Should Liquid-Based Cytology Be Repeated at the Time of Colposcopy?
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Abstract:
To evaluate the usefulness of repeated liquid cytology at the time of colposcopy.We screened 5,100 women with liquid-based cytology and human papillomavirus (HPV) DNA testing. Women with any abnormal cytology result including atypical squamous cells of undetermined significance (ASCUS) or a positive high-risk HPV DNA test result were referred for colposcopy. One thousand three hundred thirty-three women returned for colposcopy with repeated cytology and cervical biopsy.Twenty-one women had less than high-grade squamous intraepithelial lesion (HSIL) screening cytology and cervical biopsy results; however, their repeated cytology at the colposcopy visit revealed HSIL, and excisional treatment was recommended. Repeated cytology at colposcopy significantly changed the clinical management for 1.6% (21) of 1,333 women.As an adjunct test to colposcopy, liquid cytology was similar to conventional cytology. Given current practice patterns, repeated liquid cytology at the time of colposcopy is rarely clinically useful.Keywords:
Ascus (bryozoa)
Squamous intraepithelial lesion
Liquid-based cytology
<b><i>Objective:</i></b> To date, the impact of digital imaging on routine cytology remains far from perfect. Cellblock (CB) preparations from Pap samples have been shown to be diagnostically valuable. We evaluated the validity of utilizing whole-slide imaging (WSI) prepared from Pap CBs as a screening tool. <b><i>Study Design:</i></b> A total of 1,110 CB slides prepared from residual Pap samples were analyzed - 563 normal, 282 atypical squamous cells of undetermined significance (ASCUS), 12 atypical squamous cells-cannot exclude high-grade squamous intraepithelial lesion, 188 low-grade squamous intraepithelial lesions (LSIL), 36 high-grade squamous intraepithelial lesions (HSIL), 25 atypical glandular cells of undetermined significance, 1 adenocarcinoma in situ, 2 invasive adenocarcinomas, and 1 squamous cell carcinoma. Virtual slides were obtained using the Aperio system. Test performance characteristics of liquid-based samples and WSI from CB samples were compared. <b><i>Results:</i></b> Average sensitivity and specificity of the five WSI reviewers was 58.3 and 85.1% for ASCUS, respectively, 54.1 and 93.9% for LSIL, and 51.8 and 98.8% for HSIL. Overall WSI sensitivity and specificity for detecting lesions was 82.1 and 86.2%, respectively. Agreement (kappa values) between WSI reviewers was 0.56 for ASCUS, 0.69 for LSIL, 0.67 for HSIL, and 0.74 for negative samples. <b><i>Conclusions:</i></b> WSI of CB preparations is a feasible method to achieve high-quality specimen preparations. It is as sensitive as liquid-based methods and appears to be highly specific for the detection of LSIL and HSIL.
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To evaluate the effect of cellularity on the sensitivity of both screening and diagnosis in a liquid-based cervical sample.SurePath samples (TriPath Imaging Inc., Burlington, North Carolina, U.S.A.) with known diagnoses were selected, including 18 negative, 16 low grade squamous intraepithelial lesion (LSIL) and 12 high grade squamous intraepithelial lesion (HSIL) cases. Through a serial dilution technique, samples of varying cellularity were prepared. The 275 slides were assigned random numbers and were routinely screened by 1 of 2 senior cytotechnologists, blinded to the reference diagnosis. Specimens with a screening diagnosis of atypical squamous cells of undetermined significance (ASCUS) or higher were reviewed by two pathologists, resulting in a final consensus diagnosis. Using a grid counting system, cellularity was determined for each slide.There was a clear demarcation in sensitivity between specimens with a cellularity of < 5,000 or > or = 5,000 squamous cells. This applied to both the sensitivity for screening and to the final consensus diagnosis. For cases with a reference diagnosis of LSIL+, at a cytotechnologist screening level of ASCUS or greater, sensitivity increased from 72.8% (< 5,000 cells) to 98.1% (> or = 5,000 cells) and for a reference diagnosis of HSIL from 85.7% to 100%, respectively. Similarly, for the consensus diagnosis, sensitivity rose from 78.5% (< 5,000 cells) to 96.6% (> or = 5,000 cells) for LSIL+ and from 82.9% to 100%, respectively, for HSIL. These differences were statistically significant (P < .001).A minimum cellularity of 5,000 squamous cells is recommended for SurePath liquid-based cervical preparations.
Ascus (bryozoa)
Squamous intraepithelial lesion
Liquid-based cytology
Cytopathology
Bethesda system
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Objective:To explore clinical significance of the further method dealt with in ASCUS(atypical squamous cells undetermined significance) of cervical smear.Methods:118 patients with ASCUS were detected by colposcopy and high risk HPV test,simultaneously make biopsy of cervical guided by colposcopy.Result:By diagnosed with pathology,chronic cervical inflammation is 72 cases,46 cases were CIN(cervical intraepithelial neoplasia).In this study 40 cases were positive in HPV test which 33 cases are CIN(χ2=48.18,P0.05).Comparae the sensitivity of Human papillomavirus(HPV) test with colposcopy has no significance(71.74% vs 78.26%;P0.05).Conclusion:There are high CIN csses in Women with ASCUS whose should be paid attention to and strengthen management.Colposcopy and high risk HPV test are efficiency method to ASCUS,especially high risk HPV test is positive that need detective by colposcopy.The combination of colposcopy and high risk HPV test can improve detective rate and accuracy of cervical intraepithelial neoplasia(CIN).
Ascus (bryozoa)
Clinical Significance
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Objective To explore the high-risk human papillomavirus(HPV-DNA) testing and colposcopy in cervical cytology(ASCUS) for the clinical value of further processing. Methods From March 2013 to August 2013,46 patients diagnosed as ASCUS by cervical cytology were given high-risk HPV-DNA detection and colposcope examination. The abnormal cervical areas were given pathological biopsy according to the key standard of pathological diagnosis. Results The positive rate of biopsy of the high-risk HPV-DNA positive patients was higher than that of the HPV-DNA negative ones,and the difference was statistically significant( P 0. 01),the positive rate of biopsy of the positive colposcopy patients was higher than that of the negative ones(P 0. 01). The high-risk HPV-DNA detection,the sensitivity and specificity of colposcopy examination were not statistically significant(P 0. 05). Conclusion Attention should be paid to the management of patients with ASCUS. Colposcopy is an effective way for ASCUS patients with cervical lesions and cervical cancer,especially for high-risk HPV-DNA positive cases.
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According to the American Society of Colposcopy and Cervical Pathology (ASCCP), cervical cytology patients who test positive for atypical squamous cells of undetermined significance (ASCUS) and the human papilloma virus (HPV) positive are recommended to undergo colposcopies. This study compared the colposcopic biopsy evaluation results of patients with positive cervical cytology results for ASCUS and HPV with regards to their HPV genotypes.This study included 179 patients who underwent cervical cancer screening tests between June 2015 and June 2017 and whose results displayed positive cervical cervical cytology results for ASCUS and HPV. Cytological samples were classified using the Bethesda system in liquid-based specimens. The Hybrid Capture II system was used to define the HPV-DNA. Colposcopic diagnoses and biopsy results were compared in terms of the outcomes of the Pap test and HPV genotypes.There were 107 ASCUS/HPV16/18-positive patients. Of the HPV 16/18 positive patients; 28 (26.1%) patients were detected with CIN1, 8 (7.5%) patients were detected with CIN2, 6 (6%) patients were detected with CIN3, and 1 (0.9%) patient was detected with cervical cancer. Of the 72 non-HPV 16-18 positive patients; 8 (11%) patients were detected with CIN1 and 2 (2.7%) patients were detected with CIN2.This study believes that the ASCCP recommendations, which state that a 'colposcopy should be performed on all women with positive cytology for ASCUS/non-HPV16/18 oncogenic types', is required to be revised. This will reduce the rate of the colposcopy procedures by 40% in women with ASCUS/HPV positivity.
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We aimed to compare the efficiency of conventional cytology (CC) and new liquid-based cytology (LBC) techniques in the assessment and the accuracy of Pap smears reported as abnormal by histological examinations. Materials and methods: A total of 3488 women who were undergoing routine cervical screening (1308 CC and 2180 LBC) were included in the initial screening. The results were assessed as either satisfactory or unsatisfactory. Satisfactory results were subdivided as negative, atypical squamous cells of undetermined significance (ASCUS), atypical squamous cells for which high-grade lesions could not be excluded (ASC-H), low-grade squamous intraepithelial lesion (LGSIL), high-grade squamous intraepithelial lesion (HGSIL), and cancer. Results: These data show that the rate of unsatisfactory results for the LBC technique (0.05%) was lower than for the CC group (0.5%). Except for ASCUS and cancer cytology, all other atypical cytology results were diagnosed more frequently with CC than with LBC. The rates of detected ASC-H and HGSIL were higher with CC than LBC, and the difference was statistically significant (P < 0.05). Conclusion: LBC has higher satisfaction rates than CC. LBC also detected more true-abnormal cases when compared with CC. The residual specimens from the LBC technique can be used to detect human papillomavirus DNA through immunocytochemistry, if needed. However, the benefits of LBC do not seem to justify the cost. It seems that CC should be the first choice for developing countries with lower incomes.
Ascus (bryozoa)
Squamous intraepithelial lesion
Liquid-based cytology
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Objective: To evaluate the application value of HR-HPV and colposcopy in CIN and invasive cervical cancer diagnosis,when ASCUS was diagnosed by the cervical cytology,and to build the clinical diagnose pathway.Methods:320 patients who were diagnosed as ASCUS underwent the colposcopy and HR-HPV test.The relationship between ASCUS and patients' age was also analysed.Results:In ASCUS patients,49.38% patients were aged from 30 to 49 years.The histo-pathological results of 320 ASCUS were as follows:inflammation 73.13%(234/320),condyloma 5.32%(17/320),CIN(included CINⅠ,CINⅡ,CINⅢ) 20.61%(66/320),high grade CIN(included CINⅡ,CINⅢ) and invasive cancer 7.5%(24/320).144 patients were HR-HPV positive,and the positive rate was 45%(144/320).In HR-HPV positive group,43.75% patients(63/144) were CIN.In HR-HPV negative group,only 3.41% patients(6/176)were CIN.Conclusions: Those ASCUS patients with HR-HPV positive,especially between 30-year to 49-year,should undergo colposcopy.Those patients with HR-HPV negative might not undergo colposcopy,but they should receive the TCT and HR-HPV test regularly.
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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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Cervical cancer is one of the five most common cancers among women. The present study aimed to compare conventional and liquid-based Pap smear methods in 2018 in Kerman, Iran. This was a cross-sectional study. Pap smear samples (conventional Pap smear (CN) and liquid-based cytology (LBC)) were collected from five health centres in Kerman. Samples were classified into two groups of liquid and CNs, and each group was classified into normal, abnormal (including, atypical squamous cells of undetermined significance (ASCUS+), atypical squamous cells, cannot exclude high-grade squamous intraepithelial lesion (ASC-H+), low-grade squamous intraepithelial lesion (LSIL+), high-grade squamous intraepithelial lesion (HSIL+) and cancer+) and unsatisfactory. Descriptive data analysis and chi-square/Fisher's exact test were performed in SPSS 20 (SPSS Inc., Chicago, IL). Totally, 31,513 women were screened by two CN and LBC. The mean age of subjects was 39.73 ± 9.58 years. The unsatisfactory smears (1.4% versus 0.02%; p=.001) and ASCUS+ (45.1% versus 39.4%; p=.007) were more reported by conventional tests, while LSIL+ (33.1% versus 38.9%; p=.005) was reported by the LBC test. Among women who were younger than 40 years, the CIN2+ that was found by LBC was significantly more than the CN method (37.4% versus 31.7, p=.04) and among older women (older than 40 years) the CIN1+ was significantly more as well (18% versus 13.6%, p=.05). The present study showed that, although LBC had many advantages, CN is still useful. Further studies are to be suggested as a clinical trial in another population with a large number of participants to compare the diagnosing methods of cervical cancers. Impact StatementWhat is already known on this subject? The conventional Pap smear (CN) and liquid-based cytology (LBC) methods are the most common methods for screening cervical cancers. Previously, in some studies, LBC was reported as a better method and in some studies, traditional method was preferred. Conflicting results were found in previous articles.What do the results of this study add? LBC compared to CN could find truer abnormal cases. The superiority of the LBC method is seen in cases such as reducing unsatisfactory cases, etc. LBC compared to CN could find more CIN+. Also, LBC could find more CIN1+ among women older than 40 years and more CIN+ ≥2 among younger women.What are the implications of these findings for clinical practice and/or further research? Although LBC has many advantages and it is easier, CN is still useful and both methods are suitable for cervical abnormality and cancer detection. CN cannot be declared an outdated method.
Ascus (bryozoa)
Squamous intraepithelial lesion
Liquid-based cytology
Bethesda system
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Performance of Siriraj Liquid-Based Cytology: a Single Center Report Concerning over 100,000 Samples
To evaluate the performance of Siriraj liquid-based cytology (LBC) for cervical neoplasia screening after increasing use of this technology.Cytological reports of 103,057 Siriraj-LBC specimens obtained in 2007-2009 were compared with those of 23,676 specimens obtained in 2006.Comparing with the year 2006, the 2007-2009 patients were slightly older (43.4 ± 12.yr vs 42.7 ± 12.2 yr, p <0.001), and their specimens had much lower proportion of unsatisfactory slides (OR=0.06, 95%CI 0.04-0.09) with comparable detection rates (3.96% vs 3.70%, p=0.052) but different proportions of various cytological abnormalities (p<0.001). The 2007-2009 Siriraj-LBC had a negative predictive value (NPV) for cervical intraepithelial neoplasia 2+ (CIN2+) of 97.6% and an overall positive predictive value (PPV) of 43.9%. The PPV for CIN2+ varied with types of abnormal cytology, from 13.7% to 93.8% in atypical squamous cells of undetermined significance (ASCUS), low-grade squamous intraepithelial lesion (LSIL), atypical squamous cells cannot exclude HSIL (ASC-H), high-grade squamous intraepithelial lesion (HSIL), atypical glandular cells (AGC), to squamous cell carcinoma (SCC), respectively. The PPVs for CIN2+ in ASCUS and LSIL were comparable, but the PPV for CIN1 was higher for LSIL than for ASCUS (41.63% vs 16.32%).Siriraj-LBC has demonstrated a stable detection rate and NPV for CIN2+ of >95% since the first year of use. The comparable PPVs for CIN2+ of ASCUS and LSIL suggests that these two conditions may undergo similar management; other cytological abnormalities need immediate evaluation.
Ascus (bryozoa)
Squamous intraepithelial lesion
Liquid-based cytology
Bethesda system
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