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Dodd RH, Mac O, Brotherton JML, Cvejic E, McCaffery KJ. Levels of anxiety and distress following receipt of positive screening tests in Australia's HPV-based cervical screening programme: a cross-sectional survey. Sex Transm Infect 2020; 96:166-172. [PMID: 32001660 DOI: 10.1136/sextrans-2019-054290] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Revised: 12/17/2019] [Accepted: 01/11/2020] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE From December 2017, the Australian National Cervical Screening Program commenced 5 yearly primary human papillomavirus (HPV) screening; one of the first high-income countries to implement primary HPV screening. This study aimed to examine the psychosocial impact of self-reporting testing HPV positive in a sample of women screened since the renewal of the programme. METHODS Women in Australia aged 25-74 years who reported participating in cervical screening since December 2017 were recruited through an online market research company to complete a cross-sectional survey. The primary outcomes were anxiety and general distress. RESULTS 1004 women completed the online survey; 80.9% reported testing HPV negative (HPV-), 6.5% reported testing HPV positive (HPV+) and 12.9% did not know/remember their test result. Women who reported testing HPV+ had significantly poorer psychological outcomes on a range of measures. Those who reported testing HPV+ had higher anxiety scores (53.03 vs 43.58 out of 80, p<0.001), showed more general distress (3.94 vs 2.52 out of 12, p=0.004), concern about their test result (5.02 vs 2.37, p<0.001), expressed greater distress about their test result (7.06 vs 4.74, p<0.001) and cancer worry (quite or very worried 35.4% vs 11.6%, p<0.001) than women who reported testing HPV-. Concern regarding test results was also significantly higher in women who did not know/remember their test result (3.20 vs 2.37, p<0.001) compared with women who reported testing HPV-. Women who reported testing HPV+ had greater knowledge of HPV (9.25 vs 6.62, p<0.001) and HPV testing (2.44 vs 1.30, p<0.001) than women who reported testing HPV-. CONCLUSIONS Receipt of an HPV+ test result was associated with high levels of anxiety and distress, which reached clinical significance. Further work is needed to understand whether distress and concern could be reduced by ensuring all women receive high-quality standardised information with their results or by other interventions.
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Affiliation(s)
- Rachael Helen Dodd
- Faculty of Medicine and Health, School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Olivia Mac
- Faculty of Medicine and Health, School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Julia M L Brotherton
- VCS Population Health, Victorian Cytology Service, Carlton South, Victoria, Australia.,Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Erin Cvejic
- Faculty of Medicine and Health, School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Kirsten J McCaffery
- Faculty of Medicine and Health, School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
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Guthrie BL, Rositch AF, Cooper JA, Farquhar C, Bosire R, Choi R, Kiarie J, Smith JS. Human papillomavirus and abnormal cervical lesions among HIV-infected women in HIV-discordant couples from Kenya. Sex Transm Infect 2020; 96:457-463. [PMID: 31919275 DOI: 10.1136/sextrans-2019-054052] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Revised: 11/08/2019] [Accepted: 12/12/2019] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE HIV infection increases the risk of high-grade cervical neoplasia and invasive cervical carcinoma. The study addresses the limited data describing human papillomavirus (HPV) infection and cervical neoplasia among HIV-infected women in HIV-discordant relationships in sub-Saharan Africa, which is needed to inform screening strategies. METHODS A cross-sectional study of HIV-infected women with HIV-uninfected partners was conducted to determine the distribution of type-specific HPV infection and cervical cytology. This study was nested in a prospective cohort recruited between September 2007 and December 2009 in Nairobi, Kenya. Cervical cells for HPV DNA testing and conventional cervical cytology were collected. HPV types were detected and genotyped by Roche Linear Array PCR assay. RESULTS Among 283 women, the overall HPV prevalence was 62%, and 132 (47%) had ≥1 high-risk (HR)-HPV genotype. Of 268 women with cervical cytology results, 18 (7%) had high-grade cervical lesions or more severe by cytology, of whom 16 (89%) were HR-HPV-positive compared with 82 (41%) of 199 women with normal cytology (p<0.001). The most common HR-HPV types in women with a high-grade lesion or more severe by cytology were HPV-52 (44%), HPV-31 (22%), HPV-35 (22%), HPV-51 (22%) and HPV-58 (22%). HR-HPV genotypes HPV-16 or HPV-18 were found in 17% of women with high-grade lesions or more severe. HR-HPV screening applied in this population would detect 89% of those with a high-grade lesion or more severe, while 44% of women with normal or low-grade cytology would screen positive. CONCLUSION HR-HPV prevalence was high in this population of HIV-infected women with an uninfected partner. Choice of screening for all HR genotypes versus a subset of HR genotypes in these HIV-infected women will strongly affect the performance of an HPV screening strategy relative to cytological screening. Regional and subpopulation differences in HR-HPV genotype distributions could affect screening test performance.
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Affiliation(s)
- Brandon L Guthrie
- Departments of Global Health and Epidemiology, University of Washington School of Public Health, Seattle, Washington, USA
| | - Anne F Rositch
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Joy Alison Cooper
- Department of Obstetrics and Gynecology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Carey Farquhar
- Departments of Global Health, Epidemiology, and Medicine, University of Washington, Seattle, Washington, USA
| | - Rose Bosire
- Center for Public Health Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Robert Choi
- Department of Global Health, University of Washington School of Public Health, Seattle, Washington, USA
| | - James Kiarie
- Department of Reproductive Health and Research, World Health Organization (WHO), Geneva, Switzerland
| | - Jennifer S Smith
- Department of Epidemiology, Lineberger Comprehensive Cancer Center, University of North Carolina Gillings School of Global Public Health, Chapel Hill, North Carolina, USA
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An L, Zhou X, Li W, Wang Y, Shi H, Xie T. Association between secondhand smoke exposure and abnormal cervical cytology: A one-to-one matched case-control study. Tob Induc Dis 2019; 16:56. [PMID: 31516453 PMCID: PMC6659474 DOI: 10.18332/tid/99502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Revised: 10/31/2018] [Accepted: 10/31/2018] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION The aim was to evaluate the association between secondhand smoke (SHS) exposure and abnormal cervical cytology among Chinese adult women. METHODS A one-to-one matched case-control study was conducted with outpatients of the First Hospital of Jilin University between October 2013 to September 2016. In all, 228 cytologic confirmed new cases of abnormal cervical cytology and the equivalent number of age and ethnic matched controls were interviewed about SHS exposure and related factors. RESULTS Although 78.3% of all the participants had been exposed to SHS (78.1% subjects vs 78.5% controls), there were no statistical significance of cervical cytological abnormalities and SHS exposure status (never, former, current exposure), exposure intensity in cigarettes per day (none, 1–9, 10–19, and ≥20), SHS exposure duration in years (none, 1–9, 10–19, and ≥20) and the Brinkman Index (BI) (none, 1–99, 100–399, ≥400) between the two groups. The univariate analysis results showed that there were statistical differences between subjects and controls in marital status, sexual frequency in past year, number of sexual partners, age at first intercourse, age at first delivery. The stratified Cox regression model only showed that the age at first sexual intercourse was associated with the cervical cytological abnormalities (OR=1.206, 95% CI: 1.104–1.319). CONCLUSIONS Studies on the association between SHS exposure and cervical lesions have been equivocal. In this study, the SHS exposure could not be detected as an independent risk factor of abnormal cervical cytology among Chinese adult women.
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Affiliation(s)
- Libin An
- Dalian University, Dalian, China
| | | | | | - Yang Wang
- Jilin Science and Technology Vocational Technical College, Changchun, China
| | | | - Tienan Xie
- Reproductive Center, First Hospital of Jilin University, Changchun, China
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Ali MAM, Bedair RN, Abd El Atti RM. Cervical high-risk human papillomavirus infection among women residing in the Gulf Cooperation Council countries: Prevalence, type-specific distribution, and correlation with cervical cytology. Cancer Cytopathol 2019; 127:567-577. [PMID: 31390155 DOI: 10.1002/cncy.22165] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Revised: 06/16/2019] [Accepted: 07/02/2019] [Indexed: 12/24/2022]
Abstract
BACKGROUND The scarcity of updated data on the prevalence of cervical human papillomavirus (HPV) infection in the Gulf Cooperation Council (GCC) countries hampers the establishment of cervical cancer screening and HPV vaccination programs. The current study estimated the prevalence of cervical high-risk (HR) HPV infection among women residing in some countries of the GCC and analyzed the correlation between HR-HPV infection types and cytology results. METHODS In total, 2478 women residing in the Kingdom of Saudi Arabia, Qatar, the United Arab Emirates, and Bahrain were enrolled in this study. Cervical specimens were subjected to simultaneous liquid-based cytology and HR-HPV DNA analysis. RESULTS Of 2478 women, 520 (21%) tested positive for HR-HPV. Other non-HPV genotype 16 (HPV16)/HPV18 HR-HPV was the most frequently detected infection type, accounting for 63.7%. Non-Arab women had a significantly higher HR-HPV positivity rate compared with Arab women (31.6% vs 16.4%; P < .001). The HR-HPV positivity rate was highest among women residing in Qatar (31.3%), followed by women living in Bahrain (20%), the Kingdom of Saudi Arabia (17.2%), and the United Arab Emirates (14.7%). The overall prevalence of HR-HPV infections declined significantly with advancing age (P < .001). Women with abnormal cytology had a significantly higher HR-HPV positivity rate than those with normal cytology (50.6% vs 14.7%; P < .001). The HR-HPV positivity rate increased as the severity of the cytological lesion increased. CONCLUSIONS The current study provides updated data on HR-HPV prevalence in the GCC countries and delivers an evidence base for supporting the introduction of regional/national vaccination and screening programs in these countries.
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Affiliation(s)
- Mohamed A M Ali
- Department of Biochemistry, Faculty of Science, Ain Shams University, Cairo, Egypt
| | - Rania N Bedair
- Department of Chemical Pathology, Medical Research Institute, Alexandria University, Alexandria, Egypt
- Molecular Diagnostics Unit, Al Borg Medical Laboratories, Jeddah, Kingdom of Saudi Arabia
| | - Rasha M Abd El Atti
- Department of Pathology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
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Aitken CA, Holtzer-Goor KM, Uyterlinde A, van den Brule AJ, van der Linden HC, Huijsmans CJ, de Kok IM, van Kemenade FJ. The impact of knowledge of HPV positivity on cytology triage in primary high-risk HPV screening. J Med Screen 2019; 26:221-224. [PMID: 31342879 PMCID: PMC6854609 DOI: 10.1177/0969141319864991] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Objective Several studies have shown that there is an upward shift in the classification of cervical cytology when high-risk human papillomavirus (hrHPV) status is known to be positive. The Netherlands implemented primary hrHPV screening with reflex cytology as the primary screening test in 2017. Prior to implementation of the new programme, we investigated whether knowledge of hrHPV status influences cytology rating. Methods Using a set of 200 cytology slides that had been previously tested, two pairs of cytotechnicians rated 100 slides per pair twice: first without knowledge of hrHPV status and then, after a wash-out period of two months, with knowledge of hrHPV status. Results We found that hrHPV positive slides were more likely to be rated up over the referral threshold (i.e. from negative for intraepithelial lesion or malignancy to atypical squamous cells of undetermined significance+) than hrHPV negative slides at the second review when hrHPV status was known (relative risk = 3.2; 95% confidence interval: 1.3–7.9). Conclusions If the same upward shift in ratings were to be observed in the national programme, it may have implications for referrals of women with low-grade lesions.
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Affiliation(s)
- Clare A Aitken
- Department of Public Health, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Kim M Holtzer-Goor
- Dutch National Institute for Public Health and the Environment, Centre for Population Screening, Bilthoven, the Netherlands
| | - Anne Uyterlinde
- Facilitaire Samenwerking Bevolkingsonderzoeken, Utrecht, the Netherlands
| | | | | | | | - Inge McM de Kok
- Department of Public Health, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Folkert J van Kemenade
- Department of Pathology, Erasmus MC University Medical Center, Rotterdam, the Netherlands
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Blomberg M, Dehlendorff C, Kjaer SK. Risk of CIN2+ following a diagnosis of genital warts: a nationwide cohort study. Sex Transm Infect 2019; 95:614-618. [PMID: 31092605 DOI: 10.1136/sextrans-2019-054008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Revised: 04/17/2019] [Accepted: 04/24/2019] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVES Individuals with genital warts may be particularly susceptible to human papillomavirus since they have failed to clear the virus. Consequently, women with genital warts could be at increased risk of cervical dysplasia. In this cohort study we aimed to compare the incidence of cervical intraepithelial neoplasia grade 2 or worse (CIN2+) in women with a diagnosis of genital warts with that of the general female population without genital warts. METHODS Using the Danish nationwide population-based health data registers, we identified women between 15 and 45 years and followed them for diagnoses of CIN2+ from 1995 to 2006. Genital wart diagnoses were recorded from birth, and Cox regression with attained age as underlying scale was used to estimate age-dependent HRs for the risk of CIN2+ with genital warts as a time-varying exposure. RESULTS Among 918 609 women without genital warts and 32 218 women with genital warts, 30 209 and 1533 women, respectively, had a subsequent diagnosis of CIN2+. A significantly higher risk of CIN2+ was found among women with genital warts relative to those without (HR, 2.43; 95% CI 2.30 to 2.56). Treatment-resistant genital warts posed a significantly higher risk of CIN2+ than did transient genital warts (HR, 1.20; 95% CI 1.01 to 1.43). The risks remained elevated more than 4 years after the genital wart diagnosis. CONCLUSION Clinicians should ensure that women with genital warts are screened for cervical cancer after the genital wart diagnosis and that they continue to be screened on time.
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Affiliation(s)
- Maria Blomberg
- Unit of Virus, Lifestyle and Genes, Danish Cancer Society Research Center, Copenhagen, Denmark .,Department of Dermatology, Bispebjerg Hospital, Copenhagen, Denmark
| | - Christian Dehlendorff
- Statistics, Bioinformatics and Registry, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Susanne K Kjaer
- Unit of Virus, Lifestyle and Genes, Danish Cancer Society Research Center, Copenhagen, Denmark.,Juliane Marie Centre, Gynecologic Clinic, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
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Cakmak Y, Kavak Comert D, Oge T, Tosun OA, Sozen I. Evaluation of Clinicopathologic Features of Patients Diagnosed with Atypical Glandula Cells in Cervical Cytology. Medeni Med J 2019; 34:284-289. [PMID: 32821450 PMCID: PMC7433728 DOI: 10.5222/mmj.2019.55476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Accepted: 08/31/2019] [Indexed: 11/05/2022] Open
Abstract
Objective In our study we aimed to evaluate the clinicopathologic features of patients diagnosed with atyipcal glandular cells on cervical cytology. Method The records of 9375 patients who were examined in the gynecology outpatient clinic between 2010 and 2018 and underwent cervicovaginal smear were retrospectively reviewed. Seventy-three (0.8%) patients were diagnosed as atypical glandular cells. Colposcopic examination, cervical biopsy, endocervical and endometrial curettage were performed in patients diagnosed with atypical glandular cells. Age, gravida, parity, systemic diseases and clinicopathological features of the patients were examined and recorded. Results Cervical and endometrial abnormal histological findings were detected in 26 (35.6%) of 73 patients with atypical glandular cells. Of these 26 patients, 14 (19.1%) had cervical intraepithelial lesions, 3 (4.1%) had endometrial hyperplasia and 9 (12.3%) had invasive cancer. Five (6.8%) of the 9 patients with the diagnosis of invasive cancer had adenocarcinoma (endocervical and endometrial), in 3 (4.1%) patients cervical squamous carcinoma, and in 1 patient. endocervical lymphoma was observed.The majority of cancers detected in our study were in the age group of 50 years and older. Conclusion Invasive cancer is seen in 12.3% of the patients diagnosed with atypical glandular cells, and most of these patients are 50 years or older. Therefore patients diagnosed with atypical glandular cell in cervicovaginal smear should be carefully evaluated with all clinical features.
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Affiliation(s)
- Yusuf Cakmak
- Eskisehir Osmangazi University School of Medicine, Department of Obstetrics and Gynecology, Eskisehir, Turkey
| | - Duygu Kavak Comert
- Eskisehir Osmangazi University, School of Medicine, Department of Gynocology and Obstetrics, Eskisehir, Turkey
| | - Tufan Oge
- Eskisehir Osmangazi University, School of Medicine, Department of Gynocology and Obstetrics, Eskisehir, Turkey
| | - Ozgur Aydin Tosun
- Istanbul University, School of Medicine, Department of Gynecology and Obstetrics, Istanbul, Turkey
| | - Isik Sozen
- Eskisehir Osmangazi University, School of Medicine, Department of Gynocology and Obstetrics, Eskisehir, Turkey
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Abstract
Context Cervical cancer is the second most common cancer in women. The liquid based cervical cytology (LBCC) is a useful tool of choice for screening cervical cancer. Aims To train a convolutional neural network (CNN) to identify abnormal foci from LBCC smears. Settings and Design We have chosen retrospective study design from archived smears of patients undergoing screening from cervical cancer by LBCC smears. Materials and Methods 2816 images, each of 256 × 256 pixels, were prepared from microphotographs of these LBCC smears, which included 816 "abnormal" foci (low grade or high grade squamous intraepithelial lesion) and 2000 'normal' foci (benign epithelial cells and reactive changes). The images were split into three sets, Training, Testing, and Evaluation. A convolutional neural network (CNN) was developed with the python programming language. The CNN was trained with the Training dataset; performance was assayed concurrently with the Testing dataset. Two CNN models were developed, after 20 and 10 epochs of training, respectively. The models were then run on the Evaluation dataset. Statistical Analysis Used A contingency table was prepared from the original image labels and the labels predicted by the CNN. Results Combined assessment of both models yielded a sensitivity of 95.63% in detecting abnormal foci, with 79.85% specificity. The negative predictive value was high (99.19%), suggesting potential utility in screening. False positives due to overlapping cells, neutrophils, and debris was the principal difficulty met during evaluation. Conclusions The CNN shows promise as a screening tool; however, for its use in confirmatory diagnosis, further training with a more diverse dataset will be required.
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Affiliation(s)
- Parikshit Sanyal
- Department of Pathology, Military Hospital Jalandhar Cantt, Punjab, India
| | - Sanghita Barui
- Department of Pathology, Military Hospital Jalandhar Cantt, Punjab, India
| | - Prabal Deb
- Department of Pathology, Command Hospital, Alipore, Kolkata, West Bengal, India
| | - Harish Chander Sharma
- Department of Gynaecology and Obstetrics, Military Hospital Jalandhar Cantt, Punjab, India
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Chrysostomou AC, Stylianou DC, Constantinidou A, Kostrikis LG. Cervical Cancer Screening Programs in Europe: The Transition Towards HPV Vaccination and Population-Based HPV Testing. Viruses 2018; 10:E729. [PMID: 30572620 DOI: 10.3390/v10120729] [Citation(s) in RCA: 140] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Revised: 12/12/2018] [Accepted: 12/15/2018] [Indexed: 12/25/2022] Open
Abstract
Cervical cancer is the fourth most frequently occurring cancer in women around the world and can affect them during their reproductive years. Since the development of the Papanicolaou (Pap) test, screening has been essential in identifying cervical cancer at a treatable stage. With the identification of the human papillomavirus (HPV) as the causative agent of essentially all cervical cancer cases, HPV molecular screening tests and HPV vaccines for primary prevention against the virus have been developed. Accordingly, comparative studies were designed to assess the performance of cervical cancer screening methods in order to devise the best screening strategy possible. This review critically assesses the current cervical cancer screening methods as well as the implementation of HPV vaccination in Europe. The most recent European Guidelines and recommendations for organized population-based programs with HPV testing as the primary screening method are also presented. Lastly, the current landscape of cervical cancer screening programs is assessed for both European Union member states and some associated countries, in regard to the transition towards population-based screening programs with primary HPV testing.
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Yang J, Elliott A, Hoffa AL, Herring N, Houser PM. Potential influence of p16 immunohistochemical staining on the diagnosis of squamous cell lesions in cervical biopsy specimens: observation from cytologic-histologic correlation. Cancer Cytopathol 2018; 126:1003-1010. [PMID: 30307707 DOI: 10.1002/cncy.22063] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Revised: 07/19/2018] [Accepted: 08/13/2018] [Indexed: 01/10/2023]
Abstract
BACKGROUND The p16 immunohistochemical (IHC) marker has been used increasingly as an adjunct to morphologic assessment of cervical biopsies in which the differential diagnoses include high-grade squamous intraepithelial lesion (HSIL) and its mimics. The objective of this study was to assess the potential influence of p16 IHC staining on the evaluation of cervical biopsy as observed through cytologic-histologic correlation (CHC). METHODS Cervical biopsy samples that had cytologic diagnoses of either low-grade squamous intraepithelial lesion (LSIL) or HSIL and also had histologic follow-up were retrieved from the department database. CHC and the use of p16 IHC from 2 periods (group 1, 2008; group 2, 2014-2016) were compared and analyzed. RESULTS Histology on 452 samples from patients who had prior LSIL cytology in group 1 yielded 126 benign (27.9%), 272 LSIL (60.2%), and 54 HSIL (11.9%) diagnoses. By comparison, 491 samples from the patients in group 2 yielded 106 benign (21.6%), 277 LSIL (56.4%), and 108 HSIL (22.0%) diagnoses. The difference in CHC discrepancies between the 2 groups was significant (P = .0001), mainly because of the increased diagnosis of HSIL in group 2. Although p16 IHC was not applied to any sample from group 1, it was performed on 141 of 491 samples (28.7%) from group 2. Further follow-up of patients who had histologic HSIL revealed that residual HSIL was identified significantly more often in those who did not have p16 IHC applied in the preceding cervical biopsy than in those did (P = .0004). A similar comparison was performed between 113 patients from group 1 and 152 patients from group 2 who had a prior diagnosis of HSIL cytology, and the difference was statistically insignificant. CONCLUSIONS The use of p16 IHC on cervical biopsies in patients who had a prior cytologic diagnosis of LSIL may lead to greater detection and upgrading of HSIL, thereby compounding the discrepancy in CHC.
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Affiliation(s)
- Jack Yang
- The Department of Pathology & Laboratory Medicine, Medical University of South Carolina, Charleston, South Carolina
| | - Alexis Elliott
- The Department of Pathology & Laboratory Medicine, Medical University of South Carolina, Charleston, South Carolina
| | - Anne L Hoffa
- The Department of Pathology & Laboratory Medicine, Medical University of South Carolina, Charleston, South Carolina
| | - Nicole Herring
- The Department of Pathology & Laboratory Medicine, Medical University of South Carolina, Charleston, South Carolina
| | - Patricia M Houser
- The Department of Pathology & Laboratory Medicine, Medical University of South Carolina, Charleston, South Carolina
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Placidi A, Giorgi Rossi P. The impact of blind peer review (team reading) of equivocal/abnormal Papanicolaou smears on inter-reader agreement. Cytopathology 2018; 30:105-108. [PMID: 30276905 DOI: 10.1111/cyt.12637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Revised: 09/03/2018] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Peer review of equivocal/abnormal Papanicolaou smears is a standard internal quality assurance measure in cervical cancer screening laboratories. In 2014, we introduced a new method for peer review involving blinding the identity of the first reader. We present the comparison of different measures of inter-reader agreement in 2013 and 2014 in order to measure the impact of blind peer review on possible cognitive biases in reading. METHODS All suspect slides are proposed for peer review; a single reader's peer reviews are registered independently, with discordant cases discussed for consensus diagnosis. Since 2014, the first reader's name has been blinded to peers. We computed how frequently the initial diagnosis was changed, and how frequently a single reader influenced the final diagnosis when the initial one was changed. We compared κ of the first reader and that of other readers with final diagnosis. Data from 2013 were compared to those of 2014. RESULTS The final diagnosis changed in 22.9% of cases (range 16.8%-34.4%) in 2013 and in 26.8% (range 13.9%-35.6%) in 2014 (P = .2). Individual peer diagnoses agreed with final diagnosis in 52.3% (range 41.9%-66.3%) in 2013 and in 50.2% (range 36.0%-65.8%) in 2014 (P = .55). The cytologist having the highest proportion of confirmed diagnoses was also the most influential on final diagnosis, both in 2013 and in 2014. Agreement between first reader and final diagnosis was higher than that of each reader in 2013 and in 2014. CONCLUSIONS Blinding the identity of the first reader had little or no impact on inter-reader agreement measures in our laboratory.
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Affiliation(s)
- Antonio Placidi
- U.O.C. Oncologic Screening, Local Health Unit Roma 2 (Former Roma C), Roma, Italy
| | - Paolo Giorgi Rossi
- Epidemiology Unit, Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Reggio Emilia, Italy
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Thamsborg LH, Napolitano G, Larsen LG, Lynge E. Impact of HPV vaccination on outcome of cervical cytology screening in Denmark-A register-based cohort study. Int J Cancer 2018; 143:1662-1670. [PMID: 29707775 PMCID: PMC6175001 DOI: 10.1002/ijc.31568] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Revised: 04/04/2018] [Accepted: 04/19/2018] [Indexed: 12/12/2022]
Abstract
4vHPV vaccination has been tested in randomized controlled trials under almost ideal conditions, and studies of real-life use have compared outcome between vaccinated and unvaccinated women from the same birth cohort and mostly before screening age. Here we present the first-to our knowledge-evaluation of the impact of the 4vHPV vaccination in real life without selection bias in the reported data. The study has been carried out by comparing the results after first cervical screening between an HPV-vaccinated and an unvaccinated birth cohort, consisting of women born in Denmark in 1993 and 1983, respectively. Cytology data covering an 8-year period, from the age of 15 (age of HPV-vaccination) to age 23 (age of invitation to first cervical screening), were retrieved from the Danish National Pathology Register. Abnormal cytology, defined as atypical squamous cell of undetermined significance and worse (ASCUS+) was detected in 9.4% of women born in 1993 as compared with 9.0% of women born in 1983; RR = 1.04 (95% CI 0.96-1.12), p = .29. Detection of high-grade squamous intraepithelial lesion (HSIL) was statistically significantly lower in the 1993 than in the 1983 cohort, RR = 0.6 (95% CI 0.5-0.7), p < .0001, while the opposite pattern was seen for ASCUS RR = 1.4 (95% CI 1.2-1.6), p < .0001. The decrease in HSIL means that more women can be spared referral for colposcopy and biopsy. The increase of ASCUS could be explained by transition from conventional to liquid-based cytology, but this observation requires further monitoring.
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Affiliation(s)
| | - George Napolitano
- Department of Public HealthUniversity of CopenhagenCopenhagen1014Denmark
| | - Lise Grupe Larsen
- Department of PathologyZealand University HospitalRoskilde4000Denmark
| | - Elsebeth Lynge
- Nykøbing Falster HospitalUniversity of CopenhagenEjegodvej 63DK‐4800Denmark
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Campos NG, Lince-Deroche N, Chibwesha CJ, Firnhaber C, Smith JS, Michelow P, Meyer-Rath G, Jamieson L, Jordaan S, Sharma M, Regan C, Sy S, Liu G, Tsu V, Jeronimo J, Kim JJ. Cost-Effectiveness of Cervical Cancer Screening in Women Living With HIV in South Africa: A Mathematical Modeling Study. J Acquir Immune Defic Syndr 2018; 79:195-205. [PMID: 29916959 PMCID: PMC6143200 DOI: 10.1097/qai.0000000000001778] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Accepted: 06/13/2018] [Indexed: 01/25/2023]
Abstract
BACKGROUND Women with HIV face an increased risk of human papillomavirus (HPV) acquisition and persistence, cervical intraepithelial neoplasia, and invasive cervical cancer. Our objective was to determine the cost-effectiveness of different cervical cancer screening strategies among women with HIV in South Africa. METHODS We modified a mathematical model of HPV infection and cervical disease to reflect coinfection with HIV. The model was calibrated to epidemiologic data from HIV-infected women in South Africa. Clinical and economic data were drawn from in-country data sources. The model was used to project reductions in the lifetime risk of cervical cancer and incremental cost-effectiveness ratios (ICERs) of Pap and HPV DNA screening and management algorithms beginning at HIV diagnosis, at 1-, 2-, or 3-year intervals. Strategies with an ICER below South Africa's 2016 per capita gross domestic product (US$5270) were considered "cost-effective." RESULTS HPV testing followed by treatment (test-and-treat) at 2-year intervals was the most effective strategy that was also cost-effective, reducing lifetime cancer risk by 56.6% with an ICER of US$3010 per year of life saved. Other cost-effective strategies included Pap (referral threshold: HSIL+) at 1-, 2-, and 3-year intervals, and HPV test-and-treat at 3-year intervals. Pap (ASCUS+), HPV testing with 16/18 genotyping, and HPV testing with Pap or visual triage of HPV-positive women were less effective and more costly than alternatives. CONCLUSIONS Considering per capita gross domestic product as the benchmark for cost-effectiveness, HPV test-and-treat is optimal in South Africa. At lower cost-effectiveness benchmarks, Pap (HSIL+) would be optimal.
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Affiliation(s)
- Nicole G. Campos
- Harvard T.H. Chan School of Public Health, Department of Health Policy and Management, Boston, MA
| | - Naomi Lince-Deroche
- Health Economics and Epidemiology Research Office, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Carla J. Chibwesha
- Division of Global Women's Health, University of North Carolina at Chapel Hill, Chapel Hill, NC
- Clinical HIV Research Unit, Helen Joseph Hospital, Johannesburg, South Africa
| | - Cynthia Firnhaber
- Clinical HIV Research Unit, Helen Joseph Hospital, Johannesburg, South Africa
- Right to Care, Helen Joseph Hospital, Johannesburg, South Africa
| | - Jennifer S. Smith
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC
| | - Pam Michelow
- National Health Laboratory Service, Johannesburg, South Africa
- Anatomical Pathology Department, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Gesine Meyer-Rath
- Health Economics and Epidemiology Research Office, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Department of Global Health and Development, School of Public Health, Boston University, Boston, MA
| | - Lise Jamieson
- Health Economics and Epidemiology Research Office, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Suzette Jordaan
- National Health Laboratory Service, Johannesburg, South Africa
| | - Monisha Sharma
- Harvard T.H. Chan School of Public Health, Department of Health Policy and Management, Boston, MA
- Department of Epidemiology, University of Washington, Seattle, WA
| | - Catherine Regan
- Harvard T.H. Chan School of Public Health, Department of Health Policy and Management, Boston, MA
| | - Stephen Sy
- Harvard T.H. Chan School of Public Health, Department of Health Policy and Management, Boston, MA
| | - Gui Liu
- Department of Epidemiology, University of Washington, Seattle, WA
| | | | - Jose Jeronimo
- Global Coalition Against Cervical Cancer, Arlington, VA
| | - Jane J. Kim
- Harvard T.H. Chan School of Public Health, Department of Health Policy and Management, Boston, MA
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Alanbay İ, Öztürk M, Fıratlıgil FB, Karaşahin KE, Yenen MC, Bodur S. Cytohistological discrepancies of cervico-vaginal smears and HPV status. Ginekol Pol 2018; 88:235-238. [PMID: 28580567 DOI: 10.5603/gp.a2017.0044] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2016] [Revised: 04/24/2017] [Accepted: 04/05/2017] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES Discrepancies between abnormal cervical cytology or high-risk human papillomavirus (HR-HPV) status (cytolo-gy negative/HPV positive) and subsequent histological findings are a common occurrence. After using co-testing, the dis-crepancies between the HR-HPV status and cervical cytology have become an issue. In this study, we aimed to determine the characteristics of women with a discrepancy between histology and cytology/HR-HPV status, in terms of diagnosis, review and identification. MATERIAL AND METHODS A total of 52 women, patients of the University Hospital between 2013-2015, with cytohistologi-cal or HR-HPV status discrepancy were recruited for the study and retrospectively analyzed. The cytological samples were liquid-based Pap smears, classified according to the 2001 Bethesda system. The HR-HPV status was identified using the Hybrid Capture 2 HR-HPV DNA assay. The histological samples were obtained by cervical biopsy as well as large loop exci-sion of the transformation zone (LLETZ). RESULTS A cytohistological discrepancy was demonstrated in patients with (-)cytology/HR-HPV(+), ASCUS, LSIL, ASC-H, HSIL, AGC-NOS: 17.3%, 23.07%, 26.9%, 9.5%, 17.3% and 5.7%, respectively. When the degree of atypia in cytology increases, the concurrency of cervical cytology with biopsy also increases. A positive HR-HPV co-test result (19/24, 79.1%) was observed in nearly all CIN2 ≥ (+) cases. Our study emphasizes the significance of HR-HPV testing to determine CIN2 ≥ (+) cases, even in the presence of a normal cytological result. CONCLUSIONS In case of cytohistological or HR-HPV discrepancies, a careful review of the HR-HPV status and the degree of cytological atypia should be performed before further intervention.
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Affiliation(s)
| | - Mustafa Öztürk
- Etimesgut Military Hospital, Department of Obstetrics and Gynecology, Etlik-Ankara, Turkey.
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Coppock JD, Willis BC, Stoler MH, Mills AM. HPV RNA in situ hybridization can inform cervical cytology-histology correlation. Cancer Cytopathol 2018; 126:533-540. [PMID: 29975461 DOI: 10.1002/cncy.22027] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Revised: 03/12/2018] [Accepted: 05/11/2018] [Indexed: 11/08/2022]
Abstract
BACKGROUND In situ hybridization for human papillomavirus (HPV) messenger RNA (HPV RNA ISH) recently was introduced as an ancillary tool in the diagnosis of cervical squamous intraepithelial lesions, and can aid in the distinction between low-grade squamous intraepithelial lesions (LSILs) versus reactive/negative biopsies. Prior work has shown that up to one-half of cases originally diagnosed as LSIL are reclassified as negative/reactive by expert consensus review of morphology, and negative HPV RNA ISH results most often correlate with an expert diagnosis of negative/reactive. Given that LSIL overdiagnoses on biopsy may result in the erroneous clinical impression that a cervical lesion has been sampled appropriately, the authors proposed that HPV RNA ISH can inform cytology-histology correlation for challenging LSIL biopsies. METHODS A total of 92 cervical biopsies originally diagnosed as LSIL were reviewed by 3 gynecologic pathologists and reclassified based on consensus opinion of morphology. ISH was performed for high-risk and low-risk HPV E6/E7 mRNA. Prior/concurrent cytology results were collected. RESULTS Based on expert consensus morphologic review, 49% of biopsies (45 of 92 biopsies) originally diagnosed as LSIL were reclassified as negative, 6.5% (6 of 92 biopsies) were reclassified as high-grade squamous intraepithelial lesion, and 44.5% (41 of 92 biopsies) were maintained as LSIL. The majority of LSIL biopsies reclassified as negative (80%; 36 of 45 biopsies) were HPV RNA negative, whereas 93% of LSIL biopsies (39 of 41 biopsies) and 100% of high-grade squamous intraepithelial lesion biopsies were HPV RNA positive. CONCLUSIONS LSIL often is overdiagnosed by morphology on biopsy, potentially leading to the false impression that a lesion identified on cytology has been sampled. Performing RNA ISH on biopsies decreases histologic LSIL overdiagnosis, and potentially can prompt further sampling when there is cytology-histology discordance. Cancer (Cancer Cytopathol) 2018. © 2018 American Cancer Society.
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Affiliation(s)
- Joseph D Coppock
- Department of Pathology, University of Virginia, Charlottesville, Virginia
| | - Brian C Willis
- Department of Pathology, University of Virginia, Charlottesville, Virginia
| | - Mark H Stoler
- Department of Pathology, University of Virginia, Charlottesville, Virginia
| | - Anne M Mills
- Department of Pathology, University of Virginia, Charlottesville, Virginia
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Viviano M, Willame A, Cohen M, Benski AC, Catarino R, Wuillemin C, Tran PL, Petignat P, Vassilakos P. A comparison of cotton and flocked swabs for vaginal self-sample collection. Int J Womens Health 2018; 10:229-236. [PMID: 29805267 PMCID: PMC5960235 DOI: 10.2147/ijwh.s157897] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Objective Vaginal self-sampling for human papillomavirus (HPV) testing has recently been proposed to optimize cervical cancer screening coverage. The objective of this study was to compare the performance of self-taken samples using flocked and cotton swabs for HPV detection and cellular retrieval. Methods We recruited women aged 21-65 years, referred to colposcopy at the Division of Gynecology of the Geneva University Hospitals between May and September 2016. Each participant collected 2 vaginal samples: 1 with a cotton swab and 1 with a flocked swab. A 1:1 randomization determined the order in which the 2 samples were taken. The swabs were introduced into a 20 mL PreservCyt® vial. Real-time polymerase chain reaction analysis using the Anyplex™ II HPV HR assay, cytofluorometric analysis and cytological cell counting were performed on each sample. Results A total of 119 participants were recruited in the study. Their mean ± standard deviation age was 35.1±8.9 years. The HPV prevalence was 29.7% and 38.1% according to the cotton and flocked swab, respectively (p=0.006). The mean number of cells collected per milliliter according to cytofluorometry was 96,726.6 with the cotton swab and 425,544.3 with the flocked swab (p<0.001). The mean number of cells detected at cytological cell count was 13,130.42 using the cotton swab and 17,503.6 using the flocked swab (p<0.001). Conclusion The flocked swab achieved a greater cellular retrieval and showed an improved performance in HPV detection. Further studies are needed to assess the usability and cost-effectiveness of the 2 self-sampling devices.
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Affiliation(s)
- Manuela Viviano
- Division of Gynecology, Geneva University Hospitals, Geneva, Switzerland
| | - Alexia Willame
- Division of Gynecology, Geneva University Hospitals, Geneva, Switzerland
| | - Marie Cohen
- Division of Gynecology, Geneva University Hospitals, Geneva, Switzerland
| | | | - Rosa Catarino
- Division of Gynecology, Geneva University Hospitals, Geneva, Switzerland
| | | | - Phuong Lien Tran
- Division of Gynecology, Geneva University Hospitals, Geneva, Switzerland
| | - Patrick Petignat
- Division of Gynecology, Geneva University Hospitals, Geneva, Switzerland
| | - Pierre Vassilakos
- Geneva Foundation for Medical Education and Research, Geneva, Switzerland
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Starrach T, Gallwas J, Blankenstein T, Mahner S, Dannecker C. [Changes to cervical cancer screening in Germany]. MMW Fortschr Med 2018; 160:46-51. [PMID: 29417509 DOI: 10.1007/s15006-018-0152-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Teresa Starrach
- Klinik und Poliklinik für Frauenheilkunde und Geburtshilfe, Klinikum der Universität München, Campus Großhadern, Marchioninistraße 15, D-81377, München, Deutschland.
| | - Julia Gallwas
- Klinik und Poliklinik für Frauenheilkunde und Geburtshilfe, Klinikum der Universität München, Campus Großhadern, Marchioninistraße 15, D-81377, München, Deutschland
| | - Thomas Blankenstein
- Klinik und Poliklinik für Frauenheilkunde und Geburtshilfe, Klinikum der Universität München, Campus Großhadern, Marchioninistraße 15, D-81377, München, Deutschland
| | - Sven Mahner
- Klinik und Poliklinik für Frauenheilkunde und Geburtshilfe, Klinikum der Universität München, Campus Großhadern, Marchioninistraße 15, D-81377, München, Deutschland
| | - Christian Dannecker
- Klinik und Poliklinik für Frauenheilkunde und Geburtshilfe, Klinikum der Universität München, Campus Großhadern, Marchioninistraße 15, D-81377, München, Deutschland
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Abstract
Introduction The Pap stained cervical smear is a screening tool for cervical cancer. Commercial systems are used for automated screening of liquid based cervical smears. However, there is no image analysis software used for conventional cervical smears. The aim of this study was to develop and test the diagnostic accuracy of a software for analysis of conventional smears. Materials and Methods The software was developed using Python programming language and open source libraries. It was standardized with images from Bethesda Interobserver Reproducibility Project. One hundred and thirty images from smears which were reported Negative for Intraepithelial Lesion or Malignancy (NILM), and 45 images where some abnormality has been reported, were collected from the archives of the hospital. The software was then tested on the images. Results The software was able to segregate images based on overall nuclear: cytoplasmic ratio, coefficient of variation (CV) in nuclear size, nuclear membrane irregularity, and clustering. 68.88% of abnormal images were flagged by the software, as well as 19.23% of NILM images. The major difficulties faced were segmentation of overlapping cell clusters and separation of neutrophils. Conclusion The software shows potential as a screening tool for conventional cervical smears; however, further refinement in technique is required.
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Affiliation(s)
- Parikshit Sanyal
- Department of Pathology, Command Hospital (EC), Alipore, Kolkata, West Bengal, India
| | - Prosenjit Ganguli
- Department of Pathology, Command Hospital (EC), Alipore, Kolkata, West Bengal, India
| | - Sanghita Barui
- Department of Pathology, Command Hospital (EC), Alipore, Kolkata, West Bengal, India
| | - Prabal Deb
- Department of Pathology, Command Hospital (EC), Alipore, Kolkata, West Bengal, India
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Amkreutz LCM, Pijnenborg JMA, Joosten DWL, Mertens HJMM, Van Kuijk SMJ, Engelen MJA, Bergmans M, Nolting WE, Kruitwagen RFPM. Contribution of cervical cytology in the diagnostic work-up of patients with endometrial cancer. Cytopathology 2017; 29:63-70. [PMID: 29280216 DOI: 10.1111/cyt.12511] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/18/2017] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Abnormal cervical cytology in patients with endometrial cancer (EC) has been associated with poor outcome. The aim of this study was to evaluate whether cervical cytology could contribute to an improved preoperative identification of high-grade EC (serous, clear cell, carcinosarcoma, high-grade endometrioid EC) in final histology. METHODS A retrospective cohort study was performed in five hospitals in the Netherlands. A total of 554 patients with EC that underwent primary surgical treatment between 2002 and 2010 were included. Primary outcome was defined as the contribution of abnormal cervical cytology in the preoperative identification of high-grade EC. As secondary outcome, recurrence-free survival (RFS) and disease-specific survival were determined based on preoperative cervical cytology, and compared to the currently established risk factors: myometrial invasion, high-grade and lymph vascular space invasion. RESULTS Abnormal cervical cytology was present in 45.1%. For patients with preoperative inconclusive and high-grade histology, the presence of abnormal cervical cytology contributed to an improved identification of high-grade EC in final histology (odds ratio [OR] 6.40 [95% confidence interval {CI}: 1.92-21.26]; OR 2.86 [95% CI: 1.14-7.14]), respectively. Patients with abnormal cervical cytology had a significant worse 5-year median RFS. Abnormal cervical cytology was independently related to RFS (hazard ratio 1.67 [95% CI: 1.04-2.68]) and disease-specific survival (hazard ratio 3.15 [95% CI: 1.74-5.71]). CONCLUSIONS Abnormal cytology contributes to the preoperative identification of patients with high-grade EC, and is associated with compromised outcome. Future studies are warranted to determine whether cervical cytology could be incorporated into preoperative prediction models for lymph node metastasis.
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Affiliation(s)
- L C M Amkreutz
- Department of Obstetrics and Gynecology, Zuyderland Medical Centre, Sittard-Geleen and Heerlen, The Netherlands
| | - J M A Pijnenborg
- Department of Obstetrics and Gynecology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - D W L Joosten
- Department of Obstetrics and Gynecology, Zuyderland Medical Centre, Sittard-Geleen and Heerlen, The Netherlands
| | - H J M M Mertens
- Department of Obstetrics and Gynecology, Zuyderland Medical Centre, Sittard-Geleen and Heerlen, The Netherlands
| | - S M J Van Kuijk
- KEMTA-Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Centre, Limburg, The Netherlands
| | - M J A Engelen
- Department of Obstetrics and Gynecology, Zuyderland Medical Centre, Sittard-Geleen and Heerlen, The Netherlands
| | - M Bergmans
- Department of Obstetrics and Gynecology, Sint Laurentius Hospital, Roermond, The Netherlands
| | - W E Nolting
- Department of Obstetrics and Gynecology, SJG Weert, Weert, The Netherlands
| | - R F P M Kruitwagen
- Department of Obstetrics and Gynecology, Maastricht University Medical Centre, Maastricht, The Netherlands.,GROW-School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands
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Zambrano H, Waggoner J, León K, Pinsky B, Vera K, Schettino M, Rivera L, Landivar J, Granda M, Lee A, Mor G. High incidence of Zika virus infection detected in plasma and cervical cytology specimens from pregnant women in Guayaquil, Ecuador. Am J Reprod Immunol 2017; 77. [PMID: 28177195 DOI: 10.1111/aji.12630] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2016] [Accepted: 12/12/2016] [Indexed: 12/31/2022] Open
Abstract
Zika virus (ZIKV) infection during pregnancy has been linked to severe birth defects, and the epidemiologic situation of the ZIKV epidemic in Ecuador is poorly understood. Guayaquil, Ecuador, has a tropical climate and experiences frequent outbreaks of dengue and chikungunya virus, and in December 2015, ZIKV was identified. Given the well-documented effects of ZIKV in pregnancy, including microcephaly, we tested for the presence of ZIKV in both plasma and cervical cytology of pregnant women. We report the identification of a population of pregnant women with a high incidence of ZIKV infection detected in the plasma and lower reproductive tract. A case-control study was performed to determine the incidence of ZIKV infection among low-income, pregnant women at risk for preterm delivery compared to matched controls. Plasma and cervical cytology specimens were tested for ZIKV by rRT-PCR. Fifty-nine pregnant women were enrolled. The incidence of ZIKV was 54% (32/59) overall: 18/31 (58.1%) in cases and 14/28 (50.0%) in controls. ZIKV detection in plasma and cervical cytology specimens demonstrated good agreement. Overall, outcomes for neonates born to ZIKV-positive and ZIKV-negative mothers were similar. However, two neonates were born with microcephaly to case mothers who were ZIKV positive. We report a high incidence of ZIKV infection (54%) in a distinctive population in Guayaquil, Ecuador. We identify ZIKV in cervical samples that correlates with ZIKV in the plasma. These data raise concerns regarding the breadth of the ZIKV epidemic in Ecuador and demonstrate the utility of cervical cytology specimens for ZIKV testing.
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Affiliation(s)
- Hector Zambrano
- Laboratorio de Biología Molecular, Hospital Luis Vernaza, Guayaquil, Ecuador
| | - Jesse Waggoner
- Department of Medicine, Division of Infectious Diseases, Emory University School of Medicine, Atlanta, GA, USA
| | - Karina León
- Servicio de Gineco-Obstetricia, Hospital Enrique C. Sotomayor, Guayaquil, Ecuador
| | - Benjamin Pinsky
- Department of Pathology, Stanford University School of Medicine, Stanford, CA, USA.,Department of Medicine, Division of Infectious Diseases and Geographic Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Ketty Vera
- Laboratorio de Biología Molecular, Hospital Luis Vernaza, Guayaquil, Ecuador
| | - Marissa Schettino
- Laboratorio de Biología Molecular, Hospital Luis Vernaza, Guayaquil, Ecuador
| | - Lisette Rivera
- Laboratorio de Biología Molecular, Hospital Luis Vernaza, Guayaquil, Ecuador
| | - José Landivar
- Laboratorio de Biología Molecular, Hospital Luis Vernaza, Guayaquil, Ecuador
| | - María Granda
- Escuela Superior Politécnica del Litoral, ESPOL, ESPAE Graduate School of Management, Guayaquil, Ecuador
| | - Angela Lee
- Geisel School of Medicine, Dartmouth College, Hanover, NH, USA
| | - Gil Mor
- Division of Reproductive Sciences, Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University School of Medicine, New Haven, CT, USA
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Yang J, Nolte FS, Chajewski OS, Lindsey KG, Houser PM, Pellicier J, Wang Q, Ehsani L. Cytology and high risk HPV testing in cervical cancer screening program: Outcome of 3-year follow-up in an academic institute. Diagn Cytopathol 2017; 46:22-27. [PMID: 29048733 DOI: 10.1002/dc.23843] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Revised: 09/18/2017] [Accepted: 10/05/2017] [Indexed: 01/02/2023]
Abstract
BACKGROUND Combination of cervical cytology and high-risk human papillomavirus (HR-HPV) testing, co-testing, has been increasingly used in screening cervical cancers. The present study summarized the outcome of co-testing by reviewing 3-year clinical and pathological follow-up information. METHODS Patients were retrospectively identified via computerized search and were grouped based on the cytologic diagnosis and HR-HPV status as negative for intraepithelial lesion or malignancy (NILM)/HPV-, NILM/HPV+, atypical squamous cells of undetermined significance (ASC-US)/HPV-, ASC-US/HPV+, low grade squamous intraepithelial lesion (LSIL)/HPV-, LSIL/HPV+, atypical squamous cells, cannot exclude high grade squamous intraepithelial lesion (ASC-H)/HPV-, ASC-H/HPV+, high grade squamous intraepithelial lesion (HSIL)/HPV-, and HSIL/HPV+. The patients' pertinent past medical history and follow-up information were analyzed. RESULTS During 3-year follow-up period, histologically proven HSIL was found in 5 of 1565 (0.3%) patients with NILM/HPV-, 7 of 141 (5.0%) with NILM/HPV+, 2 of 502 (0.4%) with ASC-US/HPV-, 30 of 274 (10.9%) with ASC-US/HPV+, 1 of 81 (1.2%) with LSIL/HPV-, 28 of 159 (17.6%) with LSIL/HPV+, 3 of 18 (16.7%) with ASC-H/HPV-, 34 of 69 (49.3%) with ASC-H/HPV+, 7 of 7 (100%) with HSIL/HPV-, and 35 of 56 (62.5%) HSIL/HPV+. In reviewing 12 HSIL cases that were originally diagnosed as NILM, 7 remained as NILM, and the other 5 were reclassified as 1 HSIL, 1 ASC-H, and 3 ASC-US, respectively. In 18 HSIL cases with negative HR-HPV, 12 patients had a prior history of positive HR-HPV testing and/or positive p16 IHC stain in the follow-up cervical biopsy. CONCLUSION HR-HPV testing plays an important role in cervical cancer screening by identifying HSIL in patients with ASC-US, LSIL, and NILM. Co-testing is an optimal method to identifying the patients with higher risk for developing cervical abnormalities.
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Affiliation(s)
- Jack Yang
- The Department of Pathology and Laboratory Medicine, Medical University of South Carolina, Charleston, South Carolina
| | - Fredrick S Nolte
- The Department of Pathology and Laboratory Medicine, Medical University of South Carolina, Charleston, South Carolina
| | - Olga S Chajewski
- The Department of Pathology and Laboratory Medicine, Medical University of South Carolina, Charleston, South Carolina
| | - Kathryn G Lindsey
- The Department of Pathology and Laboratory Medicine, Medical University of South Carolina, Charleston, South Carolina
| | - Patricia M Houser
- The Department of Pathology and Laboratory Medicine, Medical University of South Carolina, Charleston, South Carolina
| | - Jalidsa Pellicier
- The Department of Pathology and Laboratory Medicine, Medical University of South Carolina, Charleston, South Carolina
| | - Qun Wang
- The Department of Pathology and Laboratory Medicine, Medical University of South Carolina, Charleston, South Carolina
| | - Laleh Ehsani
- The Department of Pathology and Laboratory Medicine, Medical University of South Carolina, Charleston, South Carolina
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Szentirmay Z, Veleczki Z, Kásler M. [Human papillomavirus associated cervix uteri morbidity in Hungary: epidemiology and correlation with the HPV types and the simultaneous cytological diagnosis]. Orv Hetil 2017; 158:1213-1221. [PMID: 28758434 DOI: 10.1556/650.2017.30807] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Persistent infection of human papillomavirus is known to cause cervical intraepithelial neoplasia or cancer in the cervix uteri and other HPV-associated cancers in different localization. Based on epidemiological and biological data, principally the high risk HPV is responsible for development of cervical these cancers. However, we have no information about the frequently distribution of different HPV types and what is the correlation between the HPV types and cytological diagnosis in cervical intraepithelial neoplasia (CIN). AIM In this paper, we are going to present new data involving incidence and mortality of HPV-associated cancers during the period of 2009-2015 in Hungary. We are also going to investigate the correlation of cervical cytological diagnosis and HPV typing, and the preventive effect of HPV vaccination. METHOD The epidemiological data spring from the National Cancer Registry. HPV typing was performed by Linear Array HPV Genotyping Test. Simultaneous cytological diagnosis and HPV typing was carried out on 2048 cytological samples collected in period of 2009-2016. RESULTS According to the epidemiologic data, the most frequently occurring HPV-associated cancer is the laryngeal carcinoma in man, and the cervical cancer in woman in Hungary. During the 2009-2015 time intervals, the frequency distribution of head and neck cancers was not changed in man, but the incidence of tongue root squamous cell carcinomas was gradually increasing in woman. We have defined the clinical significance of single and simultaneously multiple HPV infection and have investigated the correlation of the HPV frequency distribution and cytological diagnosis in CIN. It was found that in the cytological negativity of probably/possibly carcinogen pHR-HPV group classified by IACR was much more frequent as in HR-HPV group (56% versus 47%). The presence of simultaneous multiplex HPV infection betokens an increased cancer risk. According to the international publications, the ratio of HPV16 just twice as big as in cervical cancer, what we found in CIN (60% versus 30%). The frequency order of the HPV18 is 2nd in cancer, and 9th in CIN. Comparing the frequency distribution of HR/pHR-HPVs in cervical cancer and CIN, the HR-HPV35 is very rarely occurring in CIN, the pHR-HPV56, 66, and 73 is more frequently seen in CIN as in carcinoma. Appreciated the preventive value of anti-HPV vaccines, we have found a significant differences in group with 1 HPV/sample and in group with more than 1 HPV/sample. CONCLUSION The frequency distribution of tongue root squamous cell carcinoma and cervical cancer was gradually increasing in woman. The overall preventive effect of 9-valent vaccine is 80.3%. This preventive value should be higher because of the transformation ability of the different HPV types is not same. Out of consideration for HPV incidence in cancer, the preventive effect of 9-valent or 4-valent vaccines might reach to 93% or 73%. However, the pHR-HPVs are biologically active, it is not sufficient for the inclusion of these HPV types into population-wide HPV-DNA based cervical screening programs. Orv Hetil. 2017; 158(31): 1213-1221.
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Affiliation(s)
| | - Zsuzsa Veleczki
- Országos Onkológiai Intézet Budapest, Ráth György u. 7-9., 1122
| | - Miklós Kásler
- Országos Onkológiai Intézet Budapest, Ráth György u. 7-9., 1122
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Sørbye SW, Pedersen MK, Ekeberg B, Williams MEJ, Sauer T, Chen Y. Can an inadequate cervical cytology sample in ThinPrep be converted to a satisfactory sample by processing it with a SurePath preparation? Cytojournal 2017; 14:20. [PMID: 28900466 PMCID: PMC5583701 DOI: 10.4103/cytojournal.cytojournal_34_16] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Accepted: 03/14/2017] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND The Norwegian Cervical Cancer Screening Program recommends screening every 3 years for women between 25 and 69 years of age. There is a large difference in the percentage of unsatisfactory samples between laboratories that use different brands of liquid-based cytology. We wished to examine if inadequate ThinPrep samples could be satisfactory by processing them with the SurePath protocol. MATERIALS AND METHODS A total of 187 inadequate ThinPrep specimens from the Department of Clinical Pathology at University Hospital of North Norway were sent to Akershus University Hospital for conversion to SurePath medium. Ninety-one (48.7%) were processed through the automated "gynecologic" application for cervix cytology samples, and 96 (51.3%) were processed with the "nongynecological" automatic program. RESULTS Out of 187 samples that had been unsatisfactory by ThinPrep, 93 (49.7%) were satisfactory after being converted to SurePath. The rate of satisfactory cytology was 36.6% and 62.5% for samples run through the "gynecology" program and "nongynecology" program, respectively. Of the 93 samples that became satisfactory after conversion from ThinPrep to SurePath, 80 (86.0%) were screened as normal while 13 samples (14.0%) were given an abnormal diagnosis, which included 5 atypical squamous cells of undetermined significance, 5 low-grade squamous intraepithelial lesion, 2 atypical glandular cells not otherwise specified, and 1 atypical squamous cells cannot exclude high-grade squamous intraepithelial lesion. A total of 2.1% (4/187) of the women got a diagnosis of cervical intraepithelial neoplasia 2 or higher at a later follow-up. CONCLUSIONS Converting cytology samples from ThinPrep to SurePath processing can reduce the number of unsatisfactory samples. The samples should be run through the "nongynecology" program to ensure an adequate number of cells.
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Affiliation(s)
| | | | - Bente Ekeberg
- Department of Pathology, Akershus University Hospital, Lørenskog, Norway
| | | | - Torill Sauer
- Department of Pathology, Akershus University Hospital, Lørenskog, Norway
| | - Ying Chen
- Department of Pathology, Akershus University Hospital, Lørenskog, Norway
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Zheng B, Yang H, Li Z, Wei G, You J, Liang X, Zhao C. HPV test results and histological follow-up results of patients with LSIL Cervical Cytology from the Largest CAP-certified laboratory in China. J Cancer 2017; 8:2436-2441. [PMID: 28900480 PMCID: PMC5595072 DOI: 10.7150/jca.19421] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Accepted: 05/30/2017] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Age-adjusted evaluations have explored the possible utility of (HPV test results in women with LSIL Pap. We investigated HPV test results and histopathologic follow-up results of LSIL patients from China's largest CAP-certified laboratory. METHODS Patients with LSIL between 2011 and 2015 from the Guangzhou Kingmed Diagnostics were retrospectively retrieved and their hrHPV test results and histological follow-up results were collected and analyzed. RESULTS LSIL result was identified in 37,895 cases from 2,206,588 Pap tests (1.7%) including 1,513,265 liquid-based cytology and 693,323 conventional Pap tests. The average of these women was 38.4 years (15-88). The LSIL reporting rate in women <30 years was significantly higher than that in women > 30 years (2.1% vs 1.7%). The age specific reporting LSIL rates declined with increased age. 8,014 of 37,895 (21.2%) women with LSIL cytology also had HC2 HPV test results. 75.8% of women with LSIL Pap tests were hrHPV+ and the HPV+ rates declined with increased age except in patients older than 60 years. Overall histopathologic diagnoses within 6 months after LSIL were identified in 5,987 of 37,895 patients at Guangzhou Kingmed Diagnostics. CIN2/3 was identified in 15.2% patients, CIN1 in 66.9%, negative in 14.9% patients. No invasive carcinoma was found in all patients. Of 8014 patients with LSIL Pap test and HPV testing results, 1727 patients had histological follow-up within 6 months after Pap cytology test and HPV testing. The detection rate of CIN2/3 was significantly higher in patients with positive HPV testing result than that in patients with negative HPV testing result (17.8% vs. 8.1%). Among patients with LSIL/HPV negative tests, CIN2/3 was detected in 1 of 30 (3.3%) women aged 50 years and above, appearing lower than those in women less than 50 years (8.0%, 28/351, P=0.357). CONCLUSION This is the largest histological follow-up study in women with LSIL Pap from China and the data are helpful in establishing a baseline for better understanding the status of cervical screening in China. The 85.1% positive predict value of LSIL Pap cytology for follow-up CIN lesion was within currently recognized benchmark ranges.
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Affiliation(s)
- Baowen Zheng
- Guangzhou Kingmed Diagnostics, Guangzhou, Guangdong 510330, P. R. China
| | - Huaitao Yang
- Department of Pathology, University Cincinnati College of Medicine, Cincinnati, OH 45219, USA
| | - Zaibo Li
- Department of Pathology, Wexner Medical Center at Ohio State University, Columbus, OH 43210, USA
| | - Guijian Wei
- Guangzhou Kingmed Diagnostics, Guangzhou, Guangdong 510330, P. R. China
| | - Jia You
- Guangzhou Kingmed Diagnostics, Guangzhou, Guangdong 510330, P. R. China
| | - Xiaoman Liang
- Guangzhou Kingmed Diagnostics, Guangzhou, Guangdong 510330, P. R. China
| | - Chengquan Zhao
- Department of Pathology, Magee-Womens Hospital, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA
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75
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Wu Q, Zhao X, Fu Y, Wang X, Zhang X, Tian X, Cheng B, Lu B, Yu X, Lan S, Lu W, Ma D, Cheng X, Xie X. A cross-sectional study on HPV testing with type 16/18 genotyping for cervical cancer screening in 11,064 Chinese women. Cancer Med 2017; 6:1091-1101. [PMID: 28378404 PMCID: PMC5430103 DOI: 10.1002/cam4.1060] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2016] [Revised: 02/09/2017] [Accepted: 02/23/2017] [Indexed: 01/10/2023] Open
Abstract
Cytology‐based cervical cancer screening is restricted because of a lack of cytologists. Thus, HPV‐based instead of cytology‐based screening may be a more suitable strategy in China. Here, we assessed the effectiveness of HPV testing (Cobas® 4800 Test, Roche) and HPV‐based programs to detect high‐grade cervical intraepithelial neoplasia (CIN) or cancer compared with cytology (Thinprep, Hologic) and cytology‐based programs through a cross‐sectional study in 11,064 Chinese women aged 21–65 years who were enrolled from Longyou County in Zhejiang Province, China. The rates of HPV positivity and cytology abnormality were 9.8% and 6.1%, respectively. The HPV positivity rate had two age peaks, 21–24 (15.4%) and 60–65 (14.4%) years. According to adjusted data, HPV testing demonstrated significantly higher sensitivity and negative predictive value (NPV) than cytology for detecting CIN2 or worse (90.0% vs. 66.7%, 99.9% vs. 99.5%), and there was an acceptable specificity (91.3%) and positive predictive value (PPV, 12.5%). Furthermore, primary HPV testing with type 16/18 genotyping showed the highest sensitivity (78.6%) and NPV (99.7%) among four screening strategies, and there was similar specificity (96.8%) and PPV (23.9%) compared with co‐testing screening to detect CIN2+, while there were fewer colposcopies (4.2) and tests (106.3) performed than with co‐testing and primary cytology screening to detect a case of high‐grade CIN. The differences in effectiveness were approximately similar when CIN3+ was the identifying target. Our findings suggest that primary HPV testing with type 16/18 genotyping has a higher sensitivity and NPV, possesses optimal cost/effectiveness in the first round of screening and is a feasible strategy of cervical cancer screening for Chinese women.
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Affiliation(s)
- Qiongyan Wu
- Department of Gynecologic Oncology, Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, China.,Key Laboratory of Women's Reproductive Health of Zhejiang Province, Hangzhou, China
| | - Xiumin Zhao
- Department of Gynecologic Oncology, Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, China.,Key Laboratory of Women's Reproductive Health of Zhejiang Province, Hangzhou, China
| | - Yunfeng Fu
- Department of Gynecologic Oncology, Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Xinyu Wang
- Department of Gynecologic Oncology, Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Xiaofei Zhang
- Department of Pathology, Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Xun Tian
- Cancer Biology Research Center (Key laboratory of the ministry of education), Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Bei Cheng
- Department of Gynecologic Oncology, Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Bingjian Lu
- Department of Pathology, Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Xiao Yu
- Department of Gynecology, Women & Children Healthcare Hospital of Quzhou City, Quzhou, Zhejiang, China
| | - Suqiu Lan
- Longyou County Maternal and Child Health-Care Center, Quzhou, Zhejiang, China
| | - Weiguo Lu
- Department of Gynecologic Oncology, Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Ding Ma
- Cancer Biology Research Center (Key laboratory of the ministry of education), Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Xiaodong Cheng
- Department of Gynecologic Oncology, Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Xing Xie
- Department of Gynecologic Oncology, Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, China
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Rodriguez-Urrego PA, Dulcey-Hormiga IC, Barrera-Herrera LE, Suarez-Zamora DA, Palau-Lazaro MA, Buritica-Cifuentes C. Endometriosis mimicking glandular atypia in a cervical cytology. J Cytol 2017; 34:61-63. [PMID: 28182083 PMCID: PMC5259937 DOI: 10.4103/0970-9371.197624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Endometriosis involving the uterine cervix is a rare condition that can lead to diagnostic errors in the interpretation of Pap smear. We report the case of a 41-year-old patient in whom the initial Pap smear revealed three-dimensional clusters of glandular cells with elongated nuclei, occasional mitosis, and atypia, which was interpreted as atypical glandular cells, not otherwise specified (NOS). The patient was taken to colposcopy and endocervical biopsy. Colposcopy was normal and the biopsy presented glands with elongated nuclei and surrounded by endometrial stroma admixed with normal endocervical glands. Immunohistochemical studies were reactive for CD10 in the stromal cells and vimentin in endometrioid glands. The findings were consistent with cervical endometriosis. Endometriosis in the cervix is an uncommon pathology that mimics malignancy and may be interpreted as atypical or glandular neoplasia in the cytology.
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Affiliation(s)
- Paula A Rodriguez-Urrego
- Department of Pathology and Laboratories, Hospital Universitario Fundación Santa Fe de Bogotá, Colombia; School of Medicine, Universidad de los Andes, Colombia
| | - Isabel C Dulcey-Hormiga
- Department of Pathology and Laboratories, Hospital Universitario Fundación Santa Fe de Bogotá, Colombia
| | - Luis E Barrera-Herrera
- Department of Pathology and Laboratories, Hospital Universitario Fundación Santa Fe de Bogotá, Colombia
| | - David A Suarez-Zamora
- Department of Pathology and Laboratories, Hospital Universitario Fundación Santa Fe de Bogotá, Colombia
| | - Mauricio A Palau-Lazaro
- Department of Pathology and Laboratories, Hospital Universitario Fundación Santa Fe de Bogotá, Colombia; School of Medicine, Universidad de los Andes, Colombia
| | - Catalina Buritica-Cifuentes
- Department of Pathology and Laboratories, Hospital Universitario Fundación Santa Fe de Bogotá, Colombia; School of Medicine, Universidad de los Andes, Colombia
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Kini H, Kini JR, Suman E, Rai S. Fungal spores and fruiting bodies in cervicovaginal smears: Contaminant or infection? Diagn Cytopathol 2017; 45:191-194. [PMID: 28084685 DOI: 10.1002/dc.23658] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2016] [Revised: 11/12/2016] [Accepted: 11/30/2016] [Indexed: 11/09/2022]
Abstract
BACKGROUND Contaminants from various sources are curious findings in cervicovaginal smears and pose diagnostic challenges especially when they need to be distinguished from pathogens. Candidiasis is the most frequently encountered fungal infection but fungal contaminants are relatively common. Detection of fruiting bodies and spores of Aspergillus species is uncommon and may represent either a true infection or contamination. This study was undertaken to evaluate the presence of fungal spores, hyphae, and fruiting bodies in routine cervical smears and distinguish a true infection from contamination. METHODS Conventional cervicovaginal smears collected from women were incidentally found to have fungal fruiting bodies and spores. All smears received in the Cytology Department during that one month were reviewed for the presence of these elements. RESULTS Five out of the 120 smears, received from the outpatient department over a period of three consecutive days, showed evidence of fungal organisms. The patients were 28-59 years of age. While four patients were asymptomatic, only one patient complained of minimal vaginal discharge. All were immunocompetent. Cervicovaginal smears were prepared as part of routine screening. Fungal fruiting bodies, branching hyphae and numerous spores were seen in otherwise normal smears. Culture of scrapings from the surface of the wooden spatulas grew Aspergillus niger. CONCLUSIONS Contamination of Pap smears by fungus must be distinguished from true infection, the latter being supported by positive clinical findings and the presence of significant inflammation in the smears. Literature review was done to see the range of contaminants detected in Pap smears. Diagn. Cytopathol. 2017;45:191-194. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Hema Kini
- Departments of Pathology, Kasturba Medical College, Manipal University, Mangalore, Karnataka, India
| | - Jyoti R Kini
- Departments of Pathology, Kasturba Medical College, Manipal University, Mangalore, Karnataka, India
| | - Ethel Suman
- Departments of Microbiology, Kasturba Medical College, Manipal University, Mangalore, Karnataka, India
| | - Sharada Rai
- Departments of Pathology, Kasturba Medical College, Manipal University, Mangalore, Karnataka, India
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78
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Lim AW, Landy R, Castanon A, Hollingworth A, Hamilton W, Dudding N, Sasieni P. Cytology in the diagnosis of cervical cancer in symptomatic young women: a retrospective review. Br J Gen Pract 2016; 66:e871-e879. [PMID: 27777232 PMCID: PMC5198672 DOI: 10.3399/bjgp16x687937] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2016] [Accepted: 05/27/2016] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Cervical cancer in young women presents a diagnostic challenge because gynaecological symptoms are common but underlying disease is rare. AIM To explore the potential for using cytology as a diagnostic aid for cervical cancer in young women. DESIGN AND SETTING Retrospective review of primary care records and cytology data from the national cervical screening database and national audit of cervical cancers. METHOD Four datasets of women aged 20-29 years in England were examined: primary care records and national screening data from an in-depth study of cervical cancers; cytology from the national audit of cervical cancers; whole-population cytology from the national screening database; and general-population primary care records from the Clinical Practice Research Datalink. The authors explored the sensitivity and positive predictive value (PPV) of symptomatic cytology (earliest <12 months before diagnosis) to cervical cancer. RESULTS The estimated prevalence of cervical cancer among symptomatic women was between 0.4% and 0.9%. The sensitivity of moderate dyskaryosis (high-grade squamous intraepithelial lesion [HSIL]) or worse in women aged 20-29 years was 90.9% to 96.2% across datasets, regardless of symptom status. The PPV was estimated to be between 10.0% and 30.0%. For women aged 20-24 years, the PPV of '?invasive squamous carcinoma' was 25.4%, and 2.0% for severe or worse cytology. CONCLUSION Cytology has value beyond screening, and could be used as a diagnostic aid for earlier detection of cervical cancer in young women with gynaecological symptoms by ruling in urgent referral.
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Affiliation(s)
- Anita Ww Lim
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University, London
| | - Rebecca Landy
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University, London
| | - Alejandra Castanon
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University, London
| | - Antony Hollingworth
- Department of Gynaecology, Whipps Cross University Hospital, Barts Health NHS Trust, London
| | - Willie Hamilton
- Department of Primary Care, St Luke's Campus, University of Exeter, Exeter
| | - Nick Dudding
- East Pennine Cytology Training Centre, Raynham House, Leeds
| | - Peter Sasieni
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University, London
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Tsiambas E, Riziotis C. Implementation of a real-time reference and calibration grid platform for improved screening - mapping in Pap test slides. Pathol Int 2016; 67:24-31. [PMID: 27891686 DOI: 10.1111/pin.12481] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Revised: 10/26/2016] [Accepted: 10/27/2016] [Indexed: 11/28/2022]
Abstract
Cervical cancer screening based on the Papanicolaou (Pap) test is a widely applied but not always efficient practice for detecting Human Papillomavirus (HPV) mediated lesions, partially due to a non-systematic and inadequate screening process. Our aim was to introduce an inexpensive easy-to-use direct screening platform for improved detection of abnormal cells indicative of underlying cervical neoplasia as well as persisting HPV infection. By employing a novel, efficient technique of laser-based micromachining, we achieved the fabrication of spatial grids on commercially available coverslips allowing visual segmentation of the slide for efficient screening. Abnormal and formerly diagnosed as negative for intraepithelial lesion or malignancy (NILM) Pap test slides (n = 200) were analyzed by conventional and grid-based screening. Grid-based microscopy led to a more reliable diagnosis compared to the conventional by identifying an increased number of abnormal cells (P = 0.001). It decreased borderline ASCUS, AGC diagnosis, increasing LSIL, HSIL and in situ AdenoCa detection rates closely related with biopsy (P = 0.015; kappa = 0.978). Concerning the set of NILM diagnoses in rapid re-screening, the method upgraded six cases (n = 6) to LSIL (P = 0.001). The proposed technical solution offers a calibration and orientation visual aid during the on-site screening process providing significant advantages compared to expensive digital imaging techniques.
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Affiliation(s)
- Evangelos Tsiambas
- Department of Cytology & Digital Image Analysis, MycoLab, Athens, Greece.,Department of Molecular Biology & IHC, 401 General Military Hospital, Athens, Greece.,Department of Pathology, Medical School, National and Kapodistrian University of Athens, Greece
| | - Christos Riziotis
- Theoretical and Physical Chemistry Institute, Photonics for Nanoapplications Laboratory, National Hellenic Research Foundation, Athens, Greece
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Polman NJ, Uijterwaal MH, Witte BI, Berkhof J, van Kemenade FJ, Spruijt JWM, van Baal WM, Graziosi PGCM, van Dijken DKE, Verheijen RHM, Helmerhorst TJM, Steenbergen RDM, Heideman DAM, Ridder R, Snijders PJF, Meijer CJLM. Good performance of p16/ki-67 dual-stained cytology for surveillance of women treated for high-grade CIN. Int J Cancer 2016; 140:423-430. [PMID: 27677098 DOI: 10.1002/ijc.30449] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Revised: 08/19/2016] [Accepted: 09/07/2016] [Indexed: 11/11/2022]
Abstract
Women treated for high-grade cervical intraepithelial neoplasia (CIN) are at risk of recurrent CIN Grade 2 or worse (rCIN2+). Currently, posttreatment monitoring is performed using cytology or cytology/high-risk (hr)HPV cotesting. This study aimed to evaluate the performance of p16/Ki-67 dual-stained cytology (p16/Ki-67) for posttreatment monitoring. Three hundred and twenty-three women treated for high-grade CIN in the SIMONATH study underwent close surveillance by cytology, hrHPV and DNA methylation marker testing up to 12 months posttreatment. Histological endpoints were ascertained by colposcopy with biopsy at 6 and/or 12 months. p16/Ki-67 dual-staining was performed on residual liquid-based cytology samples obtained at, or shortly before biopsy collection. Clinical performance estimates of cytology, hrHPV, p16/Ki-67 testing and combinations thereof for the detection of rCIN2+ were determined and compared to each other. Sensitivity of p16/Ki-67 for rCIN2+ (69.2%) was nonsignificantly lower than that of cytology (82.1%; ratio 0.84, 95% CI: 0.71-1.01), but significantly lower than that of hrHPV testing (84.6%; ratio 0.82, 95% CI: 0.68-0.99). Specificity of p16/Ki-67 for rCIN2+ (90.4%) was significantly higher compared to both cytology (70.8%; ratio 1.28, 95% CI: 1.19-1.37) and hrHPV testing (76.2%; ratio 1.19, 95% CI: 1.12-1.26). Overall, hrHPV testing showed very high sensitivity, along with a good specificity. When considering cotesting, combined p16/Ki-67/hrHPV testing showed rCIN2+ sensitivity comparable to cytology/hrHPV cotesting (87.2% vs. 89.7%; ratio 0.97, 95% CI: 0.92-1.03), but with significantly increased specificity (74.2% vs. 58.1%; ratio 1.28, 95% CI: 1.19-1.38). Thus, when considered in combination with hrHPV, p16/Ki-67 might be an attractive approach for surveillance of women treated for high-grade CIN.
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Affiliation(s)
- Nicole J Polman
- Department of Pathology, VU University Medical Center, Amsterdam, The Netherlands
| | - Margot H Uijterwaal
- Department of Pathology, VU University Medical Center, Amsterdam, The Netherlands
| | - Birgit I Witte
- Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, The Netherlands
| | - Johannes Berkhof
- Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, The Netherlands
| | - Folkert J van Kemenade
- Department of Pathology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Johan W M Spruijt
- Department of Obstetrics and Gynecology, VU University Medical Center, Amsterdam, The Netherlands
| | - W Marchien van Baal
- Department of Obstetrics and Gynecology, Flevo Hospital, Almere, The Netherlands
| | - Peppino G C M Graziosi
- Department of Obstetrics and Gynecology, Sint Antonius Hospital, Nieuwegein, The Netherlands
| | - Dorenda K E van Dijken
- Department of Obstetrics and Gynecology, Onze Lieve Vrouwen Gasthuis West, Amsterdam, The Netherlands
| | - René H M Verheijen
- Department of Gynaecological Oncology, Division of Surgical Oncology, UMC Utrecht Cancer Center, Utrecht, The Netherlands
| | - Theo J M Helmerhorst
- Department of Obstetrics and Gynecology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | | | | | - Ruediger Ridder
- Roche mtm Laboratories AG, Mannheim, Germany.,Ventana Medical Systems, Inc., Tucson, Arizona
| | - Peter J F Snijders
- Department of Pathology, VU University Medical Center, Amsterdam, The Netherlands
| | - Chris J L M Meijer
- Department of Pathology, VU University Medical Center, Amsterdam, The Netherlands
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Abstract
This study evaluated the clinical significance of endometrial cells in Papanicolaou test (Pap test). A retrospective study was performed from the cytological database of Seoul National University Hospital. The results of Pap tests of women aged 40 years or older between January 1998 and December 2007 were sorted. Medical records were reviewed to identify the presence of endometrial cells from cytology, and cytologic and histologic follow-ups were performed to determine the clinical significance of the lesions. Among 75,673 Pap cases, 832 cases presenting normal endometrial cells (nEMCs) were included in this study. Their follow-up data are as follows: 800 with nEMCs, 5 with atypical EMCs (aEMCs), and 27 with endometrial cancer cells (EMCCs) on cytologic and histologic follow-ups. Significant endometrial or cervical diseases were found in 0.5%, 40%, and 100% of the cases on the following-up the pathologic examination of the women with nEMCs, aEMCs, and EMCCs, respectively. Unlike aEMCs and EMCCs, nEMCs on Pap tests did not increase the risk of developing endometrial hyperplasia or endometrial cancer in women aged 40 years or older. There is no clinical benefit to perform routine endometrial work-up in women with nEMCs, as recommended in the 2001 Bethesda System. However, symptomatic women with nEMCs on Pap test should perform endometrial work-up regardless of menopausal status.
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Affiliation(s)
- Eun Jeong Yu
- a Department of Obstetrics and Gynecology, College of Medicine , Seoul National University , Seoul , Korea
| | - Noh-Hyun Park
- a Department of Obstetrics and Gynecology, College of Medicine , Seoul National University , Seoul , Korea
| | - Yong-Sang Song
- a Department of Obstetrics and Gynecology, College of Medicine , Seoul National University , Seoul , Korea
| | - Yoo-Kyung Lee
- b Department of Obstetrics and Gynecology , Cheil General Hospital, College of Medicine, Dankook University , Seoul , Korea
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82
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Bellisano G, Ambrosini-Spaltro A, Faa G, Ravarino A, Piccin A, Peer I, Kasal A, Vittadello F, Negri G. Pap-tests with non-hyperchromatic dyskariosis are often associated with squamous intraepithelial lesions of the cervix uteri with eosinophilic features. Diagn Cytopathol 2016; 44:783-6. [PMID: 27407066 DOI: 10.1002/dc.23532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Revised: 05/25/2016] [Accepted: 06/24/2016] [Indexed: 11/07/2022]
Abstract
BACKGROUND Squamous intraepithelial lesions of the cervix uteri with eosinophilic features (eosinophilic dysplasia, ED) are a peculiar type of dysplasia with metaplastic phenotype which was described in histological specimens. The cytological features of these lesions have not been studied yet. METHODS Histological samples from 66 women with features of ED and positive p16(INK4a) staining were included in the study. Within the previous year, all women had at least one pap-test, whose features were recorded and compared with 31 control samples with high-grade dysplasia of usual type. RESULTS The previous pap-test showed high-grade dysplastic cells with non-hyperchromatic nuclei in 56/66 (84.8%) cases and metaplastic features in 60/66 (90.9%) cases. Conversely, the dysplastic cells of the usual lesions showed non-hyperchromatic nuclei in 6/31 (19.4%) and metaplastic features in 4/31 (12.9%) cases. Statistical analysis showed significant differences in distribution of the non-hyperchromatic nuclei (P < 0.001), metaplastic features (P < 0.001), presence of both non-hyperchromatic nuclei and metaplastic features (P < 0.001) and usual dysplastic features (P < 0.001) among the study and control groups. CONCLUSIONS A high-grade squamous intraepithelial lesion with non-hyperchromatic nuclei or metaplastic features is often found in the pap-test previous to the histological diagnosis of ED and may represent the cytologic correlate of this particular type of dysplasia. Diagn. Cytopathol. 2016;44:783-786. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Giulia Bellisano
- Department of Surgical Sciences, Division of Pathology, Section Anatomic Pathology, University of Cagliari, Cagliari, Italy.,Department of Pathology, Sirai Hospital Carbonia, Carbonia, Italy
| | | | - Gavino Faa
- Department of Surgical Sciences, Division of Pathology, Section Anatomic Pathology, University of Cagliari, Cagliari, Italy
| | - Alberto Ravarino
- Department of Surgical Sciences, Division of Pathology, Section Anatomic Pathology, University of Cagliari, Cagliari, Italy
| | - Andrea Piccin
- Department of Hematology, Central Hospital Bolzano, Bolzano, Italy
| | - Irmgard Peer
- Department of Pathology, Central Hospital Bolzano, Bolzano, Italy
| | - Armin Kasal
- Department of Pathology, Central Hospital Bolzano, Bolzano, Italy
| | | | - Giovanni Negri
- Department of Pathology, Central Hospital Bolzano, Bolzano, Italy.
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83
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Davis G, Anderson L, Pather S. Extramammary paget's disease mimicking localized malignancy on cervical cytology. Diagn Cytopathol 2016; 44:931-934. [PMID: 27390216 DOI: 10.1002/dc.23530] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2016] [Revised: 05/30/2016] [Accepted: 06/24/2016] [Indexed: 11/06/2022]
Abstract
A case of Extramammary Paget's Disease (EMPD) involving the cervix mimicking cervical carcinoma on routine cervical cytology in a 66-year-old woman with a history of recurrent multifocal EMPD involving the vulva, perineum, perianal area, and rectum is reported. The patient had undergone multiple excisions and reconstructions of EMPD, however, had a benign cervical smear history and reported no vaginal bleeding. The conventional papanicolaou smear was reported as concerning for carcinoma with abundant, well preserved material illustrating highly atypical cells with anisonucleosis and dense cytoplasm and focal microacini. Gross anatomical distortion from EMPD and previous surgery precluded satisfactory outpatient colposcopic assessment. Examination under anesthesia was performed and colposcopy revealed a four quadrant high grade lesion extending into the vagina with one area suspicious for malignancy on the cervix. Directed biopsies were taken and histopathology confirmed EMPD with diffuse adenocarcinoma in situ cells infiltrating skin and mucosa of all specimens. These large pale cells were seen both a singly and in clusters of nests within the mucosa. Periodic Acid Schiff staining was positive for intracytoplasmic mucin and supportive immunohistochemistry was performed with strong reactivity in atypical cells for CK7, CEA, and Cam 5.2. There was no evidence of invasive malignancy and the patient remains under clinical surveillance. Cervical EMPD is rare but should be considered in women with abnormal cervical cytology and a history of vulval EMPD. Diagn. Cytopathol. 2016;44:931-934. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Georgina Davis
- Department of Gynaecology Oncology, Chris O'Brien Lifehouse, Camperdown, New South Wales, Australia
| | - Lyndal Anderson
- Department of Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia.
| | - Selvan Pather
- Department of Gynaecology Oncology, Chris O'Brien Lifehouse, Camperdown, New South Wales, Australia
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84
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Landy R, Castanon A, Hamilton W, Lim AWW, Dudding N, Hollingworth A, Sasieni PD. Evaluating cytology for the detection of invasive cervical cancer. Cytopathology 2016; 27:201-9. [PMID: 26126636 PMCID: PMC4913744 DOI: 10.1111/cyt.12259] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/23/2015] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To assess the sensitivity, the number needed to screen (NNS) and the positive predictive value (PPV) of cervical cytology for the diagnosis of cancer by age in a screening population. METHODS A retrospective cohort of women with invasive cervical cancer nested within a census of cervical cytology. All (c. 8 million) women aged 20-64 years with cervical cytology (excluding tests after an earlier abnormality). From April 2007 to March 2010, 3372 women had cervical cancer diagnosed within 12 months of such cytology in England. The sensitivity of cervical cytology to cancer, NNS to detect one cancer and predictive values of cytology were calculated for various 'referral' thresholds. These were calculated for ages 20-24, 25-34, 35-49 and 50-64 years. RESULTS The sensitivity of at least moderate dyskaryosis [equivalent to a high-grade squamous intraepithelial lesion (HSIL) or worse] for cancer of 89.4% [95% confidence interval (CI) 88.3-90.4%] in women offered screening was independent of age. At all ages, women with borderline-early recall or mild dyskaryosis on cytology (equivalent to ASC-US and LSIL, respectively, in the Bethesda system) had a similar risk of cervical cancer to the risk in all women tested. The PPV of severe dyskaryosis/?invasive and ?glandular neoplasia cytology (equivalent to squamous cell carcinoma and adenocarcinoma/adenocarcinoma in situ, respectively, in the Bethesda System) were 34% and 12%, respectively; the PPV of severe dyskaryosis (HSIL: severe dysplasia) was 4%. The NNS was lowest when the incidence of cervical cancer was highest, at ages 25-39 years, but the proportion of those with abnormal cytology who have cancer was also lowest in younger women. CONCLUSIONS The PPV of at least severe dyskaryosis (HSIL: severe dysplasia) for cancer was 4-10% of women aged 25-64 years, justifying a 2-week referral to colposcopy and demonstrating the importance of failsafe monitoring for such patients. The sensitivity of cytology for cervical cancer was excellent across all age groups.
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Affiliation(s)
- R Landy
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Bart's & The London School of Medicine, Queen Mary University of London, London, UK
| | - A Castanon
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Bart's & The London School of Medicine, Queen Mary University of London, London, UK
| | - W Hamilton
- College House, St Luke's Campus, Exeter, UK
| | - A W W Lim
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Bart's & The London School of Medicine, Queen Mary University of London, London, UK
| | - N Dudding
- Cytology Department, Sheffield Teaching Hospitals, NHS Foundation Trust, Sheffield, UK
| | - A Hollingworth
- Whipps Cross University, Hospital, Barts Health NHS Trust, London, UK
| | - P D Sasieni
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Bart's & The London School of Medicine, Queen Mary University of London, London, UK
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85
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Smart LM, Buchan M, Cropper AJ, Cross PA, Denton KJ, Mutch AF, Wilson A. BAC recommended code of practice for cytology laboratories participating in the UK cervical screening programmes 2015: a secondary publication. Cytopathology 2016; 27:8-34. [PMID: 26818038 DOI: 10.1111/cyt.12320] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/18/2015] [Indexed: 01/14/2023]
Affiliation(s)
- L M Smart
- NHS Grampian - Department of Pathology, Aberdeen Royal Infirmary, Aberdeen, UK
| | - M Buchan
- Department of Cytology, Derby Teaching Hospitals, NHSFT, Derby, UK
| | - A J Cropper
- Department of Cytology, Derby Teaching Hospitals, NHSFT, Derby, UK
| | - P A Cross
- Department of Histocytopathology, Queen Elizabeth Hospital, Sheriff Hill, Gateshead, UK
| | - K J Denton
- Public Health England - Screening Quality Assurance Service, Bristol, UK
| | - A F Mutch
- Department of Cellular Pathology, Bedford Hospital, NHS Trust, Bedford, UK
| | - A Wilson
- Department of Histopathology, Monklands Hospital, Airdrie, UK
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86
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Mahajan A, Kucher E, Hoefle W, Engelhardt S, Accola M, Barasch S, Rehrauer W, Selvaggi SM. Maximizing the adequacy of Hologic(®) Cervista(®) HPV HR results on ThinPrep(®) Pap samples treated with glacial acetic acid. Diagn Cytopathol 2016; 44:215-9. [PMID: 26779984 DOI: 10.1002/dc.23426] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Revised: 09/14/2015] [Accepted: 12/16/2015] [Indexed: 11/10/2022]
Abstract
BACKGROUND Although glacial acetic acid (GAA) treatment of bloody cervical samples has reduced the rate of unsatisfactory Pap Tests, recent studies suggest that it may negatively impact high-risk (hr)-HPV test results. The objectives of this study were to compare the levels of genomic DNA between GAA treated and nontreated ThinPrep(®) samples using the Hologic(®) Cervista(®) HPV-HR assay and to compare the adequacy of the ThinPrep(®) Pap Test between aliquoted and nonaliquoted samples. METHODS Prior to GAA treatment, 2.5 ml of the cervical sample was prealiquoted from 102 bloody ThinPrep(®) vials. Both GAA treated and nontreated samples were analyzed for hr-HPV using the Cervista(®) HPV HR assay. The levels of genomic DNA were measured and compared between these samples. In addition, ThinPrep(®) Pap Test adequacy rates were calculated and compared on aliquoted and nonaliquoted cervical samples. RESULTS Of the 102 cervical samples, 95 (93%) nontreated aliquots contained satisfactory levels of genomic DNA as compared to 36 (35%) GAA-treated samples (p < 0.00001). Ninety-nine (97%) aliquoted cervical samples were satisfactory for cytologic evaluation as compared to 1,326 (96%) GAA treated samples from 2013 (nonaliquoted); not statistically significant (p = 0.7968). CONCLUSION The levels of genomic DNA were significantly decreased in GAA treated vs non-treated TP samples. Aliquoting from the TP sample prior to treatment with GAA enables accurate measurement of DNA without affecting the adequacy of the TP cytology slide.
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Affiliation(s)
- Aparna Mahajan
- Department of Pathology and Laboratory Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Erek Kucher
- University of Wisconsin Hospital and Clinics, Madison, Wisconsin
| | - Wanda Hoefle
- University of Wisconsin Hospital and Clinics, Madison, Wisconsin
| | | | - Molly Accola
- University of Wisconsin Hospital and Clinics, Madison, Wisconsin
| | - Samuel Barasch
- Department of Pathology and Laboratory Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - William Rehrauer
- Department of Pathology and Laboratory Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Suzanne M Selvaggi
- Department of Pathology and Laboratory Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
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87
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Kovacevic G, Nikolic N, Jovanovic-Galovic A, Hrnjakovic-Cvjetkovic I, Vuleta D, Patic A, Radovanov J, Milosevic V. Frequency of twelve carcinogenic human papilloma virus types among women from the South Backa region, Vojvodina, Serbia. Turk J Med Sci 2016; 46:97-104. [PMID: 27511341 DOI: 10.3906/sag-1410-47] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2014] [Accepted: 03/23/2015] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND/AIM The aim of this study was to determine the presence and age distribution of different oncogenic human papilloma virus (HPV) types in women in the South Backa region and its relationship to Pap results. MATERIALS AND METHODS In a group of 1087 women with normal and abnormal cytology, the commercial HR HPV Real-TM kit (Sacace Biotechnologies, Italy) was used. RESULTS Overall, 50.5% of the women were HPV positive. The presence of HPV types 18, 31, 51, and 58 was significantly influenced by age, while the presence of HPV types 16 and 45 was significantly influenced by cervical cytology. Results of the LSD test show a wide spectrum of high risk HPV among women with normal cytology and women with a low grade cervical lesion rate (atypical squamous cell of undetermined significance (ASCUS) and low grade squamous intraepithelial lesions (LSIL). The most prevalent HPV types found were 16, 31, 51, 18, and 52. In the HSIL group the most prevalent HPV types were 16 and 45. CONCLUSION The reported results provide new data on the circulation of oncogenic HPV genotypes and frequency of multiple infections among women in Vojvodina and suggest that a prophylactic vaccine against HPV 16 and 18 has the potential to prevent approximately half of the high-grade lesions.
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Affiliation(s)
| | - Natasa Nikolic
- Institute for Public Health of Vojvodina, Novi Sad, Serbia
| | | | | | - Dusan Vuleta
- Clinical Center of Vojvodina, Department of Obstetrics and Gynecology, Novi Sad, Serbia
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88
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Landy R, Castanon A, Dudding N, Lim AWW, Hollingworth A, Hamilton W, Sasieni PD. Cervical cytology and the diagnosis of cervical cancer in older women. J Med Screen 2015; 22:207-12. [PMID: 26346038 PMCID: PMC4638314 DOI: 10.1177/0969141315598174] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Accepted: 06/29/2015] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Most non-screen-detected cervical cancers are advanced stage. We assess the potential for cytology to expedite diagnosis when used outside of routine call and recall screening for cervical cancer. METHODS Two cohorts of women with cytology that did not appear to have been taken as part of routine screening, nested within a census of cervical cytology, in England between April 2007 and March 2010 were studied: 93,322 women aged 40-69 at first cytology, and 14,668 women aged ≥70. The diagnostic performance of high grade cervical squamous intraepithelial lesion (HSIL) or worse cytology was estimated. We also estimated case-fatality from stage distribution in women aged ≥66 with and without cytology in the year prior to diagnosis. RESULTS There were 259 cancers diagnosed in women aged 40-69 at first cytology, and 78 in women aged ≥70. The sensitivity of cytology ≥ HSIL for cancer was 89% and 83% respectively, and the number of women needed to test to identify one cancer was 404 (95% confidence interval [CI]: 355-462) and 226 (95% CI: 177-292) respectively. Women aged ≥66 with cytology within a year of diagnosis had earlier stage cancers than those without, corresponding to a 17-22% reduction in case fatality. CONCLUSIONS Cervical cytology is an excellent identifier of cancer among women tested outside routine screening call and recall. Its use as a triage tool, for instance in women with vague gynaecological symptoms, could facilitate earlier stage diagnosis and reduce cervical cancer mortality.
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Affiliation(s)
- Rebecca Landy
- Queen Mary University of London, Charterhouse Square, London, UK
| | | | - Nick Dudding
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | | | | | | | - Peter D Sasieni
- Queen Mary University of London, Charterhouse Square, London, UK
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89
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Frisch NK, Ahmed Y, Sethi S, Neill D, Kalinicheva T, Shidham V. The effectiveness of acetic acid wash protocol and the interpretation patterns of blood contaminated cervical cytology ThinPrep(®) specimens. Cytojournal 2015; 12:23. [PMID: 26604976 PMCID: PMC4630822 DOI: 10.4103/1742-6413.168060] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2014] [Accepted: 06/17/2015] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND ThinPrep(®) (TP) cervical cytology, as a liquid-based method, has many benefits but also a relatively high unsatisfactory rate due to debris/lubricant contamination and the presence of blood. These contaminants clog the TP filter and prevent the deposition of adequate diagnostic cells on the slide. An acetic acid wash (AAW) protocol is often used to lyse red blood cells, before preparing the TP slides. DESIGN From 23,291 TP cervical cytology specimens over a 4-month period, 2739 underwent AAW protocol due to initial unsatisfactory smear (UNS) with scant cellularity due to blood or being grossly bloody. Randomly selected 2739 cervical cytology specimens which did not undergo AAW from the same time period formed the control (non-AAW) group. Cytopathologic interpretations of AAW and non-AAW groups were compared using the Chi-square test. RESULTS About 94.2% of the 2739 cases which underwent AAW were subsequently satisfactory for evaluation with interpretations of atypical squamous cells of undetermined significance (ASCUS) 4.9% (135), low-grade squamous intraepithelial lesions (LSIL) 3.7% (102), and high-grade squamous intraepithelial lesions (HSIL) 1% (28). From the 2739 control cases, 96.3% were satisfactory with ASCUS 5.5% (151), LSIL 5.1% (139), and HSIL 0.7% (19). The prevalence of ASCUS interpretations was similar (P = 0.33). Although there were 32% more HSIL interpretations in the AAW group (28 in AAW vs. 19 in non-AAW), the difference was statistically insignificant (P = 0.18). AAW category; however, had significantly fewer LSIL interpretations (P = 0.02). The percentage of UNS cases remained higher in the AAW group with statistical significance (P < 0.01). CONCLUSIONS While AAW had a significantly higher percent of UNS interpretations, the protocol was effective in rescuing 94.2% of specimens which otherwise may have been reported unsatisfactory. This improved patient care by avoiding a repeat test. The prevalence of ASCUS and HSIL interpretations between AAW and non-AAW groups were comparable. Though not statistically significant, HSIL interpretations were relatively higher in the AAW group. LSIL interpretations showed lower prevalence in AAW group.
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Affiliation(s)
- Nora K Frisch
- Address: Department of Pathology, University at Buffalo, Buffalo General Hospital, Buffalo, NY 14203
| | - Yasin Ahmed
- Address: Department of Pathology, University at Buffalo, Buffalo General Hospital, Buffalo, NY 14203
| | - Seema Sethi
- Address: Department of Pathology, University at Buffalo, Buffalo General Hospital, Buffalo, NY 14203
| | - Daniel Neill
- Address: Department of Pathology, University at Buffalo, Buffalo General Hospital, Buffalo, NY 14203
| | - Tatyana Kalinicheva
- Address: Department of Pathology, University at Buffalo, Buffalo General Hospital, Buffalo, NY 14203
| | - Vinod Shidham
- Address: Department of Pathology, University at Buffalo, Buffalo General Hospital, Buffalo, NY 14203
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90
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Keller MJ. Screening for Human Papillomavirus-Associated Cervical Disease in HIV-Infected Women. Top Antivir Med 2015; 23:142-145. [PMID: 26713504 PMCID: PMC6148917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
HIV-infected women have higher rates of persistence of human papillomavirus (HPV) infection, of abnormal cervical cytology results, and of cervical cancer than uninfected women. It is currently recommended that HIV-infected, sexually active women have a Papanicolaou (Pap) test performed at the time of initial diagnosis of HIV infection, followed by annual Pap testing if the previous test result is normal. Women whose test results show abnormalities greater than atypical squamous cells of undetermined significance (ASCUS) should be referred for colposcopy. Those with ASCUS should undergo immediate colposcopy or repeat cervical cytology in 6 months to 12 months, and those whose repeat cervical cytology results show ASCUS or greater abnormalities should undergo colposcopy. Recent findings indicate that screening intervals can be lengthened for HIV-infected women whose Pap test results are persistently normal and who are engaged in routine care, and that HPV DNA testing may have a role in screening. This article summarizes a presentation by Marla J. Keller, MD, at the IAS-USA continuing education program, Improving the Management of HIV Disease, held in Atlanta, Georgia, in March 2015.
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Affiliation(s)
- Marla J Keller
- Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, USA
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91
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Wielding S, Flynn B. Does service integration improve the sexual and reproductive healthcare of women living with HIV? Int J STD AIDS 2015; 27:1063-1065. [PMID: 26384941 DOI: 10.1177/0956462415606341] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2015] [Accepted: 08/18/2015] [Indexed: 11/16/2022]
Abstract
The sexual and reproductive health (SRH) care needs of a cohort of HIV-positive women were studied pre- and post-integration of genitourinary medicine (GUM) and SRH services. Pre-integration, 24.9% of women at risk of pregnancy were using an effective method of contraception, with a non-significant improvement post-integration to 39.3%. Pre-integration, 47.6% of pregnancies were unplanned, whilst 50% were still unplanned post-integration. Cervical cytology uptake within the previous 12 months improved significantly. It appears that the integration of services alone does not improve all aspects of the SRH of women living with HIV and additional novel strategies should be explored.
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Affiliation(s)
- S Wielding
- Chalmers Centre, NHS Lothian, Edinburgh, UK
| | - B Flynn
- Chalmers Centre, NHS Lothian, Edinburgh, UK
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92
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Liu YQ, He X, Xu SS, Qu JX, Wang Y, Diao XL, Liu J, Wang SZ. Epidemiology and genotype distribution of high risk human papillomavirus in population of hospital opportunistic screening. Int J Clin Exp Med 2015; 8:16007-16014. [PMID: 26629105 PMCID: PMC4658994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Accepted: 09/01/2015] [Indexed: 06/05/2023]
Abstract
This study aimed to determine the prevalence of high-risk human papillomavirus (HR-HPV) in population of hospital opportunistic screening and to identify the correlation of prevalent genotypes and cervical cytological abnormalities. A cross-sectional study was employed between July 2013 and July 2014 in the Chaoyang hospital, in Beijing. Cervical samples were collected for the Type-specific HPV and the cervical cytological analyses in the population of hospital opportunistic screening. Total of 8975 samples from female patients aged 17-86 years were tested. Of these, 10.4% were infected by HR-HPV, the highest prevalence of HR-HPV in the youngest group and decreasing with aging (X(2)=19.68, P=0.02). Of these, 78.73% were single infections and 21.27% were multiple infections. Age-specific prevalence of multiple HPV exhibited a "U" shaped curve (X(2)=19.98, P=0.018). The most prevalent genotype is HPV 52, then descending order of frequency were HPV-58, 16, 39, 51, 56, 59, 18, 31, 33, 35, 68 and 45. 15.9% had an abnormal cytology in HR-HPV positive women, vs 4.13% in HR-HPV negative women. The prevalence of HR-HPV were 9.2%, 26.8%, 32%, 35.3% and 36.4% in normal cell, ASCUS, LSIL, ASC-H and HSIL, respectively (X(2)=234.67, P=0.000). Women with HPV 52, 16, 18, 58, 39, 51, 59, 56, 33, 31 infections related to the abnormal cytology, while the HPV68, 45, 35 didn't. The prevalent characteristic in population of the hospital opportunistic screening is similar to the population of cervical screen, But the most five prevalent genotype in rank are different .Women with HR-HPV infections were more likely to have the cervical abnormal cytology.
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Affiliation(s)
- Ying-Qiao Liu
- Department of Obstetrics and Gynecology, Luohe Teaching Hospital Affiliated to Capital Medical UniversityBeijing 101100, China
| | - Xin He
- Department of Obstetrics and Gynecology, Chaoyang Hospital Affiliated to Capital Medical UniversityBeijing 100020, China
| | - Sha-Sha Xu
- Department of Obstetrics and Gynecology, Chaoyang Hospital Affiliated to Capital Medical UniversityBeijing 100020, China
| | - Jiu-Xin Qu
- Department of Clinical Laboratory, Chaoyang Hospital Affiliated to Capital Medical UniversityBeijing 100020, China
| | - Yue Wang
- Department of Pathology, Chaoyang Hospital Affiliated to Capital Medical UniversityBeijing 100020, China
| | - Xiao-Li Diao
- Department of Pathology, Chaoyang Hospital Affiliated to Capital Medical UniversityBeijing 100020, China
| | - Jun Liu
- Department of Obstetrics and Gynecology, Chaoyang Hospital Affiliated to Capital Medical UniversityBeijing 100020, China
| | - Shu-Zhen Wang
- Department of Obstetrics and Gynecology, Chaoyang Hospital Affiliated to Capital Medical UniversityBeijing 100020, China
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Ozlem A, Umit I. Comparative analysis of cervical cytology screening methods and staining protocols for detection rate and accurate interpretation of ASC-H: Data from a high-volume laboratory in Turkey. Diagn Cytopathol 2015; 43:863-9. [PMID: 26173757 DOI: 10.1002/dc.23311] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2014] [Revised: 04/04/2015] [Accepted: 06/22/2015] [Indexed: 11/08/2022]
Abstract
BACKGROUND This study evaluated the effectiveness of the ThinPrep(®) Imaging System (TIS) and ThinPrep(®) Pap Stain (TPPS). A comparative analysis was conducted to determine the detection rates of atypical squamous cells, cannot exclude high-grade squamous intraepithelial lesion (ASC-H), the ASC:squamous intraepithelial lesion (SIL) ratio, biopsy follow-up for ASC-H in terms of the screening method used (manual screening [MS] vs. TIS screening [TISS]) and the staining protocol (regular Pap stain [RPS] vs. TPPS). METHODS This study was performed over two periods. The RPS period included manually screened slides, whereas the TPPS period included TIS + manually screened slides. All data from the study periods were compared using statistical analysis. RESULTS The detection rate of ASC-H was significantly higher during the TPPS period than during the RPS period (0.49% vs. 0.23%); this finding is in contrast to the insignificant difference between the screening method periods. The positive predictive value (PPV) of ASC-H cytodiagnosis for cervical intraepithelial neoplasia of grade 2 or more severe histologies was significantly different between manually screened and TIS slides (22.10% vs. 38.55%), in contrast to an insignificant difference between RPS and TPPS periods (37.14% vs. 29.77%). CONCLUSION Implementation of the TIS did not change the ASC-H detection rates appreciably. However, the new technology improved PPV for ASC-H cytodiagnosis and enabled the detection of true disease. Our laboratory statistics indicate that the TPPS is not a superior staining protocol and did not increase our diagnostic accuracy for ASC-H compared with RPS.
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Affiliation(s)
- Aydin Ozlem
- Acibadem University, Medical School, Department of Pathology, Istanbul, Turkey
| | - Ince Umit
- Acibadem University, Medical School, Department of Pathology, Istanbul, Turkey
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94
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Decker KM, McLachlin CM, Lotocki R. Performance measures related to colposcopy for canadian cervical cancer screening programs: identifying areas for improvement. J Obstet Gynaecol Can 2015; 37:245-251. [PMID: 26001871 DOI: 10.1016/s1701-2163(15)30310-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To describe performance measures related to colposcopic examinations in Canadian cervical cancer screening programs; specifically, time to colposcopy, histological investigation rate, and agreement between cytology and histology. METHODS As part of a national report on the performance of cervical cancer screening, aggregate provincial cervical cancer screening data provided by provinces to the Pan-Canadian Cervical Screening Network were used to evaluate colposcopy program performance measures for women 20 to 69 years of age who had a Pap test in 2009 and 2010. RESULTS A total of 37 523 women had a high-grade or more severe Pap test result. The proportion of women who had a colposcopy ≤ 90 days after their Pap test ranged from 30.9% to 51.5%. Fewer women 60 to 69 years of age had a colposcopy than women in younger age groups. The proportion of women who had a high-grade or more severe Pap test result and colposcopy who had a biopsy within 12 months ranged from 82.1% to 96.5%. The proportion of biopsy results that agreed with the Pap test result ranged from 59.5% to 82.1%. CONCLUSION The time from having a high-grade Pap test result to undergoing colposcopy must be reduced to lower the risk of adverse outcomes and the stress associated with delayed follow-up. The agreement between screening cytology and histology meets the national target of ≥ 65%. Although six of 13 provinces and territories provided data for colposcopy-related performance measures, more information is needed to assess colposcopy services accurately at the national level.
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Affiliation(s)
- Kathleen M Decker
- Department of Community Health Sciences, University of Manitoba, Winnipeg MB; Screening Programs, CancerCare Manitoba, Winnipeg MB
| | | | - Robert Lotocki
- Screening Programs, CancerCare Manitoba, Winnipeg MB; Division of Gynecologic Oncology, University of Manitoba, Winnipeg MB
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95
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Khunamornpong S, Settakorn J, Sukpan K, Srisomboon J, Intaraphet S, Siriaunkgul S. High performance of combined HPV testing and genotyping for HPV16/18/52/58 in triaging women with minor cervical cytological abnormalities in northern Thailand. J Med Virol 2015; 88:135-43. [PMID: 26129775 DOI: 10.1002/jmv.24290] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/29/2015] [Indexed: 11/06/2022]
Abstract
Human papillomavirus (HPV) infection is an important cause of cervical cancer. Screening with cytology or combined cytology and HPV testing helps to detect early cervical cancers and precancerous lesions (high-grade squamous intraepithelial lesion or worse [HSIL+]). Minor cytological abnormalities (atypical squamous cells of undetermined significance and low-grade squamous intraepithelial lesion) account for the majority of abnormal cervical cytology results, but only 10-20% of women with minor cytological abnormalities have histologic HSIL+. Triage tests are useful to identify the high-risk patients and reduce the colposcopy burden. This study was aimed to evaluate the triage performance of combined HPV DNA testing and genotyping. Cervical samples from women with minor cytological abnormalities, who underwent colposcopy at Chiang Mai University Hospital in northern Thailand between October 2010 and February 2014, were tested for HPV DNA using Hybrid Capture 2 (HC2). Genotyping was performed using Linear Array assay. Of 223 women with cervical histology confirmation, histologic HSIL+ was detected in 25 women (11.2%). The sensitivity, specificity, positive predictive value, and negative predictive value of 3 triage methods for histologic HSIL+ were; 100%, 47.5%, 19.4%, and 100% by HC2 only; 40.0%, 88.4%, 30.3%, and 92.1% by combined HC2 and genotypes HPV16/18; and 96.0%, 75.8%, 33.3%, and 99.3% by combined HC2 and genotypes HPV16/18/52/58. Triage using combined HC2 and genotypes HPV16/18/52/58 showed significantly greater area under the receiver operating curve than the other 2 methods (P < 0.001). Combined HPV DNA testing and genotyping for HPV16/18/52/58 is useful for triaging women with minor cervical cytological abnormalities in northern Thailand.
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Affiliation(s)
- Surapan Khunamornpong
- Department of Pathology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Jongkolnee Settakorn
- Department of Pathology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Kornkanok Sukpan
- Department of Pathology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Jatupol Srisomboon
- Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | | | - Sumalee Siriaunkgul
- Department of Pathology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
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96
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Bergeron C, Ikenberg H, Sideri M, Denton K, Bogers J, Schmidt D, Alameda F, Keller T, Rehm S, Ridder R. Prospective evaluation of p16/Ki-67 dual-stained cytology for managing women with abnormal Papanicolaou cytology: PALMS study results. Cancer Cytopathol 2015; 123:373-81. [PMID: 25891096 DOI: 10.1002/cncy.21542] [Citation(s) in RCA: 75] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2015] [Revised: 03/02/2015] [Accepted: 03/02/2015] [Indexed: 12/21/2022]
Abstract
BACKGROUND Testing for the presence of the human papillomavirus (HPV) is widely accepted for triaging Papanicolaou cytology results categorized as atypical squamous cells of undetermined significance (ASC-US). In contrast, HPV testing has limited use in triaging cytological low-grade squamous intraepithelial lesions (LSILs) due to prevalence rates of typically >80%. In the current study, the authors assessed the diagnostic performance of p16/Ki-67 dual-stained cytology in triaging ASC-US and LSIL cases within the prospective, multicentric Primary ASC-US LSIL Marker Study (PALMS). METHODS A total of 575 ASC-US cases and 529 LSIL cases from a cohort of 27,349 women who were prospectively enrolled into the PALMS study in 5 European countries were tested with p16/Ki-67 dual-stained cytology and Hybrid Capture 2 (HC2) HPV testing. Colposcopy-guided biopsy results of cervical intraepithelial neoplasia of grade 2 or worse (CIN2+) were used as clinical endpoints. RESULTS p16/Ki-67 dual-stained cytology demonstrated comparable (ASC-US: 94.4% for dual-stained cytology vs 100% for HC2 testing; P = .317) or lower (LSIL: 85.7% for dual-stained cytology vs 98.4% for HC2 testing; P = .005) sensitivity for CIN2+, but higher levels of specificity compared with HC2 HPV testing in both ASC-US (78.7% vs 60.4%; P<.001) and LSIL (53.3% vs 15.6%; P<.001) cases. Positive predictive values for CIN2+ were substantially higher for dual-stained cytology versus HC2 HPV testing, especially in LSIL, and in ASC-US cases for women aged <30 years. CONCLUSIONS The clinical usefulness and efficiency of triaging women with ASC-US or LSIL Papanicolaou cytology results by p16/Ki-67 dual-stained cytology testing has been confirmed in this prospective, pan-European study. The high positive predictive value of dual-stained cytology for the presence of high-grade CIN may help to reduce the number of unnecessary colposcopy referrals.
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Affiliation(s)
| | | | | | - Karin Denton
- North Bristol NHS Trust, Bristol, United Kingdom
| | - Johannes Bogers
- Algemeen Medisch Laboratorium BVBA, Sonic Healthcare, Antwerp, Belgium
| | | | - Francisco Alameda
- Department of Pathology, Hospital del Mar, Autonomous University of Barcelona, Barcelona, Spain
| | | | | | - Ruediger Ridder
- Roche mtm laboratories, Mannheim, Germany.,Ventana Medical Systems Inc, Tucson, Arizona
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97
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Sakane J, Taniyama K, Miyamoto K, Saito A, Kuraoka K, Nishimura T, Sentani K, Oue N, Yasui W. Aberrant DNA methylation of DLX4 and SIM1 is a predictive marker for disease progression of uterine cervical low-grade squamous intraepithelial lesion. Diagn Cytopathol 2015; 43:462-70. [PMID: 25614457 DOI: 10.1002/dc.23256] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2014] [Revised: 12/12/2014] [Accepted: 12/23/2014] [Indexed: 12/12/2022]
Abstract
BACKGROUND A few uterine cervical low-grade squamous intraepithelial lesions (LSILs) are known to progress with high-risk human papillomavirus (hrHPV). METHODS One hundred and thirteen patients were classified into four groups according to their cervical cytology, hrHPV infection, and follow up. Cytology samples were examined for aberrant DNA methylation of DLX4 and SIM1 genes and protein expressions. CaSki cells were treated with 5-Aza-2'-deoxycytidine (5-aza-dC). RESULTS Group 1 was negative for intraepithelial lesions or malignancies. LSIL in group 2 showed a continuance of LSIL for longer than 365 days and LSIL in group 3 showed an upgrading to high-grade (H) SIL or higher (HSIL+) within 365 days of LSIL diagnosis. Group 4 was squamous cell carcinoma. All but group 1 were infected with hrHPV. Significant differences existed in the frequency of DNA methylation between groups 2 and 3 (p = 0.044), between groups 3 and 4 (p = 0.020) for DLX4, and between groups 1 and 3 (p = 0.0003), and groups 2 and 3 (p = 0.005) for the SIM1 gene. DLX4 protein expression was significantly reduced in the DLX4 methylation positive tissues (p = 0.008). The 5-aza-dC treatment restored DLX4 mRNA expressions of CaSki cells (p < 0.005). The LSIL cases with DNA methylation of the SIM1 gene, or both genes, progressed faster to HSIL+ than did the others (p = 0.033 and p = 0.045, respectively). CONCLUSION Aberrant DNA methylation of the DLX4 and SIM1 genes should be a novel progression marker for uterine cervical LSIL with hrHPV infection.
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Affiliation(s)
- Junichi Sakane
- Department of Molecular Pathology, Hiroshima University Institute of Biomedical and Health Sciences, Hiroshima, Japan; Institute for Clinical Research, National Hospital Organization Kure Medical Center and Chugoku Cancer Center, Kure, Japan; Department of Diagnostic Pathology, National Hospital Organization Kure Medical Center and Chugoku Cancer Center, Kure, Japan
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98
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Bohîlțea RE, Ancăr V, Rădoi V, Furtunescu F, Bohîlțea LC. Project for the National Program of Early Diagnosis of Endometrial Cancer Part II. J Med Life 2015; 8:423-31. [PMID: 26664463 PMCID: PMC4656945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
RATIONALE Endometrial cancer recorded a peak incidence in ages 60-64 years in Romania. Since 2013, an increased trend of endometrial cancer occurrence has been registered in urban areas as compared with rural ones. Unfortunately, most of the cancer cases are diagnosed too late, in an advanced stage of the disease, resulting into diminished lifetime expectancy. The first part of the article concentrated on issues such as: the description of the study, results, and discussions regarding the study, definitions and terms, risk factors specific for endometrial carcinomas, presentation of the activities of the Program, etc. OBJECTIVE Drafting a national program that will serve as an early diagnosis method of endometrial cancer. This second part of the study continues with the presentation of the activities of the Program, analyzes the human resources and materials needed to implement the Program, presents the strategies and the indicators specific for the implementation of the project. METHODS AND RESULTS A standardization of the diagnostic steps was proposed and the focus was on 4 key elements for the early diagnosis of endometrial cancer: The first steps were approached in the first part of the study and the second part of the study investigated the proper monitoring of precursor endometrial lesions or cancer associated endometrial lesions and screening high risk populations (Lynch syndrome, Cowden syndrome). DISCUSSION Improving medical practice based on diagnostic algorithms and programs improves and increases the lifetime expectancy, due to the fact that endometrial cancer is early diagnosed and treated before it causes serious health problems or even death.
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Affiliation(s)
- RE Bohîlțea
- “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
| | - V Ancăr
- “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
| | - V Rădoi
- “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
| | - F Furtunescu
- “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
| | - LC Bohîlțea
- “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
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99
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Curiel-Valdés JJ, Briones-Pimentel J, Bandala C. Improving sensitivity of cervical cytology by removal of cervical secretions before sampling: a prospective study in Mexico. Int J Clin Exp Pathol 2014; 7:5895-5901. [PMID: 25337232 PMCID: PMC4203203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 07/04/2014] [Accepted: 08/20/2014] [Indexed: 06/04/2023]
Abstract
UNLABELLED Sensitivity of cervical cytology is suboptimal, especially in developing countries such as Mexico, despite available guidelines aimed at improving this. When obtaining cervical samples, whether the samples are taken from the transformation zone and whether abnormal cells are missing must be considered. Cervical secretions (CS) are always present in variable proportions, and when cleaning the cervix, better samples may be obtained. In this study, we analyzed samples obtained with or without cleaning the cervix, and compared their contents in order to determine the sensitivity and specificity of these two methods. METHODS Of 500 patients who underwent cytology and colposcopy, 271 (54.2%) required a second opinion due to a diagnosis of cervical intraepithelial neoplasia (CIN). CS was removed and compared with the clean, second sample (SS) using in both liquid-based cytology. The quality of samples according to the Bethesda System, the presence of CIN, and inflammatory reactions were recorded. The sensitivity and specificity were calculated using biopsy as the gold standard. RESULTS The SS resulted in a higher proportion of adequate samples being obtained (97.6% vs. 44.8%), and in increased sensitivity (88.2% vs. 58.8%). CIN was detected in the SS 26% more often than in the CS (34 vs. 27 samples), whereas inflammatory reactions were noted more often in the CS (91.4% vs. 74%). CONCLUSION Cervical sampling including CS results in lower sensitivity and CIN detection rates, and in more inflammatory reactions. By excluding CS from cervical samples, the sensitivity could be improved and the false negative rate could be reduced.
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Affiliation(s)
- J J Curiel-Valdés
- Laboratorio de Patología Grupo Diagnóstico México D.F. México ; Academia Mexicana de Cirugía, ASCP México
| | | | - C Bandala
- Departamento de Apoyo a la investigación, Instituto Nacional de Rehabilitación SSA México D.F. México
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100
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Confortini M, Di Stefano C, Biggeri A, Bulgaresi P, Di Claudio G, Grisotto L, Maddau C, Matucci M, Petreschi C, Troni GM, Turco P, Foxi P. Daily peer review of abnormal cervical smears in the assessment of individual practice as an additional method of internal quality control. Cytopathology 2014; 27:35-42. [PMID: 25123613 DOI: 10.1111/cyt.12195] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/07/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVE An important internal quality control system used in the Cancer Prevention and Research Institute cytopathology laboratory in Florence is the peer review procedure, based on the review of all abnormal cytological smears which routinely emerge. Peer review is an important training opportunity for all cytologists, especially for those with less experience. This article shows the results of the peer review procedure. METHODS Of the 63 754 Papanicolaou (Pap) smears screened in 2011, 1086 were considered to be abnormal [at least atypical squamous cells of undetermined significance (ASC-US+)] on primary screening (selected by a single cytologist) and were subjected to the peer review procedure. The overall performance of the laboratory's cytologists was evaluated using a multiple rater analysis and the comparison of each cytologist with the final diagnosis. Further, the agreement was assessed by means of Cohen's kappa and weighted kappa statistics. RESULTS In general, a moderate/substantial level of agreement between the ten cytologists and the final diagnoses was evident. Kappa values for each reader compared with the final diagnosis ranged from 0.54 to 0.69. The overall kappa value was 0.62 [95% confidence interval (CI), 0.58-0.66] and overall weighted kappa value was 0.76 (95% CI, 0.74-0.79). The category-specific agreement showed the lowest values for atypical squamous cells, cannot exclude high-grade squamous intraepithelial lesion (ASC-H). CONCLUSION In summary, peer review represents an important internal quality control in the evaluation and improvement of inter-observer agreement and of the functioning of the laboratory as a whole. Multi-head microscope sessions may improve particularly the reproducibility of borderline diagnoses and, above all, can be an important training contribution for cytologists.
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Affiliation(s)
- M Confortini
- Cytopathology Unit, ISPO - Cancer Prevention and Research Institute, Florence, Italy
| | - C Di Stefano
- Cytopathology Unit, ISPO - Cancer Prevention and Research Institute, Florence, Italy
| | - A Biggeri
- Biostatistics Unit, ISPO - Cancer Prevention and Research Institute, Florence, Italy.,Department of Statistics, Informatics and Applications "G. Parenti", University of Florence, Florence, Italy
| | - P Bulgaresi
- Cytopathology Unit, ISPO - Cancer Prevention and Research Institute, Florence, Italy
| | - G Di Claudio
- Cytopathology Unit, ISPO - Cancer Prevention and Research Institute, Florence, Italy
| | - L Grisotto
- Biostatistics Unit, ISPO - Cancer Prevention and Research Institute, Florence, Italy.,Department of Statistics, Informatics and Applications "G. Parenti", University of Florence, Florence, Italy
| | - C Maddau
- Cytopathology Unit, ISPO - Cancer Prevention and Research Institute, Florence, Italy
| | - M Matucci
- Cytopathology Unit, ISPO - Cancer Prevention and Research Institute, Florence, Italy
| | - C Petreschi
- Cytopathology Unit, ISPO - Cancer Prevention and Research Institute, Florence, Italy
| | - G M Troni
- Cytopathology Unit, ISPO - Cancer Prevention and Research Institute, Florence, Italy
| | - P Turco
- Cytopathology Unit, ISPO - Cancer Prevention and Research Institute, Florence, Italy
| | - P Foxi
- Cytopathology Unit, ISPO - Cancer Prevention and Research Institute, Florence, Italy
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