Prevalence of Abnormal Anal Cytology in Women with Abnormal Cervical Cytology

Objective: The aim of this study was to evaluate the prevalence of abnormal anal cytology in women presenting with abnormal cervical cytology (intraepithelial lesion or cervical cancer) at the largest tertiary university hospital in Thailand. Methods: A cross-sectional prospective study design was used. Anal cytology was performed on 145 women with abnormal cervical cytology between June 2014-Octoble 2014. If abnormal anal cytology was detected, anoscopy was performed with biopsy in any suspicious area of precancerous change. Results: Prevalence of abnormal anal cytology was 5.5% (8 patients). Of 8 patients, six patients presented with low-grade squamous intraepithelial lesion, one patient with high-grade squamous intraepithelial lesion, and one with atypical squamous cell cannot exclude high-grade squamous intraepithelial lesion. Abnormal anoscopic impression was found in 3 cases, as follow: The first case showed faint acetowhite lesion and anoscopic impression was low grade squamous intraepithelial lesion; the second case was reported as human papillomavirus (HPV) change by anoscopic impression; and the third case showed dense acetowhite lesion with multiple punctation and pathologic examination showed anal intraepithelial neoplasm III (AIN3). The last patient underwent wide local excision of AIN3 with split-thickness skin graft reconstruction. Final pathology confirmed AIN3 with free resection margin. Conclusion: Prevalence of abnormal anal cytology was 5.5%  in patients with abnormal cervical cytology. The prevalence might be support anal cytology screening in this group of patients.     

Consistency of Cytology Diagnosis for Cervical Cancer between Two Laboratories

The principal approach to the prevention of cancer of the cervix uteri has been through screening programmes,using the cervical smear (Pap test) to detect precursor lesions. The sensitivity and specificity of Pap smears dependon the skill of the observer in recognizing and classifying a variety of cellular abnormalities. We have studied thereproducibility of cytological diagnosis, according the Bethesada classification, made by cytologists in Khon Kaen,north-east Thailand, and in Helsinki, Finland, on smears taken from rural women undergoing screening during1994-2001. A total of 313 slides were reviewed. The prevalence of abnormalities was relatively high, since the seriesincluded smears judged abnormal in Khon Kaen or from women who developed cancer during follow-up, as well asa group whose smears were negative.In general, the reviewing cytologist in Finland evaluated more slides as abnormal than in the initial report. Thelevel of agreement between the two observers was evaluated by calculating the coefficient of concordance (Kappa).The kappa score depended upon the degree of detail in the diagnosis; it was 0.43 for the presence or not of anepithelial abnormality (the General Categorization of the Bethesda system), and rather higher (0.5) for separatinglow grade from high grade (HSIL or worse) abnormalities or glandular lesions. Agreement was only fair (0.37) whenthe more detailed Bethesda categories (seven) were used.The reproducibility of cervical cytology evaluations is critical to the success of screening programmes, and in thisprogramme in a moderate-high risk population of women in rural Thailand, we found that agreement betweenskilled observers, at the level of tests requiring diagnostic follow-up or not, was only moderate. The women in thisstudy are being traced to evaluate the true sensitivity of screening in terms of the lesions found on histology, duringa prolonged follow up of 4 or more years.     

Performance of HPV DNA Testing with Hybrid Capture 2 in Triaging Women with Minor Cervical Cytologic Abnormalities (ASC-US/LSIL) in Northern Thailand

Background: Minor cervical cytologic abnormalities include atypical squamous cells of undeterminedsignificance (ASC-US) and low-grade squamous intraepithelial lesion (LSIL). Approximately 10-20% of womenwith minor cytologic abnormalities have histologic high-grade squamous intraepithelial or worse lesions (HSIL+).In Thailand, women with minor cytologic abnormalities have a relatively high risk of cervical cancer, and referralfor colposcopy has been suggested. A triage test is useful in the selection of women at risk for histologic HSIL+ toreduce the colposcopy burden. The aim of this study was to assess the performance of high-risk HPV DNA test intriage of women with minor cytologic abnormalities in northern Thailand. Materials and Methods: All womenwith ASC-US/LSIL cytology who were referred to our colposcopy clinic from October 2010 to February 2014were included. HPV DNA testing was performed using Hybrid Capture 2 (HC2). All patients received colposcopicexamination. Accuracy values of HC2 in predicting the presence of histologic HSIL+ were calculated. Results:There were 238 women in this study (121 ASC-US and 117 LSIL). The HC2 positivity rate was significantlyhigher in the LSIL group than in ASC-US group (74.8% versus 41.0%, p<0.001). Histologic HSIL+ was detectedin 9 women (7.4%) in the ASC-US group and 16 women (13.7%) in the LSIL group (p=0.141). There was nohistologic HSIL+ detected among HC2-negative cases (sensitivity and negative predictive value of 100%). Theperformance of HC2 triage was highest among women aged >50 years with ASC-US cytology. An increase in thecut-off threshold for positive HC2 resulted in a substantial decrease of sensitivity and negative predictive value.Conclusions: HPV DNA testing with HC2 shows very high sensitivity and negative predictive value in triage ofwomen with minor cervical cytologic abnormalities in northern Thailand. An increase of the cut-off thresholdfor HC2 triage is not recommended in this region.     

Histopathological Outcomes of Women with Squamous Cell Carcinoma on Cervical Cytology

The aim of this study was to determine the final histopathological outcome for women with a squamous cellcarcinoma (SCCA) diagnosed by cervical cytology. The medical records and computerized colposcopic database ofpatients with SCCA on cytology who underwent colposcopy at Chiang Mai University Hospital between February2003 and December 2005 were reviewed and 48 women with SCCA cytology were identified (mean age 50 years,range 31-73). Nineteen (39.6%) women were postmenopausal. Unsatisfactory colposcopy was noted in 42 (87.5%).Thirty one (64.6%) of the patients had a final pathological diagnosis of high-grade squamous intraepithelial lesions(HGSIL), whereas only 16 (33.3%) had invasive cancer. The remaining one patient had a low-grade squamousintraepithelial lesion. Sensitivity and specificity of colposcopic examination for predicting invasive cancer was 50%and 78%, respectively. In conclusion, most women with a SCCA on cervical cytology have high-grade cervical lesionson final pathology, with only one third demonstrating invasive cancer. The loop electrosurgical excision procedure(LEEP) remains an important measure for combined treatment and diagnosis.     

Factors Affecting Cervical Cancer Screening Uptake by Hmong Hilltribe Women in Thailand

Background: Cervical cancer is relatively common in Thai women, but the proportion of females receivingPap smear screening is still low. Objective: The purpose of this cross-sectional study was to study factors relatedto cervical cancer screening uptake by Hmong hilltribe women in Lomkao District, Phetchabun Province.Materials and Methods: Interview data were collected from 547 of these women aged 30-60 years living in thestudy area and analyzed using multiple logistic regression. Results: The results showed that 64.9% of the studysample had received screening, and that 47.2% had attended due to a cervical screening campaign. The mostcommon reason given for not receiving screening was lack of time (21.4%). The factors found to be positivelyassociated with uptake (p value <0.05) were as follows: number of years of school attendance (OR=1.56,95%CI:1.02-2.38), animistic religious beliefs (OR=0.55, 95%CI:0.33-0.91), a previous pregnancy (OR=6.20,95%CI:1.36-28.35), receipt of information about cervical cancer screening (OR=2.25, 95%CI:1.35-3.76), andperceived risk of developing cervical cancer (OR=1.83, 95%CI:1.25-2.67). Conclusions: To promote the uptakeof cervical screening, Hmong hilltribe women need to know more about cervical cancer and cervical cancerscreening, and access to screening services should be provided in conjunction with existing everyday services,such as family planning and routine blood pressure monitoring or diabetes services.     

Population-based Cervical Cancer Screening Using Highrisk HPV DNA Test and Liquid-based Cytology in Northern Thailand

Background: Northern Thailand is a region with a high cervical cancer incidence. Combined high-risk HPV (hrHPV) DNA testing and cytology (co-testing) has increasingly gained acceptance for cervical cancer screening. However, to our knowledge, data from a population-based screening using co-testing have not been available in this region. This study therefore aimed to evaluate the performance of cytology and hrHPV test in women in northern Thailand. Materials and Methods: Cervical samples were collected for hybrid capture 2 (HC2) testingand liquid-based cytology from women aged 30 to 60 years who were residents in 3 prefectures of Chiang Mai in northern Thailand between May and September 2011. Women with positive cytology were referred to colposcopy, while women with positive for HC2 only were followed for 2 years. Results: Of 2,752 women included in this study, 3.0% were positive in both tests, 4.1% for HC2 only, and 1.3% had positive cytology only. At baseline screening, positive HC2 was observed in 70.6% among cytology-positive women compared with 4.3% amongcytology-negative women. The prevalence of positive HC2 or cytology peaked in the age group 35-39 years and was lowest in the age group 55-60 years. High-grade squamous intraepithelial lesion or worse lesions (HSIL+) were histologically detected in 23.5% of women with positive baseline cytology and in 9.8% of women with positive baseline HC2 only on follow-up. All women with histologic HSIL+ had positive baseline HC2. Conclusions: The hrHPV test is superior to cytology in the early detection of high-grade cervical epithelial lesions. In this study, the prevalence of histologic HSIL+ on follow-up of women with positive hrHPV test was rather high, and these women should be kept under careful surveillance. In northern Thailand, hrHPV testing has a potential to beused as a primary screening test for cervical cancer with cytology applied as a triage test.     

Histopathological Findings for Cervical Lesions in Malaysian Women

Objective: The objective of this study was to determine the histopathological features and cell morphologyof various cervical lesions observed among Malaysian women. Methodology: A retrospective study was conductedto evaluate 77 cervical cases collected from the histopathology laboratory of Ipoh hospital from 1st January,2005, to 31st December, 2006. Results: Cervical intraepithelial neoplasia (CIN) was found in 33 (42%) cases,CIN III accounting for 27%, and CIN I, CIN II and CIN II-III 5% each. The highest rate for CIN cases was43% in the 41-50 year age group and the lowest rate was 6% in the group aged 61-70 years . Non-keratinizingand metastatic squamous cell carcinomas (SCCs) accounted for 16% and 13%, respectively, the combinationbeing second in majority (29%), followed by adenocarcinoma (17%). The histopathological results showed CINI to be characterized by mild papillary projections of the epithelium with some degree of nuclear enlargement,pleomorphism, mild koilocytosis, bionucleated cells and a low nucleo-cytoplasmic ratio. CIN II demonstratedtypical squamous epithelium with disorganization of the lower part of the epithelium accompanied by nuclearhyperchromatism, an increased nucleo-cytoplasmic ratio, and scanty mitotic figures. CIN III was characterizedby pleomorphic nuclei, atypical cells with mitotic figures, nucleo-cytoplasmic ratio, anisokaryosis andhyperchromasia. Conclusion: Lesions related to cervical cancer showed tumor progression correlating withhistopathological changes in cell morphology.     

Human Papillomavirus Genotypes and Cervical Cancer in Northeast Thailand

Human papillomavirus (HPV) is a major cause of cervical cancer. More than 100 HPV genotypes have beenidentified; however the distribution varies geographically and according to ethnicity. The purpose of this studywas to investigate the prevalence and distribution of HPV subtypes among Northeast Thai women. Subjectsincluded 198 cases of SCCA and 198 age-matched, healthy controls. HPV-DNA was amplified by PCR using theconsensus primers GP5+/6+ system followed by reverse line blot hybridization genotyping. The prevalence ofhigh-risk HPV infection was 21 (10.1%) and 152 (76.8%) in the controls and in the cases, respectively. High-riskHPV significantly increased the risk for cervical cancer with an OR of 42.4 (95%CI: 22.4-81.4, p<0.001) and anadjusted OR of 40.7-fold (95%CI: 21.5-76.8, p <0.001). HPV-16 was the most prevalent HPV type in the SCCA(56.2%) followed by HPV-58 (17.8%) and HPV-18 (13.6%); whereas HPV-58 (46.4%) was a prominent genotypein the controls followed by HPV-16 (39.3%) and unidentified HPV types (25.0%). These findings indicate thatHPV infection remains a critical risk factor for SCCA; particularly, HPV-16, HPV-58 and HPV-18. In orderto eradicate cervical cancer, sustained health education, promoted use of prophylactics and a HPV-58 vaccineshould be introduced in this region.     

Prevalence of Abnormal Anal Cytology in HIV-Infected Women: a Hospital-Based Study

Background: To study the prevalence of abnormal anal cytology by Papanicolaou (Pap) technique in HIVinfected women who attended a HIV clinic at Prapokklao Hospital, Chanthaburi, Thailand. Materials and Methods: HIV-infected women who attended a HIV clinic at Prapokklao Hospital from March 2013 to February2014 were recruited for anal Pap smears. Participants who had abnormal results of equally or over “abnormal squamous/glandular cells of undetermined significance” (ASC-US) were classified as abnormal anal cytology. Results: A total of 590 anal Pap smears were performed at HIV clinic of Prapokklao Hospital during the study period. There were only 13 patients who had abnormal Pap tests, which were: 11 ASC-US and 2 HSIL (high grade squamous intraepithelial lesion). The prevalence of abnormal anal Pap smears in HIV-infected women who attended HIV clinic at Prapokklao Hospital was 2.2 percent. Percentage of high risk HPV in patients who had abnormal Pap test was 88.9 (8/9). Conclusions: The prevalence of abnormal anal Papanicolaou smears in HIV-infected women who attended the HIV clinic at Prapokklao hospital was quite low in comparison to theearlier literature.     

Haplotype Analysis of MDR1 and Risk for Cervical Cancer in Northeastern Thailand

Objective: The aim of this study was to investigate the association between genotype and haplotype of MDR1 (C1236T, G2677T/A and C3435T) and the risk for cervical cancer in Northeastern Thai women. Methods: An age-matched case-control study involving squamous cell cervical cancer (SCCA) patients (n=204) and healthy controls (n=204) was enrolled for MDR1 genotyping by real-time PCR method. Results: The genotype distribution of MDR1 in both patients and controls was not significantly different (p>0.05). The haplotype analysis showed that T-T-T was the most common haplotype in this population. Significantly increased risk of cervical cancer was observed in carriers of T-T-C and C-G-T haplotypes with ORs of 1.86 (95%CI=1.02-3.39, p=0.0416) and 2.00 (95%CI=1.18-3.40, p=0.0140), respectively. Analysis of 2677-3435 haplotype showed increased risk for cervical cancer in G-T (OR=1.55; 95% CI=1.12-2.13, p=0.0432) and T-C (OR=1.91; 95%CI=1.05-3.47, p=0.0325). Conclusion: The results provide evidence that haplotype of MDR1 may be an important risk factor for cervical cancer development in Northeastern Thai women.     

Prevalence and Predicting Factors for Anxiety in Thai Women with Abnormal Cervical Cytology Undergoing Colposcopy

Aim: To compare prevalence of anxiety in women with abnormal cervical cytology (Pap) undergoingcolposcopy to that of women attending the outpatient clinic for check-up and to examine predicting factors.Materials and Methods: In this cross-sectional analytical study, 100 women with abnormal cervical cytology(abnormal Pap group) and 100 women who attended our outpatient clinic for check-up (control group) wererecruited from June 2013 to January 2014. The Hospital Anxiety and Depression Scale (HADS) was employedto determine anxiety in the participants with the score of ≥ 11 suggestive of clinically significant anxiety. Theprevalence of anxiety and the mean HADS scores for anxiety were compared between the groups. For those withabnormal Pap, association between clinical factors and anxiety was assessed. A p-value of < 0.05 was consideredsignificant. Results: Median age was different between the groups, 44.0 years in the abnormal Pap group and50.0 years in the control group (p=0.01). The proportion of participants who had more than one sexual partnerwas higher in the abnormal Pap group, 39.2% vs. 24.7% (p=0.03) and the prevalence of anxiety was significantlyhigher 14/100 (14.0%) vs. 3/100 (3.0%) (p < 0.01). The prevalence of depression was comparable between thegroups. The mean HADS scores for anxiety and depression subscales were significantly higher in the abnormalPap group, 6.6 vs. 4.8 (P < 0.01) and 3.9 vs. 3.1 (p=0.05), respectively. For the abnormal Pap group, no definiteassociation between clinical factors and anxiety was demonstrated. Conclusions: The prevalence of anxiety inwomen with abnormal Pap awaiting colposcopy was significantly higher than that of normal controls. Specialattention including thorough counselling, with use of information leaflets and psychological support, should bedirected to these women.     

Anxiety and Depression in Thai Women with Abnormal Cervical Cytology who Attended Colposcopic Unit in Thammasat University Hospital

Background: Colposcopy is the standard investigation for women with abnormal cervical cytology. Waiting timeto colposcopy could impact to psychological distress. Data about anxiety and depression in eastern countries patientswere limited. Aim of this investigation was to evaluate anxiety and depression status in Thai women who were waitingfor colposcopy compared to women who attended gynecology clinic for cervical cancer screening. Materials andmethods: This study was conducted at the outpatient gynecology clinic of Thammasat University Hospital betweenJanuary 2017 to March 2018. A Total of 200 women were recruited into the study. The cases were divided into the studyand control group. Study group consisted of one hundred women with abnormal cervical cytology referred to colposcopy.One hundred of women who attended gynecology clinic for cervical cancer screening was classified as control group.The Hospital Anxiety and Depression Scale (HADS) was used to determine anxiety in the participants. Results: Totalof 200 women who met criteria of the study were recruited. The mean ages of both groups were 40 years old. Bothgroups were significantly different when it came to their education, 30 and 59 percent of study and control group hadeducation level more than bachelor (p=0.003). The prevalence of anxiety was statistically significantly higher in studygroup than the control group (15% and 6%, respectively). There was only one case of depression in study. Waiting timeand abnormal cervical cytology severity did not affected to anxiety level. Conclusions: Colposcopy and appointmentcaused anxiety. However anxiety was not associated with waiting time to colposcopy or Pap result’s severity.     

Prevalence of Human Papillomavirus Genotypes in Women with Normal and Abnormal Cervical Cytology in Iran

Introduction: HPV infection has a prime etiologic role in development and progression of cervical cancer, one ofthe most frequent forms of cancer among women in developing countries. This study was designed to determine themost prevalent HPV genotypes in women with normal and abnormal cervical cytology in Iran. Materials and Methods:Samples from134 patients, including 127 who attended gynecology clinics and 7 with solid cervical tumors wereused. All 127 patients underwent routine Pap tests for cytological evaluation and at the same visit a sample ofcervical epithelial cells was obtained by scraping the cervix osteum. In each case HPV infection was primarily evaluatedby PCR using GP 5/6 primers and then subtyping was performed in proved infected samples with specific primersfor HPV 16, 18, 31, 33, 11 and 6. After cytological evaluation, 50 patients with abnormal Pap tests were categorizedas the abnormal group and the remaining 77 patients as the normal group. Results: In the normal group, HPVinfection was established in 10 cases (13% infection rate), while 30 HPV positive cases were discovered in the abnormalgroup (60% infected). The most prevalent genotypes among the infected samples were HPV 16 (76%), HPV18 (12.7%)and HPV11/6 (8.5%). Moreover, all 7 tumor samples were positive for HPV general primers of which, 5 sampleswere infected with HPV 16, two were co-infected with HPV16,18 and HPV16,31 genotypes and one was infected withHPV 18. Conclusions: Infection with HPV 16 was found to be significantly higher in abnormal group in comparisonwith normal group (42% vs. 11.6%, P value <0.005), likewise HPV18 genotypes were proved to be more prevalent inabnormal group (8% vs. 0%, P value <0.05). No significant relation between other HPV genotypes and pathologiccervical changes was obtained. According to our study high rates of infection with HPV genotypes in sexually activeIranian women makes molecular investigation for HPV16 and 18 very essential in clinical approaches to patientswith proven dysplasia in their screening tests and also for those patients with borderline (i.e. ASCUS) or incongruouspathology reports. Larger studies are required to determine the most appropriate vaccine with highest protection inIranian women.     

Long Term Outcomes of Laser Conization for High Grade Cervical Intraepithelial Neoplasia in Thai Women

Aim: To report long term outcomes of laser conization for high grade cervical intraepithelial neoplasia (CIN)in Thai women. Materials and Methods: A retrospective cohort study was conducted in patients undergoing laserconization due to abnormal cervical cytology suggesting neoplasia during 1989 to 1994 and having follow-up datauntil December 2010. Conization was performed under colposcopy using a 0.5-mm CO2 laser beam with powerdensity of 18,000-20,000 watts/cm2, and the surgical base was vaporized using a low power defocused beam. Thefollow-up protocol included cervical cytology and colposcopy. Long term outcome measures were failure rate(persistence and recurrence), post-conization status of transformation zone, and obstetric outcomes. Results:Of 104 patients undergoing conization, 71 had therapeutic conization for high grade CIN and were followed upfor a median time of 115 (range 12-260) months. There was one case of persistent and one of recurrent diseasecomprising a failure rate of 2.8%. The post treatment transformation zone was well visualized in 68.3% of 63patients with an intact uterus. Sixteen patients achieved 25 pregnancies; none had second trimester miscarriage.The obstetric outcomes were unremarkable. Conclusions: Laser conization under colposcopic visualization for thetreatment of high grade CIN in Thai women has a low failure rate of 2.8%. The post-conization transformationzone could not be evaluated completely in approximately 30% of cases; therefore the follow-up protocol shouldinclude both cytology and colposcopy. Obstetric outcomes are not adversely affected by this therapeutic procedure.     

High-grade Cervical Histopathology in Women with Atypical Glandular Cell Cytology

This study was undertaken to evaluate the prevalence of underlying significant lesions among women referred for colposcopy after atypical glandular cell (AGC) smears and the associated risks. The present study reviewed data from women with AGC smears undergoing colposcopy at the Colposcopy Clinic, Faculty of Medicine, Khon Kaen University, Thailand between January 2001 to December 2014. Significant lesions included cervical intraepithelial neoplasia grade 2-3, adenocarcinoma in situ, endometrial hyperplasia, and cancer. During the study period, 170 women with AGC cytology were reviewed. The mean age was 45.7 years. Thirty-eight women (22.4%) were postmenopausal. Eighteen smears (10.6%) were further subclassified as AGC-favor neoplasia (AGC-FN). In total, significant lesions were noted in 27 women (15.9%; 95%CI, 7.8%-18.3%). Thirteen women (7.6%, 95%CI, 4.1%-12.7%) were found to have cervical cancer or endometrial cancer. Two variables were independently associated with an increased risk of significant histopathology results: level of educational attainment (secondary level or lower versus bachelor degree or higher) and types of AGC (AGC versus AGCFN). Women who had low level of education and those with AGC-FN were at the higher risk of significant lesions (OR, 3.16; 95%CI 1.10-9.11 and OR, 4.62; 95%CI, 1.54-13.85, respectively). In conclusion, the rate of significant lesions among women referred for colposcopy after AGC smears is considerably high. Low education and smear subtypes appear independently associated with a higher risk of significant lesions.     

Lack of Participation of the GSTM1 Polymorphism in Cervical Cancer Development in Northeast Thailand

The potential association between the GSTM1 deletion polymorphism and risk of cervical cancer wasinvestigated in Northeastern Thailand. DNA was extracted from buffy coat specimens of 198 patients withsquamous cell carcinoma of the cervix and 198 age-matched healthy controls. Genotyping of the GSTM1 wasconducted by using two PCR methods, a short- and a long-PCR. Distribution of the GSTM1 genotypes inbetween the cases and the controls was not significantly different (p>0.5 by χ2 test). The results suggest that theGSTM1 deletion polymorphism is not a risk factor for squamous cell carcinoma of the cervix in the northeastThai women.     

Prevalence of High Risk Human Papillomavirus Infection ith Different Cervical Cytological Features among Women ndergoing Health Examination at the National Cancer nstitute,Thailand

High-risk (HR) human papillomavirus (HPV) testing is important in cervical cancer screening for triagecolposcopy. The objective of the study was to evaluate the prevalence of HR HPV infection with different cervicalcytological features among women undergoing health examination. A total of 2,897 women were retrospectivelyevaluated between May 2011 to December 2011. DNA was extracted from residual specimens collected duringroutine liquid-based cytology tests at the National Cancer Institute. Overall, HR HPV prevalence was 9.3%including 1.6% of HPV-16 and 0.4% of HPV-18. Of all 270 HPV positive samples, 211 (78.1% were HR-HPVnon 16/18; 47 (17.4%) were HPV-16 and 12 (4.4%) were HPV-18. The prevalence of HPV infection was similarin all age groups, although a higher rate was observed in women age 31-40 years. Among women with normalcytology, HR HPV positive were found in 6.7%. In abnormal cytology, HR HPV were found 46.7% in atypicalsquamous cells (ASC), 54.8% in low-grade squamous intraepithelial lesions (LSIL) and 80.0% in high-gradesquamous intraepithelial lesions (HSIL). HPV-16 was detected in 8.6%, 6.4% and 12.0% of ASC, LSIL andHSIL, respectively. The results of this study provide baseline information on the HPV type distribution, whichmay be useful for clinicians to decide who should be monitored or treated more aggressively.     

Human Papillomavirus Genotype Distribution among Thai Women with High-Grade Cervical Intraepithelial Lesions and Invasive Cervical Cancer: a Literature Review

Infection with high-risk human papillomavirus (HR-HPV) is an essential cause of cervical cancer. Becauseof substantial geographical variation in the HPV genotype distribution, data regarding HPV type-specificprevalence for a particular country are mandatory for providing baseline information to estimate effectivenessof currently implemented HPV-based cervical cancer prevention. Accordingly, this review was conducted toevaluate the HR-HPV genotype distribution among Thai women with precancerous cervical lesions i.e. cervicalintraepithelial neoplasia grade 2-3 (CIN 2-3), adenocarcinoma in situ (AIS), and invasive cervical cancer byreviewing the available literature. The prevalence of HR-HPV infection among Thai women with CIN 2-3 rangedfrom 64.8% to 90.1% and the three most common genotypes were HPV 16 (38.5%), HPV 58 (20.0%), and HPV18 (5.5%). There were high squamous cell carcinoma/CIN 2-3 prevalence ratios in women with CIN 2-3 infectedwith HPV 33 and HPV 58 (1.40 and 1.38, respectively), emphasizing the importance of these subtypes in the riskof progression to invasive cancer among Thai women. Data regarding the prevalence and genotype distributionof HR-HPV in Thai women with AIS remain unavailable. Interesting findings about the distribution of HPVgenotype in cervical cancer among Thai women include: (1) a relatively high prevalence of HPV 52 and HPV58 in invasive squamous cell carcinoma; (2) the prevalence of HPV 18-related adenocarcinoma is almost doublethepreviously reported prevalence, and (3) 75% of neuroendocrine carcinomas are HPV18-positive when takinginto account both single and multiple infections.     

Clinicopathologic Importance of Women with Squamous Cell Carcinoma Cytology on Siriraj Liquid-Based Cervical Cytology

Objectives: The purposes of this study were to determine the prevalence and predictive value to detectsignificant neoplasia and invasive lesions, and to evaluate the correlation between clinical and histopathology ofwomen with squamous cell carcinoma (SCCA) on Siriraj liquid-based cervical cytology (Siriraj-LBC). Methods:The computerized database of women who underwent Siriraj-LBC at Siriraj Hospital, Mahidol Universityfrom January 2007 to December 2010 were retrieved. The hospital records of women with SCCA cytology werereviewed. Results: The prevalence of SCCA cytology was 0.07%. A total of 86 women, mean age was 58.1 years.Sixty-one women (70.9%) were post-menopausal. Overall significant pathology and invasive gynecologic cancerwere detected in 84 women (97.7%) and 71 women (82.5%), respectively. The positive predictive values fordetection of significant neoplasia and invasive lesion were 97.7% and 82.6%, respectively. The cervical cancerwas diagnosed in 69 women and among these 58 women were SCCA. Thirteen women (15.1%) had cervicalintraepithelial neoplasia (CIN) 3 and two women (2.3%) had cervicitis. The sensitivity and specificity of colposcopyfor cervical cancer detection in SCCA cytology were 83.3% and 75%, respectively. Median follow up period was17.6 months and 64 patients were alive without cytologic abnormality. Conclusions: The final histopathology ofSCCA cytology in our populations demonstrated a wide variety, from cervicitis to invasive cancer and the mostcommon diagnosis was invasive cervical cancer. Colposcopy with biopsy and/or endocervical curettage and loopelectrosurgical excision procedure should be undertaken to achieve histologic diagnosis.