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Introduction: Good compliance of the management of abnormal results is important for effective cervical screening. This study investigated the rate of surveillance and follow-up outcomes for human papillomavirus (HPV)-positive women in cervical screening. Method: Women on surveillance by repeat HPV testing were identified in a prospectively managed database. Data retrieved included women's age, country residence status, history of colposcopy, HPV-DNA status on the first and repeat tests, dates of follow-up during the 5 years since the initial screening, and histological diagnosis of cervical lesions. The main outcome measures were compliance rate for repeat HPV testing, regression and persistence rates of HPV subtypes, and detection rate of high-grade lesions (CIN2+). Results: This analysis included 680 residents in the community, mean age 44.8 (95% confidence interval 20.1-69.5) years. The compliance rate of repeat testing was 28.2% at 12 months and, cumulatively, 42.8% for the entire 5-year follow-up period. The rates were unaffected by age (P=0.5829) nor prior colposcopy (P=0.1607). There were 5 (1.7%) cases of CIN2+ detected. Of 391 women on longitudi-nal follow-up, 194 (60.8%) cleared their HPV infection. Some women with multiple HPV infection cleared 1 but not the other subtype(s). Thus, the regression rate was 90.3% for HPV-16, 87.0% for HPV-18 and 65.2% for HPV-12-others (P=0.001). The annualised HPV regression rates were similar for HPV subtypes and for each follow-up year. Conclusion: Surveillance of HPV positivity is clinically important for detecting high-grade lesions. Despite a high regression rate of HPV, surveillance hesitancy is a serious weakness in routine cervical screening.

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In Norway, single cohort vaccination with quadrivalent HPV (qHPV) vaccine targeting 12-year-old girls took place from 2009-2016. In 2020, the oldest vaccinated cohort was 23 years old and had approached the age where risk of being diagnosed with cervical intraepithelial lesion grade 2 or worse (CIN2+) increases rapidly. The aim of this cohort study was to assess direct qHPV vaccine effectiveness (VE) against CIN2+ among Norwegian women aged 16-30 in 2007-2020. By using population-based health registries and individual-level data on vaccination status and potential subsequent CIN2+ incidence, we found 82% qHPV VE among women vaccinated before the age of 17.

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BACKGROUND: An Operational Framework document for population-wide screening of common cancers in India was launched in 2016. The target age for screening is 30-65 years for cervical, breast and oral cancers. This study was designed to review the frequency and distribution of cervical lesions among women aged 21-29, 30-65 and > 65 years. STUDY DESIGN: A retrospective review of all satisfactory cervical smears (n = 79,896) received over a ten-year period (2010-2019) was conducted. Three age bands were defined: 21-29 years, 30-65 years and > 65 years. The frequency and distribution of the various epithelial cell abnormalities (ECAs) across the three age bands were calculated. Cytohistologic correlation was performed wherever available. RESULTS: Of the 1357 ECAs (1.7% of all smears), about 16.9% were seen in the age band 21-29 years, while 4.5% presented in > 65 years of age. About 80% of the ECAs seen in younger women were low-grade squamous lesions, while 75% of lesions in women > 65 years were high-grade squamous abnormalities. Among the total 512 significant high-grade and malignant (squamous and glandular) lesions, 5.6% presented in women 21-29 years, while 10.1% were seen in > 65 years of age. CONCLUSION: Majority of the significant cervical lesions would be detected if the screening focuses on the 30-65 years age group. However, about 19% of high-grade squamous preneoplastic lesions (ASC-H/ HSIL) and 13% of preneoplastic glandular lesions (AGC-N) are likely to be missed if women 21-29 years and > 65 years are excluded. The cost of screening incurred by including these age groups has to be weighed against the benefits derived, especially in low-resource settings. In the absence of universal implementation of HPV immunization, there is a felt need to enhance cervical cancer awareness and encourage screening, more so in high-risk category and symptomatic females beyond the selected age group.

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OBJECTIVE: To study the influence of HIV status on the occurrence of cervical precancerous lesions (CPL). METHODS: This analytical cross-sectional study was carried out between December 1, 2019 and May 31, 2020. All women with documented HIV status screened for CPL with biopsies performed were recruited. The main variables recorded included maternal age, educational level, number of sexual partners, age at first sexual intercourse, smoking, alcohol consumption, HIV status, CD4 count, and cervical biopsy result. Fisher exact test and Student's t test were used for comparison. A p value <0.05 was considered statistically significant. RESULTS: Concerning women attending our screening units, CPL was more frequent among those living with HIV/AIDS (20/92; 21.7%) than among those not living with HIV/AIDS (29/290; 10.0%) (p = 0.004). As regards women living with HIV/AIDS, those with a CD4 count below 350/mL were more at risk of having a CPL (odds ratio [OR] 21.39, 95% confidence interval [CI] 5.60-81.56, p Ë‚ 0.001). High-grade lesions (cervical intraepithelial neoplasia Stage 2 or 3) were more often found in women living with HIV/AIDS (OR 3.83, 95% CI 1.09-13.45, p = 0.033). CONCLUSION: More attention should be paid to women living with HIV/AIDS, especially those with CD4 count less than 350/mL, who should be screened more often with biopsy frequently conducted if indicated.

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AIM: Cervical cancer, the fourth most common cancer in women, is preventable. Colposcopy and colposcopic scoring systems are helpful tools to guide the treatment of precancerous lesions. This study was done to compare the association between Reid colposcopic index (RCI) and Swede score. METHODS: This prospective study enrolled 159 subjects aged 18 years or over with abnormal pap smears or high-risk HPV (types 16 and/or 18). All women underwent colposcopies, and the findings were classified by RCI and Swede score. Biopsies were done in all cases. The performance of both scores was evaluated. RESULTS: A total of 43 (27.0%) high-grade lesions were detected. AUC of ROC of both tests showed excellent performance with 0.906 for RCI and 0.902 for Swede score. The correlation coefficient was 0.986. At a cutoff of 5, RCI had a sensitivity, specificity, positive predictive value, and negative predictive value for detected CIN2+ lesions of 83.7%, 89.7%, 75.0%, and 93.7%, respectively. At a cutoff of 7 for RCI score, the corresponding figures were 46.5%, 99.1%, 95.2%, and 83.3%. At a cutoff of 5, Swede score had a sensitivity, specificity, positive predictive value, and negative predictive value of 88.4%, 87.1%, 71.7%, and 95.3%. At a cutoff of 9 for Swede score, those values were 14.0%, 99.1%, 85.7%, and 75.7%. CONCLUSION: There was a good association between RCI and Swede score. Both scoring systems had the good performance. Swede score is effective for practical use and applied in Thailand.

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The relative as well as absolute increase in cervical adenocarcinomas has brought the glandular lesions of cervix into attention of the cytologists and molecular biologists alike. Though the cytologic criteria for diagnosis of these lesions have been refined to a great extent through the evolution of the Bethesda System for reporting cervical smears, still some challenges exist regarding an accurate recognition of glandular cell changes in cervical smears and molecular tests to aid their detection. The present review is a narrative compilation of the current status of identification of cervical glandular abnormalities in the smear, the changing scenario of their histologic outcomes, newer entities within the category of glandular lesions and molecular cytology as relevant to this topic. The script also briefly explores the role of HPV DNA testing, the outcomes of HPV-positive and negative glandular abnormalities and the potential status of glandular lesions in the wake of implementation of HPV vaccination. Though this review is not an exhaustive one, it aims to put the issues pertaining to cervical glandular abnormalities into perspective and to explore the future research directions.

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BACKGROUND: Low-grade squamous intraepithelial lesion/cervical intraepithelial neoplasia grade 1 (LSIL/CIN1) preceded by colposcopy guided biopsy is recommended conservative follow-up, although some of these lesions are actually high-grade lesions, which are missed on an initial colposcopy. Therefore, in this work, we evaluate the potential role of miRNA detection in cervical exfoliated cells in a clinic-based population for predicting missed high-grade lesions in women diagnosed with LSIL/CIN1 after colposcopy-guided biopsy. METHODS: A total number of 177 women with a diagnosis of LSIL/CIN1 obtained by colposcopy-guided biopsy were grouped into two categories according to the histology of the conization specimens: consistent LSIL/CIN1 group (surgical pathology consistent with colposcopic diagnosis) and missed high-grade lesion group (surgical pathology found high-grade lesion). The expression of eight miRNAs, such as miRNA195, miRNA424, miRNA375, miRNA218, miRNA34a, miRNA29a, miRNA16-2, and miRNA20a was detected by real time-quantitative polymerase chain reaction (RT-qPCR) in cervical exfoliated cells of the 177 patients. Pearson Chi-Square was used to compare the performance efficiency of patients' characteristics. Nonparametric Man-Whitney U test was used to assess differences in miRNA expression. The receiver operating characteristic (ROC) curve was used to assess the performance of miRNA evaluation in detecting missed high-grade lesions. RESULTS: Among the 177 women with biopsy-confirmed CIN1, 15.3% (27/177) had CIN2+ in the conization specimen (missed high-grade lesion group) and 84.7% (150/177) had CIN1-(consistent LSIL/CIN1 group). The relative expression of miRNA-195 and miRNA-29a in the missed high-grade lesion group was significantly lower than that in the consistent LSIL/CIN1 group. The relative expression of miRNA16-2 and miRNA20a in the missed high-grade lesion group was significantly higher than that in the consistent LSIL/CIN1 group. No significant difference was observed between these two groups regarding the other four miRNAs. Of these significant miRNAs, miRNA29a detection achieved the highest Youden index (0.733), sensitivity (92.6%), positive predictive value (46.2%), negative predictive value (98.3%) and higher specificity (80.7%) when identifying missed high-grade lesions. CONCLUSIONS: Detection of miRNA might provide a new triage for identifying a group at higher risk of missed high-grade lesions in women with colposcopy diagnosis of LSIL/CIN1.

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