The Performance of Artificial Intelligence in Cervical Colposcopy: A Retrospective Data Analysis

Objective. We aimed to evaluate the performance of artificial intelligence (AI) system in detecting high-grade precancerous lesions. Methods. A retrospective and diagnostic study was conducted in Chongqing Cancer Hospital. Anonymized medical records with cytology, HPV testing, colposcopy findings with images, and the histopathological results were selected. The sensitivity, specificity, and areas under the curve (AUC) in detecting CIN2+ and CIN3+ were evaluated for the AI system, the AI-assisted colposcopy, and the human colposcopists, respectively. Results. Anonymized medical records from 346 women were obtained. The images captured under colposcopy of 194 women were found positive by the AI system; 245 women were found positive either by human colposcopists or the AI system. In detecting CIN2+, the AI-assisted colposcopy significantly increased the sensitivity (96.6% vs. 88.8%, p = 0.016 ). The specificity was significantly lower for AI-assisted colposcopy (38.1%), compared with human colposcopists (59.5%, p < 0.001 ) or the AI system (57.6%, p < 0.001 ). The AUCs for the human colposcopists, AI system, and AI-assisted colposcopy were 0.741, 0.765, and 0.674, respectively. In detecting CIN3+, the sensitivities of the AI system and AI-assisted colposcopy were not significantly higher than human colposcopists (97.5% vs. 92.6%, p = 0.13 ). The specificity was significantly lower for AI-assisted colposcopy (37.4%) compared with human colposcopists (59.2%, p < 0.001 ) or compared with the AI system (56.6%, p < 0.001 ). The AUCs for the human colposcopists, AI system, and AI-assisted colposcopy were 0.759, 0.674, and 0.771, respectively. Conclusions. The AI system provided equally matched sensitivity to human colposcopists in detecting CIN2+ and CIN3+. The AI-assisted colposcopy significantly improved the sensitivity in detecting CIN2+.

Impact of Delaying Effective and Cost-Effective Policy Decisions: An Example From Cervical Cancer Prevention in Norway

Introduction. Delayed implementation of evidence-driven interventions has consequences that can be formally evaluated. In Norway, programs to prevent cervical cancer (CC)—screening and treatment of precancerous lesions and prophylactic vaccination against human papillomavirus (HPV) infection—have been implemented, but each encountered delays in policy implementation. To examine the effect of these delays, we project the outcomes that would have been achieved with timely implementation of two policy changes compared with the de facto delays in implementation (in Norway). Methods. We used a multimodeling approach that combined HPV transmission and cervical carcinogenesis to estimate the health outcomes and timeline for CC elimination associated with the implementation of two CC prevention policy decisions: a multicohort vaccination program of women up to age 26 years with bivalent vaccine in 2009 compared with actual “delayed” implementation in 2016, and a switch from cytology to primary HPV-based testing in 2015 compared with “delayed” rollout in 2020. Results. Timely implementation of two policy changes compared with current Norwegian prevention policy timeline could have averted approximately 970 additional cases (range of top 10 sets: 830–1060) and accelerated the CC elimination timeline by around 4 years (from 2039 to 2035). Conclusions. If delaying implementation of effective and cost-effective interventions is being considered, the decision-making process should include quantitative analyses on the effects of delays.

Investigation On Psychological Status of Patients With Cervical Precancerous Lesions And Cancer Among Han And Ethnic Minority In Yunnan Province of China

Objective The aim of this study was to explore the correlation and difference of influencing factors by analyzing the psychological status of patients with cervical precancerous lesions and cancer in Han and Ethnic minorities. So as to provide evidence for more targeted psychological intervention for categories types of patients. Methods 200 Han patients with cervical lesions and 100 Ethnic minority patients in Yunnan cancer center were investigated with the Chinese version of Kessler 10 Scale. Statistical analysis was performed using t-test, analysis of variance, and multivariable linear regression. Results There was no significant difference in the distribution of demographic characteristics between the two groups (P>0.05).The results of univariate analysis showed that the impression of K10 score was statistically significant among the following factors: educational level, awareness of HPV vaccine, disease screening status, employee medical insurance, economic burden of disease, cancerous or not, pathological type, treatment modalities, marital status, and family genetic history of tumor (P<0.05).Among them, the marital status had opposite effects on the two groups of patients. The mean score of married Han patients were higher than those of Han patients with other marital status, but the score of Ethnic minority patients the opposite. Multivariate analysis indicates that the economic burden of the disease, occupation, and family genetic history of tumor had a greater impact on the total score of Han patients among many factors, accounting for a total of 8.1% (Adj=0.081).Treatment modalities had the greatest effect on the scores of ethnic minority patients, accounting for 8.4%(Adj=0.084). Conclusion The factors affecting the psychological status of patients between the two groups have similarities and differences. Multifactorial analysis showed that the main factors affecting the psychology of Han patients were: economic burden caused by the disease, occupation, and family genetic history of tumor; while the main factors affecting the psychology of minority patients were: treatment modalities. Therefore, targeted recommendations and policy measures can be proposed respectively. We should not only increase the publicity of disease-related knowledge, but also call on all women to receive vaccines and regular screening of women in the high incidence age group. It is also necessary to positively guide patients with higher education level and give more encouragement and spiritual support to patients with family genetic history of tumor and heavy economic burden of the disease. The effect of marital relationship on patients cannot be neglected at the same time. More targeted psychological intervention and more favorable treatment modalities should be provided for patients.

Endometrial Metaplastic/Reactive Changes Coexistent with Endometrial Hyperplasia and Carcinoma: A Morphological and Immunohistochemical Study

The aim of this study was to assess the relationship between endometrial metaplastic/reactive changes (EMRCs) and endometrial neoplastic lesions. Twenty cases of “simple” (without architecture complexity) EMRCs coexistent with endometrial malignant/premalignant lesions, twenty cases of neoplasia-unassociated EMRCs, and eight cases of complex metaplastic lesions were assessed by immunohistochemistry. EMRCs coexisted with endometrioid carcinoma (n = 12), atypical endometrial hyperplasia (n = 3), serous carcinoma (n = 2), and clear cell carcinoma (n = 3). Neoplasia-associated EMRCs showed a mean Ki67 labeling index of 12.6% (range 0–30%); with nuclear atypia in 16/20 (80%) cases; diffuse p16 expression in 15/20 (75%) cases; and heterogeneous ER, PR, and vimentin expression. Compared to the associated neoplasia, EMRCs showed a lower Ki67 expression (p < 0.001) and higher p16 expression (p < 0.001). No EMRC case showed mitotic activity, PTEN loss, MMR deficiency, nuclear β-catenin, p53-mutant pattern, Napsin A, or AMACR expression. No significant differences were found between neoplasia-associated and neoplasia-unassociated EMRCs. Complex metaplastic lesions showed a lower Ki67 expression than EMRCs (p = 0.044) and PTEN loss in 5/8 cases, even in the absence of nuclear atypia. In conclusion, neoplasia-associated simple EMRCs may show evident atypia and a worrisome immunophenotype, but no data support their involvement in endometrial carcinogenesis. Architectural complexity appears as a crucial factor to identify precancerous lesions.

Evaluation of Dynamic Thiol-Disulfide Homeostasis on Hpv Positive-Women in Progression to Cervical Intraepithelial Lesion

PURPOSE: Dynamic thiol disulfide homeostasis (TDH) is critical in cervical carcinogenesis at HPV infection as a sign of antioxidant consumption native and total thiol levels decrease in progress to cervical intraepithelial lesions. TDH is the main actor in signaling pathways, apoptosis, antioxidant and detoxification reactions. In this study, we aimed to evaluate the effect of TDH intraepithelial progression of cervical precancerous lesions on HPV positive women.METHODS: This was a prospective cross-sectional study. Subjects were selected from newly diagnosed high risk HPV DNA-positive patients. TDH results were calculated as the levels of disulfide, native and total thiol, the ratios of disulfide/total thiol (SS/SH+SS), disulfide/native thiol (SS/SH) and native thiol/total thiol (SH/SH+SS).RESULTS: A total of 146 women were included in the study. Study groups were as group one; control included 66 participants, group two; HPV DNA-positive women without preinvasive cervical lesion included 30 participants and group three; HPV DNA-positive women with preinvasive cervical lesion included 50 participants. Native and total thiol levels were elevated on HPV-positive women without preinvasive cervical lesions. There were no significant differences between groups related to the ratios of SS/SH, SS/ Total SH, SH/ Total SH levels. CONCLUSIONS: HPV infection related to oxidative stress has effects on oxidant/antioxidant balance and could be demonstrated in systemic circulation by TDH parameters. Consumption of thiol substances play role in the cervical neoplastic process, replacement with antioxidants would be a treatment option for HPV infections.

Nanoparticles mediated target-specific drug delivery in prostate cancer: In-depth review

: Nanotechnology has been extensively exploited for its enormous therapeutics and diagnostics potential in the management of multiple disorders. It employs nanomaterials as drug carriers with enhanced efficacy and limited side effects on normal tissues. A lot of nanomaterials have been studied and produced, imminently reforming the treatment and diagnostics of numerous malignancies including cancer. The purpose of the present study is to explore the role of nanotechnology-based devices/therapies that have a vital function in the therapeutics and diagnostics of cancer with potential impact at three levels: early detection, tumor imaging, and drug delivery methods. Concentrating on cancer, promising nanotechnology-based approaches have been planned to satisfy the need for targeted specificity of traditional agents of chemotherapeutics, in addition to early recognition of malignant and precancerous lesions. Prostate cancer is the fifth utmost well-known cancer worldwide and the second most usually detected cancer in men. Therefore, there is a crucial need to improve therapeutic prospects for the diagnosis and treatment of prostate cancer via exploitation of the potential of nanomaterials for cell-targeted specificity and improved primary diagnosis of precancerous tumours. The present review, therefore, focuses on summarizing all prospective applications of nanotechnology in the prognosis and diagnosis of prostate cancer, which would further help researchers to elucidate a more potent therapeutic approach for the better management of prostate cancer in the days ahead.