Prophylactic HPV vaccines

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Bayesian Estimation of Performance Measures of Cervical Cancer Screening Tests in the Presence of Covariates and Absence of a Gold Standard

In this paper we develop a Bayesian analysis to estimate the disease prevalence, the sensitivity and specificity of three cervical cancer screening tests (cervical cytology, visual inspection with acetic acid and Hybrid Capture II) in the presence of a covariate and in the absence of a gold standard. We use Metropolis-Hastings algorithm to obtain the posterior summaries of interest. The estimated prevalence of cervical lesions was 6.4% (a 95% credible interval [95% CI] was 3.9, 9.3). The sensitivity of cervical cytology (with a result of ≥ ASC-US) was 53.6% (95% CI: 42.1, 65.0) compared with 52.9% (95% CI: 43.5, 62.5) for visual inspection with acetic acid and 90.3% (95% CI: 76.2, 98.7) for Hybrid Capture II (with result of >1 relative light units). The specificity of cervical cytology was 97.0% (95% CI: 95.5, 98.4) and the specificities for visual inspection with acetic acid and Hybrid Capture II were 93.0% (95% CI: 91.0, 94.7) and 88.7% (95% CI: 85.9, 91.4), respectively. The Bayesian model with covariates suggests that the sensitivity and the specificity of the visual inspection with acetic acid tend to increase as the age of the women increases

[the New Classification Of Breast Cancers: Finding The Luminal A].

To compare the distributions of patients with clinical-pathological subtypes of luminal B-like breast cancer according to the 2011 and 2013 St. Gallen International Breast Cancer Conference Expert Panel. We studied 142 women with breast cancer who were positive to estrogen receptor and had been treated in São Paulo state, southeast Brazil. The expression of the following receptors was assessed by immunohistochemistry: estrogen, progesterone (PR) and Ki-67. The expression of HER-2 was measured by fluorescent in situ hybridization analysis in tissue microarray. There were 29 cases of luminal A breast cancers according to the 2011 St. Gallen International Breast Cancer Conference Expert Panel that were classified as luminal B-like in the 2013 version. Among the 65 luminal B-like breast cancer cases, 29 (45%) were previous luminal A tumors, 15 cases (20%) had a Ki-67 >14% and were at least 20% PR positive and 21 cases (35%) had Ki-67 >14% and more than 20% were PR positive. The 2013 St. Gallen consensus updated the definition of intrinsic molecular subtypes and increased the number of patients classified as having luminal B-like breast cancer in our series, for whom the use of cytotoxic drugs will probably be proposed with additional treatment cost.36575-8

Viral load of human papillomavirus as a predictor of the severity of cervical lesions in women with atypical cells at pap smear

Made available in DSpace on 2019-09-11T20:58:44Z (GMT). No. of bitstreams: 0 Previous issue date: 2003OBJETIVO: avaliar o desempenho da carga viral do HPV por captura de híbridos II (CHII) na predição da gravidade das lesões cervicais. MÉTODOS: foram incluídas 309 mulheres admitidas por resultado anormal da colpocitologia oncológica (CO) entre agosto de 200 e novembro de 2002. Todas foram submetidas a avaliação histológica, sendo que a presença de neoplasia intra-epitelial cervical (NIC) grau 2 ou mais (NIC 3, carcinoma invasor) foi considerada doença grave. A CHII foi realizada para tipos de HPV de alto risco oncogênico e a carga viral medida em unidades relativas de luz (URL). O desempenho da CHII foi avaliado por curva receiver operating characteristics (ROC). RESULTADOS: na avaliação histológica, 140 (45,3%) mulheres apresentavam cervicite ou NIC 1 e 199 (54,7%), NIC 2/3, adenocarcinoma in situ ou câncer invasor. O melhor ponto de corte da CHII para a detecção de doença grave foi 35 URL, com sensibilidade de 69% e especificidade de 70%. O valor preditivo positivo das alterações compatíveis com lesão de alto grau na CO associado a CHII de 35 URL (unidades relativas de luz) foi de 88,2% para a detecção de NIC 2 ou mais. Já 95,7% das mulheres com lesões de baixo grau na CO e CHII menor que 1 URL não apresentaram lesões histológicas graves. CONCLUSÃO: o melhor desempenho da CHII no diagnóstico de NIC 2 ou lesão mais grave foi encontrado com 35 URL. A associação da CO com a CHII em diferentes cargas virais mostrou valores preditivos positivos e negativos muito altos.PURPOSE: to assess the performance of hybrid capture II (HCII) HPV viral load in predicting the grade of cervical lesions. METHODS: between August 2000 to November 2002, 309 women admitted due to an abnormal Pap smear result were recruited. Histological disease confirmation was done in all women and cervical intraepithelial neoplasia (CIN) grade 2 or above was considered as severe disease. HCII was done for high-risk HPV types and viral load was estimated in relative light units (RLU). Receiver operating characteristics analysis was used to test the performance of HCII. RESULTS: histological findings included 140 (45.3%) cervicitis or CIN 1 and 199 (54.7%) CIN 2/3, in situ adenocarcinoma or invasive cancer. The best cutoff for HCII in detecting severe disease was 35 RLU, showing a sensitivity of 69% and a specificity of 70%. Association of high-grade cervical lesions at Pap smear and HCII at 35 RLU showed a positive predictive value of 88.2% in diagnosis of CIN 2 or above. On the other hand, 95.7% of the women with low grade lesion at cytology and HCII below 1 RLU presented no severe histological disease. CONCLUSIONS: the best performance of HCII in diagnosing CIN 2 or above was found at 35 RLU. Association of cytology and HCII in different settings provided very high positive and negative predictive values.[Santos, André Luis Ferreira] Universidade de TaubatéMorais, Sirlei Siani] Universidade Estadual de Campinas, BrazilSarian, Luis Otávio Zanatta; Derchain, Sophie Françoise Mauricette; Figuereido, Priscila Garcia] Universidade Estadual de Campinas, Brazi