The Influence of SARS-CoV-2 Pandemic in the Diagnosis and Treatment of Cervical Dysplasia

Background and objectives. The risk of developing invasive cancer increased during the COVID-19 pandemic, especially in Romania, where the incidence of this disease is high due to limited medical education and broad screening. This study’s objective is to analyze the number of patients admitted with different types of cervical dysplasia and the treatment applied for the lesions during the SARS-CoV-2 pandemic compared to the same period for the year before the pandemic. Materials and methods: This is a retrospective study that took place in the Obstetrics and Gynecology Clinics I/II (OG I/II) of the Emergency County Hospital of Craiova during the SARS-CoV-2 pandemic (SP) (15.03.2020–14.03.2021) and in the 12 months before (non-pandemic period) (NPP) (15.03.2019–14.03.2020). The study includes 396 patients with pathological PAP smear results. All the patients included in this study were clinically examined and with colposcopy. The patients with Low-Grade Dysplasia were managed in a conservatory manner and reevaluated after six months. The patients with High-Grade Dysplasia were admitted for an excisional biopsy of the lesion. The excised fragments were sent to the Pathological Anatomy Laboratory for a histopathological examination. Results: This study reveals a decrease of more than half in the number of patients admitted with cervical intraepithelial neoplasia (CIN) lesions during the pandemic compared to the same period of the year before. The number of biopsies and excisional procedures has been decreasing by more than a factor of three during the pandemic period compared to the year before. Conclusion: During the SARS-CoV-2 pandemic, we found that the patients’ admission rate, diagnosis, and treatment was almost four times lower. As hospital restrictions were not dictated for cancer/precancer management during SP, we may assume that the differences were due to the fear of becoming infected with SARS-CoV-2 due to hospitalization. In the context of poor screening performance and high cervical cancer incidence, the influence of the SP may result in a further increase of severe cases related to this condition.

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Cervical intraepithelial neoplasia grade 3 in a patient following Gardasil vaccination

BMJ Case Reports ◽

10.1136/bcr-2019-230366 ◽

2019 ◽

Vol 12 (8) ◽

pp. e230366

Author(s):

Bruce McLucas ◽

Eric Vail ◽

Katherine Jane Chua ◽

Gabriel Walt

Keyword(s):

Cervical Intraepithelial Neoplasia ◽

Pap Smear ◽

Cervical Dysplasia ◽

Intraepithelial Neoplasia ◽

Hpv Infection ◽

Low Grade ◽

Cervical Intraepithelial Neoplasia Grade ◽

The Usa ◽

Grade 3 ◽

High Risk Hpv

Essentially all cervical dysplasia is caused by human papilloma virus (HPV). Three HPV vaccines have been available, with Gardasil-9 being the most recently approved in the USA. Gardasil-9 covers high-risk HPV strains 16, 18, 31, 33, 45, 52 and 58 as well as low-risk strains 6 and 11. A 33-year-old woman (Gravida 2, Para 2) received Gardasil in 2006. Subsequently, her pap smear revealed low grade squamous intraepithelial lesion. Cervical biopsies performed in 2015 and 2016 revealed cervical intraepithelial neoplasia grade 1 (CIN 1). She underwent loop electrosurgical excision procedure for persistent CIN 1, which demonstrated CIN 3. Genotyping revealed HPV type 56 infection. The advancement of Gardasil-9 vaccine only offers 90% protection to patients against HPV-related disease. Lay literature may mislead patients to think they have no risk of HPV infection.

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COMPARSION THE HISTOPATHOLOGICAL FINDINGS AFTER CERVICAL BIOPSY AND EXCISIONAL PROCEDURES

Acta Medica (Hradec Kralove Czech Republic) ◽

10.14712/18059694.2014.33 ◽

2013 ◽

Vol 56 (1) ◽

pp. 19-22

Author(s):

Aljosa Mandic ◽

Slavica Knezevic-Usaj ◽

Dejan Nincic ◽

Jelka Rajovic ◽

Marina Popovic ◽

...

Keyword(s):

Biopsy Specimen ◽

Histopathological Examination ◽

Cervical Dysplasia ◽

Intraepithelial Neoplasia ◽

Excisional Biopsy ◽

Punch Biopsy ◽

Transformation Zone ◽

Large Loop ◽

Cold Knife ◽

Histopathological Results

Introduction: A definitive diagnosis of cervical intraepithelial neoplasia (CIN) is confirmed after histopathological (HP) examination of the tissue obtained through the biopsy. The aim of this study was to compare histopathological results obtained with punch biopsy and results obtained through one of the excisional techniques. Material and methods: We analysed histology results of 130 patients referred to our institution with abnormal smear. Punch biopsy was performed after colposcopic examination in all patients before one of the excision methods. Excision methods performed were: large loop excision of transformation zone (LLETZ), radio-frequency knife conisation or cold knife conisation. Based on the histopathological examination of the punch biopsy specimen or excisional specimen diagnosis of CIN was established. Results: CIN and invasive cancer were the most common diagnoses in the 31–40 age group at 45.4% (59/130). Discrepancies in the histological diagnosis between punch biopsy and excisional biopsy was identified in 58.5% (76/130) of the patients. In 6% of the of the cases the biopsy did not detect an invasive carcinoma. Conclusion: The most frequent discrepancies between punch biopsy and excisional biopsy were in the group of patients with a higher grade cervical dysplasia. Mild dysplastic changes diagnosed through punch biopsy, require a more conservative approach, as the majority of this group had negative specimens on the cone after excision, especially in the younger population. It is advisable that the patients above 30 years of age and a higher grade dysplasia in the biopsy specimen, should undergo one of the excisional techniques as a diagnostic/therapeutic method of treatment.

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Low Utility in Colposcopy-directed Biopsies for Non-high Grade Cytological Abnormalities on PAP Smear

Current Women s Health Reviews ◽

10.2174/1573404815666190821093421 ◽

2020 ◽

Vol 16 (1) ◽

pp. 18-22

Author(s):

Eronmwon E. Gbinigie ◽

Joshua Fogel ◽

Maggie Tetrokalashvili

Keyword(s):

Pap Smear ◽

Multinomial Logistic Regression ◽

Cervical Dysplasia ◽

Outcome Variable ◽

Low Grade ◽

High Grade ◽

Squamous Intraepithelial Lesion ◽

Intraepithelial Lesion ◽

Cytologic Abnormalities ◽

Cytology Screening

Background: Clinicians commonly perform colposcopy directed biopsies on patients with low grade squamous intraepithelial lesion (LSIL) on PAP cytology even when not consistent with clinical guidelines. Objective: We study the association of PAP cytology screening results with cervical intra-epithelia neoplasia (CIN) 2-3 high-grade dysplasia, as confirmed by colposcopy-directed biopsy. Methods: A retrospective study of 263 women with an abnormality on the PAP smear. Multinomial logistic regression was performed with predictors of PAP cytology screening results with the outcome variable of colposcopy-directed biopsy. Results: High grade squamous intraepithelial lesion (HSIL) had significantly increased relative risk for CIN 2-3 (RR: 9.85, 95% CI: 1.84, 52.79, p=0.008). LSIL was not significantly associated with CIN 2-3. In the comparisons of negative with CIN-1, both HSIL and LSIL were not significantly associated with a negative biopsy. Conclusion: HSIL is associated with cervical dysplasia of CIN 2-3 while LSIL is not associated with cervical dysplasia of CIN 2-3. We do not recommend routine biopsies in patients with LSIL cytologic abnormalities unless additional compelling factors exist.

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Bilateral ocular surface squamous neoplasia: A study of 25 patients and review of literature

European Journal of Ophthalmology ◽

10.1177/11206721211007109 ◽

2021 ◽

pp. 112067212110071

Author(s):

Vijitha S Vempuluru ◽

Monalisha Pattnaik ◽

Neha Ghose ◽

Swathi Kaliki

Keyword(s):

Risk Factors ◽

Ocular Surface ◽

Histopathological Examination ◽

Topical Steroid ◽

Case Series ◽

Intraepithelial Neoplasia ◽

Excisional Biopsy ◽

Ocular Surface Squamous Neoplasia ◽

Retrospective Case

Purpose: To describe the risk factors, clinical presentation, management, and outcomes of patients with bilateral ocular surface squamous neoplasia (OSSN). Methods: Retrospective case series. Results: Of the 25 patients with bilateral OSSN, the mean age at diagnosis of OSSN was 31 years (median, 24 years; range, 2–60 years). Risk factors for bilateral OSSN included xeroderma pigmentosum ( n = 15, 60%), human immunodeficiency virus infection ( n = 3, 12%), conjunctival xerosis ( n = 1, 4%), and topical steroid use ( n = 1, 4%). There were no identifiable ocular or systemic risk factors in 7 (28%) patients. Presentation was synchronous in 14 (56%) and metachronous in 11 (44%) patients. Tumor morphology was bilaterally similar in 12 (48%) patients. Histopathological examination ( n = 36) revealed conjunctival intraepithelial neoplasia (CIN) grade 1 in 4 (8%); grade 2 in 7 (14%); carcinoma in situ in 5 (10%), and invasive carcinoma in 20 (40%). Primary management of OSSN ( n = 49) included excisional biopsy ( n = 31, 62%), topical immunotherapy (IFN α2B) ( n = 11; 22%), topical Mitomycin C (MMC) ( n = 3, 6%), enucleation ( n = 1, 2%), orbital exenteration ( n = 2, 4%), and plaque brachytherapy (PBT) ( n = 1, 2%). One patient was lost to follow-up after detection of tumor in the second eye. Recurrent tumors were noted in 16 (32%) eyes and binocular globe salvage was achieved in 16 (64%) patients at a mean follow up of 41 months (median 30 months; range, 1–164 months). Conclusion: OSSN occurrence can be synchronous or metachronous. Meticulous examination of the fellow eye is important for an early diagnosis of OSSN.

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Early Detection of Precursors of Cervical Cancer with Cervical Cytology and Visual Inspection of Cervix with Acetic Acid

Journal of Nepal Medical Association ◽

10.31729/jnma.316 ◽

2008 ◽

Vol 47 (170) ◽

Cited By ~ 4

Author(s):

Pragya Dhaubhadel ◽

A Vaidya ◽

P Choudhary

Keyword(s):

Early Detection ◽

Visual Inspection ◽

Pap Smear ◽

Smoking Habit ◽

Cervical Dysplasia ◽

Intraepithelial Neoplasia ◽

Maternity Hospital ◽

Cervical Neoplasia ◽

Intraepithelial Lesion ◽

Age Of Marriage

A hospital-based, prospective study was done in 350 women of 20-50 years to compare VIA withPap smear for early detection of cervical dysplasia at Maternity Hospital, Thapathali, from May2004 to December 2004. Pap smear was taken from each woman followed by VIA. Women withpositive VIA and/or positive Pap smear were referred for colposcopy-directed cervical biopsy. Thevariables studied were age group, presenting complaint, age of marriage, parity, smoking habit andappearance of cervix.The incidence of positive VIA and Pap smear was 2.86 and 0.57 respectively. Pelvic pain was themost common presenting complaint. The majority of the women were married before 20 years ofage. All women with either positive VIA and/or Pap smear were of parity two or above. Therewas no significant association between smoking and positive VIA (P=0.699) or Pap smear (P=0.397).Approximately 36.57% of the women screened had abnormal looking cervix. There were two womenwith high grade intraepithelial lesion (HSIL) and both were VIA positive and this was statisticallysignificant (Fischer exact P=0.0007). Of the ten VIA positive women, on histopathological examinationsix showed chronic cervicitis, one acute cervicitis, one showed cervical intraepithelial neoplasia (CIN)II, one had normal finding and one was lost to follow up.VIA as a screening test for cervical neoplasia did not miss any lesion detected by Pap smear andconfirmed by cervical biopsy.Key words: cervical neoplasia, pap smear, visual inspection

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Novel Genital Alphapapillomaviruses in Baboons (Papio hamadryas Anubis) With Cervical Dysplasia

Veterinary Pathology ◽

10.1177/0300985812439725 ◽

2012 ◽

Vol 50 (1) ◽

pp. 200-208 ◽

Cited By ~ 17

Author(s):

I. L. Bergin ◽

J. D. Bell ◽

Z. Chen ◽

M. K. Zochowski ◽

D. Chai ◽

...

Keyword(s):

Cervical Dysplasia ◽

Intraepithelial Neoplasia ◽

Papio Hamadryas ◽

Primate Species ◽

Low Grade ◽

Sexually Transmitted ◽

Olive Baboons ◽

Papio Hamadryas Anubis ◽

Squamous Intraepithelial Neoplasia ◽

Human Infections

Genital Alphapapillomavirus (αPV) infections are one of the most common sexually transmitted human infections worldwide. Women infected with the highly oncogenic genital human papillomavirus (HPV) types 16 and 18 are at high risk for development of cervical cancer. Related oncogenic αPVs exist in rhesus and cynomolgus macaques. Here the authors identified 3 novel genital αPV types (PhPV1, PhPV2, PhPV3) by PCR in cervical samples from 6 of 15 (40%) wild-caught female Kenyan olive baboons ( Papio hamadryas anubis). Eleven baboons had koilocytes in the cervix and vagina. Three baboons had dysplastic proliferative changes consistent with cervical squamous intraepithelial neoplasia (CIN). In 2 baboons with PCR-confirmed PhPV1, 1 had moderate (CIN2, n = 1) and 1 had low-grade (CIN1, n = 1) dysplasia. In 2 baboons with PCR-confirmed PhPV2, 1 had low-grade (CIN1, n = 1) dysplasia and the other had only koilocytes. Two baboons with PCR-confirmed PhPV3 had koilocytes only. PhPV1 and PhPV2 were closely related to oncogenic macaque and human αPVs. These findings suggest that αPV-infected baboons may be useful animal models for the pathogenesis, treatment, and prophylaxis of genital αPV neoplasia. Additionally, this discovery suggests that genital αPVs with oncogenic potential may infect a wider spectrum of non-human primate species than previously thought.

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A CASE OF CERVICAL INTRAEPITHELIAL NEOPLASIA - MANAGEMENT THROUGH AYURVEDA

November 2020 - International Ayurvedic Medical Journal ◽

10.46607/iamj3609122021 ◽

2021 ◽

Vol 9 (12) ◽

pp. 3143-3150

Author(s):

Deepthi. G. B ◽

Gayathri Bhat. N.V

Keyword(s):

Cervical Cancer ◽

Pap Smear ◽

Disease Incidence ◽

Cervical Screening ◽

Intraepithelial Neoplasia ◽

Treatment Modalities ◽

Low Grade ◽

Disease Manifestation ◽

Mild Dysplasia

Introduction – Cervical cancer is the 2nd most leading prevalent cancer in India. There are an estimated 123,000 new cases of cervical cancer in India every year with 67,000 deaths in women alone. Cervical cancer in Recent studies shows that screening of cervical cancer reduces the disease incidence and disease mortality by 50%. Low- grade squamous intraepithelial lesion (LSIL) is a common abnormal result on a Pap smear cervical test. It’s also known as mild dysplasia. Methodology – Here is a case report of a patient aged 26yrs with complaints of white discharge per vagina with severe itching, on routine cervical screening investigations found to have Low grade squamous intraepithelial neoplasms. She was treated with Ayurvedic sthanika chikitsa (Local therapies) such as Yoni prakshalana (Vaginal douching), and Yoni pichu (Vaginal tamponing) for 7 days along with shaman chikitsa. Later PAP smear was repeated after 1 month of follow up and found to have negative for intraepithelial neoplasia. And there was relief in the symptoms following treatment. Results- In this case, there was a relief of symptoms and on follow up when Pap smear was repeated, there was negative for intraepithelial neoplasia. Ayurvedic treatment modalities such as Sthanika chikitsa which includes yoni prakshalana and Yoni Pichu are the line of treatment for various gynecological problems and help in reducing mortality and morbidity caused due to cervical cancer in India. Discussion- Here Low-grade squamous Intraepithelial neoplasia can be considered as the Sanchaya avastha and hence diagnosing the disease in its Sanchaya avastha i.e mild dysplasia, is important. During Sanchaya avastha there is localized neoplastic changes of cervical cells and there is Manifestation of Low-grade Intraepithelial Neo- plasia. In the later stages of Kriyakala (Stages of disease manifestation) the neoplasia turns into metastasis and further differentiation occurs which Manifests all the symptoms of Cervical Cancer. Hence treatment modalities such as Yoni prakshalana and yoni pichu helps in preventing later conditions such as cervical cancer. Keywords: Cervical Cancer, LSIL, Ayurveda, Sanchaya

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Expression of p16INK4a and cervical infection with high-risk human papillomavirus are not related to p53 activity in cervical intraepithelial neoplasia

International Journal of Gynecological Cancer ◽

10.1111/j.1525-1438.2007.01148.x ◽

2008 ◽

Vol 18 (5) ◽

pp. 1060-1064 ◽

Cited By ~ 5

Author(s):

J. F. Bragança ◽

L. O. Sarian ◽

D. R. Pitta ◽

A. B. Maito ◽

J. Vassallo ◽

...

Keyword(s):

Human Papillomavirus ◽

High Risk ◽

Cervical Intraepithelial Neoplasia ◽

Pap Smear ◽

Strong Association ◽

Intraepithelial Neoplasia ◽

Low Grade ◽

Cross Sectional ◽

Gynecological Examination ◽

Hpv Status

The objective of the study was to investigate the expression of p53 and p16INK4a in cervical intraepithelial neoplasia (CIN) and their relation with disease severity and high-risk human papillomavirus (HR-HPV) status. A series of 125 women with previous positive Pap smear were selected for this cross-sectional study. All patients underwent gynecological examination, including colposcopy. Specimens for Pap smears, Hybrid Capture 2 (HC2) test, and pathologic analysis were obtained. After evaluation of CIN grade, immunohistochemical detection of proteins p53 and p16INK4a was performed on paraffin-embedded sections. The extent of immunoexpression of both proteins was analyzed in relation to CIN grade and HR-HPV status. CIN was graded as 1 in 21, 2 in 17, and 3 in 87 specimens. p16INK4a positivity (at least 5% of epithelial cells stained) was found in 99 of 125 cases (79.2%) and was significantly higher in high-grade lesions as compared to low-grade CIN (P< 0.001). The expression of p53 did not differ across histologic strata. Protein expression neither of p16INK4a nor of p53 correlated with HR-HPV status. Expression of p16INK4a was not related with that of p53. Our study gives further support to previous findings of strong association of p16INK4a immunostaining with severity of epithelial atypia, but this protein may not be considered a predictor of HR-HPV status determined with HC2. By contrast, immunoexpression of p53 was related neither to CIN grade nor to HR-HPV status.

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Colposcopic evaluation of cervix with persistent inflammatory Pap smear: A prospective analytical study

CytoJournal ◽

10.4103/1742-6413.67112 ◽

2010 ◽

Vol 7 ◽

pp. 16 ◽

Cited By ~ 5

Author(s):

Papa Dasari ◽

S Rajathi ◽

Surendra V Kumar

Keyword(s):

Analytical Study ◽

Pap Smear ◽

Invasive Carcinoma ◽

Cervical Screening ◽

Intraepithelial Neoplasia ◽

Pap Smears ◽

Screening Algorithm ◽

Number Of Patients ◽

Malignant Lesions ◽

Inflammatory Changes

Background: Inflammatory Pap smear is the most common report received by a gynecologist. The cervical screening algorithm for benign cellular changes on the Pap smear recommends treatment of infection if indicated and a repeat Pap smear in 4 to 6 months time. If the inflammatory changes still persist, subject the patient to colposcopy. However, in practice, this is not followed, especially in developing countries like ours where proper screening protocols are not available. Hence, a good number of patients in the premalignant stage are being missed. This study was undertaken to evaluate patients with persistent inflammatory Pap smears without atypia using colposcopy. Methods: A prospective analytical study of 150 gynecologial patients with persistent inflammatory Pap smear between 2006 and 2008 in an out-patient setting. All of them were subjected to colposcopy and biopsy from the abnormal areas. The incidence of cervical intraepithelial neoplasia (CIN)/invasive carcinoma was calculated by proportions/percentages. Results: The incidence of invasive carcinoma was <1%. But, the incidence of pre-malignant lesions (CIN) was high (20.9%). CIN 2/3 and carcinoma in situ were present in 6.9% of the cases. Conclusions: Patients with persistent inflammatory Pap smears can harbour a high proportion of CIN and hence these patients will need further evaluation.

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Effectiveness of the Quadrivalent Human Papillomavirus Vaccine Against Cervical Dysplasia in Manitoba, Canada

Journal of Clinical Oncology ◽

10.1200/jco.2013.52.4645 ◽

2014 ◽

Vol 32 (5) ◽

pp. 438-443 ◽

Cited By ~ 24

Author(s):

Salaheddin M. Mahmud ◽

Erich V. Kliewer ◽

Pascal Lambert ◽

Songul Bozat-Emre ◽

Alain A. Demers

Keyword(s):

Human Papillomavirus ◽

Pap Smear ◽

Cox Regression ◽

Cervical Dysplasia ◽

Population Based ◽

Low Grade ◽

Human Papillomavirus Vaccine ◽

Abnormal Cytology ◽

Individual Level ◽

Screening Programs

Purpose Effectiveness of the quadrivalent human papillomavirus (QHPV) vaccine against cervical dysplasia has not been estimated using population-based individual level data. We assessed the vaccine effectiveness (VE) of the QHPV vaccine against cervical dysplasia using data collected routinely in Manitoba. Methods Females ≥ 15 years old who received the QHPV vaccine in Manitoba between September 2006 and April 2010 privately (n = 3,541) were matched on age to up to three nonvaccinated females (n = 9,594). We used Cox regression models to estimate the hazard ratios for three outcomes: atypical squamous cells of undetermined significance (ASCUS), low-grade squamous intraepithelial lesions (LSILs), and high-grade SILs (HSILs). Results Among the 15- to 17-year-olds, the adjusted VE estimates were 35% (95% CI, −19% to 65%), 21% (−10% to 43%), and −1% (−44% to 29%) against the detection of HSILs, LSILs, and ASCUS, respectively. The corresponding estimates were higher (46% [0% to 71%], 35% [10% to 54%], and 23% [−8% to 45%]) among those who had ≥ one Pap smear after enrollment. The QHPV vaccine was associated with 23% (−17% to 48%) reduction in HSIL risk among those ≥ 18 with no history of abnormal cytology, but there was no evidence of protection among those with such a history (−8% [−59% to 27%]). Conclusion A significant percentage of vaccinated women may not be protected against HSIL and lesser dysplasia especially if they were vaccinated at older age (≥ 18) or had abnormal cytology before vaccination. These findings affirm the importance of vaccination before any significant exposure to HPV occurs and underscore the need for screening programs that cover all sexually active women, even if they were vaccinated.

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