Prevalence of cervical neoplastic lesions and Human Papilloma Virus infection in Egypt: National Cervical Cancer Screening Project

<p>Abstract</p> <p>Background</p> <p>Data from Egyptian studies provide widely varying estimates on the prevalence of pre-malignant and malignant cervical abnormalities and human papilloma virus (HPVs) infection. To define the prevalence and risk factors of pre-invasive and invasive cervical cancer (cacx), a community based full-scale cross sectional, household survey including 5453 women aged between 35 and 60 years was conducted.</p> <p>Methods</p> <p>The study period was between February 2000 and December 2002. Initially, conventional Papanicolaou (Pap) smears were evaluated using the Bethesda system (TBS), followed by colposcopic guided biopsy (CGB) for all epithelial abnormalities (EA). In a third step, HPV was tested on all EA by in-situ hybridization (ISH) using first the broad spectrum HPV probe recognizing HPVs 6, 11, 16, 18, 30, 31, 35, 45, 51 and 52 followed by subtyping with probes 6/11, 16/18 and 31/33. Lastly, unequivocal cases were immunostained for herpes simplex type-2 (HSV-2), cytomegalovirus (CMV), and human immunodeficiency virus (HIV).</p> <p>Results</p> <p>EA representing 7.8% (424/5453), were categorized into atypical squamous cell of undetermined significance (ASCUS) (34.4%), atypical glandular cell of undetermined significance (AGCUS) (15.3%), combined ASCUS and AGCUS (3.1%), low grade squamous intraepithelial lesions (SIL) (41.0%), high grade SIL (5.2%) and invasive lesions (1%). CGB of EA (n = 281) showed non neoplastic lesions (12.8%), atypical squamous metaplasia (ASM) (19.2%), cervical intraepithelial neoplasia I (CIN) (44.4%), CIN II (4.4%), CINIII (2.8%), endocervical lesions (5.2%), combined squamous and endocervical lesions (10.0%), invasive squamous cell carcinoma (SCC) (0.02%) and extranodal marginal zone B cell lymphoma (MZBCL) (0.02%). The overall predictive value of cytology was 87% while the predictive value for high grade lesions was 80%. On histological basis, HPVs were present in 94.3% of squamous lesions while it was difficult to be identified in endocervical ones. ISH revealed positivity for pan HPV in 65.9% of the studied biopsies (n = 217), with incorporation of the viral genome HPV 6/11, 16/18 and 31/33 in 11.1%, 33.3% and 17.1% respectively. Multiple HPVs infections were identified in 0.02%.</p> <p>Conclusion</p> <p>Pre-invasive high grade lesions and invasive cervical carcinoma represent 0.5% and 0.04% respectively in Egyptian women. HPV mostly 16/18 as a risk factor (p < 0.001), was frequently associated with mixed infections (p < 0.001) and bilharzial infestation (p < 0.001).</p

Combined dysplasia, A- ASCUS, the nucleus is twice the size of the left intermediate cell on the right, Pap stain, ×40

<p><b>Copyright information:</b></p><p>Taken from "Prevalence of cervical neoplastic lesions and Human Papilloma Virus infection in Egypt: National Cervical Cancer Screening Project"</p><p>http://www.infectagentscancer.com/content/2/1/12</p><p>Infectious Agents and Cancer 2007;2():12-12.</p><p>Published online 4 Jul 2007</p><p>PMCID:PMC1945019.</p><p></p> B- Another area showing nuclear pseudostratification and loss of the normal honey combing, Pap stain, ×40. C- A third area showing ASCUS and AGCUS in the same field, Pap stain, ×40. D- Glandular colonization by the neoplastic cells and dysplastic endocervical lining, H&E, ×10. E- Higher power magnification of the colonized glands showing koilocytes, increased nucleo-cytoplasmic ratio and large nucleolated nuclei, H&E, ×40. F- Higher power magnification of the endocervical dysplastic cells, H&E, ×40. G- Another field showing colonization of the glands by the koilocytes and residual normal endocervical cells, H&E staining, ×40. H- Surface epithelium showing koilocytic atypia, acanthosis, papillomatosis and basal cell hyperplasia, H&E, ×40

LCNK SCC, A- Fibres cells (arrow) and koilocytes (arrow head), Pap stain, × 400

<p><b>Copyright information:</b></p><p>Taken from "Prevalence of cervical neoplastic lesions and Human Papilloma Virus infection in Egypt: National Cervical Cancer Screening Project"</p><p>http://www.infectagentscancer.com/content/2/1/12</p><p>Infectious Agents and Cancer 2007;2():12-12.</p><p>Published online 4 Jul 2007</p><p>PMCID:PMC1945019.</p><p></p> B- Marked nuclear pleomorphism and hyperchromasia and heavy neutrophilic infiltrate, Pap stain, × 400. C- Corresponding biopsy: islands of neoplastic cells surrounded by heavy neutrophilic infiltrate, H&E, ×1

LGSIL HPV associated showing koilocytic atypia (A), binucleation (B) and dyskeratosis (C) Papanicolaou stain, × 40

<p><b>Copyright information:</b></p><p>Taken from "Prevalence of cervical neoplastic lesions and Human Papilloma Virus infection in Egypt: National Cervical Cancer Screening Project"</p><p>http://www.infectagentscancer.com/content/2/1/12</p><p>Infectious Agents and Cancer 2007;2():12-12.</p><p>Published online 4 Jul 2007</p><p>PMCID:PMC1945019.</p><p></p