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Xu H, Chen Y, Zhao C, Wang Q, Tang M, Zhang W, Wang Q, Lou R, Liu T, Feng Y, Zhang H. Bethesda system reporting rates, histological follow-up and HPV genotypes distribution of abnormal cytology in Anhui province of China: Analysis of 93,168 cervical liquid-based cytology test reports. Diagn Cytopathol 2023. [PMID: 37114437 DOI: 10.1002/dc.25150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 04/19/2023] [Accepted: 04/20/2023] [Indexed: 04/29/2023]
Abstract
OBJECTIVE To analyze the Bethesda System reporting rates, histological follow-up, and HPV genotypes distribution of abnormal cytology in Anhui province of China. METHODS According to the Bethesda Reporting System of Cervical Cytology (2014), a retrospective analysis of the cervical liquid-based cytology (LBC) results, abnormal cytology with concurrent HPV genotype testing, and immediate histological follow-up. HPV genotype testing was performed for 15 High-risk types and 6 Low-risk types. Immediate histological correlation results within 6 months after the LBC and HPV results. RESULTS 6.70% of women with abnormal LBC results, and ASC/SIL was 1.42. The severe histological results in abnormal cytology were ASC-US (18.58%), ASC-H (53.76%), LSIL (16.62%), HSIL (82.07%), SCC/ACa (100.00%), AGC (63.77%). The total HPV-positive rate in abnormal cytology was 70.29%, of which ASC-US, ASC-H, LSIL, HSIL, SCC/ACa, and AGC were 60.78%, 80.83%, 83.05%, 84.93%, 84.51%, 33.33%. The top three detected genotypes were HR HPV 16, 52, and 58. The most commonly detected genotype in HSIL and SCC/ACa was HPV 16. Of the 91 AGC patients, 34.78% were cervical lesions, and 42.03% were endometrial lesions. The HPV-positive rate in the group of AGC-FN was highest and lowest in the group of AGC-EM. CONCLUSION The Bethesda System reporting rates of cervical cytology were all within the benchmark range of the CAP laboratory. HPV 16, 52, and 58 were the most common genotypes in our population, and HPV 16 infection has a higher degree of malignancy of cervical lesions. Among patients with ASC-US results, HPV positive patients had a higher rate of biopsy-detected CIN2+ than HPV negative patients.
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Affiliation(s)
- Hongliang Xu
- Department of Pathology, Anhui Province Maternity and Child Health Hospital, Anhui Medical University, Hefei, China
| | - Yong Chen
- Department of Pathology, Anhui Province Maternity and Child Health Hospital, Anhui Medical University, Hefei, China
| | - Caixia Zhao
- Department of Pathology, Anhui Province Maternity and Child Health Hospital, Anhui Medical University, Hefei, China
| | - Qin Wang
- Department of Pathology, Anhui Province Maternity and Child Health Hospital, Anhui Medical University, Hefei, China
| | - Man Tang
- Department of Pathology, Anhui Province Maternity and Child Health Hospital, Anhui Medical University, Hefei, China
| | - Weiqin Zhang
- Department of Pathology, Anhui Province Maternity and Child Health Hospital, Anhui Medical University, Hefei, China
| | - Qing Wang
- Department of Pathology, Anhui Province Maternity and Child Health Hospital, Anhui Medical University, Hefei, China
| | - Rong Lou
- Department of Pathology, Anhui Province Maternity and Child Health Hospital, Anhui Medical University, Hefei, China
| | - Tingting Liu
- Department of Pathology, Anhui Province Maternity and Child Health Hospital, Anhui Medical University, Hefei, China
| | - Yi Feng
- Department of Pathology, Anhui Province Maternity and Child Health Hospital, Anhui Medical University, Hefei, China
| | - Heping Zhang
- Department of Pathology, Anhui Province Maternity and Child Health Hospital, Anhui Medical University, Hefei, China
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Zhao D, Zhang L, Xie F, Peng D, Wei J, Jiang L, Zhang S, Qi D. Outcomes of prior cervical cytology and HR-HPV testing in women subsequently diagnosed with CIN1, CIN2/3, and invasive cervical cancer: a 4-year routine clinical experience after implementation of systematic training and quality control programs. BMC Cancer 2020; 20:810. [PMID: 32847541 PMCID: PMC7448325 DOI: 10.1186/s12885-020-07321-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Accepted: 08/19/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND In 2013, Jinan KingMed Diagnostics (JKD) first established a systematic cervical cytology training and quality control (QC) program in Shandong Province, China. We compared the efficacy of high-risk human papillomavirus (HR-HPV) detection, cytology, and their combination in routine clinical practice after the implementation of the training and QC program to identify the optimal first-line screening method in this region. METHODS The data of patients histologically diagnosed with cervical intraepithelial neoplasia (CIN) 1, CIN2/3, and invasive cervical cancer (ICC) between January 2014 and December 2017 were retrieved from the JKD database. Cytology and/or HR-HPV testing results within 3 months preceding the CIN1 diagnoses and 6 months preceding the CIN2/3 and ICC diagnoses were analyzed. RESULTS Prior screening data were available for 1829 CIN1 patients, 2309 CIN2/3 patients, and 680 ICC patients. Cytology alone and HR-HPV testing alone had similar rates of positive results for CIN2/3 (97.2% [854/879] vs. 95.4% [864/906], P = 0.105) and ICC detection (89.1% [205/230] vs. 92.7% [204/220], P = 0.185). Compared with either method alone, co-testing slightly increased the screening sensitivity for CIN2/3 (99.8% [523/524], all P < 0.001) and ICC (99.6% [229/230], all P < 0.001) detection. In the CIN1 group, cervical cytology alone (92.9% [520/560]) was more sensitive than HR-HPV testing alone (79.9% [570/713], P < 0.001), and co-testing (95.3% [530/556]) did not significantly improve the screening sensitivity (P = 0.105). CONCLUSIONS After the implementation of a systematic training and QC program, both cytology and HR-HPV testing may be adopted for primary cervical cancer screening in Shandong Province.
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Affiliation(s)
- Dongman Zhao
- Department of Pathology, Jinan KingMed Diagnostics, Jinan, 250101, Shandong Province, China
| | - Liran Zhang
- Department of Pathology, Jinan KingMed Diagnostics, Jinan, 250101, Shandong Province, China
| | - Fengxiang Xie
- Department of Pathology, Jinan KingMed Diagnostics, Jinan, 250101, Shandong Province, China
| | - Dezhi Peng
- Department of Laboratory Medicine, Jinan KingMed Diagnostics, Jinan, 250101, Shandong Province, China
| | - Jie Wei
- Department of Laboratory Medicine, Jinan KingMed Diagnostics, Jinan, 250101, Shandong Province, China
| | - Lingbo Jiang
- Department of Laboratory Medicine, Jinan KingMed Diagnostics, Jinan, 250101, Shandong Province, China
| | - Shoudu Zhang
- Department of Laboratory Medicine, Jinan KingMed Diagnostics, Jinan, 250101, Shandong Province, China
| | - Debo Qi
- Department of Laboratory Medicine, Jinan KingMed Diagnostics, Jinan, 250101, Shandong Province, China.
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Xie F, Zhang L, Zhao D, Wu X, Wei M, Zhang X, Wu X, Fang H, Xu X, Yang M, Qi D. Prior cervical cytology and high-risk HPV testing results for 311 patients with invasive cervical adenocarcinoma: a multicenter retrospective study from China's largest independent operator of pathology laboratories. BMC Infect Dis 2019; 19:962. [PMID: 31711435 PMCID: PMC6849166 DOI: 10.1186/s12879-019-4614-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Accepted: 11/04/2019] [Indexed: 01/09/2023] Open
Abstract
Background High-risk human papillomavirus (HR-HPV) testing is more sensitive than cytology for the detection of cervical cancer and its precursors. However, limited and inconsistent data are available about the efficacy of the combination of these two methods for screening cervical adenocarcinoma. This multicenter retrospective study investigated the screening results of a cohort of Chinese patients who were subsequently diagnosed with invasive cervical adenocarcinoma, with the goal of identifying the optimal cervical adenocarcinoma screening method. Methods We retrospectively retrieved and analyzed the data from patients with histologically confirmed primary invasive cervical adenocarcinoma from eight local pathology laboratories operated by KingMed Diagnostics, the largest independent operator of pathology laboratories in China, over a 2-year period. Only patients who underwent cytology and/or HR-HPV testing within 6 months before the adenocarcinoma diagnosis were included. HR-HPV DNA was detected using one of two HPV test kits: the Hybrid Capture 2 (HC2) assay (Qiagen, Hilden, Germany) and an HPV genotyping panel (Yaneng Bio, Shenzhen, China). Results Of the 311 patients, 136 underwent cytology alone, 106 underwent HR-HPV testing alone, and 69 underwent cytology and HR-HPV co-testing. The sensitivities of cytology alone (64.0, 95% confidence interval [CI]: 55.9–72.0) and HR-HPV testing alone (66.0, 95% CI: 57.0–75.1) were similar (P = 0.738). The sensitivity of cytology and HR-HPV co-testing (87.0, 95% CI: 79.0–94.9) was significantly higher than that of either cytology (P = 0.001) or HR-HPV testing alone (P = 0.002). Conclusions Both cytology alone and HR-HPV testing alone showed poor screening efficiency, whereas the combination of the two clearly increased the efficiency of primary cervical adenocarcinoma screening. Thus, cytology and HR-HPV co-testing might be the most efficient cervical adenocarcinoma screening method.
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Affiliation(s)
- Fengxiang Xie
- Department of Pathology, Jinan KingMed Diagnostics, Jinan, 250101, Shandong Province, China
| | - Liran Zhang
- Department of Pathology, Jinan KingMed Diagnostics, Jinan, 250101, Shandong Province, China
| | - Dongman Zhao
- Department of Pathology, Jinan KingMed Diagnostics, Jinan, 250101, Shandong Province, China
| | - Xuefen Wu
- Department of Pathology, Kunming KingMed Diagnostics, Kunming, 650000, Yunnan Province, China
| | - Mingsong Wei
- Department of Pathology, Guangxi KingMed Diagnostics, Nanning, 530007, Guangxi Autonomous Region, China
| | - Xuelian Zhang
- Department of Pathology, Nanjing KingMed Diagnostics, Nanjing, 250032, Jiangsu Province, China
| | - Xiaohui Wu
- Department of Pathology, Chongqing KingMed Diagnostics, Chongqing, 400050, Chongqing Municipality, China
| | - Hao Fang
- Department of Pathology, Changsha KingMed Diagnostics, Changsha, 410205, Hunan Province, China
| | - Xue Xu
- Department of Pathology, Hefei KingMed Diagnostics, Hefei, 230088, Anhui Province, China
| | - Meng Yang
- Department of Pathology, Zhengzhou KingMed Diagnostics, Zhengzhou, 450000, Henan Province, China
| | - Debo Qi
- Department of Genetics, Jinan KingMed Diagnostics, Jinan, 250101, Shandong Province, China.
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de Morais LSF, Magalhães JC, Braga IDS, Marega LA, Tavares SBDN, Amaral RG. Performance of Laboratories after 10 Years of Participating in External Quality Monitoring in Cervical Cytology. Acta Cytol 2019; 64:224-231. [PMID: 31480038 DOI: 10.1159/000502433] [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: 03/02/2019] [Accepted: 07/31/2019] [Indexed: 01/30/2023]
Abstract
OBJECTIVE To evaluate the performance of laboratories accredited by the National Health System that perform cytopathology examination of the uterine cervix after 10 years of participation in external quality monitoring (eQM). STUDY DESIGN Seven laboratories were assessed in this study. To assess the concordance of the representation of epithelia and results, 6,536 examinations (3,433 in 2007 and 3,103 in 2017) were reviewed. Statistical analysis was performed using the κ coefficient as well as the χ2 and the Fisher exact test (p < 0.05). RESULTS All laboratories showed adequate infrastructure and internal quality monitoring. Regarding the representation of the epithelia, the concordance remained excellent (κ between 0.84 and 0.94). In 2007, 26 false-negative results (FN), 157 false-positive results (FP), and 79 delays in clinical conduct (DCC) were identified (κ = 0.80). In 2017, 24 FN, 42 FP, and 38 DCC were identified (κ = 0.90). Five laboratories showed improvement in concordance from 2007 to 2017. We observed significant improvement in cytomorphological criteria of the results: atypical squamous cells of undetermined significance (p < 0.001), atypical squamous cells cannot exclude high-grade squamous intraepithelial lesion (p < 0.016), and low-grade squamous intraepithelial lesion (p < 0.001). We also observed a considerable improvement in the results of cellular abnormalities in glandular epithelium (p < 0.0504). CONCLUSIONS Ten years after the implementation of eQM, improvements in the concordance of results were observed as well as reductions in FN, FP, and DCC in all laboratories monitored.
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Tao X, Austin RM, Kong L, Sun Q, Lv Q, Xu H, Meng G, Huang X, Hao M, Zhou Q, Zhou X, Wang L, Zhang Y, Xu S, Shi Q, Zhou Q, Guo L, Zeng S, Wang Y, Zhou J, Nie X, Tian L, Shen D, Lei Z, Liu Y, Mei J, Wong KW, Cheung AAY, Li J, Zhu M, Zhao C. Nationwide survey of cervical cytology laboratory practices in China. J Am Soc Cytopathol 2019; 8:250-257. [PMID: 31543224 DOI: 10.1016/j.jasc.2019.02.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2019] [Revised: 02/12/2019] [Accepted: 02/14/2019] [Indexed: 02/05/2023]
Abstract
INTRODUCTION Cervical cancer rates in China remain high, with only limited opportunistic screening in urban centers and large mostly unscreened rural areas. Cervical cytology practices in China have been changing over the last decade with introduction of The Bethesda System reporting terminology, liquid-based cytology (LBC), and programs for cervical cytology screening of underserved rural populations. An effort was undertaken for the first time to collect nationwide data on cervical cytology laboratory practices in China, a possible first step toward increased standardization and potential development of nationwide cytology quality benchmarks. MATERIALS AND METHODS Data on cervical cytology practices from 1572 laboratories operating in 26 nationwide Provisional Level Administrative Divisions was collected in an online survey approved through the Obstetrics and Gynecology Hospital of Fudan University in Shanghai. RESULTS Over 90% of cervical cytology laboratories in China now solely use Bethesda System reporting terminology. LBC is now the most commonly utilized form of cervical cytology, with lower-cost Chinese-manufactured LBC formulations used in almost 70% of laboratories. Nationwide, significantly higher abnormal cytology rates were reported with LBC than with the conventional Papanicolaou smear (CPS); however, the CPS remains a useful low-cost alternative as China strives to extend cervical screening to large underserved rural areas. CONCLUSIONS Abnormal cytology rates were not significantly different when different levels of hospitals were compared. The survey identified nationwide opportunities for cytology quality improvement, including low rates of reporting of unsatisfactory cases and low rates for atypical glandular cells.
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Affiliation(s)
- Xiang Tao
- Department of Pathology, Obstetrics & Gynecology Hospital of Fudan University, Shanghai, China.
| | - R Marshall Austin
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Lingfei Kong
- Department of Pathology, Henan Provincial Hospital, Zhengzhou, China
| | - Qing Sun
- Department of Pathology, Shandong Provincial Qianfoshan Hospital, Jinan, China
| | - Qinjie Lv
- Department of Pathology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Haimiao Xu
- Department of Pathology, Zhejiang Cancer Hospital, Hangzhou, China
| | - Gang Meng
- Department of Pathology, Anhui Medical University, Hefei, China
| | - Xianghua Huang
- Department of Gynecology, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Min Hao
- Department of Obstetrics and Gynecology, The Second Hospital of ShanXi Medical University, Taiyuan, China
| | - Qiao Zhou
- Department of Pathology, West China Hospital, Sichuan University, Chengdu, China
| | - Xianrong Zhou
- Department of Pathology, Obstetrics & Gynecology Hospital of Fudan University, Shanghai, China
| | - Liantang Wang
- Department of Pathology, The First Affiliated Hospital, Sun Yat-sun University, Guangzhou, China
| | - Yue Zhang
- Department of Pathology, Horqin Right Front Banner People's Hospital, Ulanhot, China
| | - Shuxia Xu
- Department of Pathology, Fujian Provincial Maternity and Children's Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Qingfang Shi
- Department of Pathology, Gansu Provincial Maternity and Child-Care Hospital, Lanzhou, China
| | - Qi Zhou
- Department of Gynecological Oncology, Chongqing Cancer Hospital, Chongqing, China
| | - Linchuan Guo
- Department of Pathology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Sien Zeng
- Department of Pathology, Affiliated Hospital of Guilin Medical College, Guilin, China
| | - Yulan Wang
- Department of Pathology, Xinjiang Military District General Hospital, Urumqi, China
| | - Jianhua Zhou
- Department of Pathology, Xiangya Hospital, Central South University, Changsha, China
| | - Xiu Nie
- Department of Pathology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Lixiang Tian
- Department of Pathology, Changchun Gynecological and Obstetric Hospital, Changchun, China
| | - Danhua Shen
- Department of Pathology, Peking University People's Hospital, Beijing, China
| | - Zi Lei
- Department of Pathology, First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Yixin Liu
- Department of Pathology, Tianjin Central Hospital of Gynecology Obstetrics, Tianjin, China
| | - Jinhong Mei
- Department of Pathology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Kam Weng Wong
- Department of Obstetrics & Gynecology, Centro Hospitalar Conde de São Januário, Macau SAR, China
| | - Annie A Y Cheung
- Department of Pathology, HKU Cervical Cytology Laboratory and HKU-Shenzhen Hospital Cytology Laboratory, The University of Hong Kong, Hong Kong SAR, China
| | - Juan Li
- Department of Pathology, Jinan Maternity and Child Care Hospital, Shandong, China
| | - Minghua Zhu
- Department of Pathology, Shanghai Changhai Hospital, Shanghai, China
| | - Chengquan Zhao
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
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