자궁경부암 검진시 비정상 자궁경부 세포진 검사(ASCUS,LSIL)에 따른 추적방법

구희주,김수녕,손인숙,이지영,윤병일 건국대학교 의과학연구소 2002 건국의과학학술지 Vol.12 No.-

The considerable false-negative rates associate with Pap smear and increasing number of minor cytological abnormalities have prompted gynecologists to look for an adjuvant test either to improve primary screening or to act as a triage for minor abnormalities. This study was conducted to determine the follow-up and triage method for ASCUS(atypical squamous cells of undetermined significance) and LSIL(low-grade squamous intraepithelial lesion) smears. A total of 2591 asymptomatic women who presented to the outpatient department of Obstetrics and Gynecology in KonKuk University Hospital between April 1, 1996 and March 30, 1999 were screened for CIN(cervical intraepithelial neoplasia) and invasive cervical cancer by Pap smear. Women whose cytologic screening showing ASCUS or LSIL were evaluated with HPV-DNA testing, cervicography, and colposcopy in 6 months interval. Initial Pap smear was normal in 2395(92.4%), ASCUS in 93(3.9%), and LSIL in 77(3.2%) women. HPV-DNA test was positive in 9(20.9%) of 43 women with Pap smears showing ASCUS, and in 13(40.6%) of 32 women with Pap smears showing LSIL. The positive rate of HPV-DNA test was higher in LSIL group than in ASCUS group, but there was no statistical significance. Women with ASCUS on Pap smear, their cervicographic finding was positive in 26 patients(28.0%), and colposcopic finding was CIN in 12 patients(12.9%). Clinicopathologic diagnosis was CIN in 12 patients(12.9%) and invasive cancer in 2 patients(2.2%). Women with LSIL on Pap smear, their cervicographic finding was positive in 65 patients(84.4%), colposcopic finding was CIN in 59 patients(76.6%), and their pathologic finding was dysplasia in 63 patients(81.8%). The positive rate of cervicography was higher than colposcopy in both ASCUS and LSIL group, but there was no statistically significant difference between two study. We followed up 122 of 170 patients with ASCUS and LSIL in initial Pap smear every 6 months with cytology, cervicography and colposcopy. In ASCUS group, 42(56.7%) were negative and 33(43.1%) were positive in second Pap smear, 59(78.7%) were negative and 16(21.3%) were positive in cervicography, 6(8.0%) were CIN in colposcopy. In LSIL group, 8(17.0%) were negative, 39(83.0%) were positive in second Pap smear, 10(21.3%) were negative and 37(78.7%) were positive in cervicography and 23(49.0%) were CIN in colposcopy. Among patients with ASCUS and LSIL in Pap smear, the positive rate of cervicography was higher than of colposcopy, but there was no statistically significant difference between two study. Cervicography and colposcopy can be used as an important intermediate triage technique for the evaluation of patients with Pap smears showing ASCUS or LSIL and follow-up every 6 months in patients whose Pap smear revealed ASCUS and LSIL may improve the diagnosis rate of CIN and prevent invasive cancer.

자궁경부 세포진검사에서 ASCUS와 LSIL로 진단된 환자의 임상적 의의와 처치

이광현,전효정,김지현,차문석,제구화,나서희 대한부인종양 콜포스코피학회 2003 Journal of Gynecologic Oncology Vol.14 No.1

목적 : The Bethesda System에 따른 자궁경부 세포진검사에서 Atypical Squamous Cells of Undetermined Significance (ASCYS) 또는 Low-grade Squamous Intraepithelial Lesion (LSIL)으로 진단된 환자를 대상으로 그 빈도 및 재검 소견과 조직학적 소견을 분석하여 이들이 가지는 임상적 의의와 처치에 관해 고찰해 보고자 하였다. 연구 방법 : 2000년 11월부터 2002년 2월까지 동아대학교병원을 내원하여 자궁경부 세포진검사를 실시한 5752명의 환자 중 ASCYS로 진단된 64명과 LSIL로 진단된 62명을 대상으로 하였으며 판독은 The Bethesda System(TBS)의 진단기준에 따랐고 이들 중 추적관찰이 가능한 ASCYS 35명, LSIL 28명을 중심으로 연구하였다. 결과 : 조사기간 동안 자궁경부 세포진검사를 받았던 5752명중 Within Normal Limit (WNL)로 진단받은 경우는1680명, Benign Cellular Change (BCC) 3828명, Atypical Squamous Cells of Undetermined Significance (ASCUS) 64명,Atypical Glandular Cells of Undetermined Significance (AGUS) 6명, Low-grade Squamous Intraepithelial Lesion (LSIL)62명, High-grade Squamous Intraepithelial Lesion (HSIL) 64명, Squamous Cell Carcinoma (SCC) 48명 등이었으며ASCUS와 LSIL의 비율은 각각 1.1%, ASCUS/SIL ratio는 1.97이었다. ASCUS에서 추적관찰이 가능하였던 35명 중 반복 세포진 검사나 조직학적 검사로 확인 시 다시 ASCUS인 경우는 1예(2.8%), 양성변화의 소견이 25예(71.4%), 이형성증 이상의 소견을 보인 경우는 9예(25.8%)였다. 추적관찰이 이루어진 28명의 LSIL환자의 추가적인 검사에서는 정상소견 15예(53.5%), ASCUS 1예(3.6%), 만성자궁경부염 3예(10.7%), CIN I 예(3.6%), koilocytosis Ifl(3.6%), condyloma 예(3.6%), LSIL 6예(21.4%)로 고등급 병변은 관찰되지 않았다. 결론 : 자궁경부 세포진검사에서 TBS 진단기준에 따른 ASCUS시 이형성증 이상의 소견으로 진행될 가능성이25.8%에 달해 보다 적극적인 추적관찰과 검사가 필요하다고 생각한다. Objective : To evaluate the clinical significance and management of patients with Atypical Squamous Cells of Undetermined Significance (ASCUS) and Low-grade Squamous Intraepithelial Lesion (LSIL). Methods : Pathologic reports of 5752 patients who have underwent cervical Pap smear screening were reviewed at Dong-A university hospital from November 2000 to February 2002. Cytologic diagnosis was classified by the TBS. Of these patients, 63 women with ASCUS and LSIL were followed by repeat Pap smear, colposcopy-directed punch biopsy, cone biopsy and hysterectomy. Results : The rate of abnormal cytology was 4.2%, with 1.1% of ASCUS, 0.1% of AGUS, 1.1% of LSIL, 1.1% of HSIL, and 0.8% of SCC. The ratio of ASCUS/SIL was 1.97. Of the 35 patients who had a cervical cytologic diagnosis of ASCUS, 9 patients (25.8%) were above dysplasia, 25 (71.4%) were normal or benign changes, and 1 (2.8%) was ASCUS. The 62 cases had diagnosed LSIL by TBS. Of these patients, 28 cases were follow up with repeat smear and/or cervical biopsy. They showed WNL or BCC in 15 cases (53.5%), chronic cervicitis in 3 (10.7%), ASCUS in 1 (3.6%), CIN I in 1 (3.6%), koilocytic atypia in 1 (3.6%), condyloma in 1 (3.6%), and LSIL in 6 (21.4%). Conclusion : Most of ASCUS or LSIL revealed negative for malignancy, usually conservative management such as repeat Pap smear is desirable. But this study showed that a cytologic diagnosis of ASCUS was associated with SIL and cancer in one fourth. So further active management such as colposcopic directed biopsy is required.

저등급 자궁경부세포이상의 처치에 있어서의 인유두종 바이러스 DNA의 검색의 의의

연정은(Jung Eun Yeon),김재욱(Jae Wook Kim),김영태(Young Tae Kim) 대한산부인과학회 1999 Obstetrics & Gynecology Science Vol.42 No.10

목적: 1988년 Bethesda system이 제정된 이래 ASCUS와 LSIL의 진단과 치료에 많은 논란과 문제점이 제기되고 있다. 본 저자들은 세포진 검사에서 이러한 저등급 자궁경부세포이상을 보인 환자에서 고위험 인유두종바이러스 감염사실이 고등급 편평상피내손상 및 침윤성 암을 예측하는 지표로 사용할 수 있는지 알아보고자 하였으며, 또한 저등급 자궁경부세포이상에 대한 처치에 관한 지침을 마련하고자 하였다. 연구대상 및 방법: 1995년 1월부터 1999년 3월까지 연세대학교 세브란스병원 산부인과 외래에서 세포진 검사를 실시하였던 18,942명의 환자를 대상으로 하였다. 이중 ASCUS 및 LSIL의 결과를 보인 249명의 환자에서 조직검사를 시행, 분석하였다. 또한 115명의 환자에서 중합효소연쇄반응을 이용하여 고위험 인유두종바이러스(type 16, 18) 감염여부를 조사하였다. 결과: 112명의 ASCUS 환자 중에서 CIN II 3례(2.7%), CIN III 및 CIS 22례(19.6%), 편평상피암이 18례(16.1%)이었다. 137명의 LSIL 환자 중에서는 CIN II 22례(16.1%), CIN III 및 CIS 36례(26.3%), 편평상피암이 7례(5.1%)이었다. PCR법을 이용하여 고위험 인유두종바이러스(HPV 16/18)를 검사한 경우는 전체 환자 중 ASCUS 51명, LSIL 64명이었다. 고위험 인유두종바이러스에 대한 PCR 검사를 시행한 51명의 ASCUS 환자 중 바이러스 검출 결과가 음성인 경우 22.5%(9/40)에서 CIN II, III 및 편평상피암의 병변이 확인되었으나, 양성인 경우에는 54.5%(6/11)로 고위험 병변 및 편평상피암이 많았다. ASCUS군에서 고위험 인유두종바이러스와 고위험 병변 및 편평상피암과의 연관성을 알아본 결과 민감도 40.0%, 특이도 86.1%, 양성예측률 54.5%, 음성예측률 77.5%이었다. 고위험 인유두종바이러스에 대한 PCR 검사를 시행한 64명의 LSIL 환자 중 바이러스 검출 결과가 음성인 경우 39.6%(21/53)에서 CIN II, III 및 편평상피암의 병변이 확인되었으나, 양성인 경우에는 81.8%(9/11)로 고위험 병변 및 편평상피암이 많았다. LSIL군에서 고위험 인유두종바이러스와 고위험 병변 및 편평상피암과의 연관성을 알아본 결과 민감도 30.0%, 특이도 94.1%, 양성예측률 81.8%, 음성예측률 60.4%이었다. 결론: 본 연구의 결과를 토대로 세포진검사에서 ASCUS 및 LSIL이 진단된 경우 질확대경조준하생검 등과 같은 적극적인 처치를 해야 할 것으로 사료되며, HPV DNA test인 PCR방법이 진단에 보조적인 도움을 줄 수 있으며 특히 고위험인유두종바이러스 양성인 경우 고등급자궁경부 상피내손상이나 편평상피암의 위험도가 높음을 예측할 수 있을 것으로 사료된다. Objectives: Objective: The diagnosis of ASCUS(atypical squamous cells of undetermined significance) and LSIL(low-grade squamous intraepithelial lesion) was introduced in 1988 by the Bethesda system for reporting cervical/vaginal cytologies. A significant proportion of women referred for colposcopy with low grade cervical cytologic abnormalities(ASCUS and LSIL) will have high grade cervical intraepithelial neoplasia(CIN II or CIN III) and therefore require adequate management. The purposes of this study were to evaluate the usefulness of high risk type HPV(human papillomavirus) DNA detection using PCR(polyerase chain reaction) in patients with low grade cervical cytologic abnormalities in the prediction of high grade CIN and invasive cancer and to determine the clinical triage in the management of low grade cervical cytologic abnormalities. Methods: We reviewed 18,942 cases of Papanicolau smears that were performed at our hospital from Jan. 1995 to Mar. 1999. Colposcopically directed biopsy or LLETZ(large loop excision of transformation zone) or hysterectomy were performed on 318 patients with abnormal PAP smears of low degree. HPV PCR testing of high risk types(16 and 18) was also performed on 115 patients. Results: Histologic outcome of ASCUS included 43 cases(38.4%) of high grade CIN and invasive cancer, and that of LSIL included 65 cases(47.5%) of high grade CIN and invasive cancer. In cases of high risk HPV type, 19 patients(73.1%) were at age over 30 years. A highly significant correlation was found between a positive test for high risk types of HPV and finding of high grade CIN and invasive cancer. Among 51 women with ASCUS, a positive test for high risk type had a sensitivity and specificity of 40.0% and 86.1%, and positive predictive value(PPV) and negative predictive value(NPV) of 54.5% and 77.5%, respectively. In 64 women with LSIL, a positive high risk type test was associated with sensitivity and specificity of 30.0% and 94.1%, and PPV and NPV of 81.8% and 60.4%, respectively. Conclusion: Our results suggest that high risk type HPV may be positively predictive of and may act as a surrogate marker for high grade CIN and invasive cancer in women with low grade cervical cytologic abnormalities. The management of women with a low grade cervical cytologic abnormalities should be active such as colposcopically directed biopsies.

한국 여성 자궁경부 종양 환자에서 인유두종 바이러스 유전자형 분석

박태철,김찬주,이근호,윤주희,김지훈,고영미,남궁성은,박종섭 대한부인종양 콜포스코피학회 2003 Journal of Gynecologic Oncology Vol.14 No.1

인유두종 바이 러스(human papillomavirus; HPV)는 자궁경부암의 발생 에 있어서 가장 중요한 원인으로 인정되고 있으며, 자궁경부 세포진 검사에 대해 보조적인 방법으로 HPV 진단법의 효용성이 확인되었다. HPV 백신의 개발이 예상되고 있는 시점에서 한국 여성에서 HPV 유전자형 분포도에 대한 지식은 자궁경부암의 진단과 치료와 예방에 있어서 매우 중요할 것으로 생각된다. 2001년 11월부터 2002년 5월까지 가톨릭대학교 의과대학 강남 성모 병원 산부인과를 방문한 외래 및 입원 환자를 대상으로 하여, 자궁경부 세포진 또는 병리 조직 검사 소견에 따른 HPV 유전자형의 분포를 분석하였다. 환자들의 평균 연령은 43.4세이며, 21세에서 91세의 범위에 있었다. 자궁경부 세포진 또는 병리 조직 검사 소견에 따라 정상 세포진 소견을 보이는 여성(n=290), LSIL (low-grade squamous intraepithelial lesion) 세포진 검사와 일치하는 조직 검사 결과로 HPV 감염 또는 경증 상피이형증으로 나타난 환자(n=68), HSIL (high-grade squamousintraepithelial lesion) 세포진 검사와 일치하는 조직 검사 결과로 중등도 상피이형증, 중증 상피이형증 또는 상피내암으로 나타난 환자(n=51), 자궁경부암 환자(n=55)로 분류하였으며, HPV DNA chip을 이용하여 각 군에서 채취한 자궁경부 세포에서 HPV의 존재를 파악하고 유전자형 분포와 복합 감염을 관찰하였다. 각 군당 HPV 발견율은 정상군 290명 중 51명(17.6%)에서 HPV 양성이었으며, LSIL에서 68명 중 50명(73.5%),HSIL에서 51명 중 47명(92.2%),자궁경부암에서 62명 중 59명(95.1%)에서 HPV 양성이었으며, 그 중 편평세포암환자 55명 중 53명(96.4%)에서, 선암 환자 7명 중 6명(85.7%)에서 HPV 양성 소견이 관찰되었다 HPV-16형은 정상군에서 7.9% (23/290), LSIL에서 24.2% (16/68), HSIL에서 33.3% (17/51), 자궁경부암에서 75.8% (47/62) 검출되었으며, 자궁경부 병소의 중증도가 진행됨에 따라 HPV-16형의 발견 빈도가 유의하게 증가됨을 관찰할 수 있었다(β<0.01). 그 외 HPV-18, -58형들은 자궁경부암 환자와 HSIL에서 높게 검출되었으며, HPV-18, -51, -52, -58, -68형들은 LSIL에서 높게 검출되었다(β<0.05). 여러 종류의 HPV들이 검출되는 복합 감염의 경우는 정상군에서 19명(37.3%), LSIL에서 21명(42.0%), HSIL에서 13명(27.7%), 자궁경부암에서 17명(28.8%)에서 바이 러스가 발견되 었다한국 여성의 자궁경부 정상 세포진에서 HPV 감염, 자궁경부 상피이형증을 거쳐서 자궁경부암으로 진행되는 상태에 따라 HPV 감염률의 차이와 HPV 유전자형의 분포도 및 복합 감염 여부를 파악할 수 있었다. 자궁경부병소를 가진 여성에서 HPV를 탐색한 본 연구 결과로서 HPV감염과 자궁경부 상피 이형증의 예후를 결정할 수있는 분자 생물학적 지표로 사용하거나 자궁경부 상피내 암과 자궁경부암을 조기 진단하기 위한 보조적 인 방법으로 가능성을 고려할 수 있을 것으로 생각되며, 자궁경부암의 예방을 위하여 향후 개발될 HPV 백신을 사용하기위한 한국 여성에서의 기초 자료로서 가치가 있을 것으로 사료된다. Objective : It has been widely acknowledged that human papillomavirus (HPV) is the most important cause of cervical carcinoma, and the HPV DNA test has been proved as an effective adjuvant to Pap smear. As the development of HPV vaccine is now at the planning stage, the role of HPV genotype profile has become very important in early diagnosis, management and prevention of cervical neoplasia. Methods : Analysis was made on the HPV genotype profile of a number of the inpatients and outpatients who visited at the Department of Gynecology, Kangnam St. Mary’s Hospital between November, 2001 and May, 2002, based on the Pap smear test and tissue pathology. The age range of the patients covered in this study was between 21 years and 91 years and the average age of the patients was 43.4 years. Based on the results of the Pap smear and tissue pathology, the patients were broken down into the following 4 groups; the women with normal cytology (n=290), the patients with LSIL (low-grade squamous intraepithelial lesion); koilocytosis and mild dysplasia (n= 68), the patients with HSIL (highgrade squamous intraepithelial lesion); moderate and severe dysplasia, or carcinoma in situ (n= 51), and the patients with cervical cancer (n=55), respectively and a study was made on the HPV genotype profile of cervix of each of the above 4 groups by utilizing HPV DNA chip. Results : The proportions of the detected HPV-16 in the individual groups were 7.9% (23/290) for women with normal cytology, 24.2% (16/68) for the patients with LSIL, 33.3% (17/51) for HSIL, 75.8% (47/62) for those with cervical cancer, respectively and it was noticed that detection rates increased significantly in accordance with advancing the severity of cervical lesions (P<0.01). Of the rest of the HPV types, HPV -18, -33, -35, -39, -52, -56, -58 were related with cervical cancer (P<0.05); HPV-18, -58 were related with HSIL (P<0.05); HPV -18, -39, -51, -52, -58, -68 were related LSIL (P<0.05). In the case of multiple HPV infections, 19 (37.3%) were detected in women with normal cytology, 21 (42.0%) were detected in patients with LSIL, 13 (27.7%) were detected in HSIL, and 17 (28.8%) were detected in those with cervical cancer, respectively, but there was no statistically significant differences. Conclusion : As a result of this study, HPV genotype profiles and multiple infections by pathological severity can be obtained for the Korean female patients groups ranging from normal cervical cytology through cervical intraepithelial neoplasia to cervical carcinoma. It is expected that the results of this study might be utilized as a molecular biological index to determine prognosis of HPV infection and cervical dysplasia or as an adjunctive diagnostic method for early detection of carcinoma in situ and cervical carcinoma, and that the results can also become very valuable basic data that can be used in developing HPV vaccine for prevention of cervical carcinoma in the near future.

Number of External Anogenital Warts is Associated with the Occurrence of Abnormal Cervical Cytology

Chayachinda, Chenchit,Boriboonhirunsarn, Dittakarn,Thamkhantho, Manopchai,Nuengton, Chanon,Chalermchockcharoenkit, Amphan Asian Pacific Journal of Cancer Prevention 2014 Asian Pacific journal of cancer prevention Vol.15 No.3

Background: Anogenital warts (AGWs) are common results of sexually transmitted infection (STI). Human papillomavirus (HPV) types 6 and 11, which are non-oncogenic types, account for 90% of the clinical manifestations. Although the quadrivalent HPV vaccine has been launched, AGW remains prevalent in some countries and shows association with abnormal cervical cytology. Objectives: To study the prevalence of abnormal cervical cytology (low grade squamous intraepithelial lesions or worse; LSIL+) in immunocompetent Thai women newly presenting with external AGWs. Materials and Methods: Medical charts of all women attending Siriraj STI clinic during 2007-2011 were reviewed. Only women presenting with external AGWs who were not immunocompromised (pregnant, human immunodeficiency virus positive or being on immunosuppressant drugs) and had not been diagnosed with cervical cancer were included into the study. Multivariate analysis was used to determine the association between the characteristics of the patients and those of AGWs and LSIL+. Results: A total of 191 women were eligible, with a mean age of $27.0{\pm}8.9$ years; and a mean body mass index of $20.6{\pm}8.9kg/m^2$. Half of them finished university. The most common type of AGWs was exophytic (80.1%). The posterior fourchette appeared to be the most common affected site of the warts (31.9%), followed by labia minora (26.6%) and mons pubis (19.9%). The median number of lesions was 3 (range 1-20). Around 40% of them had recurrent warts within 6 months after completing the treatment. The prevalence of LSIL+ at the first visit was 16.3% (LSIL 12.6%, ASC-H 1.1%, HSIL 2.6%). After adjusting for age, parity and miscarriage, number of warts ${\geq}5$ was the only factor associated with LSIL+(aOR 2.65, 95%CI 1.11-6.29, p 0.027). Conclusions: LSIL+ is prevalent among immunocompetent Thai women presenting with external AGWs, especially those with multiple lesions.

Clinical Prediction Based on HPV DNA Testing by Hybrid Capture 2 (HC2) in Combination with Liquid-based Cytology (LBC)

Junyangdikul, Pairoj,Tanchotsrinon, Watcharaporn,Chansaenroj, Jira,Nilyaimit, Pornjarim,Lursinsap, Chidchanok,Poovorawan, Yong Asian Pacific Journal of Cancer Prevention 2013 Asian Pacific journal of cancer prevention Vol.14 No.2

Primary screening by HPV DNA testing is an effective method for reducing cervical cancer and has proven more sensitive than cytology. To advance this approach, many molecular methods have been developed. Hybrid capture 2 provides semi-quantitative results in ratios of relative light units and positive cutoff values (RLU/PC). Twenty-five thousand and five patients were included in this study to analyze the correlation between the ratio of RLU/PC and stage of cervical dysplasia. The results show that the RLU/PC ratios ranged from 0-3500 while almost normal cases, ASC-US and ASC-H, had values below 200. Of those samples negative for cytology markers, 94.6% were normal and their RLU/PC ratios were less than 4. With an RLU/PC ratio greater than 4 and less than or equal to 300, the percentages in all age groups were normal 53.6%, LSIL 20.2%, ASC-US 17.2%, HSIL 6.13%, ASC-H 2.72%, and AGC 0.11%, respectively. In contrast, 64.0% of samples with a RLU/PC ratio greater than 300 and less than or equal to 3500 were LSIL. These results should contribute to cost effective cervical cancer management strategies. Further studies of associations with particular HPV genotypes would be useful to predict the risk of progression to cancer.

ASCUS와 LSIL의 추적 조사

김경윤,김종성,황승욱,양정희,백유진,유태우 대한가정의학회 2001 Korean Journal of Family Medicine Vol.22 No.11

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

Khunamornpong, Surapan,Settakorn, Jongkolnee,Sukpan, Kornkanok,Srisomboon, Jatupol,Suprasert, Prapaporn,Siriaunkgul, Sumalee Asian Pacific Journal of Cancer Prevention 2014 Asian Pacific journal of cancer prevention Vol.15 No.24

Background: Minor cervical cytologic abnormalities include atypical squamous cells of undetermined significance (ASC-US) and low-grade squamous intraepithelial lesion (LSIL). Approximately 10-20% of women with 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 referral for colposcopy has been suggested. A triage test is useful in the selection of women at risk for histologic HSIL+ to reduce the colposcopy burden. The aim of this study was to assess the performance of high-risk HPV DNA test in triage of women with minor cytologic abnormalities in northern Thailand. Materials and Methods: All women with ASC-US/LSIL cytology who were referred to our colposcopy clinic from October 2010 to February 2014 were included. HPV DNA testing was performed using Hybrid Capture 2 (HC2). All patients received colposcopic examination. 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 significantly higher in the LSIL group than in ASC-US group (74.8% versus 41.0%, p<0.001). Histologic HSIL+ was detected in 9 women (7.4%) in the ASC-US group and 16 women (13.7%) in the LSIL group (p=0.141). There was no histologic HSIL+ detected among HC2-negative cases (sensitivity and negative predictive value of 100%). The performance of HC2 triage was highest among women aged >50 years with ASC-US cytology. An increase in the cut-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 of women with minor cervical cytologic abnormalities in northern Thailand. An increase of the cut-off threshold for HC2 triage is not recommended in this region.

Local Cervical Immunity in Women with Low-grade Squamous Intraepithelial Lesions and Immune Responses After Abrasion

Ekalaksananan, Tipaya,Malat, Praphatson,Pientong, Chamsai,Kongyingyoes, Bunkerd,Chumworathayi, Bandit,Kleebkaow, Pilaiwan Asian Pacific Journal of Cancer Prevention 2014 Asian Pacific journal of cancer prevention Vol.15 No.10

Minor trauma to the uterine cervix is supposed to induce local immunity to prevent cervical lesions caused by human papillomavirus (HPV) infection. This study aimed to investigate the local cervical immunity in women with low grade squamous intraepithelial lesion (LSIL) and effects of abrasion after cryosurgery or Pap smear. One hundred women with LSIL and known results of HPV detection were recruited. HPV positive women were randomly divided according to abrasion into cryotherapy and Pap smear observation groups. Cervical tissues and cervico-vaginal lavage (CVL) were collected at 6 and 12 months after allocation. The levels of cytokines at first recruitment were compared with cytokine levels at 6 months after abrasions. The mRNA of IFN-${\gamma}$, TNF-${\alpha}$ and IL-10 in cervical tissues and these cytokines secreted in CVL were determined using real time PCR and ELISA, respectively. Anti-HPV16 IgG and IgA antibodies in CVL were assessed by western blotting. At first recruitment of women with LSIL (100 cases), IL-10 mRNA and cytokine in HPV positive group (60 cases) was significantly higher than negative group (40 cases). IFN-${\gamma}$ and TNF-${\alpha}$ mRNA level in both groups were comparable but their secretions in CVL were significantly increased in HPV negative group. After abrasion for 6 months in HPV-positive women, all mRNA and secreted cytokines were changed, but no significant difference was observed between cryotherapy and observation groups. When individuals were compared between first recruitment and after abrasion for 6 months, IFN-${\gamma}$ mRNA and anti-HPV16 L1 IgA antibodies were significantly increased in the cryotherapy group. The results suggest that modulation of local cervical immunities by abrasion might promote different effects in clearance of HPV-related cytological abnormalities.

Occurrence of Ureaplasma parvum and Ureaplasma urealyticum in Women with Cervical Dysplasia in Katowice, Poland

Alicja M. Ekiel,Daniela A. Friedek,Malgorzata K. Romanik,Gayane Martirosian,Jaroslaw Jozwiak 대한의학회 2009 Journal of Korean medical science Vol.24 No.6

The aim of this study was to evaluate the occurrence of genital mycoplasmas, especially Ureaplasma parvum and Ureaplasma urealyticum, in women with atypical squamous cells of undetermined significance (ASCUS), low grade squamous intraepithelial lesions (LSIL) and high grade squamous intraepithelial lesions (HSIL), compared to women with normal cytology living in Katowice, Poland. Two sterile swabs were used to obtain material from the posterior vaginal fornix of 143 women with squamous intraepithelial lesions and 39 healthy women: first for general bacteriology, second for detection of urogenital mycoplasmas using Mycoplasma IST2 kit. From each positive Mycoplasma IST2 culture DNA was isolated and PCR was performed for identification of U. parvum and U. urealyticum. Mycoplasma IST was positive in 34.1% cases. Urogenital mycoplasmas were demonstrated in women with HSIL significantly more often compared to women with LSIL, ASCUS, and with normal cytology. DNA of U. parvum was demonstrated in majority of Mycoplasma IST2-positive cases, U. urealyticum DNA-only in 9 (4.9%). Predominance of 3/14 serovars of U. parvum was demonstrated. U. urealyticum biovar 2 was present more often in women with squamous intraepithelial lesions.