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Chen F, Hsu Lin L, Hindi I, Sun W, Shafizadeh N, Szeto O, Brandler TC, Simsir A. HPV Cotesting of Unsatisfactory Papanicolaou Tests: Implications for Follow-up Intervals. Am J Clin Pathol 2023; 160:137-143. [PMID: 37052613 DOI: 10.1093/ajcp/aqad026] [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: 11/11/2022] [Accepted: 02/16/2023] [Indexed: 04/14/2023] Open
Abstract
OBJECTIVES The 2019 American Society of Colposcopy and Cervical Pathology management guidelines recommend that patients with an unsatisfactory Papanicolaou (Pap) test (UPT) and negative human papillomavirus (HPV) cotest undergo repeat age-based screening in 2 to 4 months. The rationale is that a negative HPV test in the setting of an UPT may reflect an inadequate sample and therefore should not be interpreted as truly "negative." For patients 25 years and older who are cotested, if HPV is positive for the 16 or 18 genotypes, direct referral for colposcopy is recommended. Our study aimed to determine if a negative HPV cotest result is predictive of the absence of a high-grade squamous intraepithelial lesion (HSIL) and whether these patients may be called back for repeat testing at an interval longer than 2 to 4 months. METHODS Follow-up cervical cytology and biopsy results in women with UPT and HPV cotests from January 2017 to December 2021 were collected. Original UPT and HPV cotest results were correlated with the follow-up Pap and biopsy results. RESULTS There were 1,496 (2.28%) UPT cases out of 65,641 total Pap tests. Among the 1,496 UPT cases, 1,010 (67.5%) had HPV cotesting; 676 (45.1%) were followed by repeat Pap or biopsy within 4 months and 850 (56.8%) within 12 months. The total follow-up rate was 81%, with a range of 3 days to 36 months. The HSIL rate in HPV-positive cases was 5.7% (3/53) vs 0.4% (2/539) (P = .006) in HPV-negative cases. In UPT, HPV cotesting showed negative predictive values for low-grade and high-grade squamous intraepithelial lesion detection of 98.5% and 99.6%, respectively, while positive predictive values were 19% and 5.7%. CONCLUSIONS A negative HPV cotest in individuals with UPT predicted the lack of HSIL in our study. Compliance with the recommended follow-up time of 2 to 4 months for women with UPT was low (45.1%). Our study suggests that women with UPT and negative HPV cotest may be safely called back at an interval longer than 4 months.
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Affiliation(s)
- Fei Chen
- Department of Pathology, NYU Langone Health, New York, NY, US
| | | | - Issa Hindi
- Department of Pathology, NYU Langone Health, New York, NY, US
| | - Wei Sun
- Department of Pathology, NYU Langone Health, New York, NY, US
| | | | - Oliver Szeto
- Department of Pathology, NYU Langone Health, New York, NY, US
| | | | - Aylin Simsir
- Department of Pathology, NYU Langone Health, New York, NY, US
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Toro de Méndez M, Azuaje de Inglessis AB. Importancia de la adecuación de la muestra citológica en la pesquisa de cáncer de cuello uterino. REPERTORIO DE MEDICINA Y CIRUGÍA 2022. [DOI: 10.31260/repertmedcir.01217372.1085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objetivo: revisión realizada para destacar la importancia de una muestra citológica óptima para la pesquisa de cáncer de cuello uterino y sus lesiones precursoras, con fines preventivos de diagnóstico y conocimiento de los lineamientos de manejo clínico vigentes, mediante una adecuada muestra. Material y metodología. se realizó una búsqueda electrónica en la base de datos PubMed utilizando los siguientes términos y combinaciones: cervical cytology, screening cervical cáncer, Bethesda system, adecuacy, false negatives, clinical follow-up. Las variables fueron la adecuación de la muestra citológica para pesquisa de cáncer de cuello uterino establecida por el sistema Bethesda y el seguimiento clínico vigente. Resultados: la evaluación de la calidad de la muestra citológica se considera como principal aporte de garantía de calidad del sistema Bethesda para el informe de los hallazgos. Existen lineamientos de manejo clínico relacionados con la adecuada muestra y el seguimiento clínico establecidos hace más de una década y que aún son vigentes. Conclusiones: una muestra citológica óptima permite detectar una mayor proporción de lesiones del cuello uterino significativas, contribuye a la efectividad clínica de la pesquisa de cáncer y establece el mejor cuidado para la paciente. Es necesario concientizar al personal involucrado sobre la importancia de obtener muestras adecuadas.
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The use of biomarkers and HPV genotyping to improve diagnostic accuracy in women with a transformation zone type 3. Br J Cancer 2021; 126:91-99. [PMID: 34716397 DOI: 10.1038/s41416-021-01539-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Revised: 07/21/2021] [Accepted: 08/23/2021] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Twenty percent of women referred to colposcopy have a type 3 transformation zone-where colposcopic assessment for high-grade dysplasia (CIN2+) is not possible. This study examines the effectiveness of HPV biomarkers and genotyping in combination with techniques that sample an endocervical TZ. METHODS A prospective diagnostic accuracy study. Women booked for large-loop excision (LLETZ) with squamous dyskaryosis, high-risk HPV and a TZ3 were recruited. Immediately prior to LLETZ samples were collected for p16/Ki-67 dual-stained cytology, HPV genotyping and H&E, p16- and Ki-67-stained endocervical curettings. RESULTS In women with low-grade screening (n = 64), 35.9% had CIN2+; dual-stained cytology had the greatest effect on the PPV of routine screening (76.1% vs 35.9%) and perfectly predicted the absence of CIN2+. In women with a high-grade screening result (n = 37); 75.6% had CIN2+ and dual-stained curettings improved the PPV (96.5 vs 75.6%). CONCLUSIONS With high-grade screening and a TZ3, LLETZ appears safest as three quarters have CIN2+ . Women with low-grade screening and a TZ3 have a twofold increased risk of CIN2+ when compared to women where the TZ is visible. The use of dual-stained cytology may help identify those women who can be safely offered surveillance and those who require treatment.
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Sharma R, Ambroise MM, Ramdas A, Ravichandran K. Predictors of Unsatisfactory Conventional Pap Smears. J Midlife Health 2021; 11:231-235. [PMID: 33767564 PMCID: PMC7978046 DOI: 10.4103/jmh.jmh_110_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 07/03/2020] [Accepted: 11/26/2020] [Indexed: 01/10/2023] Open
Abstract
Objective: The objective of this study is to determine the clinical predictors of unsatisfactory Pap smears. Methodology: This was a case–control study done in a tertiary care institute. All unsatisfactory conventional pap (CP) smears between January 2015 and June 2017 were retrieved, and the slides were viewed. Clinical details were recorded from request forms and case files. Simple and multiple logistic regression analyses were used to identify the predictors of unsatisfactory CP smears. Results: In this study, we have included 314 unsatisfactory Pap smears and 541 controls with satisfactory Pap smears. Clinical parameters such as older age and cervical erosion proved to be important predictors of unsatisfactory pap smears. The most common reason for unsatisfactory pap smears was due to a paucity of epithelial elements (66.6%), followed by obscuration of smear details by blood/inflammatory cells/mucus (9.9%) and air drying artifacts (4.4%). There were multiple reasons in 19.1% of cases with unsatisfactory pap smears. Conclusion: Our study shows that older age groups and cervical erosion are predictors of unsatisfactory pap smears. Incidence of unsatisfactory pap smears can be reduced by education and retraining of health-care workers and doctors.
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Affiliation(s)
- Reetika Sharma
- Department of Pathology, Pondicherry Institute of Medical Sciences, Puducherry, India
| | - Marie Moses Ambroise
- Department of Pathology, Pondicherry Institute of Medical Sciences, Puducherry, India
| | - Anita Ramdas
- Department of Pathology, Pondicherry Institute of Medical Sciences, Puducherry, India
| | - Kandasamy Ravichandran
- Department of Biostatistics, Pondicherry Institute of Medical Sciences, Puducherry, India
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Manley KM, Wills AK, Villeneuve N, Hunt K, Patel A, Glew S. Comparison of the Cervex-Brush alone to Cytobrush plus Cervex-Brush for detection of cervical dysplasia in women with a transformation zone type 3. Cytopathology 2018; 30:157-163. [PMID: 30414286 DOI: 10.1111/cyt.12647] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Revised: 09/26/2018] [Accepted: 10/28/2018] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Twenty percent of colposcopic assessments are inadequate due to a type 3 transformation zone (TZ3). In the absence of colposcopic or histological assessment, subsequent management is guided by the referral screening test. In the UK, routine cervical screening is completed by a Cervex-Brush alone. This study examines the effectiveness of a Cytobrush in addition to a standard Cervex-Brush when used in TZ3 assessment. METHODOLOGY An 18-month diagnostic accuracy study in a single National Health Service (NHS) Trust. Women with a TZ3 booked for large loop excision of the transformation zone (LLETZ) with a referral cytology of high-risk HPV and squamous dyskaryosis were recruited. Immediately prior to LLETZ, a Cervex-Brush plus Cytobrush liquid-based cytology sample was taken. Presence of endocervical cells was compared. Predictability of high-grade cervical intra-epithelial neoplasia (CIN2+) was by blind standardised reporting of the LLETZ histology. RESULTS One hundred and five women were recruited from a total eligible population of 153 cases (68.8%). Endocervical cell yield was increased with the Cervex-Brush plus Cytobrush when compared to the Cervex-Brush alone (99.1% vs 79.1%, P < .001). Irrespective of cytological grade, age or parity, there was no difference in predictability of CIN2+ between sampling methods. CONCLUSIONS When compared to Cervex-Brush sampling alone, the addition of a Cytobrush improves endocervical sampling but does not improve cytological predictability of CIN2+ in women with a TZ3. These data suggest that women who will reliably attend for cytological follow-up can be safely referred to primary care for a Cervex-Brush alone.
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Affiliation(s)
- Kristyn M Manley
- University of Bristol, Bristol, UK.,University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | | | | | | | - Amit Patel
- University Hospitals Bristol NHS Foundation Trust, Bristol, UK
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Arbyn M, Van Veen EB, Andersson K, Bogers J, Boulet G, Bergeron C, von Knebel-Doeberitz M, Dillner J. Cervical Cytology Biobanking in Europe. Int J Biol Markers 2018; 25:117-25. [DOI: 10.1177/172460081002500301] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
A cervical cytology biobank (CCB) is an extension of current cytopathology laboratory practice consisting in the systematic storage of Pap smears or liquid-based cytology samples from women participating in cervical cancer screening with the explicit purpose to facilitate future scientific research and quality audit of preventive services. A CCB should use an internationally agreed uniform cytology terminology, be integrated in a national or regional screening registry, and be linked to other registries (histology, cancer, vaccination). Legal and ethical principles concerning personal integrity and data safety must be respected strictly. Biobank-based studies require approval of ethical review boards. A CCB is an almost inexhaustible resource for fundamental and applied biological research. In particular, it can contribute to answering questions on the natural history of HPV infection and HPV-induced lesions and cancers, screening effectiveness, exploration of new biomarkers, and surveillance of the short- and long-term effects of the introduction of HPV vaccination. To understand the limitations of CCB, more studies are needed on the quality of samples in relation to sample type, storage procedures, and duration of storage.
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Affiliation(s)
- Marc Arbyn
- Unit of Cancer Epidemiology, Scientific Institute of Public Health, Brussels - Belgium
| | | | - Kristin Andersson
- Department of Medical Microbiology, Lund University, Malmö University Hospital, Malmö - Sweden
| | - Johannes Bogers
- Applied Molecular Biology Research Group (AMBIOR), Laboratory for Cell and Tissue Research, University of Antwerp - Belgium
| | - Gaëlle Boulet
- Applied Molecular Biology Research Group (AMBIOR), Laboratory for Cell and Tissue Research, University of Antwerp - Belgium
| | | | | | - Joakim Dillner
- Department of Medical Microbiology, Lund University, Malmö University Hospital, Malmö - Sweden
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Ravikumar KE, MacLaughlin KL, Scheitel MR, Kessler M, Wagholikar KB, Liu H, Chaudhry R. Improving the Accuracy of a Clinical Decision Support System for Cervical Cancer Screening and Surveillance. Appl Clin Inform 2018; 9:62-71. [PMID: 29365341 PMCID: PMC5801884 DOI: 10.1055/s-0037-1617451] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Background
Clinical decision support systems (CDSS) for cervical cancer prevention are generally limited to identifying patients who are overdue for their next routine/next screening, and they do not provide recommendations for follow-up of abnormal results. We previously developed a CDSS to automatically provide follow-up recommendations based on the American Society of Colposcopy and Cervical Pathology (ASCCP) guidelines for women with both previously normal and abnormal test results leveraging information available in the electronic medical record (EMR).
Objective
Enhance the CDSS by improving its accuracy and incorporating changes to reflect the latest revision of the guidelines.
Methods
After making enhancements to the CDSS, we evaluated the performance of the clinical recommendations on 393 patients selected through stratified sampling from a set of 3,704 patients in a nonclinical setting. We performed chart review of individual patient's record to evaluate the performance of the system. An expert clinician assisted by a resident manually reviewed the recommendation made by the system and verified whether the recommendations were as per the ASCCP guidelines.
Results
The recommendation accuracy of the enhanced CDSS improved to 93%, which is a substantial improvement over the 84% reported previously. A detailed analysis of errors is presented in this article. We fixed the errors identified in this evaluation that were amenable to correction to further improve the accuracy of the system. The source code of the updated CDSS is available at
https://github.com/ohnlp/MayoNlpPapCdss
.
Conclusion
We made substantial enhancements to our earlier prototype CDSS with the updated ASCCP guidelines and performed a thorough evaluation in a nonclinical setting to improve the accuracy of the CDSS. The CDSS will be further refined as it is utilized in the practice.
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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
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Digumarti L, Nayak SS, Nutakki R. An Audit on Adequacy of Pap Smears. INDIAN JOURNAL OF GYNECOLOGIC ONCOLOGY 2016. [DOI: 10.1007/s40944-016-0067-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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10
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Sun L, Wang PH, Lee CH, Fu TF, Chou MM, Hwang SF, Ke YM, Hsu ST, Lu CH. Clinical parameters associated with absence of endocervical/transformation zone component in conventional cervical Papanicolaou smears. Taiwan J Obstet Gynecol 2016; 55:81-4. [PMID: 26927255 DOI: 10.1016/j.tjog.2014.03.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/17/2014] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE To study clinical factors predicting the absence of endocervical/transformation zone (EC/TZ) components of conventional cervical Papanicolaou (Pap) smears. MATERIALS AND METHODS The medical charts of patients who received Pap smears between March 2006 and August 2006 in the hospital were reviewed. The results of their Pap smears were retrieved while their demographic and clinical information were obtained from the medical charts. After excluding 378 cases with incomplete demographic data and 1397 cases with a history of pelvic irradiation, pelvic malignancy, and hysterectomy, 5662 cases were enrolled for data analysis. The relationship between clinical parameters and the absence of EC/TZ component was analyzed by Pearson Chi-square tests with Yates continuity correction and binary logistic regression tests. RESULTS The incidence of satisfactory but absence of EC/TZ component was 8.7% (491/5662). Pregnancy increased the absence of EC/TZ component [odds ratio (OR}: 2.84, 95% confidence interval (CI): 2.14-3.77, p<0.0001]. Postpartum status and endocervical polyps decreased incidence (OR: 0.61, 95% CI: 0.38-0.98, p = 0.043 and OR: 0.33, 95% CI: 0.25-0.44, p<0.0001, respectively). CONCLUSIONS Pregnancy is the only clinical factor associated with increased incidence of absence of EC/TZ cells. For these pregnant women undergoing a Pap smear, a more effective strategy may be needed to get a satisfactory smear with adequate EC/TZ components.
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Affiliation(s)
- Lou Sun
- Department of Obstetrics and Gynecology, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Peng-Hui Wang
- Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Obstetrics and Gynecology, National Yang-Ming University School of Medicine, Taipei, Taiwan; Department of Medical Research, China Medical University Hospital, Taichung, Taiwan
| | - Chen-Hui Lee
- Department of Pathology and Laboratory Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Tsai-Feng Fu
- Graduate Institute of Biomedicine and Biomedical Technology, National Chi Nan University, Nantou County, Taiwan
| | - Min-Min Chou
- Department of Obstetrics and Gynecology, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Sheau-Feng Hwang
- Department of Obstetrics and Gynecology, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Yu-Min Ke
- Department of Obstetrics and Gynecology, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Shih-Tien Hsu
- Department of Obstetrics and Gynecology, Taichung Veterans General Hospital, Taichung, Taiwan; School of Medicine, China Medical University, Taichung, Taiwan
| | - Chien-Hsing Lu
- Department of Obstetrics and Gynecology, Taichung Veterans General Hospital, Taichung, Taiwan; Department of Obstetrics and Gynecology, National Yang-Ming University School of Medicine, Taipei, Taiwan; Department of Pathology and Laboratory Medicine, Taichung Veterans General Hospital, Taichung, Taiwan; Institute of Biomedical Sciences, National Chung-Hsing University, Taichung, Taiwan; Rong-Hsing Research Center for Translational Medicine, National Chung-Hsing University, Taichung, Taiwan.
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Darwish-Yassine M, Garvin AD, Johnston CM, Zoschnick L, Conners A, Laing S, Wojcik C. An Assessment of Gynecological Cytology Screening Practices Among Health Care Providers Nationwide. Arch Pathol Lab Med 2015; 139:650-5. [DOI: 10.5858/arpa.2013-0620-oa] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Cervical and anal HPV infection: cytological and histological abnormalities in HIV-infected women in Thailand. J Virus Erad 2015. [DOI: 10.1016/s2055-6640(20)30485-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
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Garner D. Clinical application of DNA ploidy to cervical cancer screening: A review. World J Clin Oncol 2014; 5:931-65. [PMID: 25493231 PMCID: PMC4259955 DOI: 10.5306/wjco.v5.i5.931] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2013] [Revised: 04/21/2014] [Accepted: 05/16/2014] [Indexed: 02/06/2023] Open
Abstract
Screening for cervical cancer with DNA ploidy assessment by automated quantitative image cytometry has spread throughout China over the past decade and now an estimated 1 million tests per year are done there. Compared to conventional liquid based cytology, DNA ploidy has competitive accuracy with much higher throughput per technician. DNA ploidy has the enormous advantage that it is an objective technology that can be taught in typically 2 or 3 wk, unlike qualitative cytology, and so it can enable screening in places that lack sufficient qualified cytotechnologists and cytopathologists for conventional cytology. Most papers on experience with application of the technology to cervical cancer screening over the past decade were published in the Chinese language. This review aims to provide a consistent framework for analysis of screening data and to summarize some of the work published from 2005 to the end of 2013. Of particular interest are a few studies comparing DNA ploidy with testing for high risk human papilloma virus (hrHPV) which suggest that DNA ploidy is at least equivalent, easier and less expensive than hrHPV testing. There may also be patient management benefits to combining hrHPV testing with DNA ploidy. Some knowledge gaps are identified and some suggestions are made for future research directions.
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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.
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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.
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2012 updated consensus guidelines for the management of abnormal cervical cancer screening tests and cancer precursors. J Low Genit Tract Dis 2013; 17:S1-S27. [PMID: 23519301 DOI: 10.1097/lgt.0b013e318287d329] [Citation(s) in RCA: 483] [Impact Index Per Article: 43.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
A group of 47 experts representing 23 professional societies, national and international health organizations, and federal agencies met in Bethesda, MD, September 14-15, 2012, to revise the 2006 American Society for Colposcopy and Cervical Pathology Consensus Guidelines. The group's goal was to provide revised evidence-based consensus guidelines for managing women with abnormal cervical cancer screening tests, cervical intraepithelial neoplasia (CIN) and adenocarcinoma in situ (AIS) following adoption of cervical cancer screening guidelines incorporating longer screening intervals and co-testing. In addition to literature review, data from almost 1.4 million women in the Kaiser Permanente Northern California Medical Care Plan provided evidence on risk after abnormal tests. Where data were available, guidelines prescribed similar management for women with similar risks for CIN 3, AIS, and cancer. Most prior guidelines were reaffirmed. Examples of updates include: Human papillomavirus-negative atypical squamous cells of undetermined significance results are followed with co-testing at 3 years before return to routine screening and are not sufficient for exiting women from screening at age 65 years; women aged 21-24 years need less invasive management, especially for minor abnormalities; postcolposcopy management strategies incorporate co-testing; endocervical sampling reported as CIN 1 should be managed as CIN 1; unsatisfactory cytology should be repeated in most circumstances, even when HPV results from co-testing are known, while most cases of negative cytology with absent or insufficient endocervical cells or transformation zone component can be managed without intensive follow-up.
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Hong JH, Lee JK. Updates of the current screening guidelines for the early detection of cervical cancer. J Gynecol Oncol 2013; 24:212-4. [PMID: 23875069 PMCID: PMC3714457 DOI: 10.3802/jgo.2013.24.3.212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2013] [Accepted: 06/09/2013] [Indexed: 11/30/2022] Open
Affiliation(s)
- Jin Hwa Hong
- Department of Obstetrics and Gynecology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
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Smyczek P, Singh AE, Romanowski B. Anal intraepithelial neoplasia: review and recommendations for screening and management. Int J STD AIDS 2013; 24:843-51. [DOI: 10.1177/0956462413481527] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Anal cancer is a rare malignancy of the distal gastrointestinal tract, often associated with human papillomavirus, the most common sexually transmitted infection worldwide. Currently available screening methods for anal intraepithelial neoplasia, a precursor for anal cancer, combine anal Papanicolaou cytology and high resolution anoscopy with biopsy of suspicious lesions. Significant barriers to establishing anal cancer screening programmes include the small number of healthcare professionals performing high resolution anoscopy and the lack of data showing that anal cancer screening can reduce morbidity and mortality related to anal carcinoma. Despite several controversies surrounding anal cancer screening, the rising incidence of this disease in some groups supports routine screening programmes in high-risk populations, especially in HIV-positive men who have sex with men. This review outlines the epidemiology of anal intraepithelial neoplasia and anal cancer and summarizes issues related to the introduction of anal cancer screening programmes.
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Affiliation(s)
- Petra Smyczek
- Department of Medicine, University of Alberta, Edmonton, Canada
| | - Ameeta E Singh
- Department of Medicine, University of Alberta, Edmonton, Canada
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2012 updated consensus guidelines for the management of abnormal cervical cancer screening tests and cancer precursors. Obstet Gynecol 2013; 121:829-846. [PMID: 23635684 DOI: 10.1097/aog.0b013e3182883a34] [Citation(s) in RCA: 514] [Impact Index Per Article: 46.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
A group of 47 experts representing 23 professional societies, national and international health organizations, and federal agencies met in Bethesda, MD, September 14-15, 2012, to revise the 2006 American Society for Colposcopy and Cervical Pathology Consensus Guidelines. The group's goal was to provide revised evidence-based consensus guidelines for managing women with abnormal cervical cancer screening tests, cervical intraepithelial neoplasia (CIN) and adenocarcinoma in situ (AIS) following adoption of cervical cancer screening guidelines incorporating longer screening intervals and co-testing. In addition to literature review, data from almost 1.4 million women in the Kaiser Permanente Northern California Medical Care Plan provided evidence on risk after abnormal tests. Where data were available, guidelines prescribed similar management for women with similar risks for CIN 3, AIS, and cancer. Most prior guidelines were reaffirmed. Examples of updates include: Human papillomavirus-negative atypical squamous cells of undetermined significance results are followed with co-testing at 3 years before return to routine screening and are not sufficient for exiting women from screening at age 65 years; women aged 21-24 years need less invasive management, especially for minor abnormalities; postcolposcopy management strategies incorporate co-testing; endocervical sampling reported as CIN 1 should be managed as CIN 1; unsatisfactory cytology should be repeated in most circumstances, even when HPV results from co-testing are known, while most cases of negative cytology with absent or insufficient endocervical cells or transformation zone component can be managed without intensive follow-up.
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Gupta S, Sodhani P, Sardana S, Singh V, Sehgal A. Clinical determinants and smear characteristics of unsatisfactory conventional cervicovaginal smears. Eur J Obstet Gynecol Reprod Biol 2013; 168:214-7. [DOI: 10.1016/j.ejogrb.2013.01.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2012] [Revised: 12/24/2012] [Accepted: 01/16/2013] [Indexed: 12/16/2022]
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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.
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Affiliation(s)
- Lori A Boardman
- Department of Clinical Sciences, University of Central Florida College of Medicine, Orlando, FL 32827, USA.
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Clary KM, Davey DD, Naryshkin S, Austin RM, Thomas N, Chmara BA, Sugrue C, Tworek J. The Role of Monitoring Interpretive Rates, Concordance Between Cytotechnologist and Pathologist Interpretations Before Sign-Out, and Turnaround Time in Gynecologic Cytology Quality Assurance: Findings From the College of American Pathologists Gynecologic Cytopathology Quality Consensus Conference Working Group 1. Arch Pathol Lab Med 2013; 137:164-74. [DOI: 10.5858/arpa.2012-0120-cc] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Lee SH. Guidelines for the use of molecular tests for the detection and genotyping of human papilloma virus from clinical specimens. Methods Mol Biol 2012; 903:65-101. [PMID: 22782812 DOI: 10.1007/978-1-61779-937-2_5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/20/2023]
Abstract
Accurate genotyping of a human papilloma virus (HPV) isolated from clinical specimens depends on molecular identification of the unique and exclusive nucleotide base sequence in the hypervariable region of a highly conserved segment of the HPV L1 gene. Among other options, a heminested (nested) polymerase chain reaction (PCR) technology using two consecutive PCR replications of the target DNA in tandem with three consensus general primers may be used to detect a minute quantity of HPV DNA in crude proteinase K digestate of cervicovaginal cells, and to prepare the template for genotyping by automated direct DNA sequencing. A short target sequence of 40-60 bases excised from the computer-generated electropherogram is sufficient for BLAST determination of all clinically relevant HPV genotypes, based on the database stored in the GenBank. This chapter discusses the principle and the essential technical elements in performing nested PCR DNA amplification for the detection of HPV from clinical specimens and short target sequence genotyping for HPV, using standard molecular biology laboratory equipment and commercially available reagents.
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Affiliation(s)
- Sin Hang Lee
- Department of Pathology, Milford Hospital, Milford, CT, USA.
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Siebers AG, van der Laak JAWM, Huberts-Manders R, Vedder JEM, Bulten J. Accurate assessment of cell density in low cellular liquid-based cervical cytology. Cytopathology 2012; 24:216-21. [DOI: 10.1111/j.1365-2303.2012.00990.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Paulin H, Geldenhuys L, Naugler C. Predictors of an unsatisfactory conventional cervical cytology smear. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2011; 33:725-728. [PMID: 21749749 DOI: 10.1016/s1701-2163(16)34958-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Cervical cytology smears reported as unsatisfactory for interpretation represent an unrealized screening opportunity and may have significant laboratory and patient costs. Identifying patients at higher risk for an unsatisfactory smear could alert clinicians to take extra care in the acquisition of the smear. Few studies have examined patient characteristics that could predict an unsatisfactory cervical cytology smear. The purpose of this study was to determine the effect of patient age, day of the menstrual cycle, postmenopausal status, postpartum status, and the use of oral contraceptives on the rate of unsatisfactory cervical cytology smears. METHODS We performed a case-control study of all unsatisfactory cervical cytology smears at a large tertiary care teaching hospital over one year compared with a random sample of smears that were satisfactory for interpretation. Data were obtained from the cytology requisitions. Continuous variables were tested with unpaired t tests, and dichotomous variables were analyzed with chi-square tests. Multivariate significance was tested with binary logistic regression analysis. RESULTS Of all cervical cytology smears, 1.1% were reported as unsatisfactory. In univariate analyses increased age, earlier date in the menstrual cycle, and postpartum status were associated with unsatisfactory smears. However, following Bonferroni correction for multiple comparisons and multivariate regression analysis, only increased age remained a significant predictor of an unsatisfactory cervical cytology smear. CONCLUSION Older women are at greater risk of having an unsatisfactory cervical cytology smear. Clinicians and public health officials must be aware of this risk and must encourage optimal collection techniques for women in this demographic group.
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Affiliation(s)
- Heidi Paulin
- Department of Pathology and Laboratory Medicine, Dalhousie University, Halifax NS
| | - Laurette Geldenhuys
- Department of Pathology and Laboratory Medicine, Dalhousie University, Halifax NS
| | - Christopher Naugler
- Department of Pathology and Laboratory Medicine, University of Calgary, Calgary AB; Calgary Laboratory Services, Calgary AB
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Lu CH, Chang CC, Chang MC, Chen SJ, Jan YJ, Fu TF, Ho ESC. Clinical parameters associated with unsatisfactory specimens of conventional cervical smears. Diagn Cytopathol 2011; 39:87-91. [PMID: 20091895 DOI: 10.1002/dc.21329] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Although The Bethesda System 2001 attempted to standardize the criteria for specimen adequacy, much confusion still exists, which includes the significance of unsatisfactory smears, the causes and clinical conditions related to unsatisfactory smears, and the appropriate management of unsatisfactory smears. The aim of this study is to find out the clinical factors associated with unsatisfactory cervical smears. We reviewed the medical charts of patients who received conventional Pap smears between March 2006 and August 2006 in a tertiary care center. After excluding 378 cases with incomplete demographic data, the clinical data of 7,059 cases were processed for analysis. Clinical parameters retrieved included: history of pelvic malignancy, pelvic irradiation, conization, hysterectomy, pregnancy status, within 3-months postpartum. Vaginal bleeding, abnormal vaginal discharge, intrauterine device, and cervical polyps found during pelvic examinations were also documented. The 1,397 cases with history of pelvic irradiation, pelvic malignancy, and hysterectomy were excluded. Finally, 5,662 cases were enrolled for data analysis. The relationship between clinical parameters and unsatisfactory smears were analyzed by Pearson's chi-square test with Yates' continuity correction and multivariate binary logistic regression test. The incidence of unsatisfactory smears was 4.5% (252/5,662). Clinical parameters correlated with unsatisfactory smears were postpartum status (OR = 1.92, 95% CI = 1.23-3.01, P = 0.004), vaginal bleeding (OR = 2.02, 95% CI = 1.30-3.16, P = 0.002), and endocervical polyps (OR = 2.62, 95% CI = 1.39-4.947, P = 0.003). In conclusion, if any of these parameters are noted prior to obtaining a Pap smear, optimal collecting devices, better sampling techniques, and liquid-based cytology should be considered to decrease the incidence of unsatisfactory smears.
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Affiliation(s)
- Chien-Hsing Lu
- Department of Obstetrics and Gynecology, Taichung Veterans General Hospital, 160 Chung-Kang Road Sec. 3, Taichung City, Taiwan.
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Castle PE, Bulten J, Confortini M, Klinkhamer P, Pellegrini A, Siebers AG, Ronco G, Arbyn M. Age-specific patterns of unsatisfactory results for conventional Pap smears and liquid-based cytology: data from two randomised clinical trials. BJOG 2010; 117:1067-73. [PMID: 20604775 DOI: 10.1111/j.1471-0528.2010.02650.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To investigate the rate of unsatisfactory cervical cell samples in liquid-based cytology (LBC) versus conventional cytology (CC) by age. DESIGN Randomised clinical trials. SETTING Population-based cervical cancer screening in the Netherlands and Italy. POPULATION Asymptomatic women invited for screening enrolled in two randomised trials: Netherlands ThinPrep versus conventional cytology (NETHCON; 39 010 CC, 46 064 LBC) and New Technologies in Cervical Cancer Screening (NTCC; 22 771 CC, 22 403 LBC). METHODS Comparison of categorical variables using Pearson's chi-square test, logistic regression and trend tests. MAIN OUTCOME MEASURES Proportion of unsatisfactory samples, ratio of LBC versus CC, and variation by 5-year group. RESULTS In NETHCON, a lower percentage of LBC samples were judged to be unsatisfactory compared with CC samples (0.33 versus 1.11%). There was no significant trend in unsatisfactory results by age group for conventional cytology (P(trend) = 0.54), but there was a trend towards an increasing percentage of unsatisfactory results with increasing age for LBC (P(trend) < 0.001). In NTCC, a lower percentage of LBC samples were judged to be unsatisfactory compared with conventional cytology (2.59 versus 4.10%). There was a decrease in the unsatisfactory results by age group with conventional cytology (P(trend) < 0.001) and with LBC (P(trend) = 0.01), although the latter trend arose from the 55-60-years age group (P(trend) = 0.62 when excluding this group). CONCLUSIONS The clinical trial in which the results were collected and the cytologic method used were the most important determinants of unsatisfactory cytology. In all situations, the proportion of unsatisfactory samples was lower in LBC compared with CC. The effects of age depended on the criteria used to define unsatisfactory results.
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Affiliation(s)
- P E Castle
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH/DHHS, Bethesda, Maryland, USA
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Lu CH, Chang CC, Ho ESC, Chen SJ, Lin SJ, Fu TF, Chang MC. Should adequacy criteria in cervicovaginal cytology be modified after radiotherapy, chemotherapy, or hysterectomy? Cancer Cytopathol 2010; 118:474-81. [DOI: 10.1002/cncy.20110] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2010] [Revised: 08/10/2010] [Accepted: 08/12/2010] [Indexed: 11/07/2022]
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High-risk human papillomavirus DNA test results are useful for disease risk stratification in women with unsatisfactory liquid-based cytology pap test results. J Low Genit Tract Dis 2009; 13:79-84. [PMID: 19387127 DOI: 10.1097/lgt.0b013e31818474fd] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES This study assesses whether high-risk human papillomavirus (HPV) DNA test results from residual vial fluid of unsatisfactory liquid-based cytology(LBC) samples might provide useful information on disease risk. MATERIALS AND METHODS Patients with unsatisfactory imaged ThinPrep Pap test results and available Hybrid Capture 2 high-risk HPV results were identified at an academic women's hospital laboratory between July 1, 2005, and July 31, 2007. Follow-up repeat cytology results, HPV results, and available biopsy results were analyzed. RESULTS Three hundred four patients with unsatisfactory cytology results and HPV test results were studied. Eleven (3.6%) of 304 tested positive for HPV DNA, and 293 tested HPV negative. Five (45%) of 11 HPV-positive patients had detectible low-grade squamous intraepithelial/cervical intraepithelial neoplasia 1 during a mean follow-up period of almost 6 months. Among 293 women with negative HPV results, only 1 case of cervical intraepithelial neoplasia 1 was identified during roughly the same follow-up period. CONCLUSIONS A positive high-risk HPV result associated with an unsatisfactory ThinPrep Pap test result identified patients at risk for diagnosis of an undetected squamous intraepithelial/cervical intraepithelial neoplasia. Negative high-risk HPV results associated with an unsatisfactory LBC had high negative predictive value in this limited study. The overall low detection rate for significant disease on follow-up of all patients with unsatisfactory imaged LBC is similar to findings reported in another LBC study but differs from studies reporting increased risk for undetected disease in women screened with unsatisfactory conventional Pap smears.
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Alsharif M, McKeon DM, Gulbahce HE, Savik K, Pambuccian SE. Unsatisfactory SurePath liquid-based Papanicolaou tests: causes and significance. Cancer 2009; 117:15-26. [PMID: 19347825 DOI: 10.1002/cncy.20009] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND The introduction of liquid-based Papanicolaou (Pap) tests (LBPTs) has reduced the incidence of unsatisfactory Pap tests (UPTs), but little is known about their causes and significance, especially in the case of SurePath LBPTs. METHODS All unsatisfactory LBPTs from January 1, 2003 to December 31, 2006 were retrieved. The characteristics of patients, providers, and LBPTs; the reason for UPTs; and any cytologic or histologic follow-up within 24 months were recorded. Negative Pap tests that were evaluated immediately after a UPT served as a control group. RESULTS Of 243,006 Pap tests (95.5% SurePath LBPTs), 0.23% were unsatisfactory. Scant cellularity was the primary cause of SurePath UPT. Women in this UPT group were older, had more diagnostic Pap tests taken, less frequently were taking contraceptives or were pregnant, and were more likely to be menopausal or posthysterectomy. The 278 women who had UPTs had significantly higher rates of follow-up Pap tests (65.1% vs 22.2%), abnormal Pap tests (5.4% vs 1.4%), biopsies (10% vs 1%), and abnormal biopsies (5% vs 1%) than the 284 women in the control group, including 7 women with cervical intraepithelial neoplasia 1 (CIN-1), 1 woman with CIN-2, 4 women with CIN-3, and 2 women with endometrial hyperplasia. The UPT rates varied little between provider groups (physicians vs nonphysicians and gynecologists vs nongynecologists). CONCLUSIONS The frequency of UPTs in a predominantly SurePath LBPT-screened population was very low and was caused mainly by low cellularity. Similar to conventional Pap smears, unsatisfactory SurePath LBPTs had a higher risk of significant histologic abnormalities on follow-up than negative satisfactory Pap tests and could have benefited from a repeat Pap test or other evaluation, according to current management guidelines.
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Affiliation(s)
- Mariam Alsharif
- Division of Cytopathology, Department of Laboratory Medicine and Pathology, University of Minnesota, 420 Delaware SE, Minneapolis, MN 55455, USA
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Reimers LL, Anderson WF, Rosenberg PS, Henson DE, Castle PE. Etiologic heterogeneity for cervical carcinoma by histopathologic type, using comparative age-period-cohort models. Cancer Epidemiol Biomarkers Prev 2009; 18:792-800. [PMID: 19258470 DOI: 10.1158/1055-9965.epi-08-0965] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Cervical carcinomas comprise two main histopathologic types, squamous cell carcinomas and adenocarcinomas. Human papillomavirus (HPV) infections are causative for both types but the respective tumors may have different carcinogenic pathways. METHODS To assess potential etiologic heterogeneity of cervical cancer by histopathologic type, we examined invasive squamous cell carcinomas and adenocarcinoma cervical cancer incidence rates in the National Cancer Institute's Surveillance, Epidemiology, and End Results database. We complemented standard descriptive epidemiology with comparative age-period-cohort (APC) models fitted to each histopathologic type. RESULTS Squamous cell tumors (n=25,219) were nearly 5-fold more common than adenocarcinomas (n=5,451). Age-adjusted incidence trends decreased for squamous cell carcinomas but increased for adenocarcinomas. Cross-sectional age-specific incidence rates increased more rapidly for squamous cell carcinomas than adenocarcinomas in adolescents and young adults then leveled off for both types. APC models confirmed that secular trends and age-specific rates differed for the two types (P=0 for the null hypothesis of no difference). For squamous cell carcinoma, the APC "fitted" age-at-onset rate curve peaked before age 40 years then declined; for adenocarcinoma, the fitted curve increased rapidly until age 40 years then rose more slowly. CONCLUSIONS Despite the necessary role of HPV infection in both squamous cell carcinomas and adenocarcinomas of the cervix, secular trends and age-related natural histories differed for the two tumor types, consistent with etiologic heterogeneity. Future analytic and clinical studies should consider the interaction (effect modification) of HPV infection and other cervical carcinoma risk factors by histopathologic type, time, and age.
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Affiliation(s)
- Laura L Reimers
- George Washington University School of Public Health and Human Services, Department of Pathology, Washington, DC, USA
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Zhao C, Austin RM. Adjunctive high-risk human papillomavirus DNA testing is a useful option for disease risk assessment in patients with negative Papanicolaou tests without an endocervical/transformation zone sample. Cancer 2008; 114:242-248. [DOI: 10.1002/cncr.23598] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
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Davis-Devine S, Day SJ, Anderson A, French A, Madison-Henness D, Mohar N, Tansy D, Hiremath A, Douglas JA, Freund GG. Collection of the BD SurePath Pap Test with a broom device plus endocervical brush improves disease detection when compared to the broom device alone or the spatula plus endocervical brush combination. Cytojournal 2008; 6:4. [PMID: 19495403 PMCID: PMC2678824 DOI: 10.4103/1742-6413.45495] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2008] [Accepted: 11/21/2008] [Indexed: 11/18/2022] Open
Abstract
Objective: Here we examine the diagnostic utility of the US Food And Drug Administration (FDA) approved Spatula + endocervical brush combination for the BD SurePath Pap Test (SPPT) and compare it to SPPT collection with the broom alone or to an off-label combination of broom + EC brush. This question is important due to lingering concerns over the value of EC detection to a satisfactory Pap test. Methods: 20,125 SPPT vials were examined for the collection devices contained. The SPPT collection device combinations allowed were: Rovers Cervex-Brush (broom, FDA approved), Medscand Pap Perfect Spatula + Medscand CytoBrush Plus GT (spatula + GT brush, FDA approved) or Rovers Cervex-Brush + Surgipath C-E Brush (broom + CE brush, off label). Results: Examination of SPPT vials revealed 11,130 collected with the broom, 4,687 collected with the spatula + GT brush and 2,921 collected with the broom + CE brush. Absence of an endocervical/transformation zone was seen in 22.86% of broom cases, 13.10% of spatula + GT brush cases (p= 0.00005 vs broom) and 10.17% of broom + CE brush cases (p= 0.00005 vs broom, p= 0.00005 vs spatula + GT brush). Importantly, LSIL detection was: broom 2.99%; spatula + GT brush 2.45% (p= 0.053 vs broom); broom + CE brush 4.18% (p= 0.034 vs broom, p= 0.0001 vs spatula + GT brush). Conclusion: When broom + brush combination is compared to broom alone or to spatula + GT brush, the broom + CE brush combination better sampled the endocervical/transformation zone and increased LSIL detection.
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