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Ma L, Gao X, Geng L, You K, Wu Z, Li Y, Han Q, Wang Y, Guo H. Efficacy and safety of photodynamic therapy mediated by 5-aminolevulinic acid for the treatment of cervical intraepithelial neoplasia 2: A single-center, prospective, cohort study. Photodiagnosis Photodyn Ther 2021; 36:102472. [PMID: 34348187 DOI: 10.1016/j.pdpdt.2021.102472] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 07/22/2021] [Accepted: 07/30/2021] [Indexed: 01/10/2023]
Abstract
BACKGROUND Photodynamic therapy (PDT) mediated by 5-aminolevulinic acid (5-ALA) is a minimally-invasive treatment for cervical intraepithelial neoplasia (CIN). The present study was carried out to investigate the effect of 5-ALA-PDT on CIN2 and the factors influencing outcome of 5-ALA-PDT. METHODS Patients diagnosed as CIN2 who met the inclusion criteria were enrolled in this study sequentially from January 2019 to April 2020. Patients were treated by PDT or cryotherapy according to their intentions. The primary endpoint was pathological regression. The secondary endpoint was HPV clearance. Affecting factors of the efficacy of PDT and adverse events were also assessed during treatment. RESULTS A total of 210 patients were enrolled, including 97 patients in PDT group and 101 patients in cryotherapy group, with 12 patients excluded. There was no statistical difference in population characteristics. The pathological regression rate in PDT group was 92.0% (80/87), compared with 81.4% (79/97) in cryotherapy group (P < 0.05). The HPV clearance rate was 64.4% (56/87) in PDT group and 57.8% (56/97) in cryotherapy group (P = 0.36). The main side effects of PDT were abdominal pain (24.1%, 21/87) and increased vaginal secretions (23.0%, 20/87). On univariate analysis, the risk for lesions persisting at 6 months after PDT was increased by recurrent genital tract inflammation (P = 0.004), smoking or passive smoking (P = 0.020), and multicentric lesions (P = 0.020). CONCLUSION PDT can be a safe and efficient treatment for CIN2. Risk factors for persisting HSIL after PDT include recurrent genital tract inflammation, smoking or passive smoking, and multicentric lesions.
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Affiliation(s)
- Lingyu Ma
- Department of Obstetrics and Gynecology, Peking University Third Hospital, 100191, 49 North Garden Rd., Haidian District, Beijing, China
| | - Xinran Gao
- Department of Obstetrics and Gynecology, Peking University Third Hospital, 100191, 49 North Garden Rd., Haidian District, Beijing, China
| | - Li Geng
- Department of Obstetrics and Gynecology, Peking University Third Hospital, 100191, 49 North Garden Rd., Haidian District, Beijing, China
| | - Ke You
- Department of Obstetrics and Gynecology, Peking University Third Hospital, 100191, 49 North Garden Rd., Haidian District, Beijing, China
| | - Zhangxin Wu
- Department of Obstetrics and Gynecology, Peking University Third Hospital, 100191, 49 North Garden Rd., Haidian District, Beijing, China
| | - Yuan Li
- Department of Obstetrics and Gynecology, Peking University Third Hospital, 100191, 49 North Garden Rd., Haidian District, Beijing, China
| | - Qin Han
- Department of Obstetrics and Gynecology, Peking University Third Hospital, 100191, 49 North Garden Rd., Haidian District, Beijing, China
| | - Yanjie Wang
- Department of Obstetrics and Gynecology, Peking University Third Hospital, 100191, 49 North Garden Rd., Haidian District, Beijing, China.
| | - Hongyan Guo
- Department of Obstetrics and Gynecology, Peking University Third Hospital, 100191, 49 North Garden Rd., Haidian District, Beijing, China.
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Liu Y, Alqatari M, Sultan K, Ye F, Gao D, Sigel K, Zhang D, Kalir T. Using p16 immunohistochemistry to classify morphologic cervical intraepithelial neoplasia 2: correlation of ambiguous staining patterns with HPV subtypes and clinical outcome. Hum Pathol 2017; 66:144-151. [PMID: 28705710 DOI: 10.1016/j.humpath.2017.06.014] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Revised: 06/18/2017] [Accepted: 06/30/2017] [Indexed: 01/10/2023]
Abstract
p16INK4a immunohistochemistry (IHC) is widely used to facilitate the diagnosis of human papillomavirus (HPV)-associated cervical precancerous lesions. Although most p16 results are distinctly positive or negative, certain ones are ambiguous: they meet some but not all requirements for the "block-positive" pattern. It is unclear whether ambiguous p16 immunoreactivity indicates oncogenic HPV infection or risk of progression. Herein, we compared HPV genotypes and subsequent high-grade squamous intraepithelial lesion (HSIL) outcomes among 220 cervical biopsies with a differential diagnosis of cervical intraepithelial neoplasia 2 based on hematoxylin and eosin morphology and varying degrees of p16 immunoreactivity. p16 results were classified as block positive (n=40, 18%), negative (n=130, 59%), or ambiguous (n=50, 23%), a category we further grouped into 3 patterns: strong/basal (n=18), strong/focal (n=15), and weak/diffuse (n=17). Seventy percent of ambiguous p16 lesions were negative for the most common low- and high-risk HPV types; the remaining 30% were positive for HPV 16, 18, 45, 58, 59, or 66. Three patterns revealed comparably low HPV detection rates (28%, 27%, and 35%). During 12-month surveillance, HSILs were detected in 35% of the p16 block-positive group, 1.5% of negative group, and 16% of the ambiguous group. The accuracy of ambiguous p16 immunoreactivity in predicting oncogenic HPV and HSIL outcome is significantly lower than that of the block-positive pattern but greater than negative staining. Specific guidelines for this intermediate category should prevent diagnostic errors and help implement p16 IHC in general practice.
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Affiliation(s)
- Yuxin Liu
- Division of Gynecologic Pathology, Department of Pathology, Icahn School of Medicine at Mount Sinai, Mount Sinai Health System, New York, NY 10029.
| | - Mahfood Alqatari
- Department of Pathology, Icahn School of Medicine at Mount Sinai, Mount Sinai Health System, New York, NY 10029
| | - Kieran Sultan
- Division of Gynecologic Pathology, Department of Pathology, Icahn School of Medicine at Mount Sinai, Mount Sinai Health System, New York, NY 10029
| | - Fei Ye
- Division of Molecular Pathology, Icahn School of Medicine at Mount Sinai, Mount Sinai Health System, New York, NY 10029
| | - Dana Gao
- Division of Molecular Pathology, Icahn School of Medicine at Mount Sinai, Mount Sinai Health System, New York, NY 10029
| | - Keith Sigel
- Division of General Internal Medicine, Department of Medicine, Icahn School of Medicine at Mount Sinai, Mount Sinai Health System, New York, NY 10029
| | - David Zhang
- Division of Molecular Pathology, Icahn School of Medicine at Mount Sinai, Mount Sinai Health System, New York, NY 10029
| | - Tamara Kalir
- Division of Gynecologic Pathology, Department of Pathology, Icahn School of Medicine at Mount Sinai, Mount Sinai Health System, New York, NY 10029
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Koeneman MM, van Lint FHM, van Kuijk SMJ, Smits LJM, Kooreman LFS, Kruitwagen RFPM, Kruse AJ. A prediction model for spontaneous regression of cervical intraepithelial neoplasia grade 2, based on simple clinical parameters. Hum Pathol 2016; 59:62-69. [PMID: 27697590 DOI: 10.1016/j.humpath.2016.09.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Revised: 08/30/2016] [Accepted: 09/09/2016] [Indexed: 12/12/2022]
Abstract
This study aims to develop a prediction model for spontaneous regression of cervical intraepithelial neoplasia grade 2 (CIN 2) lesions based on simple clinicopathological parameters. The study was conducted at Maastricht University Medical Center, the Netherlands. The prediction model was developed in a retrospective cohort of 129 women with a histologic diagnosis of CIN 2 who were managed by watchful waiting for 6 to 24months. Five potential predictors for spontaneous regression were selected based on the literature and expert opinion and were analyzed in a multivariable logistic regression model, followed by backward stepwise deletion based on the Wald test. The prediction model was internally validated by the bootstrapping method. Discriminative capacity and accuracy were tested by assessing the area under the receiver operating characteristic curve (AUC) and a calibration plot. Disease regression within 24months was seen in 91 (71%) of 129 patients. A prediction model was developed including the following variables: smoking, Papanicolaou test outcome before the CIN 2 diagnosis, concomitant CIN 1 diagnosis in the same biopsy, and more than 1 biopsy containing CIN 2. Not smoking, Papanicolaou class <3, concomitant CIN 1, and no more than 1 biopsy containing CIN 2 were predictive of disease regression. The AUC was 69.2% (95% confidence interval, 58.5%-79.9%), indicating a moderate discriminative ability of the model. The calibration plot indicated good calibration of the predicted probabilities. This prediction model for spontaneous regression of CIN 2 may aid physicians in the personalized management of these lesions.
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Affiliation(s)
- Margot M Koeneman
- Department of Obstetrics and Gynecology, Maastricht University Medical Center, 6202 AZ, Maastricht, the Netherlands; GROW-School for Oncology and Developmental Biology, Maastricht University, 6200 MD, Maastricht, the Netherlands.
| | - Freyja H M van Lint
- Department of Obstetrics and Gynecology, Maastricht University Medical Center, 6202 AZ, Maastricht, the Netherlands; GROW-School for Oncology and Developmental Biology, Maastricht University, 6200 MD, Maastricht, the Netherlands
| | - Sander M J van Kuijk
- Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Center, 6202 AZ, Maastricht, the Netherlands
| | - Luc J M Smits
- Department of Epidemiology, Maastricht University, 6200 MD, Maastricht, the Netherlands
| | - Loes F S Kooreman
- Department of Pathology, Maastricht University Medical Center, 6202 AZ, Maastricht, the Netherlands
| | - Roy F P M Kruitwagen
- Department of Obstetrics and Gynecology, Maastricht University Medical Center, 6202 AZ, Maastricht, the Netherlands; GROW-School for Oncology and Developmental Biology, Maastricht University, 6200 MD, Maastricht, the Netherlands
| | - Arnold J Kruse
- Department of Obstetrics and Gynecology, Maastricht University Medical Center, 6202 AZ, Maastricht, the Netherlands; GROW-School for Oncology and Developmental Biology, Maastricht University, 6200 MD, Maastricht, the Netherlands
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Schulte-Uebbing C, Schlett S, Craiut I, Antal L, Olah H. Chronical cervical infections and dysplasia (CIN I, CIN II): Vaginal vitamin D (high dose) treatment: A new effective method? Dermatoendocrinol 2014; 6:e27791. [PMID: 24605180 PMCID: PMC3940490 DOI: 10.4161/derm.27791] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/02/2013] [Accepted: 01/09/2014] [Indexed: 12/31/2022]
Abstract
In a small praxis/ambulance study we evaluated data of 200 women with chronical recurrent cervical infections and with a cervix dysplasia (CIN 1, CIN 2). who got after the primary therapy a treatment with vitamin D vaginal suppositories (12.500 IU, 3 nights a week, for 6 weeks). We found that - when compared with the lactobacillus vaginal suppositories - the high dose vitamin D vaginal treatment might be more effective. Vitamin D showed very good anti-inflammatory effects. In the survey after six weeks therapy 79% of the women had “less vaginal problems,” “less discharge” and “less problems with the sexual intercourse.” Objectively after six weeks therapy only 7% of the patients still had bacterial and/or fungal vaginal infections that required a treatment. We found that vitamin D is reabsorbed by the vaginal mucosa, but the reabsorption may be individually very different. In the CIN 1 group we found six weeks after treatment good antidysplastic effects, in the CIN 2 group we often found no or only temporary antidysplastic effects. So this vaginal vitamin D treatment method might be an option for the therapy and prevention of chronical cervical infections and maybe of a cervic dysplasia CIN 1 (good antiinflammatory effects, antidysplastic effects). This small study is not representative. We need much bigger studies with much more dates and with a longer follow up. Caution: At the moment we do not know, if the vaginal vitamin D treatment with 12500 IE is possible in pregnancy. We have no experience. Therefore we recommend an effective contraception during the application.
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Affiliation(s)
- C Schulte-Uebbing
- International Vitamin D Congress; University Charité; Berlin, Germany
| | - S Schlett
- International Vitamin D Congress; University Charité; Berlin, Germany
| | - Id Craiut
- International Vitamin D Congress; University Charité; Berlin, Germany
| | - L Antal
- International Vitamin D Congress; University Charité; Berlin, Germany
| | - H Olah
- International Vitamin D Congress; University Charité; Berlin, Germany
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