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Re: Change of management?From: Dr. John Provatopoulos B.Sc. M.D.C.M. F.R.S.C. (johnprov@sympatico.ca)Thu May 1 16:46:50 2003
At Tue, 29 Apr 2003, Richard Chudacoff, MD wrote: > >I have been following this patient for 4 years. She initially came to see me >and had a LGSIL on conventional Pap smear. Colposcopy directed findings >confirmed the diagnosis, and she elected to be followed every 6 months, >rather than have a LEEP. Every six months she returns, and every time her >pap smear is LGSIL. The most recent pap, also LGSIL, somehow got reflexive >HPV testing, and high risk HPV was noted in the liquor. So, patient managed >appropriately for a conventional pap, but now has new finding on the liquid >based Pap smear, without change in clinical appearance. Would anyone change >his or her management? > >-- >Richard Chudacoff, MD, FACOG > >Chudacoff Obstetrics & Gynecology, PLLC >15200 Southwest Freeway, #270 >Sugar Land, TX 77478 > >Tel: 281-277-3900 >Fax: 281-277-3901 > >rchudacoff@mylinuxisp.com >Richard.Chudacoff@obgyn.net > >http://www.mdhub.com/281-277-3900 >http://www.chudacoffobgyn.yourmd.com >*****HIPAA Confidentiality Notice***** >The documents inside this electronic transmission contain confidential >information belonging to the sender that is legally privileged. This >information is intended only for the use of the individual or entity named >above. The authorized recipient of this information is prohibited from >disclosing this information to any other party and is required to destroy >the information after its stated need has been fulfilled, unless otherwise >required by law. >If you are not the intended recipient, you are hereby notified that any >disclosure, copying, distribution, or action taken in reliance on the >contents of these documents is strictly prohibited. If you received this >electronic transmission in error, please notify the sender immediately to >arrange for return. > I think managing her conservatively is perfectly acceptable, make sure she understands that she must be followed forever, the literature is beginning to show that women with cervical cancers in there 50's and 60' often have high risk Hpv subtypes most of these women acquired the hpv more than 10 years ago and for whatever reason chemo, AIDS etc thier immune response became compromise ed and the HPV reactivated with a vengeance.
Factors associated with an increased risk of prevalent and incident
grade III cervical intraepithelial neoplasia and invasive cervical
cancer among women with Papanicolaou tests classified as grades I or II
cervical intraepithelial neoplasia.
Petry KU - Am J Obstet Gynecol - 01-Jan-2002; 186(1): 28-34
>From NIH/NLM MEDLINE NLM Citation ID: 11810080 (PubMed) 21667857 (MEDLINE) Full Source Title: American Journal of Obstetrics and Gynecology Publication Type: Journal Article Language: English Author Affiliation: Department of Gynecologic Oncology, Medizinische Hochschule Hannover, Germany. kupet@aol.com Authors: Petry KU; Böhmer G; Iftner T; Davies P; Brummer O; Kühnle H Abstract: OBJECTIVE: Women with Papanicolaou tests classified as cervical intraepithelial neoplasia grade I or II are treated conservatively in many countries. However, these women are at an increased risk of having underlying prevalent and incident grade III cervical intraepithelial neoplasia and invasive cancer. This study was undertaken to identify factors that could predict these clinically important disease states. STUDY DESIGN: Five hundred women with Papanicolaou tests classified as persistent grade I or II cervical intraepithelial neoplasia underwent a repeat test, human papillomavirus testing with Hybrid Capture assay (Digene, Silver Spring, Md) and polymerase chain reaction, and colposcopy with histologic assessment. One hundred fifty-seven women with histologically proven grade I or II cervical intraepithelial neoplasia were monitored conservatively for a minimum of 9 months to assess predictors of incident grade III cervical intraepithelial neoplasia. RESULTS: One hundred fifty-one women with prevalent grade III cervical intraepithelial neoplasia and 5 women with prevalent invasive cancer were identified at the first colposcopy. A repeated Papanicolaou test classified as higher than grade II cervical intraepithelial neoplasia and detection of oncogenic human papillomavirus types were significant predictors of underlying grade III cervical intraepithelial neoplasia and cancer in the multivariate analysis. Seventeen of 157 women (10.8%) with grade I or II cervical intraepithelial neoplasia progressed to grade III cervical intraepithelial neoplasia. Age >30 years and detection of oncogenic human papillomavirus were significantly correlated with progression in the multivariate analysis. No progression was observed in women who were negative for human papillomavirus. CONCLUSION: The high rate of underlying prevalent grade III cervical intraepithelial neoplasia and cancer found in our study (31.2%) indicates that conservative management of women with persistent grade I or II cervical intraepithelial neoplasia should be discouraged. Colposcopy with histologic assessment should be recommended as the standard of care. However, for women with histologically proven grade I or II cervical intraepithelial neoplasia, subsequent conservative management was safe in our study for those who were negative for human papillomavirus by type-specific polymerase chain reaction.
High-risk HPV DNA detection by Hybrid Capture II. An adjunctive test
for mildly abnormal cytologic smears in women > or = 50 years of age.
Lin CT - J Reprod Med - 01-Apr-2000; 45(4): 345-50
>From NIH/NLM MEDLINE NLM Citation ID: 10804494 (PubMed} 20264615 (MEDLINE) Full Source Title: Journal of Reproductive Medicine Publication Type: Clinical Trial; Journal Article Language: English Author Affiliation: Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Taoyuan, Taiwan. Authors: Lin CT; Tseng CJ; Lai CH; Hsueh S; Huang HJ; Law KS Abstract: OBJECTIVE: To determine whether high-risk human papillomavirus (HPV) DNA testing could improve the detection of cervical intraepithelial neoplasia (CIN) and cancer in older women (> or = 50 years old) with mildly abnormal results on conventional cytology. STUDY DESIGN: The study was based on 119 patients aged over 50 (median, 62; range, 50-78) referred for colposcopy with Pap smears reported as atypical squamous cells of undetermined significance (ASCUS) or low grade squamous intraepithelial lesion (LSIL) from February 1997 to September 1998. The presence of high-risk HPV DNA (including HPV types 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59 and 68) was determined with the Hybrid Capture II (Digene, Inc., Silver Spring, Maryland) microplate method. Cytologic examination by Pap smear was based on the Bethesda System and, cervical biopsy was done via colposcopy. RESULTS: High-risk HPV DNA was demonstrated in 75.6% (34/45) of patients with LSIL and 52.7% (39/74) with ASCUS. Those who were HPV positive were significantly more likely to have CIN or cancer (odds ratio, 33.40; 95% confidence interval, 11.89-93.97; P < .0001). The sensitivity of HPV assay for detection of lesions more severe than CIN 2 was 100%, specificity 64.8%, positive predictive value 66.7% and negative predictive value 100%. CONCLUSION: The addition of a high-risk HPV DNA assay to cytologic examination appears to provide excellent sensitivity and negative predictive value for early detection of high grade CIN or cancer in older women with minimally abnormal Pap smears. Take care, John
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