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B Lloveras

Publications and source records attributed to B Lloveras.

At least 19 recordsLinked to original sources
PubMed2005

Human papillomavirus testing for primary screening in women at low risk of developing cervical cancer. The Greek experience.

OBJECTIVE: To compare the performance of human papillomavirus (HPV) DNA detection against routine Papanicolaou smear for the detection of low- and high-grade cervical intraepithelial neoplasia in a low-risk population. MATERIALS AND METHODS: A cross-sectional study was performed involving 1296 women attending six outpatient clinics in Northern Greece (Thessaloniki, Thermi, Mihaniona, Corfu, Veria, and Serres). Women underwent a gynecological examination, including collection of exfoliated cervical cells for Papanicolaou cytology and HPV DNA detection. Cytology was processed according the conventional routine manner, and HPV DNA was determined using the polymerase chain reaction technique. In positive cases of either method, a complete colposcopic evaluation was performed with directed biopsies. Tests (HPV DNA, cytology, and colposcopy) performance characteristics were determined using the histopathologic diagnosis as the reference standard. RESULTS: HPV DNA testing showed a significantly better sensitivity than the Papanicolaou smear in detecting cervical intraepithelial neoplasia (75% versus 50% for high-grade lesions and 81.2% versus 50% for lesions of any grade, respectively). Specificity, and positive and negative predictive values did not significantly differ. Even after dividing women in younger or older than 30 years, the sensitivity of the HPV DNA test was greater than cytology (100% and 70% versus 50% for cytology in both groups, respectively), with a 6.3% loss in specificity when performed in women younger than 30 years. CONCLUSION: HPV testing could be useful in screening women at low risk for cervical cancer, either as an adjunct tool to augment existing cytology programs or as a unique test of its own.

Adolescent↗
PubMed2005

Self-sampling versus physician-sampling for human papillomavirus testing.

We evaluated the detection of human papillomavirus (HPV) infection using two sampling methods of cervical exfoliated cells, consisting of self-sampling of vaginal cells and cervical sampling performed by the physician. Women included were 379 patients of the general population attending outpatient clinics in Northern Greece for routine cytological cervical dysplasia screening. HPV DNA detection was similar with both sampling techniques. The HPV prevalences in self-collected samples were 4.7% and 3.7% in the physician-collected samples (P>0.05). The Kappa statistic for HPV DNA agreement between the two methods was 0.54 (95% Confidence interval = 0.33-0.75). Self-sampling of cervico-vaginal exfoliated cells could be used as an alternative option to test for HPV infection.

Cervix Uteri↗
PubMed2004

Cervical human papillomavirus infection in women attending gynaecological outpatient clinics in northern Greece.

Human papillomavirus (HPV) is the necessary cause for the development of invasive cervical cancer. Identification of HPV determinants may contribute to the targeting of high-risk groups for cervical cancer. The study was aimed at estimating HPV prevalence and its determinants among 1296 women attending six gynaecological outpatient clinics in northern Greece. Information was available through personal interview and the study of cervical exfoliated cells. HPV DNA was detected by reverse line-blot polymerase chain reaction using the L1 primers PGMY09/11. The overall HPV prevalence was 2.5%. After controlling for potential confounders, the two independent risk factors associated with an increased prevalence were young age and parity. The prevalence odds ratio (POR) for those younger than 27 years against those older than 42 years was 5.31 (95% confidence interval (CI)=1.53-18.44) and the POR for nulliparous women compared with women with two or more children was 4.15 (95% CI=1.35-12.76). HPV was present in 10 of 12 women with low-grade cervical intraepithelial lesions (CIN) (83.3%) and in 3 of 4 with high-grade CIN (75%). The prevalence of genital HPV infections in the study population was among the lowest ever reported internationally.

Adolescent↗
PubMed2001

Human papillomavirus genotypes in rural Mozambique.

We studied the genotype distribution of cervical human papillomavirus (HPV) infections in an age-stratified sample of 262 women in Mozambique using the PGMYO9-PGMY11 primer system in a reverse line-blot strip-based assay with high sensitivity in type-specific amplification. Despite the low precision of the estimates, we found that HPV-16 was not the dominant type. Instead, HPV 35 was the most commonly identified genotype among HPV-positive women (16/96 [17%]) and women with cervical neoplasia (7/23 [30%]). Certain genotypes might have been under-detected in previous studies, and type-specific HPV distributions might vary across populations. Therefore, the estimated proportion of cervical neoplasia that could be prevented by an HPV-16-based vaccine could be lower than expected.

Adolescent↗
PubMed2000

[Human papillomavirus and human immunodeficiency virus infections as risk factors for cervix cancer in women prisoners].

BACKGROUND: The identification of high risk groups for genital human papillomavirus (HPV) infection may contribute to cervical cancer prevention. The study was designed to estimate the prevalence of HPV infection and the related risk of cervical cancer among imprisoned women. PATIENTS AND METHODS: 157 women were visited at the Medical Office of a prison in Barcelona, Spain. Women underwent a structured interview, determination of HIV serostatus and detection of HPV cervical infection by means of PCR. RESULTS: The prevalence of HPV infection was 46%. Prostitution was reported by 38.2% and intravenous drug use by 64.3%. HIV infection was detected in 56.1%. Cervical cytology revealed 19 women with ASCUS and 28 with squamous intraepithelial lesions (SIL) (all grades). HPV infection was associated with an increased risk of intravenous drug use for more than 10 years (prevalence odds ratio [POR] = 2.9) and seropositivity to HIV (POR = 4.7). The increase in risk for SIL related to HIV was explained by the presence of HPV. HIV positive women with low CD4 counts may increase the risk for SIL independently of HPV. CONCLUSION: HIV positive women are at high risk for HPV infection and as a consequence, for developing SIL. HIV positive women should be closely monitored for cervical cancer.

Adolescent↗
PubMed2000

Bcl-2 with loss of apoptosis allows accumulation of genetic alterations: a pathway to metastatic progression in human breast cancer.

We have examined whether the extended life span of cells induced by Bcl-2 in T(1) ductal breast carcinomas might favor the acquisition and accumulation of genetic alterations that induce lymph node metastases. We analyzed the expression of c-Myc, c-erbB-2 and epidermal growth factor receptor by immuno-histochemistry in a group of 142 T(1) (<2 cm) ductal breast carcinomas embedded in paraffin, previously studied for p53 mutation and Bcl-2 over-expression. We also measured the apoptotic status and estimated the excess risk (pOR) for lymph node metastasis according to the number of accumulated oncogene alterations and Bcl-2 and p53 expression. The linear relationship between number of oncogene alterations and presence of lymph node metastasis was statistically significant in Bcl-2-positive tumors (trend test, p = 0.03), p53-mutated tumors (trend test, p = 0.08) and tumors with loss of apoptosis (trend test, p = 0.08). Very large associations (pOR > 12) between the number of oncogene alterations and lymph node metastasis were observed among Bcl-2-positive tumors that showed increased loss of apoptosis (trend test, p = 0.03). Furthermore, in p53-negative tumors, a strong linear association was found between the number of oncogene alterations and risk of lymph node metastasis among Bcl-2-positive tumors (trend test, p = 0.03). In human T(1) ductal breast carcinoma, over-expression of Bcl-2 along with loss of apoptosis might render breast cancer cells susceptible to the acquisition of additional genetic lesions related to disease progression among p53-negative tumors. Thus, in breast cancer, there are at least 2 pathways to progression: Bcl-2- and p53-dependent mechanisms.

Antibodies, Monoclonal↗
PubMed2000

Circulating HER2 extracellular domain and resistance to chemotherapy in advanced breast cancer.

To test the hypothesis of an association between HER2 and chemotherapy resistance, we performed a prospective assessment of the predictive value of the circulating HER2 extracellular domain (ECD) in patients with advanced breast carcinoma in the setting of a multicenter Phase II trial using paclitaxel and doxorubicin. Serum samples were collected from 58 patients with metastatic breast carcinoma before first-line chemotherapy for advanced disease, and the levels of circulating HER2 ECD were measured using an enzyme immunoassay. Immunohistochemistry with anti-HER2 monoclonal antibody CB11 was used to assess the overexpression of HER2 in the primary tumors. When 450 fmol/ml was used as a cutoff, 24 cases (41%) had elevated HER2 ECD levels. Elevated levels of circulating HER2 ECD were associated with the expression of HER2 in the primary tumor tissue and with the metastatic tumor burden (evaluated with the marker CA 15-3; P = 0.032 and P = 0.002, respectively) but not with variables such as menopausal status, stage at diagnosis, previous adjuvant therapy, or the number of metastatic sites. The levels of circulating HER2 ECD correlated inversely with the response to treatment. The probability of obtaining a complete response to chemotherapy was significantly lower (P = 0.021) in patients with elevated HER2 ECD levels (0%; 95% confidence interval, 0-13%) compared with patients with nonelevated HER2 (26%; 95% confidence interval, 12-45%). In addition, the duration of clinical response was significantly shorter in patients with elevated HER2 ECD, compared with the cases with nonelevated HER2 (7.5 versus 11 months; P = 0.035). In conclusion, elevated levels of circulating HER2 ECD in patients with metastatic breast cancer correlate with reduced efficacy of a paclitaxel-doxorubicin chemotherapy combination. We suggest that the poor response rate associated with HER2 expression in advanced breast cancer may not be reversed by aggressive chemotherapy alone.

Antibodies, Monoclonal↗
PubMed1998

[Detection of human papillomavirus DNA by PCR in high-risk women. Validation of a protocol].

OBJECTIVE: To validate a protocol for HPV DNA detection using PCR (polymerase chain reaction). METHOD: HPV was investigated in cervical exfoliative specimens from 93 women at high risk for HPV infection Blind comparisons of HPV DNA detection using two PCR protocols were carried out in our laboratory and a widely accepted reference laboratory. RESULTS: HPV DNA prevalence varied according to the different protocols. A good agreement with the reference protocol was reached when a reduction of the cellular amount for DNA extraction was carried out. The prevalence of HPV DNA in this population was 50.5%. All cases with dysplasia were HPV DNA positive. The HPV type distribution was as follows: 29.8% HPV 16, 17% HPV 33, 12.7% HPV 11/6, 12.7%, HPV 18, 23.4% HPV 31, 3.6% HPV 39 y 4.3% HPV 51. An underestimation of the prevalence of HPV 51 was detected by our procedure in relation to the reference laboratory. CONCLUSIONS: HPV DNA detection by PCR may increase with simple protocol modifications. Regular validation studies are important to reach good sensitivity levels.

Adult↗
PubMed1997

Ductal carcinoma in situ of the breast: correlation between histologic classifications and biologic markers.

The expression of hormone receptors (estrogen and progesterone), c-erb-B2 (neu), p53, and Ki-67) was studied by immunohistochemical analysis in a series of 94 carcinomas in situ of the breast. The tumors were classified in two (high grade vs. low grade) and three (high grade vs. intermediate grade vs. low grade) categories. High-grade carcinomas were well defined by biologic markers showing statistically significant differences for all of the parameters tested. No clear biologic distinction, however, between low-grade and intermediate-grade cancers could be obtained. Negative progesterone receptors and a high proliferative index are the best discriminant parameters for the final assignment of doubtful cases.

Adult↗
PubMed1996

Apoptosis loss and bcl-2 expression: key determinants of lymph node metastases in T1 breast cancer.

The Bcl-2 proto-oncogene extends cell survival but does not confer any proliferative advantage to cells that express it. Thus, the loss of apoptosis may have a role in progression allowing the acquisition of additional mutations. To determine whether apoptosis loss at diagnosis is associated with the metastatic advantage of ductal breast carcinomas and to examine the relationship between Bcl-2 expression, p53, and tumor cell death status, we examined tumor samples from 116 patients diagnosed with T1 (2 cm or less) breast cancer with (n = 49) or without (n = 67) lymph node metastases. Apoptosis loss in histological sections was considered when <1% of tumor nuclei were stained with terminal deoxynucleotidyl transferase labeled with biotin. We studied the expression of Bcl-2 and p53 by immunohistochemistry and in 37 p53 mutations by single-strand conformational polymorphism analysis and cycle sequencing. Multivariate logistic regression modeling was used to estimate prevalence odds ratios (pORs) for apoptosis loss and presence of lymph node metastases. Patients with marked apoptosis loss in their tumor cells were about 5 times more likely to present lymph node metastases than those with no apoptosis loss in their tumor cells (adjusted pOR, 4.7; 95% confidence interval, 1.4-15.6; trend test, P = 0.008). Bcl-2 expression was strongly associated with both apoptosis loss (pOR, 6.9; trend test, P < 0.0001) and presence of lymph node metastases (pOR, 5.7; trend test, P = 0.002). These associations were more evident in histological grade I and II tumors than in poorly differentiated histological grade III tumors and in p53-negative tumors than in p53-positive tumors. This study demonstrates for the first time that the lymphatic progression of T1 human breast cancer is strongly related to apoptosis loss.

Adult↗
PubMed1995

Bcl-2 expression is associated with lymph node metastasis in human ductal breast carcinoma.

The Bcl-2 proto-oncogene product blocks apoptosis. We retrospectively studied Bcl-2 expression in 124 primary tumors from patients diagnosed with T1 (2 cm or less) breast carcinoma with (T1N1) or without (T1N0) lymph-node metastasis. Bcl-2 protein was detected by immunohistochemistry on paraffin-embedded tissue sections. Multivariate logistic regression modeling was used to estimate prevalence odds ratios for lymph-node metastasis. Bcl-2 was widely expressed among T1 tumors showing a strong positive relationship with estrogen (ER)- and progesterone (PR)-receptor-positive tumors. However, a significant inverse correlation was seen between Bcl-2 expression and histological grade, Bcl-2 being absent in the majority of T1 undifferentiated tumors (grade-III carcinomas). Furthermore, Bcl-2 was more frequently expressed in T1N1 cases (72.2%) than in T1N0 specimens (45.7%). The odds for lymph-node metastasis in the Bcl-2-positive group was 3.6 times larger than that in the Bcl-2-negative group. The co-expression of PR significantly modified the effect of Bcl-2 on the odds for lymph-node metastasis, suggesting the existence of a synergistic interaction between the 2 parameters. We studied the percentage of dead cells in primary tumors by in situ DNA fragmentation (FDNA), and found an inverse correlation between Bcl-2 expression and FDNA. This supported the hypothesis that Bcl-2 extends cell survival. In conclusion, our study provides evidence that Bcl-2 expression is involved in breast-cancer progression, at least in a subset of well-differentiated and PR-positive tumors.

Adult↗
PubMed1994

In vitro bromodeoxyuridine labeling of malignant neoplasms. A comparative study with flow cytometry cell-cycle analysis.

Proliferative fraction has been defined as an independent prognostic marker for some malignant neoplasms. An estimate of the proliferative fraction can be obtained by cell-cycle analysis of flow cytometric DNA measurements. However, overlapping DNA distributions of aneuploid neoplasms are difficult to analyze, even with sophisticated computer programs, and results are not always reproducible. Bromodeoxyuridine (BrdUrd) labeling followed by immunohistochemical detection has been proposed as an alternative, simple, and accurate method for identifying and counting DNA synthesizing cells. In vitro BrdUrd labeling was performed on 87 tumors, including 35 lung cancers, 25 breast carcinomas, and 27 tumors of other origin. Results were compared with flow cytometric S-phase estimates in 46 cases. Mean BrdUrd labeling of lung tumors was 8.5% +/- 5.2%, compared with a mean flow cytometric S-phase fraction of 20% +/- 18.4%. Mean BrdUrd labeling of breast carcinomas was 6.8% +/- 3.8%, compared with a mean flow cytometric S-phase fraction of 12.5% +/- 9.9%. In both tumor types, BrdUrd labeling correlated well with histologic grade. Correlation between BrdUrd labeling and flow cytometric S-phase estimates were generally poor, particularly with aneuploid tumors.

Breast Neoplasms↗
PubMed1991

Evaluation of in vitro bromodeoxyuridine labeling of breast carcinomas with the use of a commercial kit.

The prognostic significance of S-phase fraction analyses of breast carcinomas has been reported by several investigators. The Cell Proliferation Kit (Amersham Corporation, Arlington Heights, IL), which uses in vitro bromodeoxyuridine (BRDU) labeling to evaluate cell cycle kinetics without a flow cytometer or radioisotopes, simplifies this assay for the clinical-based laboratory by providing standardized reagents and recommended methods. This study was performed to determine whether data derived from its use were comparable to published S-phase data from the use of thymidine labeling, BRDU, or other methods on breast carcinomas. Primary infiltrating ductal carcinomas (n = 142) and primary lobular carcinomas (n = 6) showed mean and median BRDU labeling of 4.63% and 3%, 1.3% and 1%, respectively, with a range of 0-28%. Benign lesions always had less than 3% BRDU uptake (n = 21). Estrogen receptor (ER) and progesterone receptor (PR) status correlated with BRDU labeling (P less than 0.05), with the highest S-phase fractions in ER- and PR-negative tumors. Correlations between BRDU uptake and histologic tumor type or size were observed. Significant correlations between BRDU uptake and lymph node status, patient age, or histologic tumor grade were not observed. S-phase studies of breast carcinomas using other techniques have shown similar data, therefore, the Cell Proliferation Kit appears to be a practical and useful method for in vitro S-phase analysis that allows concomitant histologic examination of the same tumor tissue sample.

Aging↗
PubMed1991

Estrogen receptors in skin appendage tumors and extramammary Paget's disease.

Determination of estrogen receptors (ER) in breast carcinoma is valuable in the management of patients. However, little is known about the presence of these receptors in other tumors. Normal skin appendages and their neoplasms, including extramammary Paget's disease (EPD), might be expected to express ER since the breast is histogenetically related to sweat glands. In this study, 41 cases of skin appendage tumors (SAT) and 11 cases of EPD were stained using the ER-ICA monoclonal kit (Abbott, Chicago, IL) with a modified technique for paraffin-embedded sections. Controls included 10 biopsies of primary breast carcinoma and 4 cases of metastatic breast carcinoma to skin, all positive for ER. None of the samples of SAT or EPD showed staining for ER. Normal skin appendages were also negative. Normal vaginal epithelium in one case of EPD showed positive nuclear staining for ER. ER determination using immunohistochemical technique in paraffin-embedded sections may be useful in the differential diagnosis between malignant SAT and metastatic breast carcinoma in the skin. The absence of ER in normal skin appendages suggests that its apparition is a feature of specialized differentiation of breast epithelium.

Adult↗
PubMed1989

Surgical outlook regarding leiomyoma of the rectum. Report of three cases.

The authors report experience with three patients with leiomyomas of the rectum between the years 1979 and 1987. Since Malassez's first description in 1872, approximately 200 cases have been reported. The diagnosis of these rare tumors is difficult. The authors present the ultrasonic characteristics of rectal leiomyoma by means of endorectal ultrasound, a method which, although not definitive, does delimit and orient the diagnosis in regard to the rectal mass and the follow-up of these tumors. A histologic diagnosis constitutes a dilemma between benign and malignant forms. The authors believe that treatment should always be surgical, realizing local extirpation when the histologic study reveals no signs of malignancy; even though it is mandatory to perform regular follow-up checkups (mainly with endorectal ultrasound) and radical treatment in regard to malignant lesions and local relapse of the anterior forms.

Adult↗