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Suzuki H, Kondo Y, Oda C, Nishikawa T, Takeuchi M, Tatsumi S, Hosokawa S, Irino S, Uchiyama T, Fujii T, Norimatsu Y. Can Mitotic Figures in Hyperchromatic Crowded Groups be Cytodiagnostic Criteria for High-Grade Squamous Intra-epithelial Lesions? J Cytol 2024; 41:116-122. [PMID: 38779606 PMCID: PMC11108039 DOI: 10.4103/joc.joc_156_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 10/12/2023] [Accepted: 03/18/2024] [Indexed: 05/25/2024] Open
Abstract
Aims The present study aimed to investigate whether the presence of mitoses in hyperchromatic crowded groups (HCGs) in cervical cytological specimens can serve as cytological criteria for high-grade squamous intra-epithelial lesions (HSILs). Methods and Material Various parameters were examined, including the frequency of mitotic figures per high power field (HPF) in Pap, hematoxylin eosin (HE) samples, and PHH3 immunocytochemical (ICC) and immunohistochemical (IHC) analyses. Results In the Pap and PHH3-ICC samples, the number of mitotic figures observed in HCGs was significantly higher in HSIL (P < 0.001) compared to other groups. Furthermore, the frequency of observing two or more mitoses was significantly higher in HSIL (Pap: P = 0.002, PHH3-ICC: P < 0.001) than in low-grade squamous intra-epithelial lesions (LSILs). Moreover, a comparison between Pap samples and PHH3-ICC showed that the frequency of two or more mitoses was significantly higher in the PHH3-ICC analysis of HSIL (P = 0.042). Regarding HE and PHH3-IHC samples, counting the number of mitoses in the lower and middle/upper layers of the squamous epithelial layer revealed that HSIL had a significantly higher value (HE: P = 0.0089, PHH3-IHC: P = 0.0002) than LSIL in the middle/upper layers. Conclusions Hence, the presence of two or more mitotic figures in HCGs per HPF in cervical cytology indicates a suspicion of HSIL. The detection of mitoses in PHH3-ICC samples is more sensitive and easier to observe than in Pap samples, making it a valuable mitotic marker.
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Affiliation(s)
- Hisae Suzuki
- Department of Pathology, Nara Medical University Hospital, Nara, Japan
| | - Yumeno Kondo
- Department of Medical Technology, The Graduate School of Ehime Prefectural University of Health Sciences, Ehime, Japan
| | - Chihiro Oda
- Department of Medical Technology, The Graduate School of Ehime Prefectural University of Health Sciences, Ehime, Japan
| | - Takeshi Nishikawa
- Department of Pathology, Nara Medical University Hospital, Nara, Japan
| | - Mao Takeuchi
- Department of Pathology, Nara Medical University Hospital, Nara, Japan
| | - Shigenobu Tatsumi
- Department of Pathology, Nara Medical University Hospital, Nara, Japan
| | - Sho Hosokawa
- Department of Medical Technology, The Graduate School of Ehime Prefectural University of Health Sciences, Ehime, Japan
- Department of Medical Technology, Faculty of Health Sciences, Ehime Prefectural University of Health Sciences, Ehime, Japan
| | - Satoshi Irino
- Department of Nursing, Faculty of Health Sciences, Ehime Prefectural University of Health Sciences, Ehime, Japan
| | - Tomoko Uchiyama
- Department of Diagnostic Pathology, Nara Medical University, Nara, Japan
| | - Tomomi Fujii
- Department of Diagnostic Pathology, Nara Medical University, Nara, Japan
| | - Yoshiaki Norimatsu
- Department of Medical Technology, The Graduate School of Ehime Prefectural University of Health Sciences, Ehime, Japan
- Department of Medical Technology, Faculty of Health Sciences, Ehime Prefectural University of Health Sciences, Ehime, Japan
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Salibay C, Chen Z, Ma B, Pan H, Hijazi M, Elatre W, Shulman I, Martin SE, Wang T. High-risk HPV testing improves accuracy in detection of CIN2+ lesions in ASC-H postmenopausal women? An academic hospital experiences. J Am Soc Cytopathol 2023; 12:58-65. [PMID: 36270913 DOI: 10.1016/j.jasc.2022.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 07/29/2022] [Accepted: 08/27/2022] [Indexed: 11/18/2022]
Abstract
Reflex human papilloma virus (HPV) testing with "atypical squamous cells, cannot exclude high-grade squamous lesion (ASC-H)" cytologic diagnosis is not recommended by American Society for Colposcopy and Cervical Pathology guidelines. Studies have shown human papillomavirus (HPV)-negative ASC-H patients of increased age are low risk for cervical intraepithelial neoplasia 2 or worse (CIN2+) lesions on colposcopic follow-up. We retrospectively assessed the efficacy of reflex HPV testing in postmenopausal women with ASC-H in the Los Angeles County hospitals and clinics in a 5-year period. Of a total 85 clinically postmenopausal women with ASC-H, 31 (36.5%) women were found to have CIN2+ lesions on follow-up biopsy and five of them were HPV-negative. Of the women with CIN2+ lesions and positive HPV, 13 (41.9%) were high-risk HPV (hrHPV) 16/18/45 positive and 13 (41.9%) were hrHPV-other subtype positive. Women with positive HPV had an over 3-fold increased risk of developing CIN2+ lesions (P = 0.008). Relative risk of hrHPV16/18/45 was 1.79-fold higher than that of hrHPV-other subtype. The positive predictive value and negative predictive value of hrHPV were 49.1% and 84.4%, respectively. CIN2+ detection rate in Hispanic women with positive hrHPV was higher than in non-Hispanic women (53.8% versus 35.7%). Overall, postmenopausal women with ASC-H cytology result and negative hrHPV were less likely to develop CIN2+ lesions, whereas about half of ASC-H postmenopausal women develop CIN2+ lesions if hrHPV positive, especially if hrHPV 16/18/45 positive. Therefore, triaging ASC-H postmenopausal women with cotesting or, ideally, hrHPV genotyping should be considered as optimal clinical practice to avoid overtreatment.
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Affiliation(s)
- Christine Salibay
- Department of Pathology and Laboratory Medicine, University of Southern California/LAC-USC Medical Center, Los Angeles, California; Kaiser Permanente, South Bay Medical Center Pathology Department. Harbor City, California
| | - Zhengshan Chen
- Department of Pathology and Laboratory Medicine, University of Southern California/LAC-USC Medical Center, Los Angeles, California; Department of Pathology and Laboratory Medicine, University of California, Los Angeles, California
| | - Brian Ma
- Department of Pathology and Laboratory Medicine, University of Southern California/LAC-USC Medical Center, Los Angeles, California
| | - Hui Pan
- Department of Pathology and Laboratory Medicine, University of Southern California/LAC-USC Medical Center, Los Angeles, California
| | - Maya Hijazi
- Department of Pathology and Laboratory Medicine, University of Southern California/LAC-USC Medical Center, Los Angeles, California
| | - Wafaa Elatre
- Department of Pathology and Laboratory Medicine, University of Southern California/LAC-USC Medical Center, Los Angeles, California
| | - Ira Shulman
- Department of Pathology and Laboratory Medicine, University of Southern California/LAC-USC Medical Center, Los Angeles, California
| | - Sue E Martin
- Department of Pathology and Laboratory Medicine, University of Southern California/LAC-USC Medical Center, Los Angeles, California
| | - Tiannan Wang
- Department of Pathology and Laboratory Medicine, University of Southern California/LAC-USC Medical Center, Los Angeles, California.
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Abbas M, Erduran I, De Jonge J, Bettendorf O. Evaluation of P16/Ki67 (CINtecPlus) and L1‑capsid compared with HPV‑genotyping in cervical cytology in women ≥35 years old focusing on patients with atypical squamous cells of undetermined significance. Oncol Lett 2022; 24:242. [PMID: 35720497 PMCID: PMC9185144 DOI: 10.3892/ol.2022.13362] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 05/06/2022] [Indexed: 11/23/2022] Open
Abstract
Cervical cancer is the third most common cancer in women worldwide. Conventional cytological examination as a screening method with Papanicolaou has been established to reduce the incidence of dysplasia and cervical cancer for years. In addition to the conventional screening, the introduction of immunocytochemical examinations, including CINtecPlus and L1-capsid, has been demonstrated to have a positive impact on screening results. In addition to morphological screening methods, human papillomavirus (HPV)-testing has also been demonstrated to possess an enormous potential in the cervical screening process. Additionally, different screening models ranging from conventional cytological screening to primary HPV-testing do exist in different countries. At the beginning of the year 2020, a combination of cytological screening and HPV-testing was introduced in Germany for women ≥35 years. The aim of the present study was to evaluate the role of morphological screening, including immunocytochemistry, and to compare it with HPV-genotyping. Immunocytochemistry was added to confirm the diagnosis but needs established infrastructure and well-trained personnel. Furthermore, there was a need to establish the HPV-screening method. In the Institute for Pathology and Cytology (Schuettorf, Leer, Germany), 146,800 samples of women (>35 years old) were examined between January 2020 and January 2021. The present study retrospectively analyzed 146,800 samples. Each sample was examined using a conventional cytological technique and HPV-high risk-Test (HPV-HR-Test) with Viper-BD. Immunocytochemistry with CINtecPlus and L1-capsid was added in some cases. A total of 555 cases were cytological diagnosed as atypical squamous cells of undetermined significance (ASC-US; IIp). After performing immunocytochemistry, 79% of cases were suspected to be positive and 1.48% of cases were definitely positive. The HPV-HR-Test was positive in 26.4% of cases. Among cases of ASC-US and HPV-HR-negativity, 33.7% were suspicious of immunocytochemical positivity and 0.5% were definitely positive. Among patients with HPV-16-negativity, 13.6% were patients with highly squamous intraepithelial lesion (HSIL) and 22.7% were patients with low-grade squamous intraepithelial lesion (LSIL) and HSIL. Among patients with HPV-18-negativity, 14.3% were patients with HSIL and 19.5% were patients with LSIL and HSIL. There were 107 cases in this group of cases with negativity of both HPV-16 and HPV-18. After performing the colposcopy and biopsy, there were 6.5% with cervical intra-epithelial neoplasia (CIN) I, 8.4% with CIN II and 5.6% with CIN III. In conclusion, there is still a need for conventional cytological examination and maybe the addition of immunocytochemistry to confirm the diagnosis and to exclude dysplasia of cervical epithelium. The HPV-HR-Test is not enough as a screening method and may be misleading.
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Affiliation(s)
- Mahmoud Abbas
- Department of Pathology, Gerhard‑Domagk Institute for Pathology, D-48149 Muenster, Germany
| | - Ismail Erduran
- Department of Pathology, Medical Hospital, University Muenster, D-48149 Muenster, Germany
| | - Jan De Jonge
- Department of Pathology, Institute for Pathology and Cytology (IPN), D-48465 Schuettorf, Germany
| | - Olaf Bettendorf
- Department of Pathology, Institute for Pathology and Cytology (IPN), D-48465 Schuettorf, Germany
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Marujo AT, Correia L, Brito M, Paula T, Borrego J. ASC-H cytological result: clinical relevance and accuracy of colposcopy in predicting high-grade histological lesions-a 7-year experience of a single institution in Portugal. J Am Soc Cytopathol 2017; 6:248-253. [PMID: 31043295 DOI: 10.1016/j.jasc.2017.07.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Revised: 07/26/2017] [Accepted: 07/31/2017] [Indexed: 06/09/2023]
Abstract
INTRODUCTION Atypical squamous cells, cannot exclude high-grade squamous intraepithelial lesion (ASC-H) represents an interpretative challenge in clinical practice. We aimed to evaluate the histological outcome of ASC-H cytology and to evaluate the accuracy of colposcopy in predicting high-grade histological lesions. MATERIALS AND METHODS Retrospective study of ASC-H cervical cytology results, from January 2010 to December 2016, at a tertiary hospital. Demographic characteristics, colposcopic findings, diagnostic procedures, and histological outcomes were analyzed using SPSS, version 22.0. RESULTS ASC-H prevalence was 0.25%. Patient mean age was 42.02 ± 12.8 years. The overall incidence of cervical dysplasia of any grade was 83.6% (n = 56) and the incidence of high-grade lesions was 50.8% (n = 34) (including 1 case of in situ adenocarcinoma and 2 cases of squamous cell carcinoma). Among patients with type 1 or 2 transformation zone (TZ), 84.9% (n = 45) had abnormal colposcopic findings, with 62.2% (n = 28) corresponding to grade 2 and 37.8% (n = 17) to grade 1. Colpo-histologic concordance was 85.4% (82.1% for grade 2 lesions and 100% for grade 1 lesions). The sensitivity, specificity, positive predicted value (PPV) and negative predictive value (NPV) was 100%, 75%, 82.1%, and 100%, respectively. The histological study of patients with type 3 TZ revealed 45.8% (n = 11) of high-grade lesions. CONCLUSIONS ASC-H is strongly associated with high-grade histological lesions. Immediate evaluation of patients with this cytology abnormality is therefore mandatory. Colposcopy, when performed by expert clinicians, has great accuracy in detecting high-grade lesions. Histological evaluation of patients with type 3 TZ is extremely important because almost 50% of patients have this type of lesion.
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Affiliation(s)
- Ana Teresa Marujo
- Maternity Dr. Alfredo da Costa, Department of Cervical-Vulvovaginal Pathology, Lisboa, Portugal.
| | - Lúcia Correia
- Maternity Dr. Alfredo da Costa, Department of Cervical-Vulvovaginal Pathology, Lisboa, Portugal
| | - Marta Brito
- Maternity Dr. Alfredo da Costa, Department of Cervical-Vulvovaginal Pathology, Lisboa, Portugal
| | - Tereza Paula
- Maternity Dr. Alfredo da Costa, Department of Cervical-Vulvovaginal Pathology, Lisboa, Portugal
| | - Jorge Borrego
- Maternity Dr. Alfredo da Costa, Department of Cervical-Vulvovaginal Pathology, Lisboa, Portugal
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Díaz Del Arco C, Sanabria Montoro MC, García López D, Rodríguez Escudero E, Fernández Aceñero MJ. Clinical Relevance of ASC-H Cytologies: Experience in a Single Tertiary Hospital. Acta Cytol 2016; 60:217-24. [PMID: 27490700 DOI: 10.1159/000448022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Accepted: 06/27/2016] [Indexed: 12/20/2022]
Abstract
OBJECTIVES To review the cases of atypical squamous cells (ASC), cannot exclude squamous intraepithelial lesion (ASC-H) diagnosed at a single institution and to discuss the interpretation challenges and clinical management of these cases. STUDY DESIGN The ASC-H cases diagnosed at our institution from 2006 to 2015 were studied retrospectively; of 159,000 Pap smears, there were 959 cases of ASC of undetermined significance (ASC-US) and 148 cases of ASC-H. We have reviewed the clinical records of the ASC-H cases, and data have been analyzed using SPSS 20.0. RESULTS Median age was 43.1 years; 49.6% of the patients had previous cervical cytologies, and 55.9% of them were negative. Following ASC-H diagnosis, another smear was obtained in 97.1% of the cases and in 67.6% a biopsy was performed. Biopsy revealed low-grade dysplasia in 18.8% of the cases, high-grade dysplasia in 27.8%, and infiltrating carcinoma in 2.3%. Patients with significant lesions in histology were younger than patients with negative results (p = 0.08). A diagnosis of ASC-H/squamous intraepithelial lesion in the repeated cytology had a sensitivity of 74.2%, specificity of 39.6%, positive predictive value of 44.8%, and negative predictive value of 70% for the diagnosis of dysplasia. CONCLUSIONS ASC-H diagnosis is associated with a high incidence of histological high-grade lesions. A repeat cytology can aid in the selection of high-risk patients, but there may be false-negative results.
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Xu L, Verdoodt F, Wentzensen N, Bergeron C, Arbyn M. Triage of ASC-H: A meta-analysis of the accuracy of high-risk HPV testing and other markers to detect cervical precancer. Cancer Cytopathol 2016; 124:261-72. [PMID: 26618614 PMCID: PMC4833620 DOI: 10.1002/cncy.21661] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2015] [Revised: 11/03/2015] [Accepted: 11/04/2015] [Indexed: 01/15/2023]
Abstract
BACKGROUND Women with a cytological diagnosis of atypical squamous cells, cannot exclude high-grade squamous intraepithelial lesion (ASC-H) are usually immediately referred for colposcopy. However, triage may reduce the burden of the diagnostic workup and prevent overtreatment. METHODS A meta-analysis was conducted to assess the accuracy of high-risk human papillomavirus (hrHPV) testing and testing for other molecular markers for the detection of grade 2 cervical intraepithelial neoplasia or worse (CIN2+) or grade 3 cervical intraepithelial neoplasia or worse (CIN3+) in women with ASC-H. An additional question that was assessed was whether triage would be useful in light of the relatively high pretriage probability of underlying precancer. RESULTS The pooled absolute sensitivity and specificity of the Hybrid Capture 2 (HC2) assay for CIN2 + (derived from 19 studies) were 93% (95% confidence interval [CI], 89%-95%) and 45% (95% CI, 41%-50%), respectively. p16(INK4a) staining (only 3 studies) had similar sensitivity (93%; 95% CI, 75%-100%) but superior specificity (specificity ratio, 1.69) to HC2 for CIN2+. Testing for paired box 1 gene methylation (only 1 study) showed a superior specificity of 95% (specificity ratio, 2.08). The average pretest risk was 34% for CIN2 + and 20% for CIN3+. A negative HC2 result decreased this to 8% and 5%, respectively, whereas a positive result upgraded the risk to 47% and 28%, respectively. CONCLUSIONS Because of the high probability of precancer with a diagnosis of ASC-H, the utility of triage is limited. The usual recommendation for referring women with ASC-H for colposcopy is not altered by a positive triage test, whatever test is used. A negative hrHPV DNA or p16(INK4a) test may allow repeat testing, but this recommendation will depend on local decision thresholds for referral.
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Affiliation(s)
- Lan Xu
- Belgian Cancer Centre/Unit of Cancer Epidemiology, Scientific Institute of Public Health, Brussels, Belgium
| | - Freija Verdoodt
- Belgian Cancer Centre/Unit of Cancer Epidemiology, Scientific Institute of Public Health, Brussels, Belgium
- Unit of Virus, Lifestyle and Genes, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Nicolas Wentzensen
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, USA
| | | | - Marc Arbyn
- Belgian Cancer Centre/Unit of Cancer Epidemiology, Scientific Institute of Public Health, Brussels, Belgium
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Padilla-España L, Repiso-Jiménez JB, Fernández-Sánchez F, Pereda T, Rivas-Ruiz F, Fernández-Morano T, de la Torre-Lima J, Palma F, Redondo M, de Troya-Martín M. [Effectiveness of human papillomavirus genotyping for detection of high-grade anal intraepithelial neoplasia compared to anal cytology]. Enferm Infecc Microbiol Clin 2016; 34:400-5. [PMID: 26976378 DOI: 10.1016/j.eimc.2016.02.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2015] [Revised: 02/01/2016] [Accepted: 02/03/2016] [Indexed: 12/17/2022]
Abstract
INTRODUCTION The incidence of high-grade anal intraepithelial neoplasia (HGAIN) -with an aetiological based on high-risk types of human papillomavirus- is increasing in some high-risk groups. Screening for HGAIN includes routine anal cytology and, more recently, HPV genotyping. The main objective of this study was to determine the sensitivity and specificity of anal cytology and HPV genotyping for the detection of HGAIN. MATERIALS AND METHODS This is a study to determine the correlation of cytological and microbiological findings with anal biopsy findings in a cohort of patients at high risk of developing AIN referred to the department of sexually transmitted infections of the Hospital Costa del Sol, Spain, between January 2008 and December 2014. RESULTS Of the 151 patients subjected to screening, a total of 92 patients, all of them with the result of three screening test (anal cytology, genotyping and biopsy) were included in the study. Just under two-thirds (62%) of them were HIV-positive. The sensitivity and specificity of anal cytology to detect HGAIN were 52.8 and 85.7%, respectively (k: 0.328), and 78 and 62.8% to detect two or more HPV oncogenic genotypes (k: 0.417). The detection of oncogenic HPV genotypes allowed the identification of 23 new cases of HGAIN that had been underdiagnosed with anal cytology, with 14 cases containing at least three high-risk genotypes. CONCLUSION Anal cytology did not show enough sensitivity in HGAIN screening. HPV genotyping has shown to be a useful tool to detect HGAIN cases, although it could lead to an over-diagnosis as a solitary screening procedure.
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Affiliation(s)
| | | | | | - Teresa Pereda
- Anatomía Patológica, Hospital Costa del Sol , Marbella, España
| | | | | | | | - Fermín Palma
- Cirugía General, Hospital Costa del Sol, Marbella, España
| | - Maximino Redondo
- Universidad de Málaga, Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Málaga, España
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Ázara CZS, Manrique EJC, Tavares SBDN, Alves de Souza NL, Magalhães JC, Amaral RG. Reproducibility of cervical cytopathology following an intervention by an external quality control laboratory. Diagn Cytopathol 2016; 44:305-10. [DOI: 10.1002/dc.23445] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2015] [Revised: 01/06/2016] [Accepted: 01/08/2016] [Indexed: 12/26/2022]
Affiliation(s)
| | | | | | | | - Juliana Cristina Magalhães
- Postgraduate Program in Health Sciences; School of Medicine, Federal University of Goiás; Goiânia Brazil
| | - Rita Goreti Amaral
- External Quality Control Laboratory; School of Pharmacy, Federal University of Goiás; Goiânia Brazil
- School of Pharmacy; Federal University of Goiás; Goiânia Brazil
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Ryu KJ, Lee S, Min KJ, Kim JW, Hong JH, Song JY, Lee JK, Lee NW. Reflex Human Papillomavirus Test Results as an Option for the Management of Korean Women With Atypical Squamous Cells Cannot Exclude High-Grade Squamous Intraepithelial Lesion. Oncologist 2015; 20:635-9. [PMID: 25964305 DOI: 10.1634/theoncologist.2014-0459] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2014] [Accepted: 03/01/2015] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Current guidelines recommend initial colposcopy with biopsy regardless of human papillomavirus (HPV) test results in women with atypical squamous cells, cannot exclude high-grade squamous intraepithelial lesion (ASC-H). The purpose of this study was to evaluate the value of HPV testing in women with ASC-H based on colposcopic pathology results. MATERIALS AND METHODS A multicenter cross-sectional study was carried out at three academic hospitals and involved 40,847 Korean women who underwent cervical cancer screening with cytology and HPV tests with or without subsequent colposcopic biopsies between January 2007 and December 2013. RESULTS ASC-H was diagnosed in 276 women (0.7%). Only 6 of 68 (8.8%) women with ASC-H who were HPV negative had cervical intraepithelial neoplasia grade ≥2 (CIN ≥2) lesions, whereas 47.4% of the women with ASC-H who were HPV positive had CIN ≥2 lesions. No cases of invasive cervical cancer were diagnosed among women with ASC-H who were HPV negative. Logistic regression analysis was performed using the group with normal Papanicolaou test results and HPV-negative status as the reference group. Women with ASC-H who were HPV positive had a significantly increased risk of CIN ≥2 lesions, whereas no significant increase was observed in patients with ASC-H and HPV-negative status. CONCLUSION If the result of the HPV test was negative, the risk of CIN ≥2 lesions in Korean women with ASC-H cytology was low. Reflex HPV testing should be an option for the management of women with cytology showing ASC-H to decrease unnecessary colposcopic biopsies, which are expensive and invasive. IMPLICATIONS FOR PRACTICE Current American Society for Colposcopy and Cervical Pathology guidelines recommend universal colposcopy for the management of women with atypical squamous cells, cannot exclude high-grade squamous intraepithelial lesion (ASC-H) on cytology, regardless of human papillomavirus (HPV) test results. The present study suggested that HPV cotesting in patients with ASC-H cytology can provide more detailed and useful information regarding the risk of high-grade cervical intraepithelial neoplasia (CIN) lesions and the need for further treatment. When the result of the HPV test was negative, the risk of CIN lesions of grade ≥2 in women with ASC-H cytology was low. Consequently, reflex HPV testing, rather than immediately performance of invasive and expensive colposcopy with biopsy, should be an option for the management of women with ASC-H.
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Affiliation(s)
- Ki-Jin Ryu
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Korea University College of Medicine, Seoul, Republic of Korea
| | - Sanghoon Lee
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Korea University College of Medicine, Seoul, Republic of Korea
| | - Kyung-Jin Min
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Korea University College of Medicine, Seoul, Republic of Korea
| | - Jae Won Kim
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Korea University College of Medicine, Seoul, Republic of Korea
| | - Jin Hwa Hong
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Korea University College of Medicine, Seoul, Republic of Korea
| | - Jae Yun Song
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Korea University College of Medicine, Seoul, Republic of Korea
| | - Jae Kwan Lee
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Korea University College of Medicine, Seoul, Republic of Korea
| | - Nak Woo Lee
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Korea University College of Medicine, Seoul, Republic of Korea
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Zhou F, Pulinthanathu R, Elgert P, Cangiarella J, Simsir A. Sensitivity of high-risk HPVHybrid Capture II (hrHPV HC2) test using SurePathTMspecimens in the prediction of cervical high-grade squamous lesions. Diagn Cytopathol 2014; 43:381-7. [DOI: 10.1002/dc.23243] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2014] [Revised: 11/12/2014] [Accepted: 12/02/2014] [Indexed: 12/11/2022]
Affiliation(s)
- Fang Zhou
- Department of Pathology; New York University School of Medicine; New York
| | | | - Paul Elgert
- Department of Pathology; New York University School of Medicine; New York
| | - Joan Cangiarella
- Department of Pathology; New York University School of Medicine; New York
| | - Aylin Simsir
- Department of Pathology; New York University School of Medicine; New York
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