Current views on cervical intraepithelial neoplasia.

Anderson, M. C.; Brown, Christopher L.; Buckley, C. H.; Fox, H.; Jenkins, David; Lowe, Donna; Manners, B. T. B.; Melcher, D. H.; Robertson, Ashley; Wells, Max M.

doi:10.1136/jcp.44.12.969

Cited by 78 publications

(52 citation statements)

References 9 publications

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“…In contrast, the introduction of a borderline category in histological diagnosis, as being either basal abnormalities of uncertain significance [8,11] or borderline condiloma [12,13] has been strongly criticised, because of the increased inter-observer disagreement and low reproducibility in distinguishing AL from normal tissue and low dysplasia [7,23] . Also by using the Bethesda system, the pathologist's intra-and inter-observer agreement in the LSIL assessment remains low [2][3][4][5][6][7][8][9] .…”

Section: Resultsmentioning

confidence: 99%

“…All of them had been performed on colposcopically evidenced aceto-white foci and consisted of cases lacking of alterations required to qualify the lesion as CIN1 [11] , in which the features of HPV infections were either inconsistently present or only mildly/focally evident.…”

Section: Methodsmentioning

confidence: 99%

“…One likely reason is that also experienced histopathologists sometimes diagnose as LSIL some less striking HPV-induced lesions, which are not characterized by clear dysplasia and thus should not be considered as CIN [10] . Some authors [8,11,12,13] described in detail some of these lesions which, for the aim of this analysis, are hereafter referred to as Atypical Lesions (AL). In AL, histological features of HPV infection [11,14,15] (namely, koilocytosis, multinucleation, acanthosis, papillomatosis, parakeratosis, individual cell keratinisation, mitosis in the lower basal third of the epithelium, hyperplasia of basal layers and absence of distinct basal cell layer) are either inconsistently present or only mildly/focally evident.…”

Section: Introductionmentioning

confidence: 99%

“…Some authors [8,11,12,13] described in detail some of these lesions which, for the aim of this analysis, are hereafter referred to as Atypical Lesions (AL). In AL, histological features of HPV infection [11,14,15] (namely, koilocytosis, multinucleation, acanthosis, papillomatosis, parakeratosis, individual cell keratinisation, mitosis in the lower basal third of the epithelium, hyperplasia of basal layers and absence of distinct basal cell layer) are either inconsistently present or only mildly/focally evident. Moreover, from the colposcopical point of view, both AL and metaplastic/reactive lesions and LSIL appear like acetowhite foci, which are usually bioptised and represent one of the most frequent challenges in routine surgical pathology practice.…”

Section: Introductionmentioning

confidence: 99%

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Histological Features and ki-67 Index in Cervical Atypical Lesions

Cabibi¹,

Giovannelli²,

Cacciatore³

et al. 2008

American J. of Infectious Diseases

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Abstract:One of the most frequent challenges in routine diagnostic assessment of cervical biopsies consists of some lesions in which histological features of HPV infection are either inconsistently present or only mildly/focally evident. We named them Atypical Lesions (AL) because differential diagnosis with metaplastic/reactive lesions and LSIL is difficult. It would be important to identify among them those lesions that are really HPV-associated. We studied 52 AL cases to evaluate whether the morphological features and the proliferation index, assessed by Mib1 (Ki67) immunostaining, would be useful to better understand the real nature of AL, with relation to the HPV presence and to the proliferative activity HPV induced. By univariate analysis, koilocytosis was found to be the only relatively sensitive and specific morphologic parameter associated with HPV status (74% sensitivity, 72% specificity, 77.0% PPV). Mib1 index was not proven to be either a sensitive or a specific method (40.7% sensitivity, 64.0%, specificity and 55.0% PPV). Nevertheless, when AL were stratified by the three investigated features (koilocytosis, Mib1 immunostaining and HPV-DNA presence), they could be divided in subgroups consisting of normal cases (lacking of all the three studied features) reactive/repair changes, mimics of koilocytosis, latent, sub-clinical infection, cytopathic infection, without replicative activity (all of them at least lacking of one of the studied features) and finally, proliferative infection cases, in which all the three features were present. The last group showed high probability to harbour HR-HPV DNA (91% of cases). In conclusion, AL appear as a very heterogeneous group of lesions, in which Mib1 assessment alone is not sensitive and specific enough to distinguish HPV negative from HPV positive lesions. Nevertheless, the Mib1 together with koylocitosis, could be useful to identify cases with HPV infection and increased proliferative activity that are at high risk of harbouring HR-HPV DNA and that could have a greater clinical rilevance.

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Section: Resultsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Histological Features and ki-67 Index in Cervical Atypical Lesions

Cabibi¹,

Giovannelli²,

Cacciatore³

et al. 2008

American J. of Infectious Diseases

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“…Debates on this topic continue in the early twenty-first century. Evaluations of the rate of progression of premalignant lesions to cancer continued to differ widely, and the distinction between dysplasia and in situ cancer remains fluid (Springgs, 1984;Anderson et al, 1991;Payne et al, 1996;Koss, 1978Koss, , 1989. On the other hand, clinical guidelines that reinforced the principle of physical elimination of every suspicious cervical lesion diminished even more the practical importance of an accurate classification of these lesions.…”

Section: Saving the Uterus: From Radical To Conservative Surgerymentioning

confidence: 99%

Cancer, women, and public health: the history of screening for cervical cancer

Löwy¹

2010

Hist. cienc. saude-Manguinhos

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Cytological screening for cervical cancer (the Pap smear), the first attempt at mass screening for a human malignancy, is often presented as a non-problematic demonstration of the feasibility of such screening. Screening for this tumor became a model for screening for other malignancies: breast, colon and prostate. My text follows the early history of the Pap smear and the conditions that led to its transformation into a routine screening test, despite persistent problems in stabilizing the readings of microscopic slides. It then analyzes the consequences of diffusion of the Pap smear, controversies surrounding this test, the mutual shaping of diagnostic tests and the disease cervical cancer, and the problematic extension of the lessons learned in screening for cervical tumors to other malignancies.

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Susceptibility to human papillomavirus-associated cervical intra-epithelial neoplasia is determined by specific HLA DR-DQ alleles

Odunsi

Terry

et al. 1996

Int. J. Cancer

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Human papillomaviruses (HPV) play a causative role in the aetiology of cervical intra-epithelial neoplasia (CIN) and cervical cancer. Human leukocyte antigens (HLA) are important in the regulation of immune response to foreign antigens. The role of genetic variation at the HLA class II loci (DR and DQ) in CIN (HPV 16, 18, 31 and 33 typed) was investigated by PCR DNA amplification and oligonucleotide probe typing of cervical smears from British Caucasian patients (n = 176) and controls (n = 416). The alleles of the DQB1*03, DRB1*04 and DRB1*11 loci were strongly associated with susceptibility to CIN. Specifically, the haplotypes DRB1*0401-DQB1*0301 and DRB1*1101-DQB1*0301 were significant and indicated susceptibility. The DQB1*03 locus was more contributory to this association than the DRB1 loci. A weak protective effect was shown for the haplotype DRB1*0101-DQB1*0501. Positive correlation was also observed for HPV-positive CIN, suggesting that specific HLA class II alleles may be important in determining the immune response to HPV antigens and the risk for CIN after HPV infection. Our results should help in the rational design of vaccines against HPV.

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Current views on cervical intraepithelial neoplasia.

Cited by 78 publications

References 9 publications

Histological Features and ki-67 Index in Cervical Atypical Lesions

Histological Features and ki-67 Index in Cervical Atypical Lesions

Cancer, women, and public health: the history of screening for cervical cancer

Susceptibility to human papillomavirus-associated cervical intra-epithelial neoplasia is determined by specific HLA DR-DQ alleles

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