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Zamurovic M, Tomic A, Pikula A, Simanic S, Knezevic A, Jankovic M, Lackovic M, Djakovic E, Rovcanin M. Understanding the Dynamics of Human Papillomavirus and Diagnostic Discrepancies in Cervical Pathology: A Single Center Experience. Diagnostics (Basel) 2023; 13:3614. [PMID: 38132198 PMCID: PMC10743259 DOI: 10.3390/diagnostics13243614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 11/16/2023] [Accepted: 12/01/2023] [Indexed: 12/23/2023] Open
Abstract
Cervical cancer (CC) is the most prevalent gynecological malignancy and a leading cause of death among women. It is primarily caused by human papillomavirus (HPV) infection, with 99.7% of cases showing high-risk HPV genotypes. This study sheds light on HPV dynamics as well as the discrepancies of different CC screening modalities results while highlighting factors that may have contributed to such a scenario. Moreover, we underscore the importance of the non-viral etiology of CC as well. We examined the current trends of HPV infection and its effects on cervical health in women treated at a tertiary care center in Belgrade, Serbia. Patients with abnormal colposcopy findings like dysplasia and re-epithelization were more likely to test negative for HPV (p < 0.001). Interestingly, women with a positive Pap smear tested HPV negative significantly more often (p = 0.041). Finally, HPV-positive individuals were more likely to have CIN I and II histologies (p < 0.001), while CIN III occurred equally in women with and without the virus. It may be inferred that inconsistencies in detecting HPV and the presence of cervical lesions may eventually result in adjustments to screening guidelines, as is crucial to adopt a meticulous approach to promote periodical CC screening, as initial samples may test negative for HPV.
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Affiliation(s)
- Milena Zamurovic
- Clinic for Gynecology and Obstetrics, Narodni Front, Kraljice Natalije 62, 11000 Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, Dr Subotica Starijeg 8, 11000 Belgrade, Serbia
| | - Ana Tomic
- Faculty of Medicine, University of Belgrade, Dr Subotica Starijeg 8, 11000 Belgrade, Serbia
| | - Aleksandra Pikula
- Clinic for Gynecology and Obstetrics, Narodni Front, Kraljice Natalije 62, 11000 Belgrade, Serbia
| | - Sara Simanic
- Faculty of Medicine, University of Belgrade, Dr Subotica Starijeg 8, 11000 Belgrade, Serbia
| | - Aleksandra Knezevic
- Faculty of Medicine, University of Belgrade, Dr Subotica Starijeg 8, 11000 Belgrade, Serbia
- Institute of Microbiology and Immunology, Department of Virology, Faculty of Medicine, University of Belgrade, Dr Subotića Starijeg Street, 11000 Belgrade, Serbia
| | - Marko Jankovic
- Faculty of Medicine, University of Belgrade, Dr Subotica Starijeg 8, 11000 Belgrade, Serbia
- Institute of Microbiology and Immunology, Department of Virology, Faculty of Medicine, University of Belgrade, Dr Subotića Starijeg Street, 11000 Belgrade, Serbia
| | - Milan Lackovic
- Clinical Hospital Center, Dr Dragiša Mišović, Heroja Milana Tepica 1, 11000 Belgrade, Serbia
| | - Elena Djakovic
- Clinic for Gynecology and Obstetrics, Narodni Front, Kraljice Natalije 62, 11000 Belgrade, Serbia
| | - Marija Rovcanin
- Clinic for Gynecology and Obstetrics, Narodni Front, Kraljice Natalije 62, 11000 Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, Dr Subotica Starijeg 8, 11000 Belgrade, Serbia
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Pontré JC, Nathan E, Goldsmith H, McElhinney B. Does the New National Cervical Screening Programme Guideline Detect Cases of High-Grade Squamous Intraepithelial Lesions That Previously Would Have Been Missed? J Low Genit Tract Dis 2023; 27:230-235. [PMID: 37379440 DOI: 10.1097/lgt.0000000000000751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/30/2023]
Abstract
OBJECTIVE The aim of this study was to determine the number of patients undergoing large loop excision of the transformation zone (LLETZ), for biopsy-confirmed high-grade squamous intraepithelial lesions (HSIL), where the original cervical screening test (CST) reported oncogenic human papillomavirus (HPV) and negative liquid-based cytology (LBC). This reflects the number of patients where a LLETZ procedure would not have occurred under the previous guideline. METHODS Retrospective observational chart review of all patients (n = 477) who underwent LLETZ procedure in a single tertiary unit over a 36-month period. Prevalence of negative histopathology, positive margins, incidental cervical cancer, and accuracy of HSIL identification at colposcopy were measured. Diagnostic accuracy of HSIL diagnosis from initial colposcopic impression was calculated; factors influencing accuracy were evaluated using multivariable logistic regression analysis. There were no comparators. RESULTS Of 477 LLETZs, 5.9% (n = 28) were for oncogenic HPV and normal LBC on referral CST. Demographics between the "study" (oncogenic HPV and normal LBC on referral CST) and the "standard" group were similar, except the study group was less likely to be using contraception (25% vs 47%, p = .023). In the study group, initial colposcopic cervical biopsy confirmed HSIL in 91.6% (n = 27) and low-grade squamous intraepithelial lesions in 3.6% (n = 1). Histopathological analysis of LLETZ specimens confirmed HSIL in 20 patients (71.4%) and low-grade squamous intraepithelial lesions in 2 (7.1%). No microinvasion was detected. CONCLUSIONS The renewed National Cervical Screening Programme (NCSP), is detecting more "at risk" patients, predicted to lead to a further reduction in incidence of cervical cancer in adequately screened patients.
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Affiliation(s)
| | - Elizabeth Nathan
- Division of Obstetrics and Gynaecology, University of Western Australia, Perth, Western Australia, Australia
| | - Hilary Goldsmith
- King Edward Memorial Hospital, Perth, Western Australia, Australia
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Non-Invasive Differential Diagnosis of Cervical Neoplastic Lesions by the Lipid Profile Analysis of Cervical Scrapings. Metabolites 2022; 12:metabo12090883. [PMID: 36144287 PMCID: PMC9506087 DOI: 10.3390/metabo12090883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 09/12/2022] [Accepted: 09/13/2022] [Indexed: 11/17/2022] Open
Abstract
Cervical cancer is one of the most common cancers in women with pronounced stages of precancerous lesions. Accurate differential diagnosis of such lesions is one of the primary challenges of medical specialists, which is vital to improving patient survival. The aim of this study was to develop and test an algorithm for the differential diagnosis of cervical lesions based on lipid levels in scrapings from the cervical epithelium and cervicovaginal canal. The lipid composition of the samples was analyzed by high-performance chromato-mass spectrometry. Lipid markers were selected using the Mann–Whitney test with a cutoff value of 0.05 and by projections to latent structures discriminant analysis, where a projection threshold of one was chosen. The final selection of variables for binomial logistic regressions was carried out using the Akaike information criterion. As a result, a final neoplasia classification method, based on 20 logistic regression sub-models, has an accuracy of 79% for discrimination NILM/cervicitis/LSIL/HSIL/cancer. The model has a sensitivity of 83% and a specificity of 88% for discrimination of several lesions (HSIL and cancer). This allows us to discuss the prospective viability of further validation of the developed non-invasive method of differential diagnosis.
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Kawase R, Suzuki S. Evaluation of High-Risk Human Papillomavirus Testing in Women with Atypical Squamous Cells of Undetermined Significance to Detect Cervical Intraepithelial Neoplasia. ASIAN JOURNAL OF ONCOLOGY 2022. [DOI: 10.1055/s-0042-1744437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
Abstract
Introduction We retrospectively examined the changes in the management and outcomes of the cases with atypical squamous cells of undetermined significance (ASC-US) according to the Bethesda system (TBS).
Materials and Methods Between May 2009 and December 2018, 432 cases with ASC-US were retrospectively examined for the implementation of high-risk human papillomavirus (hrHPV) testing and/or cervical biopsy and clinical courses.
Results The hrHPV testing was performed in 277 cases (64.1%). Of these, there were 80 with positive hrHPV (28.9%). Of the 80 cases, cervical biopsy was performed in 71 (88.9%) cases based on the finding of colposcopy. Cervical intraepithelial neoplasia (CIN) was diagnosed in 55 cases (77.4%). The sensitivity, specificity, positive predictive value, and negative predictive value of CIN diagnosis by hrHPV testing in cases of ASC-US were 72.5, 95.0, 88.7, and 86.3%, respectively (p < 0.01).
Conclusion The conducting of hrHPV test on women who were evaluated as ASC-US according to TBS affirmed its clinical usefulness.
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Affiliation(s)
- Rieko Kawase
- Department of Obstetrics and Gynecology, Nippon Medical School, Tokyo, Japan
- Department of Obstetrics and Gynecology, Japanese Red Cross Katsushika Maternity Hospital, Tokyo, Japan
| | - Shunji Suzuki
- Department of Obstetrics and Gynecology, Japanese Red Cross Katsushika Maternity Hospital, Tokyo, Japan
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Gupta R, Hariprasad R, Dhanasekaran K, Sodhani P, Mehrotra R, Kumar N, Gupta S. Reappraisal of cytology-histology correlation in cervical cytology based on the recent American Society of Cytopathology guidelines (2017) at a cancer research centre. Cytopathology 2019; 31:53-58. [PMID: 31535740 DOI: 10.1111/cyt.12774] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Revised: 08/16/2019] [Accepted: 09/16/2019] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To assess the impact of recently published American Society of Cytopathology (ASC) guidelines (2017) on the conduct of cervical cytology-histology correlation (CHC). METHODS A retrospective review was conducted for cervical biopsies with their corresponding conventional cervical smears over a 7.5-year period (January 2011-June 2018). As per the ASC guidelines, a discrepancy assessment grid was prepared. Major cytology-histology discordance was defined as a diagnosis of high-grade squamous intraepithelial lesion (HSIL) or CIN2+ in one of the tests with negative result in the other. Smears and biopsies of all discordant cases were reviewed for reasons of overcall and undercall. RESULTS Of the 341 cervical biopsies with corresponding Papanicolaou smear, cytology-histology agreement was noted in 249 (73%) cases. Major discordance was observed in 22 cases (6.4%)-16 undercalls and six overcalls on cytology-while minor discrepancies were noted in 70 cases. Atypical metaplasia and repair changes were the main reasons for overcall while small HSIL cells in atrophic smear and scant HSIL cells were important causes of undercall on cytology review. Using the ASC guidelines, we could improvise upon the existing CHC methodology for categorisation of cyto-histological pairs of cases with a cytological diagnosis of atypical glandular cells. CONCLUSION The present study demonstrates, for the first time, that the recent ASC guidelines facilitate cervical CHC, especially for categorisation of cases with atypical glandular cells on cytology. Uniform application of these guidelines would standardise the conduct of cervical CHC internationally and provide scope for inter-laboratory comparison of data as well as enhance self-learning and peer learning.
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Affiliation(s)
- Ruchika Gupta
- Division of Cytopathology, ICMR-National Institute of Cancer Prevention and Research, Noida, India
| | - Roopa Hariprasad
- Division of Clinical Oncology, ICMR-National Institute of Cancer Prevention and Research, Noida, India
| | - Kavitha Dhanasekaran
- Division of Clinical Oncology, ICMR-National Institute of Cancer Prevention and Research, Noida, India
| | - Pushpa Sodhani
- Division of Cytopathology, ICMR-National Institute of Cancer Prevention and Research, Noida, India
| | - Ravi Mehrotra
- ICMR-National Institute of Cancer Prevention and Research, Noida, India
| | - Neeta Kumar
- Department of Pathology, Faculty of Dentistry, Jamia Millia Islamia (Central University), Delhi, India
| | - Sanjay Gupta
- Division of Cytopathology, ICMR-National Institute of Cancer Prevention and Research, Noida, India
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Glandular cell abnormalities in cervical cytology: What has changed in this decade and what has not? Eur J Obstet Gynecol Reprod Biol 2019; 240:68-73. [DOI: 10.1016/j.ejogrb.2019.06.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Revised: 06/04/2019] [Accepted: 06/09/2019] [Indexed: 11/22/2022]
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Pyo JS, Kang G, Yoon HK, Kim HJ. Diagnostic Test Accuracy Review of Cytology for Squamous Intraepithelial Lesion and Squamous Cell Carcinoma of Uterine Cervix. J Korean Med Sci 2019; 34:e16. [PMID: 30636946 PMCID: PMC6327093 DOI: 10.3346/jkms.2019.34.e16] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Accepted: 10/25/2018] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Even though cervico-vaginal smears have been used as a primary screening test for cervical carcinoma, the diagnostic accuracy has been controversial. The present study aimed to evaluate the diagnostic accuracy of cytology for squamous intraepithelial lesion (SIL) and squamous cell carcinoma (SqCC) of the uterine cervix through a diagnostic test accuracy (DTA) review. METHODS A DTA review was performed using 38 eligible studies that showed concordance between cytology and histology. In the DTA review, sensitivity, specificity, diagnostic odds ratio (OR), and the area under the curve (AUC) on the summary receiver operating characteristic (SROC) curve were calculated. RESULTS In the comparison between abnormal cytology and histology, the pooled sensitivity and specificity were 93.9% (95% confidence interval [CI], 93.7%-94.1%) and 77.6% (95% CI, 77.4-77.8%), respectively. The diagnostic OR and AUC on the SROC curve were 8.90 (95% CI, 5.57-14.23) and 0.8148, respectively. High-grade squamous intraepithelial lesion (HSIL) cytology had a higher sensitivity (97.6%; 95% CI, 94.7%-97.8%) for predicting HSIL or worse histology. In the comparison between SqCC identified on cytology and on histological analysis, the pooled sensitivity and specificity, diagnostic OR, and AUC were 92.7% (95% CI, 87.3%-96.3%), 87.5% (95% CI, 87.2%-87.8%), 865.81 (95% CI, 68.61-10,925.12), and 0.9855, respectively. Geographic locations with well-organized screening programs had higher sensitivity than areas with insufficient screening programs. CONCLUSION These results indicate that cytology had a higher sensitivity and specificity for detecting SIL and SqCC of the uterine cervix during primary screening.
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Affiliation(s)
- Jung-Soo Pyo
- Department of Pathology, Eulji University Hospital, Eulji University School of Medicine, Daejeon, Korea
| | - Guhyun Kang
- Department of Pathology, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea
| | - Hye Kyoung Yoon
- Department of Pathology, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Hyun Jung Kim
- Department of Pathology, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea
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