Prognostic value of p16‐INK4A protein in women with negative or CIN1 histology result: A follow‐up study

P16‐INK4A overexpression has been proposed as a prognostic marker to manage the follow up of women with positive cytology and/or HPV test but without high‐grade cervical intraepithelial neoplasia (CIN2+). This study measures the relative risk (RR) of CIN2+ of p16 positive versus negative in these women. All the women referred to colposcopy from October 2008 to September 2010 with negative or CIN1 colposcopy‐guided biopsy were included in the study; women surgically treated or having a CIN2–3 were excluded. All baseline biopsies were dyed with hematoxylin and eosin and p16. Women were followed up according to screening protocols, with cytology or colposcopy at 6 or 12 months. CIN2/3 RRs and 95% confidence intervals (95%CI) were computed. Of 442 eligible women, 369 (83.5%) had at least one follow‐up episode. At baseline, 113 (30.6%) were CIN1, 248 (67.2%) negative, and 8 (2.2%) inadequate histology; 293 (79.4%) were p16‐negative, 64 (17.3%) p16 positive and 12 (3.2%) not valid. During follow up, we found ten CIN2 and three CIN3; of these, six were p16 positive (sensitivity 46%, 95% CI 19–75). The absolute risk among p16 positives was 9.4/100 compared to 1.7/100 of the p16 negatives (RR 5.5; 95% CI 1.7–17.4). The risk was also higher for CIN1 than for histologically negative women (RR 4.4; 95% CI 1.3–14.3). The RR for p16 in CIN1 did not change (RR 5.2; 95% CI 0.6–47.5). P16 overexpression is a good candidate for modulating follow‐up intensity after a negative colposcopy but is limited by its low prospective sensitivity.     

妊娠滋养细胞肿瘤患者的治疗方案研究

目的探讨对妊娠滋养细胞肿瘤患者应用不同规范化方案治疗的疗效。方法对80例妊娠滋养细胞肿瘤患者分别采用CMV(卡铂、氨甲蝶呤、长春新碱)方案治疗、双枪(5-氟尿嘧啶、更生霉素)治疗及化疗联合手术治疗,观察比较3种治疗方案的疗效和副作用。结果 CMV方案的总有效率和总治愈率均高于双枪方案,在总有效率上具有统计学差异(P<0.05);而相对双枪方案,CMV方案治疗副作用较少,在恶心、呕吐反应和脱发副作用指标上差异明显(P<0.01)。单纯化疗方案的综合总有效率较化疗合并手术低,且具有统计学差异(P<0.05)。化疗合并手术治疗副作用较单纯化疗方案偏低,且差异有统计学意义(P<0.05)。结论在单纯运用化学治疗方案中,CMV方案在总有效率、安全性方面优于双枪方案,而化疗联合手术治疗是最佳的治疗方案,但也要考虑个体的差异。     

Reduction of low- and high-grade cervical abnormalities associated with high uptake of the HPV bivalent vaccine in Scotland

Background:

In Scotland, a national HPV immunisation programme began in 2008 for 12- to 13-year olds, with a catch-up campaign from 2008 to 2011 for those under the age of 18. To monitor the impact of HPV immunisation on cervical disease at the population level, a programme of national surveillance was established.

Methods:

We analysed colposcopy data from a cohort of women born between 1988 and 1992 who entered the Scottish Cervical Screening Programme (SCSP) and were aged 20–21 in 2008–2012.

Results:

By linking datasets from the SCSP and colposcopy services, we observed a significant reduction in diagnoses of cervical intraepithelial neoplasia 1 (CIN 1; RR 0.71, 95% CI 0.58 to 0.87; P=0.0008), CIN 2 (RR 0.5, 95% CI 0.4 to 0.63; P<0.0001) and CIN 3 (RR 0.45, 95% CI 0.35 to 0.58; P<0.0001) for women who received three doses of vaccine compared with unvaccinated women.

Conclusions:

To our knowledge, this is one of the first studies to show a reduction of low- and high-grade CIN associated with high uptake of the HPV bivalent vaccine at the population level. These data are very encouraging for countries that have achieved high HPV vaccine uptake.     

The influence of type‐specific human papillomavirus infections on the detection of cervical precancer and cancer: A population‐based study of opportunistic cervical screening in the United States

There are limited data on the prospective risks of detecting cervical precancer and cancer in United States (US) populations specifically where the delivery of opportunistic cervical screening takes place outside managed care and in the absence of organized national programs. Such data will inform the management of women with positive screening results before and after widespread human papillomavirus (HPV) vaccination and establishes a baseline preceding recent changes in US cervical cancer screening guidelines. Using data reported to the statewide passive surveillance systems of the New Mexico HPV Pap Registry, we measured the 3‐year HPV type‐specific cumulative incidence of cervical intraepithelial neoplasia grade 2 or more severe (CIN2+) and grade 3 or more severe (CIN3+) detected during real‐world health care delivery across a diversity of organizations, payers, clinical settings, providers and patients. A stratified sample of 47,541 cervical cytology specimens from a screening population of 379,000 women underwent HPV genotyping. Three‐year risks for different combinations of cytologic interpretation and HPV risk group ranged from <1% (for several combinations) to approximately 70% for CIN2+ and 55% for CIN3+ in women with high‐grade (HSIL) cytology and HPV16 infection. A substantial proportion of CIN2+ (35.7%) and CIN3+ (30.9%) were diagnosed following negative cytology, of which 62.3 and 78.2%, respectively, were high‐risk HPV positive. HPV16 had the greatest 3‐year risks (10.9% for CIN2+,8.0% for CIN3+) followed by HPV33, HPV31, and HPV18. Positive results for high‐risk HPV, especially HPV16, the severity of cytologic interpretation, and age contribute independently to the risks of CIN2+ and CIN3+.     

人角化层糜蛋白酶在子宫颈腺癌中的表达及其临床意义

目的 研究人角化层糜蛋白酶（SCCE）在子宫颈腺癌中的表达及临床意义.方法 采用免疫组织化学SP法检测子宫颈腺癌45例、子宫颈腺上皮内瘤变（CGIN） 24例和正常子宫颈组织24例中SCCE、雌激素受体（ER）、癌胚抗原（CEA）及波形蛋白（Vimentin）的表达情况.结果 子宫颈腺癌、CGIN和正常子宫颈组中,SCCE的阳性表达率分别为84.44％（38/45）、58.33％（14/24）和8.33％（2/24）,子宫颈腺癌组中SCCE表达率明显高于正常子宫颈组（P＜ 0.012 5）,CGIN组中SCCE表达率高于正常子宫颈组（P＜0.0125）,子宫颈腺癌组与CGIN组SCCE表达率差异无统计学意义（P＞0.0125）.结论 SCCE可以作为子宫颈腺癌早期筛查中的一项新指标,并可作为判断预后的指标.     

Vulvar intraepithelial neoplasia: Incidence and long‐term risk of vulvar squamous cell carcinoma

The risk of vulvar squamous cell carcinoma (VSCC) in patients with high‐grade vulvar intraepithelial neoplasia (VIN) is considered lower in high‐grade squamous intraepithelial lesion (HSIL) compared to differentiated VIN (dVIN), but studies are limited. Our study investigated both the incidence of high‐grade VIN and the cumulative incidence of VSCC in patients with HSIL and dVIN separately. A database of women diagnosed with high‐grade VIN between 1991 and 2011 was constructed with data from the Dutch Pathology Registry (PALGA). The European standardized incidence rate (ESR) and VSCC risk were calculated, stratified for HSIL and dVIN. The effects of type of VIN (HSIL vs dVIN), age and lichen sclerosis (LS) were estimated by Cox regression. In total, 1148 patients were diagnosed with high‐grade VIN between 1991 and 2011. Between 1991‐1995 and 2006‐2011, the ESR of HSIL increased from 2.39 (per 100 000 woman‐years) to 3.26 and the ESR of dVIN increased from 0.02 to 0.08. The 10‐year cumulative VSCC risk was 10.3%; 9.7% for HSIL and 50.0% for dVIN (log rank P < .001). Type of VIN, age and presence of LS were independent risk factors for progression to VSCC, with hazard ratios of 3.0 (95% confidence interval [CI] 1.3‐7.1), 2.3 (95% CI 1.5‐3.4) and 3.1 (95% CI 1.8‐5.3), respectively. The incidence of high‐grade VIN is rising. Because of the high cancer risk in patients with dVIN, better identification and timely recognition are urgently needed.     

高危型HPV对CINⅡ治疗指导意义的临床研究

[目的]探讨宫颈高危型人乳头病毒(HPV)感染对于CIN Ⅱ进行手术治疗时手术方式、范围、深度的指导意义.[方法]选取经阴道镜下多点活检为CIN Ⅱ并在本院接受LEEP治疗的患者60例,按高危型HPV感染阴性阳性分两组,每组各30例,比较两组术前术后的病理结果变化.[结果]宫颈高危型HPV感染阴性的CIN Ⅱ患者LEEP术后病理结果仅1例(1/30,3.33％)出现病理升级,而HPV感染阳性者有8例(8/30,26.67％)出现病理升级,两组比较有显著性差异(P＜0.05).[结论]对于高危型HPV感染阳性的CIN Ⅱ患者进行手术治疗时可采用LEEP,手术范围及深度均可适度扩大.     

Magnifying endoscopy with narrow-band imaging may improve diagnostic accuracy of differentiated gastric intraepithelial neoplasia: a feasibility study

Background  Magnifying narrow-band imaging has enabled observation of the mucosal and vascular patterns of gastrointestinal lesions. This study investigated the potential value of magnifying endoscopy with narrow-band imaging for the classification of gastric intraepithelial neoplasia.

Methods  Seventy-six patients with gastric intraepithelial neoplasia (82 lesions) at People’s Liberation Army General Hospital from December 2009 to November 2010 were analyzed. All patients underwent magnifying endoscopy with narrow-band imaging, and their lesions were differentiated into probable low-grade intraepithelial neoplasia or possible high-grade intraepithelial neoplasia on the basis of the imaging features. Pathologic proof was subsequently obtained by endoscopic submucosal dissection in every case. The validity of magnifying endoscopy with narrow-band imaging was calculated, considering histopathology to be the gold standard.

Results  Magnifying endoscopy with narrow-band imaging showed 22 low-grade intraepithelial neoplastic lesions and 60 high-grade intraepithelial neoplastic lesions. Of the 22 low-grade intraepithelial neoplastic lesions, 16 showed the same results on both imaging and pathology. Of the 60 high-grade intraepithelial neoplastic lesions, 53 showed the same results on both imaging and pathology. Thus, the sensitivity of magnifying endoscopy with narrow-band imaging for high-grade intraepithelial neoplasia was 89.83%, which was higher than that for low-grade intraepithelial neoplasia (69.57%). However, the specificity for high-grade intraepithelial neoplasia (69.57%) was lower than that for low-grade intraepithelial neoplasia (89.83%). The overall accuracy of magnifying endoscopy with narrow-band imaging was 84.15%.

Conclusions  Magnifying endoscopy with narrow-band imaging can distinguish between gastric low- and high-grade intraepithelial neoplasia. It may be a convenient and effective method for the classification of gastric intraepithelial neoplasia.

     

多发性内分泌腺瘤病2b型患者眼部特征分析

目的 研究多发性内分泌腺瘤病2b型患者的眼部表现特征.方法 回顾分析北京协和医院眼科1980年7月至2007年12月3例多发性内分泌腺瘤病2b型患者的临床资料,重点分析其眼部表现特征.结果 在常见的全身表现和眼部表现中,3例患者均有甲状腺髓样癌和角膜神经粗大,2例患者有肾上腺嗜铬细胞瘤、口唇舌黏膜神经瘤、类马方体型、眼睑结节、结膜结节,仅1例患者有虹膜结节.结论 角膜神经粗大是MEN 2b型最常见的眼部表现.