The Positive Predictive Value of High-Grade Squamous Intraepithelial Lesion on Cytology for the Histological Diagnosis of Cervical Intraepithelial Neoplasia 2 or Higher: A Systematic Review

2019 ◽  
Vol 63 (3) ◽  
pp. 206-214 ◽  
Author(s):  
Nina Karia ◽  
Alison Van Loon ◽  
Cindy Simoens ◽  
Ina Benoy ◽  
Johannes Bogers
Keyword(s):  
Systematic Review ◽  
Cervical Cancer ◽  
Positive Predictive Value ◽  
Cervical Intraepithelial Neoplasia ◽  
Predictive Value ◽  
Intraepithelial Neoplasia ◽  
Histological Diagnosis ◽  
High Grade ◽  
Cervical Lesions ◽  
Intraepithelial Lesion

Cervical cancer is a major worldwide health problem. Therefore, regular cervical screening in order to make an early diagnosis can help to prevent cervical cancer, through identifying and treating preinvasive cervical lesions. The aim of this review is to evaluate the correlation between the cytological screening result and the final gold standard histological outcome in the diagnosis of cervical lesions. More specifically, the correlation between high-grade intraepithelial lesion (HSIL) on cytology and histological cervical intraepithelial neoplasia grade 2 or higher (CIN2+) was intended, by calculating the positive predictive value (PPV). PPV is an important value from a clinical point of view. An electronic search was carried out in the electronic databases MEDLINE (through PubMed) and the Cochrane Library (last searched beginning of December 2017), supplemented with the related article feature in PubMed and snowballing. Article selection (predefined inclusion and exclusion criteria) and data extraction were evaluated by two independent reviewers (N.K. and A.V.L.). After identifying 1,146 articles, 27 articles were finally included in this systematic review, representing 28,783 cytological HSIL diagnoses in total. The PPV of HSIL was 77.5% (range: 45.4–95.2%) for the histological diagnosis of CIN2+ and 55.4% (range: 36.4–67.6%) for the diagnosis of CIN3+. In this systematic review, 77.5% of the HSIL-positive women eventually had a CIN2+ diagnosis. The diagnostic value of a cytological HSIL result (conventional or liquid-based cytology) in the diagnosis of CIN2+ lesions is good, but a combination of tests could raise this value.

scholarly journals HPV Detection Methods

2007 ◽  
Vol 23 (4) ◽  
pp. 273-281 ◽  
Author(s):  
Antoinette A. T. P. Brink ◽  
Peter J. F. Snijders ◽  
Chris J. L. M. Meijer
Keyword(s):  
Cervical Cancer ◽  
Human Papillomavirus ◽  
High Risk ◽  
Cervical Intraepithelial Neoplasia ◽  
Causal Relation ◽  
Cervical Screening ◽  
Intraepithelial Neoplasia ◽  
Detection Methods ◽  
High Grade ◽  
Cervical Lesions

Given the causal relation between a persistent high-risk human papillomavirus (hrHPV) infection and the development of high-grade cervical intraepithelial neoplasia (CIN) and cervical cancer, hrHPV testing has been advocated in addition to cytology for the detection of clinically relevant cervical lesions. HrHPV testing is thought to improve cervical screening algorithms, the management of women with cytologically equivocal smears, and the management of women treated for high grade CIN. In this chapter we discuss different methods for HPV detection and genotyping and their respective applications.

scholarly journals Accuracy of Smartphone Images of the Cervix After Acetic Acid Application for Diagnosing Cervical Intraepithelial Neoplasia Grade 2 or Greater in Women With Positive Cervical Screening: A Systematic Review and Meta-Analysis

2021 ◽  
pp. 1711-1721
Author(s):  
Emma R. Allanson ◽  
Natacha Phoolcharoen ◽  
Mila P. Salcedo ◽  
Bryan Fellman ◽  
Kathleen M. Schmeler
Keyword(s):  
Systematic Review ◽  
Acetic Acid ◽  
Positive Predictive Value ◽  
Cervical Intraepithelial Neoplasia ◽  
Predictive Value ◽  
Precancerous Lesions ◽  
Meta Analysis ◽  
Cervical Screening ◽  
Intraepithelial Neoplasia ◽  
Cervical Intraepithelial Neoplasia Grade

PURPOSE Smartphones are used in cervical screening for visual inspection after acetic acid or Lugol's iodine (VIA/VILI) application to capture and share images to improve the sensitivity and interobserver variability of VIA/VILI. We undertook a systematic review and meta-analysis assessing the diagnostic accuracy of smartphone images of the cervix at the time of VIA/VILI (termed S-VIA) in the detection of precancerous lesions in women undergoing cervical screening. METHODS This systematic review was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Studies from January 1, 2010, to June 30, 2020, were assessed. MEDLINE/PubMed, Embase, CINAHL, Cochrane, and LILACS were searched. Cohort and cross-sectional studies were considered. S-VIA was compared with the reference standard of histopathology. We excluded studies where additional technology was added to the smartphone including artificial intelligence, enhanced visual assessment, and other algorithms to automatically diagnose precancerous lesions. The primary outcome was the accuracy of S-VIA for the diagnosis of cervical intraepithelial neoplasia grade 2 or greater (CIN 2+). Data were extracted, and we plotted the sensitivity, specificity, negative predictive value, and positive predictive value of S-VIA using forest plots. This study was prospectively registered with The International Prospective Register of Systematic Reviews:CRD42020204024. RESULTS Six thousand three studies were screened, 71 full texts assessed, and eight studies met criteria for inclusion, with six included in the final meta-analysis. The sensitivity of S-VIA for the diagnosis of CIN 2+ was 74.56% (95% CI, 70.16 to 78.95; I2 61.30%), specificity was 61.75% (95% CI, 56.35 to 67.15; I2 95.00%), negative predictive value was 93.71% (95% CI, 92.81 to 94.61; I2 0%), and positive predictive value was 26.97% (95% CI, 24.13 to 29.81; I2 61.3%). CONCLUSION Our results suggest that S-VIA has accuracy in the detection of CIN 2+ and may provide additional support to health care providers delivering care in low-resource settings.

scholarly journals Kanker serviks dan gen Fas-promoter-670

2019 ◽  
Vol 2 (3) ◽  
pp. 90-91
Author(s):  
ML Edy Parwanto
Keyword(s):  
Cervical Cancer ◽  
Human Papillomavirus ◽  
Cervical Intraepithelial Neoplasia ◽  
Incidence Rate ◽  
Invasive Cervical Cancer ◽  
Intraepithelial Neoplasia ◽  
Low Grade ◽  
High Grade ◽  
Squamous Intraepithelial Lesion ◽  
Intraepithelial Lesion

Kanker serviks merupakan keganasan pada serviks. Jenis kanker tersebut terjadi pada perempuan dan masih menjadi masalah di Indonesia. Indonesia merupakan negara urutan ke 4 di Asia Tenggara dengan insiden kanker serviks terbesar setelah Kamboja, Myanmar dan Thailand. Berdasar data statistik tahun 2012, tingkat insidensi (incidence rate) kanker serviks di Indonesia 17 per 100.000 perempuan per tahun.(1) Telah terbukti bahwa penyebab primer terjadinya kanker serviks yaitu virus papilloma atau yang lebih dikenal dengan istilah “human papillomavirus (HPV)”. Terdapat beberapa jenis serotype HPV, tetapi tidak semua jenis serotype bersifat progesif menjadikan kanker serviks. Salah satu serotype yang bersifat progesif menjadikan kanker serviks yaitu HPV serotype 16. HPV serotype 16 mampu mengubah sel epitel squamosa serviks (cervical-squamous-epithelial cells=CSEC) normal menjadi lesi intraepitelial squamosa tingkat rendah (low-grade squamous intraepithelial lesion=LSIL) atau neoplasia intraepitel serviks (cervical intraepithelial neoplasia=CIN) 1. Selanjutnya, LSIL atau CIN 1 berkembang menjadi lesi intraepitelial squamosa tingkat tinggi (high-grade squamous intraepithelial lesion=HSIL) atau CIN 2, dan akhirnya menjadi kanker serviks yang invasif (invasive cervical cancer=CIN3).(2)

scholarly journals High-risk HPV genotypes and cervical lesions association in postmenopausal women

2021 ◽  
Vol 31 (Supplement_2) ◽  
Author(s):  
Ana Rita Fernandes Miranda da Costa ◽  
Cláudia Sousa ◽  
Erica Isidoro ◽  
Regina Silva ◽  
Cristiana Mourato
Keyword(s):  
Cervical Cancer ◽  
High Risk ◽  
Postmenopausal Women ◽  
Age Groups ◽  
Low Grade ◽  
High Grade ◽  
Cervical Lesions ◽  
Intraepithelial Lesion ◽  
The Bethesda System ◽  
High Risk Hpv

Abstract Background Persistent infection by high-risk Human Papillomavirus (hrHPV) are the major cause of cervical cancer. Studies report disparities in the incidence of infection and the various genotypes of this virus in different age groups, suggesting a higher frequency of hrHPV in young women and low-risk subtypes being predominant in older women. This study aimed to investigate the incidence and distribution of hrHPV genotypes in postmenopausal women as well as the correlation with the cytological findings. Methods 16 859 women, aged 50–64 years, performed cervical cancer screening test in Friuri Venezia Giulia region, Italy. The infection was evaluated by the Polymerase Chain Reaction methodology and the positive samples were evaluated by Liquid Based Cytology according to the Bethesda System from 2014. A statistical analysis was performed to study the molecular and cytological data of this population. Results hrHPV infection were found in 5.8% of the women and 78.3% of these were caused by hrHPV other than HPV16 and HPV18 (). Also, 65.7% of the positive samples were negative for intraepithelial lesion or malignancy while low grade squamous intraepithelial lesion was the most frequent (22.4%). There was an increase in the number of high-grade intraepithelial lesions in the presence of HPV16 compared to that recorded when this genotype was absent (20.8% vs. 8.5%). No cervical cancers were detected. Conclusions Infection with hrHPV is uncommon in postmenopausal women and it is mostly caused by subtypes less associated with the development of cervical cancer. Yet, HPV16 infection triggers the development of high-grade lesions.

scholarly journals Abnormal colposcopic images in patients with preinvasive cervical lesions

2013 ◽  
Vol 3 (2) ◽  
pp. 98-102
Author(s):  
Adnan Babović ◽  
Dženita Ljuca ◽  
Gordana Bogdanović ◽  
Lejla Muminhodžić
Keyword(s):  
Intraepithelial Neoplasia ◽  
Control Group ◽  
Low Grade ◽  
High Grade ◽  
Cervical Lesions ◽  
Cytological Examination ◽  
Chi Square ◽  
Chi Square Test ◽  
Intraepithelial Lesion ◽  
Experimental Group

Introduction: The objective of the study was to determine frequency and to compare frequency of the abnormal colposcopic images in patients with low and high grade pre-invasive lesions of cervix.Methods: Study includes 259 patients, whom colposcopic and cytological examination of cervix was done. The experimental group of patients consisted of patents with pre-invasive low grade squamousintraepithelial lesion (LSIL) and high grade squamous intraepithelial lesion (HSIL), and the control group consisted of patients without cervical intraepithelial neoplasia (CIN).Results: In comparison to the total number of satisfactory fi ndings (N=259), pathological findings were registered in N=113 (43.6 %) and abnormal colposcopic fi ndings in N=128 (49.4%). The study did notinclude patients with unsatisfactory fi nding N=22 (8.5%). Abnormal colposcopic image is present most frequently in older patients but there are no statistically important difference between age categories(Pearson Chi-Square 0.47, df -3, p=0.923). Frequency of abnormal colposcopic fi ndings (N=128) is the biggest in pathological cytological (N=113) and HSIL 58 (45.3%), LSIL 36 (28.1%). There is statisticallysignifi cant difference in frequency of abnormal colposcopic images in patients with low-grade in comparison to patients with high-grade pre-invasive cervix lesions (Chi-Square test, Pearson Chi-Square 117.14,df-12 p<0.0001).Conclusion: Thanks to characteristic colposcopic images, abnormal epithelium is successfully recognized, but the severity grade of intraepithelial lesion cannot be determined.

scholarly journals Prevalence of cervical intraepithelial neoplasia grades II/III and cervical cancer in patients with cytological diagnosis of atypical squamous cells when high-grade intraepithelial lesions (ASC-H) cannot be ruled out

2009 ◽  
Vol 127 (5) ◽  
pp. 283-287 ◽  
Author(s):  
Andréa Cytryn ◽  
Fábio Bastos Russomano ◽  
Maria José de Camargo ◽  
Lucília Maria Gama Zardo ◽  
Nilza Maria Sobral Rebelo Horta ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Cervical Intraepithelial Neoplasia ◽  
Prevalence Ratio ◽  
Intraepithelial Neoplasia ◽  
Uterine Cervical Cancer ◽  
High Grade ◽  
Cross Sectional ◽  
Squamous Cells ◽  
Bethesda System ◽  
Undetermined Significance

CONTEXT AND OBJECTIVE: The latest update of the Bethesda System divided the category of atypical squamous cells of undetermined significance (ASCUS) into ASC-US (undetermined significance) and ASC-H (high-grade intraepithelial lesion cannot be ruled out). The aims here were to measure the prevalence of pre-invasive lesions (cervical intraepithelial neoplasia, CIN II/III) and cervical cancer among patients referred to Instituto Fernandes Figueira (IFF) with ASC-H cytology, and compare them with ASC-US cases. DESIGN AND SETTING: Cross-sectional study with retrospective data collection, at the IFF Cervical Pathology outpatient clinic. METHODS: ASCUS cases referred to IFF from November 1997 to September 2007 were reviewed according to the 2001 Bethesda System to reach cytological consensus. The resulting ASC-H and ASC-US cases, along with new cases, were analyzed relative to the outcome of interest. The histological diagnosis (or cytocolposcopic follow-up in cases without such diagnosis) was taken as the gold standard. RESULTS: The prevalence of CIN II/III in cases with ASC-H cytology was 19.29% (95% confidence interval, CI, 9.05-29.55%) and the risk of these lesions was greater among patients with ASC-H than with ASC-US cytology (prevalence ratio, PR, 10.42; 95% CI, 2.39-45.47; P = 0.0000764). Pre-invasive lesions were more frequently found in patients under 50 years of age with ASC-H cytology (PR, 2.67; 95% CI, 0.38-18.83); P = 0.2786998). There were no uterine cervical cancer cases. CONCLUSION: The prevalence of CIN II/III in patients with ASC-H cytology was significantly higher than with ASC-US, and division into ASC diagnostic subcategories had good capacity for discriminating the presence of pre-invasive lesions.

scholarly journals Residual or Recurrent Precancerous Lesions After Treatment of Cervical Lesions in Human Immunodeficiency Virus–infected Women: A Systematic Review and Meta-analysis of Treatment Failure

2019 ◽  
Vol 69 (9) ◽  
pp. 1555-1565 ◽  
Author(s):  
Pierre Debeaudrap ◽  
Joelle Sobngwi ◽  
Pierre-Marie Tebeu ◽  
Gary M Clifford
Keyword(s):  
Systematic Review ◽  
Cervical Cancer ◽  
Human Immunodeficiency Virus ◽  
Treatment Failure ◽  
Post Treatment ◽  
High Grade ◽  
Cervical Lesions ◽  
Pooled Prevalence ◽  
Increased Risk ◽  
Immunodeficiency Virus

Abstract Background Screening and treating premalignant cervical lesions (cervical intraepithelial neoplasia 2+ [CIN2+]) is an effective way to prevent cervical cancer, and recommendations exist for the monitoring of treatment success. Yet, there is no specific recommendation for human immunodeficiency virus (HIV)-infected women, who are at a known, increased risk of cervical cancer. Methods A systematic review was performed by searching MEDLINE, EMBASE, and Web of Science for studies published from January 1980 through May 2018. Eligible studies described the prevalence of histologically- and/or cytologically-defined lesions in HIV-infected women at least 6 months post-treatment. The primary endpoint was treatment failure, defined as the presence of residual and/or recurrent high-grade CIN2+/high-grade squamous intraepithelial lesions post-treatment. The pooled prevalence in HIV-infected women and the odds ratios (ORs) for HIV-infected compared to HIV-uninfected women were estimated using random-effects models. Results Among 40 eligible studies, the pooled prevalence of treatment failure in HIV-infected women was 21.4% (95% confidence interval [CI] 15.8–27.0). There was no significant difference in the treatment failure prevalence for cryotherapy (13.9%, 95% CI 6.1–21.6) versus loop electrosurgical excision procedure (13.8%, 95% CI 8.9–18.7; P = .9), but the treatment failure prevalence was significantly higher in women with positive (47.2%, 95% CI 22.0–74.0) than with negative (19.4%, 95% CI 11.8–30.2) excision margin (OR 3.4, 95% CI 1.5–7.7). Treatment failure was significantly increased in HIV-infected versus HIV-uninfected women, both overall (OR 2.7, 95% CI 2.0–3.5) and in all sub-group analyses. Conclusions There is strong evidence for an increased risk of treatment failure in HIV-infected women, in comparison to their HIV-negative counterparts. The only significant predictor of treatment failure in HIV-infected women was a positive margin status, but further data is needed on long-term outcomes after ablative treatment in HIV-infected women.

HPV screening performance indicators in women who previously tested HPV-negative: The second round of Vallecamonica screening programme, Northern Italy

2020 ◽  
Vol 27 (4) ◽  
pp. 207-214
Author(s):  
Luigi Pasquale ◽  
Paolo G Rossi ◽  
Francesca Carozzi ◽  
Serena Domenighini ◽  
Cristina Ruggeri ◽  
...  
Keyword(s):  
Positive Predictive Value ◽  
Cervical Intraepithelial Neoplasia ◽  
Performance Indicators ◽  
Predictive Value ◽  
Screening Programme ◽  
Intraepithelial Neoplasia ◽  
Female Population ◽  
Hpv Test ◽  
Hpv Screening ◽  
One Year

Objective To present performance indicators from the second round of the Vallecamonica-Sebino HPV screening programme in women who had tested negative about four years earlier (mean 45 months). Methods From 2010 to 2012, the target female population (aged 25–64) was invited to the first HPV screening round. In 2013–2017, women were rescreened for the second round. HPV-negative women at the first round were initially rescreened after three years. The interval was gradually increased to five years. HPV-positive women underwent cytology triage: positives were referred to colposcopy and negatives to repeat testing after one year. If HPV was persistently positive, women were referred to colposcopy, if negative, to normal interval rescreening. Results In the second round, of 13,824 previously HPV-negative women, 598 were HPV-positive (4.3%), of whom 297 were positive at cytology triage. Of those referred to one-year HPV test, 291 complied (98.0%), 133 (50.2%) of whom were persistently positive. Total referral was 3.1% compared with 6.6% in the first round (age-adjusted relative referral 0.59, 95% CI: 0.53–0.65). There were 24 cervical intraepithelial neoplasia 2+ (three cervical intraepithelial neoplasia 3+). Detection was 0.17%, compared with 0.9% in the first round. Age-adjusted relative detections were 0.25 (95% CI: 0.16–0.39) and 0.18 (95% CI: 0.05–0.61) for cervical intraepithelial neoplasia 2+ and cervical intraepithelial neoplasia 3+, respectively. Positive predictive value was 5.7%, compared with 14.6% in the first round. Conclusions At second round, referral was half that at first round, while cervical intraepithelial neoplasia 2+ detection decreased nine-fold. Consequently, positive predictive value decreased dramatically. Rescreening four years after an HPV-negative test makes the process inefficient due to the low prevalence of lesions.

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