Publications
243 results found
Mitra A, MacIntyre D, lee YS, et al., 2015, Cervical intraepithelial neoplasia disease progression is associated with increased vaginal microbiome diversity, Scientific Reports, Vol: 5, ISSN: 2045-2322
Persistent infection with oncogenic Human Papillomavirus (HPV) is necessary for cervical carcinogenesis. Although evidence suggests that the vaginal microbiome plays a functional role in the persistence or regression of HPV infections, this has yet to be described in women with cervical intra-epithelial neoplasia (CIN). We hypothesised that increasing microbiome diversity is associated with increasing CIN severity. llumina MiSeq sequencing of 16S rRNA gene amplicons was used to characterise the vaginal microbiota of women with low-grade squamous intra-epithelial lesions (LSIL; n = 52), high-grade (HSIL; n = 92), invasive cervical cancer (ICC; n = 5) and healthy controls (n = 20). Hierarchical clustering analysis revealed an increased prevalence of microbiomes characterised by high-diversity and low levels of Lactobacillus spp. (community state type-CST IV) with increasing disease severity, irrespective of HPV status (Normal = 2/20,10%; LSIL = 11/52,21%; HSIL = 25/92,27%; ICC = 2/5,40%). Increasing disease severity was associated with decreasing relative abundance of Lactobacillus spp. The vaginal microbiome in HSIL was characterised by higher levels of Sneathia sanguinegens (P < 0.01), Anaerococcus tetradius (P < 0.05) and Peptostreptococcus anaerobius (P < 0.05) and lower levels of Lactobacillus jensenii (P < 0.01) compared to LSIL. Our results suggest advancing CIN disease severity is associated with increasing vaginal microbiota diversity and may be involved in regulating viral persistence and disease progression.
Kyrgiou M, Mitra A, Arbyn M, et al., 2015, FERTILITY AND EARLY PREGNANCY OUTCOMES AFTER TREATMENT FOR CERVICAL INTRAEPITHELIAL NEOPLASIA: SYSTEMATIC REVIEW AND META-ANALYSIS, INTERNATIONAL JOURNAL OF GYNECOLOGICAL CANCER, Vol: 25, Pages: 321-321, ISSN: 1048-891X
Mitra A, MacIntyre DA, Lee YS, et al., 2015, THE VAGINAL MICROBIOME OF WOMEN WITH CERVICAL INTRAEPITHELIAL NEOPLASIA, INTERNATIONAL JOURNAL OF GYNECOLOGICAL CANCER, Vol: 25, Pages: 976-977, ISSN: 1048-891X
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- Citations: 3
Kyrgiou M, Swart A-M, Qian W, et al., 2015, A Comparison of Outcomes Following Laparoscopic and Open Hysterectomy With or Without Lymphadenectomy for Presumed Early-Stage Endometrial Cancer <i>Results From the Medical Research Council ASTEC Trial</i>, INTERNATIONAL JOURNAL OF GYNECOLOGICAL CANCER, Vol: 25, Pages: 1424-1436, ISSN: 1048-891X
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- Citations: 18
Nasser S, Lazaridis A, Jones B, et al., 2015, CORRELATION OF PRE-OPERATIVE CT FINDINGS WITH SURGICAL & HISTOLOGICAL TUMOR DISSEMINATION PATTERNS AT CYTOREDUCTION FOR ADVANCED OVARIAN CANCER: A RETROSPECTIVE EVALUATION, INTERNATIONAL JOURNAL OF GYNECOLOGICAL CANCER, Vol: 25, Pages: 502-502, ISSN: 1048-891X
Kyrgiou M, Mitra A, Arbyn M, et al., 2015, Fertility and early pregnancy outcomes after conservative treatment for cervical intraepithelial neoplasia, Cochrane Database of Systematic Reviews, Vol: 9, ISSN: 1469-493X
BACKGROUND: Cervical intra-epithelial neoplasia (CIN) typically occurs in young women of reproductive age. Although several studies have reported the impact that cervical conservative treatment may have on obstetric outcomes, there is much less evidence for fertility and early pregnancy outcomes. OBJECTIVES: To assess the effect of cervical treatment for CIN (excisional or ablative) on fertility and early pregnancy outcomes. SEARCH METHODS: We searched in January 2015 the following databases: the Cochrane Gynaecological Cancer Specialised Register, Cochrane Central Register of Controlled Trials (CENTRAL; The Cochrane Library, Issue 12, 2014), MEDLINE (up to November week 3, 2014) and EMBASE (up to week 52, 2014). SELECTION CRITERIA: We included all studies reporting on fertility and early pregnancy outcomes (less than 24 weeks of gestation) in women with a history of CIN treatment (excisional or ablative) as compared to women that had not received treatment. DATA COLLECTION AND ANALYSIS: Studies were classified according to the treatment method used and the fertility or early pregnancy endpoint. Pooled risk ratios (RR) and 95% confidence intervals (CI) were calculated using a random-effects model and inter-study heterogeneity was assessed with I(2). Two review authors (MK, AM) independently assessed the eligibility of retrieved papers and risk of bias. The two review authors then compared their results and any disagreements were resolved by discussion. If still unresolved, a third review author (MA) was involved until consensus was reached. MAIN RESULTS: Fifteen studies (2,223,592 participants - 25,008 treated and 2,198,584 untreated) that fulfilled the inclusion criteria for this review were identified from the literature search. The meta-analysis demonstrated that treatment for CIN did not adversely affect the chances of conception. The overall pregnancy rate was higher for treated (43%) versus untreated women (38%; RR 1.29, 95% CI 1.02 to 1.64; 4 studies, 38,050
Theophilou G, Paraskevaidi M, Lima KMG, et al., 2015, Extracting biomarkers of commitment to cancer development: potential role of vibrational spectroscopy in systems biology, EXPERT REVIEW OF MOLECULAR DIAGNOSTICS, Vol: 15, Pages: 693-713, ISSN: 1473-7159
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- Citations: 15
Pouliakis A, Karakitsou E, Chrelias C, et al., 2015, The Application of Classification and Regression Trees for the Triage of Women for Referral to Colposcopy and the Estimation of Risk for Cervical Intraepithelial Neoplasia: A Study Based on 1625 Cases with Incomplete Data from Molecular Tests, Biomed Research International, Vol: 2015, ISSN: 2314-6133
Objective. Nowadays numerous ancillary techniques detecting HPV DNA and mRNA compete with cytology; however no perfect test exists; in this study we evaluated classification and regression trees (CARTs) for the production of triage rules and estimate the risk for cervical intraepithelial neoplasia (CIN) in cases with ASCUS+ in cytology. Study Design. We used 1625 cases. In contrast to other approaches we used missing data to increase the data volume, obtain more accurate results, and simulate real conditions in the everyday practice of gynecologic clinics and laboratories. The proposed CART was based on the cytological result, HPV DNA typing, HPV mRNA detection based on NASBA and flow cytometry, p16 immunocytochemical expression, and finally age and parous status. Results. Algorithms useful for the triage of women were produced; gynecologists could apply these in conjunction with available examination results and conclude to an estimation of the risk for a woman to harbor CIN expressed as a probability. Conclusions. The most important test was the cytological examination; however the CART handled cases with inadequate cytological outcome and increased the diagnostic accuracy by exploiting the results of ancillary techniques even if there were inadequate missing data. The CART performance was better than any other single test involved in this study.
Kyrgiou M, Valasoulis G, Stasinou S-M, et al., 2015, Proportion of cervical excision for cervical intraepithelial neoplasia as a predictor of pregnancy outcomes, INTERNATIONAL JOURNAL OF GYNECOLOGY & OBSTETRICS, Vol: 128, Pages: 141-147, ISSN: 0020-7292
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- Citations: 50
Kyrgiou M, Horwell D, Farthing A, 2015, Laparoscopic radical abdominal trachelectomy for the management of stage IB1 cervical cancer at 14 weeks' gestation: Case report and review of the literature, BJOG: An International Journal of Obstetrics and Gynaecology, ISSN: 1470-0328
Lima KMG, Gajjar K, Valasoulis G, et al., 2014, Classification of cervical cytology for human papilloma virus (HPV) infection using biospectroscopy and variable selection techniques, ANALYTICAL METHODS, Vol: 6, Pages: 9643-9652, ISSN: 1759-9660
Papakonstantinou K, Kyrgiou M, Lyons D, et al., 2014, Management of stage Ia1 squamous cervical cancer and the importance of excision margins: a retrospective study of long-term outcome after 25 years of follow-up, AMERICAN JOURNAL OF OBSTETRICS AND GYNECOLOGY, Vol: 211, ISSN: 0002-9378
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- Citations: 10
Kyrgiou M, Mitra A, Arbyn M, et al., 2014, Fertility and early pregnancy outcomes after treatment for cervical intraepithelial neoplasia: systematic review and meta-analysis, British Medical Journal, Vol: 349, Pages: 1-17, ISSN: 1468-5833
Objective To determine the impact of cervical excision for cervical intraepithelial neoplasia on fertility and early pregnancy outcomes.Design Systematic review and meta-analysis of cohort studies.Data sources Medline and Embase.Eligibility criteria Studies assessing fertility and early pregnancy outcomes in women with a history of treatment for cervical intraepithelial neoplasia versus untreated women. We classified the included studies according to treatment type and fertility or early pregnancy endpoint.Analysis Pooled relative risks and 95% confidence intervals using a random effect model, and interstudy heterogeneity with I2 statistics.Results 15 studies fulfilled the inclusion criteria and were included. The meta-analysis did not provide any evidence that treatment for cervical intraepithelial neoplasia adversely affected the chances of conception. The overall pregnancy rate was higher for treated women than for untreated women (four studies; 43% v 38%, pooled relative risk 1.29, 95% confidence interval 1.02 to 1.64), although the heterogeneity between studies was high (P<0.0001). Pregnancy rates did not differ between women with an intention to conceive (two studies; 88% v 95%, 0.93, 0.80 to 1.08) and the number requiring more than 12 months to conceive (three studies, 15% v 9%, 1.45, 0.89 to 2.37). Although the rates for total miscarriages (10 studies; 4.6% v 2.8%, 1.04, 0.90 to 1.21) and miscarriage in the first trimester (four studies; 9.8% v 8.4%, 1.16, 0.80 to 1.69) was similar for treated and untreated women, cervical treatment was associated with a significantly increased risk of miscarriage in the second trimester. The rate was higher for treated women than for untreated women (eight studies; 1.6% v 0.4%, 16 558 women; 2.60, 1.45 to 4.67). The number of ectopic pregnancies (1.6% v 0.8%; 1.89, 1.50 to 2.39) and terminations (12.2% v 7.4%; 1.71, 1.31 to 2.22) was also higher for treated women.Conclusion There is no evidence suggesting that tre
Kyrgiou M, Shafi MI, 2014, Colposcopy and cervical intraepithelial neoplasia, Obstetrics, Gynaecology and Reproductive Medicine, Vol: 24, Pages: 204-214, ISSN: 1751-7214
Cervical cancer is both preventable and curable. It has a long natural history with a prolonged pre-cancerous phase that is easily detectable and treatable. Exfoliative cytology has been the mainstay for screening of cervical intra-epithelial neoplasia (CIN). Assessment of women presenting with abnormal cervical cytology and the selection of those requiring treatment relied mainly on colposcopic impressions of the cervical transformation zone and the histological appraisal of directed punch biopsies. The need to maximise clinical resources, achieve quicker and more effective management of patients, limit postoperative complications and preserve reproductive function has led to the popularity of local excisional methods for cervical premalignancy. Although the cure rates for all local ablative and excisional methods are more than 90% after one treatment, the excisional methods provide a more reliable histopathological diagnosis and the patient can be treated at the initial visit. The recognition that persistent infection with oncogenic human papillomavirus (HPV) causes cervical cancer has led to the development of new HPV tests/biomarkers and prophylactic vaccines against HPV. The HPV DNA test that targets the viral DNA has been introduced as a test of cure after CIN treatment and as a triage tool in women presenting with borderline or low-grade findings at cytology. HPV DNA test will be introduced in primary screening in the future. The national HPV immunisation programme was initiated in the NHS in September 2008. The vaccines are safe, well tolerated and highly efficacious in HPV naive women. © 2014 Elsevier Ltd.
Kyrgiou M, Martin-Hirsch P, Singh M, 2014, The Use of a Rusch Intrauterine Balloon to Cause Tamponade on a Severe Hemorrhage in a Case of Endometrial Cancer, INTERNATIONAL JOURNAL OF GYNECOLOGICAL CANCER, Vol: 24, Pages: 946-949, ISSN: 1048-891X
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- Citations: 2
Kyrgiou M, 2014, Survival, Morbidity & Patient-reported outcomes of laparoscopic versus open hysterectomy for endometrial cancer: the MRC ASCTEC trial
Bountris P, Haritou M, Pouliakis A, et al., 2014, An intelligent clinical decision support system for patient-specific predictions to improve cervical intraepithelial neoplasia detection, Biomed Research International, Vol: 2014, ISSN: 2314-6133
Nowadays, there are molecular biology techniques providing information related to cervical cancer and its cause: the human Papillomavirus (HPV), including DNA microarrays identifying HPV subtypes, mRNA techniques such as nucleic acid based amplification or flow cytometry identifying E6/E7 oncogenes, and immunocytochemistry techniques such as overexpression of p16. Each one of these techniques has its own performance, limitations and advantages, thus a combinatorial approach via computational intelligence methods could exploit the benefits of each method and produce more accurate results. In this article we propose a clinical decision support system (CDSS), composed by artificial neural networks, intelligently combining the results of classic and ancillary techniques for diagnostic accuracy improvement. We evaluated this method on 740 cases with complete series of cytological assessment, molecular tests, and colposcopy examination. The CDSS demonstrated high sensitivity (89.4%), high specificity (97.1%), high positive predictive value (89.4%), and high negative predictive value (97.1%), for detecting cervical intraepithelial neoplasia grade 2 or worse (CIN2+). In comparison to the tests involved in this study and their combinations, the CDSS produced the most balanced results in terms of sensitivity, specificity, PPV, and NPV. The proposed system may reduce the referral rate for colposcopy and guide personalised management and therapeutic interventions.
Kyrgiou M, Valasoulis G, Stasinou S-M, et al., 2014, Proportion of Cervical Excision for CIN as a Predictor of Future Pregnancy Outcomes: A Prospective Study, REPRODUCTIVE SCIENCES, Vol: 21, Pages: 208A-208A, ISSN: 1933-7191
Kyrgiou M, Abrol P, Papakonstantinou K, et al., 2014, Follow-Up and Outcomes of Women with Untreated CIN2 Lesions: Is There a Role for the Use of HPV-Related Biomarkers?, REPRODUCTIVE SCIENCES, Vol: 21, Pages: 208A-208A, ISSN: 1933-7191
Kyrgiou M, Pugh R, Hird V, et al., 2014, Fertility-Sparing Treatment for Young Women with Atypical Hyperplasia and Early Endometrial Cancer with High-Dose Medrocyprogesterone Acetate, REPRODUCTIVE SCIENCES, Vol: 21, Pages: 208A-208A, ISSN: 1933-7191
Kyrgiou M, Valasoulis G, Stasinou M-S, et al., 2014, Long-Term Data on the Value of HPV-Related Biomarkers Post-Treatment for CIN, REPRODUCTIVE SCIENCES, Vol: 21, Pages: 207A-207A, ISSN: 1933-7191
Valasoulis G, Stasinou S-M, Nasioutziki M, et al., 2014, Expression of HPV-related biomarkers and grade of cervical intraepithelial lesion at treatment, ACTA OBSTETRICIA ET GYNECOLOGICA SCANDINAVICA, Vol: 93, Pages: 194-200, ISSN: 0001-6349
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- Citations: 10
Arbyn M, Kyrgiou M, Gondry J, et al., 2014, Long term outcomes for women treated for cervical precancer, BMJ-BRITISH MEDICAL JOURNAL, Vol: 348, ISSN: 1756-1833
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- Citations: 25
Gajjar K, Ahmadzai AA, Valasoulis G, et al., 2014, Histology verification demonstrates that biospectroscopy analysis of cervical cytology identifies underlying disease more accurately than conventional screening: Removing the confounder of discordance, PLOS One, Vol: 9, ISSN: 1932-6203
BackgroundSubjective visual assessment of cervical cytology is flawed, and this can manifest itself by inter- and intra-observer variability resulting ultimately in the degree of discordance in the grading categorisation of samples in screening vs. representative histology. Biospectroscopy methods have been suggested as sensor-based tools that can deliver objective assessments of cytology. However, studies to date have been apparently flawed by a corresponding lack of diagnostic efficiency when samples have previously been classed using cytology screening. This raises the question as to whether categorisation of cervical cytology based on imperfect conventional screening reduces the diagnostic accuracy of biospectroscopy approaches; are these latter methods more accurate and diagnose underlying disease? The purpose of this study was to compare the objective accuracy of infrared (IR) spectroscopy of cervical cytology samples using conventional cytology vs. histology-based categorisation.MethodsWithin a typical clinical setting, a total of n = 322 liquid-based cytology samples were collected immediately before biopsy. Of these, it was possible to acquire subsequent histology for n = 154. Cytology samples were categorised according to conventional screening methods and subsequently interrogated employing attenuated total reflection Fourier-transform IR (ATR-FTIR) spectroscopy. IR spectra were pre-processed and analysed using linear discriminant analysis. Dunn’s test was applied to identify the differences in spectra. Within the diagnostic categories, histology allowed us to determine the comparative efficiency of conventional screening vs. biospectroscopy to correctly identify either true atypia or underlying disease.ResultsConventional cytology-based screening results in poor sensitivity and specificity. IR spectra derived from cervical cytology do not appear to discriminate in a diagnostic fashion when categories were based on conventional screening. Scores plo
Kyrgiou M, Arbyn M, Paraskevaidis E, 2014, Pregnancy outcomes following cold coagulation for CIN have not yet been reported, BJOG: An International Journal of Obstetrics and Gynaecology, Vol: 121, Pages: 941-942, ISSN: 1470-0328
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- Citations: 12
Kyrgiou M, Shafi MI, 2013, Invasive cancer of the cervix, Obstetrics, Gynaecology and Reproductive Medicine, Vol: 23, Pages: 343-351, ISSN: 1751-7214
Invasive cervical cancer remains the second commonest female malignancy worldwide. Early-stage disease may be asymptomatic. Advances in imaging techniques have improved selection of the appropriate treatment approach. Treatment options vary for each stage. An excisional cone is sufficient for treatment of micro-invasive disease (Ia1) provided the margins are clear. The management of stage Ia2 disease is more controversial. Surgery and radiation have similar survival rates for stage Ib-IIa disease, while the combination of both increases morbidity. Later stage tumours (IIb-IV) should be treated with chemoradiation as this is related to improved survival but also higher short- and medium-term toxicity in comparison to radiotherapy alone. Fertility-sparing surgical techniques such as radical trachelectomy may be appropriate in selected cases. Management of recurrent disease depends on the initial treatment, the individual characteristics and the presence of distant disease. Management of cervical cancer during pregnancy remains a challenge and appropriate counselling on individual patient basis is necessary. As the disease usually affects young women, psychological morbidity is significant and emotional support is essential. © 2013 Elsevier Ltd.
Purandare NC, Trevisan J, Patel II, et al., 2013, Exploiting biospectroscopy as a novel screening tool for cervical cancer: towards a framework to validate its accuracy in a routine clinical setting, BIOANALYSIS, Vol: 5, Pages: 2697-2711, ISSN: 1757-6180
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- Citations: 16
Kyrgiou M, Chatterjee J, Lyus R, et al., 2013, The role of cytology and other prognostic factors in endometrial cancer, JOURNAL OF OBSTETRICS AND GYNAECOLOGY, Vol: 33, Pages: 729-734, ISSN: 0144-3615
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- Citations: 6
Kyrgiou M, Papakonstantinou K, Valasoulis G, et al., 2013, FOLLOW-UP AND OUTCOMES OF WOMEN WITH UNTREATED CIN2 LESIONS: IS THERE A ROLE FOR THE USE OF HPV-RELATED BIOMARKERS, INTERNATIONAL JOURNAL OF GYNECOLOGICAL CANCER, Vol: 23, ISSN: 1048-891X
Stasinou S, Valasoulis G, Kyrgiou M, et al., 2013, ALTERATIONS ON HPV-RELATED BIOMARKERS AFTER PROPHYLACTIC HPV VACCINATION, INTERNATIONAL JOURNAL OF GYNECOLOGICAL CANCER, Vol: 23, ISSN: 1048-891X
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