Enhanced Detection of Cervical Cancer and Precancer Through Use of Imaged Liquid-Based Cytology in Routine Cytology and HPV Cotesting

AbstractObjectivesCervical screening strives to prevent cervical cancer (CxCa), minimizing morbidity and mortality. Most large US reports on cytology and human papillomavirus (HPV) cotesting of women aged 30 years and older are from one laboratory, which used conventional Papanicolaou (Pap) smears from 2003 to 2009.MethodsWe quantified detection of CxCa and precancer (cervical intraepithelial neoplasia 3/adenocarcinoma in situ [CIN3/AIS]) in 300,800 cotests at Magee Womens Hospital since 2005. Screening histories preceding CxCa and CIN3/AIS diagnoses were examined to assess the contribution of cytology and HPV testing. Cotesting utilized Food and Drug Administration-approved imaged liquid-based cytology (LBC) and from-the-vial HPV tests.ResultsLBC identified more women subsequently diagnosed with CxCa and CIN3/AIS than HPV testing. HPV-negative/cytology-positive results preceded 13.1% of CxCa and 7.2% of CIN3/AIS diagnoses.ConclusionsLBC enhanced cotesting detection of CxCa and CIN3/AIS to a greater extent than previously reported with conventional Pap smear and HPV cotesting.

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Efficiency of HPV DNA Test versus Pap Smear in the Screening of Cervical Cancer

Journal of Karnali Academy of Health Sciences ◽

10.3126/jkahs.v1i2.24128 ◽

2018 ◽

Vol 1 (2) ◽

pp. 9-13

Author(s):

Renee Pradhan ◽

U. Pant ◽

B. Aryal

Keyword(s):

Cervical Cancer ◽

Cervical Intraepithelial Neoplasia ◽

Pap Smear ◽

Intraepithelial Neoplasia ◽

Cervical Neoplasia ◽

Hpv Testing ◽

Dna Test ◽

Hpv Dna ◽

Smear Testing ◽

Hpv Dna Test

Introduction: Cancer cervix is a common genital cancer. Human papillomavirus is the main cause of cervical cancer because of the strong association of certain HPV genotypes and the development of cervical cancer and its precursor lesions, cervical intraepithelial neoplasia CIN 2 or CIN3. Methods: The study was conducted on 180 gynecological patients seen at the outpatient department of Manipal Hospital, Bangalore. A comparative study of HPV DNA test with Pap smear in the screening of cervical neoplasia was carried out over the period of 24 months from August 2011 to June 2013. Results: The incidence of cervical cancer and its associated mortality has declined in recent years, largely due to the widespread implementation of screening programs by Pap smear testing. The management and the prevention of cervical cancer should change with HPV DNA testing for high risk HPV, which is more sensitive than pap smear testing. Infection of cervix with HPV is necessary to cause cervical neoplasia and cervical cancer. Persistent infection with HPV is required for the development of cervical dysplasia and invasive cervical cancer. Conclusions: HPV testing alone for primary screening appears promising in women aged 30 years and older as this group is at greatest risk of developing CIN 3. As compared with Pap testing, HPV testing has greater sensitivity for detection of cervical intraepithelial neoplasia.

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“A Pap smear saved my life”: Personal experiences of cervical abnormalities shape attitudes to cervical screening renewal

Journal of Medical Screening ◽

10.1177/0969141319889648 ◽

2019 ◽

Vol 27 (4) ◽

pp. 223-226 ◽

Cited By ~ 1

Author(s):

Helena M Obermair ◽

Kirsten J McCaffery ◽

Rachael H Dodd

Keyword(s):

Cervical Cancer ◽

Pap Smear ◽

Screening Program ◽

Cervical Screening ◽

Personal History ◽

Pap Smears ◽

Increased Risk ◽

Women's Lives ◽

History Of ◽

Screening Intervals

Objective In 2017, the Australian National Cervical Screening Program changed from two-yearly Pap smears between ages 18 and 69, to five-yearly human papillomavirus screening between ages 25 and 74 (the “Renewal”). This study investigated attitudes towards the changes, among individuals previously affected by cervical abnormalities/cervical cancer, personally or through a friend/relative. Methods We conducted a thematic analysis of comments expressing personal history or a family/friend history of cervical abnormalities/cervical cancer as a reason for opposing changes to the cervical screening program. The comments were taken from a 20% random sample of 19,633 comments posted on the “Change.org” petition “Stop May 1st Changes to Pap Smears – Save Women's Lives” in February–March 2017. Results There were 831 (20.8%) commenters who reported that they were concerned about a change in screening due to: feelings of increased personal vulnerability to cervical cancer due to their own personal history of cervical abnormalities; comparison of extended screening intervals and later age of first screening to their own experiences; and a perception of increased personal risk due to family history. Conclusion Women previously affected by cervical abnormalities or cervical cancer, personally or through a friend/relative, expressed concern about changes to cervical screening due to perceived increased risk and feeling vulnerable due to personal history.

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A CASE OF CERVICAL INTRAEPITHELIAL NEOPLASIA - MANAGEMENT THROUGH AYURVEDA

November 2020 - International Ayurvedic Medical Journal ◽

10.46607/iamj3609122021 ◽

2021 ◽

Vol 9 (12) ◽

pp. 3143-3150

Author(s):

Deepthi. G. B ◽

Gayathri Bhat. N.V

Keyword(s):

Cervical Cancer ◽

Pap Smear ◽

Disease Incidence ◽

Cervical Screening ◽

Intraepithelial Neoplasia ◽

Treatment Modalities ◽

Low Grade ◽

Disease Manifestation ◽

Mild Dysplasia

Introduction – Cervical cancer is the 2nd most leading prevalent cancer in India. There are an estimated 123,000 new cases of cervical cancer in India every year with 67,000 deaths in women alone. Cervical cancer in Recent studies shows that screening of cervical cancer reduces the disease incidence and disease mortality by 50%. Low- grade squamous intraepithelial lesion (LSIL) is a common abnormal result on a Pap smear cervical test. It’s also known as mild dysplasia. Methodology – Here is a case report of a patient aged 26yrs with complaints of white discharge per vagina with severe itching, on routine cervical screening investigations found to have Low grade squamous intraepithelial neoplasms. She was treated with Ayurvedic sthanika chikitsa (Local therapies) such as Yoni prakshalana (Vaginal douching), and Yoni pichu (Vaginal tamponing) for 7 days along with shaman chikitsa. Later PAP smear was repeated after 1 month of follow up and found to have negative for intraepithelial neoplasia. And there was relief in the symptoms following treatment. Results- In this case, there was a relief of symptoms and on follow up when Pap smear was repeated, there was negative for intraepithelial neoplasia. Ayurvedic treatment modalities such as Sthanika chikitsa which includes yoni prakshalana and Yoni Pichu are the line of treatment for various gynecological problems and help in reducing mortality and morbidity caused due to cervical cancer in India. Discussion- Here Low-grade squamous Intraepithelial neoplasia can be considered as the Sanchaya avastha and hence diagnosing the disease in its Sanchaya avastha i.e mild dysplasia, is important. During Sanchaya avastha there is localized neoplastic changes of cervical cells and there is Manifestation of Low-grade Intraepithelial Neo- plasia. In the later stages of Kriyakala (Stages of disease manifestation) the neoplasia turns into metastasis and further differentiation occurs which Manifests all the symptoms of Cervical Cancer. Hence treatment modalities such as Yoni prakshalana and yoni pichu helps in preventing later conditions such as cervical cancer. Keywords: Cervical Cancer, LSIL, Ayurveda, Sanchaya

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A Comparative Study between Conventional Pap Smear and Liquid-Based Cytology: A Clinco-Cytological Study of Iraqi Women with Some Health Problems of Cervix

Iraqi Journal of Science ◽

10.24996/ijs.2019.60.11.6 ◽

2019 ◽

pp. 2362-2370

Author(s):

Huda Hameed K. Alabbody ◽

Zahraa Adnan G. Al-Ghuraibawi

Keyword(s):

Cervical Cancer ◽

Uterine Cervix ◽

Visual Inspection ◽

Pap Smear ◽

Cervical Screening ◽

Health Problems ◽

Low Grade ◽

Sexually Active ◽

Iraqi Women ◽

Liquid Based Cytology

A cervical screening by Pap test is necessary in recognizing precancerous and cancerous cases to reduce mortality due to cervical cancer among women. Regular screening and follow up can make it easier to early diagnose and eventually, to treat and control cervical cancer. This study aimed to detect atypical pathological changes of the vagina and uterine cervix of a sample of Iraqi women by macro- and micro-examination, and to determine the link with the demographic features. Also the study aimed to evaluate the two Pap smear techniques; the conventional and the base liquid methods. The study included 50 women with genital health problems (18-50 years old) who were referred to the National Cancer Research Center (NCRC), the University of Baghdad, during the period from 1st April to 30st of September 2018. Both visual inspection of the uterine cervix and Papanicolaou smear were performed for all of the participants. The results showed that most patient women (96%) were married and sexually active, with 51% being married under 20 years of age .Visual inspection of the cervix showed that 30% of the women had translucent, opaque or erosion lesions. Upon cytology examination, 92% of the women showed nonspecific inflammation, 70% revealed reactive squamous metaplasia, 10% had Koilocytotic atypia, and 8% suffered from cervical intraepithelial neoplasia (CIN1) or low grade squamous intraepithelial lesion (LGSIL). Contraception was used by 82% of the patients, while 36% used pills. The causes of the referral to the centre were abnormal vaginal discharge (44%) and post-coital bleeding "and\or" dyspareunia (20% each). Lastly, 74% of the participants did not make this test previously. Liquid-based cytology technique outperformed conventional pap smears because of improved fixation, decreased impurities factors, and standardization of cell transfer. We conclude that routine screening and Pap smear testing for uterine cervix and vagina might be useful to prevent the occurrence of precancerous lesions in the genital system of sexually active women. We recommend to apply this test before and after treatment and to activate the cellular examination in the basal fluid method

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HPV16 and HPV18 type-specific APOBEC3 and integration profiles in different diagnostic categories of cervical samples

10.1101/2020.11.25.20238477 ◽

2020 ◽

Author(s):

Sonja Lagström ◽

Alexander Hesselberg Løvestad ◽

Sinan Uğur Umu ◽

Ole Herman Ambur ◽

Mari Nygård ◽

...

Keyword(s):

Cervical Cancer ◽

Progressive Disease ◽

Intraepithelial Neoplasia ◽

Adenocarcinoma In Situ ◽

Coding Region ◽

Human Papillomavirus 16 ◽

Diagnostic Categories ◽

Cervical Cell ◽

Lesion Severity

AbstractHuman papillomavirus 16 and 18 are the most predominant types in cervical cancer. Only a small fraction of HPV infections progress to cancer, indicating that genomic factors, such as minor nucleotide variation caused by APOBEC3 and chromosomal integration, contribute to the carcinogenesis.We analysed minor nucleotide variants (MNVs) and integration in HPV16 and HPV18 positive cervical samples with different morphology. Samples were sequenced using an HPV whole genome sequencing protocol TaME-seq. A total of 80 HPV16 and 51 HPV18 positive cervical cell samples passed the sequencing depth criteria of 300× reads, showing the following distribution: non-progressive disease (HPV16 n=21, HPV18 n=12); cervical intraepithelial neoplasia (CIN) grade 2 (HPV16 n=27, HPV18 n=9); CIN3/adenocarcinoma in situ (AIS) (HPV16 n=27, HPV18 n=30); cervical cancer (HPV16 n=5).Similar rates of MNVs in HPV16 and HPV18 samples were observed for most viral genes but for HPV16, the non-coding region (NCR) showed a trend towards increasing variation with increasing lesion severity. APOBEC3 signatures were observed in HPV16 lesions, while similar mutation patterns were not detected for HPV18. The proportion of samples with integration was 13% for HPV16 and 59% for HPV18 positive samples, with a noticeable portion located within or close to cancer-related genes.

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Cervical screening in Western Kazakhstan: Liquid-based cytology ‘Cell Scan’ versus azur-eosin staining

Journal of Medical Screening ◽

10.1177/0969141319885409 ◽

2019 ◽

Vol 27 (2) ◽

pp. 90-95 ◽

Cited By ~ 2

Author(s):

Saule Balmagambetova ◽

Giovanni Gabutti ◽

Arip Koyshybaev ◽

Cecilia Acuti Martellucci ◽

Olzhas Urazayev ◽

...

Keyword(s):

Cervical Cancer ◽

Pap Smear ◽

Screening Programme ◽

Cervical Screening ◽

Staining Technique ◽

Screening Tools ◽

Female Population ◽

Hpv Dna ◽

Western Kazakhstan ◽

Liquid Based Cytology

Objective To assess the effectiveness of the current cervical cancer screening tools in Western Kazakhstan. Methods Smears taken through (i) conventional cytology using azur-eosin staining and (ii) liquid-based cytology (LBC) ‘Cell Scan’ in the general female population and in women first diagnosed with cervical cancer were collected throughout the region. ROC-analysis with curve construction and weighted Cohen's κ calculation were applied. A total of 494 cytological pairs were collected, including 94 sets with histology findings. Results The conventional (azur-eosin staining) technique contained 0.2% non-informative material and LBC ‘Cell Scan’ had 5.9%. Area under the curve was 0.95 for the conventional technique and 0.92 for ‘Cell Scan’ ( p > 0.05). The conventional smears showed κ 0.62, sensitivity 90.4% at specificity 90.0% for CIN2+, while LBC ‘Cell Scan’ smears showed κ 0.47, sensitivity 83.3% at specificity 92.5%. Conclusions In this analysis it was not possible to prove that the LBC ‘Cell Scan’ technique was superior to its predecessor, azur-eosin staining. These findings highlight the need to modify the current screening programme according to updated international scientific evidence on effective screening design, such as the use of HPV DNA testing with Pap smear triage in women aged 30 or older. Further research, and a Health Technology Assessment, are necessary if we wish to establish a national standardized screening programme using the available technology appropriately.

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Promising strategies for cervical cancer screening in the post-human papillomavirus vaccination era

Sexual Health ◽

10.1071/sh10022 ◽

2010 ◽

Vol 7 (3) ◽

pp. 376 ◽

Cited By ~ 20

Author(s):

Joseph Tota ◽

Salaheddin M. Mahmud ◽

Alex Ferenczy ◽

François Coutlée ◽

Eduardo L. Franco

Keyword(s):

Cervical Cancer ◽

Human Papillomavirus ◽

Human Error ◽

Pap Smear ◽

Cervical Screening ◽

Screening Tests ◽

Hpv Testing ◽

Human Papillomavirus Vaccination ◽

Screening Programs

Human papillomavirus (HPV) vaccination is expected to reduce the burden of cervical cancer in most settings; however, it is also expected to interfere with the effectiveness of screening. In the future, maintaining Pap cytology as the primary cervical screening test may become too costly. As the prevalence of cervical dysplasias decreases, the positive predictive value of the Pap test will also decrease, and, as a result, more women will be referred for unnecessary diagnostic procedures and follow-up. HPV DNA testing has recently emerged as the most likely candidate to replace cytology for primary screening. It is less prone to human error and much more sensitive than the Pap smear in detecting high-grade cervical lesions. Incorporating this test would improve the overall quality of screening programs and allow spacing out screening tests, while maintaining safety and lowering costs. Although HPV testing is less specific than Pap cytology, this issue could be resolved by reserving the latter for the more labour-efficient task of triaging HPV-positive cases. Because most HPV-positive smears would contain relevant abnormalities, Pap cytology would be expected to perform with sufficient accuracy under these circumstances. HPV Pap triage would also provide a low-cost strategy to monitor long-term vaccine efficacy. Although demonstration projects could start implementing HPV testing as a population screening tool, more research is needed to determine the optimal age to initiate screening, the role of HPV typing and other markers of disease progression, and appropriate follow-up algorithms for HPV-positive and Pap-negative women.

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Primary cervical screening with high risk human papillomavirus testing: observational study

BMJ ◽

10.1136/bmj.l240 ◽

2019 ◽

pp. l240 ◽

Cited By ~ 33

Author(s):

Matejka Rebolj ◽

Janet Rimmer ◽

Karin Denton ◽

John Tidy ◽

Christopher Mathews ◽

...

Keyword(s):

Cervical Cancer ◽

Human Papillomavirus ◽

High Risk ◽

Observational Study ◽

Cervical Intraepithelial Neoplasia ◽

Cervical Screening ◽

Intraepithelial Neoplasia ◽

Cervical Intraepithelial Neoplasia Grade ◽

Liquid Based Cytology ◽

Grade 3

AbstractObjectiveTo provide the first report on the main outcomes from the prevalence and incidence rounds of a large pilot of routine primary high risk human papillomavirus (hrHPV) testing in England, compared with contemporaneous primary liquid based cytology screening.DesignObservational study.SettingThe English Cervical Screening Programme.Participants578 547 women undergoing cervical screening in primary care between May 2013 and December 2014, with follow-up until May 2017; 183 970 (32%) were screened with hrHPV testing.InterventionsRoutine cervical screening with hrHPV testing with liquid based cytology triage and two early recalls for women who were hrHPV positive and cytology negative, following the national screening age and interval recommendations.Main outcome measuresFrequency of referral for a colposcopy; adherence to early recall; and relative detection of cervical intraepithelial neoplasia grade 2 or worse from hrHPV testing compared with liquid based cytology in two consecutive screening rounds.ResultsBaseline hrHPV testing and early recall required approximately 80% more colposcopies, (adjusted odds ratio 1.77, 95% confidence interval 1.73 to 1.82), but detected substantially more cervical intraepithelial neoplasia than liquid based cytology (1.49 for cervical intraepithelial neoplasia grade 2 or worse, 1.43 to 1.55; 1.44 for cervical intraepithelial neoplasia grade 3 or worse, 1.36 to 1.51) and for cervical cancer (1.27, 0.99 to 1.63). Attendance at early recall and colposcopy referral were 80% and 95%, respectively. At the incidence screen, the 33 506 women screened with hrHPV testing had substantially less cervical intraepithelial neoplasia grade 3 or worse than the 77 017 women screened with liquid based cytology (0.14, 0.09 to 0.23).ConclusionsIn England, routine primary hrHPV screening increased the detection of cervical intraepithelial neoplasia grade 3 or worse and cervical cancer by approximately 40% and 30%, respectively, compared with liquid based cytology. The very low incidence of cervical intraepithelial neoplasia grade 3 or worse after three years supports extending the screening interval.

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Colposcopic evaluation of cervix with persistent inflammatory Pap smear: A prospective analytical study

CytoJournal ◽

10.4103/1742-6413.67112 ◽

2010 ◽

Vol 7 ◽

pp. 16 ◽

Cited By ~ 5

Author(s):

Papa Dasari ◽

S Rajathi ◽

Surendra V Kumar

Keyword(s):

Analytical Study ◽

Pap Smear ◽

Invasive Carcinoma ◽

Cervical Screening ◽

Intraepithelial Neoplasia ◽

Pap Smears ◽

Screening Algorithm ◽

Number Of Patients ◽

Malignant Lesions ◽

Inflammatory Changes

Background: Inflammatory Pap smear is the most common report received by a gynecologist. The cervical screening algorithm for benign cellular changes on the Pap smear recommends treatment of infection if indicated and a repeat Pap smear in 4 to 6 months time. If the inflammatory changes still persist, subject the patient to colposcopy. However, in practice, this is not followed, especially in developing countries like ours where proper screening protocols are not available. Hence, a good number of patients in the premalignant stage are being missed. This study was undertaken to evaluate patients with persistent inflammatory Pap smears without atypia using colposcopy. Methods: A prospective analytical study of 150 gynecologial patients with persistent inflammatory Pap smear between 2006 and 2008 in an out-patient setting. All of them were subjected to colposcopy and biopsy from the abnormal areas. The incidence of cervical intraepithelial neoplasia (CIN)/invasive carcinoma was calculated by proportions/percentages. Results: The incidence of invasive carcinoma was <1%. But, the incidence of pre-malignant lesions (CIN) was high (20.9%). CIN 2/3 and carcinoma in situ were present in 6.9% of the cases. Conclusions: Patients with persistent inflammatory Pap smears can harbour a high proportion of CIN and hence these patients will need further evaluation.

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Screening of HIV sero positive women for cervical abnormalities

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20183321 ◽

2018 ◽

Vol 7 (8) ◽

pp. 3222

Author(s):

Meenakshi B. Chauhan ◽

Sushila Chaudhary ◽

Sunita Singh ◽

Manasi Juneja ◽

Smiti Nanda

Keyword(s):

Cervical Cancer ◽

Pap Smear ◽

Intraepithelial Neoplasia ◽

Developed Countries ◽

Hiv Positive ◽

Pap Smears ◽

Cross Sectional ◽

Age Related ◽

Precancerous Stage ◽

Hiv Negative

Background: Cancer cervix is a leading cause of death among women worldwide. Detection of cervical cancer in precancerous stage is 100% curable. Screening with Pap smear has reduced mortality by cervical cancer in developed countries many folds. The objective of the study is to determine prevalence of Cervical Intraepithelial Neoplasia (CIN) in HIV infected women and observe for associated lower genital infections and their correlation with CD4 counts.Methods: The present study is a cross-sectional observational study conducted at PGIMS, Rohtak, Haryana for a period of 18 months. 150 HIV patients and 150 age related control cases were taken. Pap smears were taken and analyzed for cervical abnormalities and genital infections.Results: Of the 300 Pap smear 22 (7.3%) has squamous intraepithelial abnormalities and 278 (92.7%) negative for intra epithelial abnormalities. Prevalence of cervical intraepithelial abnormities among HIV positive 12% while among HIV negative it is 2.7%. Cervical intraepithelial abnormalities were found in 40% and 3.5% of patients with CD4 count <200 and >200 respectively.Conclusions: HIV increases the risk of cervical abnormalities. Frequent screening of these patients for cervical cancer is needed.

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