scholarly journals Comparison of Conservative Treatment of Cervical Intraepithelial Lesions with Imiquimod with Standard Excisional Technique Using LLETZ: A Randomized Controlled Trial

2021 ◽  
Vol 10 (24) ◽  
pp. 5777
Author(s):  
Andrej Cokan ◽  
Maja Pakiž ◽  
Tamara Serdinšek ◽  
Andraž Dovnik ◽  
Tatjana Kodrič ◽  
...  
Keyword(s):  
Side Effects ◽  
Conservative Treatment ◽  
Controlled Trial ◽  
Treatment Compliance ◽  
Intraepithelial Neoplasia ◽  
Treatment Modalities ◽  
P Value ◽  
High Grade ◽  
Cervical Squamous Intraepithelial Lesions ◽  
Intraepithelial Lesions

(1) Background: There are limited data on the success of conservative treatment of high-grade cervical squamous intraepithelial lesions (HSIL) with imiquimod directly compared to standard of treatment with LLETZ. (2) Methods: Patients aged 18–40 with histological HSIL (with high-grade cervical intraepithelial neoplasia, CIN2p16+ and CIN3), were randomly assigned to treatment with imiquimod or LLETZ. The primary outcome was defined as the absence of HSIL after either treatment modality. The secondary outcomes were the occurrence of side effects. (3) Results: 52 patients were allocated in each group and were similar regarding baseline characteristics. In the imiquimod group, 82.7% of patients completed treatment, which was successful in 51.9%. All patients in the LLETZ group completed treatment, which was successful in 92.3% (p < 0.001). In the subgroup of CIN2p16+ patients, treatment with imiquimod was not inferior to LLETZ (73.9% vs. 84.2%, p = 0.477). During and after treatment, no cases of progression to cancer were observed. Side effects and severe side effects (local and systemic) were more prevalent in the imiquimod than in the LLETZ group (88.5% vs. 44.2% (p-value < 0.001) and 51.9% vs. 13.5% (p-value < 0.001), respectively). (4) Conclusion: Generally, in patients with HSIL, LLETZ remains the gold standard of treatment. However, in a subgroup analysis of patients with CIN2p16+, the success rate was comparable between the two treatment modalities. Due to the prevalence of side effects, the treatment compliance with imiquimod use may, however, present a clinically important issue.

scholarly journals The value of p16INK4a immunostaining for high-grade squamous intraepithelial lesions in human papillomavirus–negative patients

2020 ◽  
Author(s):  
Dai Zhang ◽  
Jie Song ◽  
Xiaosong Zhang ◽  
Hui Bi
Keyword(s):  
Human Papillomavirus ◽  
Predictive Value ◽  
Intraepithelial Neoplasia ◽  
Pathological Diagnosis ◽  
High Grade ◽  
Squamous Intraepithelial Lesions ◽  
P16 Ink4a ◽  
Objective Detection ◽  
High Risk Hpv ◽  
Intraepithelial Lesions

Abstract Background : This study aims to evaluate the value of p16 INK4a immunostaining for high-grade squamous intraepithelial lesions in human papillomavirus–negative patients in Beijing, China. Methods: In this study, we evaluated the value of p16 INK4a immunostaining, as well as cytology and colposcopy, for predicting high-grade squamous intraepithelial lesions (HSIL) in human papillomavirus (HPV)-negative patients by comparing the methods with the haematoxylin and eosin (H&E) staining pathological diagnosis of HPV-negative patients. Results: Of 122 patients negative for the high-risk HPV (HR-HPV) subtype, 26 (21.3%) underwent colposcopically directed multiple punch cervical biopsy with a H&E pathological diagnosis of HSIL and above (HSIL+), 11 patients (9.0%) had cervical intraepithelial neoplasia (CIN)2, nine patients (7.4%) had CIN3, and six patients (4.9%) had infiltrating carcinoma. Cytology, colposcopy, and p16 INK4a immunostaining had 52.4%, 38.5%, and 92.3% sensitivity, respectively, and 76.2%, 94.8%, and 99% specificity, respectively. The positive predictive value of cytology, colposcopy, and p16 INK4a immunostaining was 31.4%, 66.7%, and 96%, respectively, and the negative predictive value was 88.5%, 85.1%, and 97.9%, respectively. Compared with H&E staining, the kappa of cytology, colposcopy, and p16 INK4a immunostaining was 0.327, 0.323, and 0.926, respectively. Conclusion: Positive p16 INK4a immunostaining is very strongly consistent with an H&E diagnosis of CIN2+, and it can be used as an objective detection index for HSIL+ diagnosis of HPV-negative patients with CIN2+.

scholarly journals Anal Intraepithelial Neoplasia Associated with High-Grade Vulva Injury (Usual-Type Vulvar Intraepithelial Neoplasia): Surgical Treatment with Cutaneous Flap Advancement

2021 ◽  
Vol 41 (03) ◽  
pp. 329-331
Author(s):  
José Antonio Cunha-e-Silva ◽  
Andrea Povedano ◽  
Eduardo Vassalo ◽  
Angélica Kneipp ◽  
Guilherme Arbex ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Sexually Transmitted Infections ◽  
Young Patient ◽  
Intraepithelial Neoplasia ◽  
Vulvar Intraepithelial Neoplasia ◽  
High Grade ◽  
Sexually Transmitted ◽  
Usual Type ◽  
Cutaneous Flap ◽  
Intraepithelial Lesions

AbstractThe aim of the present article is to report the case of a young patient with bowenoid papulosis who was a carrier of other sexually-transmitted infections (STIs), such as HIV and high-grade vulva lesion (usual-type vulvar intraepithelial neoplasia, VIN), and to demonstrate the strategy used to manage the case, as well as to discuss important issues regarding the standardization of intraepithelial lesions.8

Association of Bacterial Vaginosis and Human Papilloma Virus Infection With Cervical Squamous Intraepithelial Lesions

2019 ◽  
Vol 152 (2) ◽  
pp. 185-189 ◽  
Author(s):  
Wissam Dahoud ◽  
Claire W Michael ◽  
Hamza Gokozan ◽  
Amelia K Nakanishi ◽  
Aparna Harbhajanka
Keyword(s):  
Bacterial Vaginosis ◽  
Human Papilloma Virus Infection ◽  
Hpv Infection ◽  
High Grade ◽  
Squamous Intraepithelial Lesions ◽  
Papilloma Virus ◽  
Cervical Squamous Intraepithelial Lesions ◽  
The Relationship ◽  
Intraepithelial Lesions

ABSTRACT Objectives Human papillomavirus (HPV) is known to be associated with squamous intraepithelial lesions (SILs). However, there is limited and conflicting literature on the relationship between bacterial vaginosis (BV) and SIL. The aim of this study is to determine the prevalence of BV and evaluate the association between BV and SIL. Methods A retrospective study was performed on 10,546 cases between 2012 and 2017. HPV results were available in 7,081 cases. Results BV was present in 17.6% of cases. There was significant association between BV, positive HPV infection, and high-grade SIL. BV patients with negative HPV infection showed more squamous abnormalities than BV-negative HPV-negative patients. Conclusions We found there is a significant association between BV and SIL. BV is more common among patients with HPV infection and is independently associated with squamous abnormalities in cervical smears and surgical follow-up.

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