Histopathological profile of cervical punch biopsies and risk factors associated with high-grade cervical precancerous lesions and cancer in northwest Ethiopia

Abstract

Introduction Cervical cancer is an important public health problem in Ethiopia. However, the disease is not well characterized and studied in various parts of the country. This study was designed to describe the histopathological profile of cervical biopsies and to identify risk factors associated with high-grade cervical lesions and cancer (CIN2+C). Methods A cross-sectional study was conducted at Felege Hiwot Compressive Specialized Hospital (FHCSH) between 1 March 2019 and 30 October 2021. A structured questionnaire was used to collect data on the participants’ demographic, reproductive and gynecologic history. From women presented with different degrees of cervical lesions, a senior gynecologist collected cervical swabs using (Digene HC2 DNA collection device: Qiagen, Hilden, Germany) for detection of high-risk Human papillomaviruses (HR-HPV) and punch biopsy for histopathological examinations. HR-HPVs were detected using the Abbott Alinity m system following the manufacturer protocol at the Institute of Virology, Leipzig University Hospital, Germany. Collected data entered and analyzed using SPSS version 25. A logistic regression model was used for both bivariable & multivariable analysis in order to determine the association between independent variables and CIN2+C. Statistical significance was set at a p-value <0.05. Results In this study, 335 women were included; the mean age was at 46.5±11.4 years. Most were living in rural settings, 221(66%) and had no formal education, 259 (77.3%). More than half of the participants, 193(57.6%) were unaware of cervical cancer. The prevalence of HIV infection and previous history of cervical screening were 44(13.1%) and 93(27.8%), respectively. HR-HPVs were detected in 178(54.3%) of the participants. The majority of biopsies, 140(41.8%; 95%CI: 36.6–47.1%), were diagnosed as cervical carcinoma. Normal histology, cervicitis, cervical intraepithelial neoplasia (CIN)-1, CIN-2, and CIN-3 accounted for 74(22.1%), 30(9.0%), 40(11.9%), 12(3.6%), and 12(3.6%), respectively. High-grade lesions and cancer (CIN2+C) together accounted 164(49.0%; 95%CI: 43.6–54.2). Cervical cancer increased steadily with the age of the participants (p<0.001) in which women above the age of fifty were approximately four times more likely to develop CIN2+C than the younger ones (AOR: 3.73; 95%CI: 1.80–7.82; p<0.001). Likewise, no screening history in the last five years (AOR: 2.03; 95%CI: 1.05–3.92; p = 0.035) and being infected with HR-HPVs (AOR: 14.23; 95%CI: 7.9–25.64; p<0.001) were found significantly associated with CIN2+C. Conclusions The findings of this study revealed that cervical cancer continues to be an important women’s health challenge in northwest Ethiopia. Postmenopausal women, who had no screening history within a five-year period and those women who tested positive for HR-HPV need special attention. It is important to increase the awareness of women about cervical cancer and actions for early detection of precancerous lesions should be expanded.

Histopathologic patterns and factors associated with cervical lesions at Jimma Medical Center, Jimma, Southwest Ethiopia: A two-year cross-sectional study

“…Similarly, a study performed in India showed that cervical intraepithelial neoplasia (CIN) 1 was diagnosed in 36.1% of patients, followed by CIN 2 (33.3%) and CIN 3 (30.6%) [ 20 ]. Likewise, a study done in northwestern Ethiopia on 335 cases, showed that cervical intraepithelial neoplasia (CIN)-1, CIN-2, and CIN-3 accounted for 40(11.9%), 12(3.6%), and 12(3.6%), respectively [ 37 ]. Our findings are consistent with this and other similar studies.…”

Predictors of Precancerous Diseases of the Cervix

“…Частая смена половых партнеров и, как следствие, высокий риск присоединения ИППП также относятся к общеизвестным факторам риска рака и предрака шейки матки, в этих условиях ВПЧ быстрее переходит из свободной в эписомальную форму и запускает процесс трансформации клеток эпителия шейки матки. Особенно опасно длительное течение инфекционного заболевания с переходом в хроническую форму, когда пациентка не предъявляет жалоб на приеме у акушера-гинеколога, а правильный диагноз возможен только после проведения дополнительных методов исследования [21][22][23][24][25].…”

“…Самым бесспорным является факт наличия ВПЧ у пациенток с предраковыми заболеваниями шейки матки. В нашем исследовании ВПЧ встречался как в группе женщин с CIN (43,3 %), так и в группе Уральский медицинский журнал umjusmu.ru Оригинальная статья женщин со здоровой шейкой матки (16,7 %), поэтому поиск данных о причине развития CIN в условиях наличия ВПЧ у одних женщин и отсутствия заболевания в этих же условиях у других женщин продолжается; пока многие исследователи связывают риск формирования инвазии с дефектом местного иммунитета [21][22][23][24][25].…”

“…Доля родов у женщин I группы -63,3 % (19 человек), доля абортов -53,3 % (16 человек). Индекс массы тела (ИМТ) пациенток I группы составил 23 кг/м 2 (20)(21)(22)(23)(24)(25)(26).…”

SERPINB7 as a prognostic biomarker in cervical cancer: Association with immune infiltration and facilitation of the malignant phenotype

“…As the primary symptoms of CESC are often undetectable, the disease progression may continue for 10 years. A neglect of routine physical examinations can lead to late diagnosis, thus missing the optimal period for treatment [ 17 , 18 ]. Consequently, the accuracy of the initial diagnosis is of major importance.…”