The Invasive Potential of Carcinoma in Situ of the Cervix

Mclndoe, W. A.; McLean, Malcolm R.

doi:10.1097/00004347-198203000-00011

Cited by 64 publications

(86 citation statements)

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“…This high prevalence (>50%) of such severe cytologic abnormalities in women immunocompromised by HIV is particularly alarming given the fact that approximately 12-30% of immunocompetent HIV-negative women with untreated HSIL are known to progress to invasive cancer [17][18][19]. These results indicate the crucial importance of screening HIV-infected women who live in resource-constrained settings, like those in Zambia, who are now accessing antiretroviral therapy.…”

Section: Discussionmentioning

confidence: 99%

Prevalence and predictors of squamous intraepithelial lesions of the cervix in HIV-infected women in Lusaka, Zambia

Parham

Sahasrabuddhe

Mwanahamuntu

et al. 2006

Gynecologic Oncology

118

124

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Objectives-HIV-infected women living in resource-constrained nations like Zambia are now accessing antiretroviral therapy and thus may live long enough for HPV-induced cervical cancer to manifest and progress. We evaluated the prevalence and predictors of cervical squamous intraepithelial lesions (SIL) among HIV-infected women in Zambia.Methods-We screened 150 consecutive, non-pregnant HIV-infected women accessing HIV/AIDS care services in Lusaka, Zambia. We collected cervical specimens for cytological analysis by liquidbased monolayer cytology (ThinPrep Pap Test®) and HPV typing using the Roche Linear Array® PCR assay.Results-The median age of study participants was 36 years (range 23-49 years) and their median CD4+ count was 165/μL (range 7-942). The prevalence of SIL on cytology was 76% (114/150), of which 23.3% (35/150) women had low-grade SIL, 32.6% (49/150) had high-grade SIL, and 20% (30/150) had lesions suspicious for squamous cell carcinoma (SCC). High-risk HPV types were present in 85.3% (128/150) women. On univariate analyses, age of the participant, CD4+ cell count, and presence of any high-risk HPV type were significantly associated with the presence of severely abnormal cytological lesions (i.e., high-grade SIL and lesions suspicious for SCC). Multivariable logistic regression modeling suggested the presence of any high-risk HPV type as an independent predictor of severely abnormal cytology (adjusted OR: 12.4, 95% CI 2.62-58.1, p=0.02).Conclusions-The high prevalence of abnormal squamous cytology in our study is one of the highest reported in any population worldwide. Screening of HIV-infected women in resourceconstrained settings like Zambia should be implemented to prevent development of HPV-induced SCC.

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Section: Discussionmentioning

confidence: 99%

Prevalence and predictors of squamous intraepithelial lesions of the cervix in HIV-infected women in Lusaka, Zambia

Parham

Sahasrabuddhe

Mwanahamuntu

et al. 2006

Gynecologic Oncology

118

124

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“…Reliance on this parameter alone would result in overtreatment of many women and under treatment of a small but significant group. In this respect it is relevant to realize that residual disease can also pro gress to invasive carcinoma of the cervix [6,11,12].…”

Section: Discussionmentioning

confidence: 99%

Persistent Cervical Intraepithelial Neoplasia after Incomplete Conization: Predictive Value of Clinical and Histological Parameters

Jansen

Trimbos²,

Hermans³

et al. 1994

Gynecol Obstet Invest

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In a group of 316 conizations performed from January 1984 to July 1991, 68 patients (22%) revealed no free margins of cervical intraepithelial neoplasia (CIN). They were divided into two groups with: ‘negative follow-up’ [normal cytology or less than two smears suggesting CIN I (class IIIa)] and ‘positive follow-up’ [at least two smears suggesting CIN I or one smear suggesting CIN II (class IIIb) or worse]. Forty-five patients (66%) fulfilled the criteria of negative follow-up. All patients with CIN I at the cone margin (18) were found in this group. The other 23 patients were in the positive follow-up group. Patients with positive follow-up were significantly younger (p = 0.04). Intervention after incomplete cone biopsy was necessary in approximately 10% (7/68) of cases. Cytology was thereby a reliable indicator for residual disease. Higher grade of CIN involved at the cone margin predicted a higher chance of positive follow-up. Semiquantitative measurement of CIN in the cone specimen showed a severe involvement of CIN II and CIN III in the positive follow-up group. In sum, our study showed that CIN I at the margin of the cone biopsy has no clinical significance. However, CIN II or III at the margin needs a careful cytologic follow-up, and appropriate action should be taken in case of cytologic abnormalities.

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“…Cervical intraepithelial neoplasia (CIN) is a precursor to carcinoma of the cervix and is subdivided into three grades, CIN I, CIN II and CIN III. The malignant potential of the most severe form, CIN grade III (carcinoma in situ), is thought to be approximately 36% over 20 years (Mclndoe et al, 1984). Less is understood about the malignant potential of minor CIN (grades I and II), and up to 50% of these lesions may regress spontaneously (Robertson et al, 1988).…”

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confidence: 99%

Angiogenesis is associated with vascular endothelial growth factor expression in cervical intraepithelial neoplasia

Dobbs

Hewett²,

Johnson³

et al. 1997

Br J Cancer

129

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Summary Squamous cell carcinoma of the cervix (SCC) is preceded by a premalignant condition known as cervical intraepithelial neoplasia (CIN). The majority of cases of CIN regress spontaneously; however, methods are needed to identify those lesions likely to progress. Increased blood vessel density, signifying angiogenesis, is an independent prognostic indicator in a number of cancers, although little is known about its significance in premalignant lesions. The aim of the present study was to determine the relationship between vessel density, expression of the potent angiogenic factor vascular endothelial growth factor (VEGF) and CIN grade. Using immunohistochemistry, mean vessel density (MVD) and VEGF expression were assessed in samples from 54 patients who had undergone cone biopsy for CIN or hysterectomy for SCC and from 16 patients with no cervical pathology. There were significant increases in MVD and VEGF expression from normal cervix through CIN I to CIN IlIl to invasive SCC, but no difference in mean vessel diameter between groups. There was a strong correlation between mean vessel density and VEGF expression, and both were associated with histological grade of CIN. The original MVDs for a small group of patients later presenting with recurrent disease were found to be equal to or greater than the mean for their histological grade. We conclude that the onset of angiogenesis is an early event in premalignant changes of the cervix due, in part, to enhanced expression of VEGF by the abnormal epithelium.

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The Invasive Potential of Carcinoma in Situ of the Cervix

Cited by 64 publications

References 0 publications

Prevalence and predictors of squamous intraepithelial lesions of the cervix in HIV-infected women in Lusaka, Zambia

Prevalence and predictors of squamous intraepithelial lesions of the cervix in HIV-infected women in Lusaka, Zambia

Persistent Cervical Intraepithelial Neoplasia after Incomplete Conization: Predictive Value of Clinical and Histological Parameters

Angiogenesis is associated with vascular endothelial growth factor expression in cervical intraepithelial neoplasia

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