Does the ‘equal management of equal risks’ model cause overtreatment in patients with positive cervical cytology results for ASCUS/non‐HPV16/18 oncogenic types?
İbrahim KaracaMustafa ÖztürkCihan CombaGökhan DemirayakŞakir Volkan ErdoğanMurat Hoşgörenİsa Aykut Özdemir
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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.Keywords:
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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).
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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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Objective To analyze screening methods for cervical intraepithelial neoplasia(CIN) and summarize the morbidity of CIN in the last 10 years retrospectively Methods 2107 patients who underwent colposcopy and biopsy from January 1993 to December 2002 were included in the study The morbidity of CIN among this group was reviewed and the sensitivities of computer cytological test(CCT) and artificial examination of Pap smear were compared Results The morbidity of CIN rose year by year The sensitivity of artificial examination of Pap smear is 43 9%,72 7% for CCT and 88 0% for colposcopy In the group atypical squamus cell uncertain sense (ASCUS) patients,CIN morbidity of age below 35 is higher than that of age above 35 Conclusions CCT is more sensitive than artificial examination for discovery of CIN The most sensitive method for CIN diagnosis is biopsy by the aid of colposcope The ASCUS patient under 35-years-old should be paid more attention than those above 35
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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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Objective. To determine practice patterns of the American Society for Colposcopy and Cervical Pathology (ASCCP) 2000 Biennial Meeting participants for management of women with atypical squamous cells of undetermined significance (ASCUS) and atypical glandular cells of undetermined significance (AGUS). Materials and Methods. A three-page survey was developed to query participants about their standard practices for managing atypical squamous cells and atypical glandular cells on Pap tests; use of human papillomavirus testing; and use of vaginal estrogen cream in postmenopausal women before follow-up. Results. There were 217 completed surveys (47.0% response rate). Responses of 194 qualified surveys are presented here. For women with first-time ASCUS (unqualified) and no previous history of cervical intraepithelial neoplasia (CIN), 16.4% of respondents would perform colposcopy. For ASCUS (favor squamous intraepithelial lesion [SIL]), a significantly higher percent, 74.9%, would proceed immediately to colposcopy (p < .001). For ASCUS (unqualified or favor SIL) in a woman with a previous history of CIN, 82.7% and 95.5% would perform colposcopy, respectively (p < .001). For a patient with AGUS, 97.5% would perform colposcopy (with or without endocervical curettage or endometrial biopsy). Human papillomavirus testing was seldom used in the management of ASCUS (10.4%) and AGUS (7.8%). Conclusions. Participants at the 2000 ASCCP Biennial Meeting made clear distinctions between ASCUS and AGUS in managing women with abnormalities on Pap, and management was consistent with guidelines published by the ASCCP, American College of Obstetricians and Gynecologists, and the National Cancer Institute.
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Testing for human papillomavirus (HPV) as a adjunct to the Pap smear in cervical cancer screening programs has been suggested as a means of predicting which cervical abnormality will progress to cancer. In this study, 619 women with atypical squamous cells of undetermined significance (ASCUS) or low-grade squamous intraepithelial lesions (LGSIL) diagnosed over an 18-month period were evaluated for high-risk HPV types using first-generation Hybrid Capture testing (Digene Corporation, Silver Spring, MD). All patients were followed up conservatively at 6-month intervals with repeated Pap testing. Patients with progressive or persistent disease (three consecutive findings of ASCUS or LGSIL) were referred for colposcopy, and the colposcopic findings were compared with the results of HPV testing. At the end of the study, the most severe cytologic or histologic diagnosis was used as the final diagnosis for patients who did not undergo colposcopy. One hundred thirty-five of the 197 women with LGSIL (69 percent) were positive for HPV. One hundred seven HPV-positive and 49 HPV-negative patients in this group returned for follow-up and were available for evaluation. Fifty-six HPV-positive patients were referred for colposcopy during the course of the study. Normal or low-grade changes were found in 32 of these women, but 23 (21 percent) were diagnosed with high-grade squamous intraepithelial lesions (HGSIL). One HPV-positive woman with a smear indicating LGSIL was found to have invasive cancer at colposcopy. Seventeen of the 49 HPV-negative women were referred for colposcopy, and only 3 (6 percent) were found to have high-grade disease. Of the 422 patients with an initial diagnoses of ASCUS, 116 (28 percent) were HPV positive. Follow-up information was available for 83 patients, of whom 25 were referred for colposcopy. In this group, 7 patients were diagnosed with LGSIL, and 10 were found to have HGSIL. Cancer did not develop in any of these patients. There were 232 HPV-negative patients with ASCUS who returned for follow-up; 34 underwent colposcopy. Six women with ASCUS were negative for HPV but were diagnosed with LGSIL, and four were identified as having HGSIL. One woman who presented with a Pap smear indicating ASCUS was HPV negative but had invasive cancer. Altogether, 37.3 percent of the patients who tested positive for HPV had LGSIL, HGSIL, or cancer, compared with 8.5 percent of those who were negative for HPV (P < .001). Overall, 83 percent of the women with high-grade lesions tested positive for high-risk HPV types on their initial visit. If positive HPV results had been used as the referral criterion, 40 percent of the women would have been referred for colposcopy. When Hybrid Capture HPV testing was performed multiple times, persistent positivity was more predictive of a final diagnosis of HGSIL or LGSIL than a single positive result (P = .04). In fact, of the seven initially HPV-negative patients who eventually progressed to HGSIL, four underwent multiple HPV tests and all converted to positive. When a cost analysis of this study was performed, referral of all patients with ASCUS or higher to colposcopy had a cost of $123,800, cytologic follow-up with referral for persistent or progressive disease had a cost of $81,860, and referral based on HPV Hybrid Capture HPV positive results had a total cost of $98,795. There were no patients lost to follow-up with the immediate colposcopy strategy; 148 were lost using cytological follow-up only (actual study); and 88 would be lost to follow-up if the HPV testing triage strategy were used. J Lower Genital Tract Dis 2000;4:12–17
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Objective: To investigate the clinical significance and treatment of the thin-cytologic test(TCT) result as atypical squamouns cell of undetermined significance(ASCUS).Methods: 132 patients from June 2006 to June 2009 were selected to do TCT,the results were ASCUS,132 patients were given colposcopy and multiple punch biopsy,and its results were analyzed.Results: Of the 132 patients,biopsy for the inflammation were 81 cases,accounted for 61.36%;cervical intraepithelial neoplasia Ⅰ(CINI) were 24 cases,accounted for 18.18%;cervical intraepithelial neoplasia II(CINII) were 14 cases,accounted for 10.61%;cervical intraepithelial neoplasia III(CINIII) were 11 cases,accounted for 8.33%;carcinoma were 2 cases,accounted for 1.52%.Colposcopy be diagnosed as cervical intraepithelial neoplasia(CIN) and invasive carcinoma of the sensitivity,specificity,positive predictive value,negative predictive value were 98.04%,95.06%,92.59%,98.72% respectivly.Conclusion: Colposcopy for the diagnosis of cervical lesions has higher value,the ASCUS patients can do colposcopy and biopsy for histopathological multi-point inspection in primary hospital immediately.
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This study aimed to evaluate the performance and cost of using polymerase chain reaction (PCR) and hybrid capture in the detection of cervical intraepithelial neoplasia (CIN) in patients with cytological abnormalities (ASCUS/low-grade squamous intraepithelial lesion - LSIL), and the feasibility of implementing these methods in Brazil's Unified National Health System (SUS). Colposcopy gave a negative predictive value of 92.86% and efficiency of 87.8% for diagnosing CIN. The sensitivity of PCR and hybrid capture for detecting CIN was 83.33% and 66.67%, respectively, and the negative predictive value for diagnosing CIN2/CIN3 was 100% and 94.74%, respectively. The annual cost for 80 patients was lower when all patients with ASCUS/LSIL were referred for colposcopy than when HPV testing was performed and those with positive results were referred for colposcopy. Therefore, at present, it is financially unfeasible for the National Health System to implement HPV testing to screen patients with cytological abnormalities (ASCUS/LSIL). However, considering that large-scale use might make such methods cheaper, PCR should be the chosen method, since it is less expensive, more sensitive, and has a high negative predictive value.
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