Human papillomavirus examination.

Iden­ti­fying the human papillomavirus HPV as a leading cause, along­side with developments in molecular HPV screening and HVP vaccines, resulted in an important decrease in cervical cancer mortality rates. For developing the best screening method, there are still ongoing studies which assess the per­formance of existing methods and implementation of vaccines.

The early detection of uterine cancer in the body is solely based on screening programs that require HPV testing. Identificarea papilomavirusului uman HPV ca agent etiologic principal al acestei patologii, împreună cu  dezvoltarea screeningului molecular HPV şi a vaccinului HPV au dus la scăderea incidenţei şi ceai de curățare a colonului detox prin cancer de col uterin.

În vederea conceperii celei mai bune strategii de screening, încă se cercetează performanţa metodelor actuale, dar şi implementarea human papillomavirus examination împotriva HPV.

Actualitatea în condilom anus precoce a cancerului de col uterin priveşte tranziţia spre programe de human papillomavirus examination bazate pe testarea primară a HPV. Introduction Even though it has the best developed screening system, cervical cancer is the most frequent type of gynecological cancer, still ranking the first places regarding incidence and mortality in the developing countries. Almost all cases are related to human papillomavirus HPV infections, which are sexually transmitted and explain the high incidence of cervix cancer among the population.

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Most of the infections are self-limited, only a few become persistent, causing malignant lesions. There is no treatment for HPV infection — there only exists a primary prevention by vaccination. The secondary prevention — cervical cancer screening — is used for the early detection of lesions and is represented by the Papanicolaou test Pap testwhich is recommended both for vaccinated and unvaccinated women. With the appropriate approach, through prevention, screening and treatment, this disease can be eradicated as a health public issue.

Epidemiology 2.

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The incidence and mortality of cervical cancer Incervical cancer ranked fourth in the world as frequency among women, with approximatelynew cases and representing 6. The significantly lower incidence in the developed countries highlights the screening programs success in which Pap cytology test is performed. Global estimates in According to the estimates, cervical cancer is the fourth cause of cancer among women worldwide 2.

Cervical cancer was the second most frequent type in women aged between 15 and 44 years old 3. The natural evolution of the disease Squamous cell carcinoma occurs most frequently at the squamocylindrical junction from a preexistent dysplasic lesion — due to HPV infection Bosch, — and leads to carcinoma in situ and then to an invasive malignant lesion.

The local tumor progression can be exophytic, endophytic and infiltrative when necrosis is involved. Subsequently, the human papillomavirus examination invades the ganglia near the cardinal ligaments, the anterior and posterior parameters. Once the local tumor proliferation starts, the lymphatic dissemination expands and the invasion becomes extensive to the parameters and bladder. Risk factors Cervical cancer results from persistent genital infection with HPV, rarely from other causes.

Thereupon, the major risk factors identified in the epidemiologic studies are the early onset of the sexual life, multiple sexual partners, multiparity and smoking.

Genital HPV infection is the main cause associated with cervical cancer. The infection can be transitory or persistent, the last one causing premalignant or malignant modifications. Evidence of the efficiency of the cervical cancer screening The most frequently used screening test is known as Pap test, developed by Dr. George Papanicolaou inwhen he described that the sampled human papillomavirus examination can be colored in order to evaluate the cytological abnormalities from the cervix.

Although Pap test is still the main element used to discover the early cervical lesions, it is not yet widely used. The age group for which the cervical cancer screening is recommended Because HPV has different manifestations on young women than in older women, The American College of Obstetricians and Gynecologists ACOG recommends starting the routine screening in all year-old women, regardless their sexual behaviors and risk factors, with some exceptions such human papillomavirus examination HIV-positive cases, organ transplant or immunosuppressive therapy.

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In this cases, the first screening is recommended only at the beginning of sexual life, even before 21 years old, including two Pap tests at the interval of six months, and then annually 5. Screening interval For women between 21 and 29 years old, it is recommended to perform the Pap cytology test in a liquid-based cytology medium or conventional, every two years 6.

Routine screening, including HPV test, is not recommended for this age group because the most HPV lesions regress spontaneously especially in adolescents and young women. Women between 30 and 65 years old can be examined using Pap test or HPV co-testing. In cases with negative results at three consecutive Pap tests, the screening may be repeated every three years.

In women with negative results of the cytology and HPV test, it is recommended to repeat the co-testing every five years 5.

Stopping the screening is recommended for women over 65 years old with three consecutive negative results at Pap test in the last 10 years 7.

HPV (Papilomavirusul uman) | zppp.ro

The guides recommend stopping the screening in women who have experienced total hysterectomy regardless their age. Organizing cervical cancer screening programs 3. Romanian screening policy In Romania, the organized screening for cervical cancer is made according to the recommended criteria by the European Quality Assurance Guide in Cervical Cancer Screening, every five years, for all women between 25 and 65 years old, asymptomatic, without a confirmed diagnosis of cervical cancer and with no hysterectomy.

European screening policy The European Quality Assurance Guide in Cervical Cancer Screening recommends: annual testing for the age group years old; in case of a positive result, HPV testing; follow-up of the HPV persistent infection, for the age group years old; in case of a positive result, cytological sorting. Covering a larger numbers of patients in screening programs To cover as many patients as possible into the screening programs, it is essential that the population is informed correctly and completely, understands the causes of the disease and knows the means of the available prevention.

The cervical screening test Cervical cytology is a procedure which human papillomavirus examination cervical cells exfoliation which are then fixed and analyzed under a microscope.

The test enables the evaluation of the nuclear chromatin changes and the assessment of the cellular degeneration degree. Ideally, Pap test should be performed when the patient is outside the menstrual bleeding.

Also, there must human papillomavirus examination avoided the sexual contacts, the intravaginal showers, the internal tampons and the contraceptive or pharmaceutical creams for at least hours before the test. Human papillomavirus examination is filled out a standard form with information that include the last menstrual period, the presence of pregnancy, the use of exogenous hormonal therapy, the menopause status, the existence of the abnormal uterine bleeding or a personal history of cancer or dysplasia, and the human papillomavirus examination of intrauterine devices.

Cervical brush To detect macroscopic and squamocolumnar junction lesions, it is essential to have a proper view of the cervix. Sampling is done from the transformation area. When an infection is suspected, an additional sample may be procured to detect the infection after the Pap sampling.

There are three types of devices used for cervical brush: spatula, plastic brush and endocervical brushes. Spatula is used for preferential sampling from the ectocervix.

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It is oriented by the cervical outline and the cervix surface is scraped by at least one complete rotation. The plastic brush with long bristles is surrounded by short bristles.

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With this type of device it is recommended to perform approximately five complete rotations in the same direction. The endocervical brush is used together with the spatula, only after the ectocervix sample was prelevated with the spatula. The brush is inserted endocervically, leaving only the last layer of bristles visible.

Screeningul cancerului de col uterin

The brush should be rotated so that it makes contact with the entire wall of the cervix canal. The quality of cervical brushing The papillomavirus meme avec preservatif can be evaluated when it has an adequate number of squamous cells, cells from the transformation zone. A probe is considered unsatisfactory if in the cervical smear the squamous epithelial component is inappropriate or insufficient.

Durată eliberare rezultat: 11 zile lucrătoare estimare valabilă doar pentru  centrele din București Pregătire pentru recoltare: verifică  aici  ghidul de pregătire pentru probele ginecologice. Citologie cervico-vaginala Babes — Papanicolaou in mediu lichid Testul HPV efectuat pe platforma automată Cobas Roche Diagnostics detectează printr-o metodă real-time PCR 14 genotipuri HPV cu risc crescut cu identificarea concomitentă a genotipurilor 16 și 18 alături de grupul celorlalte 12 tipuri oncogene: 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 66 și

Liquid medium sampling Sampling in liquid medium is performed with special devices which have a detachable tip and are transferred to a container with conservation solution and then sent to the laboratory. Interpretation of cervical cytology results. Atypical squamous cells of undetermined significance ASC-US represents an epithelial abnormality diagnosed when the degree of nuclear atypia is not sufficient for intraepithelial squamous lesions.

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Atypical squamous cells cannot exclude a high-grade lesion ASC-H. This type of result describe cellular changes which do not meet the cytological criteria for a high-grade intraepithelial squamous lesion, but such a lesion cannot be excluded.

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Twenty-three percent of them remain persistent and 1. The glandular cells abnormalities AGC observed on cytological samples can be associated to glandular or squamous cells abnormalities, including cervical or endometrial adenocarcinoma. Nonmalignant lesions.

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Some changes may guide the diagnosis for the presence of microorganisms such as Trichomonas vaginalis, Candida, Actinomyces and herpes simplex virus, or suggestive changes for bacterial vaginitis. Colposcopy Colposcopy is a procedure which allows the examination of the inferior anogenital tract with the help of a binocular microscope, in order to identify preinvasive and invasive neoplastic lesions with subsequent biopsy.

It represents the gold standard in the evaluation of paraziți de șoarece patients with abnormal immagini del papilloma sirop nikvorm uomo results. Under colposcopic observation, the ectocervix suspected lesions can be biopsied using the Tischler biopsy forceps.

The biopsy should be taken from places where emergency hemostasis can be provided. In this case, there are recommended to repeat the cytology after human papillomavirus examination and 12 months, colposcopy and HPV testing.

If it turns negative, co-testing is repeated after three years. If it turns positive, the patient is directed to colposcopy.

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Monitoring LSIL patients. Colposcopy is recommended. In case of adolescents, the cytology is repeated yearly, and in women who have reached menopause human papillomavirus examination are recommended HPV testing and repeating the cytology after 6 and 12 months. For women over 35 years old with bleeding or atypical endometrial cells, endometrial biopsy is recommended.

Modern methods of screening 9. According to the World Health Organization, HPV testing is now proposed as the main screening instrument for cervical cancer. In a study made for evaluating the efficacy of the cervical cancer prevention, the most cost-effective strategy was to combine the vaccination with an organized screening human papillomavirus examination, using primary HPV testing with cytological sorting every five years The age when HPV testing can be stopped is important.

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European guidelines suggest that primary HPV screening may be stopped at the same recommended age as cytology, 65 years old, if the most recent screening test is negative. The follow-up of HPV-positive patients by cervical cytology and colposcopy depending on the presence or absence of high-risk strains European guidelines recommend human papillomavirus examination in case of HPV-positive patients, cytology should be performed as the main triage test, which decreases the excessive number of requests for colposcopy.

Thereby, only HPV-positive patients with cytological abnormalities are immediately directed to colposcopy.

Unele tipuri pot cauza aparitia de leziuni pe piele, in timp ce alte tipuri provoaca boli cu transmitere sexuala BTSdintre care unele sunt insotite de aparitia verucilor genitale condiloame. Infectiile cu HPV pot fi raspandite prin sex oral, genital si anal si sunt foarte frecvente in randul femeilor si barbatilor tineri. De obicei, acestea sunt benigne.

The performance of the screening test False negative results may appear due to incorrect sampling, incorrect display on the glass slide conventional testincorrect processing in the cytology laboratory, or to incorrect interpretation by the cytologist. Conflict of interests: The authors declare no conflict of interests.

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