Intermediate‐grade squamous intraepithelial lesion may be a valid diagnostic/interpretive category
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Abstract We undertook this study to assess the characteristics of smears with features intermediate between high‐grade squamous intraepithelial lesion (HSIL) and low‐grade squamous intraepithelial lesion (ISIL). We also wanted to determine how these smears correlate with high risk biopsy diagnosis and to compare this with the biopsy correlation of LSIL and HSIL. Seventy‐four squamous intraepithelial lesion (SIL) smears were identified as intermediate‐grade SIL smears taken at colposcopy in a 1 year period. They were correlated with concurrent colposcopically guided biopsies. Thirty‐five percent of cases with intermediate‐grade SIL smears had a biopsy diagnosis of moderate dysplasia or higher as compared with 12% for LSIL 74% for HSIL. This confirmed our hypothesis that intermediate‐grade SIL smears have a rate of biopsy diagnosis of moderate dysplasia or higher intermediate to that of LSIL and HSIL. Diagn. Cytopathol. 2009. © 2008 Wiley‐Liss, Inc.Keywords:
Squamous intraepithelial lesion
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According to recent guidelines, the diagnosis of low-grade intraepithelial neoplasia (formerly known as ”low-grade dysplasia”, abbreviated to ”LGD”) in Barrett’s esophagus requires a more frequent surveillance program, examining patients until the histology is negative for neoplasia or until a higher degree of neoplasia is detected [1] [2]. This is rather difficult to understand because the guidelines for managing this condition in the colon, duodenum, and stomach advise gastroenterologists to remove foci of low-grade intraepithelial neoplasia (i. e. adenomas) completely rather than to wait for the lesion to disappear or progress (which would be regarded as a rather lazy, or at least an unethical attitude with respect to such lesions in these sites).
Barrett's esophagus
Bystander effect
Premalignant lesion
Intestinal metaplasia
Intraepithelial lymphocyte
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Purpose of investigation: Considering the relationship between high-risk human papillomavirus types and the presence or subsequent development of cervical high-grade preinvasive lesions, the aim of the study was to determine if the Hybrid Capture II test can be used to triage women with atypical colposcopic findings. Methods: The study was carried out on 100 patients with suspicious colposcopy findings (suggestive of human papillomavirus infection) who underwent a cervical smear for human papillomavirus testing DNA Hybrid Capture II and direct biopsies for histopathological analysis. Results: Sixteen patients were negative for human papillomavirus. Of the eight patients positive for high-risk HPV type, seven presented an abnormal transformation zone grade 2 (high-grade squamous intraepithelial lesion of the cervix at histopathology). There was a significant positivity of medium-high risk virus types in the cases with more abnormal colposcopy (Χ 2 = 7.44; p < 0.005). Histopathological findings of high-grade squamous intraepithelial lesions were registered in the patients positive for medium-high risk human papillomavirus types (Χ 2 = 7.66; p < 0.025). Conclusions: Based on these results it can be concluded that if a diagnosis of a high-grade squamous intraepithelial lesion has been made on the basis of colposcopic and histopathological findings, there is a high probability that the infection was due to one or more types of human papillomavirus. There are necessary further studies to interpretate both the advantages and disadvantages of intermediate triage procedures, like Hybrid Capture II testing, compared with immediate colposcopy.
Squamous intraepithelial lesion
Histopathology
Hybrid capture
Triage
Koilocyte
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Objective To investigate the clinical value of thinprep cytology test(TCT) combined with colposcopy in diagnosis of cervical lesion. Methods Retrospective analysis was conducted in 174 females with abnormal cervical smear. All the patients underwent colposcopy to screen the cervical lesions. According to the pathological results,the clinical value of TCT and colposcopy was analyzed and compared. Results In the 174 cases with abnormal cervical smear,the positive rate of atypical squamous cells(ASC) was 27. 0% (47/174). There were 92 low grade squamous intraepithelial lesion (LSIL) (52. 9%) ,33 high grade squamous intraepithelial lesion (HSIL) (19. 0%) and 2 squamous cell cancinoma (SCC) (1. 1%) . According to the diagnosis by biopsy and pathology,the positive rate of benign cervical cell(BCC) was 16. 1% (28/174) .cervical intraepithelial neoplnsia (CIN) I 42. 0% (73/174), CIN II 18.4% (32/174), CIN ffl 21. 8% (38/174) and SCC 1. 7% (3/174) . The coincidence rate of TCT and pathology was 83. 9% (146/174). Conclusions TCT and colposcopy are a practical approach for detecting cervical lesion. TCT combined with colposcopy is the optimal screening approach for cervical lesion, which can enhance the sensitivity and specificity of the diagnosis of cervical lesions.
Key words:
Thinprep cytology test; Cervical intraepithelial neoplnsia; Colposcopy; Biopsy
Squamous intraepithelial lesion
Ascus (bryozoa)
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บทคดยอ การศกษาเชงพรรณนา แบบเกบขอมลยอนหลงครงนมวตถประสงคเพอศกษาเปรยบเทยบความไว และความจำเพาะตอรอยโรค Low grade squamous intraepithelial lesion(LSIL)กบ High grade squamous intraepithelial lesion (HSIL) ของการทำ Pap smearและ Low grade lesion(LGL)กบ High grade lesion(HGL)ของการทำ colposcopy โดยรวบรวมขอมลจากแบบบนทกผลการทำPap smearผดปกต ผลตรวจ ของ colposcopy และผลตรวจชนเนอทางพยาธวทยาของสตรทมารบการตรวจวนจฉย และรกษารอยโรค ในคลนก colposcopy โรงพยาบาลสนปาตอง จงหวดเชยงใหม ระหวางวนท 1 มถนายน พ.ศ.2557 ถง 31 มนาคม พ.ศ.2560 จำนวน 160 ราย แลวนำขอมลทเกบรวบรวมมาวเคราะหดวยสถตเชงพรรณนา ผลการศกษาพบวา HSILมความไวและความจำเพาะสงกวาLSIL(รอยละ68.6,84.8 และรอยละ51.6,80.0) , LGL มความไวสงแตความจำเพาะตำกวา HGL(รอยละ77.4,72.7 และ รอยละ68.6,78.8 ) ในรอยโรคขนตำ colposcopy มความไวสง (รอยละ77.4,72.7) แตความจำเพาะ ตำกวา Pap smear ( รอยละ51.6, 80.0 ) ในรอยโรคขนสง Pap smear มความไวไมแตกตางกน (รอยละ68.6) แตมความจำเพาะสงกวา colposcopy (รอยละ84.8, 78.8 ) พบวาการมปากมดลกอกเสบมผลทำใหความไวของ LSILและ LGL ลดลง จากการศกษานเสนอแนะใหกลมทมความเสยง ควรมการตรวจ Pap smear อยางสมำเสมอทกป นอกจากนผมอาการอกเสบของปากมดลกควรไดรบการรกษากอนการตรวจ คดกรองเสมอ This retrospective descriptive study aims to compare sensitivity and specifcity of Low and High grade squamous intraepithelial lesion (LSIL and HSIL) ) from Pap smear. In addition, Low grade lesion (LGL) and High grade lesion (HGL) from colposcopy procedure were also studied. Data were collected from the Colposcopy clinic at Sanpatong Hospital, Chiangmai, during 1 st June, 2014 to 31 th March 30, 2017. A total of 160 patients who found abnormal by colposcopy and biopsy were included for retrospective descriptive analysis. Results found that sensitivity and specifcity of HSIL were higher than LSIL (68.6%, 84.8% and 51.6%, 80.0%). The sensitivity of LGL was higher than HGL (77.4%, 72.7%), but it was opposite as the specifcity of LGL that was lower than HGL (68.6%, 78.8%). In low grade cervical lesion detected by colposcopy showed higher sensitivity (77.4%, 72.7%), but it showedless specifcity (68.6%) than that detected by high grade cervical lesion of Pap smear (51.6%,80.0%). The sensitivity of high grade lesions by Pap smear and colposcopy showed no difference, but it showed higher specifcity than colposcopy respectively (84.8%, 78.8%).Moreover, cervicitis can cause reduction in sensitivity of LSIL and LGL. From this study the high risk group was recommended to be examined by Pap smear annually. Furthermorepatients who had cervicitis should receive a proper treatment before screening by Pap smear .
Squamous intraepithelial lesion
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Squamous intraepithelial lesion
Papanicolaou Test
Pap test
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The aim of the study was to assess the accuracy of colposcopy evaluation at the time of the loop electrosurgical excision procedure (LEEP) to identify women with a previous confirmatory diagnosis of squamous intraepithelial lesion/cervical intraepithelial neoplasia (SIL/CIN) with low probability of dysplasia in the LEEP specimen.We prospectively recruited a cohort of 162 women undergoing LEEP for histological high-grade SIL/CIN 2-3 or low-grade SIL/CIN 1 with high-grade SIL cytology showing a fully visible squamocolumnar junction in the colposcopy evaluation at the time of LEEP. At the referral visit cervical cytology, human papillomavirus and genotype detection, digital colposcopy, colposcopical lesion measurement, and 1 or more biopsies of the transformation zone were obtained. The uterine cervix was colposcopically evaluated intraoperatively.Thirty-four women (21.0%) had a normal colposcopy evaluation at the time of the LEEP, whereas the remaining 128 women showed abnormal findings. Absence of SIL/CIN in the LEEP specimen was confirmed in 28 (82.3%) of the 34 women with a normal colposcopy at the time of LEEP group and 8 (3.1%) of the 128 women showing abnormal colposcopy at the time of LEEP group (p < .001). A normal colposcopic evaluation at the time of LEEP was associated with an increase in the risk of absence of lesion in the cone specimen compared with cases presenting an abnormal colposcopy (95% CI = 33.8-1,555.1, p < .001). The colposcopy evaluation at the time of LEEP had a positive predictive value of 82.3% (95% CI = 66.5-91.5) and a negative predictive value of 96.9% (95% CI = 92.2-98.8) to predict low probability of SIL/CIN in the specimen.Colposcopic evaluation at the time of LEEP seems to be accurate to identify SIL/CIN postbiopsy regression; thus, its performance would be considered at the time of the treatment.
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Ascus (bryozoa)
Squamous intraepithelial lesion
Clinical Significance
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Carcinoma in situ
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Abstract Background: The optimal method for managing a patient diagnosed with atypical squamous cells of undetermined significance (ASCUS) has not yet been established. The interim guidelines published by the National Cancer Institute suggest that a patient should be referred for colposcopy after the second ASCUS diagnosis within 2 years. Aim: To assess the significance of ASCUS in predicting the presence of underlying squamous intraepithelial lesion (SIL) of the uterine cervix. Study population: Women undergoing colposcopy for ASCUS cytology at a teaching hospital in Tehran University, in the years 1998–2001, considered eligible to enter this retrospective study. Results: Of the 266 patients who underwent colposcopy, 28 (11%) had low‐grade squamous intraepithelial lesion (LSIL), 16 (6.3%) had high‐grade squamous intraepithelial lesion (HSIL) two (0.8%) had squamous cell carcinoma (SCC), and 48 (18.8%) had flat condyloma. Conclusion: Atypical squamous cells of undetermined significance (ASCUS) on a cervical smear is a good marker for detecting underlying SIL and condyloma. Thus, immediate colposcopy and directed biopsy are appropriate follow‐up procedures.
Ascus (bryozoa)
Squamous intraepithelial lesion
Not Otherwise Specified
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To evaluate the risk of progression to cervical intraepithelial neoplasia (CIN) grade 2 or 3 in women with positive human papillomavirus (HPV) testing and low-grade (low-grade squamous intraepithelial lesions), borderline (atypical squamous cells of undetermined significance), or no cervical lesions, and to determine the accuracy of initial colposcopy to predict progression.Women with HPV infection and low-grade squamous intraepithelial lesions, atypical squamous cells, or normal cytology were recruited and grouped according to cytologic or histologic diagnosis. Exclusion criteria were histologic CIN 2 or 3, previous cervical cancer and HPV infection, cervical disease, or treatment for CIN 2 or 3 in the past 3 years. Four-hundred sixty-five women were included and monitored by cytology, Hybrid Capture-2 test, and colposcopy every 6 months. Colposcopy results were described as normal, with minor or major changes, and lesion size was recorded in quadrants.Forty-three women (9.3%) had progression to CIN 2 or 3. No significant differences were found in rate of progression between women with low-grade squamous intraepithelial lesions, atypical squamous cells, or negative results (8.2%, 13.4%, and 9.8%, respectively; P=.679). Neither colposcopy pattern (P=.284) nor lesion size (P=.170) at recruitment provided any information on the risk of progression. History of cervical lesion and worsening of the colposcopy pattern during follow-up were associated with progression (P<.001).Initial colposcopy findings do not provide relevant information on the risk of progression in HPV-positive women with minor or no cervical lesions. These women have a similar risk of progression and should benefit from the same follow-up strategies.
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