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Basu P, Taghavi K, Hu SY, Mogri S, Joshi S. Management of cervical premalignant lesions. Curr Probl Cancer 2018; 42:129-136. [PMID: 29428790 DOI: 10.1016/j.currproblcancer.2018.01.010] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Revised: 12/27/2017] [Accepted: 01/10/2018] [Indexed: 01/08/2023]
Abstract
Treatment of cervical premalignant lesions (cervical intraepithelial neoplasia; CIN) of different grades is very effective, simple, and safe. The entire transformation zone of the cervix needs to be treated either by an ablative technique (cryotherapy or thermal ablation) or an excisional technique (large loop excision of transformation zone or cold knife conization); the choice of treatment depends on the size and location of the lesion and the type of the transformation zone. The cure rate after ablative treatment of high-grade CIN may be little lower than that after excisional treatment. The simplicity of the technique, low complication rate, and lesser cost make ablative technique the treatment of choice in the low resourced settings for the eligible lesions. In situations where organizing colposcopy and histopathology services is challenging, simple algorithms like screening with visual inspection with acetic acid test and immediate ablative treatment of the visual inspection with acetic acid-positive women has been recommended by the World Health Organization. Such a strategy is effective in preventing subsequent development of high-grade CIN and also ensures high compliance of the screen positive women to treatment.
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Affiliation(s)
- Partha Basu
- Screening Group, Early Detection and Prevention Section, International Agency for Research on Cancer, Lyon, France.
| | - Katayoun Taghavi
- Institute of Social and Preventative medicine, University of Bern, Bern, Switzerland
| | - Shang-Ying Hu
- National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Sushma Mogri
- Department of Obstetrics and Gynecology, American International Institute of Medical Sciences, Udaipur, India
| | - Smita Joshi
- Jehangir Clinical Development Centre, Jehangir Hospital Premises and Prayas, Pune, India
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Park KJ, Soslow RA. Current concepts in cervical pathology. Arch Pathol Lab Med 2009; 133:729-38. [PMID: 19415947 DOI: 10.5858/133.5.729] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/11/2008] [Indexed: 11/06/2022]
Abstract
CONTEXT The correct diagnosis and reporting of cervical in situ and invasive carcinoma are essential for the appropriate clinical management of patients with human papillomavirus-associated disease. OBJECTIVES To review common mistakes made in the diagnosis of cervical dysplasia and invasive carcinoma, describe variants and benign mimics of high-grade squamous intraepithelial lesion and adenocarcinoma in situ, and discuss available ancillary studies that can be useful in making the distinctions as well as to review important factors related to prognosis that should be included in the pathology report. DATA SOURCES Review of current literature. CONCLUSIONS There are many mimics and variants of cervical squamous and glandular lesions that can be resolved with ancillary studies and careful histologic examination. Prognostically important features, such as tumor size, presence of vascular invasion, and margin status, should always be included in the pathology report.
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Affiliation(s)
- Kay J Park
- Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, New York 10065, USA.
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Cuvelier CA, Bogers JPM, Bourgain C, Delvenne P, Drijkoningen M, Garbar C, Kevers M, Remmelinck M, Thienpont L, Verhest A, Weynand B, Willocx F. Belgian consensus guidelines for follow-up of women with cervical cytological abnormalities. Acta Clin Belg 2009; 64:136-43. [PMID: 19432026 DOI: 10.1179/acb.2009.023] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
In medical care cervical cancer screening is important because it enables the detection of precancer and cancer at an early stage. By adequate treatment after a screening-detected lesion it helps to reduce the mortality related to cervical cancer. Worldwide, many millions of women have smears taken at a more or less regular base and of these, approximately 7% are abnormal, and follow-up is thus required.As this represents an important cost in medical health care and has serious consequences for the affected women, it is important to have uniform and clear guidelines to allow an optimal follow-up and clinical management. A system for the uniform reporting of cervical cytology has been designed by the National Cancer Institute (U.S.A.) and resulted in the Bethesda System 1991. The present paper and the terminology used are based on the Bethesda System revised in 2001. It explains the guidelines, based on the 2001 Bethesda System and the 2004 consensus guidelines for the management of women with cervical cytological abnormalities, as developed by the members of the Board of the Belgian Society of Clinical Cytology, and adapted to the Belgian situation.
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Affiliation(s)
- C A Cuvelier
- N. Goormaghtigh Instituut voor Pathologische Anatomie, UZ Gent, Universiteit Gent, Belgium.
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Assessment of follow-up for low-grade cytological abnormalities in the National Breast and Cervical Cancer Early Detection Program, 2000-2005. J Low Genit Tract Dis 2009; 12:300-6. [PMID: 18820545 DOI: 10.1097/lgt.0b013e31817e308e] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To assess the management of women in the National Breast and Cervical Cancer Early Detection Program with low-grade squamous intraepithelial lesions (LSIL) before and after the American Society for Colposcopy and Cervical Pathology (ASCCP) guidelines for management of abnormal cytology were published in 2002. MATERIALS AND METHODS We examined the follow-up for 22,342 women with LSIL during 2 periods: 2000-2002 and 2003-2005. RESULTS The percentage of providers who followed the recommended guidelines with colposcopy for an LSIL Pap test result increased by 9% from the pre-ASCCP to the post-ASCCP period. An increase was seen in every age and racial/ethnic group. Younger women (<30 years) and white women were more likely than comparison groups to be followed by colposcopy rather than a repeat Pap test. CONCLUSIONS The increase in percentage of women having colposcopy in 2003, 1 year after the new guidelines were published, suggests a change in provider practices consistent with those guidelines.
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Saad RS, Dabbs DJ, Kordunsky L, Kanbour-Shakir A, Silverman JF, Liu Y, Kanbour A. Clinical significance of cytologic diagnosis of atypical squamous cells, cannot exclude high grade, in perimenopausal and postmenopausal women. Am J Clin Pathol 2006; 126:381-8. [PMID: 16880134 DOI: 10.1309/xvb01jqyqnm7mjxu] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
We used cytohistologic correlation to determine the clinical significance of atypical squamous cells, cannot exclude high grade (ASC-H) in perimenopausal and postmenopausal women. A computer search identified 250 Papanicolaou smears from women older than 45 years with a diagnosis of ASC- H. Cases were considered perimenopausal (45 to < 55 years; 150 cases) and postmenopausal ((3)55 years; 100 cases). No follow-up data were available for 33 cases, which were excluded. The remaining 217 cases (perimenopausal, 127; postmenopausal, 90) had surgical or cytologic follow-up. Results of follow-up colposcopic biopsy were available for 176 (81.1%) and cytology for 41 (18.9%) women. Follow-up results were as follows: perimenopausal women, negative, 50 (39.4%); mild dysplasia (low-grade squamous intraepithelial lesion [LSIL]), 46 (36.2%); high-grade dysplasia (high-grade SIL [HSIL]); 28 (22.0%); and ASC of undetermined significance (ASC-US), 3 (2.4%); postmenopausal women, negative, 52 (58%); LSIL, 31 (34%); HSIL, 5 (6%); and ASC-US, 2 (2%). The diagnosis of ASC-H in postmenopausal women usually is associated with LSIL or a negative diagnosis on follow-up, suggesting a less aggressive surveillance and treatment regimen is needed for postmenopausal women with ASC-H.
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Affiliation(s)
- Reda S Saad
- Department of Pathology, Allegheny General Hospital and Drexel University College of Medicine, Pittsburgh, PA 15212, USA
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Phongnarisorn C, Srisomboon J, Siriaungkul S, Khunamornpong S, Suprasert P, Charoenkwan K, Cheewakriangkrai C, Siriaree S, Saphan K. Women in a region with high incidence of cervical cancer warrant immediate colposcopy for low-grade squamous intraepithelial lesion on cervical cytology. Int J Gynecol Cancer 2006; 16:1565-8. [PMID: 16884366 DOI: 10.1111/j.1525-1438.2006.00405.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
The objective of this study was to determine the prevalence of high-grade histologic diagnoses in women who had low-grade squamous intraepithelial lesion (LSIL) on Pap smear in an area with high incidence of cervical cancer. We conducted a retrospective study of 220 women with LSIL cytology undergoing colposcopic examination in Chiang Mai University Hospital between January 1999 and July 2004. The histologic diagnoses, obtained from colposcopically directed biopsy or electrical loop excision after initial colposcopy, showed that 80 (36.4%) women had histologically confirmed high-grade lesions and 11 (5%) women had microinvasive (9) and frankly invasive (2) carcinomas. Overall, 41.5% of women with LSIL on Pap smear had significant underlying lesions, requiring appropriate treatment. In conclusion, in the region with high incidence of cervical cancer, women with LSIL cytology are at increased risk of having underlying high-grade lesions and invasive cancer. Immediate referral for colposcopy is warranted.
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Affiliation(s)
- C Phongnarisorn
- Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University, Thailand.
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Spitzer M, Wilkinson EJ, Ferris D, Waxman AG, Hatch KD, Werner C, Bibbo M, Colgan TJ, Cornelison T, Partridge EE. Management of Women with Cervical Cytologic Results Interpreted as Low-Grade Squamous Intraepithelial Lesion: The Foundation of the ASCCP Guidelines. J Low Genit Tract Dis 2003; 7:241-9. [PMID: 17051078 DOI: 10.1097/00128360-200310000-00003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Mark Spitzer
- North Shore University Hospital, Manhasset, NY 11030, USA.
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Zuna RE, Sienko A, Lightfoot S, Gaiser M. Cervical smear interpretations in women with a histologic diagnosis of severe dysplasia: factors associated with discrepant interpretations. Cancer 2002; 96:218-24. [PMID: 12209663 DOI: 10.1002/cncr.10718] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Because most low-grade squamous intraepithelial lesions (LSIL) regress spontaneously, the appropriate follow-up of women with a cytologic diagnosis of LSIL has engendered discussion. This retrospective study was undertaken to assess the feasibility of limiting colposcopy to women with cytologic interpretations of high-grade squamous intraepithelial lesions (HSIL) in a high-risk population. METHODS The pathology computer files (including files from January to December 1997) of The University Hospital, University of Oklahoma Health Sciences Center, revealed 197 women whose histologic samples were coded as severe dysplasia. Of these, 138 had a cervical smear interpreted in our laboratory before the colposcopic visit. On review, the tissue samples of 119 women met consensus criteria for severe dysplasia. RESULTS Original cytologic diagnoses for 119 cytologic smears included 80 (62.7%) that were interpreted as HSIL. After retrospective review, 28 cases with LSIL or less were reclassified as HSIL and were considered to be discrepant for the purpose of this study. Major confounding factors in the original categorization include lack of consistency among the pathologists for the interpretation of metaplastic patterns and specimen adequacy, particularly air-drying artifact. Eleven cases (10.2%) did not have cells identifiable as HSIL because of sampling error and/or severe air-drying artifact. CONCLUSIONS These results indicate that a substantial number of histologically verified cases of severe dysplasia can have a smear interpretation of LSIL or less. The factors that hampered recognition of the true severity of the lesion in this series were identified and tabulated.
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Affiliation(s)
- Rosemary E Zuna
- Department of Pathology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma 73190, USA.
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Pinto AP, Crum CP. Natural history of cervical neoplasia: defining progression and its consequence. Clin Obstet Gynecol 2000; 43:352-62. [PMID: 10863633 DOI: 10.1097/00003081-200006000-00015] [Citation(s) in RCA: 79] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- A P Pinto
- Federal University of Paraná, Curitiba, Brazil
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Cox JT, Massad LS, Lonky N, Tosh R, Waxman A, Wilkinson EJ. ASCCP Practice Guidelines Management Guidelines for the Follow-up of Cytology Read as Low Grade Squamous Intraepithelial Lesion. J Low Genit Tract Dis 2000. [DOI: 10.1046/j.1526-0976.2000.04205.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Lee SS, Collins RJ, Pun TC, Cheng DK, Ngan HY. Conservative treatment of low grade squamous intraepithelial lesions (LSIL) of the cervix. Int J Gynaecol Obstet 1998; 60:35-40. [PMID: 9506412 DOI: 10.1016/s0020-7292(97)00219-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To assess the accuracy of the cervical smear and colposcopy in diagnosing low grade squamous intraepithelial lesions (LSIL), and the natural history of LSIL. METHOD The cytological, colposcopic and histological findings of 145 patients with a smear diagnosis of LSIL were compared, and the final outcome studied. RESULTS The diagnosis of LSIL either by cytology alone or in combination with colposcopy was associated with a rate of overdiagnosis of 11.7% and 6.9%, respectively, and a rate of underdiagnosis of 31.0% and 26.2%, respectively. Spontaneous regression of lesions occurred in 81.1% of patients with proven LSIL, with regression within 24 months in 4/5 of cases. CONCLUSIONS The degree of dysplasia shown in the cervical smear correlated poorly with histology. All patients with cervical smear showing LSIL should have colposcopy and colposcopic-directed biopsy to exclude the presence of more advanced lesions. In the absence of some serious lesions, it is then acceptable to observe the patient for 24 months before adopting definite treatment, as spontaneous regression is common.
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Affiliation(s)
- S S Lee
- Department of Obstetrics and Gynaecology, Queen Mary Hospital, Hong Kong, China
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Abstract
The subjectivity of morphologic methods contributes to a "swamping" of colposcopic services, excessive costs, overdiagnosis, and overtreatment. HPV DNA testing provides the objectivity required to clarify difficult patient management issues, including follow-up, for low-grade cytologic abnormalities (ASCUS and LSIL), noncorrelating (nonconfirmed) Pap smears, evaluation of nondiagnostic lower genital tract lesions, and cytology and histology laboratory quality assurance. Additionally, favorable preliminary data on HPV testing as a primary screen raise the exciting prospect of potentially lowering costs of cervical cancer-screening programs, while further decreasing the incidence of cervical cancer.
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Affiliation(s)
- J T Cox
- Gynecology Clinic, University of California, Santa Barbara, USA
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Abstract
The Papanicolaou smear has been a remarkably effective tool in cancer prevention, but it is not a perfect test. Although the most important factor in failure of cervical cancer prevention is lack of adequate screening, other factors include problems with sampling, interpretation, and effective clinical follow-up. A small number of rapidly developing cervical cancers probably also arise in the interval between Papanicolaou smear screenings. Consequently, cervical cancer will develop in some women despite appropriate screening. This article will analyze some of the problems relating to diagnostic errors, which include abnormal cells that are few (< 100), small, or bland.
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Affiliation(s)
- R M DeMay
- Section of Cytopathology, University of Chicago, IL 60637, USA
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Johnson SJ, Hair T, Gibson L, Ridley B, Wadehra V. An assessment of partial rescreening as an internal quality control method for cervical smears. Cytopathology 1995; 6:376-87. [PMID: 8770539 DOI: 10.1111/j.1365-2303.1995.tb00485.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Partial screening was performed on 10,800 cervical smears, comprising 8640 filed negative and unsatisfactory smears and 2160 newly received smears prior to conventional screening. Each slide was screened for 30 s and those considered abnormal were reviewed by standard screening. Partial screening led to the detection of 27 additional infections and 44 additional cytological abnormalities. These detection rates are better than those obtained with the traditional method of rescreening only a proportion of smears. Amongst the smears partially screened before conventional screening, partial screening detected 37-66% of infections and 22-71% of cytological abnormalities. We recommend the use of partial rescreening of all negatively reported smears as a method of internal quality control in cervical cytology laboratories.
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Affiliation(s)
- S J Johnson
- Department of Histopathology, Royal Victoria Hospital, Newcastle upon Tyne, UK
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Crum CP. Binary (Bethesda) system for cervical precursor lesions: a histologic perspective. Diagn Cytopathol 1995; 13:379-85. [PMID: 8834311 DOI: 10.1002/dc.2840130505] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Affiliation(s)
- C P Crum
- Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA 02215, USA
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Herbert A. Management of cervical dyskaryosis. Cytological surveillance will still be necessary. BMJ (CLINICAL RESEARCH ED.) 1994; 309:269. [PMID: 7702650 PMCID: PMC2540739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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Robertson JH, Woodend B. Management of cervical dyskaryosis. Accurate diagnosis is essential. BMJ (CLINICAL RESEARCH ED.) 1994; 309:268-9. [PMID: 8069150 PMCID: PMC2540770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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Slater D. Cytological changes preceding cervical cancer. J Clin Pathol 1994; 47:569. [PMID: 8063948 PMCID: PMC494768 DOI: 10.1136/jcp.47.6.569-a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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