Can biopsies be omitted after normal colposcopy in women referred with low-grade cervical cytology? A prospective cohort study

Background Controversy surrounds whether women with low-risk cytology screening results but a normal colposcopic assessment should have random biopsies taken. The aim of this study was to determine the yield of CIN2+ from one to four cervical biopsies in women with cytology of LSIL or ASCUS and a normal colposcopic impression. Methods Between January 2017 and September 2020, women over 18 years old referred for colposcopic examination due to either an abnormal smear (ASCUS+) or follow-up after previous cervical intraepithelial neoplasia (CIN) were invited to participate in the study. All study participants underwent colposcopic examination and had four biopsies taken. The biopsies were analyzed separately. Results In total, 1327 women with abnormal cervical cancer screening results or attending follow-up after a previous CIN diagnosis were enrolled in the study and examined by colposcopy. Of these, 173 were newly referred with cytology of LSIL or ASCUS and had a normal colposcopic impression and four adequate biopsies. Of these, 22.0% were diagnosed with CIN2+. When combining the results of the four biopsies, we found a 100% relative increase in CIN2+ cases compared to using only one biopsy (from 11.0% to 22.0%, P = 0.006). Conclusion As we found CIN2+ from random cervical biopsies in 22.0% of women with cytology of LSIL or ASCUS who had a normal colposcopic impression, we advocate performing four random cervical biopsies at the squamocolumnar junction in such women. Trial registration NCT04249856, January 31 2020 (retrospectively registered).

Patterns of Cytokeratin 7 Expression in Cervical Squamous Intraepithelial Lesions

Introduction/Objective It has been suggested that cervical high-grade squamous intraepithelial lesions (HSIL/CIN2-3) arise from squamocolumnar junction cells that express cytokeratin 7 (CK7). Significant CK7 expression (gradation or full-thickness) has been proposed as a marker of progression of low-grade squamous intraepithelial lesions (LSIL/CIN1) to HSIL and of persistence of HSIL/CIN2. The goal of the study is to survey patterns of CK 7 expression in the different grades of squamous intraepithelial lesions (SILs). Methods 65 cervical specimens (biopsies and excisions) containing 95 lesions of different grades were assessed by immunohistochemical analysis (IHC) for CK7 expression. 26 cases contained more one lesion grade. The diagnosis of HSIL (CIN2-3) was confirmed by p16 IHC. CK7 expression was scored negative, patchy, gradation (i.e., top-down), or full-thickness pattern. In cases with heterogeneous staining, the strongest pattern was used for analysis. Results There was significant variation in patterns within morphologically contiguous lesional foci; staining heterogeneity was noted in 42% of cases. All patterns of expression were encountered in all lesion grades. LSIL/CIN1 (n=47), either alone (n=27) or in combination with HSIL (n=20), often lacked CK7 expression (53%) or were patchy (17%). The frequency of significant (gradation or full-thickness) CK7 expression in LSIL with concomitant HSIL was greater than LSIL occurring alone (40% vs. 22%, respectively). HSIL/CIN3 (n=19) was dominated by full-thickness expression (57%). HSIL/CIN2 (n=29) had a very heterogeneous spectrum of expression with 34% of cases lacking expression. Conclusion CK7 expression is variable across all grades of SILs. LSIL with concomitant HSIL was associated with significant CK7 expression more frequently than LSIL alone. Significant proportion of HSIL, particularly CIN2, lacks CK7 expression. Given this variability, caution is advised regarding the use of CK7 expression as a marker of progression.

HUBUNGAN ANTARA LESI PRAKANKER SERVIKS DENGAN SOSIODEMOGRAFI PEREMPUAN DI KECAMATAN LEGOK KABUPATEN TANGERANG TAHUN 2018

Cervical and breast cancer are the highest prevalence cancer in Indonesia in 2013 which caused death to Indonesian women, cervical cancer by 0.8‰ and breast cancer by 0.5‰. Precancerous lesions of the cervix also known as cervical intraepithelial lesions (Cervical Intraepithelial Neoplastic) are the beginning of changes to cervical carcinoma. In general, precancerous lesions of the cervix originate from the squamous columnar junction in the uterine cervix, which undergoes the process of metaplasia. This study aims to determine whether there is a relationship between precancerous cervical lesions and sociodemography of women in Kecamatan Legok Kabupaten Tangerang in 2018. This study uses an analytical study with cross sectionaI approach. The population is all women in Kecamatan Legok Kabupaten Tangerang who had sexual relations. Total sample are 47 people. ABSTRAKPenyakit kanker serviks dan payudara merupakan penyakit kanker dengan prevalensi tertinggi di Indonesia pada tahun 2013 yang menyebabkan kematian pada perempuan Indonesia, yaitu kanker serviks sebesar 0,8‰ dan kanker payudara sebesar 0,5‰. Lesi prakanker pada serviks dikenal juga dengan sebutan lesi intraepitelial serviks (Cervical Intraephitelial Neoplasia) merupakan awal dari perubahan menuju karsinoma serviks. Pada umumnya lesi prakanker serviks ini berawal dari daerah squamocolumnar junction pada serviks uteri yang mengalami proses metaplasia. Penelitian ini bertujuan untuk mengetahui adakah hubungan antara lesi prakanker serviks dengn sosiodemografi perempuan di Kecamatan Legok Kabupaten Tangerang tahun 2018. Penelitian ini merupakan studi analitik dengan pendekatan cross sectionaI. Populasi penelitian adalah semua perempuan di Kecamatan Legok Kabupaten Tangerang yang sudah berhubungan seksual. Total sampel 47 orang.

Establishment and Molecular Phenotyping of Organoids from the Squamocolumnar Junction Region of the Uterine Cervix

The metaplastic epithelium of the transformation zone (TZ) including the squamocolumnar junction (SCJ) of the uterine cervix is a prime target of human papilloma virus (HPV) infection and subsequent cancer development. Due to the lack of adequate in vitro models for SCJ, however, investigations into its physiological roles and vulnerability to carcinogenesis have been limited. By using Matrigel-based three-dimensional culture techniques, we propagated organoids derived from the normal SCJ region, along with metaplastic squamous cells in the TZ. Consisting predominantly of squamous cells, organoids basically exhibited a dense structure. However, at least in some organoids, a small but discrete population of mucin-producing endocervix cells co-existed adjacent to the squamous cell population, virtually recapitulating the configuration of SCJ in a TZ background. In addition, transcriptome analysis confirmed a higher expression level of many SCJ marker genes in organoids, compared to that in the immortalized cervical cell lines of non-SCJ origin. Thus, the obtained organoids appear to mimic cervical SCJ cells and, in particular, metaplastic squamous cells from the TZ, likely providing a novel platform in which HPV-driven cervical cancer development could be investigated.

Comparison between Conventional Cytology and Liquid-Based Cytology in the Tertiary Brazilian Navy Hospital in Rio de Janeiro

<b><i>Introduction:</i></b> Cervical cancer screening is an important tool in public health. Liquid-based cytology (LBC) has been performed at the studied hospital for 7 years. The present study compares the performance of 2 LBC techniques with conventional cytology. <b><i>Objective:</i></b> Our objective is to verify the sensitivity for the detection of neoplastic and preneoplastic epithelial atypia, as well as the positive predictive value of the 3 methodologies. <b><i>Methods:</i></b> We analyzed retrospectively 24,529 cases and evaluated the conventional cytology, ThinPrep®, and BD SurePath® performance categorizing the results according to the Bethesda system. We also compared the level of unsatisfactory samples, the presence of elements from the squamocolumnar junction, and the detection of pathogenic microorganisms. <b><i>Results:</i></b> ThinPrep® (1.43%) showed superior sensitivity over BD SurePath® (0.91%) and conventional cytology (0.71%) in terms of the detection of high-grade lesions; however, in terms of squamous atypia as a whole (ASC-US+), BD SurePath® (6.44%) proved to be more sensitive than conventional cytology (5.28%) and ThinPrep® (3.73%). <b><i>Conclusions:</i></b> The results show the advantage of implementing LBC in routine screening for cervical lesions. In this study, BD SurePath® achieved the overall best performance considering the studied variables.