JCT  Vol.5 No.1 , January 2014
Cervical Cancer in Women with Inflammatory Pap Smears
ABSTRACT

In spite of preventive measures such as Papanicolaou cervical cytological analysis and, more recently, vaccination against HPV infection, cancer of the uterine cervix continues to be one of the most frequent causes of mortality among women worldwide, particularly in developing countries. In this prospective study, sixty patients with inflammatory Pap smears had a colposcopy with directed biopsies. The average age of our patients was 42 years. Results showed that colposcopy is normal in 10% of women. It showed normal transformations, ectropion, a colpotis and polyp at 8.33%, 21.66%, 13.33% and 5% respectively. It was able to detect changes with Grade I atypical transformations (28.33%), and Grade II atypical transformations in 13.33% of cases. The biopsies were objectified dysplasia and carcinoma in 24.13% of cases with carcinoma in situ, micro invasive squamous cell carcinoma and invasive carcinoma glandular. Moreover, we detected HPV-specific antibodies in sera of these patients. Results showed that six patients (10%) showed a positive reactivity to at least one of the HPV-16 or HPV-18 antigens and sera showed different reactivity to the different antigens with the following percentages: 5%, 3%, 2%, 3% and 3% for L1 HPV-16, E6 HPV-16, E7 HPV-16, E6 HPV-18 and E7 HPV-18 respectively. Among patients having positive antibody response, 83.33% were cases of dysplasia and carcinoma. We concluded that the Pap smear, examination of key screening for cervical cancer, is a screening test without diagnostic value and more specifically any inflammatory Pap smear should be considered a positive test and led to further investigations. Moreover, colposcopy is an exam that is performed on an outpatient basis; it allows a detailed study of the cervix and reduces the negative rate of cytology. In addition, early detection of HPV antibodies could help the follow-up of patients.


Cite this paper
M. Achour and D. Zeghal, "Cervical Cancer in Women with Inflammatory Pap Smears," Journal of Cancer Therapy, Vol. 5 No. 1, 2014, pp. 82-90. doi: 10.4236/jct.2014.51011.
References
[1]   M. Maalej, A. Ben Youssef, M. Ben Andallah, et al., “Epidémiologie du Cancer du col de l’Utérus en Tunisie,” Maghreb Médical, Vol. 242, 1991, pp. 12-17.

[2]   H. Demirhindi, E. Nazlican and M. Akbada, “Cervical Cancer Screening in Turkey: A Community-Based Experience after 60 Years of Pap Smear Usage,” Asian Pacific Journal Cancer Prevention, Vol. 13, No. 12, 2012, pp. 6497-6500. http://dx.doi.org/10.7314/APJCP.2012.13.12.6497

[3]   M. Maalej, K. Mrad, L. Kochbati, et al., “Cervical Cancer in Tunisia: An Epidemiological, Clinical and Pathological Study,” European Journal of Obstetrics & Gynecology and Reproductive Biology, Vol. 113, No. 2, 2004, pp. 226-228. http://dx.doi.org/10.1016/j.ejogrb.2003.07.005

[4]   M. Ben Laabidi, “Evaluation de la Prévention des Cancers du col Utérin par le Frottis Cervico-Vaginal,” Maghreb Médical, Vol. 308, 1996, pp. 36-40.

[5]   H. H. Nguyen. T. R. Broker and L. T. Chow, “Immune Responses to Human Papillomavirus in Genital Tract of Women with Cervical Cancer,” Gynecologic Oncology, Vol. 96, No. 2, 2005, pp. 452-461. http://dx.doi.org/10.1016/j.ygyno.2004.10.019

[6]   S. Arrossi, R. Sankaranarayanan and D. M. Parkin, “Incidence and Mortality of Cervical Cancer in Latin America,” Salud Publica de Mexico, Vol. 45, No. 3, 2003, pp. 306-314.

[7]   H. Zur Hausen, “Molecular Pathogenesis of Cancer of the Cervix and Its Causation by Specific Human Papillomavirus Types,” Current Topics Microbiology and Immunology, Vol. 186, 1994, pp. 131-156.

[8]   E. L. Franco, “Cancer Causes Revisited: Human Papillomavirus and Cervical Neoplasia,” Journal of the National Cancer Institute, Vol. 87, No. 11, 1995, 779-780. http://dx.doi.org/10.1093/jnci/87.11.779

[9]   N. Munoz, F. X. Bosch, S. de Sanjosé, et al., “International Agency for Research on Cancer Multicenter Cervical Cancer Study Group: Epidemiologic Classification of Human Papillomavirus Types Associated with Cervical Cancer,” The New England Journal of Medicine, Vol. 348, 2003, pp. 518-527. http://dx.doi.org/10.1056/NEJMoa021641

[10]   J. S. Smith, L. Lindsay, B. Hoots, et al., “Human Papillomavirus Type Distribution in Invasive Cervical Cancer and High-Grade Cervical Lesions: A Meta-Analysis Update,” International Journal of Cancer, Vol. 121, No. 3, 2007, pp. 621-632. http://dx.doi.org/10.1002/ijc.22527

[11]   P. Sehr, K. Zumbach and M. Pawlita, “A Generic Capture ELISA for Recombinant Proteins Fused to Glutathione S-Transferase: Validation for HPV Serology,” Journal of Immunological Methods, Vol. 253, No. 1-2, 2001, pp. 153-162. http://dx.doi.org/10.1016/S0022-1759(01)00376-3

[12]   W. Meschede, K. Zumbach, J. Braspenning, et al., “Antibodies against Early Proteins of Human Papillomavirus as Diagnostic Markers for Invasive Cervical Cancer,” Journal of Clinical Microbiology, Vol. 36, No. 2, 1998, pp. 475-480.

[13]   L. Raymond, F. Menegoz, G. Fioretta, et al., “Recent Trends in Incidence of Cervical Cancer in Several Regions of Southern-Western Europe,” Revue d’Epidémiolologie et de Santé Publique, Vol. 43, 1995, pp. 122-126.

[14]   K. D. Hatch, A. Schnader and M. W. Abdel Nour, “An Evaluation of Human Papillomavirus Testing for Intermediate and High Risk Types as Triage before Colposcopy,” American Journal of Obstetrics and Gynecology, Vol. 172, No. 4, 1995, pp. 1150-1157. http://dx.doi.org/10.1016/0002-9378(95)91473-0

[15]   J. C. Boulanger, “Proposition d’Une Stratégie Thérapeutique,” Gynécologie, Vol. 38, 1987, pp. 397-403.

[16]   T. B. Lawly, R. B. Lee and R. R. Kapela, “The Significance of Moderate and Severe Inflammation on Class I Papnicolaou Smear,” Obstetrics & Gynecology, Vol. 76, No. 6, 1990, pp. 997-999.

[17]   S. Cecchini, A. Iossa, S. Ciatto, et al., “Routine Colposcopic Survey of Patients with Squamous Atypia, a Method for Identifying Cases with False Negative Smears,” Acta Cytological, Vol. 34, No. 6, 1990, pp. 778-780.

[18]   S. Pairmuti, “False Negative Papanicolaou Smears from Women with Cancerous and Precancerous Lesions of the Uterine Cervix,” Acta Cytologica, Vol. 35, No. 1, 1991, pp. 40-70.

[19]   G. Body, Ph. Descamps, J. Lansac, et al., “Néoplasies Intra Epithéliales du col. Encyclopédie Médico-Chirurgicale en Gynécologie 597-A-10, Cancérologie 60-200-A-10. Paris,” Elsevier, 1993, p. 29.

[20]   H. J. Soost, H. J. Lange and W. Lehmacher, “The Validation of Cervical Cytology Sensitivity and Predictive Valves,” Acta Ctytologica, Vol. 35, No. 1, 1991, pp. 8-14.

[21]   D. C. Slawson, J. H. Bennett and J. H. Herman, “Follow-Up to Papanicolaou Smear for Cervical Atypia Are We Missing Significant Disease? A Harnet Study,” Journal of Family Prost, Vol. 36, No. 3, 1993, pp. 289-293.

[22]   S. R. Lindhein and G. Smith-Ngiyen, “Aggressive Evaluation for Atypical Squamous Cells in Papanicolaou Smears,” Journal of Reproductive Medicine, Vol. 35, No. 10, 1990, pp. 971-973.

[23]   D. Dargent, “Valeur de la Cytologie Différentielle dans le Diagnostic des Formes Précliniques du Cancer Cervico-Utérin,” Nov Pree Méd, Vol. 12, 1983, pp. 631-634.

[24]   A. C. Pearlstone, P. W. Grigsby and D. G. Mutch, “High Rises of Atypical Cervical Cytology: Occurrence and Clinical Significance,” Obstetrics & Gynecology, Vol. 80, 1992, pp. 191-195.

[25]   G. L. Davis, E. Hernaudez, J. L. Davis, et al., “Atypical Squamous Cells in Papanicolaou Smears,” Obstetrics & Gynecology, Vol. 69, 1987, pp. 43-46.

[26]   R. C. Reiter, “Management of Initial Atypical Cervical Cytology: A Randomized, Prospective Study,” Obstetrics & Gynecology, Vol. 68, No. 2, 1986, pp. 237-240.

[27]   N. C. Seckin, et al., “Routine Evaluation of Patients Persistent Inflammatory Cellular Changes on Pap Smear,” International Journal of Gynecology and Obstetrics, Vol. 59, No. 1, 1997, pp. 25-29. http://dx.doi.org/10.1016/S0020-7292(97)00113-6

[28]   G. Sadoul and L. Beuret, “Analyse d’Une Serie Continue de 421 Condylomes gEnitaux,” Journal de Gynécologie Obstétrique et Biologie de la Reproduction, Vol. 14, No. 6, 1985, pp. 1049-1958.

[29]   M. J. Campion, A. Singer and H. S. Mitchell, “Complacency in Diagnosis of Cervical Cancer,” British Medical Journal, Vol. 294, 1987, pp. 1337-1339. http://dx.doi.org/10.1136/bmj.294.6583.1337

[30]   S. Kohan, J. Noumoff, E. M. Beckman, et al., “Colposcopic Screening of Women with Atypical Papanicolaou Smears,” Journal of Reproductive Medicine, Vol. 30, No. 5, 1985, pp. 383-387.

[31]   I. Nyirjesy, “Atypical or Suspicious Cervical Smears,” JAMA, Vol. 222, No. 6, 1972, pp. 691-693. http://dx.doi.org/10.1001/jama.1972.03210060045011

[32]   H. F. Sandmire, S. D. Austin and R. C. Bechtel, “Experience with 40000 Papanicolaou Smears,” Obstetrics & Gynecology, Vol. 48, No. 1, 1976, p. 56.

[33]   N. Spitzer, “Comparative Utility of Repes Papanicolaou Smears, Cervicography and Colposcopy in the Evaluation of Atypical Papanicolaou Smears,” Obstetrics & Gynecology, Vol. 69, 1987, p. 731.

[34]   S. Kohan, J. Noumoff, E. M. Beckman, et al., “Colposcopic Screening of Women with Atypical Papanicolaou Smears,” Journal of Reproductive Medicine, Vol. 30, No. 5, 1985, pp. 383-387.

[35]   G. N. Papanicolaou, “Atlas of Exfoliative Cytology,” Harvard University Press, Cambridge, 1954, p. 450.

[36]   M. Schiffman, P. E. Castle, J. Jeronimo, et al., “Human Papillomavirus and Cervical Cancer,” Lancet, Vol. 370, No. 9590, 2007, pp. 890-907. http://dx.doi.org/10.1016/S0140-6736(07)61416-0

[37]   J. J. Carter, L. A. Koutsky, G. C. Wipf, et al., “The Natural History of Human Papillomavirus Type 16 Capsid Antibodies among a Cohort of University Women,” Journal of Infectious Disease, Vol. 174, No. 5, 1996, pp. 927-936. http://dx.doi.org/10.1093/infdis/174.5.927

[38]   P E. Castle, T. Shields, R. Kirnbauer, et al., “Sexual Behavior, Human Papillomavirus Type 16 (HPV 16) Infection, and HPV 16 Seropositivity,” Sexually Transmitted Diseases, Vol. 29, No. 3, 2002, pp. 182-187. http://dx.doi.org/10.1097/00007435-200203000-00009

[39]   D. Opalka, C. E. Lachman, S. A. MacMullen, et al., “Simultaneous Quantitation of Antibodies to Neutralizing Epitopes on Virus-Like Particles for Human Papillomavirus Types 6, 11, 16, and 18 by a Multiplexed Luminex Assay,” Clinical and Diagnostic Laboratory Immunology, Vol. 10, No. 1, 2003, pp. 108-115.

[40]   J. L. Belinson, Y. L. Qiao, R. G. Pretorius, et al., “Shanxi Province Cervical Cancer Screening Study: A Cross-Sectional Comparative Trial of Multiple Techniques to Detect Cervical Neoplasia,” Gynecologic Oncology, Vol. 83, No. 2, 2001, pp. 439-444. http://dx.doi.org/10.1006/gyno.2001.6370

[41]   J. L. Belinson, S. Hu, M. Niyazi, et al., “Prevalence of Type-Specific Human Papillomavirus in Endocervical, Upper and Lower Vaginal, Perineal, and Vaginal Self-Collected Specimens; Implications for Vaginal Self-Collection,” International Journal of Cancer, Vol. 127, No. 5, 2010, pp. 1151-1157. http://dx.doi.org/10.1002/ijc.25144

[42]   M. Follen, S. Crain, C. MacAulay, et al., “Optical Technologies for Cervical Neoplasia; Update of an NCI Program Project Grant,” Clinical Advances in Hematology and Oncology, Vol. 3, No. 1, 2005, pp. 41-53.

 
 
Top