RESUMEN

OBJECTIVE: To assess strategies using repeated conventional Pap smear and human papillomavirus (HPV) DNA testing, alone or in combination, for identifying women with concomitant cervical intraepithelial neoplasia 2 and 3 (CIN 2/3) in women with atypical squamous cells of undetermined significance (ASCUS) in their Pap smears. STUDY DESIGN: A total of 360 women cytologically diagnosed with ASCUS were referred for colposcopy and underwent a repeat Pap smear, a biopsy when necessary and HPV testing using three different modes of detection of high-oncogenic-risk HPV types: 1, first-generation Hybrid Capture test (HC-1) (Digene Diagnostics, Gaithersburg, Maryland); 2, second-generation Hybrid Capture test (HC-2); and 3, polymerase chain reaction (PCR). RESULTS: Nineteen patients (5.3%) had histologic CIN 2/3. The sensitivity and specificity of the repeat Pap smear alone for the detection of CIN 2/3 were 73.7% and 62.9%, respectively, when referring all women with a repeat Pap smear using an ASCUS-positive threshold. The proportion of women referred for colposcopy was 39.0%. When HPV testing for high risk was used for identification of women with histologic CIN 2/3, sensitivity and specificity were, respectively, 68.4% and 85.9% for HC-1, 89.5% and 73.9% for HC-2 and 89.5% and 59.0% for PCR. The rate of referral for colposcopy of these three modes of HPV testing was 16.9%, 29.4% and 44.0%, respectively. The sensitivity and specificity for identification of women with concomitant CIN 2/3 using a combination of repeat cytology showing a low grade squamous intraepithelial lesion or high grade squamous intraepithelial lesion and/or a test positive for high-oncogenic-risk HPV group were, respectively, 94.7% and 73.2% when used in combination with HC-2. The referral rate of women for colposcopy of this combined strategy was 30.4%. CONCLUSION: As compared to the strategy using abnormal repeat Pap smear alone, those using high-risk HPV testing with Hybrid Capture showed statistically significantly higher specificities and lower proportions of women with ASCUS referred for colposcopy. In particular, a promising strategy would be to refer for colposcopy only women with repeat Pap smears showing squamous intraepithelial lesion and/or those positive for high-risk HPV detected by Hybrid Capture testing.

Asunto(s)

Carcinoma de Células Escamosas/patología , ADN Viral/análisis , Prueba de Papanicolaou , Displasia del Cuello del Útero/patología , Neoplasias del Cuello Uterino/patología , Frotis Vaginal/normas , Adolescente , Adulto , Estudios de Casos y Controles , Colposcopía , Femenino , Humanos , Persona de Mediana Edad , Papillomaviridae/genética , Papillomaviridae/aislamiento & purificación , Reacción en Cadena de la Polimerasa/normas , Valor Predictivo de las Pruebas , Sensibilidad y Especificidad , Neoplasias del Cuello Uterino/virología , Displasia del Cuello del Útero/virología

RESUMEN

OBJECTIVE: To identify cytologic parameters on Pap smears of women with an atypical squamous cells of undetermined significance (ASCUS) diagnosis that could help cytologists to indicate whether a particular ASCUS case is most likely related to cervical intraepithelial neoplasia (CIN) grade 1 or 2/3. STUDY DESIGN: A total of 360 eligible women diagnosed with ASCUS and referred to the colposcopy clinic of Saint-Sacrement Hospital participated in the study. Eligible women were those aged 18-50 years, newly diagnosed with ASCUS, with no history of cervical biopsies or treatment, and not pregnant at the time of the visit. Colposcopically directed biopsies of lesions were obtained. All Pap smears were reviewed according to 36 different cytomorphologic criteria. The regression logistic model was used to estimate the odds ratios (ORs) for the associations between cytologic criteria observed in smears and the diagnosis of CIN made on biopsies. All cytologic criteria significantly (P < .05) associated with CIN were entered in the models, and a backward selection was done to determine independent cytologic predictors of CIN 1 and 2/3. RESULTS: Biopsies revealed that 22.2% of the study population had concurrent CIN. CIN I and 2/3 were identified in 61 (16.9%) and 19 women (5.3%), respectively. Clear perinuclear spaces (OR = 2.5, P = .002) and moderate nuclear atypia (OR = 4.4, P = .02) were two cytologic criteria independently associated with CIN 1. Four independent predictors of CIN 2/3 were identified: the presence of clear perinuclear spaces (OR = 5.9, P = .004), hyperchromasia (OR = 3.9, P = .04), moderate anisokaryosis (OR = 13.1, P = .01 and increased nuclear volume of metaplastic cells (OR = 5.1, P = .007). CONCLUSION: These observations may help cytologists to better categorize ASCUS lesions as intraepithelial ones and will also contribute to improving the Bethesda definition of ASCUS. Further studies are planned to validate these observations.

Asunto(s)

Cuello del Útero/patología , Displasia del Cuello del Útero/diagnóstico , Displasia del Cuello del Útero/patología , Neoplasias del Cuello Uterino/diagnóstico , Neoplasias del Cuello Uterino/patología , Adolescente , Adulto , Núcleo Celular/patología , Femenino , Humanos , Persona de Mediana Edad , Prueba de Papanicolaou , Valor Predictivo de las Pruebas , Embarazo , Frotis Vaginal

RESUMEN

OBJECTIVE: To assess the relationship between human papillomavirus (HPV) infection and vulvar vestibulitis syndrome. METHODS: From November 1995 to December 1997, 135 women with vulvar vestibulitis were compared with 322 controls who had no evidence of vulvar vestibulitis. Human papillomavirus DNA was amplified by polymerase chain reaction and detected with liquid-capture molecular assay. RESULTS: Human papillomavirus DNA was found in 29.6% of cases and in 23.9% of controls (relative risk [RR] 1.4; 95% confidence interval [CI].8, 2.2). The prevalence of HPV tended to decrease with increasing duration of pain among cases. Thus, prevalences were 37. 5%, 29.6%, and 22.0% for pain durations of 3-6 months, 7-12 months, and 13-24 months, respectively (P =.14). Prevalence of HPV also tended to increase with pain intensity among cases, but that association was not statistically significant (P =.57). Prevalence percentages for women with low, moderate, or severe pain were 27.5%, 28.8%, and 34.4%, respectively. Prevalence of HPV was slightly higher in cases with the most severe pain (34.4%) than in controls (23.9%) (RR 1.8; 95% CI.8, 4.0). In cases with the most pain in the shortest time (3-6 months), prevalence of HPV was double that of controls (50% versus 23.9%) (RR 3.5; 95% CI 1.0, 12.7; P =.054). CONCLUSION: There was little support for the idea that HPV might be related to vulvar vestibulitis.

Asunto(s)

Papillomaviridae/aislamiento & purificación , Infecciones por Papillomavirus/complicaciones , Infecciones Tumorales por Virus/complicaciones , Vulvitis/virología , Adulto , Estudios de Casos y Controles , ADN Viral/aislamiento & purificación , Dispareunia/etiología , Femenino , Humanos , Reacción en Cadena de la Polimerasa , Síndrome , Vulva/virología

RESUMEN

OBJECTIVE: To compare the efficiency of two methods for routine quality assurance in gynecologic cytology: random rescreening of 10% of negative gynecologic smears and rapid rescreening of all negative gynecologic smears. STUDY DESIGN: All gynecologic smears considered to be negative or benign and diagnosed between November 1, 1996, and December 31, 1997, were rescreened using the rapid, partial rescreening technique. Results were compared to those of the 10% random rescreening method. RESULTS: Comparing the 10% review of negatives to the rapid rescreening in two comparable periods of three months, the former required review by the supervisor of 160 cases in order to find a true false negative. With rapid rescreening, the supervisor had to review fewer than eight cases to find a true false negative. Also, rapid rescreening found about four times more true false negatives than random 10% review. CONCLUSION: Rapid rescreening of all negative gynecologic smears proved more efficient than 10% random rescreening.

Asunto(s)

Tamizaje Masivo/normas , Patología Clínica/normas , Frotis Vaginal/normas , Análisis Costo-Beneficio , Reacciones Falso Negativas , Femenino , Ginecología/economía , Ginecología/normas , Costos de la Atención en Salud , Hospitales Urbanos/economía , Hospitales Urbanos/normas , Humanos , Laboratorios de Hospital/economía , Laboratorios de Hospital/normas , Tamizaje Masivo/economía , Patología Clínica/economía , Control de Calidad , Frotis Vaginal/economía

RESUMEN

OBJECTIVES: The objective of this study was to detect human papillomavirus (HPV) in women with a newly diagnosed atypical squamous cells of undetermined significance (ASCUS) using the hybrid capture (HC) test and the polymerase chain reaction (PCR). We sought to evaluate the accuracy of both tests in identifying women with a concomitant cervical intraepithelial neoplasia (CIN). MATERIALS AND METHODS: We studied 360 women who had a diagnosis of ASCUS and were referred to the colposcopy clinic. Subjects were between 18 and 50 years, had newly diagnosed ASCUS, had no history of cervical biopsies or treatment, and were not pregnant. A cell sample for HPV testing and colposcopically directed biopsies of lesions were obtained. HPV was detected using the Digene HC and PCR systems (Digene, Silver Spring, MD). RESULTS: Biopsies showed concomitant CIN in 80 patients (22.2%). Of these, 19 had CIN2 or CIN3. HPV-DNA was detected in 76 of the 360 women (21.1%) using HC and in 166 of 348 women (47.7%) using PCR. The concordance between HC and PCR for detecting HPV was 65%. The sensitivity, specificity, and positive and negative predictive values of HC for detecting CIN were 48%, 86%, 50%, and 85%, respectively. The sensitivity, specificity, and positive and negative predictive values of PCR for detecting CIN were 67%, 58%, 31%, and 86%, respectively. Focusing on CIN2 and CIN3 alone, these values were 79%, 82%, 20%, and 99% for HC, respectively, and 89%, 55%, 10%, and 99% for PCR, respectively. CONCLUSION: The specificity of HC was higher than the specificity of PCR. For this reason, the HC might be more useful than PCR as a secondary triage method for detecting CIN in women who have incident ASCUS and need colposcopy.

RESUMEN

OBJECTIVE: The percentage of women with atypical squamous cells of undetermined significance (ASCUS) with concomitant cervical intraepithelial neoplasia (CIN) is relatively high, varying between 18% and 30%, depending on the series. The objective of this study was to identify factors other than cervical human papillomavirus (HPV) infection that would help to identify women with newly diagnosed ASCUS and in need of referral to colposcopy. MATERIALS AND METHODS: A total of 360 eligible women in whom ASCUS was diagnosed and who were referred to the colposcopy clinic of Saint-Sacrement Hospital in Quebec City were included in this study (participation rate, 92%). Eligible women were those aged between 18 and 50 years, with newly diagnosed ASCUS, with no history of cervical biopsies or treatment, and not pregnant at the time of their visit. During their gynecological visit, a cell sample was collected for HPV testing, and colposcopically directed biopsies of lesions were obtained. HPVs were detected using the Digene hybrid capture test. Logistical regression was used to estimate odds ratios (ORs) for concomitant CIN and their 95% confidence intervals (CIs). All ORs were adjusted for cervical HPV infection and other risk factors. RESULTS: Cervical HPV infection was the factor most strongly related to concomitant CIN (OR = 4.0; 95% CI = 2.2-7.3). After taking into account the presence of cervical HPV infection, two variables were significantly associated with concomitant CIN. Compared to older women, those aged 35 or younger had a higher risk of concomitant CIN (OR - 2.3; 95% CI - 1.3-4.2). Current smoking was positively associated with concomitant CIN (OR - 2.7; 95% CI - 1.4-5.1), while there was no association between past smoking and concomitant CIN. Having had more than four sexual partners in the last 5 years was associated with an OR of 2.1; however, this association did not reach statistical significance. Cervical HPV infection, younger age, and current smoking were independent determinants of both CIN1 and CIN2 and 3. CONCLUSION: Age and smoking status are independent predictors of concomitant CIN in women with newly diagnosed ASCUS. When HPV testing is not available, clinicians could preferentially refer younger women and those who smoke to colposcopy, as they represent a population with ASCUS at high risk of concomitant CIN.

RESUMEN

ISSUES: The conference participants addressed the following issues: (1) reporting of equivocal diagnoses, (2) strategies to minimize the use of such diagnoses, (3) morphologic criteria, and (4) management of women with equivocal diagnoses. CONSENSUS POSITION: Equivocal diagnoses should be minimized, to the extent possible, by emphasizing cytologist education and training, improved specimen collection and quality assurance monitoring of individual and laboratory diagnosis rates. Cases fulfilling criteria for other diagnostic entities should not be included in the equivocal category. Regardless of the term utilized, an equivocal diagnosis should be qualified in some manner to indicate that the diagnosis defines a patient at increased risk of a lesion, particularly for those cases which raise concern about a possible high grade lesion. Qualification of an equivocal diagnosis can also be accomplished by appending laboratory statistics of the likelihood of various clinical outcomes or recommendations for patient follow-up. In contrast to favoring a reactive process versus squamous intraepithelial lesion (SIL), a more rationale approach to qualification of atypical squamous cells of undetermined significance may be to separate cases equivocal for low grade SIL from those suspicious for high grade SIL. With regard to glandular lesions, the conference participants expressed unanimous support for the separation of adenocarcinoma in situ (AIS) from atypical endocervical cells of undetermined significance when sufficient criteria are present. However, the diagnosis of a precursor lesion to AIS, endocervical glandular dysplasia, was controversial. The majority of conference participants discourage the use of such terms as mild glandular dysplasia and low grade glandular dysplasia for cytologic diagnoses. ONGOING ISSUES: Conference participants agreed that a term reflecting diagnostic uncertainty is necessary to communicate findings that are equivocal. However, participants could not agree on the wording of such a term. Opinions differed as to: (1) use of atypical, abnormal or morphologic changes to describe cell changes, (2) whether the diagnosis should indicate a squamous or glandular origin of the cells in question when this determination can be made, and (3) the value of defining morphologic criteria for such a diagnosis. The debate over terminology, as well as morphologic criteria, is ongoing, and the readership is invited to communicate opinions to Acta Cytologica. Management of women with equivocal diagnoses varies widely from locale to locale and may differ based on how the equivocal diagnosis is qualified. Findings insufficient for the diagnosis of a high grade lesion may warrant more aggressive follow-up than cases equivocal for a low grade lesion. Where sensitivity of detection of lesions is of paramount importance, follow-up will generally consist of more frequent cytology screening or colposcopy and biopsy. However, in some countries it is considered unethical to have a high percentage of false positive diagnoses, which result in overtreatment and an unnecessary burden for women participating in cervical screening. Future studies may provide a morphologic, or perhaps molecular, basis for distinguishing true precursors of neoplasia from minor lesions of no significant clinical import; this would allow a more coherent and rational approach to diagnosis and management of women with equivocal cytologic findings.

Asunto(s)

Cuello del Útero/patología , Células Epiteliales/patología , Displasia del Cuello del Útero/diagnóstico , Neoplasias del Cuello Uterino/diagnóstico , Frotis Vaginal/normas , Adenocarcinoma/diagnóstico , Adenocarcinoma/patología , Atrofia , Núcleo Celular/ultraestructura , Citoplasma/ultraestructura , Diagnóstico Diferencial , Glándulas Exocrinas/patología , Femenino , Humanos , Metaplasia , Reproducibilidad de los Resultados , Terminología como Asunto , Displasia del Cuello del Útero/patología , Displasia del Cuello del Útero/terapia , Neoplasias del Cuello Uterino/patología , Neoplasias del Cuello Uterino/terapia

RESUMEN

ISSUES: Cervical squamous cell carcinomas, adenocarcinomas and their precursors are caused by the human papillomavirus (HPV). Although HPV appears to be essential to the transformation of these epithelial cells, it is not sufficient, and a variety of cofactors and molecular events must take place between when an HPV infection occurs and a cervical cancer or its precursor develops. This review examines the data supporting these contentions, briefly outlines the molecular events that occur, considers the epidemiology and natural history of the disease, and details the implications of using HPV detection and typing in both clinical management and population-based screening programs. CONSENSUS POSITION: 1. Based on the available molecular, clinical and epidemiologic data, a subset of HPVs are unequivocally the etiologic agents for cervical cancers and their precursors. 2. Different mucosotropic HPVs have varying neoplastic potential. However, the great majority of cervical HPVs have oncogenic potential. Since oncogenic HPV-induced epithelial transformation to a high grade lesion or cancer is rare relative to the rate of infection, the term high risk is discouraged. 3. HPV's interaction with host cells has two principal biologic consequences: a) All anogenital HPVs induce low grade squamous lesions, which are the morphologic correlate of a productive infection. b) Rarely, HPVs induce a proliferative epithelial phenotype that pathologists recognize as a high grade lesion and that is the proximate cytohistologic precursor of invasive cervical carcinoma. 4. HPV biology and issues of practical clinical management should be reflected in the classification systems used for cytologic and histologic diagnosis. ONGOING ISSUES: The molecular identification of HPVs (HPV testing) potentially may be very useful for primary screening or secondary triage of patients with certain lesions. However, the technology available to the practicing clinician is still evolving. Optimization of type spectrum, sensitivity, specificity and ease of use is under development. Data regarding these factors as well as a clear cost benefit analysis are sparse or pending in several large trials. Until such data are available, caution in clinical implementation of HPV testing is warranted.

Asunto(s)

Papillomaviridae , Infecciones por Papillomavirus , Infecciones Tumorales por Virus , Neoplasias del Cuello Uterino/virología , Cervicitis Uterina/virología , Adenocarcinoma/epidemiología , Adenocarcinoma/patología , Adenocarcinoma/virología , Carcinoma/epidemiología , Carcinoma/patología , Carcinoma/virología , ADN Viral/análisis , Femenino , Genoma Viral , Humanos , Tamizaje Masivo , Papillomaviridae/clasificación , Papillomaviridae/aislamiento & purificación , Papillomaviridae/patogenicidad , Papillomaviridae/fisiología , Infecciones por Papillomavirus/epidemiología , Infecciones por Papillomavirus/patología , Infecciones por Papillomavirus/transmisión , Infecciones Tumorales por Virus/epidemiología , Infecciones Tumorales por Virus/patología , Infecciones Tumorales por Virus/transmisión , Neoplasias del Cuello Uterino/epidemiología , Neoplasias del Cuello Uterino/patología , Cervicitis Uterina/epidemiología , Cervicitis Uterina/patología , Frotis Vaginal

Asunto(s)

Cuello del Útero/virología , Papillomaviridae , Infecciones por Papillomavirus/patología , Infecciones Tumorales por Virus/patología , Cuello del Útero/patología , Epitelio/patología , Femenino , Humanos , Inmunohistoquímica , Microscopía Electrónica , Hibridación de Ácido Nucleico , Infecciones por Papillomavirus/diagnóstico , Infecciones Tumorales por Virus/diagnóstico , Neoplasias del Cuello Uterino/virología

RESUMEN

To identify factors associated with persistence of human papillomavirus (HPV) DNA in the uterine cervix, 179 women who were 18-49 years old and who had normal cytologies and positive cervical HPV DNA test at a routine periodic examination were analyzed. Among them, 91 (50.8%) remained HPV-positive a few months (mean, 11 weeks) later. Persistence was higher in women who had used oral contraceptives for > or = 2 years (odds ratio, 3.9; 95% confidence interval, 1.5-10.3) compared with those who never used oral contraceptives or used them for <2 years. HPV types 16, 18, and 31/33/35 appeared more persistent (odds ratio, 2.5; 95% confidence interval, 1.0-6.2) than other types. Persistence seemed to increase with virus load and decrease with increasing interval between examinations.

Asunto(s)

Papillomaviridae/genética , Infecciones por Papillomavirus/diagnóstico , Infecciones Tumorales por Virus/diagnóstico , Enfermedades del Cuello del Útero/virología , Enfermedad Crónica , ADN Viral/análisis , Femenino , Humanos , Factores de Riesgo , Factores de Tiempo

Asunto(s)

Procesamiento de Imagen Asistido por Computador , Frotis Vaginal/instrumentación , Reacciones Falso Negativas , Femenino , Humanos , Control de Calidad , Frotis Vaginal/economía , Frotis Vaginal/normas

RESUMEN

This case-control study assesses relations of human papillomavirus (HPV) type 16 infection, sexual history, cigarette smoking, and oral contraceptive use to low- and high-grade cervical intraepithelial neoplasia (CIN). A total of 548 high-grade and 338 low-grade CIN cases and 612 controls were identified among women seen at a colposcopy clinic in Quebec, Quebec, Canada, in 1988-1989. Interviews, colposcopy, cervical scrapings, and colposcopically directed biopsies were performed. One pathologist reviewed all histologic slides. Southern blot techniques were used to assay specimens for HPV 16 DNA. Lifetime number of sexual partners was related to low- and high-grade CIN. Presence of HPV 16 DNA was associated with a 8.7-fold (95% confidence interval 5.1-15.0) elevation in estimated relative risk of high-grade CIN. Relative risk of high-grade CIN increased with amount of HPV 16 DNA (p < 0.0001). Estimated relative risk of high-grade CIN in current cigarette smokers was 2.4 (95% confidence interval 1.8-3.2) compared with never smokers and increased with number of pack-years of exposure (p < 0.0001). Long-term (6 years or more) users of oral contraceptives had an estimated relative risk of high-grade CIN of 1.9 (95% confidence interval 1.1-3.3) compared with those who never used such contraceptives. In contrast, presence of HPV 16 DNA, cigarette smoking, and oral contraceptive use showed little or no relation to low-grade CIN. Risk factors for low- and high-grade CIN may differ substantially.

Asunto(s)

Displasia del Cuello del Útero/epidemiología , Neoplasias del Cuello Uterino/epidemiología , Adulto , Estudios de Casos y Controles , Anticonceptivos Orales/efectos adversos , Femenino , Humanos , Papillomaviridae/aislamiento & purificación , Infecciones por Papillomavirus/complicaciones , Factores de Riesgo , Conducta Sexual , Fumar/efectos adversos , Infecciones Tumorales por Virus/complicaciones , Neoplasias del Cuello Uterino/patología , Neoplasias del Cuello Uterino/virología , Displasia del Cuello del Útero/patología , Displasia del Cuello del Útero/virología

RESUMEN

OBJECTIVE: To assess the prevalence of genital bacterial infection among women with vulvar vestibulitis syndrome and to evaluate the association of several potential risk factors with the occurrence of the syndrome. METHODS: Fifty-seven women referred for dyspareunia who satisfied Friedrich's criteria and had symptoms for at least 6 months were recruited as cases. Controls included 173 patients without dyspareunia seen at a private clinic. Cases and controls were aged 18-35 years and were not pregnant. RESULTS: Among cases, the prevalences were low for genital infection with gonorrhea (0%), Chlamydia (0%), Trichomonas (0%), Mycoplasma (0%), Gardnerella (14%), and Candida (8.8%). Ureaplasma was detected in the Bartholin glands of ten affected women (17.5%). Human papillomavirus DNA was detected in only three cases (5.3%) based on polymerase chain reaction assays on vestibular biopsies. The relative risk (RR) of the syndrome was related to some aspects of sexual and reproductive history. In particular, the RR in women who had used oral contraceptives (OCs) early (before age 17) reached 11.0 (95% confidence interval [CI] 1.3-97.1) relative to those who had never used OCs. Women who had first intercourse at age 15 or earlier had a 3.3-fold increase in RR (95% CI 1.4-8.0) compared to those who had first intercourse at age 16 or later. CONCLUSION: Our data provide little support for the idea that infection causes the vulvar vestibulitis syndrome. Hormonal factors such as early OC use may be involved in the etiology of this condition.

Asunto(s)

Infecciones Bacterianas/epidemiología , Dispareunia/etiología , Vulvitis/microbiología , Adolescente , Adulto , Estudios de Casos y Controles , Femenino , Humanos , Prevalencia , Riesgo , Factores de Riesgo , Síndrome , Vulvitis/complicaciones

RESUMEN

In a review of cytologic findings in 446,038 premenopausal women whose smears were examined during a five-year period ending in 1990, it was established that cytomorphologic evidence of human papillomavirus infection was significantly more common in the younger groups: those under 30 years of age had about twice the rate of the older groups. Similarly, in a group of 29,153 pregnant women it was found that cytologic signs of human papillomavirus were reported twice as often during the second half of pregnancy as in the first.

Asunto(s)

Papillomaviridae , Infecciones Tumorales por Virus/diagnóstico , Frotis Vaginal , Adulto , Factores de Edad , Femenino , Humanos , Ciclo Menstrual , Embarazo

Asunto(s)

Cuello del Útero/patología , Neoplasias del Cuello Uterino/diagnóstico , Vagina/patología , Frotis Vaginal/métodos , Carcinoma de Células Escamosas/diagnóstico , Carcinoma de Células Escamosas/patología , Femenino , Humanos , Neoplasias del Cuello Uterino/patología

Asunto(s)

Enfermedades de los Genitales Femeninos/diagnóstico , Colposcopía/métodos , Femenino , Humanos , Factores de Tiempo

Asunto(s)

Papillomaviridae , Infecciones Tumorales por Virus/patología , Cervicitis Uterina/patología , Femenino , Humanos , Cervicitis Uterina/microbiología

Asunto(s)

Genitales Femeninos/patología , Infecciones Tumorales por Virus/patología , Carcinoma de Células Escamosas/diagnóstico , Carcinoma de Células Escamosas/patología , Condiloma Acuminado/patología , Diagnóstico Diferencial , Femenino , Humanos , Papillomaviridae , Infecciones Tumorales por Virus/diagnóstico , Neoplasias del Cuello Uterino/diagnóstico , Neoplasias del Cuello Uterino/patología

RESUMEN

Cervical condyloma and cervical intraepithelial neoplasia are related to human papillomavirus infections, some of which may be involved in the etiology of cancer of the uterine cervix. This case-control study was designed to assess the relation of age at first sexual intercourse, number of sexual partners, and cigarette smoking to the risk of cervical condyloma and cervical intraepithelial neoplasia. Cases and controls were premenopausal women under age 50 years who had been referred for examination at the Colposcopy Clinic of Saint-Sacrement Hospital in Quebec from 1982 to 1985. These were 136 cases of histologically confirmed cervical condyloma and 247 cases of cervical intraepithelial neoplasia. The 137 controls were women without anogenital condyloma, dysplasia, or carcinoma. Information on personal characteristics and exposures of subjects was obtained by interview. Associations observed with age at first intercourse were different for condyloma and cervical intraepithelial neoplasia. Relative risk of condyloma varied little with age at first intercourse. In contrast, relative risk of cervical intraepithelial neoplasia increased as age at first intercourse decreased. For the two types of lesions, relative risk was elevated among women with more than one sexual partner and increased steadily with increasing number of cigarettes smoked per day. The association with cigarette smoking was, however, somewhat stronger for cervical intraepithelial neoplasia.

Asunto(s)

Condiloma Acuminado/etiología , Neoplasias del Cuello Uterino/etiología , Adulto , Factores de Edad , Femenino , Humanos , Persona de Mediana Edad , Factores de Riesgo , Conducta Sexual , Fumar/efectos adversos

RESUMEN

A convoluted aceto-white lesion was observed by colposcopy on the uterine cervix of 19 patients. A search for specific types of papillomavirus was undertaken in these lesions which proved histologically to be a vertical association of CIN in the lower strata of the squamous epithelium and typical condyloma in the uppermost layers. Previous cell samples correlated with histology in only 11 out of the 19 cases, and were not therefore an accurate predictor of histologic findings. However 16 out of our 19 cases had sufficient cellular changes to warrant colposcopy and biopsy. Papillomavirus capsid antigen was detected by peroxidase-antiperoxidase staining technique in 12 out of the 19 cases (63.1%). In situ hybridization using biotinylated HPV-16 DNA probes was positive in 13 out of 18 cases (72.2%). Southern blot hybridization gave the typical PstI pattern of HPV-DNA in 8 out of 9 cases examined. The detection of HPV-DNA and HPV capsid antigen was particularly high in this "convoluted" cervical lesion, suggesting that the virus remains biologically active. It may therefore be assumed that this lesion represents a particular phase of the disease process in which early gene function and late gene expression of the viral genome are markedly manifested. Furthermore, this lesion may well represent a link between the early manifestation of HPV infection (condyloma) and CIN, which constitute a morphologic continuum initiated by papillomaviruses.

Asunto(s)

Cuello del Útero/patología , ADN Viral/análisis , Papillomaviridae/genética , Infecciones Tumorales por Virus/patología , Adolescente , Adulto , Antígenos Virales/análisis , Colposcopía , Femenino , Humanos , Hibridación de Ácido Nucleico , Papillomaviridae/inmunología , Neoplasias del Cuello Uterino/patología