Carcinoma in Situ ; diagnosis ; pathology ; Cervical Intraepithelial Neoplasia ; diagnosis ; pathology ; Endometrial Hyperplasia ; pathology ; Female ; Humans ; Uterine Cervical Neoplasms ; pathology

OBJECTIVE: To identify key factors for predicting positive cone margin and appropriate cone length. METHODS: We retrospectively reviewed the margin status of patients who received conization with high grade cervical intraepithelial neoplasia, along with other factors such as patient age, parity, preoperative cytology, size of disease, type of transformation zone, and cone length from patient records. Cut-off value of cone length was analyzed in women younger than 40 years old because we design conization with minimum length especially for women who wish for future pregnancy. Cut-off value of cone length was defined as length corresponds to estimated probability of positive cone margin equal to 0.1 by logistic regression analysis with variables selected by stepwise methods. RESULTS: Among 300 patients, 75 patients had positive cone margin. Multivariable analysis revealed that squamous cell carcinoma at preoperative cytology (p=0.001), 2 or more quadrant disease (p=0.011), and shorter cone length (p<0.001) were risk factors for positive cone margin. Stepwise methods identified cone length and size of lesion as important variables. With this condition, cut-off value of cone length was estimated as 15 mm in single quadrant disease and 20 mm in 2 or more quadrant disease, respectively. CONCLUSION: We identified the independent risk factors of positive cone margin and identified the cut-off value of cone length to avoid positive cone margin in women younger than 40 years old. Conization should be performed not only according to colposcopic findings including type of transformation zone but size of disease and cone length.
Adult ; Cervical Intraepithelial Neoplasia/*pathology ; Cervix Uteri/*pathology ; *Conization ; Female ; Humans ; Middle Aged ; Retrospective Studies ; Uterine Cervical Neoplasms/*pathology

OBJECTIVE: This study was performed to assess the efficacy of large loop excision of transformation (LLETZ) and to evaluate of clinicopathological factors with the probability of residual disease. METHODS: Retrospective study was performed in 56 patients treated with LLETZ from September, 1998 to October, 2001 in department of Obstetrics and Gynecology at Boramae Hospital. The patients underwent either immediate reoperation or monitoring with a cytologic smear and colposcopy. we investigate the significance of clinicopathological factors to predict residual disease after LLETZ. We used the Hybrid capture II test (Digene, USA) for presence of human papillomavirus (HPV). Residual disease was defined as histologic diagnosis of cervical intraepithelial neoplasia (CIN). RESULTS: Histologic assesment after LLETZ showed margin involvements in 28.6% (16/56) of cases but the residual lesion was only seen in 21.4% (12/56). There was no other serious complication. Positive margins was significantly associated with severity of lesion but not presence of HPV. Severity of lesion and margin involvements was significantly associated with residual disease (p<0.05). But age of patients and the presence of HPV was not significantly associated with residual disease. CONCLUSION: LLETZ is an effective, quick and reliable procedure on accurate diagnosis of cervical pathology and conservative treatment of CIN. Margin status and severity of lesions could be used to predict residual disease.
Cervical Intraepithelial Neoplasia* ; Colposcopy ; Diagnosis ; Equidae ; Gynecology ; Humans ; Obstetrics ; Pathology ; Reoperation ; Retrospective Studies

OBJECTIVES: To investigate whether the aspects of Pap smear affect cervical abnormality in our country. METHODS: We compared the sensitivity of Pap smear of 241 cases of pathologic proven CIN & invasive cancer, compared to that of 655 cases with normal cervical biopsy, and reviewed the history of the test of 138 cases, retrospectively. RESULTS: The sensitivity of the test was 89.6%, 92.7% in CIN & invasive cancer group, respectively, with 96.9% specificity. Among 241 cases, 138 cases were examined for the frequency of test during the 3 years with the result of 2.42, 2.17/3yr in CIN and invasive cancer. And distribution of the test was not different between the two groups. The mean intervals of last two Pap smear before diagnosing final pathology in CIN and cancer were 12.1, 13.7 months, respectively, with no statistical significance (p>0.05). CONCLUSION: We concluded that in our country the aspects of Pap smear such as frequency and interval do not influence the result of cervical abnormality, so recommend the annual Pap test as a screening.
Biopsy ; Cervical Intraepithelial Neoplasia* ; Mass Screening ; Papanicolaou Test* ; Pathology ; Retrospective Studies ; Sensitivity and Specificity

OBJECTIVE: The change of claudin expressions, integral transmembrane proteins for tight junction, might be related to progression of cervical premalignancy or malignancy. The aim of this study was to verify the tendency of expressions of claudin-1 and -7 according to the progression of cervical pathology of uterus. METHODS: There were 162 tissues obtained at AA institute. 25 tissues were normal, 26 were cervical intraepithelial neoplasia (CIN) 1, 30 were CIN2, 44 were CIN3, 25 were microinvasive cervical carcinomas, and 12 were invasive squamous cervical carcinomas (ISCC). H and E and immunohistochemical staining were done. RESULTS: Among normal tissues, 52% showed no expression, 48% weak expressions at claudin-1, and 28% no expression, 56% weak expressions at claudin-7. Among CIN3, 20% showed weak expressions, 41% showed moderate expressions at claudin-1, and 14% weak expressions, 52% moderate expressions at claudin-7. Among ISCC, 42% showed moderate expressions, 50% strong expressions at claudin-1, and 33% moderate expressions, and 33% strong expressions at claudin-7. These data shows the increasing tendency of claudin-1 and claudin-7 expressions according to the severity of lesions (p<0.01). CONCLUSION: The expressions of claudin-1 and claudin-7 were increased more according to the progression of cervical lesions.
Carcinoma, Squamous Cell* ; Cervical Intraepithelial Neoplasia ; Claudin-1* ; Pathology ; Tight Junctions ; Uterus

OBJECTIVE: The change of claudin expressions, integral transmembrane proteins for tight junction, might be related to progression of cervical premalignancy or malignancy. The aim of this study was to verify the tendency of expressions of claudin-1 and -7 according to the progression of cervical pathology of uterus. METHODS: There were 162 tissues obtained at AA institute. 25 tissues were normal, 26 were cervical intraepithelial neoplasia (CIN) 1, 30 were CIN2, 44 were CIN3, 25 were microinvasive cervical carcinomas, and 12 were invasive squamous cervical carcinomas (ISCC). H and E and immunohistochemical staining were done. RESULTS: Among normal tissues, 52% showed no expression, 48% weak expressions at claudin-1, and 28% no expression, 56% weak expressions at claudin-7. Among CIN3, 20% showed weak expressions, 41% showed moderate expressions at claudin-1, and 14% weak expressions, 52% moderate expressions at claudin-7. Among ISCC, 42% showed moderate expressions, 50% strong expressions at claudin-1, and 33% moderate expressions, and 33% strong expressions at claudin-7. These data shows the increasing tendency of claudin-1 and claudin-7 expressions according to the severity of lesions (p<0.01). CONCLUSION: The expressions of claudin-1 and claudin-7 were increased more according to the progression of cervical lesions.
Carcinoma, Squamous Cell* ; Cervical Intraepithelial Neoplasia ; Claudin-1* ; Pathology ; Tight Junctions ; Uterus

Cervical Intraepithelial Neoplasia ; diagnosis ; pathology ; virology ; China ; DNA Probes, HPV ; Female ; Humans ; Pregnancy ; Vaginal Smears ; methods

OBJECTIVE: Cervical intraepithelial neoplasia (CIN) and invasive cervix cancer were detected in some cases of atypical squamous cells of undetermined significance (ASCUS) PAP smear. So it is reasonable to evaluate and manage ASCUS PAP smear. In this study, we attempted to assess the clinical significance of a cytologic diagnosis of ASCUS and determine the usefulness of HPV DNA chip test (which is a new diagnostic method for HPV) in management and evaluation of ASCUS patients. METHODS: This study was performed from November 2001 to June 2002 and included 48 cases of ASCUS. They were evaluated by HPV DNA chip test and the pathology was evaluated by punch biopsy, cone biopsy or hysterectomy. The result of type 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 66, 68 and 69 in HPV DNA chip test were categorized as high risk. RESULTS: The rate of CIN II or above in ASCUS was 18.8% (9/48). The detection rate of high risk HPV DNA in ASCUS was 41.7% (20/48). The detection rate of high risk HPV DNA was 30.6% (11/36) in normal or reactive, 33.3% (1/3) in CIN I, 80% (4/5) in CIN II, 100% (2/2) in CIN III, 100% (2/2) in invasive cervix cancer. Higher the grade of pathology, more the detection rate of high risk HPV DNA chip test. The sensitivity for the prediction of CIN II or above by HPV DNA chip test was 88.9% and specificity was 69.2%, respectively. CONCLUSION: The use of HPV DNA chip test in patients with ASCUS may provide usefulness in detection of CIN II, CIN III and invasive cervix cancer.
Biopsy ; Cervical Intraepithelial Neoplasia ; Diagnosis ; DNA* ; Humans ; Hysterectomy ; Oligonucleotide Array Sequence Analysis* ; Pathology ; Sensitivity and Specificity ; Uterine Cervical Neoplasms

Carcinoma in Situ ; pathology ; Carcinoma, Squamous Cell ; classification ; pathology ; Cervical Intraepithelial Neoplasia ; classification ; pathology ; Diagnosis, Differential ; Female ; Humans ; Precancerous Conditions ; classification ; pathology ; Uterine Cervical Neoplasms ; classification ; pathology

OBJECTIVETo study the value of endocervical curettage (ECC) in the detection of cervical intraepithelial neoplasia (CIN) and cervical cancer, and the necessity of ECC during colposcopic examination.

METHODSIn the high prevalent area of cervical cancer in Shanxi Province, China, a total of 1997 women aged 35 approximately 45 years old were enrolled. Cervical cytology, colposcopy and targeted multiple biopsies, as well as ECC were performed for all women.

RESULTSAmong the 1997 women received ECC, 31 was positive for abnormal histologic changes with a frequency of 1.6%. Of the 31 cases, 9 had low grade squamous intraepithelial lesions (LSIL, 0.5%), 20 had high grade squamous intraepithelial lesions (HSIL, 1.0%), and 2 had squamous-cell carcinoma. No pathologic diagnosis could be made in 131 women because the tissue curretaged was insufficient. The women with positive cytologic findings had higher frequency (5.3%) of abnormal ECC than those with negative cytologic findings (0.3%). There was positive correlation between the frequency of abnormal ECC and the grade of cytolologic findings. Abnormal ECC was present in 9.1% of those with unsatisfactory colposcopy while 1.3% of those with satisfactory colposcopy (P < 0.01). The frequency of abnormal ECC was 0.6% in patients with negative colpocopy, 0.9% in LSIL and 24.1% in HSIL. Frequency of abnormal ECC in women with a negative colposcopy or LSIL was significantly lower than that with HSIL. The positive rate of ECC pathologically verified was 3.3% in LSIL, 22.2% in HSIL and 50.0% in squamous carcinoma, respectively (P < 0.01). Of the 316 patients with positive cytology but negative colposcopy, ECC was abnormal in 8 (2.5%), of which HSIL cytologically verified was in 3.

CONCLUSIONIf cytology or colposcopy shows HSIL or more severe changes, and cytology is positive while colposcopy is unsatisfactory, ECC should be done routinely.

Adult ; Carcinoma, Squamous Cell ; diagnosis ; pathology ; Cervical Intraepithelial Neoplasia ; diagnosis ; pathology ; Cervix Uteri ; pathology ; Colposcopy ; Dilatation and Curettage ; Female ; Humans ; Middle Aged ; Uterine Cervical Neoplasms ; diagnosis ; pathology