1
|
Almeida G, Sainz JE, Fonseca R, Chaves N, Silva KS, Nunes J, Furtado Y. Preventing Uterine Cervix Cancer: The Clinical Meaning of Atypical Glandular Cells. REVISTA BRASILEIRA DE GINECOLOGIA E OBSTETRÍCIA 2022; 44:483-488. [PMID: 35139566 PMCID: PMC9948133 DOI: 10.1055/s-0042-1742318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 11/11/2021] [Indexed: 10/19/2022] Open
Abstract
OBJECTIVE To determine the prevalence of the atypical glandular cells (AGCs) cytology and to analyze its clinical significance in different age ranges. METHODS Retrospective observational study using computerized data from the Brazilian National Cancer Institute, including women screened between January 2002 and December 2008. The women included were those with an AGC result who were properly followed-up with colposcopy and a second cytology. RESULTS A total of 132,147 cytopathological exams were performed during the study period. Five-hundred and thirty-three (0.4%) women with AGC cytology were identified and, of these, 69.41% (370/533) were properly referred for colposcopy and a new cytology. Most of the women (79.2%) with a 1st or 2nd AGC cytology were between the ages of 25 and 54 years. The 2nd cytology demonstrated 67.6% (250/370) of normality, 24.5% (91/370) of squamous atypia, and 6.2% (23/370) of AGC, 0.8% (3/370) adenocarcinoma in situ and 0.8% (3/370) adenocarcinoma invasor. On biopsy of the women with a second AGC cytology, 43.4% (10/23) had normal histology, 43.4% (10/23) had squamous lesions, 8.7% (2/23) had invasive adenocarcinoma, and 1.2% (1/23) had an inconclusive report. All of the women with high-grade squamous intraepithelial lesion (HSIL) or invasive adenocarcinoma (respectively 5 and 2 patients), after a 2nd AGC cytology were 25 years old or older. CONCLUSION The prevalence of the AGC cytology was low in the studied population. Most of the AGC cytology cases occurred in adult women between the ages of 25 and 54. Although most of the patients had normal histology after follow-up, several of them presented with squamous intraepithelial lesions or invasive adenocarcinoma.
Collapse
Affiliation(s)
| | | | - Renata Fonseca
- Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Neil Chaves
- Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | | | - Julio Nunes
- Department of Psychiatry and Behavior Sciences, Stanford University, Stanford, CA, United States
| | - Yara Furtado
- Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
- Universidade Federal do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| |
Collapse
|
2
|
Ratree S, Kleebkaow P, Aue-Aungkul A, Temtanakitpaisan A, Chumworathayi B, Luanratanakorn S. Histopathology of Women with “Atypical Squamous Cells Cannot Exclude High-Grade Squamous Intraepithelial Lesion”
(ASC-H) Smears. Asian Pac J Cancer Prev 2019; 20:683-686. [PMID: 30909664 PMCID: PMC6825754 DOI: 10.31557/apjcp.2019.20.3.683] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Objectives: To evaluate prevalence of underlying significant pathologies among women with cervical smears
rated as ‘atypical squamous cells cannot exclude high grade squamous intraepithelial lesion (ASC-H)’, as well as
associated risk factors. Methods: Medical records were reviewed of all consecutive women with ASC-H smears who
had undergone colposcopy at Srinagarind Hospital from January 2008 to July 2016. Significant pathology results
included cervical intraepithelial neoplasia (CIN) 2-3, adenocarcinoma in situ (AIS), endometrial hyperplasia, and
cancer of any original site. Result: During the study period, 133 women with ASC-H were reviewed. The mean age
was 45.3 years (range 21-72). The histopathologic results for the 133 women were as follows: no lesions (58; 43.6%),
CIN 1 (34; 25.6%), CIN 2-3 (33; 24.8%), AIS (2; 1.5%), and cervical cancer (6; 4.5%). The overall rate of significant
pathology was 30.8% (95% confidence interval, 22.9%-38.8%). Women younger than 40 years old carried a higher
risk of harboring significant lesions when compared to older women (41.7% versus 27.8%, respectively). There was
no significant impact of parity and menopausal status on the risk of significant pathology results. Conclusion: The
rate of significant histopathologies among women with ASC-H smears in this study was approximately 31% and the
associated risk factor was patient age.
Collapse
Affiliation(s)
- Sasivimon Ratree
- Department of Obstetrics and Gynecology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.
| | - Pilaiwan Kleebkaow
- Department of Obstetrics and Gynecology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.
| | - Apiwat Aue-Aungkul
- Department of Obstetrics and Gynecology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.
| | - Amornrat Temtanakitpaisan
- Department of Obstetrics and Gynecology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.
| | - Bandit Chumworathayi
- Department of Obstetrics and Gynecology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.
| | | |
Collapse
|
3
|
Oliveira GGD, Oliveira JMDSCD, Eleutério RMN, Barbosa RDCC, Almeida PRCD, Eleutério J. Atypical Squamous Cells: Cytopathological Findings and Correlation with HPV Genotype and Histopathology. Acta Cytol 2018; 62:386-392. [PMID: 29898441 DOI: 10.1159/000489386] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Accepted: 04/16/2018] [Indexed: 12/28/2022]
Abstract
OBJECTIVE We aimed to assess potential associations between atypical squamous cell (ASC) subgroups: ASC-US (undetermined significance) and ASC-H (cannot exclude high-grade squamous intraepithelial lesion), regarding cytomorphological features, high-risk (HR) human papillomavirus (HPV) testing, and histological outcomes in a sample of Brazilian women. STUDY DESIGN Cross-sectional study which evaluated 1,346 liquid-based cytologies between January 2010 and July 2016 with ASC results. ASC-US and ASC-H were analyzed for frequency, diagnostic criteria, and cytological findings and compared with HR-HPV tests and histological outcomes. RESULTS Enlarged nucleus was the most frequent ASC-US criterion, but alternative criteria were present in 20% of the total cases. No ASC-US criteria were associated with histological outcomes or HR-HPV positivity. Parakeratosis, corneal pearl, giant cells, and binucleation were strongly associated with ASC-US while hyperkeratosis was associated with high-grade squamous intraepithelial lesions (HSIL) or a superior outcome. HR-HPV was positive in 64.39% of ASC-US and 65.38% of ASC-H. HSIL or superior outcomes also occurred in 13.33% of ASC-US and 64.71% of ASC-H cases. CONCLUSION Alternative criteria for ASC-US were relatively frequent. Reactive cellular changes suggestive of atypias were more abundant in ASC-US. Although ASC-H is associated with worse histological outcomes, no differences in HPV positivity were found in comparison to ASC-US.
Collapse
Affiliation(s)
| | | | | | | | | | - José Eleutério
- Department of Pathology, Federal University of Ceará, Fortaleza, Brazil
- Department of Motherhood and Child, Federal University of Ceará, Fortaleza, Brazil
| |
Collapse
|
4
|
Díaz Del Arco C, Sanabria Montoro MC, García López D, Rodríguez Escudero E, Fernández Aceñero MJ. Clinical Relevance of ASC-H Cytologies: Experience in a Single Tertiary Hospital. Acta Cytol 2016; 60:217-24. [PMID: 27490700 DOI: 10.1159/000448022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Accepted: 06/27/2016] [Indexed: 12/20/2022]
Abstract
OBJECTIVES To review the cases of atypical squamous cells (ASC), cannot exclude squamous intraepithelial lesion (ASC-H) diagnosed at a single institution and to discuss the interpretation challenges and clinical management of these cases. STUDY DESIGN The ASC-H cases diagnosed at our institution from 2006 to 2015 were studied retrospectively; of 159,000 Pap smears, there were 959 cases of ASC of undetermined significance (ASC-US) and 148 cases of ASC-H. We have reviewed the clinical records of the ASC-H cases, and data have been analyzed using SPSS 20.0. RESULTS Median age was 43.1 years; 49.6% of the patients had previous cervical cytologies, and 55.9% of them were negative. Following ASC-H diagnosis, another smear was obtained in 97.1% of the cases and in 67.6% a biopsy was performed. Biopsy revealed low-grade dysplasia in 18.8% of the cases, high-grade dysplasia in 27.8%, and infiltrating carcinoma in 2.3%. Patients with significant lesions in histology were younger than patients with negative results (p = 0.08). A diagnosis of ASC-H/squamous intraepithelial lesion in the repeated cytology had a sensitivity of 74.2%, specificity of 39.6%, positive predictive value of 44.8%, and negative predictive value of 70% for the diagnosis of dysplasia. CONCLUSIONS ASC-H diagnosis is associated with a high incidence of histological high-grade lesions. A repeat cytology can aid in the selection of high-risk patients, but there may be false-negative results.
Collapse
|
5
|
Boldrini NT, Freitas LB, Coutinho AR, Loureiro FZ, Spano LC, Miranda AE. High-grade cervical lesions among women attending a reference clinic in Brazil: associated factors and comparison among screening methods. PLoS One 2014; 9:e102169. [PMID: 25019210 PMCID: PMC4094527 DOI: 10.1371/journal.pone.0102169] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2014] [Accepted: 06/16/2014] [Indexed: 11/25/2022] Open
Abstract
Background Although screening for cervical cancer is recommended for women in most countries, the incidence of cervical cancer is greater in developing countries. Our goal was to determine the prevalence and factors associated with high-grade lesions/cervical cancer among women attending a reference clinic in Brazil and evaluate the correlation of histology with cytology, colposcopy and the high-risk HPV (HR-HPV) tests. Methods A cross-sectional study of women attending a colposcopy clinic was carried out. The patients were interviewed to collect demographic, epidemiological and clinical data. Specimens were collected for cervical cytology, Chlamydia trachomatis and HPV testing using the Hybrid Capture (HC) and PCR tests. Colposcopy was performed for all patients and biopsy for histology when cell abnormalities or cervical intraepithelial neoplasia (CIN) were present. Results A total of 291 women participated in the study. The median age was 38 years (DIQ: 30–48 years). The prevalence of histologically confirmed high-grade lesions/cervical cancer was 18.2% (95%, CI: 13.8%–22.6%), with 48 (16.5%) cases of CIN-2/CIN-3 and 5 (1.7%) cases of invasive carcinoma. In the final logistic regression model, for ages between 30 and 49 years old [OR = 4.4 (95%: 1.01–19.04), history of smoking [OR = 2.4 (95%, CI: 1.14–5.18)], practice of anal intercourse [OR = 2.4 (95%, CI: 1.10–5.03)] and having positive HC test for HR-HPV [OR = 11.23 (95%, CI: 4 0.79–26, 36)] remained independently associated with high-grade lesions/cervical cancer. A total of 64.7% of the cases CIN-3\Ca in situ were related to HPV-16. Non-oncogenic HPV were only found in CIN-1 biopsy results. Compared to histology, the sensitivity of cytology was 31.8%, the specificity 95.5%; the sensitivity of colposcopy for high-grade lesions/cervical cancer was 51.0%, specificity was 91.4% and the concordance with HPV testing was high. Conclusions The results confirm an association of HR-HPV with precursor lesions for cervical cancer. These data emphasize that cytological screening to detect precursor lesions is still important in some regions and that HR-HPV should be included for screening.
Collapse
Affiliation(s)
- Neide T. Boldrini
- Post-Graduate Program in Infectious Diseases, Federal University of Espirito Santo (Universidade Federal do Espírito Santo – UFES), Vitória-Espírito Santo (ES), Brazil
| | - Luciana B. Freitas
- Post-Graduate Program in Infectious Diseases, Federal University of Espirito Santo (Universidade Federal do Espírito Santo – UFES), Vitória-Espírito Santo (ES), Brazil
| | - Amanda R. Coutinho
- Post-Graduate Program in Infectious Diseases, Federal University of Espirito Santo (Universidade Federal do Espírito Santo – UFES), Vitória-Espírito Santo (ES), Brazil
| | - Flavia Z. Loureiro
- Post-Graduate Program in Infectious Diseases, Federal University of Espirito Santo (Universidade Federal do Espírito Santo – UFES), Vitória-Espírito Santo (ES), Brazil
| | - Liliana C. Spano
- Post-Graduate Program in Infectious Diseases, Federal University of Espirito Santo (Universidade Federal do Espírito Santo – UFES), Vitória-Espírito Santo (ES), Brazil
| | - Angélica E. Miranda
- Post-Graduate Program in Infectious Diseases, Federal University of Espirito Santo (Universidade Federal do Espírito Santo – UFES), Vitória-Espírito Santo (ES), Brazil
- * E-mail:
| |
Collapse
|
6
|
López-Alegría F, De Lorenzi DS, Quezada OP. Follow-up of women with atypical squamous cells cannot exclude high-grade squamous intraepithelial lesions (ASC-H). SAO PAULO MED J 2014; 132:15-22. [PMID: 24474075 PMCID: PMC10889458 DOI: 10.1590/1516-3180.2014.1321597] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2012] [Accepted: 04/24/2013] [Indexed: 11/22/2022] Open
Abstract
CONTEXT AND OBJECTIVE The concept that the presence of atypical squamous cells cannot exclude high-grade squamous intraepithelial lesions (ASC-H) was introduced in the 2001 Bethesda System of cervical cytology classification. This nomenclature defines cervical cancer precursor lesions. The objective of this study was to investigate the colpocytological-histological results from a three-year follow-up conducted on a cohort of women with reports of ASC-H who were attended during 2005-2006 at clinics of the Southern Metropolitan Healthcare Service of Santiago, Chile. DESIGN AND SETTING Prospective cohort study at primary healthcare clinics in Santiago, Chile. METHODS Colpocytological-histological follow-up was conducted over a three-year period on 92 women with cytological reports of ASC-H who were attended at primary healthcare clinics during 2005-2006. RESULTS At the end of the follow-up period, high-grade lesions were evaluated and the following outcomes were observed: seven women presented invasive cancer (7.6%), 49 presented high-grade lesions (53.3%), 26 presented low-grade lesions (28.2%) and 10 presented normal results (10.9%). The "Conditional Probabilities Tree Diagram" was used to show the results from tests and the times of lesion detection. It demonstrated that, after a first report of ASC-H, clinical management needed to be interventionist. CONCLUSION The follow-up on our cohort of women showed that the majority of uncertain ASC-H diagnoses (82.6%) had abnormal colposcopic results and that during the follow-up using ASC-H smears, two out of every three women developed high-grade lesions.
Collapse
Affiliation(s)
- Fanny López-Alegría
- Department of Nursing, School of Nursing, Universidad Andres Bello, Santiago, Chile
| | - Dino Soares De Lorenzi
- Universidade de Caxias do Sul, Department of Obstetrics and Gynecology, Rio Grande do Sul, Brazil, MD. Professor, Department of Obstetrics and Gynecology, Universidade de Caxias do Sul, Rio Grande do Sul, Brazil
| | - Orlando Poblete Quezada
- Complejo Asistencial Barros Luco, Santiago, Chile, Medical Technologist. Cytology Laboratory, Complejo Asistencial Barros Luco, Santiago, Chile
| |
Collapse
|
7
|
Pity IS, Shamdeen MY, Wais SA. Follow up of atypical squamous cell Pap smears in Iraqi women. Asian Pac J Cancer Prev 2013; 13:3455-60. [PMID: 22994777 DOI: 10.7314/apjcp.2012.13.7.3455] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVES To report the prevalence of atypical squamous cells of undetermined significance and atypical squamous cells-cannot exclude high squamous intraepithelial lesion and to determine the possible association of Pap test results with high-risk human papillomavirus and high squamous intraepithelial lesions in women from Duhok, Iraq. DESIGN A prospective, observational study was conducted between January 2005 and December 2011. Overall, 596 women with a cervicovaginal Pap test showing atypical squamous cells of undetermined significance and 93 atypical squamous cells-cannot exclude high squamous intraepithelial lesion for whom pathologic follow-up was available were studied. Follow-up consisted of repeat cytology, colposcopy and histology. High risk human papillomavirus DNA testing was performed on exfoliated cervical cells from 106 women, using conventional PCR after at least 36 months from the initial Pap smear. RESULTS Significantly high proportions of both atypical squamous cells of undetermined significance (87.9%) and atypical squamous cells-cannot exclude high squamous intraepithelial lesion (62.4%) demonstrated no significant lesion on subsequent follow up. Low squamous intraepithelial lesions were observed in 1.7% of cases of atypical squamous cells of undetermined significance and in 5.4% of atypical squamous cells-cannot exclude high squamous intraepithelial lesion. High squamous intraepithelial lesion was demonstrated in 0.8% and 16.1% respectively. In the latter there was also one case of invasive carcinoma. High-risk HPV DNA was demonstrated in 40% of atypical squamous cells of undetermined significance and 57.1% of atypical squamous cells-cannot exclude high squamous intraepithelial lesions. CONCLUSIONS Since both atypical squamous cells of undetermined significance and atypical squamous cells-cannot exclude high squamous intraepithelial lesion identify patients who are at an increased risk for the development of high squamous intraepithelial lesions and a considerable percentage harbor high risk-HPV, both should be retained as diagnostic categories and patients warrant a diligent follow up and testing for high risk-HPV DNA. Colposcopic evaluation and biopsy, when indicated, are a must.
Collapse
Affiliation(s)
- Intisar S Pity
- Department of Pathology, Faculty of Medicine, University of Duhok, Duhok, Iraq.
| | | | | |
Collapse
|
8
|
Dasgupta S, Bhattacharya S. Is visual inspection with acetic acid better than cervical cytology to screen women ≥ 40 years of age for carcinoma cervix? A cross-sectional study on proportion of screen-positive women (by VIA and cervical cytology) having CIN II/III lesion on cervical biopsy: difference between two age groups and among screening methods. Arch Gynecol Obstet 2012; 285:1731-6. [PMID: 22262492 DOI: 10.1007/s00404-012-2228-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2011] [Accepted: 01/10/2012] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Proportion of CIN II/III lesion on cervical biopsy among screen-positive women of age group < 40 years and ≥ 40 years undergoing screening for carcinoma cervix by Pap smear and visual inspection of cervix with acetic acid (VIA) was determined (both the tests were performed on same population). Difference in proportion of CIN II/III lesion among screen-positive women, between two age groups (for both methods) and between methods (for both age groups) was determined. RESULT In < 40 years age group, proportion of screen-positive women with CIN II/III lesion was similar for both cytology or VIA (12.95 vs. 9.8%). For ≥ 40 year age group, compared to cytology, VIA detected higher proportions of CIN II or III lesion (4.1 vs. 13.3%). Proportion of screen-positive women having CIN II/III lesion was higher in < 40 years compared to ≥ 40 year age group (12.95 vs. 4.1%) with cytology, while for VIA no difference was detected in between age groups (9.8 vs. 13.3%). CONCLUSION Cytological screening is less sensitive in women ≥ 40 years while VIA has a uniform sensitivity for both groups.
Collapse
Affiliation(s)
- Subhankar Dasgupta
- Department of Gynaecology and Obstetrics, Institute of Post Graduate Medical Education and Research (IPGMER), 273, Harinibash, Nungi Station Pally, P.O. Batanagar, DT. 24 PG(S), Kolkata, 743313 West Bengal, India.
| | | |
Collapse
|
9
|
Sung CO, Oh YL, Song SY. Cervical cytology of atypical squamous cells, cannot exclude high-grade squamous intra-epithelial lesion: significance of age, human papillomavirus DNA detection and previous abnormal cytology on follow-up outcomes. Eur J Obstet Gynecol Reprod Biol 2011; 159:155-9. [PMID: 21683502 DOI: 10.1016/j.ejogrb.2011.05.022] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2010] [Revised: 10/23/2010] [Accepted: 05/19/2011] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Despite the usefulness of Pap tests for cancer screening, outcomes can be difficult to predict when atypical squamous cells (ASCs) are identified. According to the 2001 Bethesda system, ASCs can be subdivided into two groups: ASCs of undetermined significance (ASC-US); and ASCs, cannot exclude high-grade squamous intra-epithelial lesion (ASC-H). ASC-H interpretations are uncommon, and studies involving this type of lesion are based on small numbers of cases. STUDY DESIGN Cross-sectional, retrospective study of 392 ASC-H cases. The follow-up outcomes of ASC-H cases that were diagnosed during routine primary screening between 2002 and 2008 were investigated, and relationships between clinicopathological parameters were assessed, particularly positive test for high-risk HPV (HPV) DNA, patient age at diagnosis and previous abnormal cytology. RESULTS Of the 392 cases, high-grade squamous intra-epithelial lesion (HSIL) was detected in 111 (28.3%) cases, squamous cell carcinoma was detected in 15 (3.8%) cases, low-grade squamous intra-epithelial lesion was detected in 37 (9.4%) cases, reactive change was detected in 178 (45.4%) cases, atrophy was detected in 47 (12.0%) cases, and adenocarcinoma was detected in four (1.0%) cases. The prevalence of HSIL or greater was 27.8% for women aged ≥ 40 years, and 52.3% for women aged <40 years (p<0.001). HPV positivity in ASC-H smears was significantly associated with HSIL or greater, irrespective of age (<40 years, p=0.003; ≥ 40 years, p<0.001). ASC-H with previous abnormal cytology greater than ASC-US showed a significantly higher detection rate for HSIL or greater at follow-up (p<0.001). CONCLUSIONS Patient age, positive HPV DNA test and previous abnormal cytology are useful predictors of underlying HSIL or greater in women with ASC-H.
Collapse
Affiliation(s)
- Chang Ohk Sung
- Department of Pathology, Samsung Medical Centre, Sungkyunkwan University School of Medicine, 50 Ilwon-dong, Gangnam-gu, Seoul 135-710, Republic of Korea
| | | | | |
Collapse
|