Journal of Lower Genital Tract Disease最新文献

Objectives: The Pap test is effective for detecting squamous neoplasia, but the interpretation of atypical glandular cell (AGC) remains challenging because of its rarity, complex cytologic features, and interobserver variability. Although AGC represents a small proportion of Pap test diagnoses, it often leads to extensive follow-up. This study aimed to assess whether gynecologic pathology expertise improves diagnostic accuracy and reduces unnecessary interventions in AGC interpretation.

Methods: A retrospective review of AGC cases diagnosed between 2014 and 2024 at the authors' institution was conducted. Among 107,615 Pap smears, 301 (0.28%) were initially classified as AGC. Of these, 221 had slides available for review, and 184 had adequate histologic follow-up. Cases were re-evaluated by a cytopathologist with additional gynecologic pathology training, blinded to clinical information, and reclassified according to the Bethesda System.

Results: Reclassification identified 62 cases as AGC, 1 as adenocarcinoma in situ, and 4 as adenocarcinoma. The remaining 117 cases were reassigned to other diagnostic categories. The malignancy rate increased from 39.1% to 53.9%, and the positive predictive value for significant histologic findings was 59.7%. Cytology-histology concordance improved from 26.6% to 64.1% ( p = .002).

Conclusions: Gynecologic pathology expertise enhanced the diagnostic accuracy of AGC, improved malignancy detection, and significantly increased cytohistologic correlation. While decreasing sensitivity, it increases positive predictive value of AGC interpretation. These findings highlight the value of specialized training and the need for a specific, criteria-based approach to minimize unnecessary follow-up and optimize patient care.

Objectives: This study aimed to evaluate the efficacy of treatments for usual-type vulvar intraepithelial neoplasia (uVIN).

Methods: This review followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, searching PubMed, Embase, Scopus, Web of Science, the Cochrane Central Register of Controlled Trials, PsycINFO, and Clinical Trial Databases in July 2024. Clinical trials comparing treatments for uVIN to a placebo or other treatments were included. The risk of bias was assessed using the Cochrane Risk of Bias (RoB 2.0) tool, and the strength of evidence was evaluated using the GRADE approach.

Results: Out of 10,306 studies, 8 met the inclusion criteria. A meta-analysis of 2 studies comparing imiquimod 5% to placebo found that 55.3% of women in the imiquimod group experienced total lesion resolution, compared to 0% in the placebo group (risk ratio = 18.21, 95% CI = 2.60-127.69). Cidofovir 1% had a complete response rate of 41%, while imiquimod 5% showed a 42% response. Imiquimod 5% was well-tolerated and showed a trend toward noninferiority to surgical treatments. Ultrasonic surgical aspiration is less scary than CO 2 laser vaporization, with similar efficacy. Sinecatechins 10% showed lesion improvement in the best observed clinical response compared to those in the placebo group ( p = .002), while indole-3-carbinol and Omiganan were ineffective despite adherence to treatment protocols.

Conclusions: Imiquimod 5% is an effective treatment for uVIN with comparable results to surgery. Cidofovir 1% is another effective option. Less invasive treatments are beneficial for multifocal or extensive lesions but combining medical and surgical approaches has not been studied.

Objectives: Dynamic Spectral Imaging colposcopy (DSI), an AI-driven technology, may improve cervical cancer diagnostics. This study aimed to evaluate the cervical intraepithelial neoplasia grade 2 or worse (CIN2+) sensitivity of DSI compared to regular colposcopy in individuals referred due to human papillomavirus (HPV)-positive and/or low-grade cytology.

Methods: This multicenter comparative cross-sectional study included individuals aged ≥18 years referred for colposcopy due to HPV positivity and/or low-grade cytology. Participants underwent either DSI or regular colposcopy. Colposcopists first identified the most suspicious area; in the DSI group, this was done before reviewing the DSI color map. The worst colored area was then selected, followed by additional biopsies. All participants had 4 cervical biopsies taken, with the most severe diagnosis as the gold standard. The primary outcome was CIN2+ detection sensitivity comparison between groups using a chi-square test.

Results: A total of 411 individuals underwent examination with DSI and 308 had regular colposcopy. The sensitivity for detecting CIN2+ with DSI was 69.3% (95% CI = 61.2-76.7) with an average of 1.3 biopsies, comparable to the sensitivity of the regular group when 2 biopsies were taken (68.3%, 95% CI = 58.3-77.2). No significant sensitivity differences were observed between groups when 3 or 4 biopsies were combined.

Conclusion: The DSI color map did not show a clinically significant improvement in CIN2+ detection sensitivity compared to regular colposcopy. However, multiple biopsies enhanced sensitivity and remained superior for CIN2+ detection in both colposcopy groups.

Objectives: This study aims to evaluate the risk of cervical glandular neoplasia with extended high-risk human papillomavirus (hrHPV) genotyping, in patients with atypical glandular cells (AGC) cytology.

Methods: Cervical AGC cases with concurrent extended HPV genotyping between October 2017 and October 2023 were retrieved from the archives of Department of Pathology, Obstetrics, and Gynecology Hospital of Fudan University (OGHFU).

Results: A total of 497 AGC cases with extended hrHPV genotyping showed an hrHPV-positive rate of 32.0%. The top 4 hrHPV types were HPV18, 16, 52, and 59. A total of 304 cases had histological follow-up. A total of 72 cases (23.7%) had cervical adenocarcinoma in situ/cervical intraepithelial neoplasia3 or worse (AIS/CIN3+) lesions with 43 endocervical carcinoma (EC-ADC), 28 AIS, and 1 CIN3. Cervical AIS/CIN3+ lesions were detected in 50.5% (55/109) of the hrHPV-positive group. Women with HPV18/16/45 positivity had 77.6% cumulative risk of cervical AIS/CIN3 + lesions (52/67), accounting for 94.6% (52/55) of the total hrHPV-associated cervical AIS/CIN3+ lesions. For all 15 other hrHPV types, the overall risk of AIS/CIN3+ was 7.1% (3/42 cases). The sensitivity, specificity, PPV, and NPV of the composite HPV18/16/45 group for detecting endocervical glandular neoplasia was 71.8%, 93.1%, 76.1%, and 91.6%, respectively. Endocervical carcinoma was found in 17 of 195 (8.7%) women with negative hrHPV testing, accounting for 39.5% EC-ADC (17/43) cases.

Conclusions: Atypical glandular cells was rarely related to CIN3. Atypical glandular cells was strongly related to AIS and EC-ADC. Women aged 30-49 years had highest risk for AIS/CIN3+ lesions. Although HPV test can be helpful, there were still some cases of HPV-negative endocervical adenocarcinomas. Extended HPV genotyping in AGC cases identified certain HPV types associated with a higher risk of cervical glandular lesions, potentially assisting with risk stratification.

Objective: Trichomoniasis is a globally prevalent sexually transmitted infection caused by the protozoan Trichomonas vaginalis . Polymerase chain reaction (PCR) is the gold standard for diagnosing trichomoniasis, but it is expensive. Antigen tests are immunochromatographic immunoassays that detect T. vaginalis membrane proteins. Despite being user-friendly and rapid, the diagnostic accuracy of antigen tests remains uncertain. Therefore, this meta-analysis aimed to evaluate the diagnostic accuracy of antigen tests for T. vaginalis infections.

Methods: The authors mined the PubMed, Embase, and Cochrane Library databases for studies evaluating the diagnostic accuracy of antigen tests for T. vaginalis . They included studies that provided diagnostic test accuracy data in order to conduct a meta-analysis. They evaluated antigen tests based on immunochromatography and lateral flow devices. The meta-analysis was conducted by using the hierarchical summary receiver operating characteristic model.

Results: Eleven studies with 5,884 samples were included. The meta-analysis yielded a pooled sensitivity of 87.0% and a pooled specificity of 98.3%. A subgroup analysis employing PCR as the reference standard yielded a sensitivity of 58.5%, whereas another subgroup analysis using culture returned a sensitivity of 95.9%. The subgroup analysis of 6 studies comprising 2,328 specimens from symptomatic individuals yielded a pooled sensitivity of 85% and a specificity of 99.9%.

Conclusions: The antigen tests exhibited high sensitivity and specificity. Additionally, subgroup analyses revealed that antigen tests demonstrated greater sensitivity in diagnosing symptomatic patients compared to asymptomatic individuals. While less sensitive than PCR, antigen testing remains a promising avenue for detecting T. vaginalis infections.

Objectives: Cervical cancer is a preventable and manageable public health concern. This study aimed to evaluate the performance of a government-financed cervical cancer screening program and to discuss optimal primary screening approach and triage strategies for large-scale population screening.

Methods: This population-based study was conducted from 2015 to 2020 and included 6,373,279 eligible women. The performance of the cervical cancer screening program in Hunan Province was evaluated by comparing cancer incidence and mortality rates. The screening powers of primary human papillomavirus (HPV) testing and cytology were compared by calculating positive outcomes and cervical intraepithelial neoplasia 2 or worse (CIN2+) detection rates. Triage strategies for individuals positive for HPV-16/18 after primary HPV testing were discussed by comparing the CIN2+ detection rates and associated costs.

Results: The cervical cancer screening program has contributed to lower cancer mortality rates in Hunan Province. The HPV testing showed a higher CIN2+ detection rate than cytology as the primary screening approach (0.604% vs. 0.324%). For individuals positive for HPV-16/18, reflex cytology demonstrated a higher CIN2+ detection rate than direct colposcopy (51.11% vs 41.25%), although it was more expensive. For individuals with high-risk HPV types other than HPV-16/18, direct colposcopy exhibited a similar CIN2+ detection power as reflex cytology, but cost less.

Conclusions: The cervical cancer screening program should be expanded because the benefits outweigh the costs. Statistical data indicate that HPV testing is a cost-effective preliminary screening approach for large-scale population screening.

Objectives: Population-based cervical cancer screening in the Netherlands ends at age 60. This retrospective cohort study aims to identify a subgroup of people over 60 years who are at increased cervical cancer risk, and may benefit from extended screening.

Methods: People with a cervix, aged 59-61 with an abnormal exit smear (index smear), conducted as part of the screening program between 2000 and 2004, were identified from the Dutch nationwide pathology databank. A 1:3 matching was obtained with people without an abnormal screening smear at the same age. Incidence rate ratios (IRR) were calculated for the risk of developing cervical cancer or cervical intraepithelial neoplasia (CIN) later in life. Up to 22 years of follow-up was obtained.

Results: A total of 10,368 people were identified. The IRR for CIN and cervical cancer was increased for people with an abnormal index smear. This risk was highest for people with a high-grade index smear, compared with a normal index smear; IRR of high-grade CIN of 104.05 (95% CI = 38.18-353.18) and IRR for cervical cancer of 18.58 (95% CI = 5.31-61.07). The majority (82%) of people with an abnormal index test showed normal cytology or histology preceding their CIN or cervical cancer.

Conclusions: People with a cervix with abnormal cytology in their exit screening smear 59-61 years showed a 19 times increased lifelong risk of cervical cancer and more than 100 times increased risk for CIN. Because this increased risk was not limited to a specific timeframe, prolonged screening or adjusted diagnostic follow-up for this specific group should be considered.