Lesiones Intraepiteliales Escamosas Cervicales: Conclusión

Conclusión

En el diagnóstico de las lesion intraepitelial escamosa del cervix, continúan vigentes el uso de la citología, la colposcopia y la histopatología.

Sin embargo en los casos en que no sea concluyente la evaluación histológica, el marcador p16INK4a podría ser útil para excluir lesiones no asociadas a riesgo de cáncer. Además, en LIEBG, su positividad o negatividad serviría para la toma de decisiones en tratar o no tratar, una vez conocido su riesgo de progresión. En LIEAG sería útil para determinar pronóstico de las recaídas o de curación definitiva.

Abreviaturas

ASCUS: células Escamosas Atípicas de Significancia indeterminada
LIEBG: lesión Intraepitelial escamosa de Bajo Grado
LIEAG: lesión Intraepitelial escamosa de Alto Grado
VPH AR: Virus del Papiloma Humano de Alto Riesgo

Agradecimientos:

Doctor César Redondo, Unidad de Patología Cervical y Colposcopia. Dr Sergio Giraldo, Ginecólogo, Clínica de Maternidad Rafael Calvo. Elvira Mercado e Isis Buelvas: Citohistotecnólogas, Gregorio Young, Martha Puello, Ketty Mendoza y Alexandra Martínez. Profesionales. Facultad de Medicina.

Conflictos de Intereses

Ninguno que declarar.

Financiación:

Vicerectoría de investigaciones.Universidad de Cartagena.

Referencias Bibliográficas

  • 1. Puig-Tintoré LM, et al . La infección por Papilomavirus. Documentos de Consenso SEGO 2002. https://www.aepcc.org/congreso/pdf/CONS-VPH.pdf
  • 2. P. Kohlberger, , Ch. et al . Immunohistochemical expression of laminin-5 in cervical intraepithelial neoplasia-Gynecologic Oncology 2003: 89,(3): 391-394.
  • 3. Baldin V, et al. Cyclin D1 is a nuclear protein required for cell cycle progression in G1.-..Genes and Develop 1993; 7: 812-821.
  • 4. Qiao, X; Bhuiya, Tawfiqul A. Spitzer, M. Differentiating High-Grade Cervical Intraepithelial Lesion from Atrophy in Postmenopausal Women Using Ki-67, Cyclin E, and p16INK4a Immunohistochemical Analysis. Journal of Lower Genital Tract Disease. 2005. 9(2):100-107.
  • 5. Klaes R, Friedrich T, Spitkovsky D, Ridder R, et al. Overexpression of p16INK4a as a specific marker for dysplastic and neoplastic epithelial cells of the cervix uteri. 2001 Int J Cancer; 92: 276-84.
  • 6. Tringler B, Gup CJ, Singh M, et al.. Evaluation of p16INK4aINK4a and pRb expression in cervical squamous and glandular neoplasia. Hum Pathol; 2004a 35:689-96.
  • 7. Wang J. Predictive Significance of the Alterations of p16INK4A, p14ARF, p53, and Proliferating Cell Nuclear Antigen Expression in the Progression of Cervical Cancer. 2004. Clinical Cancer Research Vol. (10), 2407-2414.
  • 8. Sano T, Oyama T, Kashiwabara K, Fukuda T, et al. Expression status of p16INK4aI protein is associated with human papillomavirus oncogenic potential in cervical and genital lesions. Am J Pathol, 1998. 153: No.6, Dec 741-8,
  • 9. Keating, Jt; Cviko, A; Riethdorf, S; et al Ki-67, Cyclin E and p16INK4 are complementary surrogate biomarkers for human papilloma virus-related cervical neoplasia. Am J Surg Pathol, 2001. 25(7): 884-891.
  • 10. Bibbo M, Klump W, Dececco J, Kovatich A. Procedurefor inmunocytochemical detection of p16INK4a antigen in Thin-Layer liquid-based specimens. 2002. Act Cytol., (46) 25-29.
  • 11. Schorge, J; Lea, J; Elias, K; Rajanbabu, R; Coleman, R; Miller, D; Ashfag, R. p16 as a molecular biomarker of cervical adenocarcinoma. Am J Obstet and Gynecol. . 2004 , (190): 668-673.
  • 12. Trunk M, Dallenbach-Hellweg G, Ridder R, Ulrich K, et al.. Morphologic characteristics of p16INK4a-positive cells in cervical cytology samples. Act Cytol., 2004, (48):771-782.
  • 13. Negri G, Vittadello F, Romano F, Kasal A , Rivasi F, Girlando S, Mian C. and Egarter-Vigl E. P16INK4a expression and progression risk of low-grade intraepithelial neoplasia of the cervix uteri. Virchows Archiv 2004.Issue: Volume 445,(6,) : 616 – 620 .
  • 14. Finegan M. p16 Expression in Squamous Lesions of the Female Genital Tract Journal of Molecular Histology. 2004. Volume 35, Number 2 Pages: 111 – 114.
  • 15. Agoff SN, Lin P, Morihara J, et al. p16INK4a Expression Correlates with Degree of Cervical Neoplasia: A comparison with Ki-67 Expression and Detection of High-Risk HPV Types. Mod Pathol 2003; 16: 665-673.
  • 16. Schneider V. Tissue Microarrays for Testing Molecular Biomarkers of Cervical Intraepithelial Neoplasia. Acta Cytol. 2006.; 50 No. 2
  • 17. Medina M. Atlas de mortalidad por cáncer en Colombia 1990, 1, Instituto Nacional de Cancerología; 1994:76-77.
  • 18. Parkin DM, Bray F, Ferlay J, Pisan P. Estimating the World cancer burden: Globocan. Int J CWancer; 2001. 94 (2):153-156.
  • 19. (19).Redondo Cesar, Herrera Sandra. 2004. Registro poblacional de Cáncer en Colombia. Instituto Nacional de Cancerología. 2004.Comunicación personal.
  • 20. Jovanovic AS, Mclachlin CM, Shen L, Welch WR, Crump CP.. Post-menopausal scuamous atipia. A spectrum including “pseudo-koilocitosis”. Mod. Pathol, 1995, 8:408-412.
  • 21. Ismail SM, Colclough AB, Dinnen JS, et al. Newcombe R Reporting cervical intra-epithelial neoplasia (CIN): intra- and interpathologist variation and factors associated with disagreement, Histopathology. 1990,Apr; 16 (4):371-6.
  • 22. Lie AK, Isaksen CV, Skarsvag S, Haugen OA. Human papillomavirus (HPV) in high-grade cervical intraepithelial neoplasia (CIN) detected by morphology and polymerase chain reaction (PCR): a cytologic correlation of 277 cases treated with laser conization. Cytopathology 1998;
  • 23. Isaksen Lie AK, Isaksen CV, Skarsvag S, Haugen OA: Human papillomavirus (HPV) in high-grade cervical intraepithelial neoplasia (CIN) detected by morphology and polymerase chain reaction (PCR): a cytohistologic correlation of 277 cases treated by laser conization. Cytopathology 1999, 10:112-121.
  • 24. Apgar B.S. Colposcopia. Principios Y Práctica.Editorial McGraw-Hill. 1ª edición (27-Nov 2002) pp 200-201.
  • 25. Illescas L, Dain N, Dino A. Epitelio blanco al ácido acético. El diagnóstico diferencial. Colposcopia; 1996. 7:141.
  • 26. Molano M et al. Low grade squamous intraepithelial lesions in Colombian women British Journal of Cancer; 2002. 87: 1417 – 1421.
  • 27. Walboomers JMM, Jacobs MV, Manos MM, et al. Human papillomavirus is a necessary cause of invasive cervical cancer world-wide. J Pathol 1999; 189: 12 – 19.
  • 28. Koutsky LA, Holmes KK, Critchlow CW, et al. cohort study of the risk of cervical intraepitelial neoplasia grade 2 or 3 in relation to papillomavirus infection. N Engl J Med; 1992. 327: 1972-8.
  • 29. Liaw KL, Glass AG, Manos MM, et al. Detection of human papillomavirus DNA in cytologically normal women and subsequent cervical squamous intraepithelial lesions. J Natl Cancer Inst; 1999. 91: 954-60.
  • 30. Nobbenhuis MAE, Helmerhorst TJM, van den Brule AJC Cytological regression and clearance of high-risk human papillomavirus in women with an abnormal cervical smear. Lancet 2001; 358: 1782-83.
  • 31. Matsuura Y, Kawagoe T, Toke N, et al. The clinical course of LGSIL correlates well with HPV infection. Acta Cytol 1998. May;42(3):625-630.
  • 32. McCluggage, W.G. Immunohistochemical and Functional Biomarkers of Value in Female Genital Tract Lesions. International Journal of Gynecological Pathology. 2006. 25(2):101-120.
  • 33. Klaes R, Benner A, Friedrich T, et al. p16INK4a Immunohistochemistry improves inteobserver agreement in the diagnosis of cervical intraepithelial neoplasia. Am J Surg Pathol 2002; 26: 1389-1399.
  • 34. Agoff SN, Mendellin JE, Grieco VS, García RI. Unexpected gynecologic neoplasms in patients with proven or suspected 13 RCA-1 or mutations, implications for gross examination, cytology and clinical follow up. Am J. Pathol. 2002 26.171-178.
  • 35. Márcia C.M. Guimarães, Maria Alice G. Gonçalves,ET al. Immunohistochemical Expression of p16INK4a and bcl-2 According to HPV Type and to the Progression of Cervical Squamous Intraepithelial Lesions Journal of Histochemistry and Cytochemistry. 2005. Volume 53 (4): 509-516.
  • 36. Apgar B.S. Colposcopia. Principios y Práctica.Editorial McGraw-Hill. 2005. 1ª edición (27-Nov 02). 200-201.
  • 37. Reeves et al., Reeves WC, Brinton LA, Garcia M, et al. Human papillomavirus infection and cervical cancer in Latin America. N Eng J Med 1989 320:1437-1441. Reeves WC, Rawls WE and Brinton LA: Epidemiology of genital papillomaviruses and cervical cancer. Rev Infect Dis 1989 11(3):426-439.
  • 38. Posso V Hector J., Liga Contra El Cancer Bogota. Universidad Militar Nueva Granada.. Vph Y Cancer Cervicouterino: El Papel De Los Factores Ambientales Y Quimicos. Vii Congreso Latinoamericano De Mutagenesis, Carcinogenesis Y Teratogenesis Ambiental. Cartagena De Indias, 2007. Agosto 28-31.
  • 39. Carozzi F, Cecchini S, Confortini M, et al. Role of P16(INK4a) expression in identifying CIN2 or more severe lesions among HPV-positive patients referred to colposcopy after abnormal cytology. Cancer 2006;108:119–23.[Medline]
  • 40. Howard M, Sellors J, Kaczorowski J. Optimizing the hybrid capture II human papillomavirus test to detect cervical intraepithelial neoplasia. Obstetrics & Gynecology. 2002;100:982-980
  • 41. Sankaranarayanan R, Gaffikin L, Jacob M, Sellors J, Robles S. A critical assessment of screening methods for cervical neoplasia. International Journal of Gynaecological Obstetrics. 2005:89(S2):S4–S12.
  • 42. Puig Tintoré LM. Detección colposcópica de la neoplasia cervical intraepitelial en mujeres con citologia negativa. Avances en Obstetricia y Ginecologia. Salvat Ed. Barcelona. ; 1984 8: 5-12.
  • 43. Wright Jr ,Thomas C., MD; L. Stewart Massad, et al. For the American Society for Colposcopy and Cervical Pathology–sponsored Consensus Conference. 2006 consensus guidelines for the management of women with cervical intraepithelial neoplasia or adenocarcinoma in situ october 2007 American Journal of Obstetrics & Gynecology.2006 www.ajog.org.
  • 44. Cuzick J, Szarewski A, Cubie H, et al. Management of women who test positive for high-risk types of human papillomavirus: the HART study. Lancet 2003; 362: 1871-1876.
  • 45. OMS.Control del cancer de cervix. 2007.
  • 46. Wright T, Lox J, Mossad L, et al Consensus Guidelines for the Management of Women with Cervical Cytological Abnormalities. Jama 2002; 287: 2120-2129.
  • 47. Wright Jr ,Thomas C., MD; L. Stewart Massad, MD; et al. For the 2006 American Society for Colposcopy and Cervical Pathology–sponsored Consensus Conference. 2006 consensus guidelines for the management of women with cervical intraepithelial neoplasia or adenocarcinoma in situ october 2007 American Journal of Obstetrics & Gynecology. www.ajog. org
  • 48. Karla R. Dzul-Rosado, Marylin Puerto-Solís, et al. Cáncer cervicouterino: métodos actuales para su detección. Rev Biomed 2004; 15:233-241.
  • 49. Monsonego, Joseph MD*; Pollini, Giuseppe MD*; et al. Detection of Human Papillomavirus Genotypes Among High-Risk Women: A Comparison of Hybrid Capture and Linear Array Tests. Sexually Transmitted Diseases: 2008 – Volume 35 – Issue 5 – pp 521-527.
  • 50. Jović Milena, Nenadić Dane, Magić Zvonko, et al. Pouzdanost CINtecTM p16INK4a citološkog imunohistohemijskog testa u skriningu prekanceroznih lezija grlića materice. Vojnosanitetski pregled – jezik rada: srpski originalan članak. 2008, vol. 65, br. 3, str. 211-219.
  • 51. Rachel Redman, Irina Rufforny, Chen Liu, etal The Utility of p16 in Discriminating Between Cervical Intraepithelial Neoplasia 1 and Nonneoplastic Equivocal Lesions of the Cervix. Archives of Pathology & Laboratory Medicine: 2008, Vol. 132, No. 5, pp. 795-799.
  • 52. Nicholas J. Mulvany1†, David G. Allen2 and Sharyn M. Wilson1, Diagnostic utility of p16INK4a: a reappraisal of its use in cervical biopsies 2008, Vol. 40, No. 4 , Pages 335-344.
  • 53. Horn, Lars-Christian MD. Immunostaining for p16INK4a Used as a Conjunctive Tool Improves Interobserver Agreement of the Histologic Diagnosis of Cervical Intraepithelial Neoplasia. American Journal of Surgical Pathology: 2008 – Volume 32 – Issue 4 – pp 502-512.
  • 54. Alexandra N Kalof and Kumarasen Cooper. Our approach to squamous intraepithelial lesions of the uterine cervix Journal of Clinical Pathology 2007;60:449-455.
  • 55. Qiao, X; Bhuiya, Tawfiqul A. Spitzer, M.. Differentiating High-Grade Cervical Intraepithelial Lesion from Atrophy in Postmenopausal Women Using Ki-67, Cyclin E, and p16INK4a Immunohistochemical Analysis. Journal of Lower Genital Tract Disease.April 2005. 9(2):100- 107.

Histopatológica

CLIC AQUÍ Y DÉJANOS TU COMENTARIO

Deja un comentario

Tu dirección de correo electrónico no será publicada. Los campos obligatorios están marcados con *