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OBJECTIVE: Aim: To investigate the influence of the following prognostic factors: age, parity, hormonal status (premenopausal, postmenopausal), histological result from targeted biopsy (LSIL, HSIL), adequacy of colposcopic examination (satisfactory, unsatisfactory colposcopy), type of TZ (type 1, 2, 3), type of cervical lesions (type 1, 2, 3), the colposcopic impression (diagnosis) of the cervical lesion (LSIL, HSIL/Ca colli uteri in situ), lesion size (up to 1/3; up to 2/3; more than 2/3 of the cervical circumference) for the occurrence of LSIL and HSIL/Ca colli uteri in situ in the final histological result after LLETZ procedure. PATIENTS AND METHODS: Materials and Methods: This is a prospective study (01.01.2017 - 31.07. 2021) including 189 patients with cervical precancerous lesions received LLETZ treatment One gynaecologic oncologist performed video colposcopy, targeted biopsy, and LLETZ. One histopathologist diagnosed histological specimens from the biopsy and LLETZ procedure. RESULTS: Results: We found a statistically significant correlation between the histological result of the targeted biopsy factor and the colposcopic diagnosis factor concerning the final histological result of LLETZ. The cervical lesion size factor and cervical lesion type factor have prognostic significance for the histological outcome following LLETZ. CONCLUSION: Conclusions: The histological result of targeted biopsy and colposcopic diagnosis are significant factors for the final histological result after LLETZ. Cervical lesion invasion into the endocervical canal is a prognostic factor for HSIL, and its invisible borders - for carcinoma (in situ or microinvasive/invasive). Lesion size up to 1/3 of the cervix is a prognostic factor for LSIL and large lesions (2/3 of the cervix) - for HSIL and cervical cancer (in situ, microinvasive/invasive).
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Colposcopía , Neoplasias del Cuello Uterino , Humanos , Femenino , Pronóstico , Adulto , Estudios Prospectivos , Neoplasias del Cuello Uterino/patología , Persona de Mediana Edad , Displasia del Cuello del Útero/patología , Lesiones Intraepiteliales Escamosas de Cuello Uterino/patología , Cuello del Útero/patología , Lesiones Intraepiteliales Escamosas/patologíaRESUMEN
To compare the clearance rate of high-risk human papillomavirus (HR-HPV) in patients with high-grade squamous intraepithelial lesion (HSIL) after 2 different treatments (conization vs hysterectomy), and investigate the influencing factors. A retrospective cohort was established in HSIL patients with HR-HPV infection treated with conization or hysterectomy from July 2020 to May 2022. Age matching (1:1) was conducted between conization group and hysterectomy group. Chi-square test and t-test were employed to compare baseline and clinical characteristics between the 2 groups (conization vs hysterectomy). In addition, univariate and multivariate logistic regression analyses were conducted to compare the influencing factors for HR-HPV clearance at 6 months after surgery. The HR-HPV clearance rates at 6 months were 70.6% and 73.8% in conization group and hysterectomy group in the matched groups, respectively (Pâ =â .755). Similarly, at 12 months, the clearance rates were 78.6% and 76.5% in the matched groups, respectively (Pâ =â .844). Considering different age groups among all patients, the HR-HPV clearance rates were 81.8%, 72.9%, 73.5%, and 53.6% in the 20 to 30-year, 31 to 40-year, 41 to 50-year and 51 to 60-year groups at 6 months, respectively, and the clearance rates were 87.5%, 80.6%, 84.5% and 52.9% at 12 months, respectively. For HSIL, the postoperative HPV clearance rates were similar between the 2 groups (conization vs hysterectomy), conization is enough to resect the lesion and eliminate HPV. In addition, we should pay attention to the postoperative HR-HPV status in the older population of the 2 groups.
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Conización , Histerectomía , Infecciones por Papillomavirus , Humanos , Femenino , Conización/métodos , Adulto , Estudios Retrospectivos , Histerectomía/métodos , Persona de Mediana Edad , Infecciones por Papillomavirus/cirugía , Neoplasias del Cuello Uterino/cirugía , Neoplasias del Cuello Uterino/virología , Neoplasias del Cuello Uterino/patología , Papillomaviridae/aislamiento & purificación , Lesiones Intraepiteliales Escamosas/virología , Lesiones Intraepiteliales Escamosas/cirugía , Lesiones Intraepiteliales Escamosas/patología , Adulto Joven , Displasia del Cuello del Útero/cirugía , Displasia del Cuello del Útero/virología , Displasia del Cuello del Útero/patología , Factores de Edad , Lesiones Intraepiteliales Escamosas de Cuello Uterino/cirugía , Lesiones Intraepiteliales Escamosas de Cuello Uterino/patología , Lesiones Intraepiteliales Escamosas de Cuello Uterino/virología , Virus del Papiloma HumanoRESUMEN
OBJECTIVE: In this study, we established a Sprague-Dawley rat model of vulvar squamous intraepithelial lesions and investigated the impact of focused ultrasound on the expression of hypoxia-inducible factor-1α (HIF-1α), vascular endothelial growth factor (VEGF) and mutant type p53 (mtp53) in the vulvar skin of rats with low-grade squamous intraepithelial lesions (LSIL). MATERIALS AND METHODS: The vulvar skin of 60 rats was treated with dimethylbenzanthracene (DMBA) and mechanical irritation three times a week for 14 weeks. Rats with LSIL were randomly allocated into the experimental group or the control group. The experimental group was treated with focused ultrasound, while the control group received sham treatment. RESULTS: After 14 weeks treatment of DMBA combined with mechanical irritation, LSIL were observed in 44 (73.33%) rats, and high-grade squamous intraepithelial lesions (HSIL) were observed in 14 (23.33%) rats. 90.91% (20/22) of rats showed normal pathology and 9.09% (2/22) of rats exhibited LSIL in the experimental group at four weeks after focused ultrasound treatment. 22.73% (5/22) of rats exhibited LSIL, 77.27% (17/22) of rats progressed to HSIL in the control group. Compared with the control-group rats, the levels of HIF-1α, VEGF and mtp53 were significantly decreased in experimental-group rats (p < 0.05). CONCLUSIONS: These results indicate that DMBA combined with mechanical irritation can induce vulvar squamous intraepithelial lesion in SD rats. Focused ultrasound can treat LSIL safely and effectively, prevent the progression of vulvar lesions, and improve the microenvironment of vulvar tissues by decreasing the localized expression of HIF-1α, VEGF, and mtp53 in rats.
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Ratas Sprague-Dawley , Lesiones Intraepiteliales Escamosas , Animales , Femenino , Ratas , Lesiones Intraepiteliales Escamosas/patología , Subunidad alfa del Factor 1 Inducible por Hipoxia/metabolismo , Factor A de Crecimiento Endotelial Vascular/metabolismo , Neoplasias de la Vulva/patología , Neoplasias de la Vulva/terapia , Terapia por Ultrasonido/métodos , Proteína p53 Supresora de Tumor/metabolismoRESUMEN
BACKGROUND: Anal cancer is caused by human papillomavirus (HPV), particularly HPV-16, and is preceded by anal high-grade squamous intraepithelial lesions (HSILs). The incidence of anal cancer is highest among men who have sex with men (MSM) living with HIV (MSMLWH) and increases with age. However, most previous studies of anal HPV infection and anal HSIL were performed on men under 50 years old, and relatively little is known about HSIL among older MSMLWH or MSM not living with HIV (MSM-Not-LWH). SETTING: We enrolled MSM who were aged 50+ during 2018-2022 in San Francisco, CA. METHODS: One hundred twenty-nine MSMLWH and 109 MSM-not-LWH participated. All participants had anal HPV DNA testing (Atila Biosystems) and high-resolution anoscopy with a biopsy of visible lesions. RESULTS: Among MSMLWH, 47% had anal HSIL, 19% had HPV-16, and 51% had other oncogenic anal HPV types (excluding HPV-16). Among MSM-not-LWH, 37% had anal HSIL, 22% had HPV-16, and 34% had other oncogenic anal HPV types. Increasing age was not statistically associated with prevalent HSIL, HPV-16, or other oncogenic HPV infections in MSMLWH or MSM-not-LWH. HPV-16 (odds ratio: 45.1, 95% confidence interval: 15.8-129); other oncogenic HPV types (odds ratio: 5.95, 95% confidence interval: 2.74-12.9) were associated with increased odds of anal HSIL, adjusted for age, income, education, and HIV status. CONCLUSION: The prevalence of oncogenic anal HPV, anal HPV-16, and anal HSIL remains very high in older MSMLWH and MSM-not-LWH. With recent evidence showing that treating anal HSIL prevents anal cancer, MSM aged 50+ should be considered for anal cancer screening.
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Neoplasias del Ano , Infecciones por VIH , Homosexualidad Masculina , Infecciones por Papillomavirus , Lesiones Intraepiteliales Escamosas , Humanos , Masculino , Infecciones por Papillomavirus/epidemiología , Infecciones por Papillomavirus/complicaciones , Persona de Mediana Edad , Infecciones por VIH/complicaciones , Infecciones por VIH/epidemiología , Prevalencia , Lesiones Intraepiteliales Escamosas/virología , Lesiones Intraepiteliales Escamosas/epidemiología , Lesiones Intraepiteliales Escamosas/patología , Neoplasias del Ano/epidemiología , Neoplasias del Ano/virología , Anciano , San Francisco/epidemiología , Canal Anal/virología , Canal Anal/patología , Papillomaviridae/genética , Papillomaviridae/aislamiento & purificaciónRESUMEN
We assessed cumulative detection and determinants of anal high-grade squamous intraepithelial lesions (HSILs) in men who have sex with men living with human immunodeficiency virus and who underwent 3 visits over 2 years, with cytology and high-resolution anoscopy, within the ANRS-EP57-APACHES study. The cumulative HSIL detection rate was 33% (134 of 410), of which 48% HSILs were detected at baseline. HSIL detection varied considerably by center (from 13% to 51%). The strongest HSIL determinants were baseline human papillomavirus 16 (adjusted odds ratio, 8.2; 95% confidence interval, 3.6-18.9) and p16/Ki67 (4.6 [2.3-9.1]). Repeated annual cytology and high-resolution anoscopy improved HSIL detection but did not fully compensate for between-center heterogeneity.
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Neoplasias del Ano , Infecciones por VIH , Homosexualidad Masculina , Infecciones por Papillomavirus , Lesiones Intraepiteliales Escamosas , Humanos , Masculino , Infecciones por VIH/complicaciones , Lesiones Intraepiteliales Escamosas/virología , Lesiones Intraepiteliales Escamosas/patología , Francia/epidemiología , Adulto , Neoplasias del Ano/virología , Neoplasias del Ano/diagnóstico , Neoplasias del Ano/epidemiología , Neoplasias del Ano/patología , Persona de Mediana Edad , Infecciones por Papillomavirus/virología , Infecciones por Papillomavirus/complicaciones , Infecciones por Papillomavirus/diagnóstico , Estudios de Seguimiento , Canal Anal/virología , Canal Anal/patología , Papillomavirus Humano 16/aislamiento & purificación , Minorías Sexuales y de GéneroRESUMEN
Anal squamous cell carcinoma (ASCC) is a rare gastrointestinal malignancy linked to high-risk human papillomavirus (HPV) infection, which develops from precursor lesions like low-grade squamous intraepithelial lesions and high-grade squamous intraepithelial lesions (HGSILs). ASCC incidence varies across populations and poses increased risk for people living with HIV. Our investigation focused on transcriptomic and metatranscriptomic changes from squamous intraepithelial lesions to ASCC. Metatranscriptomic analysis highlighted specific bacterial species (e.g., Fusobacterium nucleatum, Bacteroides fragilis) more prevalent in ASCC than precancerous lesions. These species correlated with gene-encoding enzymes (Acca, glyQ, eno, pgk, por) and oncoproteins (FadA, dnaK), presenting potential diagnostic or treatment markers. Unsupervised transcriptomic analysis identified distinct sample clusters reflecting histological diagnosis, immune infiltrate, HIV/HPV status, and pathway activities, recapitulating anal cancer progression's natural history. Our study unveiled molecular mechanisms in anal cancer progression, aiding in stratifying HGSIL cases based on low or high risk of progression to malignancy.
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Neoplasias del Ano , Carcinoma de Células Escamosas , Transcriptoma , Humanos , Neoplasias del Ano/genética , Neoplasias del Ano/inmunología , Neoplasias del Ano/patología , Neoplasias del Ano/virología , Neoplasias del Ano/microbiología , Carcinoma de Células Escamosas/genética , Carcinoma de Células Escamosas/inmunología , Carcinoma de Células Escamosas/microbiología , Carcinoma de Células Escamosas/patología , Microbiota/inmunología , Masculino , Infecciones por Papillomavirus/complicaciones , Infecciones por Papillomavirus/genética , Infecciones por Papillomavirus/virología , Infecciones por Papillomavirus/inmunología , Lesiones Intraepiteliales Escamosas/genética , Lesiones Intraepiteliales Escamosas/patología , Lesiones Intraepiteliales Escamosas/virología , Femenino , Progresión de la Enfermedad , Persona de Mediana Edad , Infecciones por VIH/complicaciones , Infecciones por VIH/inmunologíaRESUMEN
BACKGROUND: Superficially invasive squamous cell carcinoma (SISCC) and high-grade squamous intraepithelial lesions (HSIL) involving the anal canal are rare, and their surgical management involves local excision. Endoscopic submucosal dissection (ESD) has recently emerged as a promising treatment. This study aimed to evaluate the feasibility and safety of ESD for SISCC and HSIL in the anal canal. METHODS: All patients diagnosed with SISCC or HSIL in the anal canal who underwent ESD between November 2018 and May 2023 were included. Patient age, sex, pathology, human immunodeficiency virus (HIV) status, human papillomavirus (HPV) status, T stage, en bloc rate, and R0 resection rate were analyzed. RESULTS: Ten patients, including two men and eight women, with a median age of 61 (51-68) years were enrolled. All patients were HIV-negative, but five (50%) were HPV-positive. Pathological examination showed tumor stage of two patients as T2, one as T0 of SISCC, and seven as Tis of HSIL. The median specimen and tumor sizes were 24 (6-65) mm and 18 (6-55) mm, respectively. The en bloc and R0 resection rates were 100% and 80%, respectively. No severe complications occurred and no recurrence was observed at the follow-up (median follow-up period, 9 (1-35) months). CONCLUSIONS: ESD is a reliable and minimally invasive procedure that enables more individualized treatment options for specific groups. As we were limited by the length of the observation period, the long-term performance of ESD for SISCC and HSIL involving the anal canal requires further investigation.
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Canal Anal , Neoplasias del Ano , Carcinoma de Células Escamosas , Resección Endoscópica de la Mucosa , Lesiones Intraepiteliales Escamosas , Humanos , Masculino , Persona de Mediana Edad , Femenino , Resección Endoscópica de la Mucosa/métodos , Anciano , Neoplasias del Ano/cirugía , Neoplasias del Ano/patología , Carcinoma de Células Escamosas/cirugía , Carcinoma de Células Escamosas/patología , Lesiones Intraepiteliales Escamosas/cirugía , Lesiones Intraepiteliales Escamosas/patología , Lesiones Intraepiteliales Escamosas/virología , Canal Anal/cirugía , Canal Anal/patología , Estudios de Factibilidad , Resultado del Tratamiento , Invasividad Neoplásica , Estudios Retrospectivos , Estadificación de NeoplasiasRESUMEN
BACKGROUND: Prevention of high-risk HPV (HR-HPV) infection and effective medical intervention of persistent HPV infection and precancerous lesions are critical for the prevention of cervical cancer. AIMS: The aim of this retrospective comparative study was to evaluate the outcomes of ALA PDT and observation only in the management of low-grade squamous intraepithelial lesions (LSIL). METHODS: In PDT Group (n = 138), ALA PDT was applied to patients with colposcopic biopsy confirmed cervical LSIL accompanied with HR-HPV infection longer than 1 year or HPV 16/18 subtype infection. Cervical LSIL only patients received 3 times of ALA PDT and those with concurrent cervical canal or vaginal lesions received 6 times ALA PDT. Control Group (n = 69) received observation only. Colposcopy, TCT and HPV typing were performed before and after treatment. Patients were followed up for up to two years. RESULT: The observation group showed 26.1%, 34.8% and 53.6% HR-HPV negative conversion at 3-6, 12 and 24 months, respectively. LSIL regression rate of the observation group was 33.33%, 36.23% and 65.22% at 3-6, 12 and 24 months, respectively. There was 62.32%, 80.56% and 89.22% patients achieved HPV clearance at 3-6, 12 and 24 months after PDT treatment, respectively. The LSIL remission rate was 89.86%, 94.40% and 96.08% at 3-6, 12 and 24 months after ALA PDT, respectively. The abnormal TCT (⧠ASCUS) was reduced from 92% to 10.1%, 4.6% and 3.9% at 3-6, 12 and 24 months after ALA PDT, respectively. The patient age was not a factor affecting the clearance of HPV infection and the LSIL regression rate of PDT treatment. CONCLUSIONS: This study demonstrates that the application of multiple ALA PDT treatments has added value in achieving both short-term and long-term HPV and lesion clearance.
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Ácido Aminolevulínico , Infecciones por Papillomavirus , Fotoquimioterapia , Fármacos Fotosensibilizantes , Humanos , Femenino , Fotoquimioterapia/métodos , Ácido Aminolevulínico/uso terapéutico , Fármacos Fotosensibilizantes/uso terapéutico , Adulto , Estudios Retrospectivos , Persona de Mediana Edad , Infecciones por Papillomavirus/tratamiento farmacológico , Lesiones Intraepiteliales Escamosas/tratamiento farmacológico , Neoplasias del Cuello Uterino/tratamiento farmacológicoRESUMEN
Men who have sex with men (MSM) with HIV are at high risk for squamous intraepithelial lesion (SIL) and anal cancer. Identifying local immunological mechanisms involved in the development of anal dysplasia could aid treatment and diagnostics. Here, we studied 111 anal biopsies obtained from 101 MSM with HIV, who participated in an anal screening program. We first assessed multiple immune subsets by flow cytometry, in addition to histological examination, in a discovery cohort. Selected molecules were further evaluated by immunohistochemistry in a validation cohort. Pathological samples were characterized by the presence of resident memory T cells with low expression of CD103 and by changes in natural killer cell subsets, affecting residency and activation. Furthermore, potentially immunosuppressive subsets, including CD15+CD16+ mature neutrophils, gradually increased as the anal lesion progressed. Immunohistochemistry verified the association between the presence of CD15 in the epithelium and SIL diagnosis for the correlation with high-grade SIL. A complex immunological environment with imbalanced proportions of resident effectors and immune-suppressive subsets characterized pathological samples. Neutrophil infiltration, determined by CD15 staining, may represent a valuable pathological marker associated with the grade of dysplasia.
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Neoplasias del Ano , Infecciones por VIH , Antígeno Lewis X , Humanos , Masculino , Infecciones por VIH/inmunología , Infecciones por VIH/complicaciones , Infecciones por VIH/patología , Neoplasias del Ano/patología , Neoplasias del Ano/inmunología , Adulto , Persona de Mediana Edad , Antígeno Lewis X/metabolismo , Homosexualidad Masculina , Lesiones Intraepiteliales Escamosas/patología , Canal Anal/patología , Células Asesinas Naturales/inmunología , Células Asesinas Naturales/metabolismo , Antígenos CD/metabolismo , Neutrófilos/inmunología , Neutrófilos/patología , Neutrófilos/metabolismo , Biopsia , Inmunohistoquímica , Cadenas alfa de Integrinas/metabolismoRESUMEN
OBJECTIVE: This study aimed to investigate the feasibility, efficacy, and safety of focused ultrasound (FUS) for the treatment of vulvar low-grade squamous intraepithelial lesions (VLSIL) with persistent symptoms. METHODS: This retrospective analysis included 24 VLSIL patients who underwent FUS treatment. At each follow-up visit, the clinical response was assessed including changes in symptoms and signs. In addition, the histological response was assessed based on the vulvar biopsy results of the 3rd follow-up. Clinical and histological response were assessed to elucidate the efficacy. RESULTS: A total of 22 patients completed follow-up and post-treatment pathological biopsies. After treatment, the clinical scores of itching decreased from 2.55 ± 0.51 to 0.77 ± 0.81 (p < 0.05). Furthermore, the clinical response rate and histological response rate were 86.4% and 81.8%, respectively. Only two cured patients indicated recurrence in the 3rd and 4th year during the follow-up period and achieved cure after re-treatment. In terms of adverse effects, only one patient developed ulcers after treatment, which healed after symptomatic anti-inflammatory treatment without scarring, and no other treatment complications were found in any patients. None of the patients developed a malignant transformation during the follow-up period. CONCLUSION: This study revealed that FUS is feasible, effective, and safe for treating VLSIL patients with persistent symptoms, providing a new solution for the noninvasive treatment of symptomatic VLSIL.
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Estudios de Factibilidad , Lesiones Intraepiteliales Escamosas , Humanos , Femenino , Persona de Mediana Edad , Adulto , Lesiones Intraepiteliales Escamosas/patología , Lesiones Intraepiteliales Escamosas/diagnóstico por imagen , Lesiones Intraepiteliales Escamosas/terapia , Estudios Retrospectivos , Neoplasias de la Vulva/terapia , Neoplasias de la Vulva/patología , Neoplasias de la Vulva/diagnóstico por imagen , Anciano , Terapia por Ultrasonido/métodosRESUMEN
OBJECTIVES: This study aims to analyze factors associated with positive surgical margins following cold knife conization (CKC) in patients with cervical high-grade squamous intraepithelial lesion (HSIL) and to develop a machine-learning-based risk prediction model. METHOD: We conducted a retrospective analysis of 3,343 patients who underwent CKC for HSIL at our institution. Logistic regression was employed to examine the relationship between demographic and pathological characteristics and the occurrence of positive surgical margins. Various machine learning methods were then applied to construct and evaluate the performance of the risk prediction model. RESULTS: The overall rate of positive surgical margins was 12.9%. Independent risk factors identified included glandular involvement (OR = 1.716, 95% CI: 1.345-2.189), transformation zone III (OR = 2.838, 95% CI: 2.258-3.568), HPV16/18 infection (OR = 2.863, 95% CI: 2.247-3.648), multiple HR-HPV infections (OR = 1.930, 95% CI: 1.537-2.425), TCT ≥ ASC-H (OR = 3.251, 95% CI: 2.584-4.091), and lesions covering ≥ 3 quadrants (OR = 3.264, 95% CI: 2.593-4.110). Logistic regression demonstrated the best prediction performance, with an accuracy of 74.7%, sensitivity of 76.7%, specificity of 74.4%, and AUC of 0.826. CONCLUSION: Independent risk factors for positive margins after CKC include HPV16/18 infection, multiple HR-HPV infections, glandular involvement, extensive lesion coverage, high TCT grades, and involvement of transformation zone III. The logistic regression model provides a robust and clinically valuable tool for predicting the risk of positive margins, guiding clinical decisions and patient management post-CKC.
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Conización , Aprendizaje Automático , Márgenes de Escisión , Neoplasias del Cuello Uterino , Humanos , Femenino , Estudios Retrospectivos , Adulto , Conización/métodos , Persona de Mediana Edad , Neoplasias del Cuello Uterino/cirugía , Neoplasias del Cuello Uterino/patología , Lesiones Intraepiteliales Escamosas/patología , Lesiones Intraepiteliales Escamosas/cirugía , Factores de Riesgo , Lesiones Intraepiteliales Escamosas de Cuello Uterino/cirugía , Lesiones Intraepiteliales Escamosas de Cuello Uterino/patología , Displasia del Cuello del Útero/cirugía , Displasia del Cuello del Útero/patología , Infecciones por Papillomavirus/complicaciones , Anciano , Modelos Logísticos , Criocirugía/métodos , Adulto JovenRESUMEN
Objective: The objective of this study was to delineate the profile of peripheral blood lymphocytic indices in patients afflicted with high-grade squamous intraepithelial lesions (HSIL) and cervical neoplasms, and to elucidate the correlation of these hematologic markers with the clinicopathological spectra in individuals diagnosed with cervical carcinoma. Methods: We adopted a retrospective case-control modality for this investigation. An aggregate of 39 HSIL patients and 42 cervical carcinoma patients, who were treated in our facility from July 2020 to September 2023, were meticulously selected. Each case of cervical malignancy was confirmed through rigorous histopathological scrutiny. Concomitantly, 31 healthy female individuals, who underwent prophylactic health evaluations during the corresponding timeframe, were enlisted as the baseline control group. We systematically gathered and analyzed clinical demographics, as well as the neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR), from peripheral blood samples. Pearson's correlation coefficient was deployed to dissect the interrelation between peripheral NLR and PLR concentrations and the clinicopathological features in the cervical cancer group. Results: Inter-group comparative analysis unveiled statistically substantial variances in the PLR and NLR values among the tripartite clusters (F = 36.941, 14.998, P < 0.001, respectively). Although discrepancy in NLR (P = 0.061) and PLR (P = 0.759) measures between the groups of cervical carcinoma and HSIL was not statistically appreciable, these indices were markedly elevated in the cervical carcinoma faction as juxtaposed with the normative control group (t = 5.094, 5.927; P < 0.001 for both parameters). A discernible gradation in peripheral blood PLR and NLR concentrations was noted when stratified by clinical stage and the profundity of myometrial invasion in cervical cancer subjects (P < 0.001). The correlation matrix demonstrated a positive liaison between peripheral blood PLR and the clinical gradation, as well as the invasiveness of the neoplastic cells into the muscularis propria (P < 0.05); a similar trend was observed with the NLR values (P < 0.05). Conclusion: Augmented NLR and PLR levels in peripheral blood specimens are indicative of HSIL and cervical malignancy. These hematological parameters exhibit a pronounced interconnection with clinical staging and muscular wall penetration depth, serving as potential discriminative biomarkers for the diagnosis and prognosis of cervical cancer.
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Neutrófilos , Neoplasias del Cuello Uterino , Humanos , Femenino , Neoplasias del Cuello Uterino/sangre , Neoplasias del Cuello Uterino/patología , Neoplasias del Cuello Uterino/inmunología , Estudios Retrospectivos , Adulto , Persona de Mediana Edad , Neutrófilos/patología , Neutrófilos/inmunología , Estudios de Casos y Controles , Linfocitos/patología , Linfocitos/inmunología , Lesiones Intraepiteliales Escamosas/patología , Lesiones Intraepiteliales Escamosas/sangre , Recuento de Linfocitos , Plaquetas/patología , Plaquetas/inmunología , Lesiones Intraepiteliales Escamosas de Cuello Uterino/sangre , Lesiones Intraepiteliales Escamosas de Cuello Uterino/patología , Lesiones Intraepiteliales Escamosas de Cuello Uterino/inmunología , Lesiones Intraepiteliales Escamosas de Cuello Uterino/diagnósticoRESUMEN
PURPOSE: We aimed to evaluate the efficacy and safety of HiPorfin-photodynamic therapy (PDT) in women with vaginal high-grade squamous intraepithelial Lesion (HSIL). METHODS: Retrospective analysis of eighteen patients with vaginal HSIL received HiPorfin-PDT between June 2019 and May 2023. Illumination with a 630-nm laser light was applied to the lesions 48-72 h after intravenous injection of 2 mg/kg HiPorfin®. The light dose to the lesions was 150 J/cm2. RESULTS: The mean age of the 18 patients was 45.8 years (range, 24 to 63). The complete response (CR) rate was 66.7% (12/18), 83.3% (15/18) and 83.3% (15/18) at 3, 6 and 12 months after PDT, respectively. Patients who achieved CR showed no signs of recurrence during long-term follow-up. There were three cases of persistent disease showing partial response (PR) and the lesion area was significantly reduced more than 50%. One patient with persistent disease then underwent thermocoagulation one time and subsequently showed no evidence of HSIL. Pre-treatment, 100% (18/18) patients were high-risk human papilloma virus (HR-HPV)-positive. HPV eradication rate was 16.7% (3/18), 22.2% (4/18) and 44.4% (8/18) after PDT at 3, 6 and 12 months, respectively. Before treatment, liquid-based cytology test ≥ atypical squamous cells of undetermined significance (ASCUS) was 94.4% (17/18). Negative conversion ratio of cytology was 47.1% (8/17), 52.9% (9/17) and 76.5% (13/17) at 3, 6 and 12 months, respectively. There were no serious adverse effects during and after PDT. CONCLUSIONS: HiPorfin-PDT may be an effective alternative treatment for vaginal HSIL for organ-saving and sexual function protection.
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Fotoquimioterapia , Lesiones Intraepiteliales Escamosas , Neoplasias Vaginales , Humanos , Adulto , Fotoquimioterapia/efectos adversos , Fotoquimioterapia/métodos , Neoplasias Vaginales/patología , Neoplasias Vaginales/terapia , Lesiones Intraepiteliales Escamosas/patología , Lesiones Intraepiteliales Escamosas/terapia , Resultado del Tratamiento , Persona de Mediana EdadRESUMEN
BACKGROUND: Solid organ transplant recipients are at an increased risk for anogenital Human Papillomavirus (HPV)-related disease, including anal high-grade squamous intraepithelial lesions (HSIL) and anal squamous cell cancer (ASCC). Guidelines for ASCC screening in transplant recipients are limited. Our aim was to understand current practice of ASCC screening in adult liver transplant (LT) candidates and recipients at transplant centers across the United States. METHODS: We surveyed medical directors of 113 LT centers across the United States which had publicly available contact information. The survey evaluated center perceptions on cancer and HPV disease risk in transplant populations, ASCC screening, barriers and facilitators for ASCC screening and HPV vaccination practices. RESULTS: We received 26/113 (23%) responses, of which 24 were complete and included in the analysis. Eleven of 24 (46%) centers reported screening for ASCC and 3/24 (12.5%) centers reported having formal guidelines. Centers who perform ASCC screening were more likely to perform transplants in people living with HIV and were more aware of the burden of HPV disease in transplant populations. All respondents believed that additional data on the impact of screening on ASCC incidence would support screening decisions. Increased access to specialists for screening/high-resolution anoscopy was also perceived as a facilitator. Only 7/24 (29%) centers regularly evaluated HPV vaccination status of their patients. CONCLUSION: This national survey of LT centers reveals non-standardized ASCC screening practices, and identified data, educational and resource needs to improve prevention of ASCC in this population.
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Neoplasias del Ano , Detección Precoz del Cáncer , Trasplante de Hígado , Infecciones por Papillomavirus , Vacunas contra Papillomavirus , Humanos , Neoplasias del Ano/virología , Neoplasias del Ano/prevención & control , Infecciones por Papillomavirus/complicaciones , Infecciones por Papillomavirus/prevención & control , Estados Unidos/epidemiología , Trasplante de Hígado/efectos adversos , Detección Precoz del Cáncer/métodos , Encuestas y Cuestionarios , Vacunas contra Papillomavirus/administración & dosificación , Vacunas contra Papillomavirus/uso terapéutico , Femenino , Masculino , Tamizaje Masivo/métodos , Carcinoma de Células Escamosas/virología , Lesiones Intraepiteliales Escamosas/virología , Receptores de Trasplantes/estadística & datos numéricosRESUMEN
INTRODUCTION: Men who have sex with men (MSM), especially those living with HIV, are at an increased risk of anal cancer. The prevalence and incidence of its precursor, anal high-grade squamous intraepithelial lesions (HSILs), among MSM who started antiretroviral therapy during acute HIV acquisition are yet to be explored. METHODS: Participants in an acute HIV acquisition cohort in Bangkok, Thailand, who agreed to take part in this study, were enrolled. All participants were diagnosed and started antiretroviral therapy during acute HIV acquisition. Human papillomavirus (HPV) genotyping and high-resolution anoscopy, followed by anal biopsy as indicated, were done at baseline and 6-monthly visits. RESULTS: A total of 89 MSM and four transgender women were included in the analyses. Median age at enrolment was 26 years. Baseline prevalence of histologic anal HSIL was 11.8%. With a total of 147.0 person-years of follow-up, the incidence of initial histologic anal HSIL was 19.7 per 100 person-years. Factors associated with incident anal HSIL were anal HPV 16 (adjusted hazards ratio [aHR] 4.33, 95% CI 1.03-18.18), anal HPV 18/45 (aHR 6.82, 95% CI 1.57-29.51), other anal high-risk HPV (aHR 4.23, 95% CI 1.27-14.14), syphilis infection (aHR 4.67, 95% CI 1.10-19.90) and CD4 count <350 cells/mm3 (aHR 3.09, 95% CI 1.28-7.48). CONCLUSIONS: With antiretroviral therapy initiation during acute HIV acquisition, we found the prevalence of anal HSIL among cisgender men and transgender women who have sex with men to be similar to those without HIV. Subsequent anal HSIL incidence, although lower than that of those with chronic HIV acquisition, was still higher than that of those without HIV. Screening for and management of anal HSIL should be a crucial part of long-term HIV care for all MSM.
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Infecciones por VIH , Homosexualidad Masculina , Lesiones Intraepiteliales Escamosas , Personas Transgénero , Humanos , Tailandia/epidemiología , Masculino , Adulto , Infecciones por VIH/tratamiento farmacológico , Infecciones por VIH/epidemiología , Infecciones por VIH/complicaciones , Prevalencia , Personas Transgénero/estadística & datos numéricos , Incidencia , Femenino , Homosexualidad Masculina/estadística & datos numéricos , Lesiones Intraepiteliales Escamosas/epidemiología , Lesiones Intraepiteliales Escamosas/patología , Adulto Joven , Neoplasias del Ano/epidemiología , Papillomaviridae/aislamiento & purificación , Papillomaviridae/genética , Infecciones por Papillomavirus/epidemiología , Estudios de Cohortes , Biopsia , Genotipo , Canal Anal/patología , Canal Anal/virologíaRESUMEN
OBJECTIVE: To identify the risk factors of cervical high-grade squamous intraepithelial lesion(HSIL) complicated with occult cervical cancer and standardize the management of initial treatment for HSIL. METHOD: The clinical data of patients who underwent total hysterectomy directly due to HSIL in the obstetrics and gynecology department of two tertiary hospitals and three secondary hospitals from 2018 to 2023 were collected. Their general characteristics, pathological parameters and survival status were analyzed. Logistic regression model was used to analyze the correlation between clinical parameters and postoperative pathological upgrading. RESULT: 1. Among the 314 patients with HSIL who underwent total hysterectomy directly, 73.2% were from primary hospitals. 2. 25 patients (7.9%) were pathologically upgraded to cervical cancer, all of which were early invasive cancer. 3. Up to now, there was no recurrence or death in the 25 patients with early-stage invasive cancer, and the median follow-up period was 21 months(range 2-59 months). 4. Glandular involvement(OR 3.968; 95%CI 1.244-12.662) and lesion range ≥ 3 quadrants (OR 6.527; 95% CI 1.78-23.931), HPV 16/18 infection (OR 5.382; 95%CI 1.947-14.872), TCT ≥ ASC-H (OR 4.719; 95%CI 1.892-11.766) were independent risk factors that affected the upgrading of postoperative pathology. 5. The area under the curve (AUC) calculated by the Logistic regression model was 0.840, indicating that the predictive value was good. CONCLUSION: There is a risk of occult cervical cancer in patients with HSIL. Glandular involvement, Lesion range ≥ 3 quadrants, HPV 16/18 infection and TCT ≥ ASC-H are independent risk factors for HSIL combined with occult cervical cancer. The prognosis of biopsy-proved HSIL patients who underwent extrafascial hysterectomy and unexpected early invasive cancer was later identified on specimen may be good.
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Histerectomía , Neoplasias del Cuello Uterino , Humanos , Femenino , Histerectomía/métodos , Estudios Retrospectivos , Persona de Mediana Edad , Neoplasias del Cuello Uterino/cirugía , Neoplasias del Cuello Uterino/patología , Adulto , Factores de Riesgo , Anciano , Lesiones Intraepiteliales Escamosas de Cuello Uterino/patología , Lesiones Intraepiteliales Escamosas de Cuello Uterino/cirugía , Lesiones Intraepiteliales Escamosas/patología , Lesiones Intraepiteliales Escamosas/cirugía , Infecciones por Papillomavirus/complicaciones , Infecciones por Papillomavirus/virología , Infecciones por Papillomavirus/patología , Displasia del Cuello del Útero/cirugía , Displasia del Cuello del Útero/patología , Clasificación del TumorRESUMEN
OBJECTIVES: Anal cancer risk is elevated in MSM with HIV (MSMWH). Anal high-risk human papillomavirus (hr-HPV) infection is necessary but insufficient to develop high-grade squamous intraepithelial lesion (HSIL), the anal cancer precursor, suggesting additional factors. We sought to determine whether the microbiome of the anal canal is distinct by comparing it with the microbiome of stool. We also sought to determine whether changes in the anal microbiome are associated with HSIL among MSMWH. DESIGN: Cross-sectional comparison of the microbiome of the anal canal with the microbiome of stool in MSMWH and cross-sectional comparison of the anal microbiome of MSMWH with anal HSIL with the anal microbiome of MSMWH without anal HSIL. METHODS: Sterile swabs were used to sample the anus of MSMWH for microbiome and HPV testing, followed by high-resolution anoscopy. Stool samples were mailed from home. 16S sequencing was used for bacterial identification. Measures of alpha diversity, beta diversity, and differential abundance analysis were used to compare samples. RESULTS: One hundred sixty-six anal samples and 103 matching stool samples were sequenced. Beta diversity showed clustering of stool and anal samples. Of hr-HPV-positive MSMWH, 31 had HSIL and 13 had no SIL. Comparison of the microbiome between these revealed 28 different species. The highest-fold enrichment among MSMWH/hr-HPV/HSIL included pro-inflammatory and carcinogenic Prevotella, Parasuterella, Hungatella, Sneathia, and Fusobacterium species. The anti-inflammatory Anaerostipes caccae showed the greatest reduction among MSMWH/hr-HPV/HSIL. CONCLUSION: The anal microbiome is distinct from stool. A pro-inflammatory and carcinogenic environment may be associated with anal HSIL.
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Canal Anal , Neoplasias del Ano , Heces , Infecciones por VIH , Homosexualidad Masculina , Humanos , Masculino , Estudios Transversales , Neoplasias del Ano/microbiología , Infecciones por VIH/complicaciones , Adulto , Canal Anal/microbiología , Canal Anal/virología , Heces/microbiología , Persona de Mediana Edad , Microbiota , Infecciones por Papillomavirus/complicaciones , Lesiones Intraepiteliales Escamosas/virología , ARN Ribosómico 16S/genética , Análisis de Secuencia de ADN , ADN Ribosómico/genéticaRESUMEN
INTRODUCTION: The Lower Anogenital Squamous Terminology (LAST) Project recommended unified classification for HPV-associated squamous lesions of the lower anogenital tract, using a 2-tiered nomenclature in 2013. Adherence to the new nomenclature worldwide is unknown. This study aims to assess the trend of the use of the two-tiered High Squamous Intraepithelial Lesion and Low Squamous Intraepithelial Lesion (HSIL/LSIL) as opposed to the traditional three-tiered Anal Intraepithelial Neoplasia (AIN I/II/III) classification as suggested by the LAST Project. METHODS: A literature search on full-text English language studies of premalignant anal lesion was performed on PubMed from 2002-2022. The studies were categorized by continent, and the prevalence of HSIL/LSIL classification vs AIN I/II/III was calculated. RESULTS: 546 studies and 251 studies were identified using the AIN I/II/II and the HSIL/LSIL classification respectively. Global trend suggested a statistically significant downward trend in the use of the two-tiered nomenclature system in publications globally. Regional trend including North America, Europe, and other (Asia and Latin America) showed variance in adoption of the two-tiered nomenclature system. CONCLUSION: Despite multidisciplinary collaborative effort, adherence to the recommendations to use the two-tiered system for HPV-associated premalignant anal lesions continues to be suboptimal. Further efforts are needed to identify the cause of poor adherence to be able to create strategies that reinforces unification of terminology and integration of LAST the recommendations.
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Neoplasias del Ano , Infecciones por Papillomavirus , Lesiones Precancerosas , Lesiones Intraepiteliales Escamosas , Humanos , Neoplasias del Ano/clasificación , Neoplasias del Ano/patología , Lesiones Precancerosas/patología , Lesiones Intraepiteliales Escamosas/patología , Lesiones Intraepiteliales Escamosas/virología , Terminología como Asunto , Adhesión a Directriz/estadística & datos numéricosRESUMEN
BACKGROUND: The cervix is the lower portion of the uterus, which connects this organ to the vagina through the endocervical canal. OBJECTIVE: This study aimed to determine the histopathologic patterns and factors associated with cervical lesions at Jimma Medical Center from September 12, 2017, to September 12, 2019. METHODS: A 2-year facility-based cross-sectional study was conducted from May 1 to June 30, 2020. RESULT: In this study, cervical cancer was the most common (71%) cause of cervical lesions. Squamous cell carcinoma was the most frequent cervical cancer diagnosed during the study, accounting for 96.4% of 331 cancerous cases, followed by adenocarcinoma (3.3%). High-grade squamous intraepithelial lesions were the most frequently diagnosed precancerous lesions, accounting for 68.4% of cases. Endocervical polyps were the most commonly diagnosed benign lesions, accounting for 59.3% of cases. CONCLUSION: The maximum age distribution of cervical lesions was in the 41-50-year age range. Squamous cell carcinoma was the most frequent type of cervical cancer. High-grade squamous intraepithelial lesions were the most frequently diagnosed precancerous cervical lesions. The most common benign cervical lesions were endocervical polyps. RECOMMENDATION: We recommend educating the community to improve health-seeking behavior and on possible preventive strategies for cervical cancer.
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Carcinoma de Células Escamosas , Lesiones Precancerosas , Lesiones Intraepiteliales Escamosas , Displasia del Cuello del Útero , Neoplasias del Cuello Uterino , Femenino , Humanos , Neoplasias del Cuello Uterino/diagnóstico , Estudios Transversales , Etiopía/epidemiología , Lesiones Precancerosas/patología , Carcinoma de Células Escamosas/epidemiología , Carcinoma de Células Escamosas/patología , Displasia del Cuello del Útero/diagnósticoRESUMEN
Anal intraepithelial neoplasia (AIN) are precancerous lesions and are sequela of human papilloma virus (HPV) infection. AIN is classified as low-grade squamous intraepithelial lesion or high-grade squamous intraepithelial lesion. Screening with anal cytology and anoscopy should be considered for high-risk populations. Diagnosis is made through high resolution anaoscopy and biopsy. Options for treatment include ablation and several topical therapies; however, recurrence rates are high for all treatment options, and an ongoing surveillance is necessary to prevent progression to anal squamous cell carcinoma. HPV vaccination is recommended to prevent disease.