• 대한세포병리학회지
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• 제15권1호
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• pp.17-27
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• 2004

To investigate a population-based survey of the prevalence of human papillomavirus (HPV) infection in South Korea, we performed Papanicolaou smears and tests for HPV DNA and anti-HPV antibody detection in 909 sexually active general women (age range; 20-74 years, median 44 years) who were randomly selected residents from S district of Busan City. The presence of DNA of 36 different HPV types was detected by means of a GP 5+/6+ primer-mediated PCR enzyme immunoassay in cervical exfoliated cells, and IgG antibodies against L1 virus-like particles (anti-VLPs) of 5 HPV types 16, 18, 31, 33, and 58 were tested by means of enzyme linked immunoassay. The incidence of cytologic abnormality was 5.2% in Pap smear. The positive rate of HPV DNA was 10.4%, high in young women younger than 35 years old and proportionally increased according to the cytologic grades. The most often found HPV type was HPV 70, followed by HPV 16 and 33, and high-risk HPV types were more frequent in women younger than 35 years old. The most common HPV type in abnormal cytologic smears was HPV 16, followed by HPV 58 and 66. Anti-VLPs was positive in 19.7% and the frequent anti-VLPs type was against HPV 18, followed by HPV 31 and 16. The concordance between the markers for each specific HPV type was noted in 10 women and HPV 16 was the most frequent one. The incidence of multiple HPV infection was 18.9% and that of multiple anti-VLPs antibodies was 31%. Among 103 self-reported virgins, 4.9% had anti-VLP antibodies.

• Asian Pacific Journal of Cancer Prevention
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• 제16권15호
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• pp.6375-6379
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• 2015

Background: Cervical cancer is the second most common cancer in women worldwide, with about 500,000 new cases and 270,000 deaths each year. Globally, it is estimated that over one million women currently have cervical cancer, most of whom have not been diagnosed, or have no access to treatment that could cure them or prolong their lives. In the United Arab Emirates (UAE) cervical cancer is the third most common cancer in women. Materials and Methods: A population-based cross-sectional retrospective survey of cervical smear abnormalities was conducted in the Emirate of Abu Dhabi, UAE, from January 2013 to December 2013 by collecting consecutive liquid-based cytology samples from the Department of Pathology at the SKMC Hospital in Abu Dhabi city. Results: The total number of women screened for cervical cancer for the year 2013 at SKMC was 4,593, with 225 (4.89%) abnormal smears. The majority of the abnormal smear results were atypical squamous cells of undetermined significance (ASCUS) 114 (2.48%). This study showed 60% increase in the rate of abnormal cervical smears in the UAE over the last 10 years. In this study the highest incidence of high grade abnormalities were seen in women above the age of 61years (1.73%), this might be due to the fact that this group of women missed the chance of screening of cervical cancer earlier in their lives or could be explained by the well-known second peak of HPV infection seen in many prevalence studies. Conclusions: We conclude that the rate of abnormal cervical smear in the screened Abu Dhabi women is not different from the rate in developed countries. A notable increase in both low and high grade abnormalities has occurred within the last decade.

• Asian Pacific Journal of Cancer Prevention
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• 제13권12호
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• pp.6203-6206
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• 2012

The aim of this study was to evaluate the outcomes of women with high-grade squamous intraepithelial lesion (HSIL) smears who had undergone the "see and treat" approach compared to those who underwent a conventional approach. The records of women with HSIL smears undergoing colposcopy at Srinagarind Hospital were reviewed. In those undergoing the conventional approach, the final histological diagnosis was made on the most severe histological results obtained after initial colposcopy. In the "see and treat" group, the final histological diagnosis was made on the examination of LEEP specimens obtained after initial colposcopy. Overtreatment in the see and treat group was defined as the LEEP specimens containing cervical intraepithelial neoplasia (CIN) 1 or less. During the study period, 302 women with HSIL underwent colposcopy. Twenty (6.6%) were nulliparous. One hundred and ninety-four (64.2%) underwent conventional management while the remaining 108 (35.8%) received the see and treat management. The prevalence of underlying high-grade lesions in women undergoing the conventional approach was significantly higher than that observed among women undergoing the see and treat approach (89.2% and 47.2%, respectively, P<0.001). The overtreatment rate in the see and treat group was 52.8%. Multivariate analysis revealed that only parity status was a statistically significant factor for predicting the overtreatment after undergoing the see and treat approach. In conclusion, the overtreatment rate among women undergoing see and treat in this study is notably high and therefore this approach should not be routinely practiced.

• Asian Pacific Journal of Cancer Prevention
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• 제16권2호
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• pp.579-583
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• 2015

This study was conducted on female patients with different gynecological problems attending the gynecology out-patient departments of two tertiary care hospitals in Peshawar city of Khyber Pakhtunkhwa, Pakistan between August 2012 and October 2013. The 200 patients had an age range of 21-65 years. Smears were taken with cervical brushes and preserved in preservative medium and processed for manual liquid based cytology (MLBC) for Pap staining. Out of 200 collected samples, 30 samples were found inadequate on cytology. Of the remaining 170 samples, 164 (96.47%) were normal, 5 (2.94%) were of atypical squamous cells of unknown significance (ASCUS) and 1 (0.6%) was of high grade squamous intraepithelial lesion (HSIL). On PCR all the samples were positive for beta globin gene fragment including those reported inadequate on cytology. Out of the 5 ASCUS samples, 2 samples were positive for HPV, one each for HPV 16 and HPV 18, and the rest of the 3 samples were negative for HPV DNA. The 1 sample of HSIL was positive for HPV 16 on PCR. Out of 164 normal samples on cytology, only 1 sample was HPV 16 positive. So overall, 4 (2%) out of 200 samples were positive for HPV DNA, where 3 were HPV 16 (1.5%), and 1 was HPV 18 (0.5%) positive, and thus the ratio of infection with of HPV 16 to HPV 18 was 3:1 in the general population. In conclusion, PCR based HPV detection is a more sensitive method for screening of HPV infection than cytology as sample inadequacy does not affect the results. However, it can be combined with cytology methods in a HPV positive female to achieve the maximum results.

• 한국컴퓨터정보학회논문지
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• 제13권3호
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• pp.179-187
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• 2008

본 논문에서는 자궁 경부 세포진 영상에서 세포핵의 후보 영역과 핵을 추출하기 위해 현미경 400배율 확대 사진을 획득하는 과정에서 훼손된 컬러 영상을 복원하기 위한 방법으로 Lighting Compensation을 적용하여 영상을 보정한다. 그리고 배경 영역과 세포핵 영역을 구분하기 위해 영상의 R,G,B 영역의 히스토그램의 분포를 이용하여 배경을 제거한다. 배경이 제거된 영상을 그레이 영상으로 변환 한 후, 히스토그램 명암도의 값을 이용하여 세포핵영역과 세포질을 분류하여 세포핵 영역을 추출한다. 그리고 Kapur 방법을 적용하여 세포핵 영역의 엔트로피 누적확률을 구한 후, 영상을 이진화한다. Kapur 방법이 적용된 이진화 영상에서 세포핵 영역의 중심과 주위 화소를 비교하는 $3{\times}3$ 마스크를 적용하여 영상의 미세한 잡음을 제거 한 후, 8 방향 윤곽선 추적 알고리즘을 적용하여 최종적으로 세포핵 영역을 추출한다. 추출된 세포핵의 영역을 분류 및 인식하는 과정으로 세포의 외각의 방향성 정보, 핵의 크기, 그리고 면적 비율의 특징을 이용하여 퍼지 소속 함수를 설계한 후, 소속 함수의 소속도를 구하고 퍼지추론 규칙을 적용하여 자궁 경부 세포진 영상에서 정상 세포핵 및 암종 세포핵을 인식한다.

• Radiation Oncology Journal
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• 제18권4호
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• pp.300-308
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• 2000

목적 :자궁경부암은 우리나라 여성에서 가장 많은 발생을 보이는 악성종양으로 비교적 완치율이 높은 것으로 알려져 있다. 자궁경부암의 치료는 병원 마다 매우 다양해졌으나 방사선에 의한 치료가 주이며 높은 완치율을 얻고있다. 치료의 실패는 대부분 3년이내에 일어나며, 국소재발시에는 자궁방 결합조직에서 더 많이 재발하는 것으로 보고되고 있다. 이에 저자들은 방사선치료를 받은 자궁경부암 환자를 대상으로 이들의 치료성적과 재발여부를 후향적으로 분석하여 생존률과 재발에 영향을 미치는 인자들을 분석하여 보았다. 대상 및 방법 : 1981년 1월 1일부터 1998년 12월 31일까지 고려대학교 방사선 종양학과에서 자궁경부암으로 방사선 치료를 받은 970명중 추적관찰이 가능했던 827명을 대상으로 하였다. 대상환자는 방사선 단독치료군과 수술후 방사선치료군으로 나누었으며 각 환자에 대하여 나이, 임상적 병기, 세포병리학적 소견, 재발유무 등이 치료결과에 미치는 영향을 알아보았고 특히 치료 후 자궁경부질세포진검사(Papanicolaou smear; Pap smear), 배아성항원(carcinoembryogenic antigen; CEA)와 편평상피 암종항원(squamous cell carcinoma antigen; SCC antigen) 수치가 생존률과 국소재발에 유의한 인자인가를 알아보았다. 결과: 전체환자의 평균나이는 51.3세(방사선 단독치료존 53.1세, 수술 후 치료곰 48.3세)였고, 평균 추적관찰기간은 38.6개월(방사선 단독치료군: 38.8개월, 수술후 치료군: 38.4개월)이었다. 방사선 단독치료군의 경우 대상환자는 521명이었고, 임상병기는 CIS; 5명, IA; 3명, IB; 36명, IIA; 77명, IIB; 284명, IIIA; 31명, IIIB; 47명, IVA; 21명, IVB; 3명, 재발암 14명이었다. 세포병리학적 소견상 편평상피암 495명, 선세포암 23명이었고 완치상태로 추적관찰된 환자는 314명(60.3$\%$), 국소재발: 47명(9$\%$), 대동맥 림프절전이; 28명(5$\%$), 폐전이: 19명(4$\%$), 골전이: 12명(2$\%$)이었다. 수술 후 치료군은 326명이었고 임상병기는 CIS; 6명, IA: 50명, IB: 181명, IIA; 46명, IIB; 43명이었다. 세포병리학적 소견상 편평상피암: 291명, 선세포앓 32명이었고, 완치상태로 추적관찰된 환자는 276명(85$\%$), 국소재발 8명(2$\%$), 대동맥 림프절전이: 7명(2$\%$), 폐전이: 10명(3$\%$), 골전이; 10(3$\%$)이었다. 전체환자를 대상으로 분석한 결과 5년 생존율은 71.2$\%$(방사선 단독치료군: 55.8$\%$, 수술 후 치료군: 88.1$\%$)였고 생존율에 있어서는 단변량분석상 임상병기(p=0.0001), 재발유무(p=0.0001), 방사선치료 후 자궁경부질세포진검(p=0.0329), CEA수치($\geq$5 ng/ml, p=0.00001), SCC수치$\geq$2 ng/ml, p=0.0001)가 의미있는 인자로 나타났고, 재발율에 있어서는 CEA가 $\geq$5 ng/ml인 경우, SCC는 $\geq$2 ng/ml인 경우가 2$\~$3배 높은 것으로 나타났다. 결론: 방사선치료 후 Pap smear, CEA, SCC는 생존율과 재발율에 모두 비교적 의미있게 작용하는 예후인자로 나타나 앞으로 방사선치료 후 환자의 추적관찰시 자궁경부암의 국소재발과 전이 그리고 생존률을 미리 예견할 수 있는 지표로 삼을 수 있을 것이다.

• 대한세포병리학회지
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• 제6권2호
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• pp.209-213
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• 1995

Primary malignant melanoma of vagina is a rare tumor which is easily misinterpretated in routine cytologic examination. We lately experienced a case of primary malignant melanoma of the vagina with direct cervical extension diagnosed by Pap smear. The cervicovaginal smear showed variable sized clusters of epithelial cells or singly scattered abnormal epithelial cells. Most of the tumor cells had round hyperchromatic nuclei with prominent nucleoli and brownish pigments in cytoplasm. The cytologic findings are compared with histologic features of resected specimen.

• Asian Pacific Journal of Cancer Prevention
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• 제15권8호
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• pp.3483-3486
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• 2014

Background: To evaluate the overtreatment rate with the see and treat approach in the management of women with abnormal cervical cytology. Materials and Methods: A retrospective review of patients with abnormal cervical cytology who underwent S&T at MSMC between January 2008 and December 2012 was conducted. Loop electrosurgical excision procedure (LEEP), histological results, cytology and colposcopic impression were analyzed to evaluate overtreatment rate, cyto-histologic correlation and related factors. Results: Average age of S&T cases was 42 years. Ninety seven percents were referred from affiliated health care providers. The study revealed 83.2% patients had HSIL or higher from cervical cytology. Correlation between HSIL and final histology was relatively low at 75% compared to other studies. Overtreatment rate was 28%. Conclusions: S&T was done in 197 patients in a tertiary care health facility with patient satisfaction. Overtreatment occurred, but the rate can be reduced with appropriate recommendations. HSIL Pap smears should be reexamined before S&T while low grade and lesser colposcopic impression groups should obtain conventional colposcopic approach for patient future reproductive benefit.

• Asian Pacific Journal of Cancer Prevention
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• 제14권8호
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• pp.4903-4906
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• 2013

Background: The purpose of this study was to determine proportional rates of cervical precancerous lesions and cancer, and associations with socio-demographic variables, HIV status, and CD4 cell count. Materials and Methods: A retrospective comparative study was conducted targeting the medical records of all women over age 18 that were diagnosed histologically through colposcopy with cervical precancerous lesions and cancer from 1 December 2011 to 30 November 2012. Results: A total of 313 patient records were used for data analysis. The average age was 39.1 (SD=2.04) years. More than a third (37.1%) of the patients had CIN III or cervical cancer. There was a significant association between age, CD4 cell count, HIV status, and cervical lesions (p<0.05). Age was found to be an influential predictor of cervical lesions (OR=0.67, 95%CI: 0.46-0.98). Conclusions: There exists an association between age and cervical lesions, with presentation of cervical precancerous lesions and cervical cancer at a younger age among HIV reactive patients. The National Guidelines should be brought in line with the National HIV Counseling and Testing Policy to offer Pap smears to all sexually active women that test HIV reactive during routine HIV Testing.

• Asian Pacific Journal of Cancer Prevention
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• 제16권4호
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• pp.1519-1523
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• 2015

Infection of the uterine cervix by human papilloma viruses (HPV) may be associated with cervical pre-cancer and invasive cervical carcinoma if left untreated. With advance in molecular techniques, it has become easier to detect the resence of HPV DNA long before the appearance of any lesion. This study concerned cervical scrape samples of 310 married non-pregnant women attending a gynecology outpatient department for both Pap and PCR testing to detect HPV DNA. Nested PCR using primers for L1 consensus gene with My9/My11 and GP6+/GP5+followed by multiplex PCR were carried out to detect HPV 16 and HPV18. Result: HPV prevalence was 11.9% out of which 3.67% cases of negative for intra-epithelial lesion or malignancy (NILM) and in 71.1% (27/38) of atypical cervical smears were HPV positive. There was increasing trend of high-risk-HPV positivity (HR HPV 16 and 18), from 20% in benign cytology (NILM) to 42.9 % in LSIL, 71.41% in HSIL and 100% in SCC. There was highly significant association of HPV infection with cervical lesion ($x^2=144.0$, p<0.01) and also with type specific HPV prevalence ($x^2=7.761^*$, p<0.05).