Background: Oesophageal squamous cell carcinoma (OSC- C) is a common cancer worldwide and has a very high mortality rate. Squamous dysplasia is the precursor lesion for OSCC and it can be seen during routine endoscopy...Background: Oesophageal squamous cell carcinoma (OSC- C) is a common cancer worldwide and has a very high mortality rate. Squamous dysplasia is the precursor lesion for OSCC and it can be seen during routine endoscopy with Lugol’s iodine staining. We aimed to examine the risk factors for squamous dysplasia and determine if a risk model could be constructed which would be useful in selecting apparently healthy subjects for endoscopic screening in a high risk population in Linzhou, People’s Republic of China. Subjects and methods: In this cross sectional study, 724 adult volunteers aged 40-65 years were enrolled. All subjects completed a questionnaire regarding potential environmental exposures, received physical and dental examinations, and underwent upper endoscopy with Lugol’s iodine staining and biopsy. Subjects were categorised as having or not having histologically proven squamous dysplasia/ early cancer. Risk factors for dysplasia were examined using univariate and multivariate logistic regression. The utility of the final multivariate model as a screening tool was assessed using a receiver operating characteristics curve. Results: We found that 230 of 720 subjects (32%) with complete data had prevalent squamous dysplasia. In the final multivariate model, more household members (odds ratio (OR) 1.12/member (95%confidence interval (CI) 0.99, 1.25)), a family history of cancer (OR 1.57 (95%CI 1.13-2.18)), higher systolic blood pressure OR 1.11/10 mm Hg (95%CI 1.03-1.19)), heating the home without a chimney (OR 2.22 (95%CI 1.27-3.86)), and having lost more but not all of your teeth (OR 1.91 for 12-31 teeth lost (95%CI 1.17-3.15))were associated with higher odds of having dysplasia. Higher household income (OR 0.96/100 RMB (95%CI 0.91-1.00)) was associated with a lower odds of having dysplasia. Although we found several statistically significant associations, the final model had little ability to accurately predict dysplasia status, with maximum simultaneous sensitivity and specificity values of 57%and 54%, respectively. Conclusions: We found that risk factors for dysplasia were similar to those previously identified as risk factors for OSCC in this population. The final model did a poor job of identifying subjectswho had squamous dysplasia. Other methodswill need to be developed to triage individuals to endoscopy in this high risk population.展开更多
Background: Although the incidence of cervical dysplasia in adolescents is increasing, a paucity of data exists regarding the outcomes of adolescents with Pap test abnormalities. We determined the natural history and ...Background: Although the incidence of cervical dysplasia in adolescents is increasing, a paucity of data exists regarding the outcomes of adolescents with Pap test abnormalities. We determined the natural history and outcome of adolescents with low- grade squamous intraepithelial lesions (LSIL) and highgrade squamous intraepithelial lesions (HSIL). Methods: A review of ail women aged 18 years or younger with a cytologic diagnosis of LSIL or HSIL between 1997 and 2003 was performed. Follow- up cytologic and histologic samples were evaluated. The most significant abnormality was recorded for each patient. Rates of regression, persistence, and progression were calculated. Results: A total of 646 arolescents were identified. Follow- up was available for 477 teenagers with LSIL and for 55 with HSIL. Among adolescents with LSIL, 146 (35% ) had negative follow- up. Low- grade abnormalities (atypical squamous cells of undetermined significance, LSIL, and cervical intraepithelial neoplasia grade 1) were seen in 199 (47% ), whereas high- grade abnormalities were documented in 77 (18% ). After 36 months, 62% had regressed, whereas 31% had progressive dysplasia. For the HSIL cohort, negative follow- up was documented in 12 (21.8% ) adolescents, and 15(27.3% ) had low- grade abnormalities, whereas more than one half (50.9% ) were found to have a high- grade abnormality. At 36 months, 31% of HSIL subjects had progressed to cervical intraepithelial neoplasia 3. Conclusion: Adolescents with LSIL and HSIL cytology are at significant risk for progression to high- grade cervical abnormalities. The rate of development of high- grade cervical abnormalities in adolescents is similar to adults. Adolescents with cytologic abnormalities mandate close follow- up.展开更多
文摘Background: Oesophageal squamous cell carcinoma (OSC- C) is a common cancer worldwide and has a very high mortality rate. Squamous dysplasia is the precursor lesion for OSCC and it can be seen during routine endoscopy with Lugol’s iodine staining. We aimed to examine the risk factors for squamous dysplasia and determine if a risk model could be constructed which would be useful in selecting apparently healthy subjects for endoscopic screening in a high risk population in Linzhou, People’s Republic of China. Subjects and methods: In this cross sectional study, 724 adult volunteers aged 40-65 years were enrolled. All subjects completed a questionnaire regarding potential environmental exposures, received physical and dental examinations, and underwent upper endoscopy with Lugol’s iodine staining and biopsy. Subjects were categorised as having or not having histologically proven squamous dysplasia/ early cancer. Risk factors for dysplasia were examined using univariate and multivariate logistic regression. The utility of the final multivariate model as a screening tool was assessed using a receiver operating characteristics curve. Results: We found that 230 of 720 subjects (32%) with complete data had prevalent squamous dysplasia. In the final multivariate model, more household members (odds ratio (OR) 1.12/member (95%confidence interval (CI) 0.99, 1.25)), a family history of cancer (OR 1.57 (95%CI 1.13-2.18)), higher systolic blood pressure OR 1.11/10 mm Hg (95%CI 1.03-1.19)), heating the home without a chimney (OR 2.22 (95%CI 1.27-3.86)), and having lost more but not all of your teeth (OR 1.91 for 12-31 teeth lost (95%CI 1.17-3.15))were associated with higher odds of having dysplasia. Higher household income (OR 0.96/100 RMB (95%CI 0.91-1.00)) was associated with a lower odds of having dysplasia. Although we found several statistically significant associations, the final model had little ability to accurately predict dysplasia status, with maximum simultaneous sensitivity and specificity values of 57%and 54%, respectively. Conclusions: We found that risk factors for dysplasia were similar to those previously identified as risk factors for OSCC in this population. The final model did a poor job of identifying subjectswho had squamous dysplasia. Other methodswill need to be developed to triage individuals to endoscopy in this high risk population.
文摘Background: Although the incidence of cervical dysplasia in adolescents is increasing, a paucity of data exists regarding the outcomes of adolescents with Pap test abnormalities. We determined the natural history and outcome of adolescents with low- grade squamous intraepithelial lesions (LSIL) and highgrade squamous intraepithelial lesions (HSIL). Methods: A review of ail women aged 18 years or younger with a cytologic diagnosis of LSIL or HSIL between 1997 and 2003 was performed. Follow- up cytologic and histologic samples were evaluated. The most significant abnormality was recorded for each patient. Rates of regression, persistence, and progression were calculated. Results: A total of 646 arolescents were identified. Follow- up was available for 477 teenagers with LSIL and for 55 with HSIL. Among adolescents with LSIL, 146 (35% ) had negative follow- up. Low- grade abnormalities (atypical squamous cells of undetermined significance, LSIL, and cervical intraepithelial neoplasia grade 1) were seen in 199 (47% ), whereas high- grade abnormalities were documented in 77 (18% ). After 36 months, 62% had regressed, whereas 31% had progressive dysplasia. For the HSIL cohort, negative follow- up was documented in 12 (21.8% ) adolescents, and 15(27.3% ) had low- grade abnormalities, whereas more than one half (50.9% ) were found to have a high- grade abnormality. At 36 months, 31% of HSIL subjects had progressed to cervical intraepithelial neoplasia 3. Conclusion: Adolescents with LSIL and HSIL cytology are at significant risk for progression to high- grade cervical abnormalities. The rate of development of high- grade cervical abnormalities in adolescents is similar to adults. Adolescents with cytologic abnormalities mandate close follow- up.
