CERVICAL INTRAEPITHELIAL NEOPLASIA IN THE “DR. SALVATOR VUIA” CLINICAL OBSTETRICS AND GYNECOLOGY HOSPITAL ARAD DURING THE 2004-2008 PERIOD

CERVICAL INTRAEPITHELIAL NEOPLASIA IN THE “DR. SALVATOR VUIA” CLINICAL OBSTETRICS AND GYNECOLOGY HOSPITAL ARAD DURING THE 2004-2008 PERIOD

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Title:	CERVICAL INTRAEPITHELIAL NEOPLASIA IN THE “DR. SALVATOR VUIA” CLINICAL OBSTETRICS AND GYNECOLOGY HOSPITAL ARAD DURING THE 2004-2008 PERIOD
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Article_Title:	CERVICAL INTRAEPITHELIAL NEOPLASIA IN THE “DR. SALVATOR VUIA” CLINICAL OBSTETRICS AND GYNECOLOGY HOSPITAL ARAD DURING THE 2004-2008 PERIOD
Authors:	Daşcău Voicu1*, Furău Gheorghe1, Păiuşan Lucian2, Radu Adriana2, Furău Cristian1, Para Cristina3, Stănescu Casiana4, Onel Cristina1, Ulgut Corina5
Affiliation:	1”Vasile Goldiş” Western University of Arad, Faculty of Medicine, Ob-Gyn Department, Romania 2”Vasile Goldiş” Western University of Arad, Faculty of Medicine, Anatomopathology Department, Romania 3”Vasile Goldiş” Western University of Arad, Faculty of Medicine, Internal Medicine Department, Romania 4”Vasile Goldiş” Western University of Arad, Faculty of Medicine, Anatomy Department, Romania 5Clinical County Emergency Hospital, Anatomopathology Department, Arad, Romania
Abstract:	Cervical Intraepithelial Neoplasia (CIN) lesions are of high importance because of their relatively high frequency, potential evolution towards cervical cancer and relatively easy diagnosis. Our study concerning the incidence of Cervical Intraepithelial Neoplasia (CIN) covers the 2004-2008 time span, the data being collected from the Histopathology Exams (HPE) registers. During the 2004-2008 period, 631 cases of cervical dysplasia cases were discovered: 606 CIN cases (96.04%) and 25 CIGD (cervical intraglandular dysplasia) cases (3.96%). There were 377 cases of CIN I (62.21% of all CIN cases, 59.75% of all dysplasia cases), 121 cases of CIN II (19.97% of all CIN cases, 19.18% of all dysplasia cases), and 108 cases of CIN III (17.82% of all CIN cases, 17.12% of all dysplasia cases).The mean patients’ age was 44.52± 9.92 years for all cervical dysplasia cases, 44.41± 9.84 years for all CIN cases, 44.70± 9.34 years, 47.15± 10.40, and 45.94±10.66years for CIN I, CIN II, and CIN III, respectively. The mean patients’ age for the CIG case was 48.12 ± 10.66 years. There were 12 cases (3.27% of the 367cervical cancer cases diagnosed during the same period, 1.98% of the 606 CIN cases) of microinvasive carcinomas combined with CIN lesions (all of them with CIN III) and one case of cervical carcinoma combined with CIN I (0.27% of the 367 cervical cancer cases diagnosed during the same period, 0.17% of the 606 CIN cases). Early detection of CIN lesions through adequate clinical and paraclinical exams is of utmost importance for preventing cervical cancer, which remains a serious and frequent health problem in Romania.
Keywords:	cervical intraepithelial neoplasia, cervical intraglandular neoplasia, CIN, LSIL, HSIL, human papilloma virus, cervical cancer, mean age, Student’s t-test, statistical significance
References:	ASCUS-LSIL Triage Study (ALTS) Group. Results of a randomized trial on the management of cytology interpretations of atypical squamous cells of undetermined significance. Am J Obstet Gynecol 2003;188:1383-1392. Cannistra SA, Niloff JM. Cancer of the uterine cervix. N Engl J Med. 1996;334:1030–1038. Cardoza-Favarato G, Fadare O: High-grade squamous intraepithelial lesion (CIN 2 and 3) excised with negative margins by loop electrosurgical excision procedure: the significance of CIN 1 at the margins of excision. Hum Pathol 2007; 38:781-786. Cox JT, Schiff man M, Solomon D. Prospective follow-up suggests similar risk of subsequent cervical intraepithelial neoplasia grade 2 or 3 among women with cervical intraepithelial neoplasia grade 1 or negative colposcopy and directed biopsy. Am J Obstet Gynecol 2003;188:1406-1412. Demopoulos RI, Horowitz LF, Vamvakas EC: Endocervical gland involvement by cervical intraepithelial neoplasia grade III. Predictive value for residual and/or recurrent disease. Cancer 1991; 68:1932-1936. Giannoudis A, Herrington CS. Human papilloma virus variants and squamous neoplasia of the cervix. J Pathol. 2001;193:295–302. Greenberg MD, Reid R, Schiffman M, Campion MJ, Precop SL, Berman NR, et al. A prospective study of biopsy-confirmed cervical intraepithelial neoplasia grade I: colposcopic, cytological and virological risk factors for progression. Journal of Lower Genital Tract Disease 1999;3:104-109. Khan MJ, Castle PE, Lorincz AT, et al. The elevated 10-year risk of cervical precancer and cancer in women with human papillomavirus (HPV) type 16 or 18 and the possible utility of type-specific HPV testing in clinical practice. J Natl Cancer Inst 2005;97: 1072-1079. Kjaer S, Hogdall E, Frederiksen K, et al. The absolute risk of cervical abnormalities in high-risk human papillomavirus-positive, cytologically normal women over a 10-year period. Cancer Res 2006;66:10630-10636. Livasy CA, Maygarden SJ, Rajaratnam CT, Novotny DB: Predictors of recurrent dysplasia after a cervical loop electrocautery excision procedure for CIN-3: a study of margin, endocervical gland, and quadrant involvement. Mod Pathol 1999; 12:233-238. Melnikow J, Nuovo J, Willan AR, Chan BK, Howell LP. Natural history of cervical squamous intraepithelial lesions: a meta-analysis, Obstet Gynecol 1998;92:727-735. Ostor AG: Natural history of cervical intraepithelial neoplasia. A critical review. Int J Gynecol Pathol 1993; 12:186-192. Paterson-Brown S, Chappatte OA, Clark SK, Wright A, Maxwell P, Taub NA, Raju KS: The significance of cone biopsy resection margins. Gynecol Oncol 1992; 46:182-185. Robertson AJ, Anderson JM, Beck JS et al. Observer variability in histopathological reporting of cervical biopsy specimens, J Clin Pathol 1989;42:231-238. Schiffman M, Castle PE, Jeronimo J, Rodriguez AC, Wacholder S. Human papillomavirus and cervical cancer. Lancet 2007;370: 890-907. Schiffman M, Herrero R, Desalle R, et al. The carcinogenicity of human papillomavirus types reflects viral evolution. Virology 2005;337:76-84. Sindos M, Ndisang D, Pisal N, Chow C, Singer A, Latchman DS. Measurement of Brn-3a levels in Pap smears provides a novel diagnostic marker for the detection of cervical neoplasia. Gynecol Oncol 2003;90:366-371. Solomon D, Davey D, Kurman R, Moriarty A, O’Connor D, Prey M, et al. The 2001 Bethesda System: terminology for reporting results of cervical cytology. JAMA 2002;287:2114-2119.
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Correspondence:	drdascauvoicu@yahoo.com

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Article Title:	CERVICAL INTRAEPITHELIAL NEOPLASIA IN THE “DR. SALVATOR VUIA” CLINICAL OBSTETRICS AND GYNECOLOGY HOSPITAL ARAD DURING THE 2004-2008 PERIOD
Authors:	Daşcău Voicu1*, Furău Gheorghe1, Păiuşan Lucian2, Radu Adriana2, Furău Cristian1, Para Cristina3, Stănescu Casiana4, Onel Cristina1, Ulgut Corina5
Affiliation:	1”Vasile Goldiş” Western University of Arad, Faculty of Medicine, Ob-Gyn Department, Romania 2”Vasile Goldiş” Western University of Arad, Faculty of Medicine, Anatomopathology Department, Romania 3”Vasile Goldiş” Western University of Arad, Faculty of Medicine, Internal Medicine Department, Romania 4”Vasile Goldiş” Western University of Arad, Faculty of Medicine, Anatomy Department, Romania 5Clinical County Emergency Hospital, Anatomopathology Department, Arad, Romania
Abstract:	Cervical Intraepithelial Neoplasia (CIN) lesions are of high importance because of their relatively high frequency, potential evolution towards cervical cancer and relatively easy diagnosis. Our study concerning the incidence of Cervical Intraepithelial Neoplasia (CIN) covers the 2004-2008 time span, the data being collected from the Histopathology Exams (HPE) registers. During the 2004-2008 period, 631 cases of cervical dysplasia cases were discovered: 606 CIN cases (96.04%) and 25 CIGD (cervical intraglandular dysplasia) cases (3.96%). There were 377 cases of CIN I (62.21% of all CIN cases, 59.75% of all dysplasia cases), 121 cases of CIN II (19.97% of all CIN cases, 19.18% of all dysplasia cases), and 108 cases of CIN III (17.82% of all CIN cases, 17.12% of all dysplasia cases).The mean patients’ age was 44.52± 9.92 years for all cervical dysplasia cases, 44.41± 9.84 years for all CIN cases, 44.70± 9.34 years, 47.15± 10.40, and 45.94±10.66years for CIN I, CIN II, and CIN III, respectively. The mean patients’ age for the CIG case was 48.12 ± 10.66 years. There were 12 cases (3.27% of the 367cervical cancer cases diagnosed during the same period, 1.98% of the 606 CIN cases) of microinvasive carcinomas combined with CIN lesions (all of them with CIN III) and one case of cervical carcinoma combined with CIN I (0.27% of the 367 cervical cancer cases diagnosed during the same period, 0.17% of the 606 CIN cases). Early detection of CIN lesions through adequate clinical and paraclinical exams is of utmost importance for preventing cervical cancer, which remains a serious and frequent health problem in Romania.
Keywords:	cervical intraepithelial neoplasia, cervical intraglandular neoplasia, CIN, LSIL, HSIL, human papilloma virus, cervical cancer, mean age, Student’s t-test, statistical significance
References:	ASCUS-LSIL Triage Study (ALTS) Group. Results of a randomized trial on the management of cytology interpretations of atypical squamous cells of undetermined significance. Am J Obstet Gynecol 2003;188:1383-1392. Cannistra SA, Niloff JM. Cancer of the uterine cervix. N Engl J Med. 1996;334:1030–1038. Cardoza-Favarato G, Fadare O: High-grade squamous intraepithelial lesion (CIN 2 and 3) excised with negative margins by loop electrosurgical excision procedure: the significance of CIN 1 at the margins of excision. Hum Pathol 2007; 38:781-786. Cox JT, Schiff man M, Solomon D. Prospective follow-up suggests similar risk of subsequent cervical intraepithelial neoplasia grade 2 or 3 among women with cervical intraepithelial neoplasia grade 1 or negative colposcopy and directed biopsy. Am J Obstet Gynecol 2003;188:1406-1412. Demopoulos RI, Horowitz LF, Vamvakas EC: Endocervical gland involvement by cervical intraepithelial neoplasia grade III. Predictive value for residual and/or recurrent disease. Cancer 1991; 68:1932-1936. Giannoudis A, Herrington CS. Human papilloma virus variants and squamous neoplasia of the cervix. J Pathol. 2001;193:295–302. Greenberg MD, Reid R, Schiffman M, Campion MJ, Precop SL, Berman NR, et al. A prospective study of biopsy-confirmed cervical intraepithelial neoplasia grade I: colposcopic, cytological and virological risk factors for progression. Journal of Lower Genital Tract Disease 1999;3:104-109. Khan MJ, Castle PE, Lorincz AT, et al. The elevated 10-year risk of cervical precancer and cancer in women with human papillomavirus (HPV) type 16 or 18 and the possible utility of type-specific HPV testing in clinical practice. J Natl Cancer Inst 2005;97: 1072-1079. Kjaer S, Hogdall E, Frederiksen K, et al. The absolute risk of cervical abnormalities in high-risk human papillomavirus-positive, cytologically normal women over a 10-year period. Cancer Res 2006;66:10630-10636. Livasy CA, Maygarden SJ, Rajaratnam CT, Novotny DB: Predictors of recurrent dysplasia after a cervical loop electrocautery excision procedure for CIN-3: a study of margin, endocervical gland, and quadrant involvement. Mod Pathol 1999; 12:233-238. Melnikow J, Nuovo J, Willan AR, Chan BK, Howell LP. Natural history of cervical squamous intraepithelial lesions: a meta-analysis, Obstet Gynecol 1998;92:727-735. Ostor AG: Natural history of cervical intraepithelial neoplasia. A critical review. Int J Gynecol Pathol 1993; 12:186-192. Paterson-Brown S, Chappatte OA, Clark SK, Wright A, Maxwell P, Taub NA, Raju KS: The significance of cone biopsy resection margins. Gynecol Oncol 1992; 46:182-185. Robertson AJ, Anderson JM, Beck JS et al. Observer variability in histopathological reporting of cervical biopsy specimens, J Clin Pathol 1989;42:231-238. Schiffman M, Castle PE, Jeronimo J, Rodriguez AC, Wacholder S. Human papillomavirus and cervical cancer. Lancet 2007;370: 890-907. Schiffman M, Herrero R, Desalle R, et al. The carcinogenicity of human papillomavirus types reflects viral evolution. Virology 2005;337:76-84. Sindos M, Ndisang D, Pisal N, Chow C, Singer A, Latchman DS. Measurement of Brn-3a levels in Pap smears provides a novel diagnostic marker for the detection of cervical neoplasia. Gynecol Oncol 2003;90:366-371. Solomon D, Davey D, Kurman R, Moriarty A, O’Connor D, Prey M, et al. The 2001 Bethesda System: terminology for reporting results of cervical cytology. JAMA 2002;287:2114-2119.
*Correspondence:	drdascauvoicu@yahoo.com

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