A 1-year experience with liquid-based and conventional papanicolaou smear in Thammasat University Hospital.
Komsun SuwannarurkKornkarn BhamarapravatanaYudthadej ThaweekulKaricha MairaingYenrudee PoomtavornJunya Pattaraarchachai
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The aim of the present study was to evaluate the prevalence of abnormal Pap smears as detected by liquid-based (LBP) and conventional (CPP) techniques in women who were patients in the gynecologic clinic, Thammasat University Hospital.Retrospective analysis of cervical cancer screening, histopathological findings and operative procedures was done between January 2009 and December 2009. Of the 6,332 participants who underwent gynecological examination and cervical screening and had a Pap smear result as atypical squamous cells of undetermined significance or worse would be performed a further colposcopic examination.A total of 6,332 women were screened for cervical cancer in the one year period. A total of 169 abnormal Pap smears were found. Of 497 (8%) and 5,835 (92%) women were screened by LBP and CPP, respectively. The mean age of patients was 39.45 years old (14-90) and 1,550 (24.5%) women were post menopausal. The Prevalence of abnormal Pap smears was 4.0 and 2.6% in the LBP and CPP groups, respectively. Among LBP group, patients with atypical smear and LSIL (low grade squamous intraepithelial lesion) were 11 (2.29%) and 9 (1.8%), respectively. While CPP group, patient with atypical smear, LSIL, HSIL (high grade squamous intraepithelial lesion) and cancer were 73 (1.25%), 49 (0.84%), 25 (0.43%) and 2 (0.03%), respectively.The prevalence of abnormal Pap smear in women who attended gynecologic clinic of Thammasat University Hospital was 4.0% and 2.6 % per LBP and CPP group, respectively. There was no significant difference in the incidence of atypical smear and false positive result between LBP and CPP.Keywords:
Squamous intraepithelial lesion
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To investigate the necessity, safety and acceptability of routine Papanicolaou (Pap) smear in pregnant women and cytological characteristics of the smears during pregnancy.Pap smear were performed in 954 pregnant women, 1,053 normal controls and 1,908 gynecological out-patients. The cytological preparations were analyzed by using PAPNET method and following Bethesda (TBS-NCI) diagnostic criteria. Quality control was carried out by following TBS-NCI standard.Abnormal epithelial change was found in 89 women (89/954, 9.3%) of pregnant group, which was quite similar to normal controls group and gynecological group. Occurrence rate of cervical squamous intraepithelial lesion (SIL) was the lowest in pregnant group (0.94%, 9 in 954 cases), comparing with control group (2.75%) and gynecological group (6.23%). However, pregnant group had the highest infection rate (89.9%), as compared to gynecological group (64.5%), and normal controls group (69.1%) (P < 0.01).Cervical Pap smear test is necessary, safety and acceptable for routine prenatal tests. Any pregnant women with infections must be treated as nonpregnant one.
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Bethesda system
Premalignant lesion
Gynecological Examination
Squamous intraepithelial lesion
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Early cytologic detection and treatment of high-grade squamous intraepithelial lesion (HSIL) is critical to cervical cancer prevention. The term atypical squamous cells (ASC), cannot exclude HSIL (ASC-H) was introduced in 2001 in the Bethesda System (TBS 2001) to define changes suggestive, but not diagnostic, of HSIL in the absence of unequivocal squamous intraepithelial lesion (SIL). Previous studies showed that women with ASC-H cytology are at an increased risk of harboring underlying histopathologic HSIL. TBS 2001, however, did not address the significance of finding ASC-H changes in a background of unequivocal low-grade SIL (LSIL). There may be a tendency for cytologists to lump these changes with either LSIL or HSIL, depending on their level of comfort. In their laboratory, the authors have referred to these changes as "LSIL, cannot exclude HSIL" (LSIL-H).Between July 2001 and July 2003, all Papanicolaou (Pap) tests that were obtained by using the ThinPrep technique were retrieved from the computer data base at the authors' institution. All categories of squamous cell abnormalities, including LSIL-H, were evaluated for their incidence and follow-up diagnoses of HSIL and more severe lesions (HSIL +). All patients had a minimum of 2 year follow-up by biopsy and cytology (range, 2-4 years).LSIL-H comprised 0.15% (n = 194) of all Pap tests (n = 129,911) that were evaluated during the study period. Follow-up biopsy was available on 59 patients (30.4%), which showed HSIL + in 40.7% of patients. This rate of associated HSIL + differed significantly from that of LSIL (13%; P < .001) and HSIL (74%; P < .001), but was similar to that of ASC-H (44.6%).The results from this study showed that patients with cytologic diagnoses of LSIL-H had an intermediate risk of harboring histopathologic HSIL +. This risk was similar to ASC-H but fell between the low risk associated with ACS-US and LSIL and the high risk associated with HSIL cytologic diagnoses. The authors believe that LSIL-H should be considered as a distinct cytologic diagnostic interpretation and should be separated from LSIL and HSIL. Although LSIL-H does not represent a unique biologic entity, it has clinical usefulness because of its high positive predictive value for HSIL + lesions.
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Background: Cervical cancer is a leading cause of mortality and morbidity among women worldwide and most common gynaecological cancer in developing countries. Papanicolaou smear is a simple and cost effective screening test for cervical cancer. The aim of this study is to evaluate and interpret the cervical pap smear cytology in a tertiary hospital. The interpretation and reporting of the pap smear is based on 2001Bethesda system.Materials and methods: This is a prospective study conducted in a tertiary hospital, Nepal Medical College over a period of two and a half years (January 2013 to June 2015). All cervical pap smears received in the department of Pathology in the study period were included.Results: A total of 4160 cervical pap smears were reported in the study period. Majority of the cases were Negative for Intraepithelial lesion or malignancy (87.9%). Bacterial vaginosis, atrophy and reactive cellular changes associated with inflammation were seen in 5.3%, 2.4% and 1.5% cases respectively. Epithelial cell abnormalities (0.5%) include Atypical squamous cells of undetermined significance, Low grade squamous intraepithelial lesion and High grade intraepithelial lesion. 88% of Low grade squamous intraepithelial lesion was seen in reproductive age group (20-45 years).Conclusion: Cervical cancer is the most common gynaecological cancer in the developing countries. Pap smear is the simple and cost effective screening tool to detect pre invasive cervical epithelial lesions.
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目的:子宮頸部細胞診の日米 (日母分類1997と2001, 年ベセスダシステムに基づく) の診断の違いを検討した.方法:材料は米国で細胞診断医によって診断, 報告された頸部細胞診標本109例を用いた. 日本側の分類を日本の細胞検査士が担当し, 日米の診断を比較した. 完全一致 (complete agreement以下, CA) と部分的一致 (partial agreement以下PA) について検討を行い, さらに米国の意義不明異型扁平上皮細胞 (atypical squamous cells of undetermined significance以下ASC-US) が日本側でどのように分類されているかを調べた.成績:全体としてのCA, PA率はそれぞれ39.4%で, CAは高度扁平上皮内病変 (high-grade squamous intraepithelial lesion以下HSIL), 軽度扁平上皮内病変 (low grade squamous intraepithelial lesion以下HSIL), 反応性変化/陰性, それぞれ, 84.6, 41.4, 74.1%であった. ASC-USは日本側で, それぞれ, 約50, 40%が反応性変化, 軽度異型成 (mild dysplasia) に分類されていた.結論:両国の診断の一致率は比較的高く (CA+PAで約80%), HSILと反応性変化/陰性に関しては, 両国の診断の差異は少ないものと考える. 一方, この間の分類 (特にLSIL) の一致率は低く, 日米の診断システムの違いはこの差によるところが大きいものと考えられる.
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Objectives The quality of cervicovaginal smears determines the success of cytology in screening programs for cervical cancer. Bethesda 2014 revisited the adequacy criteria for atrophic smears and redefined the squamous cell count in the “unsatisfactory” category. In this study, we evaluated the smear quality of Thinprep liquid‐based cervicovaginal Papanicolaou cytology slides (TPS) that were previously deemed unsatisfactory, to determine reasons for such categorization. In addition, we attempted to establish the impact of the new adequacy criteria on the rate and management of unsatisfactory diagnosis. Methods About 234 unsatisfactory TPS were examined. The reasons for unsatisfactory were noted. The number of squamous cells was recounted, as per the new Bethesda criteria, in borderline adequacy cases that showed an atrophic pattern. Results The leading cause for unsatisfactory TPS was lubricating gel, followed by blood, as observed in older and younger age groups, respectively (Figure 1). Eleven borderline cases were reclassified as “satisfactory” using the new Bethesda cell count, with 27% above 60 years of age. About 82% of these borderline cases were negative for intraepithelial lesion or malignancy on repeat testing. Conclusions There was no difference of management or change in rate of unsatisfactory when patients above 60 were reclassified into the satisfactory category using the new Bethesda count. However, a larger study is needed to evaluate whether the new recommendation for minimum cellularity can be implemented in patients above a certain age cut‐off. The study highlights the need for improvement in collection practices and education of practitioners.
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Background: Cervical cancer is an important public health problem. In Uganda, it ranks the most frequent cause of cancer among women aged between 15 to 44 years of age. Early detection and eradication of cervical cancer and its precursor lesions is the mainstay for control of this disease. The Pap smear method is the most cost-effective means of screening cervical pre-malignant, malignant processes and non-neoplastic lesions. Aim: To describe the cervical cytological abnormalities as detected byPap smear method and to determine the prevalence of such abnormalities. Methodology: This was a prospective study, in which a total of 175 women were recruited from May to June, 2016. Cervical samples were collected from these women and stained according to the papanicolaou staining protocol. Results were reported using the 2014 Bethesda reporting system. Results: Out of 175 cases, 163 (93.1%) were reported as negative for intraepithelial lesion or malignancy [NILM]. Cervical intraepithelial lesions were reported in 12 (6.9%) cases which included atypical squamous cells of undetermined significance [ASCUS] in 4(2.3%) cases, atypical squamous cells cannot exclude high grade squamous intraepithelial lesions [ASCH] in 1(0.6%) case, low-grade squamous intraepithelial lesion [LSIL] in 5 (2.9%) cases, high-grade squamous intraepithelial lesion [HSIL] in 1(0.6%) case and atypical glandular cells [AGC] in 1(0.6%) case. Conclusion: Cervical cytology by Pap smear method should be used to screen women routinely because it is an effective method in detecting pre-malignant and malignant lesions of the cervix.
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Evolution of Bethesda System for Reporting Cervical Cancer Cytological Screening Sumarin Pratumkaew BSc (Biology)* Siriwan Tangjitgamol MD** Apichote Khumsangmeun BSc (Biology)* * Department of Anatomical Pathology ** Department of Obstetrics and Gynecology Faculty of Medicine Vajira Hospital, University of Bangkok Metropolis The Bethesda system (TBS) was introduced in 1988 with an intention to replace Papanicoloau, dysplasia, cervical intraepithelial neoplasia systems. This system covers an adequacy of specimen and introduces a new classification of abnormal cells. In 1991, TBS added detail on the adequacy of specimen and included a category of “satisfactory but limited by.” In 2001, TBS included specimen type while the category “satisfactory but limited by” was eliminated, and replaced “within normal limits” with the term “negative for intraepithelial lesion or malignancy.” The category of atypical squamous cells (ASC) divided into qualifiers ASC of undetermined significance (ASC-US) and cannot exclude HSIL (ASC-H) and added HSIL (high grade squamous intraepithelial lesion) with features suspicious for invasion. The term “atypical glandular cells (AGC) was divided into AGC, NOS (not otherwise specified) and AGC favor neoplastic, while adenocarcinoma in situ (AIS) was separated from AGC categories. It also included management guidelines with cervical cytological abnormalities. Keywords: Papanicolaou , dysplasia , cervical intraepithelial neoplasia, the Bethesda system Vajira Med J 2010 ; 54 : 395 - 404
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Introduction: Cervical PAP smears are a cost effective, out-patient procedure to screen patients for cervical pathology. Objectives: To utilize cervical PAP smear examination in categorizing lesions according to the 2014 Bethesda System for cervical cytology, to analyse the spectrum of lesions andto evaluate its effectiveness as a screening procedure for detection of epithelial abnormalities in a teaching hospital in North Karnataka. Methods: A prospective one year study was carried on all conventional PAP smears received in the Department of Pathology, Navodaya Medical College, Raichur. Reporting was done in accordance with the 2014 Bethesda System for reporting cervical cytology. Correlation was done with the clinical findings. Results: A total of 578 cases were included in the study. The most common presenting complaint was abdominal pain (28.5%). The most frequent examination finding was white discharge per vaginum, WDPV (38.9%). 90.8% of PAP smears were categorized as ‘Negative for intraepithelial Lesion or Malignancy’. Specific infections were seen in 8.1%, squamous metaplasia in 15.5% and atrophic changes in 3.2%. Epithelial cell abnormalities comprised 9.2% of cases, of which Atypical Squamous Cells of Undetermined Significance (ASC-US) was 3.2%, Low grade Squamous Intraepithelial Lesion (LSIL) was 3.6%, High grade Squamous Intraepithelial Lesion (HSIL) was 1.9%, Squamous Cell Carcinoma (SCC) was 0.2% and Atypical Glandular Cells– Not Otherwise Specified (AGC-NOS) was 0.9%. Conclusion: The overall prevalence of epithelial cell abnormalities concurred with studies done in other parts of India and constituted9.2% of the total smears screened, LSIL being the most common lesion.
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In this issue of the Journal, Renshaw et al1 address the issue of subcategorizing Papanicolaou (Pap) tests diagnosed as atypical squamous cells of undetermined significance (ASCUS). I would like to make several comments about this article in light of the recommendations presented on the Web site of the 2001 Bethesda System Conference2 and in light of ancillary studies, such as human papillomavirus (HPV) testing. One of the recommendations from the 2001 Bethesda System Conference is for changing the terminology of Pap tests formerly called ASCUS (using the 1991 Bethesda System terminology).2,3 The 1991 Bethesda Committee recommended that ASCUS Pap tests could be subclassified as favor reactive or favor dysplasia (favor low-grade squamous intraepithelial lesion [SIL]), and if neither of these categories seemed to fit, then the Pap test could be diagnosed simply as ASCUS (which some prefer to term the not otherwise specified [NOS] category).3 The 2001 Bethesda Committee recommended eschewing previous ASCUS terms for the term atypical squamous cells (ASC); all Pap tests then should be subclassified as either atypical squamous cells– undetermined significance (ASC-US) or atypical squamous cells–high-grade dysplasia not excluded (ASC-H).2 Note the differences in the 1991 and the 2001 Bethesda Systems categories of ASCUS. It was argued that the ASCUS, favor reactive category be eliminated from the 2001 schema because follow-up reveals that the majority of women with this diagnosis do not have a high-grade dysplasia but have a benign lesion.2 The ASCUS, NOS and ASCUS, favor dysplasia categories were collapsed into 1 category because it was thought that both categories included women with a significant risk of having dysplasia (mostly low grade) on follow-up. Although the risk of dysplasia associated with the categories of ASCUS, NOS and ASCUS, favor dysplasia are different, this difference in risk was not considered disparate enough to warrant 2 categories. Followup data for women with ASC-H show that the risk of having dysplasia, and particularly high-grade dysplasia, is significantly higher than for women with ASC-US.2 Atypical cells classified as ASC-H usually are metaplastic, and it is interesting to note that the 1991 Bethesda Committee recognized these cells as potentially representing a high-grade dysplasia.3 As a result of these recommendations, the 1991 Bethesda System category of ASCUS morphed from 3 categories to 2 categories, one predominantly a risk category for low-grade dysplasia and the other predominantly a risk category for high-grade dysplasia. The ASCUS categories examined by Renshaw et al1 are a hybrid of the 1991 and the 2001 Bethesda categories. The 1991 ASCUS, favor reactive category is maintained; the 1991 ASCUS, favor dysplasia and ASCUS, NOS categories are not collapsed; and the 2001 ASC-H category is added. Using receiver operating characteristic curve analysis, Renshaw et al1 argued that the sensitivity of the Pap test is lowered if any ASCUS subset is eliminated. Does this mean that the 2001 Bethesda Committee is mistaken in eliminating ASCUS, favor reactive and in collapsing ASCUS, NOS and ASCUS, favor dysplasia? I believe that the 2001 Bethesda Committee is justified in its recommendations, although I agree with Renshaw et al1 that removal of ASCUS subcategories decreases Pap test sensitivity. Before discussing these points further, the data and methods of Renshaw et al1 first deserve some comment. The data used in their analysis suffer from sample bias. The
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