The objective of this study is to guide a triage for the management of cervical high-grade squamous intraepithelial lesion （HSIL） patients with positive margin by conization. Clinico-pathological data of HSIL patien...The objective of this study is to guide a triage for the management of cervical high-grade squamous intraepithelial lesion （HSIL） patients with positive margin by conization. Clinico-pathological data of HSIL patients with positive margin by conization were retrospectively collected from January 2009 to December 2014. All patients underwent secondary conization or hysterectomy within 6 months. The rate of residual lesion was calculated, and the factors associated with residual lesion were analyzed by univariate and multivariate analyses. Among a total of 119 patients, 56 （47.06%） patients presented residual HSIL in their subsequent surgical specimens, including 4 cases of invasive cervical carcinoma （3 stage IA1 and 1 stage IA2 patients）. Univariate analysis showed that patient age 〉 35 years （P = 0.005）, menopausal period 〉 5 years （P = 0.0035）, and multiple- quadrant involvement （P=0.001） were significantly correlated with residual disease; however, multivariate analysis revealed that multiple-quadrant involvement （P=0.001; OR, 3.701; 95%CI, 1.496-9.154） was an independent risk factor for residua! disease. Nearly half of HSIL patients with positive margin by conization were disease-free in subsequent surgical specimens, and those with multiple positive margins may consider re- conization or re-assessment.展开更多
High-grade squamous intraepithelial lesion(HSIL)is regarded as a serious precancerous state of cervix,and it is easy to progress into cervical invasive carcinoma which highlights the importance of earlier diagnosis an...High-grade squamous intraepithelial lesion(HSIL)is regarded as a serious precancerous state of cervix,and it is easy to progress into cervical invasive carcinoma which highlights the importance of earlier diagnosis and treatment of cervical lesions.Pathologists examine the biopsied cervical epithelial tissue through a microscope.The pathological examination will take a long time and sometimes results in high inter-and intra-observer variability in outcomes.Polarization imaging techniques have broad application prospects for biomedical diagnosis such as breast,liver,colon,thyroid and so on.In our team,we have derived polarimetry feature parameters(PFPs)to characterize microstructural features in histological sections of breast tissues,and the accuracy for PFPs ranges from 0.82 to 0.91.Therefore,the aim of this paper is to distinguish automatically microstructural features between HSIL and cervical squamous cell carcinoma(CSCC)by means of polarization imaging techniques,and try to provide quantitative reference index for patho-logical diagnosis which can alleviate the workload of pathologists.Polarization images of the H&E stained histological slices were obtained by Mueller matrix microscope.The typical path-ological structure area was labeled by two experienced pathologists.Calculate the polarimetry basis parameter(PBP)statistics for this region.The PBP statistics(stat PBPs)are screened by mutual information(MI)method.The training method is based on a linear discriminant analysis(LDA)classier whichnds the most simplied linear combination from these stat PBPs and the accuracy remains constant to characterize the specic microstructural feature quantitatively in cervical squamous epithelium.We present results from 37 clinical patients with analysis regions of cervical squamous epithelium.The accuracy of PFP for recognizing HSIL and CSCC was 83.8%and 87.5%,respectively.This work demonstrates the ability of PFP to quantitatively charac-terize the cervical squamous epithelial lesions in the H&E pathological sections.Signicance:Polarization detection technology provides an effcient method for digital pathological diagnosis and points out a new way for automatic screening of pathological sections.展开更多
High-resolution anoscopy(HRA) is a procedure where patients with an increased risk of anal cancer, like men who have sex with men, human immunodeficiency virus infected individuals, transplant patients and women with ...High-resolution anoscopy(HRA) is a procedure where patients with an increased risk of anal cancer, like men who have sex with men, human immunodeficiency virus infected individuals, transplant patients and women with a history of lower genital tract neoplasia, with abnormal anal cytology results, are submitted to anal and perianal visualization under magnification. This willallow for a better detection of anal high-grade lesions that can be treated, in an effort to prevent anal cancer. Anal cancer screening follows the same principles that cervical cancer screening. During this procedure, an anoscope is inserted and a colposcope is used to examine systematically the squamocolumnar junction, the transformation zone and the perianal skin. Initially the observation is done with no staining and then with the application of acetic acid and Lugol's iodine solution, allowing for better lesion identification and characterization. Any suspicious lesion seen should be carefully evaluated and biopsied. Without HRA only a small percentage of suspicious lesions are identified. High-grade lesions that are detected can be ablated under HRA. This is a challenging exam to perform, with a long learning curve and the number of clinicians performing it is limited, although the growing number of patients that need to been screened. Specific equipment is required, with these patients ideally been followed by a multidisciplinary team, in a reference centre. HRA remains unfamiliar for many gastroenterologists.展开更多
BACKGROUND A large cervical cyst with a cervical high-grade squamous intraepithelial lesion arising from the cervical stump is rare.After supracervical hysterectomy,there is a risk of various lesions occurring in the ...BACKGROUND A large cervical cyst with a cervical high-grade squamous intraepithelial lesion arising from the cervical stump is rare.After supracervical hysterectomy,there is a risk of various lesions occurring in the cervical stump.We review the types and characteristics of cervical stump lesions and compare total hysterectomy with subtotal hysterectomy.Gynecologists should choose the most suitable surgical method based on both the patient’s condition and wishes.If the cervix is retained,patients require a close follow-up.CASE SUMMARY A 57-year-old woman was admitted to the Gynecology Department for a large pelvic mass.Her chief complaint was abdominal distention for two months.She had undergone subtotal supracervical hysterectomy for leiomyoma 14 years prior.Abdominal ultrasonography detected a 9.1 cm×8.5 cm×8.4 cm anechoic mass with silvery fluid in the pelvic cavity and high-risk human papilloma virus 53(HPV53)was positive.The admission diagnosis we first considered was a pelvic mass mimicking carcinoma of the cervical stump.We performed a laparotomy and a rapid frozen biopsy was suggestive of a fibrous cyst wall coated with a high squamous intraepithelial lesion.The pelvic mass was removed,and a bilateral adnexectomy was implemented.Final pathology confirmed that the pelvic mass was a large inflammatory cyst with a cervical high-grade squamous intraepithelial lesion.After successful intervention,the patient was discharged one week after surgery and there was no recurrence of the vaginal stump at 43 mo.CONCLUSION When addressing benign uterine diseases,gynecologists should pay adequate attention to retaining the cervix.If the cervix is retained,patients require a close follow-up.展开更多
文摘The objective of this study is to guide a triage for the management of cervical high-grade squamous intraepithelial lesion （HSIL） patients with positive margin by conization. Clinico-pathological data of HSIL patients with positive margin by conization were retrospectively collected from January 2009 to December 2014. All patients underwent secondary conization or hysterectomy within 6 months. The rate of residual lesion was calculated, and the factors associated with residual lesion were analyzed by univariate and multivariate analyses. Among a total of 119 patients, 56 （47.06%） patients presented residual HSIL in their subsequent surgical specimens, including 4 cases of invasive cervical carcinoma （3 stage IA1 and 1 stage IA2 patients）. Univariate analysis showed that patient age 〉 35 years （P = 0.005）, menopausal period 〉 5 years （P = 0.0035）, and multiple- quadrant involvement （P=0.001） were significantly correlated with residual disease; however, multivariate analysis revealed that multiple-quadrant involvement （P=0.001; OR, 3.701; 95%CI, 1.496-9.154） was an independent risk factor for residua! disease. Nearly half of HSIL patients with positive margin by conization were disease-free in subsequent surgical specimens, and those with multiple positive margins may consider re- conization or re-assessment.
基金the Guangming District Economic Development Special Fund(2020R01043)。
文摘High-grade squamous intraepithelial lesion(HSIL)is regarded as a serious precancerous state of cervix,and it is easy to progress into cervical invasive carcinoma which highlights the importance of earlier diagnosis and treatment of cervical lesions.Pathologists examine the biopsied cervical epithelial tissue through a microscope.The pathological examination will take a long time and sometimes results in high inter-and intra-observer variability in outcomes.Polarization imaging techniques have broad application prospects for biomedical diagnosis such as breast,liver,colon,thyroid and so on.In our team,we have derived polarimetry feature parameters(PFPs)to characterize microstructural features in histological sections of breast tissues,and the accuracy for PFPs ranges from 0.82 to 0.91.Therefore,the aim of this paper is to distinguish automatically microstructural features between HSIL and cervical squamous cell carcinoma(CSCC)by means of polarization imaging techniques,and try to provide quantitative reference index for patho-logical diagnosis which can alleviate the workload of pathologists.Polarization images of the H&E stained histological slices were obtained by Mueller matrix microscope.The typical path-ological structure area was labeled by two experienced pathologists.Calculate the polarimetry basis parameter(PBP)statistics for this region.The PBP statistics(stat PBPs)are screened by mutual information(MI)method.The training method is based on a linear discriminant analysis(LDA)classier whichnds the most simplied linear combination from these stat PBPs and the accuracy remains constant to characterize the specic microstructural feature quantitatively in cervical squamous epithelium.We present results from 37 clinical patients with analysis regions of cervical squamous epithelium.The accuracy of PFP for recognizing HSIL and CSCC was 83.8%and 87.5%,respectively.This work demonstrates the ability of PFP to quantitatively charac-terize the cervical squamous epithelial lesions in the H&E pathological sections.Signicance:Polarization detection technology provides an effcient method for digital pathological diagnosis and points out a new way for automatic screening of pathological sections.
文摘High-resolution anoscopy(HRA) is a procedure where patients with an increased risk of anal cancer, like men who have sex with men, human immunodeficiency virus infected individuals, transplant patients and women with a history of lower genital tract neoplasia, with abnormal anal cytology results, are submitted to anal and perianal visualization under magnification. This willallow for a better detection of anal high-grade lesions that can be treated, in an effort to prevent anal cancer. Anal cancer screening follows the same principles that cervical cancer screening. During this procedure, an anoscope is inserted and a colposcope is used to examine systematically the squamocolumnar junction, the transformation zone and the perianal skin. Initially the observation is done with no staining and then with the application of acetic acid and Lugol's iodine solution, allowing for better lesion identification and characterization. Any suspicious lesion seen should be carefully evaluated and biopsied. Without HRA only a small percentage of suspicious lesions are identified. High-grade lesions that are detected can be ablated under HRA. This is a challenging exam to perform, with a long learning curve and the number of clinicians performing it is limited, although the growing number of patients that need to been screened. Specific equipment is required, with these patients ideally been followed by a multidisciplinary team, in a reference centre. HRA remains unfamiliar for many gastroenterologists.
基金Supported by National Natural Science Foundation of China,No.81772790 and No.81602293Postgraduate Innovation Fund of 13th Five-year Comprehensive Investment,Tianjin Medical University,No.YJSCX201812
文摘BACKGROUND A large cervical cyst with a cervical high-grade squamous intraepithelial lesion arising from the cervical stump is rare.After supracervical hysterectomy,there is a risk of various lesions occurring in the cervical stump.We review the types and characteristics of cervical stump lesions and compare total hysterectomy with subtotal hysterectomy.Gynecologists should choose the most suitable surgical method based on both the patient’s condition and wishes.If the cervix is retained,patients require a close follow-up.CASE SUMMARY A 57-year-old woman was admitted to the Gynecology Department for a large pelvic mass.Her chief complaint was abdominal distention for two months.She had undergone subtotal supracervical hysterectomy for leiomyoma 14 years prior.Abdominal ultrasonography detected a 9.1 cm×8.5 cm×8.4 cm anechoic mass with silvery fluid in the pelvic cavity and high-risk human papilloma virus 53(HPV53)was positive.The admission diagnosis we first considered was a pelvic mass mimicking carcinoma of the cervical stump.We performed a laparotomy and a rapid frozen biopsy was suggestive of a fibrous cyst wall coated with a high squamous intraepithelial lesion.The pelvic mass was removed,and a bilateral adnexectomy was implemented.Final pathology confirmed that the pelvic mass was a large inflammatory cyst with a cervical high-grade squamous intraepithelial lesion.After successful intervention,the patient was discharged one week after surgery and there was no recurrence of the vaginal stump at 43 mo.CONCLUSION When addressing benign uterine diseases,gynecologists should pay adequate attention to retaining the cervix.If the cervix is retained,patients require a close follow-up.
