• 【宫颈上皮修复: 形态学特征的评估以及与细胞学诊断的相关性。】 复制标题 收藏 收藏
    DOI:10.1097/00004347-199610000-00006 复制DOI
    作者列表:Yelverton CL,Bentley RC,Olenick S,Krigman HR,Johnston WW,Robboy SJ
    BACKGROUND & AIMS: This study evaluates the morphologic features of squamous epithelial repair of the uterine cervix, a condition describing a state of regeneration, and compares them with the features of its two histologic mimics, squamous metaplasia and mild dysplasia. The materials examined were from 20 patients with a histologic diagnosis of repair, 42 with cervical biopsy specimens of acceptable quality obtained within 3 weeks of a cervical smear showing repair, and 20 each with squamous metaplasia or mild dysplasia. Specimens with repair disclosed distinctive morphologic characteristics. On low-power magnification, the stroma was chronically inflamed (100%), often floridly (55%). The nuclei were uniform with absent or minimal pleomorphism (90%). The chromatin was bland and evenly distributed (70%). Nucleoli of a bull's eye or macronucleolar appearance (45%) were easily found. Mildly dysplastic epithelium, unlike reparative epithelium, was infrequently associated with an intensely inflamed stroma (20%); its nuclei were pleomorphic (100%) and commonly displayed coarse chromatin (75%) and mitoses (60%). Metaplastic epithelium ws also infrequently associated with an intensely inflamed stroma (10%). Nuclear pleomorphism (10%) and mitotic figures were infrequent (10%), never atypical (0%), and always basally located. Most nuclei had nucleoli, but the majority were small (80%). This study indicates that most cases of repair, mild dysplasia, and metaplasia can be readily distinguished, although due to overlapping features, some cases are difficult to classify as shown by interobserver variability.

    背景与目标: 这项研究评估了子宫颈鳞状上皮修复的形态学特征,这是一种描述再生状态的状况,并将其与两种组织学模拟物 (鳞状化生和轻度不典型增生) 的特征进行了比较。检查的材料来自20例组织学诊断为修复的患者,42例在宫颈涂片显示修复后3周内获得质量可接受的宫颈活检标本,以及20例鳞状上皮化生或轻度不典型增生。修复标本显示出独特的形态学特征。在低倍率放大时,基质长期发炎 (100%),通常是花哨的 (55%)。核是均匀的,不存在或极小的多形性 (90%)。染色质平淡且均匀分布 (70%)。很容易发现牛眼的核仁或大核仁外观 (45%)。与修复性上皮不同,轻度发育不良的上皮很少与强烈发炎的基质相关 (20%); 它的核是多形的 (100%),通常显示粗染色质 (75%) 和有丝分裂 (60%)。化生上皮也很少与强烈发炎的基质相关 (10%)。核多形性 (10%) 和有丝分裂图很少 (10%),从不非典型 (0%),并且始终位于基部。大多数核具有核仁,但大多数是小的 (80%)。这项研究表明,大多数修复,轻度不典型增生和化生的情况都可以很容易地区分,尽管由于重叠的特征,某些情况很难像观察者间变异性所显示的那样进行分类。
  • 【宫颈浸润性分层粘液癌 (iSMC) 通常具有高危特征,是不良预后的决定因素: 一项国际多中心研究。】 复制标题 收藏 收藏
    DOI:10.1097/PAS.0000000000001485 复制DOI
    作者列表:Stolnicu S,Boros M,Segura S,Horn LC,Parra-Herran C,Oliva E,Abu-Rustum N,Soslow RA,Park KJ
    BACKGROUND & AIMS: :Invasive stratified mucinous carcinoma (iSMC) has been suggested to represent an aggressive subtype of endocervical adenocarcinoma. We sought to investigate the outcomes of iSMC and determine which clinical and pathologic parameters may influence the prognosis. Slides from 52 cases of iSMC were collected and classified as follows: pure iSMC (>90% of the entire tumor) and iSMC mixed with other human papillomavirus-associated adenocarcinoma components (miSMC) (>10%, but <90% of the entire tumor). Clinical and pathologic parameters were evaluated and compared with overall survival (OS) and recurrence-free survival (RFS). One third of patients with iSMC presented with lymph node metastases (LNM) and 25% developed local recurrences, whereas 4 (7.7%) developed distant recurrences. 29 cases (55.8%) were pure iSMC, whereas 23 cases (44.23%) were miSMC. OS was 74.7% in pure iSMC versus 85.2% in miSMC (P=0.287). RFS was 56.5% in pure iSMC and 72.9% in miSMC (P=0.185). At 5 years, OS in stage I was 88.9% versus stage II to IV 30% (P=0.004), whereas RFS in stage I was 73.9% versus stage II to IV 38.1% (P=0.02). OS was influenced by International Federation of Gynecology and Obstetrics (FIGO) stage (P=0.013), tumor size (P=0.02), LNM (P=0.015), and local recurrence (P=0.022), whereas RFS was influenced by FIGO stage (P=0.031), tumor size (P=0.001), local recurrence (P=0.009), LNM (P=0.008), and type of surgical treatment (P=0.044). iSMC is an aggressive cervical tumor biologically different from other human papillomavirus-associated adenocarcinomas due to the propensity for LNM, local/distant recurrence. FIGO stage, tumor size, LNM, and presence of local/pelvic recurrences are determinants of outcome in iSMCs.
    背景与目标: : 浸润性分层粘液癌 (iSMC) 已被认为是一种侵袭性子宫颈癌。我们试图调查iSMC的结果,并确定哪些临床和病理参数可能影响预后。收集了52例iSMC的载玻片并将其分类如下: 纯iSMC (> 整个肿瘤的90%) 和与其他人乳头瘤病毒相关的腺癌成分 (miSMC) 混合的iSMC (>10%,但 <整个肿瘤的90%)。评估临床和病理参数,并与总生存期 (OS) 和无复发生存期 (RFS) 进行比较。三分之一的iSMC患者出现淋巴结转移 (LNM),25% 出现局部复发,而4 (7.7%) 出现远处复发。29例 (55.8%) 为纯iSMC,23例 (44.23%) 为miSMC。OS在纯iSMC中74.7%,而在miSMC中85.2% (P = 0.287)。RFS在纯iSMC中56.5%,在miSMC中72.9% (P = 0.185)。在5年时,阶段I的OS与阶段II至IV 30% 88.9% (P = 0.004),而阶段I的RFS与阶段II至IV 38.1% 73.9% (P = 0.02)。OS受国际妇产科联合会 (FIGO) 分期 (P = 0.013),肿瘤大小 (P = 0.02),LNM (P = 0.015) 和局部复发 (P = 0.022) 的影响,而RFS受FIGO分期 (P = 0.031) 的影响,肿瘤大小 (P = 0.001),局部复发 (P = 0.009),LNM (P = 0.008) 和手术治疗类型 (P = 0.044)。由于LNM,局部/远处复发的倾向,iSMC是一种侵袭性宫颈肿瘤,在生物学上与其他人乳头瘤病毒相关的腺癌不同。FIGO分期,肿瘤大小,LNM和局部/盆腔复发是ismc预后的决定因素。
  • 【cyclooxygenase-2抑制剂塞来昔布在宫颈癌患者中的前瞻性i-ii期试验,并对肿瘤微环境进行生物标志物评估。】 复制标题 收藏 收藏
    DOI:10.1016/j.ijrobp.2006.08.024 复制DOI
    作者列表:Herrera FG,Chan P,Doll C,Milosevic M,Oza A,Syed A,Pintilie M,Levin W,Manchul L,Fyles A
    BACKGROUND & AIMS: PURPOSE:To evaluate the toxicity and effectiveness of celecoxib in combination with definitive chemoradiotherapy (CRT) in women with locally advanced cervical cancer. METHODS AND MATERIALS:Thirty-one patients were accrued to a phase I-II trial of celecoxib 400 mg by mouth twice per day for 2 weeks before and during CRT. Tumor oxygenation (HP(5)) and interstitial fluid pressure (IFP) were measured before and 2 weeks after celecoxib administration alone. The median follow-up time was 2.7 years (range, 1.1-4.4 years). RESULTS:The most common acute G3/4 toxicities were hematologic (4/31, 12.9%) and gastrointestinal (5/31, 16.1%) largely attributed to chemotherapy. Late G3/4 toxicity was seen in 4 of 31 patients (13.7% actuarial risk at 2 yr), including fistulas in 3 patients (9.7%). Within the first year of follow-up, 25 of 31 patients (81%) achieved complete response (CR), of whom 20 remained in CR at last follow-up. After 2 weeks of celecoxib administration before CRT, the median IFP decreased slightly (median absolute, -4.6 mm Hg; p = 0.09; relative, -21%; p = 0.07), whereas HP(5) did not change significantly (absolute increase, 3.6%; p = 0.51; median relative increase, 11%; p = 0.27). No significant associations were seen between changes in HP(5) or IFP and response to treatment (p = 0.2, relative HP(5) change and p = 0.14, relative IFP change). CONCLUSIONS:Celecoxib in combination with definitive CRT is associated with acceptable acute toxicity, but higher than expected late complications. Celecoxib is associated with a modest reduction in the angiogenic biomarker IFP, but this does not correspond with tumor response.
    背景与目标:
  • 【HIV-1-infected妇女子宫颈的T淋巴细胞分布以及总免疫球蛋白和病毒特异性免疫球蛋白浓度。】 复制标题 收藏 收藏
    DOI:10.1097/QAI.0b013e31802c5b3a 复制DOI
    作者列表:Quayle AJ,Kourtis AP,Cu-Uvin S,Politch JA,Yang H,Bowman FP,Shah M,Anderson DJ,Crowley-Nowick P,Duerr A
    BACKGROUND & AIMS: BACKGROUND:The mucosal lymphocyte population is the largest in the body, and the gastrointestinal compartment has been well characterized in HIV infection. Much less is known about the effects of HIV on the genital tract. OBJECTIVE:: To examine the T-lymphocyte phenotype and receptor repertoire as well as total and virus-specific immunoglobulin concentrations in the endocervix of HIV-infected women at different stages of infection as compared with uninfected women. PATIENTS AND METHODS:Participants were 12 seronegative women, 10 HIV-infected "slow progressors" not taking antiretroviral therapy, and 9 HIV-infected women whose antiretroviral therapy was failing. We used multiparameter flow cytometry to enumerate T-cell populations on cytobrush-obtained cervical specimens, the immunoscope technique to determine the T-cell receptor (TCR) repertoire, and quantitative enzyme-linked immunosorbent assays for antibody determinations on cervical secretions absorbed onto ophthalmic sponges. Nonparametric statistical analyses were performed. RESULTS:We found marked depletion of leukocytes and CD4 T lymphocytes in the endocervix of HIV-infected women as compared with uninfected women; this was significant at more advanced disease stages. Naive T cells were rare in the endocervix of all groups. Activation marker expression was higher in endocervical T lymphocytes than in peripheral blood among control and slow-progressing HIV-infected women but not in women failing therapy. Endocervical T lymphocytes showed highly restricted utilization of Vbeta TCR families. Unlike other mucosal sites, the cervix contained IgG as the predominant immunoglobulin isotype. HIV-IgG was detected in the cervix of most HIV-infected women and in blood of all infected women. CONCLUSIONS:HIV infection induces substantial changes in the immune profile of the female genital tract. Further study of the implications of these findings for HIV acquisition and transmission is needed.
    背景与目标:
  • 【宫颈癌早期浸润性癌的根治性子宫切除术和盆腔淋巴结切除术-14年经验。】 复制标题 收藏 收藏
    DOI:10.1046/j.1525-1438.1993.03040231.x 复制DOI
    作者列表:Sivanesaratnam V,Sen DK,Jayalakshmi P,Ong G
    BACKGROUND & AIMS: :During a 14-year period, 397 radical hysterectomies and pelvic lymphadenectomies were performed for early invasive carcinoma of the cervix. Twenty-one patients were in stage IA2 with lymphatic/vascular channel permeation (5.2%), 340 in stage IB (85.6%) and 34 in early stage 2A disease (8.5%). Eighteen patients (4.5%) were pregnant. Adenocarcinoma comprised 26.9% of cases. The mean operative time was 4.14 h; the intraoperative blood loss was less than 1.51 in 77.3% patients. There was no operative mortality; one patient died 3 weeks after surgery from clostridium difficile enterocilitis. Eleven patients (2.7%) developed venous thrombosis; severe lymphedema occurred in four (1%). The incidence of uretero-vaginal fistula was 0.2% and that of vesico-vaginal fistula 0.5%. Ovarian metastases were noted in 4.3% of cases with adenocarcinoma. Sixty-six patients had positive nodes (16.6%). Five-year survival in patients with more than 2 positive nodes was 68%. The use of adjuvant chemotherapy in patients with 'high risk' factors resulted in survival rates approaching those without risk factors. Neo-adjuvant chemotherapy was used in 10 patients with large bulky tumors; the results were favorable. Recurrences occurred in 47 patients (11.8%); 36 patients have died (9.1%). Age did not appear to influence survival. The overall 5-year survival was 92.2%.
    背景与目标: : 在14年的时间里,对宫颈早期浸润性癌进行了397次根治性子宫切除术和盆腔淋巴结切除术。21例患者处于IA2期,淋巴/血管通道渗透 (5.2%),340例处于IB期 (85.6%),34例处于2A期早期 (8.5%)。18例患者 (4.5%) 怀孕。腺癌包括26.9% 例。平均手术时间为4.14 h; 77.3% 例患者术中出血量少于1.51。没有手术死亡; 一名患者在手术后3周死于艰难梭菌肠系炎。11例患者 (2.7%) 出现静脉血栓形成; 4例 (1% 例) 发生严重淋巴水肿。输尿管-阴道瘘的发生率0.2%,膀胱阴道瘘的发生率0.5%。在4.3% 腺癌病例中发现卵巢转移。66例患者淋巴结阳性 (16.6%)。超过2个阳性淋巴结的患者的5年生存率为68%。在具有 “高风险” 因素的患者中使用辅助化疗会导致生存率接近没有危险因素的患者。10例大体积肿瘤患者使用了新辅助化疗; 结果是有利的。47例患者 (11.8% 例) 复发; 36例患者死亡 (9.1% 例)。年龄似乎没有影响生存率。总体5年生存率为92.2%。
  • 【一项I/II期研究,将根治性放疗与同期顺铂相结合,用于治疗晚期子宫颈鳞状细胞癌。】 复制标题 收藏 收藏
    DOI:10.1046/j.1525-1438.1992.02040215.x 复制DOI
    作者列表:Pearcey RG,MacLean GD
    BACKGROUND & AIMS: :Sixteen patients with advanced cervix cancer have been treated in a phase I/II study of concurrent radiotherapy and cisplatin chemotherapy. The external beam radiotherapy was given as a 'split course' because of initial concerns about acute toxicity. The treatment was well tolerated with all patients completing the prescribed radiotherapy and all patients received the intended four doses of cisplatin. One of 5 patients with stage IVB disease is alive and disease free 35 months after treatment. Six of the 11 patients with disease confined to the pelvis are alive and disease free between 28 and 53 months after treatment. One patient has required surgery for a recto-sigmoid stricture.
    背景与目标: : 在同步放疗和顺铂化疗的I/II期研究中,已对16例晚期宫颈癌患者进行了治疗。由于最初对急性毒性的担忧,将外部束放射治疗作为 “分裂过程”。所有患者均完成了规定的放射治疗,并且所有患者均接受了预期的四剂顺铂,治疗耐受性良好。5例IVB期患者中有1例在治疗后35个月存活且无病。11名局限于骨盆的患者中有6名在治疗后28至53个月内存活且无疾病。一名患者因直肠乙状结肠狭窄需要手术治疗。
  • 【使用体内压缩的应变弹性成像在怀孕期间评估子宫颈中的可靠性。】 复制标题 收藏 收藏
    DOI:10.1515/jpm-2019-0370 复制DOI
    作者列表:Kwak DW,Kim M,Oh SY,Park HS,Kim SJ,Kim MY,Hwang HS
    BACKGROUND & AIMS: :Objective To determine the reproducibility of the mean strain value in various cervical areas and new elastographic parameters for measuring cervical stiffness evaluated by strain elastography using in vivo compression generated by internal organ movement. Methods A prospective observational study (140 singleton pregnant women; 15-33 weeks of gestation) was performed at two tertiary centers. Cervical strain was evaluated using E-cervix™ elastography. The mean strain levels of various cervical areas [internal os (IOS), external os (EOS) and endocervical area] and several new parameters [i.e. the ratio of the strain level of IOS and EOS, elasticity contrast index (ECI), and hardness ratio] were assessed twice by two independent examiners. The inter-observer and intra-observer variances were calculated using the intraclass correlation coefficient (ICC) with a 95% confidence interval (CI). Bland-Altman (B-A) analysis was also performed. Results The median gestational age was 24.0 weeks, and the mean cervical length (CL) was 3.8 cm. The intra-observer and inter-observer ICCs of the mean strain levels of the specified cervical area and new elastographic parameters were statistically significant (P < 0.001, all); the intra-observer ICC was 0.639-0.725, and the inter-observer ICC was 0.538-0.718. Conclusion The reproducibility of elastographic parameter measurements using in vivo compression is improvable.
    背景与目标: : 目的确定各种颈椎区域的平均应变值的可重复性,以及通过使用内部器官运动产生的体内压缩通过应变弹性成像评估的用于测量颈椎刚度的新的弹性成像参数。方法在两个三级中心进行前瞻性观察性研究 (140名单胎孕妇; 妊娠15-33周)。使用电子子宫颈评估宫颈劳损™弹性成像。各种宫颈区域 [内部os (IOS),外部os (EOS) 和宫颈内膜区域] 的平均应变水平以及几个新参数 [即IOS和EOS的应变水平之比,弹性对比指数 (ECI),和硬度比] 由两名独立检查员评估两次。使用具有95% 置信区间 (CI) 的组内相关系数 (ICC) 计算观察者间和观察者内方差。还进行了Bland-Altman (b-a) 分析。结果中位胎龄为24.0周,平均宫颈长度 (CL) 为3.8厘米。指定颈部区域的平均应变水平和新的弹性成像参数的观察者内和观察者间ICCs具有统计学意义 (p  <  0.001,all); 观察者间ICC为0.639-0.725,观察者间ICC为0.538-0.718。结论使用体内压缩进行弹性成像参数测量的可重复性是可以改善的。
  • 【子宫颈腺癌。治疗前血清CA 125,鳞状细胞癌抗原和癌胚抗原水平与临床和组织病理学肿瘤特征的关系的预后意义。】 复制标题 收藏 收藏
    DOI:10.1002/1097-0142(19900415)65:8<1830::aid-cncr2820 复制DOI
    作者列表:Duk JM,De Bruijn HW,Groenier KH,Fleuren GJ,Aalders JG
    BACKGROUND & AIMS: :The prognostic value of the pretreatment serum CA 125, squamous cell carcinoma antigen (SCC), and carcinoembryonic antigen (CEA) levels in relation to tumor type, vascular invasion by tumor cells, and lymph node metastases was investigated in 77 patients with cervical adenocarcinoma. In Stage IB (International Federation of Gynecology and Obstetrics [FIGO]), the five-year actuarial survival of patients with pretreatment serum CA 125 levels greater than 16 U/ml was 52.4% versus 95.6% when normal serum CA 125 levels were determined (P less than 0.01). Pretreatment serum SCC or CEA levels had no substantial prognostic value. In Stage IB (FIGO), 42% of the patients with elevated serum CA 125 levels had lymph node metastases versus 4% when normal levels were found (P = 0.012). The presence of vascular invasion (P = 0.01) or lymph node metastases (P = 0.001) was associated with an increased risk for recurrent disease. Adenosquamous tumors showed a higher incidence of vascular invasion (P = 0.05) and a higher incidence of elevated serum CA 125 levels (P = 0.03). Particularly in Stage II, adenosquamous tumors were found to have a poorer prognosis than adenocarcinomas (P = 0.0566). We conclude that in cervical adenocarcinoma serum CA 125 is an important prognostic factor and an implicit indicator of tumor virulence.
    背景与目标: : 研究了77例宫颈腺癌患者的治疗前血清CA 125,鳞状细胞癌抗原 (SCC) 和癌胚抗原 (CEA) 水平与肿瘤类型,肿瘤细胞的血管浸润和淋巴结转移的关系的预后价值。在IB期 (国际妇产科联合会 [FIGO]) 中,在测定正常血清CA 125水平时,治疗前血清CA 125水平大于16 u/ml的患者的五年精算生存期为52.4%,而95.6% 为 (P小于0.01)。治疗前血清SCC或CEA水平没有实质性的预后价值。在IB期 (FIGO) 中,42% 血清CA 125水平升高的患者有淋巴结转移,而发现正常水平时则有4% (P = 0.012)。血管侵犯 (P = 0.01) 或淋巴结转移 (P = 0.001) 与复发风险增加相关。腺鳞癌的血管侵犯发生率较高 (P = 0.05),血清CA 125水平升高的发生率较高 (P = 0.03)。特别是在II期,发现腺鳞癌的预后比腺癌差 (P = 0.0566)。我们得出结论,在宫颈腺癌中,血清CA 125是重要的预后因素,也是肿瘤毒力的隐性指标。
  • 【子宫颈小细胞癌: 188患者的治疗和生存结果。】 复制标题 收藏 收藏
    DOI:10.1016/j.ajog.2010.04.019 复制DOI
    作者列表:Cohen JG,Kapp DS,Shin JY,Urban R,Sherman AE,Chen LM,Osann K,Chan JK
    BACKGROUND & AIMS: OBJECTIVE:To determine the clinicopathologic factors associated with survival in neuroendocrine small cell cervical cancer patients. STUDY DESIGN:Patients were identified from a review of literature with an additional 52 patients from four hospitals. Kaplan-Meier and Cox regression methods were used for analyses. RESULTS:Of 188 patients, 135 had stages I-IIA, 45 stages IIB-IVA, and 8 stage IVB disease. A total of 55.3% underwent surgery, 16.0% had chemoradiation, 12.8% radiation, and 3.2% chemotherapy alone. The 5-year disease-specific survival in stage I-IIA, IIB-IVA, and IVB disease was 36.8%, 9.8%, and 0%, respectively (P < .001). Adjuvant chemotherapy or chemoradiation was associated with improved survival in patients with stages IIB-IVA disease compared with those who did not receive chemotherapy (17.8% vs 6.0%; P = .04). On multivariable analysis, early-stage disease and use of chemotherapy or chemoradiation were independent prognostic factors for improved survival. CONCLUSION:Use of adjuvant chemotherapy or chemoradiation was associated with higher survival in small cell cervical cancer patients.
    背景与目标:
  • 【妊娠子宫颈的超声衰减估计: 初步报告。】 复制标题 收藏 收藏
    DOI:10.1002/uog.7643 复制DOI
    作者列表:McFarlin BL,Bigelow TA,Laybed Y,O'Brien WD,Oelze ML,Abramowicz JS
    BACKGROUND & AIMS: OBJECTIVE:Estimates of ultrasonic attenuation (the loss of energy as an ultrasonic wave propagates through tissue) have been used to evaluate the structure and function of tissues in health and disease. The purpose of this research was to develop a method to estimate ultrasonic cervical attenuation during human pregnancy using a clinical ultrasound system. METHODS:Forty women underwent a cervical scan once during pregnancy with the Zonare z.one clinical ultrasound system using a 4-9-MHz endovaginal transducer. This ultrasound system provides access to radiofrequency (RF) image data for processing and analysis. In addition, a scan of a tissue-mimicking phantom with a known attenuation coefficient was acquired and used as a reference. The same settings and transducer used in the clinical scan were used in the reference scan. Digital data of the beam-formed image were saved in Digital Imaging and Communications in Medicine (DICOM) format on a flash drive and converted to RF data on a personal computer using a Matlab program supplied by Zonare. Attenuation estimates were obtained using an algorithm that was independently validated using tissue-mimicking ultrasonic phantoms. RESULTS:RF data were acquired and analyzed to estimate attenuation of the human pregnant cervix. Regression analysis revealed that attenuation was: a predictor of the interval from ultrasound examination to delivery (beta = 0.43, P = 0.01); not a predictor of gestational age at time of examination (beta = - 0.23, P = 0.15); and not a predictor of cervical length (beta = 0.077, P = 0.65). CONCLUSIONS:Ultrasonic attenuation estimates have the potential to be an early and objective non-invasive method to detect interval between examination and delivery. We hypothesize that a larger sample size and a longitudinal study design will be needed to detect gestational age-associated changes in cervical attenuation.
    背景与目标:
  • 【宫颈腺癌和鳞状细胞癌妇女口服避孕药的比较。】 复制标题 收藏 收藏
    DOI:10.1159/000293004 复制DOI
    作者列表:Honoré LH,Koch M,Brown LB
    BACKGROUND & AIMS: :The possible link between oral contraceptives (OCs) and cervical adenocarcinoma was tested by a case-case study of prior and current OC use in women with adenocarcinoma and squamous cell carcinoma. Cases were matched by age, year of diagnosis, and stage of the lesion, and personal, reproductive, and contraceptive data were obtained by mailed questionnaires. Except for smoking, which was significantly more prevalent in women with squamous cell carcinoma, the two groups were identical, with similar OC exposure. This study does not support the idea that OCs modulate the expression of cervical neoplasia in favor of adenocarcinoma.
    背景与目标: : 通过对患有腺癌和鳞状细胞癌的女性先前和当前使用OC的案例研究,测试了口服避孕药 (OCs) 与宫颈腺癌之间的可能联系。病例按年龄,诊断年份和病变阶段进行匹配,并通过邮寄问卷获得个人,生殖和避孕数据。除了吸烟 (在鳞状细胞癌女性中明显更普遍) 外,两组相同,OC暴露相似。这项研究不支持OCs调节宫颈肿瘤的表达而有利于腺癌的观点。
  • 【在没有子宫颈的妇女中进行宫颈癌筛查。】 复制标题 收藏 收藏
    影响因子 :
    发表时间:2004-06-23
    来源期刊:JAMA
    DOI:10.1001/jama.291.24.2990 复制DOI
    作者列表:Sirovich BE,Welch HG
    BACKGROUND & AIMS: CONTEXT:Most US women who have undergone hysterectomy are not at risk of cervical cancer-they underwent the procedure for benign disease and they no longer have a cervix. In 1996, the US Preventive Services Task Force recommended that routine Papanicolaou (Pap) smear screening is unnecessary for these women. OBJECTIVE:To determine whether Pap smear screening among women who have undergone hysterectomy has decreased following the recommendation. DESIGN:We used data from the Behavioral Risk Factor Surveillance System (1992-2002), an annual, population-based telephone survey of US adults conducted by the Centers for Disease Control and Prevention. Data about timing, type, and indication for hysterectomies were obtained from the Nationwide Inpatient Sample and other sources. STUDY PARTICIPANTS:In each year of the survey, a representative sample of US women 18 years and older who had undergone hysterectomy (combined n = 188,390) was studied. MAIN OUTCOME MEASURE:The main outcome was the proportion of women with a history of hysterectomy who reported a current Pap smear (within 3 years). Overall proportions are age adjusted to the 2002 US female population. RESULTS:Twenty-two million US women 18 years and older have undergone hysterectomy, representing 21% of the population. The proportion of these women who reported a current Pap smear did not change during the 10-year study period. In 1992 (before the US Preventive Services Task Force recommendations), 68.5% of women who had undergone hysterectomy reported having had a Pap smear in the past 3 years; in 2002 (6 years after the recommendation), 69.1% had had a Pap smear during the same period (P value for the comparison =.22). After accounting for Pap smears that may have preceded a recent hysterectomy and hysterectomies that spared the cervix or were performed for cervical neoplasia, we estimate that almost 10 million women, or half of all women who have undergone hysterectomy, are being screened unnecessarily. CONCLUSIONS:Many US women are undergoing Pap smear screening even though they are not at risk of cervical cancer. The US Preventive Services Task Force recommendations either have not been heard or have been ignored.
    背景与目标:
  • 【干扰素-α 和视黄酸联合放疗治疗晚期宫颈癌是否优于化疗?】 复制标题 收藏 收藏
    DOI:10.4103/0019-509x.25885 复制DOI
    作者列表:Basu P,Biswas J,Mandal R,Choudhury P
    BACKGROUND & AIMS: :Locally advanced cervical cancers comprise a large majority of the gynecologic cancers in India and other developing countries. Concurrent chemo-radiation has improved the survival of high risk stage I and stage II cervical cancers. There is no evidence that the same survival benefit has been achieved with chemo-radiation in stage III and stage IV disease. Interferon-alpha and Retinoic acid have synergistic anti-proliferative activity. In combination with radiation, they substantially enhance the sensitivity of the squamous carcinoma cells to radiation. Based on these observations from the in vitro studies, a few clinical trials have evaluated the combination of interferon-alpha and Retinoic acid, concomitant with radiation, to treat cervical cancers. The results from these early trials were encouraging and the combination had minimal toxicities. However, till date, no phase III randomized controlled trial has been done to evaluate this therapeutic modality.
    背景与目标: : 在印度和其他发展中国家,局部晚期宫颈癌占妇科癌症的绝大多数。同步放化疗提高了高危I期和II期宫颈癌的生存率。没有证据表明在III期和IV期疾病中进行化学放射治疗可获得相同的生存益处。干扰素-α 和维甲酸具有协同抗增殖活性。与辐射相结合,它们显着增强了鳞状癌细胞对辐射的敏感性。基于这些来自体外研究的观察结果,一些临床试验已经评估了干扰素-α 和视黄酸的结合,并伴有辐射,以治疗宫颈癌。这些早期试验的结果令人鼓舞,并且该组合的毒性很小。然而,到目前为止,还没有进行III期随机对照试验来评估这种治疗方式。
  • 【淋病奈瑟菌使用不同的机制感染人子宫颈的异质上皮。】 复制标题 收藏 收藏
    DOI:10.1371/journal.ppat.1008136 复制DOI
    作者列表:Yu Q,Wang LC,Di Benigno S,Gray-Owen SD,Stein DC,Song W
    BACKGROUND & AIMS: :Sexually transmitted infections are a critical public health issue. However, the mechanisms underlying sexually transmitted infections in women and the link between the infection mechanism and the wide range of clinical outcomes remain elusive due to a lack of research models mimicking human infection in vivo. We established a human cervical tissue explant model to mimic local Neisseria gonorrhoeae (GC) infections. We found that GC preferentially colonize the ectocervix by activating integrin-β1, which inhibits epithelial shedding. GC selectively penetrate into the squamocolumnar junction (TZ) and endocervical epithelia by inducing β-catenin phosphorylation, which leads to E-cadherin junction disassembly. Epithelial cells in various cervical regions differentially express carcinoembryonic antigen-related cell adhesion molecules (CEACAMs), the host receptor for GC opacity-associated proteins (OpaCEA). Relatively high levels were detected on the luminal membrane of ecto/endocervical epithelial cells but very low levels intracellularly in TZ epithelial cells. CEACAM-OpaCEA interaction increased ecto/endocervical colonization and reduced endocervical penetration by increasing integrin-β1 activation and inhibiting β-catenin phosphorylation respectively, through CEACAM downstream signaling. Thus, the intrinsic properties of cervical epithelial cells and phase-variation of bacterial surface molecules both play a role in controlling GC infection mechanisms and infectivity, preferential colonization or penetration, potentially leading to asymptomatic or symptomatic infection.
    背景与目标: : 性传播感染是一个至关重要的公共卫生问题。然而,由于缺乏模仿体内人类感染的研究模型,女性性传播感染的潜在机制以及感染机制与广泛的临床结果之间的联系仍然难以捉摸。我们建立了人类宫颈组织外植体模型,以模拟局部淋病奈瑟菌 (GC) 感染。我们发现,GC通过激活整合素-β1 (抑制上皮脱落) 优先定植外宫颈。GC通过诱导 β-catenin磷酸化选择性渗透到鳞状结肠交界处 (TZ) 和宫颈内膜上皮,从而导致E-cadherin交界处的拆卸。不同宫颈区域的上皮细胞差异表达癌胚抗原相关细胞粘附分子 (CEACAMs),这是GC不透明相关蛋白 (OpaCEA) 的宿主受体。在胞外/宫颈上皮细胞的腔膜上检测到相对较高的水平,但在TZ上皮细胞内检测到的水平非常低。CEACAM-OpaCEA相互作用通过CEACAM下游信号传导分别增加整联蛋白-β1活化和抑制 β-catenin磷酸化,从而增加了胞外/胞内定植并减少了胞内渗透。因此,宫颈上皮细胞的固有特性和细菌表面分子的相变都在控制GC感染机制和感染性,优先定植或渗透方面发挥作用,可能导致无症状或症状感染。
  • 【深度卷积神经网络用于显微宫颈细胞图像中的恶性肿瘤检测和分类。】 复制标题 收藏 收藏
    DOI:10.31557/APJCP.2019.20.11.3447 复制DOI
    作者列表:P B S,Faruqi F,K S H,Kudva R
    BACKGROUND & AIMS: OBJECTIVE:Automated Pap smear cervical screening is one of the most effective imaging based cancer detection
    tools used for categorizing cervical cell images as normal and abnormal. Traditional classification methods depend on
    hand-engineered features and show limitations in large, diverse datasets. Effective feature extraction requires an efficient
    image preprocessing and segmentation, which remains prominent challenge in the field of Pathology. In this paper, a
    deep learning concept is used for cell image classification in large datasets. METHODS:This relatively proposed novel
    method, combines abstract and complicated representations of data acquired in a hierarchical architecture. Convolution
    Neural Network (CNN) learns meaningful kernels that simulate the extraction of visual features such as edges, size,
    shape and colors in image classification. A deep prediction model is built using such a CNN network to classify the
    various grades of cancer: normal, mild, moderate, severe and carcinoma. It is an effective computational model which
    uses multiple processing layers to learn complex features. A large dataset is prepared for this study by systematically
    augmenting the images in Herlev dataset. RESULT:Among the three sets considered for the study, the first set of single
    cell enhanced original images achieved an accuracy of 94.1% for 5 class, 96.2% for 4 class, 94.8% for 3 class and
    95.7% for 2 class problems. The second set includes contour extracted images showed an accuracy of 92.14%, 92.9%,
    94.7% and 89.9% for 5, 4, 3 and 2 class problems. The third set of binary images showed 85.07% for 5 class, 84%
    for 4 class, 92.07% for 3 class and highest accuracy of 99.97% for 2 class problems. CONCLUSION:The experimental
    results of the proposed model showed an effective classification of different grades of cancer in cervical cell images,
    exhibiting the extensive potential of deep learning in Pap smear cell image classification.
    背景与目标:

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