CyclinA1 Promoter Methylation in Self-Sampling Test

Background: Self sampled HPV testing is a cervical cancer screening method . However, cytology in self-sampled specimen cannot be used as a triage test.  Therefore, other methods for triage should be considered. CyclinA1 (CCNA1) promoter methylation has strong association with cervical precancerous and cancerous lesion. The objective of this study was to compare the diagnostic value of CCNA1 and self-sampled specimen for detecting high-grade cervical intraepithelial lesions or worse (CIN2+). Materials and Methods: A cross sectional study was conducted. Women with abnormal cytology or positive for high risk HPV (hrHPV) indicated for colposcopic examination were enrolled.  Self-collected sampling for hrHPV DNA (SS-HPV) and CCNA1 were performed. hrHPV DNA testing was done by Cobas 4800 method. CCNA1 promoter methylation was detected by CCNA1 duplex methylation specific PCR. Histopathologic result as CIN2+ obtaining from colposcopic directed biopsy or excisional procedure  was considered as positive a gold standard. The results of hrHPV and CCNA1 were reported as positive or negative. Sensitivity specificity, positive predictive value, and negative predictive value of SS-HPV and CCNA1 were calculated by comparing the results with the gold standard. Results: Two hundreds and eighty women were recruited. High-grade cervical lesions and cervical cancer (CIN2+) were diagnosed in 21.8% (61 cases) of the patients. The most common type of hrHPV was non 16, 18 subtype, followed by HPV16 and 18. CCNA1 was positive in 13 patients out of whom, twelve were CIN2+. Sensitivity of CCNA1 was 19.7 % and its  specificity and accuracy were 99.5% and 82.14%, respectively.  The sensitivity of SS-HPV was 70.5%, and its  specificity and accuracy were 39.2% and 43.3%, respectively. Conclusion:  Due to high specificity and positive predictive value of CCNA1, it can be used as alarming sign of having high-grade cervical intraepithelial lesions, especially in patient who has positive hrHPV DNA test based on self-collected sampling.     

骨髓增生异常综合征及慢性原因不明性粒细胞减少症患者骨髓CFU—GM和CFU—F的初步观察

利用人类骨髓粒一单核系祖细胞集落(CFU—GM)和成纤维细胞集落(CFU—F)体外检测技术,比较观察32例骨髓增生异常综合征(MDS)和11例慢性原因不明性粒细胞减少症(CIN)患者的造血改变。结果表明,MDS 和 CIN 的造血状态存在显著区别,69%的 MDS 患者 CFU—GM集落显著受抑,集簇、簇/落比值明显升高;其 CFU—F 集落亦存在明显缺陷。而 CIN 患者的上述指标均类似于正常。这提示体外集落检测技术有助于 MDS 和 CIN 的鉴别。此外,CFU—GM 系列培养对 MDS 患者具有一定预后价直。     

宫颈上皮内瘤变108例临床分析

目的通过总结108例宫颈上皮内瘤变（CIN）的临床与预后，探讨分析CIN的诊断与治疗。方法归纳总结共108例各级CIN的临床特点及治疗方法，术前肉眼多点活检及阴道镜下活检与术后病理诊断的符合率，分析其预后。结果所有病人均有性生活史。除45／108（417％）无症状外，63／108（58．3％）有分泌物增多，或同房出血或阴道不规则流血。术前阴道镜下活检与术后病理诊断的符合率高于肉眼多．最活检符合率，但统计学差异无显著性，（P〉0．05）。根据病人要求、CIN级别及病变部位、范围采取不同的手术方式，其中14例随访超过5a，全部病人无1例复发，3、5a存活率均为100％。结论临床上对有性生活史的生育年龄妇女要警惕CIN，肉眼多点活检或阴道镜下活检可作为确诊手段，对不同的病人，依据病灶的性质，采用不同的手术方式，可避免复发，获100％的治愈率。     

宫颈CIN2～3治疗后的随诊

宫颈C IN2~3的治疗方法包括宫颈病变表面破坏术、宫颈局部切除术以及必要时的全子宫切除术,宫颈局部切除术是宫颈C IN2~3的的标准术式。宫颈C IN2~3手术治疗后的复发率为0.7%~21%;影响宫颈C IN2~3术后复发的高危因素为切缘阳性、病变严重程度和年龄大于40岁;宫颈C IN2~3术后随诊的基本内容是细胞学、阴道镜及ECC,可采用HPV检测;宫颈C IN2~3术后随诊,细胞学出现两次低度病变或一次高度病变应行阴道镜和ECC检查,再次治疗的方式应临床个体化;C IN2~3的随诊和治疗具有同样的意义。     

Intraepithelial neoplasia, human papilloma virus infection and argyrophilic nucleoprotein in cervical epithelium

A silver colloid technique was applied to 50 colposcopic biopsies of cervix. These comprised nine cases of wart virus infection of the cervix, 11 cases of cervical intraepithelial neoplasia (CIN) I, nine cases of CIN II, eight cases of CIN III, seven normal biopsies and six cases showing only incomplete squamous metaplasia. The mean numbers of argyrophilic nucleolar organizer regions (AgNORS) increased from CIN I to CIN III. Statistically significant differences for AgNORs were found in comparisons between CIN III, normal basal cells, human papilloma virus-infected basal cells and incomplete squamous metaplasia, and in comparisons between normal basal cells and human papilloma virus-infected basal cells. CIN III could be distinguished from incomplete squamous metaplasia and from basal cells and from human papilloma virus-infected basal cells. The latter could be distinguished from normal basal cells on the basis of their AgNORs. It is suggested that this simple technique is diagnostically useful and has considerable clinicopathological potential in cervical pathology and cytology.     

Papillomavirus and cervical cancer: a clinical and laboratory study

It is now widely accepted that HPV types 16, 18, 31, and 33 are associated with the development of high grade intraepithelial neoplasia and malignant lesions in the cervix. On this basis, the identification of HPV types in cervical scrape samples has been advocated as a supplement to cytological screening tests. However, little is known of the distribution of the virus at different sites in the lower female genital tract or of how this distribution may change during the natural course of HPV infection. In this survey, HPV DNA dot hybridizations and, in some instances, Southern blot hybridizations with mixed HPV 6/11 and 16/18 probes were undertaken to detect HPV DNA in cervical scrapes and biopsies of the cervix, vagina, and vulva. A total of 92 women attending a Sydney hospital were screened: 59 of these patients had cervical disease, either invasive cervical carcinoma (CaCx) or cervical intraepithelial neoplasia (CIN), grades I-III. A group of 33 women who lacked evidence of cervical abnormalities served as controls. HPV DNA, predominantly type 16/18, was detected in the cervical biopsies of 96% of the CaCx patients, 80% of the CIN III patients, and 65% of the CIN I-II patients. In contrast only 9% of the cervical biopsies from the control group contained detectable HPV 6, 11, 16, or 18 DNA. A high proportion of the women with cervical abnormalities had evidence of concurrent vaginal and/or vulval papillomavirus involvement. The significance of these findings for routine screening and subsequent management of patients with HPV-associated cervical disease is discussed.     

宫颈细胞学和电子阴道镜在宫颈病变早期诊断中的应用研究

目的进一步评价细胞学和电子阴道镜在宫颈病变的早期诊断中的价值.方法回顾性分析431例宫颈涂片和阴道镜检的结果,与活检组织病理学的结果进行对比研究.结果 431例中检出宫颈上皮内瘤变(CIN)Ⅰ 39例、CIN Ⅱ 36例、CIN Ⅲ 32例、宫颈鳞癌11例和宫颈湿疣27例,其余286例为慢性宫颈炎.宫颈涂片检出了93.5%宫颈病变,阴道镜检出了95.9%宫颈病变,细胞学与阴道镜下活检联合应用无漏诊.结论细胞学与阴道镜下活检联合应用能提高宫颈病变的检出率,阴道镜检查能明显提高宫颈湿疣的检出率.     

高危型人类乳头瘤病毒检测对不典型鳞状细胞分流监测的临床价值

目的评价高危型人类乳头瘤病毒（HPV）检测对不典型鳞状上皮细胞（atypical squamous cells of undetermined significance，ASCUS）分流临测的临床价值。方法对654例宫颈细胞学检查结果为ASCUS的患者。进行高危型HPV检测和阴道镜检查，镜下定位活检可疑病灶．以病理学诊断作为金标准。结果654例中，高危型HPV检测呈阳性的病例为411例，阳性率为62.8％。经病理学确诊宫颈上皮内瘤样病变（CIN）病例为58例，占总数的8．9%（58／654），其中CIN Ⅱ和CIN Ⅲ共计43例．占CIN的74．1％（43／58）；CINⅡ，CINⅢ的高危型HPV阳性率分别为80．8％及94．1％。ASCUS患者中以高危型HPV检测、直接选择阴道镜检查，检出CIN的敏感度分别为88.9％和65．5%；对诊断CINⅡ和CINⅢ。高危型HPV的敏感度为94．1％，阴道镜的敏感度为65．1％。结论ASCUS患者中高危型HPV的CINⅡ和CINⅢ检出有较高的敏感度，对ASCUS可有效地进行分流监测，患者可不必再做阴道镜检查和活检。     

70例宫颈上皮内瘤样病变宫颈环形电切术后情况分析

对70例要求保留生育功能的宫颈上皮内瘤样病变（CIN）患者进行宫颈环形电切术（LEEP），并对其疗效、病灶持续存在和复发等情况进行分析。结果：70例中，首次LEEP治愈65例（92．86％），2例（2．86％）病变持续存在，2例（2．86％）术后复发，1例LEEP后病检为宫颈微小浸润癌而行根治术。5例（7．14％）出现术中、术后并发症。认为LEEP治疗CIN安全有效，但术后随访非常重要。     

Western blot法检测CIN宫颈液基细胞残液中HPV16、18E6感染的临床意义

目的：探讨免疫印记法（Western blot）检测子宫颈上皮内瘤变（cervical intraepithelial neoplasis，CIN）宫颈液基细胞残液中人乳头状瘤病毒（human papillomaviruses，HPV）16、18E6感染的临床意义。方法：采用Westem blot法检测经病理证实的86例CLN和14例慢性宫颈炎的宫颈液基细胞残液中HPV16、18E6的感染状况。结果：宫颈液基细胞残液中HPV16、18E6感染的阳性率分别为CINⅠ组33．3％（8／24）；CINⅡ组46．7％（14／30）；CINⅢ组59．3％（19／32）。慢性宫颈炎（对照组）阳性率7．1％（1／14）。CINⅠ组与对照组比较差异无显著性（P＞0．05），CINⅡ组和CINⅢ组与对照组比较均有统计学差异（P＜0．05）。结论：Westem blot法检测CIN患者宫颈液基细胞残液中HPV16、18E6感染可以补充细胞学检查结果，对预防宫颈癌发生及降低其死亡率有重要意义。