1
|
Arroyo Mühr LS, Wang J, Hassan SS, Yilmaz E, Elfström MK, Dillner J. Nationwide registry-based trial of risk-stratified cervical screening. Int J Cancer 2024. [PMID: 39146489 DOI: 10.1002/ijc.35142] [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: 04/04/2024] [Revised: 07/05/2024] [Accepted: 07/25/2024] [Indexed: 08/17/2024]
Abstract
In well-screened populations, most cervical cancers arise from small groups of women with inadequate screening. The present study aims to assess whether registry-based cancer risk assessment could be used to increase screening intensity among high-risk women. The National Cervical Screening Registry identified the 28,689 women residents in Sweden who had either no previous cervical screening or a screening history indicating high risk. We invited these women by SMS and/or physical letter to order a free human papillomavirus (HPV) self-sampling kit. The Swedish national HPV reference laboratory performed extended HPV genotyping and referred high-risk HPV-positive women to their regional gynecologist. A total of 3691/28,689 (12.9%) women ordered a self-sampling kit and 10.0% (2853/28,689) returned a sample for testing. Participation among women who had never attended screening was low, albeit improved. Up to 22.5% of women in other high-risk groups attended. High-risk HPV types were detected in 8.3% of samples. High-risk HPV-positive women (238/2853) were referred without further triaging and severe cervical precancer or cancer (HSIL+) in histopathology were detected in 36/158 (23%) of biopsied women. Repeat invitations gave modest additional participation. Nationwide contacting of women with high risk for cervical cancer with personal invitations to order HPV self-sampling kits resulted in high yield of detected CIN2+. Further efforts to improve risk-stratified screening strategies should be directed to improving (i) the precision of the risk-stratification algorithm, (ii) the convenience for the women to participate and, (iii) ensuring that screen-positive women are followed-up.
Collapse
Affiliation(s)
- Laila Sara Arroyo Mühr
- Center for Cervical Cancer Elimination, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden
| | - Jiangrong Wang
- Center for Cervical Cancer Elimination, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden
| | - Sadaf S Hassan
- Center for Cervical Cancer Elimination, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden
| | - Emel Yilmaz
- Center for Cervical Cancer Elimination, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden
| | - Miriam K Elfström
- Center for Cervical Cancer Elimination, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden
- Center for Cervical Cancer Elimination, Karolinska University Hospital Huddinge, Stockholm, Sweden
| | - Joakim Dillner
- Center for Cervical Cancer Elimination, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden
- Center for Cervical Cancer Elimination, Karolinska University Hospital Huddinge, Stockholm, Sweden
| |
Collapse
|
2
|
Monti E, Di Loreto E, Libutti G, Alberico D, Barbara G, Boero V, Cetera GE, Pasquali Coluzzi M, Cipriani S, Parazzini F. Clinical significance of atypical glandular cells on cytology: 10 years' experience of a colposcopic referral center. Eur J Cancer Prev 2024:00008469-990000000-00160. [PMID: 39150089 DOI: 10.1097/cej.0000000000000910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/17/2024]
Abstract
INTRODUCTION 'Atypical glandular cells' (AGC) is an uncommon cytological result of cervical Pap smears which includes a wide of histopathological diagnoses, from benign to premalignant and malignant cervical disorders, endometrial cancer and, occasionally, other genital malignancies. This study aims to provide a comprehensive overview of AGC, assessing risk factors and clinical and histological features in affected patients. MATERIALS AND METHODS A retrospective analysis was conducted on a cohort of 239 women diagnosed with AGC between 2012 and 2022 at the 'Regional Referral Center for Prevention, Diagnosis and Treatment of HPV-related Genital Disorders', Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy. Following AGC detection, patients underwent colposcopy with endocervical sampling and endometrial assessment via pelvic ultrasound. Selective cases also received endometrial biopsies. RESULTS Among a total of 190 women who underwent both colposcopy and endometrial assessment, 116 (61%) had negative clinical and histopathological findings. The remainder displayed various abnormalities: 36 women (18.9%) were found to have endometrial or cervical polyps, 23 (12.1%) were diagnosed with preinvasive cervical neoplasia, and 21 (10.9%) with invasive cervical or endometrial disease. Menopause, multiparity, and older age were all significantly associated with endometrial cancer, but none of the abovementioned variables were significantly associated with cervical neoplasia. CONCLUSION Our data confirm that AGC may reveal the presence of a wide range of histopathological conditions. Patients diagnosed with AGC should undergo a careful evaluation including both colposcopy with endocervical sampling and an endometrial assessment.
Collapse
Affiliation(s)
- Ermelinda Monti
- Dipartimento Materno-Infantile, Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico
| | - Eugenia Di Loreto
- Dipartimento Materno-Infantile, Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico
| | - Giada Libutti
- Dipartimento Materno-Infantile, Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico
| | - Daniela Alberico
- Dipartimento Materno-Infantile, Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico
| | - Giussy Barbara
- Dipartimento Materno-Infantile, Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico
- Dipartimento di Scienze Cliniche e di Comunità, Università degli Studi di Milano, Milan, Italy
| | - Veronica Boero
- Dipartimento Materno-Infantile, Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico
| | - Giulia Emily Cetera
- Dipartimento Materno-Infantile, Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico
| | - Maria Pasquali Coluzzi
- Dipartimento Materno-Infantile, Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico
| | - Sonia Cipriani
- Dipartimento di Scienze Cliniche e di Comunità, Università degli Studi di Milano, Milan, Italy
| | - Fabio Parazzini
- Dipartimento di Scienze Cliniche e di Comunità, Università degli Studi di Milano, Milan, Italy
| |
Collapse
|
3
|
Wang T, Hua Y, Liu L, Leng B. Analysis of atypical glandular cells in ThinPrep Pap smear and follow-up histopathology. Proc AMIA Symp 2024; 37:403-407. [PMID: 38628324 PMCID: PMC11018051 DOI: 10.1080/08998280.2024.2324656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 01/31/2024] [Indexed: 04/19/2024] Open
Abstract
Background Diagnosing atypical glandular cells (AGC) is a significant challenge in cytomorphology. Methods A retrospective study was undertaken to assess the prevalence of AGC and the subsequent histological outcomes over 5 years at a single institution. Results A total of 159,649 ThinPrep Pap tests, including 395 cases of AGC, were retrieved, of which 330 AGC cases had follow-up histopathology. Among these 330 cases, 43.9% were classified as AGC not otherwise specified, followed by AGC-endocervical cells at 33.3%. The most frequently observed histological findings at follow-up included CIN1 and benign mucosa with reactive changes, followed by high-grade squamous intraepithelial lesion and cervical squamous cell carcinoma. The overall 5-year insignificant AGC rate was 0.12%, and the overall 5-year significant AGC rate was 0.08%. Notably, 36.7% of AGC cases tested positive for high-risk human papillomavirus. Interestingly, the level of experience did not significantly impact the rates for significant or insignificant AGC diagnosis. However, senior cytopathologists had a higher AGC report rate compared to their junior peers. Conclusion The AGC diagnostic rate at our institution falls within the range given by the College of American Pathologists. A significant number of cases had follow-up histologic results available, and the overall 5-year insignificant AGC rate was 0.12%.
Collapse
Affiliation(s)
- Tengfei Wang
- Department of Pathology, Baylor Scott and White Health, Temple, Texas, USA
| | - Yinan Hua
- Department of Pathology, Baylor Scott and White Health, Temple, Texas, USA
| | - Lina Liu
- Department of Pathology, Baylor Scott and White Health, Temple, Texas, USA
| | - Bing Leng
- Department of Pathology, Baylor Scott and White Health, Temple, Texas, USA
| |
Collapse
|
4
|
Yilmaz E, Lagheden C, Ghaderi M, Wang J, Dillner J, Elfström KM. Assessment of Human Papillomavirus Non-16/18, Type-Specific Risk for Cervical Intraepithelial Neoplasia Grade 3 or Worse Among Women With Cervical Atypical Glandular Cells. Obstet Gynecol 2023; 142:679-687. [PMID: 37535949 DOI: 10.1097/aog.0000000000005286] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 05/25/2023] [Indexed: 08/05/2023]
Abstract
OBJECTIVE To evaluate the risk for cervical intraepithelial neoplasia grade 3 (CIN 3) or worse (including adenocarcinoma in situ [AIS] and invasive cervical cancer) associated with non-16/18 human papillomavirus (HPV) types (other HPV) among women with atypical glandular cells (AGC) in cervical cytology. METHODS This population-based cohort study evaluates the risk of CIN 3 or worse associated with other HPV types. Human papillomavirus genotyping was performed on Pap tests collected in Sweden from 341 women with AGC that were positive for other HPV types from February 17, 2014, to December 31, 2018. The women were followed for histopathologic outcomes using comprehensive registry linkages until December 31, 2019. Cumulative incidence proportions of CIN 3 or worse by specific HPV type were calculated using 1-minus Kaplan-Meier function. Hazard ratios (HRs) for CIN 3 or worse were generated using multivariate Cox regression. RESULTS Of 341 women, 134 (39.3%) had CIN 3-AIS, but there were only five (1.5%) women in the cohort with invasive cervical cancer. Human papillomavirus 45 preceded 80.0% of invasive cervical cancer cases. Among women positive for HPV33, 82.9% (95% CI 58.0-97.3%) had CIN 3 or worse during follow-up. Positivity for HPV31 conferred the highest HR for CIN 3 or worse relative to other types, both in primary cytology and primary HPV screening (HR 2.71, 95% CI 1.47-5.00 and HR 3.41, 95% CI 1.95-5.96, respectively). CONCLUSION Among non-16/18 HPV types in AGC, HPV31 and 33 had the highest risk for CIN 3 or worse, whereas most of the women with invasive cancer were positive for HPV45. Extended HPV genotyping may be helpful for the management of AGC.
Collapse
Affiliation(s)
- Emel Yilmaz
- Center for Cervical Cancer Elimination, Department of Clinical Pathology and Cancer Diagnostics, Medical Diagnostics Karolinska, Karolinska University Hospital, Huddinge, and the Division for of Cervical Cancer Elimination, Department of Clinical Science, Intervention and Technology, CLINTEC, Karolinska Institutet, Stockholm, Sweden
| | | | | | | | | | | |
Collapse
|
5
|
Mavragani A, Eysenbach G, Yang J, Wang C, Yang M, Yu T, Shen L, Xu X, Xing H. The Risk Factors for Cervical Cytological Abnormalities Among Women Infected With Non-16/18 High-Risk Human Papillomavirus: Cross-sectional Study. JMIR Public Health Surveill 2022; 8:e38628. [PMID: 36480259 PMCID: PMC9782330 DOI: 10.2196/38628] [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: 04/10/2022] [Revised: 08/14/2022] [Accepted: 10/11/2022] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND High-risk human papillomavirus (hrHPV) infection is a necessary cause of almost all cervical cancers. Relative to hrHPV 16/18 infection, non-16/18 hrHPV infection is of less concern. However, the increasing prevalence of non-16/18 hrHPV infections has become an important public health issue. The early identification and treatment of cervical cytological abnormalities in women infected with non-16/18 hrHPV reduces the incidence of cervical cancer. To date, no study has examined the risk factors for cytological abnormalities in this high-risk population. OBJECTIVE This population-based, cross-sectional study aimed to identify the risk factors for cervical cytological abnormalities in women infected with non-16/18 hrHPV. METHODS A total of 314,587 women from the general population were recruited for cervical cancer screening at 136 primary care hospitals in Xiangyang, China. Of these, 311,604 women underwent HPV genotyping, and 17,523 non-16/18 hrHPV-positive women were referred for cytological screening according to the screening program. A logistic regression model was used to assess the risk factors for cytological abnormalities among these non-16/18 hrHPV-positive women. A separate analysis was performed to determine the factors influencing high-grade cytological abnormalities. RESULTS The non-16/18 hrHPV infection rate was 5.88% (18,323/311,604), which was 3-fold higher than that of hrHPV 16/18 (6068/311,604, 1.95%). Among the non-16/18 hrHPV-positive women who underwent ThinPrep cytologic test, the overall prevalence rates of cervical cytological abnormalities and high-grade cytological abnormalities were 13.46% (2359/17,523) and 1.18% (206/17,523), respectively. Multivariate logistic regression analysis revealed that women with middle or high school educational attainment were at a higher risk of having cytological abnormalities than those who received primary education (odds ratio [OR] 1.31, 95% CI 1.17-1.45; P<.001, and OR 1.32, 95% CI 1.14-1.53; P<.001, respectively). Living in rural areas (OR 2.58, 95% CI 2.29-2.90; P<.001), gravidity ≥3 (OR 2.77, 95% CI 1.19-6.45; P=.02), cervix abnormalities detected in pelvic examination (OR 1.22, 95% CI 1.11-1.34; P<.001), and having a cervical cancer screening 3 years ago (OR 0.79, 95% CI 0.62-1.00; P=.048) were associated with cytological abnormalities. The risk factors for high-grade cytological abnormalities included middle school education (OR 1.45, 95% CI 1.07-1.98; P=.02), living in rural regions (OR 1.52, 95% CI 1.10-2.10; P=.01), and cervix abnormality (OR 1.72, 95% CI 1.30-2.26; P<.001). CONCLUSIONS The dominant epidemic of non-16/18 hrHPV infection is revealed in Chinese women. Multiple risk factors for cervical cytological abnormalities have been identified in women infected with non-16/18 hrHPV. These findings can provide important information for clinically actionable decisions for the screening, early diagnosis, intervention, and prevention of cervical cancer in non-16/18 hrHPV-positive women.
Collapse
Affiliation(s)
| | | | - Jun Yang
- School of Public Health, Guangzhou Medical University, Guangzhou, China
| | - Chunhua Wang
- Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, China
| | - Mei Yang
- Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, China
| | - Tingyu Yu
- Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, China
| | - Liang Shen
- Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, China
| | - Xiaohan Xu
- State Key Laboratory of Organ Failure Research, Department of Biostatistics, School of Public Health, Southern Medical University, Guangzhou, China
| | - Hui Xing
- Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, China
| |
Collapse
|
6
|
Chen YC, Liang CN, Wang XF, Wang MF, Huang XN, Hu JD. Follow-up study on ThinPrep cytology test-positive patients in tropical regions. World J Clin Cases 2022; 10:12543-12550. [PMID: 36579088 PMCID: PMC9791535 DOI: 10.12998/wjcc.v10.i34.12543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Revised: 10/16/2022] [Accepted: 11/17/2022] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND As shown in the statistics from the World Health Organization, it is estimated that approximately 75000 new cases of cervical cancer occur every year in China. In 2008, 33000 people died of cervical cancer in China. It is proven that most women are at risk of cervical cancer. The progression from human papillomavirus (HPV) infection to cervical cancer can be several years or decades, which offers a unique opportunity to prevent cancer.
AIM To observe the changes in ThinPrep cytology tests (TCT) and HPV infection in patients who were detected to be positive via TCT screening of cervical cancer and further explore the biopsy results.
METHODS This paper performed a follow-up study on 206 cervical cancer screening-positive patients of 12231 total cases from our previous research. We conducted an observational study on the TCT results based on the interpretation of The Bethesda System.
RESULTS Over a 5-year period, 10 cases received consistent follow-up. The proportions of cases in which glandular epithelial lesions were detected increased over the follow-up period. The differences between the years were statistically significant (P < 0.01). Over the 5 years, the proportion of patients whose squamous epithelial lesions transformed into glandular epithelial lesions increased yearly. Annual positive rates of HPV infection were: year 1, 73% (24/33); year 2, 43% (6/14); year 3, 36% (9/25); year 4, 50% (9/18); and year 5, 25% (6/24). The positive detection rate after biopsy over a 9-year period was 29%.
CONCLUSION The follow-up study for 5 years to 9 years revealed a tendency to change from squamous epithelial lesions to glandular epithelial lesions and an improvement of the disease (which had not been reported previously). The HPV test indicated a high negative conversion ratio of the viral infection. However, the follow-up cases were not found to have persistent infection of high-risk HPV. Therefore, early intervention of cervical cancer screening is necessary. Low re-examination compliance, patient education, and preventive measures should be enhanced.
Collapse
Affiliation(s)
- Yun-Chun Chen
- Department of Laboratory Medicine, Haikou Branch of Yueyang Integrative Medicine Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Haikou 570216, Hainan Province, China
| | - Chong-Nan Liang
- Department of Laboratory Medicine, Haikou Hospital of Traditional Chinese Medicine, Haikou 570216, Hainan Province, China
| | - Xiang-Feng Wang
- Department of Ultrasound Medicine, Second Affiliated Hospital of Hainan Medical University, Haikou 570311, Hainan Province, China
| | - Min-Fa Wang
- Department of Ultrasound Medicine, Second Affiliated Hospital of Hainan Medical University, Haikou 570311, Hainan Province, China
| | - Xu-Ning Huang
- Department of Ultrasound Medicine, Second Affiliated Hospital of Hainan Medical University, Haikou 570311, Hainan Province, China
| | - Jian-Dong Hu
- Department of Internal Medicine, Haikou branch of Yueyang Hospital of Integrated Traditional Chinese and Western Medicine Shanghai University of Traditional Chinese Medicine (Haikou Hospital of Traditional Chinese Medicine), Haikou 570216, Hainan Province, China
| |
Collapse
|
7
|
Norman I, Yilmaz E, Hjerpe A, Hortlund M, Elfström KM, Dillner J. Atypical glandular cells and development of cervical cancer: Population-based cohort study. Int J Cancer 2022; 151:2012-2019. [PMID: 36029205 PMCID: PMC9804756 DOI: 10.1002/ijc.34242] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Revised: 07/14/2022] [Accepted: 07/26/2022] [Indexed: 01/09/2023]
Abstract
The effect of cervical screening on cervical adenocarcinoma has been variable, possibly because the risk associated with the precursor atypical glandular cells (AGC) is not well known. A cohort of all 885 women in the capital region of Sweden with AGC, a concomitant human papillomavirus (HPV) analysis, and a histopathology was followed until 2019. Cumulative incidence proportions of cervical intraepithelial lesion grade 3 or worse (CIN3+) by HPV type was determined by 1-Kaplan-Meier estimates. Hazard ratios (HR) for CIN3+ or for invasive cancer were estimated with Cox regression. After 2 years of follow-up, the cumulative incidence proportions of CIN3+ were 80% (95% confidence interval [CI]: 74-86%), 58% (95% CI: 50-60%) and 10% (95% CI: 5-18%) among HPV16/18 positive, "other HPV" positive and HPV-negative women, respectively. Among the 300 women with HPV16/18 positive AGC, 217 developed CIN3+ of which 35 were invasive cervical cancer. The 2-year cumulative invasive cancer risk for HPV16/18 positive AGC was 17% (95% CI: 12-24%). Primary HPV-screening had a similar yield of CIN3+ as cytology screening, albeit HPV-negative AGC is by design not detected by HPV screening. Among 241 women with HPV-negative AGC, 11 developed CIN3+ mostly after clinically indicated samples. We found no significant risk differences depending on age or sampling indication. The low CIN3+ risk after HPV-negative AGC implies safety of primary HPV screening. The high risk of invasive cervical cancer after HPV16/18 positive AGC implies that management of this finding is a priority in cervical screening.
Collapse
Affiliation(s)
- Ingrid Norman
- Department of Laboratory MedicineKarolinska InstitutetStockholmSweden,Department of Clinical Pathology and Cancer Diagnostics, Center for Cervical Cancer Prevention, Medical Diagnostics KarolinskaKarolinska University HospitalStockholmSweden
| | - Emel Yilmaz
- Department of Clinical Pathology and Cancer Diagnostics, Center for Cervical Cancer Prevention, Medical Diagnostics KarolinskaKarolinska University HospitalStockholmSweden
| | - Anders Hjerpe
- Department of Clinical Pathology and Cancer Diagnostics, Center for Cervical Cancer Prevention, Medical Diagnostics KarolinskaKarolinska University HospitalStockholmSweden
| | - Maria Hortlund
- Department of Laboratory MedicineKarolinska InstitutetStockholmSweden,LINK Medical Research ABMalmöSweden
| | - Klara Miriam Elfström
- Department of Laboratory MedicineKarolinska InstitutetStockholmSweden,Department of Clinical Pathology and Cancer Diagnostics, Center for Cervical Cancer Prevention, Medical Diagnostics KarolinskaKarolinska University HospitalStockholmSweden
| | - Joakim Dillner
- Department of Laboratory MedicineKarolinska InstitutetStockholmSweden,Department of Clinical Pathology and Cancer Diagnostics, Center for Cervical Cancer Prevention, Medical Diagnostics KarolinskaKarolinska University HospitalStockholmSweden
| |
Collapse
|
8
|
Wang J, Elfström KM, Borgfeldt C, Dillner J. A pilot study of risk-stratified cervical cancer screening. OPEN RESEARCH EUROPE 2022; 1:84. [PMID: 37645164 PMCID: PMC10445943 DOI: 10.12688/openreseurope.13398.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/17/2022] [Indexed: 08/31/2023]
Abstract
Background: Cervical screening programs target entire populations, although it is well established that cervical cancer risks can vary >100-fold based, in particular, on the woman's screening history. Since cervical screening switched to Human Papillomavirus (HPV) testing as the primary screening method, the risk differences are even larger as different HPV types may vary in associated cancer risk by 100 times. Furthermore, HPV infections with the most oncogenic types are declining dramatically because of HPV vaccination programs. Tailoring screening intensity based on the known cancer risk of the individual (risk-stratified screening) therefore has great potential to increase both the sensitivity and specificity. Within Horizon 2020 a major project for Risk-stratified Screening for Cervical Cancer (RISCC) has therefore been launched. We performed a pilot study of risk-stratified screening to evaluate feasibility and acceptability of offering vaginal HPV self-sampling tests to women with a higher risk of cervical cancer. Methods: We identified resident women who had had either i) atypical glandular cells in screening tests during the past six years (risk >150/100,000 woman-years) or ii) abnormal screening findings above the age of 50, but without sufficient follow-up (risk >65/100,000). The women were invited, either by short message service (SMS) or physical letters, to order an HPV self-sampling kit via the study web-platform. The returned self-collected samples were tested for HPV. If positive, women were invited for clinical follow-up. Results: Among 920 targeted women, 191 (21%) placed an order and 163 (18%) returned a self-collected sample. Among all tested samples, 19 (12%) were positive for hrHPV and 18 of these women attended clinical follow-up. Conclusions: SMS invitations to high-risk women complemented with physical letters are feasible and result in substantial requests for kits and submission of samples. Future work will focus on improving the efficiency of the procedure and further increasing attendance.
Collapse
Affiliation(s)
- Jiangrong Wang
- Department of Laboratory Medicine, Karolinska Institute, SE-141 52 Stockholm, Sweden
| | - K. Miriam Elfström
- Regional Cancer Center Stockholm Gotland, Lindhagensgatan 98, SE-102 39 Stockholm, Sweden
- Karolinska University Laboratory, Karolinska University Hospital, Anna Steckséns gata 49, SE-171 76 Stockholm, Sweden
| | - Christer Borgfeldt
- Department of Obstetrics & Gynecology, Skåne University Hospital, Department of Clinical Sciences, Lund University, Klinikgatan 12, SE-222 42 Lund, Sweden
| | - Joakim Dillner
- Department of Laboratory Medicine, Karolinska Institute, SE-141 52 Stockholm, Sweden
- Karolinska University Laboratory, Karolinska University Hospital, Anna Steckséns gata 49, SE-171 76 Stockholm, Sweden
| |
Collapse
|
9
|
Belkić K, Andersson S, Alder S, Mints M, Megyessi D. Predictors of treatment failure for adenocarcinoma in situ of the uterine cervix: Up to 14 years of recorded follow‑up. Oncol Lett 2022; 24:357. [PMID: 36168314 PMCID: PMC9478621 DOI: 10.3892/ol.2022.13477] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Accepted: 07/26/2022] [Indexed: 11/17/2022] Open
Abstract
The incidence of adenocarcinoma-in-situ (AIS) of the uterine cervix is rising, with invasive adenocarcinoma becoming increasingly common relative to squamous cell carcinoma. The present study reviewed a cohort of 84 patients first-time treated by conization for histologically-confirmed AIS from January 2001 to January 2017, to identify risk factors associated with recurrent/persistent AIS as well as progression to invasive cervical cancer. Nearly 80% of the patients were age 40 or younger at conization. Endocervical and ectocervical margins were deemed clear in 42 of the patients. All but two patients had ≥1 follow-up, with post-conization high-risk human papilloma virus (HPV) results documented in 52 patients. Altogether, 12 histopathologically-confirmed recurrences (14.3%) were detected; two of these patients had microinvasive or invasive carcinoma. In three other patients cytology showed AIS, but without recorded histopathology. Eight patients underwent hysterectomy for incomplete resection very soon after primary conization; they were not included in bivariate or multivariate analyses. Having ≥1 post-follow-up positive HPV finding yielded the highest sensitivity for histologically-confirmed recurrence: 87.5 [95% confidence interval (CI) 47.4-99.7]. Current or historical smoking status provided highest specificity: 94.4 (95% CI 72.7-99.9) and overall accuracy: 88.0 (95% CI 68.8-97.5) for histologically-confirmed recurrence. With multiple logistic regression (MLR), adjusting for age at conization and abnormal follow-up cytology, positive HPV18 was the strongest predictor of histologically-confirmed recurrence (P<0.005). Having ≥2 positive HPV results also predicted recurrence (P<0.02). Any unclear margin yielded an odds ratio 7.21 (95% CI 1.34-38.7) for histologically-confirmed recurrence adjusting for age, but became non-significant when including abnormal cytology in the MLR model. The strong predictive value of HPV, particularly HPV18 and persistent HPV positivity vis-à-vis detected recurrence indicated that regular HPV testing for patients treated for AIS is imperative. In conclusion, furthering a participatory approach, including attention to smoking with encouragement to attend needed long-term follow-up, can better protect these patients at high risk for cervical cancer.
Collapse
Affiliation(s)
- Karen Belkić
- Department of Oncology‑Pathology, Karolinska Institute, SE‑17176 Stockholm, Sweden
| | - Sonia Andersson
- Department of Women's and Children's Health, Obstetrics‑Gynecology Division, Karolinska Institute, Stockholm, SE‑17176 Stockholm, Sweden
| | - Susanna Alder
- Department of Women's and Children's Health, Obstetrics‑Gynecology Division, Karolinska Institute, Stockholm, SE‑17176 Stockholm, Sweden
| | - Miriam Mints
- Department of Women's and Children's Health, Obstetrics‑Gynecology Division, Karolinska Institute, Stockholm, SE‑17176 Stockholm, Sweden
| | - David Megyessi
- Department of Women's and Children's Health, Obstetrics‑Gynecology Division, Karolinska Institute, Stockholm, SE‑17176 Stockholm, Sweden
| |
Collapse
|
10
|
Khan MYA, Bandyopadhyay S, Alrajjal A, Choudhury MSR, Ali-Fehmi R, Shidham VB. Atypical glandular cells (AGC): Cytology of glandular lesions of the uterine cervix. Cytojournal 2022; 19:31. [PMID: 35673694 PMCID: PMC9168395 DOI: 10.25259/cmas_03_11_2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 03/06/2022] [Indexed: 11/08/2022] Open
Abstract
The Pap smear is a well-known screening tool for squamous lesions of the uterine cervix. However, its screening role in glandular lesions is less effective. The incidence of squamous cell carcinoma of the cervix has dramatically decreased with the advent of Pap smear and recent understanding related to HPV carcinogenesis of cervical cancers including the advent of HPV vaccines. However, in recent years, the incidence of glandular abnormalities, diagnosed on Pap smears, has increased with greater sensitivity and precision. The incidence of atypical glandular cells (AGC) is approximately 0.18–0.74% of all cervical smears with a reported prevalence of 2.5% among all Pap smears. A high degree of suspicion, good clinical history, and the presence of diagnostic cytomorphological findings are essential for the proper interpretation of glandular cell abnormalities. A methodical approach to evaluate Pap smear greatly helps interpretation and avoids the diagnostic pitfalls. The Bethesda System for reporting cervical cytology has categorized glandular cell abnormalities into various categories as follows: Endocervical adenocarcinoma in situ (AIS) Atypical glandular cells (AGCs) Endocervical cells: a1 NOS or specify in comments; a2 Favor neoplastic Endometrial cells: NOS or specify in comments
Adenocarcinoma (AdCa) Endocervical Endometrial Extrauterine NOS
Subtle differences in quantitative and qualitative cytologic features are essential for distinguishing one category from another. In this chapter, we highlight an organized approach for the interpretation of glandular abnormalities in Pap smear for our readers. This is an overview of the Bethesda categories, the reason for classification, and differential diagnosis with key characteristic features. An approach to the methodical evaluation of hyperchromatic crowded groups is discussed with key cytomorphologic differences. An algorithmic approach is suggested to facilitate the interpretation of various AGC categories.
Collapse
|
11
|
Keles E, Ozturk UK, Alınca CM, Giray B, Kabaca C, Cetiner H. Factors Affecting the Histopathological Outcomes of Atypical Glandular Cells on Pap Test. J Cytol 2022; 38:210-215. [PMID: 35002114 PMCID: PMC8670458 DOI: 10.4103/joc.joc_54_21] [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: 03/23/2021] [Revised: 04/06/2021] [Accepted: 08/26/2021] [Indexed: 11/26/2022] Open
Abstract
Background: Glandular cell abnormalities may indicate the presence of pre-malignant or malignant lesions. Aim: This study aimed to investigate the relationship between atypical glandular cells (AGC) and patients' demographics, histopathological outcomes, Human Papillomavirus (HPV) test results. Material and Methods: Between January 2015 and December 2019, women with AGC on Pap tests were retrieved from the hospital electronic database. The patients with AGC on cervicovaginal smears who underwent further pathological, laboratory, and imaging diagnostic testing and who were followed up at least 1-year were included in the study, while those who had a history of cervical dysplasia or cancer, lost during follow-up, or had missing data were excluded. Results: Of 85,692 Pap smears, 114 (0.13%) were diagnosed with AGC, of those 88 cases were eligible for final analysis. Gynecological malignancies were detected in 13 (14.8%) patients; including 6 (6.8%) endometrioid endometrial cancers, 3 (3.4%) non-endometrioid endometrial cancers, 2 (2.3%) cervical adenocarcinomas, 1 (1.1%) cervical squamous cell carcinoma, and 1 (1.1%) high-grade tubal serous cancer. Multivariate analysis revealed that presence of concomitant abnormal squamous lesion (P = 0.002), being 50 years and older (P = 0.028), HPV positivity (P < 0.001), and menopause (P = 0.023) were risk factors for significant pathology. Conclusion: The diagnosis of AGC may be related to the preneoplastic/neoplastic processes. A further comprehensive histopathological examination is required in women with AGC, aged 50 years and older, postmenopausal, HPV-positivity and concomitant squamous cell abnormality Clinicians should consider ovarian pathologies when there is no pathological finding on endometrial or cervical histopathological examination.
Collapse
Affiliation(s)
- Esra Keles
- Department of Gynecologic Oncology, Zeynep Kamil Training and Research Hospital, University of Health Sciences Turkey, Istanbul, Turkey
| | - Ugur K Ozturk
- Department of Gynecologic Oncology, Zeynep Kamil Training and Research Hospital, University of Health Sciences Turkey, Istanbul, Turkey
| | - Cihat M Alınca
- Department of Gynecologic Oncology, Zeynep Kamil Training and Research Hospital, University of Health Sciences Turkey, Istanbul, Turkey
| | - Burak Giray
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Koc University School of Medicine, Istanbul, Turkey
| | - Canan Kabaca
- Department of Gynecologic Oncology, Zeynep Kamil Training and Research Hospital, University of Health Sciences Turkey, Istanbul, Turkey
| | - Handan Cetiner
- Department of Pathology, Zeynep Kamil Training and Research Hospital, University of Health Sciences, Turkey
| |
Collapse
|
12
|
Keltto N, Leivonen A, Pankakoski M, Sarkeala T, Heinävaara S, Anttila A. Cervical testing beyond the screening target age - A register-based cohort study from Finland. Gynecol Oncol 2021; 162:315-321. [PMID: 34074539 DOI: 10.1016/j.ygyno.2021.05.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 05/20/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE It has been proposed that cervical cancer screening should be continued in women with previous abnormal results or irregular attendance. We examined the coverage and factors that might influence cervical testing beyond the age range of the organized cervical screening programme in Finland. The national programme invites women in every five years least until the age of 60. After the stopping age, only opportunistic service is available. METHODS Data on cervical testing were collected from the Mass Screening Registry and providers of opportunistic Pap/HPV-testing and were linked with information on socio-economic variables. The study included 373,353 women who had at least one invitation to the national screening programme between ages 50-60 years, and who were aged 65-74 years in the follow-up period 2006-2016. Multivariable binomial regression models were conducted to determine associations. RESULTS Altogether 33% of the study population had been tested at least once at ages 65-74 years. Previous regular screening attendance (adjRR 1.70; 95% CI 1.67-1.73) and earlier abnormal results (adjRR 2.08; 95% CI 2.04-2.12) were most clearly related to higher testing adherence at older age. Other factors related to higher testing adherence were urban area of residence, domestic mother tongue, high education level, and high socio-economic status. CONCLUSION Testing at older age was frequent with normal results, whereas only a small proportion of women with earlier abnormal results or irregular attendance were tested. The upper age limit of the national programme should be raised to 65 years, and the invitations thereafter should be targeted to selected high-risk groups.
Collapse
Affiliation(s)
- Natalie Keltto
- Mass Screening Registry, Finnish Cancer Registry, Helsinki, Finland.
| | - Aku Leivonen
- Mass Screening Registry, Finnish Cancer Registry, Helsinki, Finland
| | - Maiju Pankakoski
- Mass Screening Registry, Finnish Cancer Registry, Helsinki, Finland
| | - Tytti Sarkeala
- Mass Screening Registry, Finnish Cancer Registry, Helsinki, Finland
| | - Sirpa Heinävaara
- Mass Screening Registry, Finnish Cancer Registry, Helsinki, Finland
| | - Ahti Anttila
- Mass Screening Registry, Finnish Cancer Registry, Helsinki, Finland
| |
Collapse
|
13
|
Aitken CA, Jansen EEL, Siebers AG, van Haaften-de Jong AMLD, van Kemenade FJ, de Kok IMCM. Risk of Gynecologic Cancer after Atypical Glandular Cells Found on Cervical Cytology: A Population-Based Cohort Study. Cancer Epidemiol Biomarkers Prev 2021; 30:743-750. [PMID: 33563645 DOI: 10.1158/1055-9965.epi-20-1384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 12/18/2020] [Accepted: 02/02/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Atypical glandular cells (AGC) are rare abnormalities found on cervical cytology associated with a range of lesions of the female reproductive system. We compared the risk of cervical and other gynecologic cancers following AGC on cervical cytology with the risk following squamous cell abnormalities of comparable severity. METHODS We used data from the Dutch Pathology Archive (PALGA) from 2000 to 2015 to categorize cervical cytology tests into groups based on most severe cytologic abnormality and correlated follow-up advice (normal cytology and "no follow-up" advice, squamous-cell-based, AGC-based, and combined AGC/squamous-cell based each with either repeat testing or referral advice). Cancer data were linked from the Netherlands Cancer Registry. Cox proportional hazard models were calculated stratified by age [younger (<50 years) and older (50+ years)], adjusted for number of previous primary cytology tests. RESULTS 8,537,385 cytology smears and 9,061 cancers were included. When repeat cytology testing was advised, HRs of cervical cancer (younger women: HR, 6.91; 95% CI, 5.48-8.71; older women: HR, 3.98; 95% CI, 2.38-6.66) or other gynecologic cancer diagnosis in younger women (HR, 2.82; 95% CI, 1.39-5.74) were significantly higher after an AGC-based abnormality compared with squamous-based abnormalities. Hazards were also significantly higher for "referral" advice cytology, except for cervical cancer among older women (HR, 0.88; 95% CI, 0.63-1.21). CONCLUSIONS AGC indicates an increased risk of gynecologic cancer compared with squamous-based abnormalities of comparable severity. IMPACT Gynecologists should be alert for cervical and endometrial cancers when examining women referred following AGC.
Collapse
Affiliation(s)
- Clare A Aitken
- Department of Public Health, Erasmus MC University Medical Center Rotterdam, Rotterdam, the Netherlands.
| | - Erik E L Jansen
- Department of Public Health, Erasmus MC University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Albert G Siebers
- The Nationwide Network and Registry of Histo-and Cytopathology in the Netherlands (PALGA Foundation), Houten, the Netherlands.,Department of Pathology, Radboud University Medical Center, Nijmegen, the Netherlands
| | | | - Folkert J van Kemenade
- Department of Pathology, Erasmus MC University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Inge M C M de Kok
- Department of Public Health, Erasmus MC University Medical Center Rotterdam, Rotterdam, the Netherlands
| |
Collapse
|
14
|
Hashmi AA, Naz S, Ahmed O, Yaqeen SR, Irfan M, Asif MG, Kamal A, Faridi N. Comparison of Liquid-Based Cytology and Conventional Papanicolaou Smear for Cervical Cancer Screening: An Experience From Pakistan. Cureus 2020; 12:e12293. [PMID: 33520497 PMCID: PMC7834527 DOI: 10.7759/cureus.12293] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Introduction After the introduction of cervical cancer screening program with cervical cytology, a marked decline in deaths secondary to cervical cancer was observed in developed countries. Two methods are used for cervical cytology. The first one is the conventional Papanicolaou (PAP) and the second one is liquid-based cytology (LBC). Although various studies in western countries established the role of LBC in cervical cancer screening, no large-scale study was conducted in our population to compare the two techniques for cervical cancer screening. Therefore, in this study, we compared the diagnostic utility of these two techniques for detecting cervical epithelial lesions. Methods A total of 3,929 patients, who presented to the Gynecology Clinic, Liaquat National Hospital, for cervical cancer screening from January 2015 until December 2019, over a period of five years, were included in the study. A total of 1,503 specimens were prepared by LBC, and 2,426 specimens were prepared by a conventional PAP smear method. All smears were interpreted using the Bethesda System of Reporting Cytopathology. Results The mean age of the patients was 39.46±11.14 years. For cytological evaluation, 98.7% of specimens were adequate. The inadequacy rate was 1.3% for conventional PAP smear and 1.2% for LBC. While 97.2% of specimens were reported as negative for intraepithelial lesion or malignancy, 1.1% of specimens showed squamous epithelial lesions. There was a significant difference in the detection rate of squamous epithelial lesions using the two techniques. The detection rate of squamous intraepithelial lesions using LBC was 2.1%, which was higher than that of the conventional PAP smear (0.6%). The detection rates of glandular lesions using LBC and conventional PAP smear were 0.5% and 0.2%, respectively. Conclusion We found a higher disease detection rate of squamous epithelial lesions using LBC compared to conventional PAP smear. Therefore, we recommend a widespread use of LBC for mass cervical cancer screening in our population.
Collapse
Affiliation(s)
- Atif A Hashmi
- Pathology, Liaquat National Hospital and Medical College, Karachi, PAK
| | - Samreen Naz
- Pathology, Liaquat National Hospital and Medical College, Karachi, PAK
| | - Omer Ahmed
- Internal Medicine, Liaquat National Hospital and Medical College, Karachi, PAK
| | | | - Muhammad Irfan
- Statistics, Liaquat National Hospital and Medical College, Karachi, PAK
| | | | - Anwar Kamal
- Pathology, Liaquat National Hospital and Medical College, Karachi, PAK
| | - Naveen Faridi
- Pathology, Liaquat National Hospital and Medical College, Karachi, PAK
| |
Collapse
|
15
|
Mulholland R, Yousef HMSA, Laing M, Gupta R, Leung EYL. Comparison of women with possible endocervical and non-cervical glandular neoplasms detected in liquid-based cervical cytology- incidence, clinical characteristics and outcomes: A cohort study. Eur J Obstet Gynecol Reprod Biol 2020; 257:100-105. [PMID: 33383409 DOI: 10.1016/j.ejogrb.2020.12.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 11/14/2020] [Accepted: 12/12/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To compare the incidence, demographics and clinical outcomes of women presenting with possible non-cervical (NC) and endocervical (EC) glandular neoplasms in their cervical smears. STUDY DESIGN Retrospective analysis of a prospective cohort within the NHS Greater Glasgow and Clyde- the largest health organisation in Scotland, UK. METHODS Cases identified from the Scottish Cervical Call Recall System between January 2013 and December 2017. Incidence and clinical trajectories of NC and EC were reviewed. RESULTS Two-hundred-and-thirty cases (NC = 41; EC = 189) from 486,240 smears were evaluated. The incidence was 8.4 and 38.9 per 100,000 smear-year for NC and EC, respectively. Compared to women with EC, women with NC were significantly older (p < 0.0001), had higher body mass index (p < 0.0001), more likely to present with symptoms (58.5 % vs 10.5 %; p < 0.0001), had cancers (48.8 % vs 13.8 %; p < 0.0001) and died from their diseases (9.8 % vs 0.5 %; p < 0.0001). Even in the asymptomatic screen-detected NC group, almost a quarter (23.5 %) had endometrial cancer. Age was not associated with high-risk histology (p = 0.289). High-risk colposcopic appearance had good positive predictive value (90.0 %; 95 %CI: 81.2-95.6 %) for high-risk histology, but poor negative predictive value (41.3 %; 95 %CI: 29-54 %). Negative excision margin was associated with favourable outcomes. CONCLUSIONS NC and EC are rare, but they are distinct and should be reported separately in future studies. The risks of malignancies are high, particularly in women with NC, even if they are asymptomatic. Thus, prompt and thorough investigations and treatments are required to prevent and treat malignancies.
Collapse
Affiliation(s)
- Roisin Mulholland
- Women and Children's Directorate, Queen Elizabeth University Hospital, 1345 Govan Rd, Glasgow, G51 4TF, United Kingdom
| | - Hazem M S A Yousef
- Women and Children's Directorate, Royal Alexandra Hospital, Castlehead, Paisley, PA2 9PJ, United Kingdom
| | - Margaret Laing
- Women and Children's Directorate, Queen Elizabeth University Hospital, 1345 Govan Rd, Glasgow, G51 4TF, United Kingdom
| | - Rachana Gupta
- Women and Children's Directorate, Royal Alexandra Hospital, Castlehead, Paisley, PA2 9PJ, United Kingdom
| | - Elaine Y L Leung
- Women and Children's Directorate, Queen Elizabeth University Hospital, 1345 Govan Rd, Glasgow, G51 4TF, United Kingdom; School of Medicine, the University of Glasgow, Glasgow, G12 8QQ, United Kingdom.
| |
Collapse
|
16
|
Bui CN, Choi E, Suh M, Jun JK, Jung KW, Lim MC, Choi KS. Trend analysis of process quality indicators for the Korean National Cervical Cancer Screening Program from 2005 to 2013. J Gynecol Oncol 2020; 32:e14. [PMID: 33327046 PMCID: PMC7767658 DOI: 10.3802/jgo.2021.32.e14] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Revised: 10/12/2020] [Accepted: 11/08/2020] [Indexed: 11/30/2022] Open
Abstract
Objective This study sought to examine changes in trends for quality indicators of the population-based Korean National Cancer Screening Program (KNCSP) for cervical cancer from years 2005 to 2013. Methods Our study data were derived from the KNCSP database. Cervical cancer diagnosis information was ascertained through linkage with the Korean National Cancer Registry and the KNCSP database. Performance measures for cervical cancer screening were estimated, including participation rate, positive rate, crude detection rate (CDR), interval cancer rate (ICR), positive predictive value (PPV), sensitivity, and specificity. Joinpoint analysis was applied to calculate annual percentage changes (APCs) in all indicators according to socio-demographic factors. Results A significant increasing trend was noted in participation rates (APC=13.4%; 95% confidence interval [CI]=10.5, 16.4). PPV and specificity increased from years 2005 to 2009 and remained stable till 2013. An increasing trend was discovered in CDRs for cervical cancer in situ (APC=3.9%; 95% CI=1.0, 6.9), whereas a decreasing trend was observed in ICRs for invasive cervical cancer (APC=−2.5%; 95% CI=−4.5, −0.5). Medical Aid recipients and women older than 70 years showed the lowest participation rates, but higher CDRs and ICRs, compared to other groups. In general, most of the quality indicators for cervical cancer screening improved from 2005 to 2009 and remained stable to 2013. Conclusion The KNCSP for cervical cancer in Korea has improved in terms of participation rate and accuracy of the screening test. These results may be attributed to the National Quality Improvement Program for KNCSP.
Collapse
Affiliation(s)
- Cam Nhung Bui
- Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Korea
| | - Eunji Choi
- Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Korea
| | - Mina Suh
- National Cancer Control Institute, National Cancer Center, Goyang, Korea
| | - Jae Kwan Jun
- Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Korea.,National Cancer Control Institute, National Cancer Center, Goyang, Korea
| | - Kyu Won Jung
- National Cancer Control Institute, National Cancer Center, Goyang, Korea
| | - Myong Cheol Lim
- Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Korea.,Division of Tumor Immunology, Center for Uterine Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea
| | - Kui Son Choi
- Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Korea.,National Cancer Control Institute, National Cancer Center, Goyang, Korea.
| |
Collapse
|
17
|
Zhong P, Yin C, Jin Y, Chen T, Zhan Y, Tian C, Zhu L, Zheng X. More focus on atypical glandular cells in cervical screening: Risk of significant abnormalities and low histological follow-up rate. Cytojournal 2020; 17:22. [PMID: 33193804 PMCID: PMC7656032 DOI: 10.25259/cytojournal_77_2019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2019] [Accepted: 05/12/2020] [Indexed: 11/04/2022] Open
Abstract
Objectives Atypical glandular cells (AGC) detected by Papanicolaou (Pap) smears are in close relation with adenocarcinoma and precursors detected by histopathology. Yet, sometimes the cytological diagnosis of AGC has been neglected. With increase of adenocarcinoma and precursors, we need more focus on glandular abnormalities. Material and Methods Clinicopathological data of patients who had AGC on Pap smears between April 2015 and October 2018 and underwent histological follow-up were retrieved from the computerized database of Beijing Obstetrics and Gynecology Hospital, Capital Medical University. Patients with a prior history of cancer were excluded from the study. Statistical analyses were performed using Pearson's Chi-square test in SPSS software version 23. P < 0.05 (two sided) was considered as statistical significance. Results Liquid-based cytological examination of the uterine cervix was carried out in 164,080 women. Five hundred and twenty-five women were diagnosed with AGC, 314 with not otherwise specified (AGC-NOS), and 211 with favor neoplastic (AGC-FN). Only 310 cases had histological follow-up, 168 women (168/314, 53.5%) originally with AGC-NOS on Pap smears, and 142 (142/211, 67.3%) with AGC-FN. The median age of histological significant abnormalities was 46.7 years, and 126 women (126/162, 77.8%) were postmenopausal. Sixty-six cases (66/168, 39.3%) of AGC-NOS had significant abnormalities (96/142, 67.6%, AGC-FN). One hundred and sixty-two cases of significant abnormalities included 40 high-grade squamous abnormalities and 122 glandular abnormalities. AGC-FN was more likely to be associated with a clinically significant abnormalities (P < 0.001) compared to AGC-NOS. Conclusions Patients with AGC on Pap smears are in close relation with significant abnormalities, especially with significant glandular abnormalities on histopathology slices. AGC should be evaluated vigilantly with histological workup, especially if patients are diagnosed with AGC-FN and are aged 41-60 years. We need more focus on AGC.
Collapse
Affiliation(s)
- Pingping Zhong
- Department of Pathology, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, No. 17, Qi He Lou Street, Dongcheng, Beijing, China
| | - Chenghong Yin
- Department of Pathology, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, No. 17, Qi He Lou Street, Dongcheng, Beijing, China
| | - Yulan Jin
- Department of Pathology, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, No. 17, Qi He Lou Street, Dongcheng, Beijing, China
| | - Tianbao Chen
- Department of Pathology, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, No. 17, Qi He Lou Street, Dongcheng, Beijing, China
| | - Yang Zhan
- Department of Pathology, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, No. 17, Qi He Lou Street, Dongcheng, Beijing, China
| | - Cheng Tian
- Department of Pathology, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, No. 17, Qi He Lou Street, Dongcheng, Beijing, China
| | - Li Zhu
- Department of Pathology, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, No. 17, Qi He Lou Street, Dongcheng, Beijing, China
| | - Xingzheng Zheng
- Department of Pathology, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, No. 17, Qi He Lou Street, Dongcheng, Beijing, China
| |
Collapse
|
18
|
Yüksel S, Şimşek E, Yetkinel S, Alemdaroğlu S, Aka Bolat F, Çelik H. Clinicopathologic importance of atypical glandular cells in cervico-vaginal cytology. J Turk Ger Gynecol Assoc 2020; 21:102-106. [PMID: 31450881 PMCID: PMC7294838 DOI: 10.4274/jtgga.galenos.2019.2019.0059] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Objective: To analyze the histopathologic outcomes of patients with atypical glandular cells (AGC) in cervicovaginal cytology examinations. Material and Methods: Patients with AGC in cervicovaginal cytology were included in this study between March 2011 and March 2018 and patient data were collected retrospectively among all cytology results. AGC classification of cervicovaginal cytology were based on the Bethesda 2001 classification system. Results: The total prevalence of cervical epithelial cell abnormality and AGC were found as 4.2% and 0.2%, respectively, in the study cohort. AGC-favor neoplasia (AGC-FN) was the subgroup of AGC with the highest malignancy rate with 62.5% (p=0.06). The incidence of malignancy in the postmenopausal group (33.3%) was detected higher than in the premenopausal group (8.3%) (p=0.07). Conclusion: The probability of malignancy in AGC-FN cytology is more commonly associated with malignancy in the postmenopausal group. Therefore, histopathologic examination is strongly recommended in these patients with AGC smears because of the high risk for malignancy in this group.
Collapse
Affiliation(s)
- Seda Yüksel
- Clinic of Obstetrics and Gynecology, Başkent University, Adana Dr. Turgut Noyan Practice and Research Center, Adana, Turkey
| | - Erhan Şimşek
- Clinic of Obstetrics and Gynecology, Başkent University, Adana Dr. Turgut Noyan Practice and Research Center, Adana, Turkey
| | - Selçuk Yetkinel
- Clinic of Obstetrics and Gynecology, Başkent University, Adana Dr. Turgut Noyan Practice and Research Center, Adana, Turkey
| | - Songül Alemdaroğlu
- Clinic of Obstetrics and Gynecology, Başkent University, Adana Dr. Turgut Noyan Practice and Research Center, Adana, Turkey
| | - Filiz Aka Bolat
- Clinic of Obstetrics and Gynecology, Başkent University, Adana Dr. Turgut Noyan Practice and Research Center, Adana, Turkey
| | - Hüsnü Çelik
- Clinic of Obstetrics and Gynecology, Başkent University, Adana Dr. Turgut Noyan Practice and Research Center, Adana, Turkey
| |
Collapse
|
19
|
Sahlgren H, Elfström KM, Lamin H, Carlsten-Thor A, Eklund C, Dillner J, Elfgren K. Colposcopic and histopathologic evaluation of women with HPV persistence exiting an organized screening program. Am J Obstet Gynecol 2020; 222:253.e1-253.e8. [PMID: 31585095 DOI: 10.1016/j.ajog.2019.09.039] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Revised: 09/13/2019] [Accepted: 09/16/2019] [Indexed: 11/16/2022]
Abstract
BACKGROUND Human papillomavirus-based screening has a higher sensitivity for precursors of cervical cancer compared with cytology-based screening. However, more evidence is needed on optimal management of human papillomavirus-positive women. OBJECTIVE The objective of the study was to compare the risk of histopathologically confirmed cervical intraepithelial lesions grade 2 or worse after 1 and 3 years of human papillomavirus persistence, respectively, and evaluate the clinical management of human papillomavirus-positive women in the 56-60 year age group. STUDY DESIGN This was a randomized health care policy offering human papillomavirus screening to 50% of resident women aged 56-60 years in the Stockholm/Gotland region of Sweden during January 2012 through May 2014. Women who were human papillomavirus positive/cytology negative at baseline were referred for a repeat test after 1 or 3 years. In case of human papillomavirus persistence, women were referred for colposcopy, including biopsies and endocervical sampling. RESULTS The human papillomavirus prevalence was 5.5% (405 women of 7325 attending). Among the 405 human papillomavirus-positive women, 313 were reflex test cytology negative at baseline and were referred for a repeat human papillomavirus test, 176 women after 1 year and 137 women after 3 years. After 1 year, 91 of 176 (52%) were persistently human papillomavirus positive and after 3 years 55 of 137 (40%) (P = .042). In repeat cytology, 10 of the 91 (12%) were positive after 1 year and 15 of 55 (33%) after 3 years (P = .005). The attendance rates for colposcopy were similar: 82 of 91 (90%) in the 1 year group and 45 of 55 (82%) in the 3 year group. All women attending colposcopy were postmenopausal, and endocervical sampling and punch biopsies were performed to facilitate colposcopic management, with a positive predictive value of 43-50% and 28-31%, respectively. Histopathologically confirmed cervical intraepithelial lesions grade 2 or worse was found in 19 of 82 women (23%) and 9 of 45 women (20%) in the 1 year and 3 year groups, respectively, and registry linkage follow-up found no cancers in either group. Human papillomavirus genotyping was predictive of cervical intraepithelial lesions grade 2 or worse, and human papillomavirus 16 was the most common genotype at human papillomavirus persistence, occurring in 18% of the cases in the 1 year group and 20% in the 3 year group. CONCLUSION It was safe to postpone repeat human papillomavirus tests for 3 years in postmenopausal women attending the organized cervical screening program. There was a high risk for cervical intraepithelial lesions grade 2 or worse at follow-up and noteworthy yields from human papillomavirus genotyping as well as endocervical sampling and random biopsies in the absence of visible colposcopic lesions.
Collapse
Affiliation(s)
- Hanna Sahlgren
- Department of Medical Epidemiology and Biostatistics, Karolinska Institute, and Department of Obstetrics and Gynecology, Falun Hospital, Falun, Sweden.
| | - K Miriam Elfström
- Department of Laboratory Medicine, Karolinska Institute, Stockholm, Sweden; Swedish National Cervical Screening Registry, Stockholm, Sweden; Cancer Screening Unit, Regional Cancer Center, Stockholm, Sweden
| | - Helena Lamin
- Center for Cervical Cancer Prevention, Department of Pathology, Karolinska University Laboratory, Stockholm, Sweden
| | | | - Carina Eklund
- Department of Laboratory Medicine, Karolinska Institute, Stockholm, Sweden
| | - Joakim Dillner
- Swedish National Cervical Screening Registry, Stockholm, Sweden; Center for Cervical Cancer Prevention, Department of Pathology, Karolinska University Laboratory, Stockholm, Sweden
| | - Kristina Elfgren
- Division of Obstetrics and Gynecology, Department of Clinical Science, Intervention, and Technology, Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden
| |
Collapse
|
20
|
Landy R, Schiffman M, Sasieni PD, Cheung LC, Katki HA, Rydzak G, Wentzensen N, Poitras NE, Lorey T, Kinney WK, Castle PE. Absolute risks of cervical precancer among women who fulfill exiting guidelines based on HPV and cytology cotesting. Int J Cancer 2020; 146:617-626. [PMID: 30861114 PMCID: PMC6742586 DOI: 10.1002/ijc.32268] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Revised: 02/05/2019] [Accepted: 02/25/2019] [Indexed: 01/05/2023]
Abstract
US guidelines recommend that most women older than 65 years cease cervical screening after two consecutive negative cotests (concurrent HPV and cytology tests) in the previous 10 years, with one in the last 5 years. However, this recommendation was based on expert opinion and modeling rather than empirical data on cancer risk. We therefore estimated the 5-year risks of cervical precancer (cervical intraepithelial neoplasia grade 3 or adenocarcinoma in situ [CIN3]) after one, two and three negative cotests among 346,760 women aged 55-64 years undergoing routine cotesting at Kaiser Permanente Northern California (2003-2015). Women with a history of excisional treatment or CIN2+ were excluded. No woman with one or more negative cotests was diagnosed with cancer during follow-up. Five-year risks of CIN3 after one, two, and three consecutive negative cotests were 0.034% (95% CI: 0.023%-0.046%), 0.041% (95% CI: 0.007%-0.076%) and 0.016% (95% CI: 0.000%-0.052%), respectively (ptrend < 0.001). These risks did not appreciably differ by a positive cotest result prior to the one, two or three negative cotest(s). Since CIN3 risks after one or more negative cotests were significantly below a proposed 0.12% CIN3+ risk threshold for a 5-year screening interval, a longer screening interval in these women is justified. However, the choice of how many negative cotests provide sufficient safety against invasive cancer over a woman's remaining life represents a value judgment based on the harms versus benefits of continued screening. Ideally, this guideline should be informed by longer-term follow-up given that exiting is a long-term decision.
Collapse
Affiliation(s)
- Rebecca Landy
- Centre for Cancer PreventionWolfson Institute of Preventive Medicine, Queen Mary University of LondonLondonUnited Kingdom
- Division of Cancer Epidemiology and GeneticsNational Cancer Institute, National Institutes of Health, DHHSBethesdaMDUSA
| | - Mark Schiffman
- Division of Cancer Epidemiology and GeneticsNational Cancer Institute, National Institutes of Health, DHHSBethesdaMDUSA
| | - Peter D. Sasieni
- Faculty of Life Sciences & MedicineSchool of Cancer & Pharmaceutical Sciences, Guys Cancer Centre, Guys Hospital, King's College LondonLondonSE1 9RTUnited Kingdom
| | - Li C. Cheung
- Division of Cancer Epidemiology and GeneticsNational Cancer Institute, National Institutes of Health, DHHSBethesdaMDUSA
| | - Hormuzd A. Katki
- Division of Cancer Epidemiology and GeneticsNational Cancer Institute, National Institutes of Health, DHHSBethesdaMDUSA
| | - Greg Rydzak
- Information Management Services Inc.CalvertonMDUSA
| | - Nicolas Wentzensen
- Division of Cancer Epidemiology and GeneticsNational Cancer Institute, National Institutes of Health, DHHSBethesdaMDUSA
| | - Nancy E. Poitras
- Regional LaboratoryKaiser Permanente Northern CaliforniaBerkeleyCAUSA
| | - Thomas Lorey
- Regional LaboratoryKaiser Permanente Northern CaliforniaBerkeleyCAUSA
| | - Walter K. Kinney
- Division of Gynaecologic OncologyKaiser Permanente Medical Care ProgramOaklandCAUSA
| | | |
Collapse
|
21
|
Graue R, Lönnberg S, Skare GB, Saether SMM, Bjørge T. Atypical glandular lesions of the cervix and risk of cervical cancer. Acta Obstet Gynecol Scand 2020; 99:582-590. [PMID: 31853943 DOI: 10.1111/aogs.13790] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Revised: 11/30/2019] [Accepted: 12/14/2019] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Cytology screening has been effective in reducing risks for cervical squamous cell carcinoma but less so for adenocarcinoma. We explored the association of atypical glandular cells or absence of glandular cells in cytology, and subsequent histological diagnoses and cancer risk. MATERIAL AND METHODS All women in Norway with atypical glandular cells of undetermined significance (AGUS), adenocarcinoma in situ (ACIS) and normal/benign cells, but absence of endocervical or metaplastic cells (NC-NEC) in their first cytology during 1992-2014 (NC-NEC; 2005-2014), recorded in the Cancer Registry of Norway, were included (n = 142 445). Histology diagnoses (stratified by age) within 1 and 3 years after cytology were examined. The Nelson-Aalen cumulative hazard function for gynecological cancer risk was displayed. RESULTS The majority of AGUS and particularly ACIS were followed with histology within 1 and 3 years. Cervical intraepithelial neoplasia (CIN) lesions were more common in women <35 than in women ≥35 years. Cervical adenocarcinoma followed 13% of ACIS after 1 and 3 years. After ACIS and AGUS, cervical adenocarcinoma was the most frequent cancer subtype. Cumulative risks of cervical adenocarcinoma following ACIS, AGUS and NC-NEC were 3.5%, 0.9% and 0.05%, respectively, after 22, 22 and 9 years of follow-up. CONCLUSIONS There was a high-risk of glandular malignancies after AGUS and ACIS in cytology. If effective treatment of pre-cancer and early cancer is available, cytology screening provides some level of prevention of adenocarcinoma. Lack of glandular cells did not entail a higher cancer risk.
Collapse
Affiliation(s)
- Renate Graue
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | | | | | - Solbjørg M M Saether
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Tone Bjørge
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.,Cancer Registry of Norway, Oslo, Norway
| |
Collapse
|
22
|
Abstract
Zusammenfassung
Zielstellung
Das CIN2+-/CIN3+(zervikale intraepitheliale Neoplasie)-Risiko plattenepithelialer zytologischer Befunde (Gruppe II‑p, IIID1, III‑p, IIID2 der Münchner Nomenklatur [MN] III) soll bewertet und mit Empfehlungen für das Patienten-Management korreliert werden.
Material und Methoden
Alle 4321 Frauen mit einer Gruppe II‑p, IIID1, III‑p, IIID2, IVa‑p, IVb-p und V‑p von Januar 2014 bis Dezember 2016 wurden in einer Praxis für Pathologie erfasst. Zytologische Vorbefunde, alle zytologischen und histologischen Folgebefunde bis Juli 2019 wurden dokumentiert. Für die Erstbefunde wurde pro Befundgruppe mittels Kaplan-Meier-Schätzung das Risiko für CIN2+/CIN3+ ermittelt. Das Risiko bei persistierenden Befunden und der Einfluss des Alters wurden untersucht.
Ergebnisse
Für die Erstbefunde der Gruppen II‑p, IIID1, III‑p und IIID2 beträgt das Risiko für CIN2+ nach 12, 24 und 60 Monaten 1,0/3,3/11,8; 3,1/9,4/22,7; 33,4/38,4/55,5 bzw. 35,1/46,2/64,4 (%). Das Risiko für CIN3+ beträgt für die gleichen Zeiträume 0,6/2,7/9,7; 1,9/5,2/14,3; 28,8/32,4/44,0 bzw. 28,5/36,7/52,4 (%). Bei persistierenden Befunden derselben Gruppe steigt das Risiko für CIN2+ und CIN3+ signifikant vom ersten zum zweiten II-p‑, IIID1-, III-p- und IIID2-Befund. Bei den Gruppen II‑p, IIID1 und IIID2 finden sich keine signifikanten Altersunterschiede, bei III-p-Befunden ist das Risiko für Frauen <30 und <35 signifikant größer als für ältere Frauen.
Schlussfolgerung
Die MN III mit 3‑gliedriger Dysplasiegraduierung klassifiziert die zytologischen Befunde risikoorientiert. Ihre Befundgruppen eignen sich als Basis für ein risikoadaptiertes Management, um insbesondere Überdiagnostik und -therapie zu vermeiden.
Collapse
|
23
|
Glandular cell abnormalities in cervical cytology: What has changed in this decade and what has not? Eur J Obstet Gynecol Reprod Biol 2019; 240:68-73. [DOI: 10.1016/j.ejogrb.2019.06.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Revised: 06/04/2019] [Accepted: 06/09/2019] [Indexed: 11/22/2022]
|
24
|
Xu J, Zhang J. LncRNA TP73-AS1 is a novel regulator in cervical cancer via miR-329-3p/ARF1 axis. J Cell Biochem 2019; 121:344-352. [PMID: 31232491 DOI: 10.1002/jcb.29181] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Accepted: 05/29/2019] [Indexed: 12/29/2022]
Abstract
Cervical cancer holds one of the highest morbidity and mortality in various types of cancers. It even leads to the most number of cancer-related deaths of women. A lot of research has indicated that the anomalous expression of long noncoding RNAs (lncRNAs) would induce carcinogenesis and is associated with poor prognosis of patients with cancer. However, the function and mechanism of many lncRNAs still call for further research. Tumor Protein P73 Antisense RNA 1 (TP73-AS1) is no exception. LncRNA TP73-AS1 has been found to promote cancer progressions in various cancers. It is upregulated in cervical cancer cells. The proliferation and migration ability of cervical cancer cells can also be boosted by TP73-AS1 in return. Meanwhile, miRNA-329-3p is downregulated in cervical cancer cells and could bind with both TP73-AS1 and ADP Ribosylation Factor 1 (ARF1). TP73-AS1 inhibited miR-329-3p expression while miR-329-3p inhibited ARF1 expression. More importantly, TP73-AS1 can positively regulate ARF1 expression. Based on all these experiments, TP73-AS1 regulates ARF1 expression by competitively binding with miR-329-3p, thus regulating cervical cancer progression. Further rescue assays confirmed TP73-AS1 regulates cervical cell proliferation and migration via miR-329-3p/ARF1. TP73-AS1 might serve as a novel regulator in cervical cancer.
Collapse
Affiliation(s)
- Jingning Xu
- Department of Obstetrics and Gynecology, Northwest Women and Children's Hospital, Xi'an, Shaanxi, China
| | - Jinmei Zhang
- Department of Obstetrics and Gynecology, Chang'an District Hospital, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| |
Collapse
|
25
|
Wang J, Elfström KM, Andrae B, Nordqvist Kleppe S, Ploner A, Lei J, Dillner J, Sundström K, Sparén P. Cervical cancer case-control audit: Results from routine evaluation of a nationwide cervical screening program. Int J Cancer 2019; 146:1230-1240. [PMID: 31107987 PMCID: PMC7003887 DOI: 10.1002/ijc.32416] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Revised: 04/26/2019] [Accepted: 04/30/2019] [Indexed: 01/24/2023]
Abstract
Our study used a refined case–control cervical cancer Audit framework to investigate effectiveness of cervical screening, with measures of three screening failures: irregular‐participation, cervical cancer developed after cytological abnormalities and after normal screening results. The register‐based study included 4,254 cervical cancer cases diagnosed in Sweden during 2002–2011, and 30 population‐based controls per case. We used conditional logistic regression models to examine relative risks of cervical cancer in relation to screening participation and screening results in the past two screening rounds from 6 months before cancer diagnosis. We found that women unscreened in past two screening rounds showed four times increased risk of cervical cancer compared to women screened in time (OR = 4.1, 95% CI = 3.8–4.5), and women unscreened in the previous round but screened in the most recent round also showed a statistically significantly elevated risk (OR = 1.6, 95% CI = 1.5–1.8). Women having abnormality in previous two rounds exhibited higher risk of cervical cancer compared to women screened with normal results, while having normal results in the subsequent round after the abnormality also yielded an increased risk (OR = 4.0, 95% CI = 3.2–5.1). Being screened with only normal results was associated with 89% risk reduction for squamous cell cancer, compared to women unscreened, but only 60% reduction for adenocarcinoma. Our findings emphasize the importance of routine participation in cervical screening and suggest that management of abnormalities, as well as sensitivity of the test, warrants improvement especially for preventing cervical adenocarcinoma. The Audit framework serves as routine evaluation model and the findings benchmark for future evaluation of changes in screening practice. What's new? Systematic review of cancer screening is critical to ensuring high‐quality, effective disease prevention and detection and management. In this study, case–control audit was used to evaluate cervical cancer screening in Sweden. Analyses show that relative to women who undergo routine screening, cervical cancer risk is elevated for women who are screened at irregular intervals. Risk was significantly increased among women with abnormalities detected at screening. The audit further revealed that, overall, management of abnormalities for preventing cervical adenocarcinoma is inferior compared to squamous cell cancer. The findings suggest that case–control auditing is a useful means of evaluating cervical screening programs.
Collapse
Affiliation(s)
- Jiangrong Wang
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - K Miriam Elfström
- Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden.,Regional Cancer Center of Stockholm Gotland, Stockholm, Sweden
| | - Bengt Andrae
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.,Centre for Research and Development, Uppsala University/Region of Gävleborg, Gävle, Sweden
| | | | - Alexander Ploner
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Jiayao Lei
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Joakim Dillner
- Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden.,Karolinska University Laboratory, Karolinska University Hospital, Stockholm, Sweden
| | - Karin Sundström
- Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Pär Sparén
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| |
Collapse
|
26
|
Toyoda S, Kawaguchi R, Kobayashi H. Clinicopathological Characteristics of Atypical Glandular Cells Determined by Cervical Cytology in Japan: Survey of Gynecologic Oncology Data from the Obstetrical Gynecological Society of Kinki District, Japan. Acta Cytol 2019; 63:361-370. [PMID: 31048578 DOI: 10.1159/000498977] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Accepted: 02/13/2019] [Indexed: 12/19/2022]
Abstract
BACKGROUND The purpose of this study was to clarify the clinicopathological characteristics of, and the clinical approach used to identify, atypical glandular cells (AGCs) in Japan based on cervical cytology screening. OBJECTIVES This study included 1,254 patients with AGCs who underwent cervical cytology. METHOD Data from patients with AGCs were used to examine the practical management of AGCs and the histological results. RESULTS The incidence of AGCs was 0.20% (1,254/614,791). The 1,254 AGC cases included 859 endocervical cells not otherwise specified (NOS), 3 glandular cells NOS, 91 endocervical cells favor neoplasia (FN), and 301 atypical endometrial cells (AEMCs). Among the 1,254 AGC patients, the histological diagnosis was benign in 666 (53.1%), cervical intraepithelial neoplasia (CIN) 1 in 60 (4.8%), CIN2 in 31 (2.5%), CIN3 in 52 (4.1%), squamous cell carcinoma in 19 (1.5%), adenocarcinoma in situ in 39 (3.1%), cervical adenocarcinoma in 106 (8.5%), endometrial carcinoma in 209 (16.7%), ovarian cancer in 26 (2.1%), other malignancy in 4 (0.3%), and other under follow-up in 42 (3.3%). When the 1,254 AGC patients were divided into three medical intervention degrees according to histology, AGC-NOS, AGC-FN, and AEMC required no medical intervention in 78.7, 13.2, and 25.9% (678, 12, and 78) of the patients, cervical cone resection in 13.0, 9.9, and 0.3% (112, 9, and 1) of the patients, and radical laparotomy for invasive cancer in 8.3, 76.9, and 73.8% (72, 70, and 222) of the patients, respectively. CONCLUSIONS Our histological results supported the medical interventions applied for AGC diagnosis and treatment. AGC cases require careful histological evaluation.
Collapse
Affiliation(s)
- Shinji Toyoda
- Department of Obstetrics and Gynecology, Nara Prefecture General Medical Center, Nara, Japan,
| | - Ryuji Kawaguchi
- Department of Obstetrics and Gynecology, Nara Medical University, Kashihara, Japan
| | - Hiroshi Kobayashi
- Department of Obstetrics and Gynecology, Nara Medical University, Kashihara, Japan
| |
Collapse
|
27
|
dos Santos AV, dos Santos GT, Brackmann RL, Prolla JC, Bica CG. Follow-Up of Women with Cervical Cytological Abnormalities:
Progression and Regression Events. Asian Pac J Cancer Prev 2019; 20:1019-1024. [PMID: 31030468 PMCID: PMC6948908 DOI: 10.31557/apjcp.2019.20.4.1019] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Section Title Abnormalities in the cervix, when identified early by Pap smear, can be treated in the early stages or in the precursor stages of the neoplasia, which may increase the chances of regression of the lesion. The aim to verify the rate of cervical abnormalities and to evaluate the risk of progression or regression associated with age and cytological diagnosis. Methods: The study was conducted in a referral hospital in Southern Brazil, based on the results of pathology and cytopathology laboratory tests of uterine cervix. The historical cohort included patients with an abnormal cytology diagnosis in the period from January 2010 to December 2014, followed until July 2016. Results: A total of 42,389 cervical smears were analyzed, 4,427 of which were eligible for analysis of the evolution of cervical abnormalities. In progression and regression events analysis, we observed that patients with a cytological diagnosis of atypical glandular cells presented a higher risk of cervical abnormality progression (Hazard Ratio: 2.0 and 95% confidence intervals 1.36–3.48). We also observed that patients younger than 25 years old were more likely to regress the cervical lesions (Hazard Ratio:1.4 and 95% confidence intervals 1.20–1.74). Conclusions: The associations found between the events (progression and regression), age and cytological diagnosis, highlights the importance of cytological screening in populations at risk of precursor of cervical cancer lesions, especially in women older than 25 years.
Collapse
Affiliation(s)
- Aniúsca Vieira dos Santos
- Pathology Research Laboratory,Federal University of Health Sciences of Porto Alegre, Rio Grande do Sul, Brazil
| | - Giovana Tavares dos Santos
- Pathology Research Laboratory,Federal University of Health Sciences of Porto Alegre, Rio Grande do Sul, Brazil
| | | | - João Carlos Prolla
- Laboratory of Pathology, Santa Casa de Misericórdia of Porto Alegre, Rio Grande do Sul, Brazil
| | - Claudia Giuliano Bica
- Department of Basic Health Sciences, Federal University of Health Sciences of Porto Alegre, Rio Grande do Sul, Brazil.
| |
Collapse
|
28
|
Lei J, Andrae B, Ploner A, Lagheden C, Eklund C, Nordqvist Kleppe S, Wang J, Fang F, Dillner J, Elfström KM, Sparén P. Cervical screening and risk of adenosquamous and rare histological types of invasive cervical carcinoma: population based nested case-control study. BMJ 2019; 365:l1207. [PMID: 30944091 PMCID: PMC6446178 DOI: 10.1136/bmj.l1207] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To examine the association of cervical cytology screening with the risk of adenosquamous cell carcinoma (ASC) and rare histological types of invasive cervical carcinoma (RICC), using comprehensive registry data, and to assess tumour human papillomavirus status of ASC and RICC. DESIGN Nationwide, population based, nested case-control study. SETTING Sweden. PARTICIPANTS All cases of invasive cervical carcinoma in Sweden during 2002-11 (4254 confirmed cases after clinical and histopathological review). 338 cases were neither squamous cell carcinoma nor adenocarcinoma, including 164 cases of ASC and 174 cases of RICC (glassy cell carcinoma, clear cell carcinoma, small cell carcinoma, neuroendocrine cell carcinoma, large cell carcinoma, and undifferentiated carcinoma). 30 birth year matched controls from the general Swedish population were matched to each case by applying incidence density sampling. MAIN OUTCOME MEASURES Conditional logistic regression was used to calculate odds ratios, interpreted as incidence rate ratios, for risk of ASC and RICC in relation to screening status and screening history, adjusted for education. Human papillomavirus distribution of ASC and RICC was based on available archival tumour tissues from most Swedish pathology biobanks. RESULTS Women with two screening tests in the previous two recommended screening intervals had a lower risk of ASC (incidence rate ratio 0.22, 95% confidence interval 0.14 to 0.34) and RICC (0.34, 0.21 to 0.55), compared with women without any test. High risk human papillomavirus was detected in 148/211 (70%) cases with valid human papillomavirus results from tumour tissues. The risk reduction among women with tumours that were positive (incidence rate ratio 0.28, 0.18 to 0.46) and negative (0.27, 0.13 to 0.59) for high risk human papillomavirus was similar, compared with women who did not attend any test. CONCLUSIONS Cervical screening is associated with reduced risk of ASC and RICC, and most ASC and RICC are positive for high risk human papillomavirus. This evidence provides a benchmark for evaluating future cervical screening strategies.
Collapse
Affiliation(s)
- Jiayao Lei
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, 171 77 Stockholm, Sweden
| | - Bengt Andrae
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, 171 77 Stockholm, Sweden
- Center for Research and Development, Uppsala University/Region of Gävleborg, 801 88 Gävle, Sweden
| | - Alexander Ploner
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, 171 77 Stockholm, Sweden
| | - Camilla Lagheden
- Department of Laboratory Medicine, Karolinska Institutet, 141 83 Stockholm, Sweden
| | - Carina Eklund
- Department of Laboratory Medicine, Karolinska Institutet, 141 83 Stockholm, Sweden
| | - Sara Nordqvist Kleppe
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, 171 77 Stockholm, Sweden
- Department of Laboratory Medicine, Karolinska Institutet, 141 83 Stockholm, Sweden
| | - Jiangrong Wang
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, 171 77 Stockholm, Sweden
- Department of Laboratory Medicine, Karolinska Institutet, 141 83 Stockholm, Sweden
| | - Fang Fang
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, 171 77 Stockholm, Sweden
| | - Joakim Dillner
- Department of Laboratory Medicine, Karolinska Institutet, 141 83 Stockholm, Sweden
- Karolinska University Laboratory, Karolinska University Hospital, 171 76 Stockholm, Sweden
| | - K Miriam Elfström
- Department of Laboratory Medicine, Karolinska Institutet, 141 83 Stockholm, Sweden
- Regional Cancer Center Stockholm-Gotland, 118 27 Stockholm, Sweden
| | - Pär Sparén
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, 171 77 Stockholm, Sweden
| |
Collapse
|
29
|
Abstract
The rapidly increasing incidence and mortality of cancer calls for a focused effort to increase the effect of cancer‐prevention efforts. In the area of early detection, there are major differences in the preventive impact of implemented screening policies, even when solid, evidence‐based international recommendations are issued. Studies are needed to determine why evidence‐based interventions are not used and to investigate why effects are less than predicted by solid research on the subject. Currently, population‐based screening is recommended only for three forms of cancer (cervical, breast and colorectal cancer) but, given the increasing cancer burden, efforts are required to facilitate the discovery of new biomarkers for screening, as well as the identification of barriers to implementation of new cancer screening discoveries. The creation of a network of excellence in research on Cancer Prevention (Cancer Prevention Europe) is likely to significantly contribute to progress in these areas. In the present review, some possible strategies to ensure progress are discussed, with specific examples from the cervical cancer screening area.
Collapse
Affiliation(s)
- Joakim Dillner
- Center for Cervical Cancer Prevention, Department of Pathology, Karolinska University Laboratory and Karolinska Institutet, Stockholm, Sweden
| |
Collapse
|
30
|
Norman I, Hjerpe A, Dillner J. Risk of high-grade lesions after atypical glandular cells in cervical screening: a population-based cohort study. BMJ Open 2017; 7:e017070. [PMID: 29247086 PMCID: PMC5735403 DOI: 10.1136/bmjopen-2017-017070] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES To determine how human papillomavirus (HPV) positivity of atypical glandular cells (AGCs) affects the predictive values for the presence of high-grade cervical lesions. DESIGN Population-based cohort study. SETTING Stockholm-Gotland region, Sweden. PARTICIPANTS Between 17 February 2014 and 30 June 2016, there were 562 women with AGC detected in a cervical sample. Registry linkages up to 30 June 2016 identified 392 women with an associated HPV test and a histopathological follow-up. MAIN OUTCOME MEASURE Presence of a high-grade cervical lesion in the cervical biopsy taken after the AGC smear, in relation to the HPV status of the AGC-containing index smear. RESULTS The proportion of HPV-positive AGC was 56% (n=222). In this group, there were six cases of invasive cervical adenocarcinoma, 33 cases of cervical adenocarcinoma in situ and 93 cases of high-grade squamous intraepithelial lesion (HSIL), giving a positive predictive value (PPV) for a cervical high-grade lesion of 60% (132/222). Among the 170 women with HPV-negative AGC, there was one invasive cervical squamous cell cancer and four HSIL, giving an PPV for a cervical high-grade lesion of 2.9% (5/170). This group also contained five endometrial cancers and one breast cancer. CONCLUSIONS HPV triaging of AGC will greatly increase the predictive ability for identifying cervical high-grade lesions (OR: 48.4 (95% CI 19.1 to122.6)) and the high sensitivity (96%; 132/137 women) implies safety of primary HPV screening strategies, with regard to this subset of patients. The measurable risk for endometrial cancer among women with HPV-negative AGC (2.9%) suggests that research on screening for endometrial cancer is needed.
Collapse
Affiliation(s)
- Ingrid Norman
- Department of Clinical Pathology and Cytology, Karolinska University Laboratory, Karolinska University Hospital, Stockholm, Sweden
- Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Anders Hjerpe
- Department of Clinical Pathology and Cytology, Karolinska University Laboratory, Karolinska University Hospital, Stockholm, Sweden
- Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Joakim Dillner
- Department of Clinical Pathology and Cytology, Karolinska University Laboratory, Karolinska University Hospital, Stockholm, Sweden
- Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden
| |
Collapse
|
31
|
Theuws J, Allen DG. Effect of treatment choices for cervical adenocarcinoma in situ on rates of residual disease, recurrence and progression. SOUTHERN AFRICAN JOURNAL OF GYNAECOLOGICAL ONCOLOGY 2017. [DOI: 10.1080/20742835.2017.1402434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Affiliation(s)
| | - David G. Allen
- Department of Gynecologic Oncology, Mercy Hospital for Women, Melbourne, Australia
| |
Collapse
|
32
|
Wang J, Andrae B, Sundström K, Ploner A, Ström P, Elfström KM, Dillner J, Sparén P. Effectiveness of cervical screening after age 60 years according to screening history: Nationwide cohort study in Sweden. PLoS Med 2017; 14:e1002414. [PMID: 29065127 PMCID: PMC5655486 DOI: 10.1371/journal.pmed.1002414] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2017] [Accepted: 09/25/2017] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND The relatively high incidence of cervical cancer in women at older ages is a continuing concern in countries with long-established cervical screening. Controversy remains on when and how to cease screening. Existing population-based studies on the effectiveness of cervical screening at older ages have not considered women's screening history. We performed a nationwide cohort study to investigate the incidence of cervical cancer after age 60 years and its association with cervical screening at age 61-65, stratified by screening history at age 51-60. METHODS AND FINDINGS Using the Total Population Register, we identified 569,132 women born between 1 January 1919 and 31 December 1945, resident in Sweden since age 51. Women's cytological screening records, cervical cancer occurrence, and FIGO stage (for those diagnosed with cancer) were retrieved from national registers and medical charts. We calculated the cumulative incidence of cervical cancer from age 61 to age 80 using a survival function considering competing risk, and estimated the hazard ratio (HR) of cervical cancer in relation to screening status at age 61-65 from Cox models, adjusted for birth cohort and level of education, conditioning on women's screening history in their 50s. In women unscreened in their 50s, the cumulative incidence up to age 80 was 5.0 per 1,000 women, and screening at age 61-65 was associated with a lower risk for cervical cancer (HR = 0.42, 95% CI 0.24-0.72), corresponding to a decrease of 3.3 cancer cases per 1,000 women. A higher cumulative incidence and similarly statistically significant risk decrease was seen for women with abnormal smears in their 50s. In women adequately or inadequately screened with only normal results between age 51 and age 60, the cumulative incidence of cervical cancer from age 61 to 80 was 1.6 and 2.5 per 1,000 women, respectively, and further screening at age 61-65 was not associated with statistically significant decreases of cervical cancer risk up to age 80, but with fewer cancer cases of advanced stages at age 61-65. Adjustment for potential lifestyle confounders was limited. CONCLUSIONS In this study, cervical screening with cytology at age 61-65 was associated with a statistically significant reduction of subsequent cervical cancer risk for women who were unscreened, or screened with abnormalities, in their 50s. In women screened with normal results in their 50s, the risk for future cancer was not sizeable, and the risk reduction associated with continued screening appeared limited. These findings should inform the current debate regarding age and criteria to discontinue cervical screening.
Collapse
Affiliation(s)
- Jiangrong Wang
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- * E-mail:
| | - Bengt Andrae
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Centre for Research and Development, Uppsala University/Region of Gävleborg, Gävle, Sweden
| | - Karin Sundström
- Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Alexander Ploner
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Peter Ström
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - K. Miriam Elfström
- Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Joakim Dillner
- Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden
- Karolinska University Laboratory, Karolinska University Hospital, Stockholm, Sweden
| | - Pär Sparén
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| |
Collapse
|
33
|
Impact of GP reminders on follow-up of abnormal cervical cytology: a before-after study in Danish general practice. Br J Gen Pract 2017; 67:e580-e587. [PMID: 28716995 DOI: 10.3399/bjgp17x691913] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2017] [Accepted: 04/12/2017] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND Dysplasia may progress because of a loss to follow-up after an abnormal cervical cytology. Approximately 18% of Danish women postpone the recommended follow-up, which depends on the cytology results. AIM To investigate if a reminder to the GP about missed follow-up could reduce the proportion of women who fail to act on a recommended follow-up, and to analyse the effect on sociodemographic and general practice variations. DESIGN AND SETTING A national electronic GP reminder system was launched in Denmark in 2012 to target missed follow-up after screening, opportunistic testing, or surveillance indication. The authors compared follow-up proportions in a national observational before-after study. METHOD From national registries, 1.5 million cervical cytologies (from 2009 to 2013) were eligible for inclusion. Approximately 10% had a recommendation for follow-up. The proportion of cervical cytologies without follow-up was calculated at different time points. Results were stratified by follow-up recommendations and sociodemographic characteristics, and changes in practice variation for follow-up were analysed. RESULTS Fewer women with a recommendation for follow-up missed follow-up 6 months after a GP reminder. Follow-up improved in all investigated sociodemographic groups (age, ethnicity, education, and cohabitation status). Interaction was found for age and cohabitation status. Variation between practices in loss to follow-up was significantly reduced. CONCLUSION An electronic GP reminder system showed potential to improve the quality of cervical cancer screening through reduced loss to follow-up.
Collapse
|
34
|
Peixoto Pereira FR, Soares LC, de Oliveira MAP. Histological outcomes in conventional cervical cytology for invasive carcinoma: not always cancer. J OBSTET GYNAECOL 2017; 37:1112-1114. [PMID: 28657397 DOI: 10.1080/01443615.2017.1318271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The value of cytology for the detection of invasive cancer remains unknown. We performed a retrospective cohort study with 884 patients diagnosed of premalignant lesions and invasive carcinoma in cytology. 382 (43.2%) of them had cytological results of high-grade squamous intraepithelial lesions (HSIL), 244 (27.6%) showed low-grade squamous intraepithelial lesions (LSIL), 120 (13.6%) patients had atypical squamous cells of undetermined significance (ASC-US), 67 (7.6%) patients with atypical squamous cells, cannot exclude high-grade squamous intraepithelial lesion (ASC-H), 38 (4.3%) had invasive carcinoma and 33 (3.7%) patients presented with atypical glandular cells (ACG). From 38 patients with cytological results of invasive carcinoma, 24 had confirmatory histological results (63.2%). The other 14 had 4 benign lesions and 10 HSIL. The predictive positive value (PPV) was 63.2%. Cytology results of carcinoma do not confer a definitive diagnosis of invasive lesion, but it is strongly an indication of, at least, a precancerous lesion.
Collapse
|
35
|
Pradhan D, Li Z, Ocque R, Patadji S, Zhao C. Clinical significance of atypical glandular cells in Pap tests: An analysis of more than 3000 cases at a large academic women's center. Cancer Cytopathol 2016; 124:589-95. [DOI: 10.1002/cncy.21724] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2016] [Revised: 03/26/2016] [Accepted: 03/29/2016] [Indexed: 11/10/2022]
Affiliation(s)
- Dinesh Pradhan
- Department of Pathology; Magee-Womens Hospital, University of Pittsburgh Medical Center; Pittsburgh Pennsylvania
| | - Zaibo Li
- Department of Pathology; Magee-Womens Hospital, University of Pittsburgh Medical Center; Pittsburgh Pennsylvania
| | - Rebecca Ocque
- Department of Pathology; Magee-Womens Hospital, University of Pittsburgh Medical Center; Pittsburgh Pennsylvania
| | - Stell Patadji
- Department of Pathology; Magee-Womens Hospital, University of Pittsburgh Medical Center; Pittsburgh Pennsylvania
| | - Chengquan Zhao
- Department of Pathology; Magee-Womens Hospital, University of Pittsburgh Medical Center; Pittsburgh Pennsylvania
| |
Collapse
|