1
|
Goyal A, Booth CN, Souers RJ, Tabbara SO, Roberson J, Henry MR, Sundling KE, Goodrich K, Nguyen L. Navigating Practice Issues Related to the Unsatisfactory Cervicovaginal Papanicolaou Test: Survey Results of Laboratories Participating in the 2020 College of American Pathologists PAP Education Program. Arch Pathol Lab Med 2024; 148:48-54. [PMID: 37074866 DOI: 10.5858/arpa.2022-0330-cp] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/01/2023] [Indexed: 04/20/2023]
Abstract
CONTEXT.— Unsatisfactory Papanicolaou (Pap) tests pose a unique set of challenges to the laboratory with regard to their processing, review, reporting, and performance of human papillomavirus (HPV) testing. There are no standardized guidelines for the review process and handling of unsatisfactory Pap tests. OBJECTIVE.— To assess the current practice patterns regarding various aspects of the unsatisfactory Pap test, from processing to reporting, across laboratories worldwide. DESIGN.— A supplemental questionnaire was mailed to laboratories participating in the 2020 College of American Pathologists (CAP) Gynecologic Cytopathology (PAP Education) Program, requesting data regarding the unsatisfactory Pap test. RESULTS.— Of 1520 participating laboratories, 619 (40.7%) responded, and the responses of 577 laboratories were included for further analysis. Only 64.6% (373 of 577) laboratories used the unsatisfactory Pap test criteria as specified by the 2014 Bethesda System. About three-quarters of the respondents (433 of 576; 75.2%) routinely rescreened unsatisfactory Pap tests. Routine repreparation of such Pap tests was performed by 54.9% (316 of 576) of laboratories, and 52.0% (293 of 563) used glacial acetic acid for repreparing excessively bloody specimens. HPV test results were reported for unsatisfactory Pap tests, always or sometimes, by 62.4% (353 of 566) of respondents. CONCLUSIONS.— This CAP survey reveals important information regarding the practice patterns pertaining to several aspects of the unsatisfactory Pap test. It also provides valuable insight into the quality assurance measures that can be implemented for such tests. Future studies can further aid in the standardization of all components of the handling of unsatisfactory Pap tests for overall quality improvement.
Collapse
Affiliation(s)
- Abha Goyal
- From the Department of Pathology and Laboratory Medicine, Weill Cornell Medicine/New York-Presbyterian Hospital, New York, New York (Goyal)
| | - Christine N Booth
- the Department of Pathology, Cleveland Clinic, Cleveland, Ohio (Booth)
| | - Rhona J Souers
- the Departments of Biostatistics (Souers) and Proficiency Testing (Goodrich), College of American Pathologists, Northfield, Illinois
| | - Sana O Tabbara
- the Department of Pathology, H. Lee Moffitt Cancer Center, Tampa, Florida (Tabbara)
| | - Janie Roberson
- the Department of Pathology, University of Alabama Birmingham Hospital, Birmingham (Roberson)
| | - Michael R Henry
- the Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota (Henry)
| | - Kaitlin E Sundling
- the Department of Pathology and Laboratory Medicine, Wisconsin State Laboratory of Hygiene and University of Wisconsin, Madison (Sundling)
| | - Kelly Goodrich
- the Departments of Biostatistics (Souers) and Proficiency Testing (Goodrich), College of American Pathologists, Northfield, Illinois
| | - Lananh Nguyen
- the Department of Laboratory Medicine & Pathobiology, University of Toronto, Toronto, Ontario, Canada (Nguyen)
| |
Collapse
|
2
|
The possibilities of adapting the re-processing protocol in the practice of the ThinPrep Pap test. КЛИНИЧЕСКАЯ ПРАКТИКА 2023. [DOI: 10.17816/clinpract114717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023] Open
Abstract
The method of liquid cytology is a newer diagnostic test compared to the traditional cytological examination of scrapings from the cervix and allows you to standardize morphological examination and reduce the number of unsatisfactory samples. One of the factors determining the adequacy of the Pap test is the number of squamous epithelial cells in the sample. The abundance of blood elements, mucus, lubricant or inflammatory elements may affect the information content of the sample. In the practice of the ThinPrep Pap test, in the case of receiving an inadequate sample, a protocol for re-processing the contents of the vial is used in order to neutralize the possible influence of such impurities on the final result. This work contains an overview of the methods of application of the protocol of re-processing and their own experience of adapting the protocol in the practice of the clinical diagnostic laboratory.
Collapse
|
3
|
Towle S. 'Poorly relaxed women': A situational analysis of pelvic examination learning materials for medical students. MEDICAL EDUCATION 2022; 56:716-723. [PMID: 35086164 DOI: 10.1111/medu.14737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 01/04/2022] [Accepted: 01/17/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND Certain clinical pelvic examination (PE) teaching methods have been critiqued for prioritising student learning over patient autonomy and for not accurately representing diverse patient communities. As such, patient-centred and culturally competent approaches to the PE may need further emphasis in the medical curriculum-in particular, in content delivered to students before patient interaction. Classroom materials serve as students' first exposure to the sensitive procedure. This research explores how patients are represented in these materials. METHODS A situational analysis was conducted on 10 purposively sampled PE learning materials for the 2019/20 academic year from five undergraduate medical schools in Canada. Situational analysis focuses on analysing discourse but is epistemically aligned with post-structuralism (most notably Foucault's theories involving discursive power) and allows for specific consideration of 'silences' in the data. Collected data were analysed using cartographic approaches according to this methodology, with particular attention paid to the tenets and frameworks of patient-centred and culturally competent care. RESULTS Overall, content in these materials misrepresented and under-represented patients. Materials contained both outdated and unnecessarily sexualised language, in addition to a lack of patient diversity. Clinical authority was often centred over patient agency, and several updated PE techniques known to improve patient experience were absent. Patient-centred and culturally competent approaches were therefore inadequately highlighted in most of the materials. CONCLUSIONS Depictions contained in these materials may be perpetuating stereotypes and biases in medicine and may be working to maintain teaching practices that cause harm to patients (standardised and regular) who students interact with in both clinical and educational settings. Efforts may be needed to improve classroom materials on the PE so that they more adequately centre patients and provide opportunities to discuss culturally competent approaches to the procedure that (i) may not be covered in other parts of the PE curriculum and (ii) can reduce known health disparities.
Collapse
Affiliation(s)
- Sarah Towle
- Faculty of Medicine, McGill University, Montreal, Quebec, Canada
| |
Collapse
|
4
|
Outcome analysis and negative predictive value of the "unsatisfactory/nondiagnostic" category of The Paris System for Reporting Urinary Cytology. J Am Soc Cytopathol 2020; 10:64-70. [PMID: 33279453 DOI: 10.1016/j.jasc.2020.09.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2020] [Revised: 09/29/2020] [Accepted: 09/30/2020] [Indexed: 12/25/2022]
Abstract
INTRODUCTION The Paris System (TPS) for Reporting Urinary Cytology (UCyto) was published in 2016, but to date, no study addressing the unsatisfactory (UNSAT) category has been published. We aimed to identify the negative predictive value (NPV) for UNSAT UCyto after the implementation of TPS at our institution. METHOD For the period from January 1, 2017, to December 31, 2019, we identified all cases with UNSAT diagnosis on UCyto specimens and available cytologic and/or surgical pathology follow-up within 6 months from the UNSAT diagnosis. Cases were deemed true negative (TN) if the follow-up was "negative for high-grade urothelial carcinoma" (NHGUC). Information regarding previous medical history, clinical indications, and specimen type were tabulated and analyzed. RESULTS From 6348 UCyto specimens, there were 230 (3.6%) UNSAT diagnoses made on 209 patients (112 [53.6%] men and 97 [46.4%] women) with a median age of 64 years. Of these, 116 UCyto specimens from 106 patients, which had cytologic and/or surgical pathology follow-up within 6 months, were further studied. Most UNSAT UCyto specimens were bladder washing/barbotage (BW/BB), and the most common indication for UCyto was cancer surveillance. The main cause of UNSAT UCyto was low cellularity. There were 5 false-negative (FN) results for high-grade urothelial carcinoma (HGUC), which corresponds to an overall NPV of 84.4%. NPV was highest for patients with UCyto for hematuria, and for patients with BW/BB as UCyto specimen type. CONCLUSIONS Our results show that UNSAT diagnoses have a lower NPV than that typical of NHGUC diagnoses, and should be managed accordingly.
Collapse
|
5
|
Jiang X, Yang T, Li Q, Zhu X, Su X, Li J, Jiang Y. Liquid-Based Cytopathology Test: A Novel Method for Diagnosing Pulmonary Mucormycosis in Bronchial Brushing Samples. Front Microbiol 2018; 9:2923. [PMID: 30542339 PMCID: PMC6277763 DOI: 10.3389/fmicb.2018.02923] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Accepted: 11/14/2018] [Indexed: 02/05/2023] Open
Abstract
Background: Pulmonary mucormycosis, a relatively rare but severe pulmonary fungal disease with a high mortality rate, is difficult to diagnose in immunocompromised patients. Conventional cytopathology (CCP) examination of respiratory samples can help detect Mucorales, but its diagnostic sensitivity is poor. The aim of this study was to assess the first application of liquid-based cytopathology test (LCT) to detect Mucorales. Methods: A total of 33 pairs of bronchial brushing samples from 27 patients diagnosed as pulmonary mucormycosis by fiberoptic bronchoscopy biopsy were prepared as slides using both CCP and LCT. LCT and CCP used the same cytology brush to obtain samples at the same site during the same time as the fiberoptic bronchoscopy biopsy. All samples were stained with Papanicolaou, GMS and PAS. CCP and LCT slides were evaluated from the rate of positive detection, 8 cytomorphological features and 7 background features. Results: LCT-prepared slides showed a higher positive rate of Mucorales detection than CCP-prepared slides for Papanicolaou’s staining [28/33 (84.85%) vs. 15/33 (45.45%), p = 0.001] and for “special staining” with GMS and PAS [29/33 (87.88%) vs. 18/33 (54.55%), p = 0.003]. Clearer smear background and more distinct stereoscopic cytopathological features were observed in LCT. Messy yarn-like necrosis observed in conventionally prepared 75.76% (25/33) samples was cytomorphological suggestive for the diagnosis of mucormycosis. Conclusion: This retrospective study suggests that LCT may be better than CCP to detect Mucorales in bronchial brushing samples from patients with pulmonary mucormycosis.
Collapse
Affiliation(s)
- Xiaolin Jiang
- Department of Pathology, West China Hospital of Sichuan University, Chengdu, China
| | - Tian Yang
- Department of Pathology, West China Hospital of Sichuan University, Chengdu, China
| | - Qiyuan Li
- Department of Pathology, West China Hospital of Sichuan University, Chengdu, China
| | - Xianglan Zhu
- Department of Pathology, West China Hospital of Sichuan University, Chengdu, China
| | - Xueying Su
- Department of Pathology, West China Hospital of Sichuan University, Chengdu, China
| | - Jinnan Li
- Department of Pathology, West China Hospital of Sichuan University, Chengdu, China
| | - Yong Jiang
- Department of Pathology, West China Hospital of Sichuan University, Chengdu, China
| |
Collapse
|
6
|
Risley C, Geisinger KR, Robinson JC, Stewart MW, Zhang L, Alexander R, Raab SS. Precancerous cervical lesions and HPV genotypes identified in previously unsatisfactory cervical smear tests after inexpensive glacial acetic acid processing. Int J Gynaecol Obstet 2018; 144:85-89. [PMID: 30362108 DOI: 10.1002/ijgo.12699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Revised: 08/21/2018] [Accepted: 10/23/2018] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To determine the effectiveness of using glacial acetic acid (GAA) to convert unsatisfactory bloody ThinPrep (TP) cervical smear test to satisfactory, and identify associated missed diagnoses and high-risk HPV (hrHPV) genotypes. METHODS In a retrospective descriptive cross-sectional analysis, all TP tests performed in Mississippi, USA, 2012-2016, were evaluated for unsatisfactory results owing to blood. Tests that were converted to satisfactory by GAA treatment, and corresponding anomalies and HPV genotypes were identified. RESULTS Among 106 384 TP tests, there were 1460 (1.37%) unsatisfactory results, of which 1442 (98.77%) were converted to satisfactory after GAA treatment. Laboratory preprocessing with GAA increased costs minimally. Precancerous lesions were detected in 166 (11.51%) of 1442 GAA-treated samples, of which 12 (7.2%) were high-grade lesions, 110 (66.3%) were atypical squamous cells of undetermined significance, and 63 (57.3%) tested positive for hrHPV. Of 60 genotyped samples, 39 (65%) had non-HPV16 and non-HPV18. Including mixed infections, 48 (80%) contained less-common hrHPV types, reflecting an unexpected distribution in bloody specimens. CONCLUSIONS GAA pretreatment of bloody TP tests would reduce the incidence of unsatisfactory results and missed high-grade lesions, and prevent the cost of repeat tests and delayed treatment. Clinicians without access to GAA should consider HPV testing.
Collapse
Affiliation(s)
- Carolann Risley
- School of Graduate Studies and School of Nursing, University of Mississippi Medical Center, Jackson, MI, USA
| | - Kim R Geisinger
- School of Graduate Studies and School of Nursing, University of Mississippi Medical Center, Jackson, MI, USA
| | - Jennifer C Robinson
- School of Graduate Studies and School of Nursing, University of Mississippi Medical Center, Jackson, MI, USA
| | - Mary W Stewart
- School of Graduate Studies and School of Nursing, University of Mississippi Medical Center, Jackson, MI, USA
| | - Lei Zhang
- School of Graduate Studies and School of Nursing, University of Mississippi Medical Center, Jackson, MI, USA.,Mississippi State Department of Health, Jackson, MI, USA
| | - Rhonda Alexander
- School of Graduate Studies and School of Nursing, University of Mississippi Medical Center, Jackson, MI, USA
| | - Stephen S Raab
- School of Graduate Studies and School of Nursing, University of Mississippi Medical Center, Jackson, MI, USA
| |
Collapse
|
7
|
Queiroz Filho J, Eleutério J, Ney Cobucci R, de Oliveira Crispim JC, Giraldo PC, Gonçalves AK. Does 100% Rapid Review Improve Cervical Cancer Screening? Acta Cytol 2018; 62:209-214. [PMID: 29788025 DOI: 10.1159/000488872] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2018] [Accepted: 03/27/2018] [Indexed: 11/19/2022]
Abstract
OBJECTIVE The aim of this work was to evaluate 100% rapid review (100% RR) as a useful tool to detect false negative (FN) results. STUDY DESIGN A sample of 8,677 swabs was investigated; the unsatisfactory and negative results were referred to 100% RR, concordant results were taken as the final diagnosis, while the discordant results were debated in a consensus meeting to reach a conclusion. The positive results were examined by 2 cytologists. The data were entered into SAS statistical software, and the agreement of the 100% RR results with the final diagnosis was tested with the weighted kappa statistic. RESULTS There was a significant increase in unsatisfactory results from 348 to 1,927, and of positive results from 174 to 349. On the other hand, there was a substantial decrease in negative results from 8,155 to 6,401. Assessing the relative risk of FN results in smears that were not referred to quality control (100% RR) revealed the following results: atypical squamous cells of undetermined significance (ASC-US), 2.93; low-grade squamous intraepithelial lesion (LSIL), 2.72; high-grade squamous intraepithelial lesion/atypical squamous cells - cannot exclude HSIL (HSIL/ASC-H), 2.25. Evaluating by age group, a higher risk for LSIL (4.90) and ASC-US (3.85) was observed in patients aged under 25 years, whereas patients between 25 and 64 years and those over 64 years presented a higher risk for HSIL and ASC-H: 2.46 and 2.75, respectively. CONCLUSION 100% RR is an effective screening tool for FN results in countries where molecular tests for DNA-HPV and prophylactic vaccines are not available in cervical cancer screening programs.
Collapse
Affiliation(s)
| | - José Eleutério
- Department of Child and Motherhood, Faculty of Medicine, Federal University of Ceará, Fortaleza, Brazil
| | - Ricardo Ney Cobucci
- Department of Gynecology and Obstetrics, Faculty of Medicine, Federal University of Rio Grande do Norte, Natal, Brazil
| | | | - Paulo César Giraldo
- Department of Gynecology and Obstetrics, Faculty of Medicine, State University of Campinas, Campinas, Brazil
| | - Ana Katherine Gonçalves
- Federal University of Rio Grande do Norte, Natal, Brazil
- Department of Child and Motherhood, Faculty of Medicine, Federal University of Ceará, Fortaleza, Brazil
- Department of Gynecology and Obstetrics, Faculty of Medicine, Federal University of Rio Grande do Norte, Natal, Brazil
| |
Collapse
|
8
|
Mirzamani N, Chau K, Rafael O, Shergill U, Sajjan S, Sumskaya I, Gimenez C, Klein M, Das K. Quality assessment and improvement of “Unsatisfactory” liquid-based cervicovaginal papanicolaou smears. Diagn Cytopathol 2017; 45:873-877. [DOI: 10.1002/dc.23783] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Revised: 06/22/2017] [Accepted: 06/26/2017] [Indexed: 12/19/2022]
Affiliation(s)
- Neda Mirzamani
- Department of Pathology and Laboratory Medicine; Hofstra Northwell School of Medicine; New York NY
| | - Karen Chau
- Department of Pathology and Laboratory Medicine; Hofstra Northwell School of Medicine; New York NY
| | - Oana Rafael
- Department of Pathology and Laboratory Medicine; Hofstra Northwell School of Medicine; New York NY
| | - Uday Shergill
- Department of Pathology and Laboratory Medicine; Hofstra Northwell School of Medicine; New York NY
| | - Sujata Sajjan
- Department of Pathology and Laboratory Medicine; Hofstra Northwell School of Medicine; New York NY
| | - Irina Sumskaya
- Department of Pathology and Laboratory Medicine; Hofstra Northwell School of Medicine; New York NY
| | - Cecilia Gimenez
- Department of Pathology and Laboratory Medicine; Hofstra Northwell School of Medicine; New York NY
| | - Melissa Klein
- Department of Pathology and Laboratory Medicine; Hofstra Northwell School of Medicine; New York NY
| | - Kasturi Das
- Department of Pathology and Laboratory Medicine; Hofstra Northwell School of Medicine; New York NY
| |
Collapse
|
9
|
Jeong H, Hong SR, Chae SW, Jin SY, Yoon HK, Lee J, Kim EK, Ha ST, Kim SN, Park EJ, Jung JJ, Sung SH, Lim SC. Comparison of Unsatisfactory Samples from Conventional Smear versus Liquid-Based Cytology in Uterine Cervical Cancer Screening Test. J Pathol Transl Med 2017; 51:314-319. [PMID: 28415159 PMCID: PMC5445207 DOI: 10.4132/jptm.2017.03.17] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Revised: 03/09/2017] [Accepted: 03/14/2017] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Cervical cytology for uterine cervical cancer screening has transitioned from conventional smear (CS) to liquid-based cytology (LBC), which has many advantages. The aim of this study was to compare the proportion of unsatisfactory specimens from CS versus LBC at multiple institutions including general hospitals and commercial laboratories. METHODS Each participating institution provided a minimum of 500 Papanicolaou (Pap) test results for analysis. Pap tests were classified according to the participating institution (commercial laboratory or general hospital) and the processing method (CS, ThinPrep, SurePath, or CellPrep). The causes of unsatisfactory results were classified as technical problems, scant cellularity, or complete obscuring factors. RESULTS A total of 38,956 Pap test results from eight general hospitals and three commercial laboratories were analyzed. The mean unsatisfactory rate of LBC was significantly lower than that of CS (1.26% and 3.31%, p = .018). In the LBC method, samples from general hospitals had lower unsatisfactory rates than those from commercial laboratories (0.65% vs 2.89%, p = .006). The reasons for unsatisfactory results were heterogeneous in CS. On the other hand, 66.2% of unsatisfactory results in LBC were due to the scant cellularity. CONCLUSIONS Unsatisfactory rate of cervical cancer screening test results varies according to the institution and the processing method. LBC has a significantly lower unsatisfactory rate than CS.
Collapse
Affiliation(s)
- Hoiseon Jeong
- Department of Pathology, Korea University Ansan Hospital, Korea University College of Medicine, Seoul, Korea
| | - Sung Ran Hong
- Department of Pathology, Cheil General Hospital and Women’s Health Care Center, Dankook University College of Medicine, Seoul, Korea
| | - Seoung-Wan Chae
- Department of Pathology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - So-Young Jin
- Department of Pathology, Soonchunhyang University Hospital, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Hye Kyoung Yoon
- Department of Pathology, Inje University Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Juhie Lee
- Department of Pathology, Kyung Hee University School of Medicine, Seoul, Korea
| | - Eun Kyung Kim
- Department of Pathology, Eulji General Hospital, Seoul, Korea
| | - Sook Tai Ha
- T&C Diagnostic Pathology Clinic, Seoul, Korea
| | | | | | | | - Sun Hee Sung
- Department of Pathology, Ewha Womans University Mokdong Hospital, Ewha Womans University School of Medicine, Seoul, Korea
| | - Sung-chul Lim
- Department of Pathology, Chosun University School of Medicine, Gwangju, Korea
- Corresponding Author Sung-Chul Lim, MD, PhD Department of Pathology, Chosun University School of Medicine, 309 Pilmun-daero, Dong-gu, Gwangju 61452, Korea Tel: +82-62-230-6343 Fax: +82-62-226-5860 E-mail:
| |
Collapse
|
10
|
Jeong H, Hong SR, Chae SW, Jin SY, Yoon HK, Lee J, Kim EK, Ha ST, Kim SN, Park EJ, Jung JJ, Sung SH, Lim SC. Comparison of Unsatisfactory Samples from Conventional Smear versus Liquid-Based Cytology in Uterine Cervical Cancer Screening Test. J Pathol Transl Med 2017. [PMID: 28415159 DOI: 10.4132/jptm.2017.03.17.] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Cervical cytology for uterine cervical cancer screening has transitioned from conventional smear (CS) to liquid-based cytology (LBC), which has many advantages. The aim of this study was to compare the proportion of unsatisfactory specimens from CS versus LBC at multiple institutions including general hospitals and commercial laboratories. METHODS Each participating institution provided a minimum of 500 Papanicolaou (Pap) test results for analysis. Pap tests were classified according to the participating institution (commercial laboratory or general hospital) and the processing method (CS, ThinPrep, SurePath, or CellPrep). The causes of unsatisfactory results were classified as technical problems, scant cellularity, or complete obscuring factors. RESULTS A total of 38,956 Pap test results from eight general hospitals and three commercial laboratories were analyzed. The mean unsatisfactory rate of LBC was significantly lower than that of CS (1.26% and 3.31%, p = .018). In the LBC method, samples from general hospitals had lower unsatisfactory rates than those from commercial laboratories (0.65% vs 2.89%, p = .006). The reasons for unsatisfactory results were heterogeneous in CS. On the other hand, 66.2% of unsatisfactory results in LBC were due to the scant cellularity. CONCLUSIONS Unsatisfactory rate of cervical cancer screening test results varies according to the institution and the processing method. LBC has a significantly lower unsatisfactory rate than CS.
Collapse
Affiliation(s)
- Hoiseon Jeong
- Department of Pathology, Korea University Ansan Hospital, Korea University College of Medicine, Seoul, Korea
| | - Sung Ran Hong
- Department of Pathology, Cheil General Hospital and Women's Health Care Center, Dankook University College of Medicine, Seoul, Korea
| | - Seoung-Wan Chae
- Department of Pathology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - So-Young Jin
- Department of Pathology, Soonchunhyang University Hospital, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Hye Kyoung Yoon
- Department of Pathology, Inje University Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Juhie Lee
- Department of Pathology, Kyung Hee University School of Medicine, Seoul, Korea
| | - Eun Kyung Kim
- Department of Pathology, Eulji General Hospital, Seoul, Korea
| | - Sook Tai Ha
- T&C Diagnostic Pathology Clinic, Seoul, Korea
| | | | | | | | - Sun Hee Sung
- Department of Pathology, Ewha Womans University Mokdong Hospital, Ewha Womans University School of Medicine, Seoul, Korea
| | - Sung-Chul Lim
- Department of Pathology, Chosun University School of Medicine, Gwangju, Korea
| |
Collapse
|
11
|
Chaump M, Pirog EC, Panico VJA, D Meritens AB, Holcomb K, Hoda R. Detection of in situ and invasive endocervical adenocarcinoma on ThinPrep Pap Test: Morphologic analysis of false negative cases. Cytojournal 2016; 13:28. [PMID: 28105064 PMCID: PMC5200999 DOI: 10.4103/1742-6413.196237] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Accepted: 06/18/2016] [Indexed: 11/25/2022] Open
Abstract
Background: The goal of this study was to calculate the sensitivity and false negative (FN) rate of ThinPrep Pap Test (TPPT) and carefully analyze missed cases for educational purposes. Materials and Methods: Patients with histologically proven adenocarcinoma in-situ (AIS) or invasive endocervical adenocarcinoma (EAC) over a 17-year-period (1998-2015) were identified. The TPPT immediately preceding the histological diagnosis of AIS/ECA was designated as index Pap (IP). Paps up to 122 months before histologic diagnosis of AIS/ECA were considered for this study. All available negative and unsatisfactory TPPT were re-reviewed. Results: There were 78 patients with histologically-proven AIS (56) or ECA (22) with 184 TPPTs, and 95 of these TPPTs were abnormal. Of the abnormal cases, 55.7% TPPTs were diagnosed as endocervical cell abnormality (atypical endocervical cells/AIS/ECA). Notably, 44.2% of abnormal TPPTs were diagnosed as squamous cell abnormality (atypical squamous cells of undetermined significance/low-grade squamous intraepithelial lesion/high grade squamous intraepithelial lesion). Including the diagnoses of squamous cell abnormality, the sensitivity of index TPPT for histologically-confirmed AIS/ECA was 88%. Eighty-eight of 184 TPPT, including 10 IP, were negative = 87, or unsatisfactory = 1. Forty-two of these slides were available for re-review. Upon review, 21 TPPT (50%) were confirmed negative and 21 TPPT (50%) were reclassified as abnormal = 20, or unsatisfactory = 1. Of the FN cases, the main difficulty in correct diagnosis was the presence of few diagnostic cell clusters which had less feathering, and consisted of smaller, rounder cells in small and tighter clusters, with nuclear overlap. In particular, nuclear overlap in three-dimensional groups precluded the accurate diagnosis. Rare FN cases showed squamous cell abnormality on re-review, and rare cases showed obscuring blood or inflammation. Conclusion: A significant proportion of AIS/EAC is discovered after Pap showing squamous cell abnormality. FN cases were most commonly related to nuclear overlap in tight three-dimensional clusters.
Collapse
Affiliation(s)
- Michael Chaump
- Address: Department of Pathology and Laboratory Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Edyta C Pirog
- Address: Department of Pathology and Laboratory Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Vinicius J A Panico
- Department of Urology, Irmandade Da Santa Casa De Misericórdia De São Paulo, São Paulo, Brazil
| | | | - Kevin Holcomb
- Department of Obstetrics and Gynecology, Weill Cornell Medical College, New York, NY, USA
| | - Rana Hoda
- Address: Department of Pathology and Laboratory Medicine, Weill Cornell Medical College, New York, NY, USA
| |
Collapse
|
12
|
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] [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.
Collapse
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
| |
Collapse
|
13
|
Kambayashi Y, Yuki I, Ishibashi T, Ikemura A, Umezawa T, Suzuki M, Kan I, Takao H, Murayama Y. Immunohistochemical Analysis of Debris Captured by Filter-Type Distal Embolic Protection Devices for Carotid Artery Stenting. J Stroke Cerebrovasc Dis 2016; 26:816-822. [PMID: 27865698 DOI: 10.1016/j.jstrokecerebrovasdis.2016.10.025] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2016] [Revised: 10/02/2016] [Accepted: 10/23/2016] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Little is known about the micro-debris captured in filter-type distal embolic protection devices (EPD) used for carotid stenting (CAS). This study aimed to determine the histological and immunohistochemical characteristics of such debris by using a new liquid-based cytology (LBC) technique. METHODS Fifteen patients who underwent CAS using a filter-type distal EPD (FilterWire EZ; Boston Scientific, Marlborough, MA, USA) were included in the study. After gross inspection of each recovered filter device, micro-debris were collected using a new LBC technique (SurePath; TriPath Imaging, Inc., Burlington, NC). Histological and immunohistochemical analysis of the recovered debris was performed. The pre- and postoperative brain magnetic resonance imaging and neurological status of each patient were also reviewed. RESULTS No patient developed ipsilateral symptomatic stroke due to a thromboembolic event. All 15 patients (100%) had microscopically identifiable debris in the filters, whereas gross inspection detected visible debris only in 5 patients (33.3%). Histological analysis revealed various types of structural components in an advanced atheromatous plaque, including fragments of fibrous cap, calcified plaque, smooth muscle cells, and necrotic tissue fragment infiltrated with monocytes and macrophages. CONCLUSIONS Filter-type EPDs may contribute to reducing the risk of CAS-related embolic events by capturing micro-debris even when gross inspection of the recovered filter shows no visible debris in the device.
Collapse
Affiliation(s)
| | - Ichiro Yuki
- Department of Neurosurgery, Jikei University School of Medicine, Japan.
| | | | - Ayako Ikemura
- Department of Neurosurgery, Jikei University School of Medicine, Japan
| | - Takashi Umezawa
- Department of Pathology, Jikei University School of Medicine, Japan
| | - Masafumi Suzuki
- Department of Pathology, Jikei University School of Medicine, Japan
| | - Issei Kan
- Department of Neurosurgery, Jikei University School of Medicine, Japan
| | - Hiroyuki Takao
- Department of Neurosurgery, Jikei University School of Medicine, Japan
| | - Yuichi Murayama
- Department of Neurosurgery, Jikei University School of Medicine, Japan
| |
Collapse
|
14
|
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: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [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.
Collapse
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
| |
Collapse
|
15
|
Kalinicheva T, Frisch N, Giorgadze T, Madan S, Shidham A, Bhalla A, Mejias-Badillo L, Tranchida P, Bandyopadhyay S, Dhillon I, Shidham VB. Etiologic factors related to unsatisfactory ThinPrep(®) cervical cytology: Evaluation and potential solutions to improve. Cytojournal 2015; 12:21. [PMID: 26445591 PMCID: PMC4593297 DOI: 10.4103/1742-6413.165955] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2014] [Accepted: 06/16/2015] [Indexed: 11/12/2022] Open
Abstract
Background: In cervical cytology, the unsatisfactory rates for ThinPrep (TP) are slightly higher compared to SurePath. We examined various causes and explored potential for resolution of this discrepancy. Materials and Methods: Totally, 19,422 cases were reviewed and 1000 unsatisfactory specimens were selected and analyzed. 531 specimens were available for wash protocol. Out of 114 unsatisfactory specimens associated with atrophic cellular changes (ACC), 48 were resubmitted by provider and reevaluated. Results: Lubricant and lubricant-like debris/contamination (LUBE) was the most common cause of unsatisfactory specimens (68%; 681/1000) followed by blood (7.5%); ACC only (without other interfering factors) (2.4%); inflammation (3.0%); and combinations thereof (1.9%). 11.5% showed scant cellularity without an identifiable cause. 3.3% were virtually acellular. Wash protocol improved cellularity in 48% (256/531) of cases. However, only 29% (73/256) of those were satisfactory (with more than 5000 cells). Quantitative reduction in LUBE after wash protocol varied with different morphological subtypes. Interpretation patterns on satisfactory specimens after wash protocol were comparable to the results on selected cohort of specimens during the same study period. Out of 114 ACC, wash protocol was performed on 68 ACC specimens leading to satisfactory TP in 24% (16/68). Totally, 48 cases reported as unsatisfactory with ACC, were resubmitted by the providers between 2 weeks and 2 years. 44 (92%) showed increased cellularity, out of which 52% (23/44) did not show ACC. Conclusion: LUBE was the most common cause of unsatisfactory TP in addition to interference by blood and association with atrophic changes. Knowing the morphological spectrum of LUBE would help to identify it as the cause of unsatisfactory TP. Communicating the cause of unsatisfactory TP such as LUBE, ACC, and blood would hint the provider to take appropriate precaution during submission of the repeat specimen, leading to improved patient care.
Collapse
Affiliation(s)
- Tatyana Kalinicheva
- Address: Department of Pathology, Wayne State University School of Medicine and Detroit Medical Center, 4707 St. Antoine Blvd, Detroit, MI 48201, USA
| | - Nora Frisch
- Department of Pathology, University at Buffalo, Buffalo, New York, USA
| | - Tamar Giorgadze
- Department of Pathology and Laboratory Medicine, New York-Presbyterian Hospital/Weill Cornell Medical College, New York, NY 10065, USA
| | - Shashi Madan
- Address: Department of Pathology, Wayne State University School of Medicine and Detroit Medical Center, 4707 St. Antoine Blvd, Detroit, MI 48201, USA
| | | | - Amarpreet Bhalla
- Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Linette Mejias-Badillo
- Address: Department of Pathology, Wayne State University School of Medicine and Detroit Medical Center, 4707 St. Antoine Blvd, Detroit, MI 48201, USA
| | - Paul Tranchida
- Address: Department of Pathology, Wayne State University School of Medicine and Detroit Medical Center, 4707 St. Antoine Blvd, Detroit, MI 48201, USA
| | - Sudeshna Bandyopadhyay
- Address: Department of Pathology, Wayne State University School of Medicine and Detroit Medical Center, 4707 St. Antoine Blvd, Detroit, MI 48201, USA
| | - Inderpreet Dhillon
- Address: Department of Pathology, Wayne State University School of Medicine and Detroit Medical Center, 4707 St. Antoine Blvd, Detroit, MI 48201, USA
| | - Vinod B Shidham
- Address: Department of Pathology, Wayne State University School of Medicine and Detroit Medical Center, 4707 St. Antoine Blvd, Detroit, MI 48201, USA
| |
Collapse
|
16
|
Quiroga-Garza G, Satrum LS, Trujillo CJ, Mody DR, Ge Y. Common causes for unsatisfactory Pap tests in a high-risk population: insights into a yet unresolved problem in gynecologic cytology. J Am Soc Cytopathol 2014; 3:256-260. [PMID: 31051679 DOI: 10.1016/j.jasc.2014.05.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2014] [Revised: 05/24/2014] [Accepted: 05/27/2014] [Indexed: 06/09/2023]
Abstract
INTRODUCTION Although the rates are generally low (0.2%-10%), unsatisfactory Papanicolaou (Pap) tests are associated with an increased risk of epithelial lesions on subsequent follow-up. Therefore, some studies have recommended extra laboratory processing, resampling of patients, and more recently, human papillomavirus testing. MATERIALS AND METHODS Consecutive cases signed out as unsatisfactory for evaluation (UE) were identified from January 1, 2008 to December 31, 2010 in the cytology laboratory at Houston Methodist Hospital. Patient's demographics, relevant prior clinical history, type of Pap test, reasons for UE diagnosis, and cytology or histology follow-up were obtained from the pathology database. RESULTS Among 56,563 total Pap tests, 276 were signed out as UE (0.47%). Nearly half of these patients were older than 50 years (15 to 88 years). The majority (85%) of patients over 50 years old had a history of prior gynecologic cancer. Low squamous cellularity was the most common cause of UE in all age groups. Follow-up abnormalities were identified in 21 of 73 patients (29%). CONCLUSIONS Low squamous cellularity was the most common cause of UE and was often seen in women older than 50 years of age. The significant risk associated with UE emphasizes the importance of appropriate follow-up on these patients.
Collapse
Affiliation(s)
- Gabriela Quiroga-Garza
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania 15221
| | - Laura S Satrum
- Department of Pathology and Genomic Medicine, Houston Methodist, 6565 Fannin Street, Suite M227, Houston, Texas, 77030
| | - Crystal J Trujillo
- Department of Pathology, Baylor College of Medicine, Houston, Texas, 77030
| | - Dina R Mody
- Department of Pathology and Genomic Medicine, Houston Methodist, 6565 Fannin Street, Suite M227, Houston, Texas, 77030
| | - Yimin Ge
- Department of Pathology and Genomic Medicine, Houston Methodist, 6565 Fannin Street, Suite M227, Houston, Texas, 77030.
| |
Collapse
|
17
|
Zhao L, Wentzensen N, Zhang RR, Dunn ST, Gold MA, Wang SS, Schiffman M, Walker JL, Zuna RE. Factors associated with reduced accuracy in Papanicolaou tests for patients with invasive cervical cancer. Cancer Cytopathol 2014; 122:694-701. [DOI: 10.1002/cncy.21443] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2013] [Revised: 04/25/2014] [Accepted: 04/30/2014] [Indexed: 12/17/2022]
Affiliation(s)
- Lichao Zhao
- Department of Pathology; University of Oklahoma Health Sciences Center; Oklahoma City Oklahoma
| | - Nicolas Wentzensen
- Division of Cancer Epidemiology and Genetics; National Cancer Institute, National Institutes of Health; Bethesda Maryland
| | - Roy R. Zhang
- Department of Pathology; University of Oklahoma Health Sciences Center; Oklahoma City Oklahoma
| | - S. Terence Dunn
- Department of Pathology; University of Oklahoma Health Sciences Center; Oklahoma City Oklahoma
| | - Michael A. Gold
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology; University of Oklahoma Health Sciences Center; Oklahoma City Oklahoma
| | - Sophia S. Wang
- Department of Cancer Etiology; City of Hope and the Beckman Institute; Duarte California
| | - Mark Schiffman
- Division of Cancer Epidemiology and Genetics; National Cancer Institute, National Institutes of Health; Bethesda Maryland
| | - Joan L. Walker
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology; University of Oklahoma Health Sciences Center; Oklahoma City Oklahoma
| | - Rosemary E. Zuna
- Department of Pathology; University of Oklahoma Health Sciences Center; Oklahoma City Oklahoma
| |
Collapse
|
18
|
Peitzmeier SM, Reisner SL, Harigopal P, Potter J. Female-to-male patients have high prevalence of unsatisfactory Paps compared to non-transgender females: implications for cervical cancer screening. J Gen Intern Med 2014; 29:778-84. [PMID: 24424775 PMCID: PMC4000345 DOI: 10.1007/s11606-013-2753-1] [Citation(s) in RCA: 123] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2013] [Revised: 10/24/2013] [Accepted: 12/17/2013] [Indexed: 12/21/2022]
Abstract
BACKGROUND Little is known about whether and how screening for cancers of natal reproductive structures, including cervical cancer, in female-to-male (FTM) transgender individuals differs from cancer screening among non-transgender females. OBJECTIVE To investigate anecdotal reports from clinicians of high rates of inadequate Papanicolaou (Pap) tests among transgender men. DESIGN Results of Pap tests performed on 233 FTM and 3,625 female patients at an urban community health center between 2006 and 2012 were extracted from an electronic medical record. KEY RESULTS Compared to female patients, FTM patients were more likely to have an inadequate Pap, with prevalence of inadequate samples 8.3 times higher among tests of FTM patients (10.8% vs. 1.3% of tests). FTM patients had over ten times higher odds of having an inadequate Pap after adjusting for age, race, and body mass index (AOR = 10.77, 95% CI = 6.83, 16.83). When years on testosterone therapy was added to the model, the relationship between transgender identity and Pap inadequacy was attenuated, but remained strongly associated (AOR = 6.01, 95% CI = 3.00, 11.50), and time on testosterone was also associated (AOR = 1.19, 95% CI 1.04, 1.36). FTM patients were more likely than females to have had multiple inadequate tests, and had longer latency to follow-up testing. CONCLUSIONS The high unsatisfactory sample prevalence among FTM patients is likely due to a combination of physical changes induced by testosterone therapy and provider/patient discomfort with the exam. Clinicians should receive training in increasing comfort for FTM patients during the exam. FTM patients should be alerted that high rates of inadequate screening may require follow-up testing. Alternatives to repeated Pap testing, such as cytologic reprocessing of inadequate samples or primary human papillomavirus (HPV) DNA screening, should be studied for efficacy and acceptability among FTM patients.
Collapse
Affiliation(s)
- Sarah M Peitzmeier
- Department of Population, Family, and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | | | | |
Collapse
|
19
|
Abstract
OBJECTIVE Speculum lubrication with water-based gels before cervical smear sampling has been investigated and commented on thoroughly during the last decade. The present meta-analysis was based on randomized and quasi-randomized control trials and evaluated its impact on unsatisfactory cytologic results. We also assessed its efficacy in producing lower pain scores during speculum insertion. MATERIALS AND METHODS We searched MEDLINE (1966- 2013), Scopus (2004-2013), Clinicaltrials.org (1997-2013), Popline (1973-2013), Cochrane Central Register of Controlled Trials (CENTRAL) (1999-2013), and Google Scholar (2004-2013) engines for published randomized control trials, as well as the reference lists from all the included studies. RESULTS Five randomized trials and 2 quasi-randomized trials were included in the present review involving 8,717 women. Unsatisfactory results based on conventional cytology did not statistically differ among procedures performed with lubricated speculums and those without (odds ratio = 0.94, 95% CI = 0.64-1.37). Consequently, pain scores also did not differ significantly among the 2 groups (odds ratio = -0.37, 95% CI = -1.10 to 0.36). Only 2 studies evaluated unsatisfactory results on liquid-based cytology, precluding firm results. CONCLUSIONS It seems that speculum lubrication does not interfere with the rates of unsatisfactory results when examination is based on conventional cytology. Conversely, however, the limited number of studies evaluating speculum lubrication on liquid-based cytology precludes firm conclusions.
Collapse
|
20
|
Randolph ML, Wu HH, Crabtree WN. Reprocessing unsatisfactory ThinPrep Papanicolaou tests using a modified SurePath preparation technique. Cancer Cytopathol 2014; 122:343-8. [DOI: 10.1002/cncy.21408] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Melissa L. Randolph
- Department of Pathology and Laboratory MedicineIndiana University School of MedicineIndianapolis Indiana
| | - Howard H. Wu
- Department of Pathology and Laboratory MedicineIndiana University School of MedicineIndianapolis Indiana
| | - William N. Crabtree
- Department of Pathology and Laboratory MedicineIndiana University School of MedicineIndianapolis Indiana
| |
Collapse
|
21
|
Lin SN, Taylor J, Alperstein S, Hoda R, Holcomb K. Does speculum lubricant affect liquid-based Papanicolaou test adequacy? Cancer Cytopathol 2013; 122:221-6. [DOI: 10.1002/cncy.21369] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2013] [Revised: 10/15/2013] [Accepted: 10/17/2013] [Indexed: 11/11/2022]
Affiliation(s)
- Stephanie N. Lin
- Department of Obstetrics and Gynecology; University of Utah; Salt Lake City Utah
| | - Jolyn Taylor
- Department of Obstetrics and Gynecology; New York-Presbyterian Hospital Weill Cornell Medical Center, New York; New York
| | - Susan Alperstein
- Department of Pathology & Laboratory Medicine; New York-Presbyterian Hospital Weill Cornell Medical Center; New York New York
| | - Rana Hoda
- Department of Pathology & Laboratory Medicine; New York-Presbyterian Hospital Weill Cornell Medical Center; New York New York
| | - Kevin Holcomb
- Department of Obstetrics and Gynecology; New York-Presbyterian Hospital Weill Cornell Medical Center, New York; New York
| |
Collapse
|
22
|
Abstract
Recent guidelines from multiple organizations stress screening initiation no earlier than the age of 21 years and increased screening intervals for women aged 21 to 29 years. Primary prevention with human papillomavirus vaccination has the potential to significantly affect the development of high-grade cervical lesions, including cancer, and will likely affect screening guidelines in the future.
Collapse
Affiliation(s)
- Lori A Boardman
- Department of Clinical Sciences, University of Central Florida College of Medicine, Orlando, FL 32827, USA.
| | | |
Collapse
|