Atypical squamous cells and low-grade squamous intraepithelial lesion in cervical cytology: cytohistological correlation and implication for management in a low-resource setting

Cytopathology ◽  
2010 ◽  
Vol 22 (3) ◽  
pp. 189-194 ◽  
Author(s):  
N. Gupta ◽  
R Srinivasan ◽  
R. Nijhawan ◽  
A. Rajwanshi ◽  
P. Dey ◽  
...  
Keyword(s):  
Cervical Cytology ◽  
Low Grade ◽  
Squamous Intraepithelial Lesion ◽  
Squamous Cells ◽  
Low Resource ◽  
Resource Setting ◽  
Low Resource Setting ◽  
Intraepithelial Lesion

scholarly journals p16INK4a immunocytochemistry on cell blocks as an adjunct to cervical cytology: Potential reflex testing on specially prepared cell blocks from residual liquid-based cytology specimens

CytoJournal ◽  
2011 ◽  
Vol 8 ◽  
pp. 1 ◽  
Author(s):  
Vinod B. Shidham ◽  
Ravi Mehrotra ◽  
George Varsegi ◽  
Krista L. D'Amore ◽  
Bryan Hunt ◽  
...  
Keyword(s):  
Intraepithelial Neoplasia ◽  
Cervical Cytology ◽  
Low Grade ◽  
Cell Block ◽  
Squamous Intraepithelial Lesion ◽  
Squamous Cells ◽  
Cytology Specimen ◽  
Under Sampling ◽  
Reflex Testing ◽  
Intraepithelial Lesion

Background: p16 INK4a (p16) is a well-recognized surrogate molecular marker for human papilloma virus (HPV) related squamous dysplasia. Our hypothesis is that the invasive interventions and related morbidities could be avoided by objective stratification of positive cytologic interpretations by p16 immunostaining of cell block sections of cytology specimens. Materials and Methods: Nuclear immunoreactivity for p16 was evaluated in cell block sections in 133 adequate cases [20 negative for intraepithelial lesion or malignancy, 28 high-grade squamous intraepithelial lesion (HSIL), 50 low-grade squamous intraepithelial lesion (LSIL), 21 atypical squamous cells, cannot exclude HSIL (ASC-H), and 14 atypical squamous cells of undetermined significance (ASCUS)] and analyzed with cervical biopsy results. Results: (a) HSIL cytology (28): 21 (75%) were p16 positive (11 biopsies available — 92% were positive for cervical intraepithelial neoplasia (CIN) 1 and above) and 7 (25%) were p16 negative (3 biopsies available — all showed only HPV with small atypical parakeratotic cells). (b) LSIL cytology (50): 13 (26%) cases were p16 positive (12 biopsies available — all were CIN1 or above) and 37 (74%) were p16 negative (12 biopsies available — all negative for dysplasia. However, 9 (75%) of these biopsies showed HPV). (c) ASC-H cytology (21): 14 (67%) were p16 positive (6 biopsies available — 5 showed CIN 3/Carcinoma in situ/Ca and 1 showed CIN 1 with possibility of under-sampling. Cytomorphologic re-review favored HSIL) and 7 (33%) were p16 negative (5 biopsies available — 3 negative for dysplasia. Remaining 2 cases — 1 positive for CIN 3 and 1 showed CIN 1 with scant ASC-H cells on cytomorphologic re-review with possibility under-sampling in cytology specimen). (d) ASCUS cytology (14): All (100%) were p16 negative on cell block sections of cervical cytology specimen. HPV testing performed in last 6 months in 7 cases was positive in 3 (43%) cases. Conclusion: p16 immunostaining on cell block sections of cervical cytology specimens showed distinct correlation patterns with biopsy results. Reflex p16 immunostaining of cell blocks based on the algorithmic approach to be evaluated by a multiinstitutional comprehensive prospective study is proposed.

Colposcopy referral rate can be reduced by high-risk human papillomavirus triage in the management of recurrent atypical squamous cells of undetermined significance or low-grade squamous intraepithelial lesion cytology in Finland

2012 ◽  
Vol 23 (7) ◽  
pp. 485-489 ◽  
Author(s):  
M Jakobsson ◽  
J Tarkkanen ◽  
E Auvinen ◽  
R Häkkinen ◽  
P Laurila ◽  
...  
Keyword(s):  
Human Papillomavirus ◽  
High Risk ◽  
Study Groups ◽  
Referral Rate ◽  
Cervical Cytology ◽  
Low Grade ◽  
Squamous Intraepithelial Lesion ◽  
Squamous Cells ◽  
Intraepithelial Lesion ◽  
Undetermined Significance

The aim of this study was to establish whether a combination of high-risk human papillomavirus (hrHPV) testing and cervical cytology could reduce colposcopy referral among women with atypical squamous cells of undetermined significance (ASCUS) or low-grade squamous intraepithelial lesion cytology. We randomized 598 women in the Helsinki area, Finland into three study groups. Different strategies of hrHPV testing, cytology and colposcopy with biopsy were used; subsequent hrHPV test results and cytological findings were compared with histology. The rates of hrHPV positivity and CIN2+ were compared. In total, 62.5% of all samples were hrHPV-positive. Altogether 45 (12.7%) CIN2 or worse (CIN2+) lesions were found in study groups A and B. Among hrHPV-positive women the rate of CIN2+ was 19.0% ( n = 43), in contrast with 1.6% ( n = 2) among hrHPV-negative women (relative risk = 12.2, 95% confidence interval [CI] 3.6–81.1, P < 0.001). Among all hrHPV-negative women whose cytological findings were normal or ASCUS, dysplastic lesions were uncommon ( n = 4/119, 3.4%), and all were CIN1. If these women had not been referred to colposcopy, the number of colposcopies would have been reduced by 33.6%. We conclude that hrHPV testing combined with repeat cervical cytology had a high negative predictive value in patients with recurrent low-grade cervical cytology. This could reduce the referral rate to colposcopy without jeopardizing patient safety.

Human Papillomavirus Testing and Reporting Rates: Practices of Participants in the College of American Pathologists Interlaboratory Comparison Program in Gynecologic Cytology in 2006

2008 ◽  
Vol 132 (8) ◽  
pp. 1290-1294 ◽  
Author(s):  
Ann T. Moriarty ◽  
Mary R. Schwartz ◽  
Galen Eversole ◽  
Marilee Means ◽  
Amy Clayton ◽  
...  
Keyword(s):  
Human Papillomavirus ◽  
Interlaboratory Comparison ◽  
Low Grade ◽  
Hpv Testing ◽  
Squamous Intraepithelial Lesion ◽  
Papanicolaou Test ◽  
Frequency Distributions ◽  
Squamous Cells ◽  
Hpv Test ◽  
Intraepithelial Lesion

Abstract Context.—Oncogenic, high-risk human papillomavirus (HR-HPV) testing is used to evaluate women who are older than 20 years with atypical squamous cells of undetermined significance (ASC-US) and in conjunction with a screening Papanicolaou test in women older than 30 years. Objectives.—To evaluate the 2006 laboratory practice data from laboratories incorporating human papillomavirus (HPV) testing with the Papanicolaou test. Design.—To use the College of American Pathologists (CAP) Supplemental Questionnaire Survey for 2006 to determine laboratory practices of participants in the CAP Interlaboratory Comparison Program in Cervicovaginal Cytology. Results.—A total of 679 laboratories responded to the questionnaire. Most (73%) refer HPV testing to reference laboratories. Nine percent perform HPV testing in cytology. Forty-five percent offer low-risk HPV (LR-HPV) testing. The most common reflex is ASC-US, although HR-HPV is also offered with low-grade squamous intraepithelial lesion (LSIL), high-grade squamous intraepithelial lesion (HSIL), or any other Papanicolaou test result. Digene Hybrid Capture II is the most common method. Human papilloma virus median test volumes are 55 monthly. Frequency distributions of HPV test volumes are significantly different from those found in 2003. Laboratories performing in-house testing reported significantly higher monthly HPV volumes (P &lt; .001). Median rates for HR-HPV positivity are 36.6% for ASC-US, 50.0% for atypical squamous cells, cannot exclude HSIL (ASC-H), and 4% for women 30 years of age and older in conjunction with a screening Papanicolaou test. Conclusions.—Reference HPV testing remains the most common pattern. The most common reflex indication is for ASC-US, but HPV testing is modified locally to include a variety of scenarios. LR-HPV testing is commonly offered despite its lack of clinical significance. These data form a baseline for ongoing monitoring of HPV testing practice trends.

scholarly journals p16 immunostaining can avoid overdiagnosis in postmenopausal cervical cytology

2021 ◽  
Vol 9 (1) ◽  
pp. 1-8
Author(s):  
Yutaka Tsutsumi ◽  
◽  
Kazuya Shiogama ◽  
Ken Sakurai ◽  
Toru Arase ◽  
...  
Keyword(s):  
Cervical Cytology ◽  
Sampling Errors ◽  
Squamous Intraepithelial Lesion ◽  
Squamous Cells ◽  
Glass Slides ◽  
Intraepithelial Lesion ◽  
P16 Ink4a ◽  
Age Range ◽  
Chronic Cervicitis ◽  
P16 Expression

Senile (atrophic) colpitis is microscopically characterized by the predominance of parabasal squamous cells and the paucity of superficial cells. The activated parabasal cells or dyskeratotic superficial cells may be confused with squamous intraepithelial lesion (SIL) in the routine cytology practice. A total of 29 cervical cytology specimens diagnosed as atypical squamous cells (ASC) or SIL were retrospectively sampled from 24 postmenopausal women (age range: 56–84 years, mean: 65.5, median: 65). Cytological diagnoses in the routine services included ASC-US 20, ASC-H 2, LSIL 4 and HSIL 3. All the specimens showed an atrophic background (senile colpitis). There were two microscopic patterns of senile colpitis with atypia: 1) parabasal cells were clustered (n = 23) and 2) dyskeratotic superficial cells were seen in a highly inflamed background (n = 6). Immunostaining for p16-INK4a (p16 in short) was performed, after the cells were transferred to trimethoxy[3-(phenylamino)propyl]silane-coated glass slides. Only three of the 29 cytology specimens (two of the 24 cases) judged as HSIL cytologically revealed p16 positivity in clustered atypical parabasal cells. Biopsy was performed in 11 cases, and chronic cervicitis without p16 expression was seen in nine. Two lesions showed p16-positive dysplasia (one mild dysplasia and another moderate dysplasia). In one lesion in an 84 year-old female, both cytology and histology specimens showed p16 positivity (HSIL). Discrepancy of p16 expression between the cytology and histology specimens was encountered in two lesions, representing sampling errors. It is of note that the overcytodiagnosis is avoidable with the aid of p16 immunostaining. Keywords: Atypical squamous cells (ASC), cell transfer technique, p16-INK4a, senile colpitis, squamous intraepithelial lesion (SIL).

Characteristics of high-risk human papillomavirus infection in women with abnormal cervical cytology: a population-based study in Shanxi Province, China

2019 ◽  
Author(s):  
Li Song ◽  
Yuanjing Lyu ◽  
Ling Ding ◽  
Xiaoxue Li ◽  
Wen Gao ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Human Papillomavirus ◽  
High Risk ◽  
Hpv Infection ◽  
Cervical Cytology ◽  
Shanxi Province ◽  
Low Grade ◽  
Squamous Intraepithelial Lesion ◽  
Abnormal Cervical Cytology ◽  
Intraepithelial Lesion

Abstract Background: High-risk human papillomavirus (HR-HPV) infection is widely known as the major cause of cervical intraepithelial neoplasia (CIN) and cervical cancer and it’s characteristics vary greatly in different population. Women with abnormal cervical cytology could increase the risk of cervical cancer, however, HR-HPV infection characteristics in women with abnormal cervical cytology remains unclear. Methods: This study was based on baseline survey of the CIN Cohort established in Shanxi Province, China. A total number of 2300 women with cervical abnormalities were enrolled in this study. All participants gave informed consent and agreed to HPV and thinprepcytologic test (TCT). Each individual completed a questionnaire about characteristics related to HPV infection. Results: The overall prevalence of HR-HPV in 2300 women was 32.0%, and the proportion of single and multiple HR-HPV infections were 70.2% and 29.8% in HR-HPV infection women, respectively. The top five HR-HPV genotypes were ranked as HPV16, HPV58, HPV52, HPV53 and HPV51. The prevalence of HR-HPV in atypical squamous cells of undetermined significance (ASC-US), low-grade squamous intraepithelial lesion (LSIL) and high-grade squamous intraepithelial lesion and above(HSIL+) were 30.8%, 36.5% and 54.9%, respectively, showing an increasing trend with the severity of cervical cytology ( χ 2 trend =13.952; p <0.001). The women aged 35~45 years, with lower education level, less frequency of bathing, multiple gravidity, multiple parity, history of gynecological diseases and premenopausal women were prone to HR-HPV infection. Conclusions: We defined the characteristics related to HR-HPV infection in abnormal cervical cytology women, and provided an insight for the development and deeply research of HPV vaccine.

scholarly journals Bethesda 2014 Implementation and Human Papillomavirus Primary Screening: Practices of Laboratories Participating in the College of American Pathologists PAP Education Program

2019 ◽  
Vol 143 (10) ◽  
pp. 1196-1202 ◽  
Author(s):  
Diane Davis Davey ◽  
Rhona J. Souers ◽  
Kelly Goodrich ◽  
Dina R. Mody ◽  
Sana O. Tabbara ◽  
...  
Keyword(s):  
Human Papillomavirus ◽  
Education Program ◽  
Cervical Cytology ◽  
Current Status ◽  
Low Grade ◽  
Hpv Testing ◽  
Squamous Intraepithelial Lesion ◽  
Primary Screening ◽  
Intraepithelial Lesion ◽  
Bethesda System

Context.— Cervical cancer screening laboratory practices may evolve with new terminology and technologies. Objective.— To investigate changes in cervical cytopathology practice resulting from the 2014 Bethesda System updates and screening technologies. Design.— Questionnaires accompanied 2016 and 2017 mailings of the College of American Pathologists PAP Education program. Results.— In 2016, most laboratories surveyed had adopted or were planning to adopt 2014 Bethesda System updates, and the majority (53%; 365 of 689) used an age cutoff of 45 for reporting benign-appearing endometrial cells. However, 51.3% (354 of 690) of laboratories used the term low-grade squamous intraepithelial lesion, cannot exclude high-grade squamous intraepithelial lesion, for cases with indeterminate features, and 44.9% (298 of 664) of laboratories used a 5000-cell cutoff for minimum squamous cellularity for posthysterectomy and posttherapy specimens. Reporting rates for cervical cytology metrics changed very little from 2013 to 2016, and the median ratio of atypical squamous cells to squamous intraepithelial lesion cases was 1.9 for ThinPrep and 1.8 for SurePath preparations. Most laboratories (59.4%; 389 of 655) did not offer stand-alone primary human papillomavirus (HPV) testing in 2017, and primary HPV testing accounted for a low proportion of HPV testing volumes. The Roche Cobas method was the most common platform for HPV primary screening. Conclusions.— These questionnaire surveys provide data about the current status of cervical cytology screening, including changes related to the 2014 Bethesda System updates and the adoption of HPV primary screening techniques.

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