Distribution of cervical intraepithelial neoplasia on the cervix in Chinese women: pooled analysis of 19 population based screening studies

Zhao, Yu; Chang, Irene J.; Zhao, Fen; Hu, Shang Ying; Smith, Jennifer S.; Zhang, Xun; Li, Shu Min; Bai, Péter; Zhang, Wen Hua; Qiao, You‐Lin

doi:10.1186/s12885-015-1494-4

Cited by 5 publications

(12 citation statements)

References 29 publications

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“…Of note, most severe lesions were found at the 8 and 7 o’clock positions, either in low- or high-grade lesions. In a similar manner, Zhao et al (2015) identified that quadrants 2 and 3, specifically in the 4 and 7 o’clock positions, were susceptible to CIN on the cervix. CIN will be found more frequently on the posterior lip than on the anterior lip of the cervix.…”

Section: Discussionmentioning

confidence: 74%

“…Conversely, the necrotic area may become shallower in the elderly or postmenopausal subjects due to increased tight junctional resistance. This factor becomes a major determinant for epithelial permeability that maintains the integrity and organization of cells through the action mechanism of various proteins, such as claudins ( Blaskewicz et al, 2011 ; He et al, 2012 ; Zhao et al, 2015 ). Nevertheless, in this study, no association was found between age or menopausal status with the mean depth of tissue destruction or cervical physical dimensions, including length and diameter.…”

Section: Discussionmentioning

confidence: 99%

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Pilot Study on the Effect of a Single Topical Application of Trichloroacetic Acid 85% on Normal Cervical Tissue

et al. 2022

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Background: Early detection and treatment of cervical intraepithelial neoplasia (CIN) through a “see and treat” approach is a pillar of cervical cancer prevention programs in developing countries such as Indonesia. One of the major challenges faced is the limited N2O or CO2 gas supply for cryotherapy. Thus, an alternative therapeutic method such as trichloroacetic acid (TCA) topical application is needed as an alternative solution. The effectiveness of this therapy will depend on its destructive effect on eliminating the whole lesion in CIN.Objective: To estimate the extent of damage in the normal cervical tissue after a single topical application of 85% TCA solution.Design and Methods: This research was an intervention study carried out by applying ±5 ml of 85% TCA solution into the cervix of 40 patients scheduled for total hysterectomy for indications other than cervical pathology 24 h before surgery. The extent of tissue destruction was determined microscopically using histopathological specimens. The study protocol is registered at www.clinicaltrial.gov (ID NCT04911075).Results: In the final analysis, 39 subjects were included. The necrotic area was detected at the superficial layer, accompanied by the full epithelial erosion thickness. In addition, there were also fibrotic areas resembling burned tissue in the stroma. The mean depth of destruction was 1.16 ± 0.01 mm in the anterior lip and 1.01 ± 0.06 mm in the posterior lip. There was no significant depth difference between the anterior and posterior lips (p ≥0.05). Moreover, the 85% TCA topical application was tolerable, as represented by the fact that the vast majority (82.1%) of participants experienced pain with a visual analog scale score of <4.Conclusion: Single dose of TCA 85% in topical solution was able to destroy the normal cervical tissue with a deeper mean depth than the mean depth of CIN III in squamous epithelium.

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Section: Discussionmentioning

confidence: 74%

Section: Discussionmentioning

confidence: 99%

Pilot Study on the Effect of a Single Topical Application of Trichloroacetic Acid 85% on Normal Cervical Tissue

et al. 2022

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“…To date, in terms of understanding the topographic CIN distribution with colposcopy, previous studies have qualitatively evaluated CIN lesions using limited biopsy specimens or conization specimens resected with the LEEP technique. [19][20][21][22]24,25 Most studies reported a distribution bias, mainly in the anterior or posterior walls of the uterine cervix, [19][20][21][22] whereas some investigators argued for lesion heterogeneity. 24 However, the relationship between CIN distribution and clinicopathological factors has not been accurately evaluated.…”

Section: Discussionmentioning

confidence: 99%

Distribution of cervical intraepithelial neoplasia is closely associated with HPV status and uterine position

Tamura¹,

Sako

Watanabe³

et al. 2023

Journal of Medical Virology

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Although cervical intraepithelial neoplasia (CIN) lesions are considered to be not randomly distributed across the cervix, but predominantly in the anterior wall, the clinicopathological etiology remains unknown. Herein, we aimed to elucidate the relationship between quantitatively measured area of CIN2/3 and cervical cancer associated factors by retrospective cohort study. We analyzed 235 consecutive therapeutic conization specimens dissected as a single intact section to determine CIN2/3 area and its correlation with both clinical risk factors including human papillomavirus (HPV) status (single or multiple infection) and uterine position defined by transvaginal ultrasound. Cervical wall was classified into three groups: anterior: (11, 12, 1, and 2 o'clock), posterior (5, 6, 7, and 8 o'clock) and lateral (3, 4, 9, and 10 o'clock). Multiple regression revealed that younger age and HPV16 status were significantly correlated with CIN2/3 area (p = 0.0224 and p = 0.0075, respectively).The Jonckheere-Terpstra test showed a significant trend: CIN2/3 area was highest in the single HPV16 group, followed by the multiple HPV16 group and the non-HPV16 group (p < 0.0001). CIN2/3 area in the anterior wall was statistically significantly larger than the posterior and lateral wall (p = 0.0059 and p = 0.0107, respectively). CIN2/3 area in the anterior wall was significantly greater with anteversion-anteflexion than retroversion-retroflexion (p = 0.0485), whereas CIN2/3 area in the posterior wall was significantly larger with retroversion-retroflexion than anteversion-anteflexion (p = 0.0394). In conclusion, the topographical distribution of CIN2/3 area is closely associated with patient age, high-risk HPV status, especially single HPV16 infection and uterine position.

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“…Another limitation is that random biopsy was taken at fixed location on the cervix. Several studies reported there might be a topographical pattern of CIN on the cervix, which may result in underestimating the CIN2+ yield of biopsy at normal-appearing areas ( 32 - 34 ). Possible harms of taking multiple biopsies are discomfort and increased the cost of pathology processing and evaluation.…”

Section: Discussionmentioning

confidence: 99%

Value of multi-quadrants biopsy: Pooled analysis of 11 population-based cervical cancer screening studies

Zhao

et al. 2020

Chinese Journal of Cancer Research

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Objective The accuracy of colposcopy-guided biopsy is key to the success of colposcopic triage in cervical cancer screening programs. However, there is no widely adopted biopsy guideline up to date. Our study aimed to determine whether multi-quadrants biopsy improves the yield of cervical lesions. Methods Eleven population-based cervical cancer screening studies were conducted in China. Cytology, high-risk human papillomavirus (hrHPV) testing and visual inspection were performed for primary screening. Females positive on one or more tests were referred for colposcopy and biopsy. The proportion of detected cervical intraepithelial neoplasia (CIN)2+ and yields by quadrant lesion-targeted biopsy or 4-quadrant random biopsy were compared. Results Among 4,923 females included, 1,606 had quadrant lesion-targeted biopsy, and 3,317 had 4-quadrant random biopsy. The cumulative CIN2+ yield increased from 0.10 for only one quadrant-targeted biopsy to 0.21, 0.34, and 0.58 for at most two, three and four quadrants targeted biopsies. Among hrHPV positive females with high-grade squamous intraepithelial lesion (HSIL)+ cytology, the cumulative CIN2+ yield of a second targeted biopsy in another quadrant was significantly increased (P<0.05). Among hrHPV-negative females, the yield of 4-quadrant random biopsies was 0.005, and the yield by lesion-targeted biopsies was 0.017. For hrHPV positive females who had 4-quadrant random biopsy, the additional CIN2+ yield for HSIL+, low-grade squamous intraepithelial lesion (LSIL) cytology, or abnormal visual inspection via acetic acid and Lugol’s iodine (VIA/VILI) were 0.46, 0.11, 0.14. Conclusions A 4-quadrant random biopsy is recommended only for hrHPV positive females with HSIL cytology, and is acceptable if hrHPV positive with LSIL cytology or with abnormal VIA/VILI. Our findings add evidences for an objective and practical biopsy standard to guide colposcopy in cervical cancer screening programs in low- and middle-income countries.

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Distribution of cervical intraepithelial neoplasia on the cervix in Chinese women: pooled analysis of 19 population based screening studies

Cited by 5 publications

References 29 publications

Pilot Study on the Effect of a Single Topical Application of Trichloroacetic Acid 85% on Normal Cervical Tissue

Pilot Study on the Effect of a Single Topical Application of Trichloroacetic Acid 85% on Normal Cervical Tissue

Distribution of cervical intraepithelial neoplasia is closely associated with HPV status and uterine position

Value of multi-quadrants biopsy: Pooled analysis of 11 population-based cervical cancer screening studies

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