Neural network analysis of some molecular parameters of the cervical epithelium for cervical cancer diagnostics

Background. A personalized approach is the basis for the specialized care for cancer patients. The relevance of cervical cancer (CC) is still high. The searches for diagnostic criteria of cervical epithelium malignancy are continuing. The application ohm technologies has led to a big number results, the analysis of which is often difficult. The neural network data analysis allows to solve these problems.Objective: to create a technology for diagnosing cervical intraepithelial neoplasia (CIN) and CC, based on a neural network analysis of some molecular parameters.Materials and methods. The research carried out among patients with CIN III (n = 15), patients with CC stages I–IV (n = 49). The control group consisted of female volunteers without cervical pathology (n = 15). Studied molecular parameters: the spectrum of fatty acids was determined in cervical biopsies, proteins OPN, ICAM-1 were studied in blood serum, proteins of the immune cycle sCD25, sCD27 – in the cervical epithelium. Research methods: gas-liquid chromatography, flow cytometry.Results. Significant differences of fatty acids spectrum, local level sCD27 were revealed in among the studied groups. The multilayer perceptron included C18:2ω6, OPN, ICAM-1, sCD25, sCD27. The performed neural network analysis of the molecular data allows to diagnose CIN III (Se = 0.92; Sp = 0.87; AUC = 0.94; p˂0.001) and CC (Se = 1.00; Sp = 1.00; AUC = 1.00; p˂0.001).Conclusion. The created model makes it possible to diagnose CIN III and CC with high accuracy. The configuration of the multilayer perceptron allows confirming the pathophysiological relationships between the studied molecular parameters, to expand the understanding of the mechanisms of cervical carcinogenesis.

Case Report About Extraperitoneal Metastasis of Cervical Adenocarcinoma In Situ

Background: adenocarcinoma in situ(AIS) cells are often misdiagnosed, and recognizing AIS in cervical cytology is challenging. Here, we present a case of extraperitoneal metastasis 5 years after a missed diagnosis of AIS.Case presentation: We report a 49-year-old Chinese woman who presented with a retroperitoneal mass 5 years after cervical conization for AIS. The retroperitoneal mass was composed of glands lined by malignant mucinous epithelium; these tumors were metastases from her previous AIS which were misdiagonised cervical intraepithelial neoplasia(CIN) III in 2013. The patient is alive and well 2 years after resection of the tumors.Conclusions: An experienced pathologist or multiple pathologists should take part in endocervical AIS diagnosis. We should follow these patients for over 15 years. When Cancer Antigen 125(CA125) or Carcinoembryonic antigen(CEA) levels are elevated, the occurrence of metastases should be strictly monitored.

Raman spectroscopic study of cervical precancerous lesions and cervical cancer

Early detection of cervical lesions, accurate diagnosis of cervical lesions, and timely and effective therapy can effectively avoid the occurrence of cervical cancer or improve the survival rate of patients. In this paper, the spectra of tissue sections of cervical inflammation (n = 60), CIN (cervical intraepithelial neoplasia) I (n = 30), CIN II (n = 30), CIN III (n = 30), cervical squamous cell carcinoma (n = 30), and cervical adenocarcinoma (n = 30) were collected by a confocal Raman micro-spectrometer (LabRAM HR Evolution, Horiba France SAS, Villeneuve d’Ascq, France). The Raman spectra of six kinds of cervical tissues were analyzed, the dominant Raman peaks of different kinds of tissues were summarized, and the differences in chemical composition between the six tissue samples were compared. An independent sample t test (p ≤ 0.05) was used to analyze the difference of average relative intensity of Raman spectra of six types of cervical tissues. The difference of relative intensity of Raman spectra of six kinds of tissues can reflect the difference of biochemical components in six kinds of tissues and the characteristic of biochemical components in different kinds of tissues. The classification models of cervical inflammation, CIN I, CIN II, CIN III, cervical squamous cell carcinoma, and cervical adenocarcinoma were established by using a support vector machine (SVM) algorithm. Six types of cervical tissues were classified and identified with an overall diagnostic accuracy of 85.7%. This study laid a foundation for the application of Raman spectroscopy in the clinical diagnosis of cervical precancerous lesions and cervical cancer.

Occult vaginal cancer recurrence after hysterectomy: a case report and literature review

Vaginal cancer is a rare disease of the lower genital tract. We present the case of a 54-year-old woman with occult vaginal cancer after hysterectomy for cervical intraepithelial neoplasia (CIN) III. Despite persistently negative cytology and colposcopy results, a lesion was finally detected by vagino-recto-abdominal examination and she underwent radical parametrectomy and lymph node dissection. We consider the possibility that transabdominal suturing of the vaginal cuff after hysterectomy may reduce the ability to detect subsequent vaginal lesions, and discuss the benefits of a vaginal suture approach. We recommend that suturing the vagina apex transvaginally instead of transabdominally would benefit patients during follow-up.

Co-infection between genotypes of the human papillomavirus and Chlamydia trachomatis in Mexican women

Not all human papillomavirus (HPV) infections develop into cervical cancer (CC), so it is proposed that other factors may influence this, such as co-infection with Chlamydia trachomatis (CT). To identify the prevalence of co-infection, we included 189 women with suspicion of HPV. Viral typing was performed by carrying out the Roche HP Linear Array test, while CT detection was performed with the COBAS® TaqMan® 48 kit from Roche. Of the 189 women only 184 had an infection with HPV, CT or both: 56.6% were positive for one or several HPV genotypes, and 67.7% for CT. Clinical data showed an association between HPV and CIN I (n = 22; RR = 2.43; 95% CI 1.72–3.43, p < 0.05). CT infection was only associated with cervicitis (n = 40; RR = 1.73; 95% CI 1.34–2.23, p < 0.05). The CT-HPV co-infection rate was 28%. Co-infection revealed an association with CIN I (n = 31, RR= 3.33; 95% CI 2.08–5.34 p < 0.05), CIN III (n = 7; RR = 2.57; 95% CI 1.53–4.31, p < 0.05); and a significant risk of 2.3 (95% CI 1.08–4.90) times higher to develop CC; nevertheless, this risk was not statistically significant. CT/HPV co-infection was associated with the development of a high-grade lesion (CIN III) as well as an important risk for developing CC.

Screening for cervical cancer in younger women may be an issue - A comparative study

Cervical cancer is a burning issue in our health sector. A project on cervical & breast cancer screening has been running already in Bangladesh. All sexually active women of 30-years and above or those who are married for 10 years or more are included in this project. But significant numbers of women, less than 30 years of age were referred to Colposcopy clinic for evaluation. They also had high grade lesion. The purpose of this study was to identify the need for cervical cancer screening programme in younger women who are less than 30 years old. This is a comparative retrospective study conducted in 30 years old women and less than 30 years old (21-29 years) women, who were attending Colposcopy clinic for evaluation & treatment in Khulna Medical College & Hospital (KMCH) from January 2013 to December 2013. We analysed 235 Colposcopies in 225 women (30 years old in Group-A; less than 30 years old in Group-B) who were attending at Colposcopy clinic in Khulna Medical College Hospital in 2013. Among group A (n=90), colposcopic findings were: normal-36 (40%), CIN I-30 (33.33%), CIN II-15 (16.67%), CIN III-2 (2.22%), invasive carcinoma-3 (3.33%). Among group B (n=135), colposcopic findings were: normal-52 (38.52%), CIN I-38 (28.14%), CIN II-26 (19.25%), CIN III-3 (2.22%), invasive carcinoma-2 (1.48%). There characteristics were analysed and compared with each other. Although cervical cancer is extremely rare at younger age, there is increasing rate of younger women with high grade cervical lesion who may need treatment. It seems that these lesions have comparable behaviors as in older women. Early age of marriage is responsible for developing cervical cancer & precancerous conditions. So screening should be started in earlier. Careful colposcopic assessment and evaluation before treatment remain indispensable in this regard. Mediscope Vol. 7, No. 2: July 2020, Page 82-88

Histopathological Diagnosis of Colposcopically Negative Cases for CIN

Background: Colposcopy is a good diagnostic tools for the detection of abnormalities cervix of the uterus. Objective: The purpose of the present study was to see the histological diagnosis of colposcopically negative cases for CIN among VIA positive women. Methodology: This cross sectional study was conducted in the Department Of Pathology at Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh during the period of July 2007 to June 2008 for one (01) year. Patients who are colposcopically negative but clinically suspicious for cervical neoplasia were included in this study. The cervix was examined on naked eye by Cusco’s speculum to see whether it was healthy or not. Then it was examined by the colposcope after applying 3 to 5% acetic acid and colposcopic findings were collected. VIA positive cases were underwent colposcopy guided LEEP biopsy. Result: A total of 63 patients of different age group were recruited for this study. The age of 63 patients ranged from 20 years to 65 years with an average age of 34.6±9.59 years. Among 63 VIA positive patients, 54 cases were colposcopically positive for cervical intraepithelial neoplasia and carcinoma in situ, remaining 9 patients were colposcopically negative. Histological examination was also performed in nine patients who were colposcopically negative but clinically suspicious for malignancy or precancerous lesion. Of these nine cases, eight cases (89%) were diagnosed as chronic cervicitis, one case (11.0%) as CIN-I and none as CIN-II and CIN- III. Conclusion: In conclusion majority of the colposcopically negative VIA positive cases are the patients of chronic cervicitis. Journal of National Institute of Neurosciences Bangladesh, 2020;6(1): 29-32

Significance of the Viral Load of High-risk Hpv in the Diagnosis and Prediction of Cervical Lesions: A Retrospective Study

Background: The significance of HPV viral load in the detection of cervical lesions is still controversial. This study analyzed the correlation between the high-risk (HR)-HPV viral load and different cervical lesion degrees.Methods: This was a retrospective study of the patients who first visited the hospital between January 2015 and June 2018. Patients with positive HR-HPV were screening for cervical cancer. The HR-HPV DNA load was measured by the second generation hybrid capture (HC2) technology. The patients grouped as normal, CIN I, CIN II, CIN III, and cervical cancer. Multivariable logistic regression was performed to explore the association between HR-HPV DNA load and cervical lesions.Results: Finally, 265 patients were grouped as normal (n=125), CIN I (n=51), CIN II (n=23), CIN III (n=46), and cervical cancer (n=20). Among them, 139 (52.5%) had a low viral load, 90 (34.0) had a moderate viral load, and 36 (13.4%) had a high viral load. Taking the normal control group as a reference, a high viral load was an independent factor for CIN I (CIN I: OR=3.959, 95%CI: 1.300-12.059, P=0.015) CIN II (OR=6.211, 95%CI: 1.641-23.513, P=0.007), CIN III (OR=7.002, 95%CI: 2.308-21.244, P=0.001), and cervical cancer (OR=9.439, 95%CI: 2.394-37.22, P=0.001).Conclusion: Cervical lesions are closely related to HR-HPV infection. Higher HR-HPV viral load in cervical lesions was associated with a higher risk of high-grade cervical lesions.

Evaluation of colposcopic and histopathological findings in precancerous cervical lesions

Background: Cervical cancer is the most frequent cancer in women worldwide. It is a preventable and curable disease with proper screening. After primary screening Colposcopy is a valuable tool in the detection and treatment of precancerous cervical lesions. Histopathology is the gold standard method of diagnosis of Precancerous lesions. Objective: The objective of this study was to evaluate the performance of colposcopy in the diagnosis and to make correlation between colposcopic & histopathological findings in precancerous cervical neoplasia (CIN). Materials and Method: It was a cross sectional study, conducted at the Colposcopy Clinic, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka. Study was done for a period of one year from January, 2016 to December, 2016. Sixty two married women having following complaints: positive visual inspection of cervix (VIA + ve) with 3-5% Acetic acid, postcoital bleeding, postmenopausal bleeding, and intermenstrual bleeding were recruited for the study. Written informed consent was obtained from the participants. The questionnaire was pretested, corrected and finalized. The data collection was done using the interviewer administered questionnaire. Colposcopic examination of cervix was done in 62 participants. Colposcopy guided punch biopsy/Loop electrosurgical excision procedure (LEEP) from acetowhite area was taken in cases of VIA +ve women and random four quadrants (1, 5, 7 & 11 O’ clock position) cervical biopsy in cases of VIA – ve women having other indications. Histopathological examinations of specimens were done in the Department of Pathology, BSMMU. Descriptive analysis, chi-square test (X2) and Fisher’s exact test were performed. P value<0.05 was taken as statistically significant. Result: The mean age of the study population was 36.8±11.9 years ranging from 20 to72 years. Out of 62 participants, 40.3% (n=25) had VIA positive, 41.9% (n=26) had postcoital bleeding among which 24 was VIA positive and 2 was VIA negative, 8.1% (n=5) had intermenstrual bleeding with positive VIA and 9.7% (n=6) post-menopausal bleeding among which 4 was VIA positive and 2 was VIA negative. Among total 62 participants Sensitivity of colposcopy to diagnose histopathologically confirmed CIN I was 82.6%, CIN II was 25% and CIN III was also 25%. The specificity to diagnose CIN I was 42.4%, CIN II was 91.4% and CIN III was 93.1%. PPV of colposcopy to diagnose histologically confirmed CIN I was 55.8%, CIN II was 16.7% and CIN III was 20%. The NPV to diagnose CIN I was 73.7%, CIN II was 94.6% and CIN III was 94.7%. The colposcopic accuracy to diagnose CIN I was 61.3%, CIN II was 87.1% and CIN III was 90.3%. There was statistically significant (P value <0.05) correlation for colposcopic diagnosis of histopathologically confirmed CIN I,CIN II and III. Conclusion: The accuracy of colposcopy to diagnose histopathologically confirmed precancerous cervical lesions was quite high. Patients presenting with postcoital bleeding and postmenopausal bleeding should have colposcopy and biopsies even if the screening test result normal. Moreover colposcopy has high sensitivity, so we can easily adopt the see and treat method to reduce the dropout. Bangladesh Med Res Counc Bull 2020; 46(1): 48-54