Search Results (46)

Background/Objectives: Since 2020, Germany has replaced its annual cytological screening for cervical cancer in women aged 35 and older with a combination screening program. This updated protocol, conducted every three years, includes both a cervical Pap smear and an HPV (human papillomavirus) test. In addition, the 2020 update of the German Cervical Cancer Screening Program mandates a more timely follow-up for certain abnormal findings compared to the previous approach. Methods: Results of cytologic, colposcopic, and histologic examinations between 2018 and 2021 were retrospectively retrieved from the electronic patient records of the Institute of Pathology Saarbrücken Rastpfuhl in order to present relevant findings within the years 2018–2019 and 2020–2021. The present study included all women who received appropriate follow-up based on the corresponding underlying screening modality. Results: Our reporting considered data from 30,715 women in 2018/19 (prior screening modality group) and 25,924 women in 2020/21 (updated screening modality group). In 2018/19, a total of 93 histological examinations were performed, compared to 237 in 2020/21. In 2018/19, 52 cases of CIN III and 12 cases of CIN II were identified, while in 2020/21, 78 cases of CIN III and 31 cases of CIN II were detected. In contrast, while women with negative cytological findings in 2018/19 were typically not referred for further colposcopic or histological evaluation, the updated program enabled earlier detection and treatment of cases with diagnosed high-grade dysplasia based solely on a positive HPV test. Notably, 31 women who were diagnosed at an earlier stage based solely on a positive HPV test initially presented with a cytological Pap I result (negative for intraepithelial lesion or malignancy; NILM). Conclusions: Additional HPV co-testing within the updated German cervical cancer screening program resulted not only in high rates of high-grade dysplasia detection but also a rise in the number of colposcopic procedures. While negative follow-up HPV findings regularly showed remission of the original finding, incidence of high-grade dysplasia was usually linked to a positive HPV test. Full article

Background: Cervical dysplasia is a pre-malignant condition of the uterine cervix and is highly prevalent in Sub-Saharan Africa; especially affecting HIV-infected Black women. The anti-dysplastic effect of vitamin D hormones in cervical dysplasia is poorly understood. Therefore, we conducted a cross-sectional case–control observational study to assess the relationship between serum 25-hydroxycholecalciferol (25(OH)D) and cervical dysplasia, amongst Black women with and without HIV infection. Methods: The study participants attended a gynaecologic oncology clinic at an academic hospital in Pretoria, South Africa (n = 109). Patient clinical data were obtained during consultation. Cervical dysplasia was identified by cytology (PAP smear) which classified the case group as high-grade squamous epithelial lesions (HSILs), and the control group as <HSIL. Serum biochemistry measured 25(OH)D and its covariate biochemical variables. The data were statistically modelled to adjust for clinical and biochemical covariates, identify a significant relationship (p ≤ 0.05) between 25(OH)D and cervical dysplasia, and analyse subgroup interaction between HIV status and cervical dysplasia. Results: The data showed high levels of vitamin D insufficiency and deficiency in Black women with and without HIV infection. After covariate adjustment, 25(OH)D demonstrated an inverse relationship with HSIL in HIV-uninfected Black women. Furthermore, an interaction effect between women with and without HIV infection was observed. Conclusions: The role of 25(OH)D in the primary prevention of cervical dysplasia in Black women without HIV infection is promising, and dosing strategies require investigation. Also, future studies exploring the immunomodulatory role of 25(OH)D in cervical dysplasia in HIV-infected women is warranted. Full article

Background/Objectives: The 2020 American Cancer Society guidelines endorse human papillomavirus (HPV) testing as the preferred method for cervical cancer screening. This study aims to evaluate the concordance of HPV and cytology findings for cervical intraepithelial neoplasia (CIN) at a population level. Methods: A retrospective cohort review of cervical cytology, HPV testing, and biopsies for all patients at a single Oregon-based medical center was performed over 21 months. The performance of HPV and cytology in detecting high-grade CIN lesions was compared. Results: A total of 22,488 tests were evaluated, showing 7.5% abnormal cytology and 7.4% positive HPV. Among 574 patients who underwent co-testing and a subsequent biopsy, 345 had abnormal cytology, with 212 having abnormal biopsy results. HPV was positive in 455 cases, with 266 having abnormal biopsy results. Among 455 HPV-positive cases, there were 283, 104 and 33 cases of non-16/18, 16, and 18 types, respectively. Additionally, 35 cases had co-infection with multiple HPV types. Among the cases diagnosed as CIN3 on biopsy, 90.6% had positive HPV testing (N = 96), and 82.9% had abnormal cytology (N = 94). HPV testing demonstrated a slightly higher sensitivity (88.8% vs. 78.3%, p = 0.128) and lower specificity (27.1% vs. 48.9%, p < 0.01) compared to cytology for CIN2 and CIN3 diagnosis. Conclusions: HPV testing showed a similar sensitivity but lower specificity compared to cytology for detecting high-grade lesions. Full article

Background: Reinforcement learning (RL) represents a significant advancement in artificial intelligence (AI), particularly for complex sequential decision-making challenges. Its capability to iteratively refine decisions makes it ideal for applications in medicine, such as the detection of cervical cancer; a major cause of mortality among women globally. The Pap smear test, a crucial diagnostic tool for cervical cancer, benefits from enhancements in AI, facilitating the development of automated diagnostic systems that improve screening effectiveness. This research introduces RL-Cervix.Net, a hybrid model integrating RL with convolutional neural network (CNN) technologies, aimed at elevating the precision and efficiency of cervical cancer screenings. Methods: RL-Cervix.Net combines the robust ResNet-50 architecture with a reinforcement learning module tailored for the unique challenges of cytological image analysis. The model was trained and validated using three extensive public datasets to ensure its effectiveness under realistic conditions. A novel application of RL for dynamic feature refinement and adjustment based on reward functions was employed to optimize the detection capabilities of the model. Results: The innovative integration of RL into the CNN framework allowed RL-Cervix.Net to achieve an unprecedented classification accuracy of 99.98% in identifying atypical cells indicative of cervical lesions. The model demonstrated superior accuracy and interpretability compared to existing methods, addressing variability and complexities inherent in cytological images. Conclusions: The RL-Cervix.Net model marks a significant breakthrough in the application of AI for medical diagnostics, particularly in the early detection of cervical cancer. By significantly improving diagnostic accuracy and efficiency, RL-Cervix.Net has the potential to enhance patient outcomes through earlier and more precise identification of the disease, ultimately contributing to reduced mortality rates and improved healthcare delivery. Full article

Cervical cancer (CC) remains a significant health issue, especially in low- and middle-income countries (LMICs). While Pap smears are the standard screening method, they have limitations, like low sensitivity and subjective interpretation. Liquid-based cytology (LBC) offers improvements but still relies on manual analysis. This study explored the potential of deep learning (DL) for automated cervical cell classification using both Pap smears and LBC samples. A novel image segmentation algorithm was employed to extract single-cell patches for training a ResNet-50 model. The model trained on LBC images achieved remarkably high sensitivity (0.981), specificity (0.979), and accuracy (0.980), outperforming previous CNN models. However, the Pap smear dataset model achieved significantly lower performance (0.688 sensitivity, 0.762 specificity, 0.8735 accuracy). This suggests that noisy and poor cell definition in Pap smears pose challenges for automated classification, whereas LBC provides better classifiable cells patches. These findings demonstrate the potential of AI-powered cervical cell classification for improving CC screening, particularly with LBC. The high accuracy and efficiency of DL models combined with effective segmentation can contribute to earlier detection and more timely intervention. Future research should focus on implementing explainable AI models to increase clinician trust and facilitate the adoption of AI-assisted CC screening in LMICs. Full article

Trichomonas vaginalis infection is one of the most prevalent curable STIs. Although treatments are available, T. vaginalis infections pose a significant challenge, especially in resource-limited regions, as the prevalence of this STI is often unknown. We aimed to determine the prevalence of Trichomonas vaginalis infection in women screened for cervical cancer precursor lesions in Botucatu in São Paulo, Brazil. We conducted a descriptive and retrospective study that included 23,735 women who attended the cervical cancer screening program at health units in 2019 and 2022. Clinical and sociodemographic data were collected from the cancer information system (SISCAN) and test requisition forms. Descriptive analysis was conducted, and comparisons were performed using the X2 Test and Student’s t-test (SigmaPlot version 13.0). The prevalence of T. vaginalis infection was 0.84% in 2019 and 0.57% in 2022. The mean age of patients with trichomoniasis was 42 (±11.2) years; 75% self-reported as white, 43% were married or in a stable relationship, and 40% had not completed primary education. Regarding the vaginal microbiota, only 15.3% of the cytology exams with infection by T. vaginalis showed a predominance of lactobacilli species, while inflammation was present in 82% of the smears. Cytological analysis revealed precursor lesions of cervical cancer in 0.05% of patients with trichomoniasis, including ASC, LSIL, and HSIL. The study showed a low prevalence of infection with T. vaginalis in low-risk women screened for precursor lesions of cervical cancer in Botucatu in São Paulo, Brazil. Full article

(1) Background: Cervical cancer, caused mainly by high-risk Human Papillomavirus (hrHPV), is a significant global health issue. While a Pap smear remains a reliable method for early detection, identifying new biomarkers to stratify the risk is crucial. For this purpose, extensive research has been conducted on detecting DNA methylation. (2) Methods: This cross-sectional study aimed to assess the expression levels of EIF4G3 and SF3B1 in precursor lesions and cervical tumor tissues through qRT-PCR and evaluate the methylation status of their promoters through bisulfite conversion. (3) Results: Both genes showed similar mRNA expression patterns, with the highest levels observed in squamous cell carcinoma (SCC) samples (p < 0.0001). Additionally, methylation analysis indicated increased percentages in the control group for both factors. Notably, the expression levels of both genes were inversely correlated with promoter methylation (EIF4G3—p = 0.0016; SF3B1—p < 0.0001). (4) Conclusions: Regarding the methylation pattern for both genes, we observe a decreasing trend from NILM to SCC patients. Therefore, we concluded that the decrease in methylation at the promoter level for both genes could be an indicator of abnormal cytology. Full article

The human papillomavirus (HPV) is implicated in nearly all cases of cervical cancer. While most HPV infections resolve spontaneously, persistent infections can lead to high-grade lesions and cancer. Traditionally, cervical screening has relied on cervical cytology, but since 2016, HPV mRNA testing has been integrated to enhance the detection of high-grade lesions (CIN2+) in women with normal cytology. This study, conducted at the Department of Clinical Pathology at UNN from 2016 to 2019, evaluates the impact of HPV mRNA testing on quality assurance, with follow-up adhering to national guidelines through December 2022. Among 98,648 cervical samples analyzed, 61,635 women exhibited normal cytology. Of these, 752 (1.2%) tested positive for HPV mRNA, specifically targeting HPV types 16, 18, and 45. Upon the re-evaluation of the index cytology, 70.7% of these women retained normal cytology findings, while biopsies identified high-grade lesions (CIN2+) in 34% and severe lesions (CIN3+) in 14%. Notably, older women constituted a larger portion of the normal cytology group but a smaller percentage of those testing positive for HPV and exhibiting significant lesions. This underscores the effectiveness of HPV mRNA testing in promptly identifying high-grade lesions, highlighting its potential to significantly reduce cervical cancer incidence through targeted re-evaluation of a small, at-risk population. Full article

Cervical cancer ranks among the leading causes of mortality in women worldwide, underscoring the critical need for early detection to ensure patient survival. While the Pap smear test is widely used, its effectiveness is hampered by the inherent subjectivity of cytological analysis, impacting its sensitivity and specificity. This study introduces an innovative methodology for detecting and tracking precursor cervical cancer cells using SIFT descriptors in video sequences captured with mobile devices. More than one hundred digital images were analyzed from Papanicolaou smears provided by the State Public Health Laboratory of Michoacán, Mexico, along with over 1800 unique examples of cervical cancer precursor cells. SIFT descriptors enabled real-time correspondence of precursor cells, yielding results demonstrating 98.34% accuracy, 98.3% precision, 98.2% recovery rate, and an F-measure of 98.05%. These methods were meticulously optimized for real-time analysis, showcasing significant potential to enhance the accuracy and efficiency of the Pap smear test in early cervical cancer detection. Full article

Cervical cancer (CC) is one of the deadliest gynecological cancers worldwide. Human papillomavirus is the main etiological agent responsible for the initiation and development of most CC cases. The standard method utilized for CC screening in the global population is the cytological Pap smear test. Despite its effective validity in detecting precancerous lesions and its response to layer stages of this disease, greater screening and diagnostic reliability are needed, as well as an improvement in specificity and sensitivity. In this context, the use of liquid biopsies, like blood, for the isolation of circulating tumor DNA (ctDNA) in CC screening, diagnosis, prognosis, and surveillance could fill the gaps that still exist. In the present review, we aim to study the literature in order to collect knowledge on blood-based liquid biopsy based on descriptions of its precious molecular content and its utilization as a potential tool for CC patients’ management. We will mainly focus on the important role of the novel ctDNA and the unique possibilities to additionally use HPV-ctDNA in CC at various stages of clinical application. Full article

Screening is critical for prevention and early detection of cervical cancer but it is time-consuming and laborious. Supervised deep convolutional neural networks have been developed to automate pap smear screening and the results are promising. However, the interest in using only normal samples to train deep neural networks has increased owing to the class imbalance problems and high-labeling costs that are both prevalent in healthcare. In this study, we introduce a method to learn explainable deep cervical cell representations for pap smear cytology images based on one-class classification using variational autoencoders. Findings demonstrate that a score can be calculated for cell abnormality without training models with abnormal samples, and we localize abnormality to interpret our results with a novel metric based on absolute difference in cross-entropy in agglomerative clustering. The best model that discriminates squamous cell carcinoma (SCC) from normals gives $0.908\pm 0.003$ area under operating characteristic curve (AUC) and one that discriminates high-grade epithelial lesion (HSIL) $0.920\pm 0.002$ AUC. Compared to other clustering methods, our method enhances the V-measure and yields higher homogeneity scores, which more effectively isolate different abnormality regions, aiding in the interpretation of our results. Evaluation using an external dataset shows that our model can discriminate abnormality without the need for additional training of deep models. Full article

We have been encouraging practicing gynecologists to adopt molecular diagnostics tests, PCR, and cancer biomarkers, as alternatives enabled by these platforms, to traditional Papanicolaou and colposcopy tests, respectively. An aliquot of liquid-based cytology was used for the molecular test [high-risk HPV types, (HR HPV)], another for the PAP test, and one more for p16/Ki67 dual-stain cytology. A total of 4499 laboratory samples were evaluated, and we found that 25.1% of low-grade samples and 47.9% of high-grade samples after PAP testing had a negative HR HPV-PCR result. In those cases, reported as Pap-negative, 22.1% had a positive HR HPV-PCR result. Dual staining with p16/Ki67 biomarkers in samples was positive for HR HPV, and 31.7% were also positive for these markers. Out of the PCR results that were positive for any of these HR HPV subtypes, n 68.3%, we did not find evidence for the presence of cancerous cells, highlighting the importance of performing dual staining with p16/Ki67 after PCR to avoid unnecessary colposcopies. The encountered challenges are a deep-rooted social reluctance in Mexico to abandon traditional Pap smears and the opinion of many specialists. Therefore, we still believe that colposcopy continues to be a preferred procedure over the dual-staining protocol. Full article

Introduction: Cervical cancer develops slowly and may not manifest signs and symptoms at an early stage. It is worth mentioning the factors that can influence the onset of cervical cancer: smoking, early sexual life, multiple sexual partners, use of oral contraceptives, multiparity, low socioeconomic status, among others. An important risk factor for the onset of this disease is HPV infection, a virus associated with most cases of precursor lesions of this type of cancer. It is essential to understand the comprehensiveness of the scope and adherence to the recommended guidelines throughout the national territory. Therefore, health indicators are important management tools that make it possible to evaluate the services offered, measuring the reach of the target population, the supply and access to preventive exams. Objective: To analyze the trend of progress in cervical cancer coverage actions in Brazilian capitals from 2016 to 2021. Method: This is an ecological study with temporal analysis that used secondary data referring to process indicators for cervical cancer control actions in women aged between 25 and 64 years living in Brazilian capitals between 2016 and 2021. Aspects related to the quality of care in the cervical cancer prevention program were evaluated using databases of the Cancer Information System (SISCAN), available in DATASUS. The indicators used to monitor and evaluate cervical cancer control actions were (i) cervical coverage, (ii) reason for cervical surgery, and (iii) proportion of cervical cancer every 3 years. Results: In 2016, 410,000 tests were performed and notified in the SISCAN system in all Brazilian capitals, with emphasis on Curitiba, with 65,715 tests performed, and Porto Velho, with 174. In 2020, there was a reduction in exams compared to the previous year in all capitals, with the exception of Palmas, which went from 7655 exams to 9604. It was observed that all the capitals studied showed an increase in the annual percentage variation of Pap smear coverage, with the exception of Brasília, Manaus, Porto Alegre and Porto Velho, which did not show a statistically significant increase (APC = 3.01, 2.746, 3.987, 3.69, respectively). When analyzing the performance of oncotic cytology exams in the capitals according to the years 2019 and 2020, it was observed that only Manaus registered an increase in the number of procedures performed, reaching a difference of 56.5% from one year to the next. Conclusion: The ecological analysis revealed a worrying drop in the number of tests performed in 2020, reflecting a sharp drop in coverage actions in Brazilian capitals during the pandemic caused by the SARS-CoV-2 virus. The pandemic has exacerbated existing inequalities and highlighted the need for adaptive strategies to maintain essential screening services in times of crisis. Full article

(1) Background: The prediction of cervical lesion evolution is a challenge for clinicians. This prospective study aimed to determine and compare the predictive accuracy of cytology, HPV genotyping, and p16/Ki67 dual staining alone or in combination with personal risk factors in the prediction of progression, regression, or persistence of cervical lesions in human papillomavirus (HPV)-infected patients; (2) Methods: This prospective study included HPV-positive patients with or without cervical lesions who underwent follow-up in a private clinic. We calculated the predictive performance of individual tests (cervical cytology, HPV genotyping, CINtecPlus results, and clinical risk factors) or their combination in the prediction of cervical lesion progression, regression, and persistence; (3) Results: The highest predictive performance for the progression of cervical lesions was achieved by a model comprising a Pap smear suggestive of high-grade squamous intraepithelial lesion (HSIL), the presence of 16/18 HPV strains, a positive p16/Ki67 dual staining result along with the presence of at least three clinical risk factors, which had a sensitivity (Se) of 74.42%, a specificity of 97.92%, an area under the receiver operating curve (AUC) of 0.961, and an accuracy of 90.65%. The prediction of cervical lesion regression or persistence was modest when using individual or combined tests; (4) Conclusions: Multiple testing or new biomarkers should be used to improve HPV-positive patient surveillance, especially for cervical lesion regression or persistence prediction. Full article

Background: The aim was to diagnose Candida in the oral cavity of subjects with type 2 diabetes mellitus (T2DM) using a genotyping technique and compare the results with those from conventional diagnosis by Papanicolaou (Pap) staining. Methods: Palatal mucosa smears were performed on 18 dental care patients diagnosed with T2DM and grade I, II, and III prosthetic stomatitis who met the inclusion criteria; 18 healthy control subjects were also included in the study. Hemoglobin A1c (HbA1c) levels were determined from total blood. Using exfoliative cytology, the Pap staining technique was used to diagnose candidiasis. Exfoliative cytology was also used for molecular diagnosis; DNA was obtained for Candida genotyping, and RNA was used for gene expression studies. Results: Clinical patterns indicated that all subjects were positive for Candida; however, Pap analysis revealed only three positive subjects, whereas end-point polymerase chain reaction (PCR) analysis revealed 15 subjects with some type of Candida. The most common Candida species found were Candida guilliermondii (38.8%), Candida krusei (33.3%), Candida tropicalis, and Candida lusitaniae (22.2%). Interestingly, the coexpression of different species of Candida was found in various patients. In all patients, HbA1c levels were increased. Gene expression analysis showed a significant decrease (p ≤ 0.05) in TLR2 expression in positive subjects, whereas TLR4 expression did not differ significantly among patients. Conclusions: The end-point PCR technique showed better sensitivity for the diagnosis of Candida when compared with the diagnosis by Pap staining. T2DM subjects showed an increased presence of C. guilliermondii that was correlated with decreased TLR2 expression. Full article