Vol 17, No 6 (2021)
Review paper
Published online: 2021-10-08

open access

Page views 6163
Article views/downloads 1473
Get Citation

Connect on Social Media

Connect on Social Media

Precancerous lesions of the cervix — aetiology, classification, diagnosis, prevention

Yavor Kornovski12, Stanislav Slavchev12, Stoyan Kostov2, Yonka Ivanova12, Angel Yordanov3
Oncol Clin Pract 2021;17(6):271-276.

Abstract

The present review introduces the aetiology and classification of cervical precancers. The principles of diagnosis based on colposcopy are reviewed. The indications for colposcopy and targeted biopsy are steps in the diagnostic process of cervical precancers. Prophylaxis of these diseases prevents cervical cancer as high-grade precancerous lesions represent a direct precursor to cervical cancer. The basics of primary and secondary prevention, the types of screening, and the behaviour of the already-alerted patients after different screenings are presented.

Article available in PDF format

View PDF Download PDF file

References

  1. Ibeanu OA. Molecular pathogenesis of cervical cancer. Cancer Biol Ther. 2011; 11(3): 295–306.
  2. Asiaf A, Ahmad ST, Mohammad SO, et al. Review of the current knowledge on the epidemiology, pathogenesis, and prevention of human papillomavirus infection. Eur J Cancer Prev. 2014; 23(3): 206–224.
  3. Castle PE, Aslam S, Behrens C. Cervical Precancer and Cancer Risk by Human Papillomavirus Status and Cytologic Interpretation: Implications for Risk-Based Management. Cancer Epidemiol Biomarkers Prev. 2016; 25(12): 1595–1599.
  4. Park KJ, Soslow RA. Current concepts in cervical pathology. Arch Pathol Lab Med. 2009; 133(5): 729–738.
  5. Cantor SB, Atkinson EN, Cardenas-Turanzas M, et al. Natural history of cervical intraepithelial neoplasia: a meta-analysis. Acta Cytol. 2005; 49(4): 405–415.
  6. Johnson DB, Rowlands CJ. Diagnosis and treatment of cervical intraepithelial neoplasia in general practice. BMJ. 1989; 299(6707): 1083–1086.
  7. Long H, Laack N, Gostout B. Prevention, Diagnosis, and Treatment of Cervical Cancer. Mayo Clinic Proceedings. 2007; 82(12): 1566–1574.
  8. Zeqiri F, Paçarada M, Kongjeli N, et al. The importance of colposcopy in the prevention of cervical malignancies. Int J Gynaecol Obstet. 2010; 110(2): 149–150.
  9. Massad LS. Negative colposcopy reduces precancer risk after low-grade cytology. BJOG. 2015; 122(3): 387.
  10. Brown BH, Tidy JA. The diagnostic accuracy of colposcopy - A review of research methodology and impact on the outcomes of quality assurance. Eur J Obstet Gynecol Reprod Biol. 2019; 240: 182–186.
  11. Zeqiri F, Paçarada M, Zeqiri V, et al. Colposcopy and Cytodiagnosis in the Prevention of Cervical Malignancies. Nigerian Journal of Medicine. 2010; 19(2).
  12. Świderska-Kiec J, Czajkowski K, Zaręba-Szczudlik J, et al. Comparison of HPV Testing and Colposcopy in Detecting Cervical Dysplasia in Patients With Cytological Abnormalities. In Vivo. 2020; 34(3): 1307–1315.
  13. Luesley D, Downey G. Value of normal colposcopy after an abnormal cervical smear report. J Low Genit Tract Dis. 2009; 13(1): 33–37.
  14. Nakamura Y, Matsumoto K, Satoh T, et al. Optimizing biopsy procedures during colposcopy for women with abnormal cervical cancer screening results: a multicenter prospective study. Int J Clin Oncol. 2015; 20(3): 579–585.
  15. Gitsch G, Reinthaller A, Tatra G, et al. Diagnosis of cervical intraepithelial neoplasia and human papillomavirus infection: punch biopsy versus cervical smear. Arch Gynecol Obstet. 1991; 249(4): 179–184.
  16. Barker B, Garcia F, Lozevski J, et al. The correlation between colposcopically directed cervical biopsy and loop electrosurgical excision procedure pathology and the effect of time on that agreement. Gynecol Oncol. 2001; 82(1): 22–26.
  17. Heatley MK, Bury JP. The correlation between the grade of dyskaryosis on cervical smear, grade of cervical intraepithelial neoplasia (CIN) on punch biopsy and the final histological diagnosis on cone biopsies of the cervix. Cytopathology. 1998; 9(2): 93–99.
  18. Arbyn M, Xu L, Simoens C, et al. Prophylactic vaccination against human papillomaviruses to prevent cervical cancer and its precursors. Cochrane Database Syst Rev. 2018; 5: CD009069.
  19. Arbyn M, Xu L. Efficacy and safety of prophylactic HPV vaccines. A Cochrane review of randomized trials. Expert Rev Vaccines. 2018; 17(12): 1085–1091.
  20. Sawaya GF, Smith-McCune K. Cervical Cancer Screening. Obstet Gynecol. 2016; 127(3): 459–467.
  21. Brousseau EC, Ahn S, Matteson KA. Cervical Cancer Screening Access, Outcomes, and Prevalence of Dysplasia in Correctional Facilities: A Systematic Review. J Womens Health (Larchmt). 2019; 28(12): 1661–1669.
  22. Arbyn M, Ronco G, Anttila A, et al. Evidence regarding human papillomavirus testing in secondary prevention of cervical cancer. Vaccine. 2012; 30 Suppl 5: F88–F99.
  23. Ronco G, Dillner J, Elfström KM, et al. International HPV screening working group. Efficacy of HPV-based screening for prevention of invasive cervical cancer: follow-up of four European randomised controlled trials. Lancet. 2014; 383(9916): 524–532.
  24. Lindroth Y, Borgfeldt C, Thorn G, et al. Population-based primary HPV mRNA cervical screening compared with cytology screening. Prev Med. 2019; 124: 61–66.
  25. Polman NJ, Veldhuijzen NJ, Heideman DAM, et al. Management of HPV-positive women in cervical screening using results from two consecutive screening rounds. Int J Cancer. 2019; 144(9): 2339–2346.
  26. Polman NJ, Snijders PJF, Kenter GG, et al. HPV-based cervical screening: Rationale, expectations and future perspectives of the new Dutch screening programme. Prev Med. 2019; 119: 108–117.
  27. Dovnik A, Repše-Fokter A. p16/Ki-67 immunostaining in the triage of young women with LSIL, ASC-US, and ASC-H cytology. Diagn Cytopathol. 2020; 48(1): 96–97.
  28. Zhu Y, Ren C, Yang Li, et al. Performance of p16/Ki67 immunostaining, HPV E6/E7 mRNA testing, and HPV DNA assay to detect high-grade cervical dysplasia in women with ASCUS. BMC Cancer. 2019; 19(1): 271.
  29. Bogani G, Serati M, Leone Roberti Maggiore U, et al. Cervical intraepithelial neoplasia in women who had vaccination against HPV. Int J Gynaecol Obstet. 2019; 147(2): 233–237.
  30. Canfell K. Towards the global elimination of cervical cancer. Papillomavirus Res. 2019; 8: 100170.
  31. Nkwabong E, Laure Bessi Badjan I, Sando Z. Pap smear accuracy for the diagnosis of cervical precancerous lesions. Trop Doct. 2019; 49(1): 34–39.
  32. Apgar BS, Brotzman G. Management of cervical cytologic abnormalities. Am Fam Physician. 2004; 70(10): 1905–1916.