A Descriptive Review of the Community-Based Cervical Cancer Screening Programme at the Singapore Cancer Society

Background: Cervical cancer is the fourth common malignancy in women worldwide and clinical Papanicolaou (Pap) smear test is a relatively inexpensive yet efficacious screening method for the detection of precancerous or cancerous lesions. Aim: Herein, we sought to quantify the incidence and prevalence of abnormal cervical cytology in asymptomatic women who underwent routine Papanicolaou test screening at the community-based clinical setting of our Singapore Cancer Society's Multi-Service Centre. Methods: This retrospective study reviewed a total of 15,195 reports of cervical Pap smears performed from January 2015 to December 2017 to delineate epithelial abnormalities. Additionally, a descriptive cross-sectional analysis was carried out on the corroborative demographic and clinical data retrieved from the relevant case notes. Results: The mean age of women recruited for screening in this period was 49.0 ± 11.1 years. A total of 623 (4.1%) were identified with abnormal Papanicolaou test results viz., i. atypical squamous/glandular cells of undetermined significance (n=592; 3.9%), ii. low/high grade squamous intraepithelial lesions (n=28; 0.18%) and iii. high grade squamous intraepithelial lesion, suspicious of squamous cell carcinoma/adenocarcinoma (n=3; 0.02%). Clinical history in the latter two cohorts (n=31; 0.2%) revealed first sexual encounter at age ≤ 20 years (54.8%), ≥ 2 sexual partners (38.7%) or abnormal vaginal discharge (29.0%). An 80.6% and 6.5% had undergone Papanicolaou test or HPV - human papillomavirus - vaccination in the past. History of smoking, long-term contraceptive use and treatment of STI(s) were reported by 22.6%, 3.2% and 6.5% respectively. Conclusion: Cervical cancer originates in the transformation zone of the uterine cervix and screening for abnormal cytology is the cornerstone in early detection. The low percentage of epithelial cell abnormality identified in this large population sampling over three years confirms that routine Papanicolaou test testing would suffice as a cost-effective screening approach to detect precancerous cervical lesions. Where imperative, necessary follow-up on unsatisfactory Papanicolaou test result(s), HPV genotyping and/or due referral procedures would significantly aid in reducing the cervical cancer burden for women in the susceptible age range.

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Role of Colposcopy in Detection of Dysplastic Cervical Lesion as a Screening Tool

Journal of Global Oncology ◽

10.1200/jgo.18.51300 ◽

2018 ◽

Vol 4 (Supplement 2) ◽

pp. 33s-33s

Author(s):

P. Gyawali ◽

S.R. KC ◽

S. Ghimire

Keyword(s):

Cervical Cancer ◽

Cervical Carcinoma ◽

Screening Tool ◽

Cervical Lesion ◽

Histopathological Diagnosis ◽

Low Grade ◽

High Grade ◽

Age Group ◽

Cervical Lesions ◽

Papanicolaou Test

Background: Age standardized cervical cancer incidence rate in Nepal is 19.2/100,000 woman, compared with 14.0 worldwide. Similarly, mortality rate is 12.0 women which is significant in comparison with 6.8 worldwide. Cervical intraepithelial neoplasm is a precursor lesion, having high transformation rate into the cervical carcinoma. Data clearly indicates that CIN 2 and 3 has more progression into cervical carcinoma. Despite the fact that Papanicolaou test has remained an important tool in the screening for cervical cancer and has contributed in significant decrease in cervical cancer, sensitivity and specificity of conventional Papanicolaou test is quite low. Colposcopy is visual inspection of cervix under magnification. Study revealed that the positive predictive rate of the colposcopic impression is better as the cervical lesion is more severe. Aim: To find out the significance of colposcopy in the detection of dysplastic cervical lesions and possible use of this method as a screening tool. Methods: This is an observational study done at Cancer Care Foundation, Nepal done from a period of January 2015 to February 2018. Permission was obtained from ethical committee and written consent was obtained from the patients. All the patients suspected having dysplastic or invasive lesions or in whom colposcopy-guided biopsy was performed; were included in the study. Relevant data were collected which included age, colposcopic diagnosis, histopathological diagnosis. Data were entered into Microsoft Excel and statistical analysis was done from statistical package SPSS 21. Results: 6109 females were screened through colposcopy. Out of these 900 patients underwent colposcopy-guided biopsy for being suspected of dysplastic lesions or inflammatory lesions. Mean age of females was 40.65 years. With colposcopy, 407 (45.2%) were suspected to have low grade lesion, followed by 401 (44.6%) high grade lesion and 15 (1.7%) carcinoma. Nonneoplastic lesions were suspected in 77 (8.6%) females. In the histopathological examination low grade dysplasia was observed in 403 (44.8%) followed by 250 (27.8%) high grade dysplasia and 8 (0.9%) carcinoma in-situ or invasive carcinoma. Similarly, 239 (26.6%) patients had nonneoplastic lesions. In colposcopy, high grade lesions were suspected more frequently in females of 41-50 years age group than in 31-40 years age group ( P < 0.01). Correlation between increasing age and dysplastic lesions were also observed ( P < 0.05). There was significant correlation between colposcopic diagnosis and histopathological diagnosis with a P value < 0.01. The sensitivity of colposcopy to diagnose dysplastic lesions were high 96.44% with positive predictive value of 62.65%. The specificity of colposcopy to diagnose various grades of dysplastic lesions is 34.98%. Conclusion: Colposcopy is highly sensitive method of screening dysplastic cervical lesions and should be used more frequently as a screening purpose.

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Point-of-care digital cytology with artificial intelligence for cervical cancer screening at a peripheral clinic in Kenya

10.1101/2020.08.12.20172346 ◽

2020 ◽

Author(s):

Oscar Holmstrom ◽

Nina Linder ◽

Harrison Kaingu ◽

Ngali Mbuuko ◽

Jumaa Mbete ◽

...

Keyword(s):

Cervical Cancer ◽

Pap Smear ◽

Point Of Care ◽

Screening Method ◽

Machine Learning Algorithms ◽

Learning System ◽

Pap Smears ◽

Low Grade ◽

High Grade ◽

Predictive Values

Cervical cancer is highly preventable but remains a common and deadly cancer in areas without screening programmes. Pap smear analysis is the most commonly used screening method but is labour-intensive, subjective and requires access to medical experts. We developed a diagnostic system in which microscopy samples are digitized at the point-of-care (POC) and analysed by a cloud-based deep-learning system (DLS) and evaluated the system for the detection of cervical cell atypia in Pap smears at a peripheral clinic in Kenya. A total of 740 conventional Pap smears were collected, digitized with a portable slide scanner and uploaded over mobile networks to a cloud server for training and validation of the system. In total, 16,133 manually-annotated image regions where used for training of the DLS. The DLS achieved a high average sensitivity (97.85%; 95% confidence interval (CI) 83.95-99.75%) and area under the curve (AUCs) (0.95) for the detection of cervical-cellular atypia, compared to the pathologist assessment of digital and physical slides. Specificity was higher for high-grade atypia (95.9%; 95% CI 94.9-97.6%) than for low-grade atypia (84.2%; 95% CI 79.9-87.9%). Negative predictive values were high (99.3-100%), and no samples classified as high grade by manual sample analysis had false-negative assessments by the DLS. The study shows that advanced digital microscopy diagnostics supported by machine learning algorithms is implementable in rural, resource-constrained areas, and can achieve a diagnostic accuracy close to the level of highly trained experts.

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Prevalence of High-Risk Human Papillomavirus Types Among Women Screened for Cervical Cancer in Yazd, Iran, and Comparison of Cytology, Histology, and Colposcopy Results

Jundishapur Journal of Microbiology ◽

10.5812/jjm.100573 ◽

2020 ◽

Vol 13 (9) ◽

Author(s):

Mojgan Karimi-Zarchi ◽

Nastaran Hajimaghsoudi ◽

Afsarosadat Tabatabai ◽

Mansour Moghimi ◽

Mohammad Shayestehpour ◽

...

Keyword(s):

Cervical Cancer ◽

Human Papillomavirus ◽

High Risk ◽

Pap Smear ◽

Blot Hybridization ◽

High Grade ◽

Cervical Lesions ◽

Hpv Typing ◽

Hpv Types ◽

High Risk Hpv

Background: Human Papillomavirus (HPV) is a DNA virus with more than 100 genotypes, at least 12 of which are high-risk and associated with high-grade cervical lesions. Data on the prevalence of high-risk HPV genotypes among women are not yet available for the total regions of Iran. Objectives: The present study aimed to determine the prevalence of high-risk HPV types among women screened for cervical carcinoma in Yazd and compare the cytology, histology, and colposcopy results. Methods: In this cross-sectional study, 402 women referring to gynecology clinics of Shahid Sadoughi University of Medical Sciences, Yazd, Iran, were selected. The Pap smear and HPV typing were performed on cervical samples. The high-risk HPV types were detected by the polymerase chain reaction (PCR)-based reverse blot hybridization assay. Colposcopy was carried out on patients with high-risk HPV types, and biopsies were taken for histological examination. Results: Among 402 women screened by HPV-PCR, 32 (7.97%) women were positive for high-risk HPV types. Human papillomavirus 16 and HPV18 were the most frequent genotypes (46.9%). The cytology, histology, and colposcopy results were abnormal in 56.2%, 29.1%, and 71.9% of patients, respectively. Pap smear had 100% sensitivity and 58.3% specificity for the detection of high-grade cervical lesions, while these values for colposcopy were 75% and 87.5%, respectively. Conclusions: The frequency of high-risk HPV types was relatively low among women living in Yazd than in those from other provinces of Iran. A significant percentage of patients with HPV had normal cervical cytology and histology. Therefore, HPV typing is recommended to decrease the development of cervical cancer. Colposcopy had acceptable sensitivity and specificity for the detection of high-grade cervical lesions.

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Pap smear in antepartum women: an opportunity to screen and create awareness

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20184134 ◽

2018 ◽

Vol 7 (10) ◽

pp. 4093

Author(s):

Shanthi Ethirajan ◽

Srinidhi R. ◽

Jayashree K.

Keyword(s):

Pap Smear ◽

Past History ◽

Screening Method ◽

Pap Test ◽

Breast Cancers ◽

Cancer Cervix ◽

Cervical Lesions ◽

Genital Infections ◽

Pap Smear Screening ◽

A Prospective Study

Background: Cervical and breast cancers are the leading malignancies in females in India. Cancer cervix is preventable and treatable if detected at premalignant stage. Pap smear is a recommended screening method for cancer cervix and its precursors. Pap smear screening in antenatal period presents an opportunity to screen for premalignant cervical lesions and genital infections. This study was undertaken to determine the prevalence of abnormal cervical smears and genital infections among antenatal women.Methods: It is a prospective study in which, 200 antenatal mothers at booking visit, were included in the study. Details on their demographic characteristics, obstetric profile, and past history of Pap test were collected. Liquid based cytology was used for the test. The cytological results were reported based on the Bethesda classification system 2001.Results: Among 200 antenatal women 57% were between 21-25 yrs of age and 18% were less than 20 years. 38% of women were less than 20 years of age at the time of beginning of sexual activity. 56% were primi gravida and others were multi gravida. 95.5 % of women were literate. 89% of women were unaware of Pap smear test. Among the 200 Pap smear reports, 23% were normal, 55.5% nonspecific inflammatory changes, 8.5% Candida infection and 13% bacterial vaginosis. None were reported with premalignant changes.Conclusions: In a population where people do not undergo Pap test due to varied reasons, antenatal Pap test not only provides an excellent opportunity to screen and create awareness for further screening, also helps detect genital infections.

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Artificial intelligence-assisted fast screening cervical high grade squamous intraepithelial lesion and squamous cell carcinoma diagnosis and treatment planning

Scientific Reports ◽

10.1038/s41598-021-95545-y ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Ching-Wei Wang ◽

Yi-An Liou ◽

Yi-Jia Lin ◽

Cheng-Chang Chang ◽

Pei-Hsuan Chu ◽

...

Keyword(s):

Cervical Cancer ◽

Squamous Cell Carcinoma ◽

Pap Smear ◽

Jaccard Index ◽

High Grade ◽

Cervical Lesions ◽

Diagnosis And Classification ◽

F Measure ◽

Whole Slide Images

AbstractEvery year cervical cancer affects more than 300,000 people, and on average one woman is diagnosed with cervical cancer every minute. Early diagnosis and classification of cervical lesions greatly boosts up the chance of successful treatments of patients, and automated diagnosis and classification of cervical lesions from Papanicolaou (Pap) smear images have become highly demanded. To the authors’ best knowledge, this is the first study of fully automated cervical lesions analysis on whole slide images (WSIs) of conventional Pap smear samples. The presented deep learning-based cervical lesions diagnosis system is demonstrated to be able to detect high grade squamous intraepithelial lesions (HSILs) or higher (squamous cell carcinoma; SQCC), which usually immediately indicate patients must be referred to colposcopy, but also to rapidly process WSIs in seconds for practical clinical usage. We evaluate this framework at scale on a dataset of 143 whole slide images, and the proposed method achieves a high precision 0.93, recall 0.90, F-measure 0.88, and Jaccard index 0.84, showing that the proposed system is capable of segmenting HSILs or higher (SQCC) with high precision and reaches sensitivity comparable to the referenced standard produced by pathologists. Based on Fisher’s Least Significant Difference (LSD) test (P < 0.0001), the proposed method performs significantly better than the two state-of-the-art benchmark methods (U-Net and SegNet) in precision, F-Measure, Jaccard index. For the run time analysis, the proposed method takes only 210 seconds to process a WSI and is 20 times faster than U-Net and 19 times faster than SegNet, respectively. In summary, the proposed method is demonstrated to be able to both detect HSILs or higher (SQCC), which indicate patients for further treatments, including colposcopy and surgery to remove the lesion, and rapidly processing WSIs in seconds for practical clinical usages.

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Trends in High-grade Cervical Lesions and Cervical Cancer Screening in 5 States, 2008–2015

Clinical Infectious Diseases ◽

10.1093/cid/ciy707 ◽

2018 ◽

Vol 68 (8) ◽

pp. 1282-1291 ◽

Cited By ~ 13

Author(s):

Julia Warner Gargano ◽

Ina U Park ◽

Marie R Griffin ◽

Linda M Niccolai ◽

Melissa Powell ◽

...

Keyword(s):

Cervical Cancer ◽

Human Papillomavirus ◽

Cancer Screening ◽

Cervical Cancer Screening ◽

Population Level ◽

Population Based ◽

High Grade ◽

Cervical Lesions ◽

Human Papillomavirus Vaccination

We describe trends in high-grade cervical lesions (CIN2+), identified through population-based surveillance in 2008–2015. In addition to changed screening recommendations, observed CIN2+ declines among screened women aged 18–24 years indicate a population-level impact of human papillomavirus vaccination.

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Risk Factors for Cervical Cancer and Papanicolaou Test in Marginalized Adolescents in Bogotá, Colombia

Revista Ciencias de la Salud ◽

10.12804/revistas.urosario.edu.co/revsalud/a.8746 ◽

2020 ◽

Vol 18 (1) ◽

pp. 37

Author(s):

María Inés Sarmiento Medina ◽

Miryam Puerto de Amaya

Keyword(s):

Risk Factors ◽

Cervical Cancer ◽

Child Protection ◽

Pap Smear ◽

Age Of Onset ◽

Social Conditions ◽

Cervical Lesions ◽

Papanicolaou Test ◽

Future Health ◽

Cross Sectional

Introduction: Cervical cancer is rare in young women, so screening in women under 21 years is not recommended. However, early and intense exposure to risk factors could increase the likelihood of early pre-neoplastic lesions. Currently, particular social conditions in adolescents can favor exposure, generate changes in lifestyles, and affect their immediate and future health. This work describes the frequency of risk factors and Pap results in adolescents of a child protection center. Materials and Methods: This paper presents a retrospective cross-sectional study that measured the frequency of exposure to risk factors for cervical cancer and Pap results of 889 adolescents exposed to critical social conditions. It used information from the cytology report files made between 2011 and 2016. Results: Normal Pap smear was found in 85 % of the cases. The risk factors had a very high prevalence, especially the early age of onset of sexual relations with 75 % before age 14, the number of sexual partners with more than one in 66.7 %, no use of a condom 95 % and high cigarette consumption. Discussion: The frequency of pre-malignant cervical lesions was very low; however, in women under 21 years old with premature and intense exposure to risk factors, an early-onset conservative screening accompanied by gynecological consultation for prevention, diagnosis, or treatment can be considered. The marginalized adolescent’s social problem requires interdisciplinary and intersectoral management.

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Comparative study of conventional Pap smear and liquid based cytology as a screening method for cervical cancer

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20213096 ◽

2021 ◽

Vol 9 (8) ◽

pp. 2439

Author(s):

Bhagyalakshmi Atla ◽

Uma Prasad ◽

Venkata Satya Kartheek Botta ◽

Uma Namballa ◽

Lahari Pujari ◽

...

Keyword(s):

Cervical Cancer ◽

Epithelial Cell ◽

Pap Smear ◽

Screening Method ◽

P Value ◽

Pap Smears ◽

Cervical Lesions ◽

Malignant Lesions ◽

Liquid Based Cytology

Background: Pap smear is the conventional screening procedure for cervical cancer. Liquid based cytology has been developed as a cost effective alternative as it has a short screening time, better morphology and clean background while also providing residual material to test for HPV DNA. Therefore this study is undertaken to know the role of Liquid-based cytology in evaluating pre-malignant and malignant lesions of cervix. Objectives of current study were to study the distribution of various cervical lesions on liquid-based cytology and compare them with conventional Pap smears. To know the role of liquid-based cytology in evaluating pre-malignant and malignant lesions of cervixMethods: This study included 200 women attending to gynaecology OPD and the samples were taken for both conventional cytology and liquid based cytology. The smears were studied in detail and were interpreted as per The Bethesda system 2014 of reporting pap smears and results are recorded and compared.Results: The commonest cervical lesions on pap smears by liquid-based cytology are NILM-reactive changes (N=92, 46%), NILM Candida infection is seen in 9 cases (4.5%) and trichomonas vaginalis infection in 5 cases (2.5%). Unsatisfactory smears on LBC is less when compared to conventional smears as the coefficient of correlation is significant with p value of 0.000422 (<0.05). The number of cases with a diagnosis of ASCUS is reported more in liquid-based cytology (9 cases) when compared to conventional Pap (8 cases). The number of cases with diagnosis of HSIL, SCC is reported more in liquid based cytology (7 cases) when compared to conventional Pap (4 cases). Epithelial cell abnormality were easily diagnosed on LBC smears with significant p value of 0.002414 (<0.05).Conclusions: Liquid-based cytology has advantages of fewer unsatisfactory smears and better detection of epithelial cell abnormalities when compared to conventional Pap smears. LBC is better for the screening of premalignant and malignant lesions of cervix even though it is costly.

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High-risk HPV genotypes and cervical lesions association in postmenopausal women

European Journal of Public Health ◽

10.1093/eurpub/ckab120.044 ◽

2021 ◽

Vol 31 (Supplement_2) ◽

Author(s):

Ana Rita Fernandes Miranda da Costa ◽

Cláudia Sousa ◽

Erica Isidoro ◽

Regina Silva ◽

Cristiana Mourato

Keyword(s):

Cervical Cancer ◽

High Risk ◽

Postmenopausal Women ◽

Age Groups ◽

Low Grade ◽

High Grade ◽

Cervical Lesions ◽

Intraepithelial Lesion ◽

The Bethesda System ◽

High Risk Hpv

Abstract Background Persistent infection by high-risk Human Papillomavirus (hrHPV) are the major cause of cervical cancer. Studies report disparities in the incidence of infection and the various genotypes of this virus in different age groups, suggesting a higher frequency of hrHPV in young women and low-risk subtypes being predominant in older women. This study aimed to investigate the incidence and distribution of hrHPV genotypes in postmenopausal women as well as the correlation with the cytological findings. Methods 16 859 women, aged 50–64 years, performed cervical cancer screening test in Friuri Venezia Giulia region, Italy. The infection was evaluated by the Polymerase Chain Reaction methodology and the positive samples were evaluated by Liquid Based Cytology according to the Bethesda System from 2014. A statistical analysis was performed to study the molecular and cytological data of this population. Results hrHPV infection were found in 5.8% of the women and 78.3% of these were caused by hrHPV other than HPV16 and HPV18 (). Also, 65.7% of the positive samples were negative for intraepithelial lesion or malignancy while low grade squamous intraepithelial lesion was the most frequent (22.4%). There was an increase in the number of high-grade intraepithelial lesions in the presence of HPV16 compared to that recorded when this genotype was absent (20.8% vs. 8.5%). No cervical cancers were detected. Conclusions Infection with hrHPV is uncommon in postmenopausal women and it is mostly caused by subtypes less associated with the development of cervical cancer. Yet, HPV16 infection triggers the development of high-grade lesions.

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