Visual inspection with acetic acid for detection of high grade lesion in atypical squamous cells and low grade squamous intraepithelial lesions from cervical Pap smear

Objective: The aim of this study was to compare the performance of the current conventional Pap smear with liquid-based cytology (LBC) preparations. Study Design: Women routinely undergoing their cytopathological and histopathological examinations at Fundação Oncocentro de São Paulo (FOSP) were recruited for LBC. Conventional smears were analyzed from women from other areas of the State of São Paulo with similar sociodemographic characteristics. Results: A total of 218,594 cases were analyzed, consisting of 206,999 conventional smears and 11,595 LBC. Among the conventional smears, 3.0% were of unsatisfactory preparation; conversely, unsatisfactory LBC preparations accounted for 0.3%. The ASC-H (atypical squamous cells - cannot exclude high-grade squamous intraepithelial lesion) frequency did not demonstrate any differences between the two methods. In contrast, the incidence of ASC-US (atypical squamous cells of undetermined significance) was almost twice as frequent between LBC and conventional smears, at 2.9 versus 1.6%, respectively. An equal percentage of high-grade squamous intraepithelial lesions were observed for the two methods, but not for low-grade squamous intraepithelial lesions, which were more significantly observed in LBC preparations than in conventional smears (2.2 vs. 0.7%). The index of positivity was importantly enhanced from 3.0% (conventional smears) to 5.7% (LBC). Conclusions: LBC performed better than conventional smears, and we are truly confident that LBC can improve public health strategies aimed at reducing cervical lesions through prevention programs.

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Early Age at First Sexual Intercourse is Associated with Higher Prevalence of High-grade Squamous Intraepithelial Lesions (HSIL)

Revista Brasileira de Ginecologia e Obstetrícia / RBGO Gynecology and Obstetrics ◽

10.1055/s-0036-1597973 ◽

2017 ◽

Vol 39 (02) ◽

pp. 080-085 ◽

Cited By ~ 3

Author(s):

José Xavier-Júnior ◽

Rozany Dufloth ◽

Diama Vale ◽

Marcelo Lima ◽

Luiz Zeferino

Keyword(s):

Sexual Intercourse ◽

Prevalence Ratio ◽

Low Grade ◽

High Grade ◽

Squamous Intraepithelial Lesions ◽

First Sexual Intercourse ◽

Squamous Cells ◽

Intraepithelial Lesion ◽

Prevalence Ratios ◽

Intraepithelial Lesions

Objective To evaluate the association of age at first sexual intercourse with the results of the cervicovaginal cytology. Study Design Observational analytical study about the prevalence of altered cervicovaginal cytology results in women aged between 18 and 34 years from a densely populated area in Brazil, during 10 years. The patients were stratified into 2 categories according to their age at first sexual intercourse (13–16 years and 17–24 years). Results From the total of 2,505,154 exams, 898,921 tests were in accordance with the inclusion criteria. Considering women with 4 years or less from the first sexual intercourse as a reference, those with 5 to 9 years and 10 years or more showed a higher prevalence of high-grade squamous intraepithelial lesions (HSILs). Women with an earlier onset of sexual intercourse (13–16 years) showed higher prevalence ratios for atypical squamous cells (ASC), low-grade squamous intraepithelial lesion (LSIL) and HSIL. The prevalence ratio for HSIL adjusted by age at diagnosis and by age at first sexual intercourse was higher only for women with an earlier onset of sexual intercourse. Conclusions The age of first sexual intercourse could be a variable that might qualify the selection among young women who are really at a higher risk for HSIL.

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The Use of Endocervical Curettage in Women with Low-grade Squamous Intraepithelial Lesions or Atypical Squamous Cells of Unknown Significance on Pap Smear

Journal of Lower Genital Tract Disease ◽

10.1097/00128360-200607000-00005 ◽

2006 ◽

Vol 10 (3) ◽

pp. 146-150 ◽

Cited By ~ 7

Author(s):

Angel D. Miranda ◽

Rolando Rodr??guez ◽

Diana M. Novoa ◽

Alvaro Rojas ◽

Alejandro Pach??n ◽

...

Keyword(s):

Pap Smear ◽

Low Grade ◽

Squamous Intraepithelial Lesions ◽

Squamous Cells ◽

Unknown Significance ◽

Intraepithelial Lesions

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Epidemiological Approach and Precocious Diagnosis of Precancerous Cervical Lesion in Sidi Bel Abbes Region (North-West of Algeria)

Journal of Drug Delivery and Therapeutics ◽

10.22270/jddt.v10i1-s.3887 ◽

2020 ◽

Vol 10 (1-s) ◽

pp. 72-78

Author(s):

Samira Meziani ◽

Khadidja Haoud ◽

Hayet Mehida ◽

Norddine Menadi ◽

Fatima Zohra Chenni ◽

...

Keyword(s):

Cervical Cancer ◽

Pap Smear ◽

Precancerous Lesions ◽

Precancerous Lesion ◽

Public Health Problem ◽

Low Grade ◽

High Grade ◽

Squamous Intraepithelial Lesions ◽

Pathology Laboratory ◽

Intraepithelial Lesions

Object: Cervical cancer of the uterine (CCU) is the first cancer of the genital tract. In Algeria, this cancer remains a real public health problem. The diagnosis is still done often with advanced stages which makes the therapeutic results modest and the cost of the high care. Methodology: Our study aims to elucidate the reality of this type of pathology in the region of Sidi Bel Abbes, northwestern Algeria. This retrospective and descriptive study was devoted to the epidemiological and clinical analysis of cervical cancer cases over a period of 3 years. Results: This study shows that out of a total of 500 smears recorded between (2014-2016) at the Ana-pathology laboratory level in Sidi Bel Abbes, we found that 230 smears presented precancerous lesions according to a cytological study, atypical squamous cells of undetermined significance (ASC-US: were 18%; low-grade squamous intraepithelial lesions (LSIL) were 20%, while high-grade squamous intraepithelial lesions (HSIL) were 8%. The results obtained according to the distribution of the patients in relation to the various factors: the most affected age group is late 46-55 years with a total of 40%; precocious age of 1st report 18-20 years is (38.2%); gestation 4-5 pregnancies and parities 4-5 children with a rate of (38.70% and 32.6%) respectively ; the hormonal state in genital activity is estimated at 62.2%; patients on oral contraception (OC) have a rate of 48.9%. Finally, more than half of the patients (57.8%), were able to have a biopsy within three to four months of the last smear. In histology, the presence of a HPV (Human Papilloma Virus) low grade lesion does not predict the evolution of this lesion. Conclusion: HPV can be oncogenic or non-oncogenic. it is the oncogenic HPV infection that is the main risk factor for developing a high grade lesion and cervical cancers outside the associated cofactors. Keywords: Pap Smear, Precancerous lesion, Cancer, Cervix, Screening

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Follow-up of women with atypical squamous cells cannot exclude high-grade squamous intraepithelial lesions (ASC-H)

Sao Paulo Medical Journal ◽

10.1590/1516-3180.2014.1321597 ◽

2014 ◽

Vol 132 (1) ◽

pp. 15-22 ◽

Cited By ~ 1

Author(s):

Fanny Lopez-Alegria ◽

Dino Soares De Lorenzi ◽

Orlando Poblete Quezada

Keyword(s):

Primary Healthcare ◽

Lesion Detection ◽

Low Grade ◽

High Grade ◽

Squamous Intraepithelial Lesions ◽

Squamous Cells ◽

The Times ◽

Primary Healthcare Clinics ◽

Intraepithelial Lesions

CONTEXT AND OBJECTIVE: The concept that the presence of atypical squamous cells cannot exclude high-grade squamous intraepithelial lesions (ASC-H) was introduced in the 2001 Bethesda System of cervical cytology classification. This nomenclature defines cervical cancer precursor lesions. The objective of this study was to investigate the colpocytological-histological results from a three-year follow-up conducted on a cohort of women with reports of ASC-H who were attended during 2005-2006 at clinics of the Southern Metropolitan Healthcare Service of Santiago, Chile. DESIGN AND SETTING: Prospective cohort study at primary healthcare clinics in Santiago, Chile. METHODS : Colpocytological-histological follow-up was conducted over a three-year period on 92 women with cytological reports of ASC-H who were attended at primary healthcare clinics during 2005-2006. RESULTS : At the end of the follow-up period, high-grade lesions were evaluated and the following outcomes were observed: seven women presented invasive cancer (7.6%), 49 presented high-grade lesions (53.3%), 26 presented low-grade lesions (28.2%) and 10 presented normal results (10.9%). The "Conditional Probabilities Tree Diagram" was used to show the results from tests and the times of lesion detection. It demonstrated that, after a first report of ASC-H, clinical management needed to be interventionist. CONCLUSION: The follow-up on our cohort of women showed that the majority of uncertain ASC-H diagnoses (82.6%) had abnormal colposcopic results and that during the follow-up using ASC-H smears, two out of every three women developed high-grade lesions.

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Whole-Slide Imaging of Pap Cellblock Preparations Is a Potentially Valid Screening Method

Acta Cytologica ◽

10.1159/000430082 ◽

2015 ◽

Vol 59 (2) ◽

pp. 187-200 ◽

Cited By ~ 11

Author(s):

Ossama Tawfik ◽

Marilyn Davis ◽

Susan Dillon ◽

Laila Tawfik ◽

Francisco J. Diaz ◽

...

Keyword(s):

Sensitivity And Specificity ◽

Low Grade ◽

Adenocarcinoma In Situ ◽

High Grade ◽

Whole Slide Imaging ◽

Squamous Intraepithelial Lesions ◽

Squamous Cells ◽

The Impact ◽

Intraepithelial Lesions ◽

Undetermined Significance

Objective: 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. Study Design: 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. Results: 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. Conclusions: 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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Only a Small Fraction of High-Grade Cervical Lesions Are Discovered After an Interpretation of Atypical Squamous Cells of Undetermined Significance When Using Imager-Assisted, Liquid-Based Papanicolaou Tests and the Bethesda 2001 System

Archives of Pathology & Laboratory Medicine ◽

10.5858/arpa.2012-0358-oa ◽

2012 ◽

Vol 137 (7) ◽

pp. 936-941 ◽

Cited By ~ 2

Author(s):

Kelly A. Khan ◽

Debora A. Smith ◽

Michael J. Thrall

Keyword(s):

Low Grade ◽

High Grade ◽

Test Results ◽

Squamous Intraepithelial Lesion ◽

Squamous Intraepithelial Lesions ◽

Papanicolaou Test ◽

Squamous Cells ◽

Intraepithelial Lesion ◽

Intraepithelial Lesions ◽

Undetermined Significance

Context.—Previous work has reported that most high-grade cervical neoplasia is seen in patients with preceding Papanicolaou test results of atypical squamous cells of undetermined significance. This information was based on conventional test results and the Bethesda 1991 reporting system and was determined before the current treatment guidelines. Objective.—Our objective was to perform a retrospective review of all histologically confirmed, high-grade cervical neoplasia to determine the diagnosis of the preceding liquid-based Papanicolaou test. Design.—A total of 189 histologically confirmed, high-grade cervical intraepithelial neoplasia (CIN) cases grade 2 and greater were identified for a 1-year period. Results.—Of the 189 cases, 10 (5.3%) had a previous diagnosis of atypical squamous cells of undetermined significance; 55 (29.1%) had low-grade squamous intraepithelial lesions; 31 (16.4%) had low-grade squamous intraepithelial lesions, unable to rule out a high-grade squamous intraepithelial lesion; 21 (11.1%) had atypical squamous cells, unable to rule out a high-grade squamous intraepithelial lesion; 68 (36%) had high-grade squamous intraepithelial lesions; 1 (0.5%) had atypical glandular cells; 1 (0.5%) had adenocarcinoma in situ; and 2 (1%) had invasive carcinoma. Combined “low grade” Papanicolaou test results (atypical squamous cells of undetermined significance and low-grade squamous intraepithelial lesion) preceded 51 of 103 cases of CIN 2 (49.5%) and 14 of 103 cases (13.6%) of CIN 3/cancer, whereas “high grade” Papanicolaou test results (atypical squamous cells, unable to rule out a high-grade squamous intraepithelial lesion; low-grade squamous intraepithelial lesions, unable to rule out a high-grade squamous intraepithelial lesion; high-grade squamous intraepithelial lesions; atypical glandular cells; adenocarcinoma in situ; and invasive carcinoma) preceded 52 of 103 CIN 2 cases (50.5%) and 72 of 103 CIN 3/cancer cases (69.9%). Conclusions.—Our data show that we can now more-reliably predict high-grade dysplasia on routine Papanicolaou tests. Only a small fraction of histologically confirmed CIN 2/3 cases are found following a Papanicolaou test diagnosis of atypical squamous cells of undetermined significance.

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Detection of Cervical Cytological Abnormalities by Pap smears Method among Women Attending the Screening Clinic of Nsambya Hospital

10.47363/jpr/2019(1)101 ◽

2019 ◽

pp. 1-4

Author(s):

Mwesigwa Boaz ◽

◽

Andrew Livex Okwi Okwi ◽

Othieno Emmanuel ◽

◽

...

Keyword(s):

Cervical Cancer ◽

Pap Smear ◽

Public Health Problem ◽

Low Grade ◽

High Grade ◽

Squamous Intraepithelial Lesion ◽

Squamous Cells ◽

Cytological Abnormalities ◽

Intraepithelial Lesion ◽

Intraepithelial Lesions

Background: Cervical cancer is an important public health problem. In Uganda, it ranks the most frequent cause of cancer among women aged between 15 to 44 years of age. Early detection and eradication of cervical cancer and its precursor lesions is the mainstay for control of this disease. The Pap smear method is the most cost-effective means of screening cervical pre-malignant, malignant processes and non-neoplastic lesions. Aim: To describe the cervical cytological abnormalities as detected byPap smear method and to determine the prevalence of such abnormalities Methodology: This was a prospective study, in which a total of 175 women were recruited from May to June, 2016. Cervical samples were collected from these women and stained according to the papanicolaou staining protocol. Results were reported using the 2014 Bethesda reporting system. Results: Out of 175 cases, 163 (93.1%) were reported as negative for intraepithelial lesion or malignancy [NILM]. Cervical intraepithelial lesions were reported in 12 (6.9%) cases which included atypical squamous cells of undetermined significance [ASCUS] in 4(2.3%) cases, atypical squamous cells cannot exclude high grade squamous intraepithelial lesions [ASCH] in 1(0.6%) case, low-grade squamous intraepithelial lesion [LSIL] in 5 (2.9%) cases, high-grade squamous intraepithelial lesion [HSIL] in 1(0.6%) case and atypical glandular cells [AGC] in 1(0.6%) case. Conclusion: Cervical cytology by Pap smear method should be used to screen women routinely because it is an effective method in detecting pre-malignant and malignant lesions of the cervix.

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