, insufficient endocervical curettage (ECC), or colposcopic examination that showed an abnormality that required cervical biopsy. Subjects also were excluded if they were postmenopausal or had surgical or ablative therapy for cervical dysplasia within the past year. A computerized review of 2517 patient records found 860 that met the search criteria. A manual review of those records using the exclusion criteria isolated a study group of 159 women. Results: Four of 159 subjects (2.5%, 95% confidence interval [CI] 0.69, 6.3) had dysplastic cells in endocervical curettings. In these four, the ECC specimens had benign endocervical cells and separate fragments of squamous cells with mild dysplasia. In three women, loop electrosurgical excision procedures showed mild dysplasia limited to the transformation zone. The fourth subject was believed to have contamination from an unrecognized ectocervical lesion and was treated conservatively. A repeat ECC found benign endocervical cells. Involvement of the endocervix by dyplasia was excluded in all but one of 159 patients (0.63%, 95% CI 0.02, 3.5). Conclusion: Incidence of endocervical dysplasia was extremely low in women with cervical cytology of consecutive ASCUS, ASCUS favor SIL, or low-grade SIL who have a satisfactory and normal colposcopic examination. Our findings suggest that endocervical curettage might be safely avoided in those women. (Obstet Gynecol 2000;95:801-3).

关键词：宫颈上皮内瘤样病变/病理学子宫颈/病理学阴道镜检查刮宫术回顾性研究宫颈非典型增生/病理学宫颈肿瘤/病理学女(雌)性人类

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Multifocal reversible epithelial dysplasia mimicking carcinoma in situ after conditioning therapy with busulfan and cyclophosphamide

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BONE MARROW TRANSPLANTATION 1999年第4期24卷 446-447页

作者： Obermann, EC Meidenbauer, N Zeltner, R Andreesen, R Reichle, A Univ Regensburg Inst Pathol D-93053 Regensburg Germany Univ Regensburg Dept Hematol & Oncol D-93053 Regensburg Germany

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Prediction of cervical intraepithelial neoplasia grade 2-3 using risk assessment and human papillomavirus testing in women with atypia on Papanicolaou smears

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OBSTETRICS AND GYNECOLOGY 2000年第3期96卷 410-416页

作者： Shlay, JC Dunn, T Byers, T Barón, AE Douglas, JM Denver Hlth & Hosp Author Dept Publ Hlth Denver CO USA Denver Hlth & Hosp Author Dept Obstet & Gynecol Denver CO USA Denver Hlth & Hosp Author Dept Family Med Denver CO USA Univ Colorado Hlth Sci Ctr Dept Prevent Med & Biometr Denver CO 80262 USA Univ Colorado Hlth Sci Ctr Dept Family Med Denver CO 80262 USA Univ Colorado Hlth Sci Ctr Dept Med Denver CO 80262 USA Univ Colorado Hlth Sci Ctr Dept Obstet & Gynecol Denver CO 80262 USA

Objective: To determine whether human papillomavirus (HPV) DNA testing and risk assessment can predict cervical intraepithelial neoplasia (CIN) 2-3 on biopsies in women with atypia on Papanicolaou smears. Methods: One hundred ninety-five consenting women were referred for colposcopy because of atypia on Papanicolaou smears between September 1997 and April 1999. Before colposcopy, women completed risk assessments and had cervical swabs collected for HPV testing using the Hybrid Capture-II assay (Digene Corporation, Silver Spring, MD). Associations of demographic and clinical variables were assessed by chi(2) analysis, and logistic regression was used to assess factors associated with CIN 2-3. The cost-effectiveness of routine colposcopy versus reflex HPV testing by either conventional or liquid-based Papanicolaou smear media was compared. Results: Cervical intraepithelial neoplasia was diagnosed in 70 of 195 women (35.9%), 55 (28.2%) with CIN 1 and 15 (7.7%) with CIN 2-3. High-risk HPV types were detected in 31.3% of all subjects, 36.4% of those with CIN 1, and 93.3% of those with CIN 2-3. By logistic regression, CIN 2-3 was associated only with detection of high-risk HPV (odds ratio 110.08, 95% confidence interval 8.35, 999.00). The sensitivity of high-risk HPV for detecting CIN 2-3 was 93.3%, specificity 73.9%, positive predictive value 23.0%, and negative predictive value 99.3%. The cost of reflex HPV testing using conventional smear or liquid-based media was less than routine colposcopy ($4809 and $4308, respectively, versus $4875 per case detected). Conclusions: Triage based on HPV testing would result in referral of approximately 31% of patients to colposcopy and appears to be a sensitive and cost-effective alternative to colposcopy. (Obstet Gynecol 2000;96:410-16. (C) 2000 by The American College of Obstetricians and Gynecologists.).

关键词：宫颈上皮内瘤样病变/病理学子宫颈/病理学阴道镜检查/经济学费用效益分析肿瘤分期乳头状瘤病毒科乳头状瘤病毒感染/病理学癌前状态/病理学试验预期值危险性评估肿瘤病毒感染/病理学宫颈非典型增生/病理学宫颈肿瘤/病理学阴道涂片/经济学成年人女(雌)性人类中年人

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Mildly dyskaryotic smear results

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FAMILY PRACTICE 1999年第5期16卷 542-542页

作者： Monem, T Oakeshott, P Manor Hlth Ctr London SW4 6EB England

Somerset and colleagues note that the majority of cervical smear tests in the UK are taken by a GP or . . .

关键词：临床工作能力医学审核质量控制城市卫生宫颈非典型增生/病理学阴道涂片/标准女(雌)性人类

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