1
|
Carrillo T, Montealegre JR, Bracamontes CG, Scheurer ME, Follen M, Mulla ZD. Predictors of timely diagnostic follow-up after an abnormal Pap test among Hispanic women seeking care in El Paso, Texas. BMC WOMENS HEALTH 2021; 21:11. [PMID: 33407351 PMCID: PMC7788782 DOI: 10.1186/s12905-020-01161-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Accepted: 12/25/2020] [Indexed: 11/10/2022]
Abstract
BACKGROUND Diagnostic follow-up of women with an abnormal Pap test is necessary to resolve the risk developing cervical cancer. The purpose of this study is to describe patient characteristics associated with timely receipt of a diagnostic colposcopy after an abnormal Pap test among Hispanic women in El Paso, a Texas-Mexico border city. METHODS We conducted a retrospective chart review of Hispanic patients seen at an academic colposcopy clinic following an abnormal Pap test. An optimal diagnostic interval to colposcopy was based on a National Breast and Cervical Cancer Early Detection Program (NBCCEDP) quality indicator and was defined as receipt of colposcopy within 90 days or less from the date of an abnormal Pap test. Risk ratios (RR) were calculated by building a generalized linear model fit using a Poisson distribution, log link, and robust variance. RESULTS Overall, 177 of the 270 women (65.6%) received follow-up within an optimal diagnostic interval. After adjusting for other variables in the model, women who were 30 years of age or older were 32% more likely to have an optimal interval than younger women (adjusted RR = 1.32, P < 0.01). High school graduates were less likely than more educated women to have an optimal interval (adjusted RR = 0.68, P < 0.01). Participation in the NBCCEDP was not associated with receipt of follow-up within an optimal diagnostic interval. CONCLUSIONS Compared with women with greater educational attainment, high school graduates were less likely to receive follow-up within an optimal diagnostic interval, as were younger (≤ 30 years) women compared with older women. Participation in the NBCCEDP was not associated with receipt of care within an optimal diagnostic interval.
Collapse
Affiliation(s)
- Thelma Carrillo
- Department of Obstetrics and Gynecology, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center El Paso, El Paso, TX, USA
| | - Jane R Montealegre
- Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA.,Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX, USA
| | - Christina G Bracamontes
- Department of Obstetrics and Gynecology, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center El Paso, El Paso, TX, USA
| | - Michael E Scheurer
- Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA.,Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX, USA
| | - Michele Follen
- Department of Obstetrics and Gynecology, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center El Paso, El Paso, TX, USA.,NYC Health + Hospitals
- Kings County, Brooklyn, NY, USA
| | - Zuber D Mulla
- Department of Obstetrics and Gynecology, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center El Paso, El Paso, TX, USA. .,Office of Faculty Development (MSC 21007), Texas Tech University Health Sciences Center El Paso, 5001 El Paso Drive, El Paso, TX, 79905, USA.
| |
Collapse
|
2
|
Abdel-Hadi M, Khalaf A, Aboulkassem H, Naeem N, Baqy MA, Sallam H. Cervical intraepithelial lesions in females attending Women's Health Clinics in Alexandria, Egypt. Cytojournal 2015. [PMID: 26195985 PMCID: PMC4485213 DOI: 10.4103/1742-6413.159240] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background: Data from Egyptian studies provide widely varying estimates on the prevalence of preinvasive cervical lesions. The aim of this study was to estimate the rate of cervical intraepithelial neoplasia (CIN) in Egyptian women living in Alexandria to clarify the need for implementing a national organized screening program and a vaccination program in our community. Materials and Methods: The study was conducted over a 6 years period and covered the different socioeconomic levels to have a representative sample for women living in Alexandria. All women included did not have any cervical disorder related complaints. Conventional Pap smears were obtained and diagnosed using the Bethesda system. Women with abnormal Pap smears were managed according to the 2006 consensus guidelines within the available facilities. Persistent abnormal cytological results were referred for colposcopic biopsy. Histological results were grouped into: Reactive changes, CIN 1, CIN 2/CIN 3 and adenocarcinoma in-situ (AIS). Results: Out of the 6173 smears included in the study 6072 (98.36%) were normal and only 101 (1.63%) were abnormal. After colposcopic biopsies, 0.08% had CIN 1, 0.03% had CIN 2, 3 and 0.01% had AIS. Conclusion: We concluded that cervical cancer screening programs, although life-saving for a number of women, are not a sufficiently high priority in our community. Money for national health screening programs should preferably be directed more towards recruiting women for breast cancer screening, since breast cancer accounts for about 33% of all female cancers in Egypt ranking number one, while cervical cancer ranks number 13.
Collapse
Affiliation(s)
- Mona Abdel-Hadi
- Address: Department of Pathology, Faculty of Medicine. Alexandria University, Alexandria, Egypt ; Pathology Laboratory, Alexandria Regional Centre for Women's Health and Development, Alexandria, Egypt
| | - Adel Khalaf
- Gynecology Clinics, Alexandria Regional Centre for Women's Health and Development, Alexandria, Egypt
| | - Hanaa Aboulkassem
- Gynecology Clinics, Alexandria Regional Centre for Women's Health and Development, Alexandria, Egypt
| | - Noha Naeem
- Gynecology Clinics, Alexandria Regional Centre for Women's Health and Development, Alexandria, Egypt
| | - Mohamed Abdel Baqy
- Department of Community, Epidemiology Unit, Alexandria Regional Centre for Women's Health and Development, Alexandria, Egypt
| | - Hassan Sallam
- Department of Obstetrics and Gynecology, Faculty of Medicine Alexandria University, Alexandria, Egypt
| |
Collapse
|
3
|
Darwish-Yassine M, Garvin AD, Johnston CM, Zoschnick L, Conners A, Laing S, Wojcik C. An Assessment of Gynecological Cytology Screening Practices Among Health Care Providers Nationwide. Arch Pathol Lab Med 2015; 139:650-5. [DOI: 10.5858/arpa.2013-0620-oa] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
|
4
|
Verdoodt F, Jiang X, Williams M, Schnatz PF, Arbyn M. High-risk HPV testing in the management of atypical glandular cells: A systematic review and meta-analysis. Int J Cancer 2015; 138:303-10. [PMID: 25583258 DOI: 10.1002/ijc.29424] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2014] [Accepted: 01/07/2015] [Indexed: 12/15/2022]
Abstract
Whereas the utility of high-risk HPV (hrHPV) testing is widely accepted in triage of women with atypical squamous lesions, its role in managing atypical glandular cells (AGC) is not fully elucidated. A systematic review and meta-analysis were performed to evaluate the accuracy of hrHPV testing in the management of women with AGC to detect underlying high-grade intraepithelial neoplasia or worse, and adenocarcinoma in situ or worse (AIS+). Additionally, the diagnosis of extra-cervical cancer was considered as an outcome in this review. A bibliographic database search (PubMed, EMBASE, CENTRAL) identified twelve eligible studies. The occurrence of cervical intraepithelial neoplasia grade two or worse including AIS+ (CIN2+/AIS+), was 19.8% among women with AGC, and 55.7% among women with AGC and concurrent squamous lesions (atypical squamous cells of undetermined significance or worse, ASC-US+). The pooled sensitivity and specificity of hrHPV-testing with Hybrid Capture 2 (HC2) to detect CIN2+/AIS+ in women with AGC was 90.0% (95% CI = 85.1-93.4%) and 75.1% (95% CI = 64.8-83.2%), respectively. Women who were hrHPV-negative, demonstrated an increased risk for extra-cervical malignancy (endometrium, fallopian tube, ovary). In women of 50y and older, a hrHPV-negative result was linked with a 18.0% chance of extra-cervical malignancy, while the chance of cervical pre-cancer and cancer was 0.4 and 0.0%, respectively. In conclusion, given the high risk of underlying CIN2+/AIS+, women with AGC should be referred directly to colposcopy. However, hrHPV test results in combination with the age, appears to improve the diagnostic process by distinguishing the risk for cervical versus non-cervical lesions.
Collapse
Affiliation(s)
- Freija Verdoodt
- Unit of Cancer Epidemiology, Scientific Institute of Public Health, Brussels, Belgium
| | - Xuezhi Jiang
- Department of Obstetrics and Gynecology, Reading Hospital, West Reading, PA, USA.,Department of Obstetrics and Gynecology, Jefferson Medical College of Thomas Jefferson University, Philadelphia, PA, USA
| | - Mark Williams
- Department of Obstetrics and Gynecology, Reading Hospital, West Reading, PA, USA
| | - Peter F Schnatz
- Department of Obstetrics and Gynecology, Reading Hospital, West Reading, PA, USA.,Department of Obstetrics and Gynecology, Jefferson Medical College of Thomas Jefferson University, Philadelphia, PA, USA.,Department of Internal Medicine, Reading Hospital, West Reading, PA, USA.,Department of Internal Medicine, Jefferson Medical College of Thomas Jefferson University, Philadelphia, PA, USA
| | - Marc Arbyn
- Unit of Cancer Epidemiology, Scientific Institute of Public Health, Brussels, Belgium
| |
Collapse
|
5
|
Tworek JA, Volmar KE, McCall SJ, Bashleben CP, Howanitz PJ. Q-Probes studies in anatomic pathology: quality improvement through targeted benchmarking. Arch Pathol Lab Med 2014; 138:1156-66. [PMID: 25171698 DOI: 10.5858/arpa.2014-0149-oa] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
CONTEXT The Q-Probes program is a peer-comparison quality assurance service offered by the College of American Pathologists that was created in 1989. OBJECTIVE To establish national benchmarks around a specific quality metric at a specific point in time in anatomic pathology (AP). DESIGN Q-Probes are based on a voluntary subscription for an individual study. Hospital-based laboratories in the United States, Canada, and 16 other countries have participated. Approximately one-third of all Q-Probes studies address AP metrics. Each Q-Probes study has a primary quality indicator and additional minor indicators. RESULTS There have been 52 AP Q-Probes studies addressing process-, outcome-, and structure-related quality assurance issues. These Q-Probes studies often represented the first standardized national benchmark for specific metrics in the disciplines of cytopathology, surgical pathology, and autopsy pathology, and as such have been cited more than 1700 times in peer-reviewed literature. The AP Q-Probes studies that have been repeated over time demonstrate improvement in laboratory performance across an international spectrum. CONCLUSIONS The Q-Probes program has produced important national benchmarks in AP, addressing preanalytic, analytic, and postanalytic factors in the disciplines of cytopathology, surgical pathology, and autopsy pathology. Q-Probes study data have been published, cited, and used in the creation of laboratory accreditation standards and other national guidelines.
Collapse
Affiliation(s)
- Joseph A Tworek
- From the Department of Pathology, St Joseph Mercy Health System, Ann Arbor, Michigan (Dr Tworek); the Department of Pathology, Rex Healthcare, Raleigh, North Carolina (Dr Volmar); the Department of Pathology, Duke University Medical Center, Durham, North Carolina (Dr McCall); the Surveys Department, College of American Pathologists, Northfield, Illinois (Ms Bashleben); and the Department of Pathology, State University of New York Downstate, Brooklyn (Dr Howanitz)
| | | | | | | | | |
Collapse
|
6
|
Sharpless KE, Schnatz PF. Management of "Atypical Endocervical Cells" Compared to "Atypical Glandular Cells". J Low Genit Tract Dis 2014; 19:197-9. [PMID: 25279980 DOI: 10.1097/lgt.0000000000000089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To assess adherence to management guidelines based on the terminology used to describe atypical glandular cells (AGC) on cytology reports. MATERIALS AND METHODS We analyzed AGC pathology reports from Hartford Hospital, 2004-2007, and identified cases of AGC with the terminology atypical glandular cells or atypical endocervical cells (AEC). We calculated rates of clinical evaluations based on the terminology used to describe the AGC. Statistical analysis was performed using the χ test. RESULTS Seventy-eight reports contained the terminology AEC and 97 reports contained the terminology AGC. The rate of histologic sampling in women with AEC was lower than in women with AGC (52.6% vs 83.5%; p < .01). Similarly, the rate of comprehensive evaluations was lower (33.3% vs 71.1%; p < .01). Fewer endocervical curettages (47.4% vs 77.3%; p < .01) and fewer endometrial biopsies in women 35 years or older were performed (26.9% vs 69.1%; p < .01) in women with AEC than in women with AGC. CONCLUSIONS Women with AGC reports containing the term AEC were managed less optimally than those with AGC. These results suggest that the terminology used to describe the finding of atypical glandular cells may influence the clinical evaluation. Clinicians may not recognize AEC as AGCs. Ours results suggest that the terminology atypical endocervical cells should be avoided or accompanied by the terminology atypical glandular cells.
Collapse
Affiliation(s)
- Kathryn E Sharpless
- 1Baystate Medical Center, Springfield, MA, and 2The Reading Hospital and Medical Center, Reading, PA
| | | |
Collapse
|
7
|
Hui SKA, Miller SM, Wen KY, Fang Z, Li T, Buzaglo J, Hernandez E. Psychosocial barriers to follow-up adherence after an abnormal cervical cytology test result among low-income, inner-city women. J Prim Care Community Health 2014; 5:234-41. [PMID: 24718518 DOI: 10.1177/2150131914529307] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES Low-income, inner-city women bear a disproportionate burden of cervical cancer in both incidence and mortality rates in the United States, largely because of low adherence to follow-up recommendations after an abnormal cervical cytology result in the primary care setting. The goals of the present study were to delineate the theory-based psychosocial barriers underlying these persistent low follow-up rates and their sociodemographic correlates. METHODS Guided by a well-validated psychosocial theory of health behaviors, this cross-sectional, correlational study assessed the barriers to follow-up adherence among underserved women (N = 210) who received an abnormal cervical cytology result. Participants were recruited through an inner-city hospital colposcopy clinic, and were assessed by telephone prior to the colposcopy appointment. RESULTS Participants were largely of African American race (82.2%), lower than high school completion education (58.7%), single, never married (67.3%), and without full-time employment (64.1%). Knowledge barriers were most often endorsed (68%, M = 3.22), followed by distress barriers (64%, M = 3.09), and coping barriers (36%, M = 2.36). Forty-six percent reported more than one barrier category. Less education and being unemployed were correlated with higher knowledge barriers (P < .0001 and P < .01, respectively) and more coping barriers (P < .05 and P < .05, respectively). Women who were younger than 30 years displayed greater distress barriers (P < .05). CONCLUSION In the primary care setting, assessing and addressing knowledge and distress barriers after feedback of an abnormal cervical cytology result may improve adherence to follow-up recommendations. The use of structured counseling protocols and referral to navigational and other resources may facilitate this process and thereby reduce disparities in cervical cancer.
Collapse
Affiliation(s)
- Siu-Kuen Azor Hui
- Fox Chase Cancer Center/Temple University Health System, Philadelphia, PA, USA
| | - Suzanne M Miller
- Fox Chase Cancer Center/Temple University Health System, Philadelphia, PA, USA
| | - Kuang-Yi Wen
- Fox Chase Cancer Center/Temple University Health System, Philadelphia, PA, USA
| | - Zhu Fang
- Everest Clinical Research Services, Little Falls, NJ, USA
| | - Tianyu Li
- Fox Chase Cancer Center/Temple University Health System, Philadelphia, PA, USA
| | - Joanne Buzaglo
- Research and Training Institute of Cancer Support Community, Philadelphia, PA, USA
| | | |
Collapse
|
8
|
Fish LJ, Moorman PG, Wordlaw-Stintson L, Vidal A, Smith JS, Hoyo C. Factors Associated With Adherence to Follow-up Colposcopy. AMERICAN JOURNAL OF HEALTH EDUCATION 2013; 44:293-298. [PMID: 24991653 DOI: 10.1080/19325037.2013.838881] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND Understanding the gaps in knowledge about human papilloma virus (HPV) infection, transmission, and health consequences and factors associated with the knowledge gap is an essential first step for the development of interventions to improve adherence to follow-up among women with abnormal Pap smears. PURPOSE To examine the relationship between knowledge about HPV and adherence to scheduled colposcopic evaluation and variables related to lack of knowledge among women with abnormal Pap tests. METHODS Telephone surveys were conducted with women who attended their scheduled appointments (adherers) and women who did not attend their appointments (nonadherers). RESULTS The multivariable analyses indicate that lower HPV knowledge was independently associated with nonadherence to follow-up, controlling for race and education level. Factors related to lower knowledge scores included non-white race, lower education, and lack of health insurance at the time of the scheduled appointment. CONCLUSION Lack of knowledge of HPV was related to nonadherence among women scheduled for colposcopic evaluation. TRANSLATION TO HEALTH EDUCATION PRACTICE Health education interventions that deliver complex information about HPV and cervical cancer should be in a format that is accessible and understandable to the women who are most at risk of being nonadherent.
Collapse
|
9
|
Lee JK, Hong JH, Kang S, Kim DY, Kim BG, Kim SH, Kim YM, Kim JW, Kim JH, Kim TJ, Kim HJ, Kim HS, Ryu HS, Song JY, Ahn HS, Yoo CW, Yoon HK, Lee KH, Lee A, Lee Y, Lee IH, Lee JW, Lee TS, Lim MC, Chang SJ, Chung HH, Ju W, Joo HJ, Hur SY, Hong SR, Nam JH. Practice guidelines for the early detection of cervical cancer in Korea: Korean Society of Gynecologic Oncology and the Korean Society for Cytopathology 2012 edition. J Gynecol Oncol 2013; 24:186-203. [PMID: 23653837 PMCID: PMC3644696 DOI: 10.3802/jgo.2013.24.2.186] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2013] [Revised: 02/28/2013] [Accepted: 03/03/2013] [Indexed: 11/30/2022] Open
Abstract
The consensus guideline development committee of Korean Society of Gynecologic Oncology was reconvened in March 2012. The committee consisted of 36 experts representing 12 university hospitals and professional organizations. The objective of this committee was to develop standardized guidelines for cervical cancer screening tests for Korean women and to distribute these guidelines to every clinician, eventually improving the quality of medical care. Since the establishment of the consensus guideline development committee, evidence-based guidelines have either been developed de novo considering specific Korean situations or by adaptation of preexisting consensus guidelines from other countries. Recommendations for cervical cancer screening tests, management of atypical squamous and glandular cells, and management of low-grade and high-grade squamous intraepithelial lesions were developed. Additionally, recommendations for human papillomavirus DNA testing and recommendations for adolescent and pregnant women with abnormal cervical screening test results were also included.
Collapse
Affiliation(s)
- Jae Kwan Lee
- Department of Obstetrics and Gynecology, Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Jin Hwa Hong
- Department of Obstetrics and Gynecology, Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Sokbom Kang
- Center for Uterine Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea
| | - Dae-Yeon Kim
- Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Byoung-Gie Kim
- Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sung-Hoon Kim
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Yonsei University College of Medicine, Seoul, Korea
| | - Yong-Man Kim
- Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jae-Weon Kim
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea
| | - Jae-Hoon Kim
- Department of Obstetrics and Gynecology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Tae-Jin Kim
- Department of Obstetrics and Gynecology, Cheil General Hospital and Women's Healthcare Center, Kwandong University College of Medicine, Seoul, Korea
| | - Hyun Jung Kim
- Institute for Evidence-Based Medicine, The Korean Branch of Australasian Cochrane Center, Department of Preventive Medicine, Korea University College of Medicine, Seoul, Korea
| | - Hye Sun Kim
- Department of Pathology, Cheil General Hospital and Women's Healthcare Center, Kwandong University College of Medicine, Seoul, Korea
| | - Hee-Sug Ryu
- Department of Obstetrics and Gynecology, Ajou University Hospital, Ajou University School of Medicine, Suwon, Korea
| | - Jae Yun Song
- Department of Obstetrics and Gynecology, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Hyeong Sik Ahn
- Institute for Evidence-Based Medicine, The Korean Branch of Australasian Cochrane Center, Department of Preventive Medicine, Korea University College of Medicine, Seoul, Korea
| | - Chong Woo Yoo
- Department of Pathology, Center for Uterine Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea
| | - Hye-Kyoung Yoon
- Department of Pathology, Inje University Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Keun-Ho Lee
- Department of Obstetrics and Gynecology, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Ahwon Lee
- Department of Pathology, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Yonghee Lee
- Department of Pathology, Ajou University Hospital, Ajou University School of Medicine, Suwon, Korea
| | - In Ho Lee
- Department of Obstetrics and Gynecology, Cheil General Hospital and Women's Healthcare Center, Kwandong University College of Medicine, Seoul, Korea
| | - Jeong-Won Lee
- Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Taek Sang Lee
- Department of Obstetrics and Gynecology, Seoul National University Boramae Hospital, Seoul, Korea
| | - Myong Cheol Lim
- Center for Uterine Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea
| | - Suk-Joon Chang
- Department of Obstetrics and Gynecology, Ajou University Hospital, Ajou University School of Medicine, Suwon, Korea
| | - Hyun Hoon Chung
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea
| | - Woong Ju
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Ewha Womans University School of Medicine, Seoul, Korea
| | - Hee Jae Joo
- Department of Pathology, Ajou University Hospital, Ajou University School of Medicine, Suwon, Korea
| | - Soo-Young Hur
- Department of Obstetrics and Gynecology, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Sung-Ran Hong
- Department of Pathology, Cheil General Hospital and Women's Healthcare Center, Kwandong University College of Medicine, Seoul, Korea
| | - Joo-Hyun Nam
- Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| |
Collapse
|
10
|
Bergeron C, Di Bonito L. Le dépistage cytologique de l’adénocarcinome du col. Ann Pathol 2012. [DOI: 10.1016/j.annpat.2012.09.199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
|
11
|
Di Bonito L, Bergeron C. Cytological screening of endocervical adenocarcinoma. Ann Pathol 2012; 32:e8-14, 394-400. [PMID: 23244488 DOI: 10.1016/j.annpat.2012.09.230] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2012] [Accepted: 09/13/2012] [Indexed: 11/29/2022]
Abstract
Invasive endocervical adenocarcinoma represents on average 15% of cervical carcinomas and it is associated with the human papillomavirus infection high risk types 16 and 18 in most cases. Its detection has some special features compared to squamous cell carcinoma; glandular precancerous lesions are less known and only adenocarcinoma in situ is diagnosed by consensus among pathologists; adenocarcinoma in situ develops in the squamocolumnar junction by reserve cells but it is hard to be located by colposcopy in the endocervical canal or in the deep glandular recess. Sampling of endocervical cells requires brushes rather than an Ayre spatula. Cytological diagnosis of glandular cells abnormalities is based on the Bethesda System 2001 terminology which redefined endocervical cells abnormalities and also introduced the entity of adenocarcinoma in situ. This entity is characterized by specific morphological features, such as the radial arrangement of nuclei in the periphery, like "at the end of the feathers of a bird's wing"(feathering of cells), images of nuclei palissading or rosette without tumoral diathesis. Glandular cells abnormalities are rare and represent less than 0.1% of all smears and less than 5% of abnormal smears. By improving the collection and the interpretation of abnormal endocervical cells, cytological screening should allow the diagnosis of in situ adenocarcinoma and detection of invasive adenocarcinoma at a very early stage. This will lead to a decrease in mortality from endocervical adenocarcinoma, especially in young women.
Collapse
Affiliation(s)
- Luigi Di Bonito
- UCO, Anatomia e Istologia patologica, Ospedale Universitario di Cattinara, Trieste, Italy
| | | |
Collapse
|
12
|
Tseng JY, Bastu E, Gungor-Ugurlucan F. Management of precancerous lesions prior to conception and during pregnancy: a narrative review of the literature. Eur J Cancer Care (Engl) 2012; 21:703-11. [PMID: 22966861 DOI: 10.1111/ecc.12002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Special considerations aiming at preserving reproductive function have to be implemented when treating young patients with precancerous lesions of the lower genital tract. These high-grade lesions may progress into invasive cancer if left untreated. Currently, there are limited data on the impact of vulvar and vaginal precancerous lesions on fertility and its management during pregnancy. However, management and outcomes for cervical lesions have been extensively reported. The main approach for vulvar and vaginal lesions are maintaining anatomical function and cosmetics; whereas, treatment options for cervical precancerous lesions range from observation, cryotherapy or the more aggressive conisation. Gestational age is the most important factor in determining expectant management or surgical intervention. This narrative review draws attention to the relevant aspects of precancerous lesions of the lower genital tract, the potential effects and management prior to conception and during pregnancy.
Collapse
Affiliation(s)
- J-Y Tseng
- Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei, Taiwan
| | | | | |
Collapse
|
13
|
Origoni M, Cristoforoni P, Costa S, Mariani L, Scirpa P, Lorincz A, Sideri M. HPV-DNA testing for cervical cancer precursors: from evidence to clinical practice. Ecancermedicalscience 2012; 6:258. [PMID: 22778786 PMCID: PMC3388143 DOI: 10.3332/ecancer.2012.258] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2012] [Indexed: 11/17/2022] Open
Abstract
The large amount of literature published over the last two decades on human papillomavirus (HPV)-DNA testing has definitely demonstrated the association between high-risk viral genotypes (hrHPV) and cervical cancer. Moreover, hrHPV-DNA testing has shown excellent performance in several clinical applications, from screening settings to the follow-up of treated patients, compared to conventional cytology or colposcopy options. On the other hand, when a huge number of reports are published on the same subject in a relatively short period of time, with many variations in settings, study designs and applications, the result is often confusion and decreased comprehension by readers. In daily office practice, several different situations (in symptomatic or asymptomatic women) can be positively managed by the correct use of hrHPV-DNA testing. Validated hrHPV-DNA testing and, specifically, the HC2® assay, due to its excellent sensitivity and negative predictive value together with optimal reproducibility, currently represent a powerful tool in the clinician’s hands to optimally manage several situations related to HPV infection and the potential development of cervical cancer.
Collapse
|
14
|
Sharpless KE, King CR, Schnatz PF. Adherence to practice guidelines for atypical glandular cells on cervical cytology. Cancer Cytopathol 2012; 121:47-53. [PMID: 22693041 DOI: 10.1002/cncy.21211] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2012] [Revised: 04/24/2012] [Accepted: 05/04/2012] [Indexed: 11/07/2022]
Abstract
BACKGROUND Atypical glandular cells (AGC) on cervical cytology are high-risk, requiring an extensive evaluation. Compliance with practice guidelines for AGC, however, has been low. Some AGC cytology reports contain cytopathologist recommendations for evaluation. This study determines whether evaluation rates for AGC have improved over time, and whether cytopathologists' recommendations correlate with the types of evaluation women receive. METHODS Evaluation rates from 284 women with AGC (2004-2007) were compared with findings from 1998-2001. Rates of evaluations were compared based on cytology report recommendations. RESULTS A total of 76.1% of the AGC cases had histologic sampling, and 58.8% had a comprehensive evaluation. These rates are higher than those from 1998-2001 (63.5% and 35.8%, respectively; P<.01). Rates of evaluations of women with AGC "favor neoplasia" did not increase between the 2 time periods. Between 2004-2005 and 2006-2007, rates of comprehensive initial evaluations and endometrial sampling in women ≥35 years of age did not increase. Of the AGC reports that did contain cytopathologist recommendations, 28% were consistent with practice guidelines, 26% recommended an incomplete histologic evaluation, and 46% recommended repeat cytology. Women whose AGC report recommended a comprehensive evaluation or any histologic evaluation were more likely to have a comprehensive work-up (79%) than those whose reports did not contain recommendations (55%, P <0.01) or recommended repeat cytology (51%, P<0.02). CONCLUSIONS Adherence to practice guidelines for the evaluation of women with AGC has improved but continues to be suboptimal. Our findings suggest that continuing education and including practice guidelines on AGC cytology reports may improve compliance.
Collapse
|
15
|
Human papillomavirus viral load expressed as relative light units (RLU) correlates with the presence and grade of preneoplastic lesions of the uterine cervix in atypical squamous cells of undetermined significance (ASCUS) cytology. Eur J Clin Microbiol Infect Dis 2012; 31:2401-6. [PMID: 22382821 DOI: 10.1007/s10096-012-1582-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2011] [Accepted: 02/04/2012] [Indexed: 10/28/2022]
Abstract
Human papillomavirus (HPV) testing is more sensitive and has higher negative predictive value (NPV) than the Pap test for the detection of cervical intraepithelial neoplasia (CIN) in patients with atypical squamous cells of undetermined significance (ASCUS) cytology, but has low specificity, leading to high referral rates to second-level triage. Our goal was to identify the prognostic significance of HPV viral load figures. We evaluated whether a correlation between viral load, expressed as relative light units/cutoff (RLU/CO), and the severity of cervical lesions existed in 614 ASCUS cases. Hybrid Capture 2 (HC2®) RLU/CO values, categorised into five classes, were correlated to clinical outcomes and statistically analysed. A significant correlation (p < 0.0001) was observed between increasing RLU values and the prevalence of high-grade CIN (CIN2/CIN3). The mean RLU values for negative, low-grade and high-grade lesions were 68.1, 172.5 and 1,020.0 RLU/CO, respectively (p < 0.0001). CIN2/CIN3 ranged from 4% for 0 < RLU/CO values ≤ 1, to 5% for 1 < RLU/CO values ≤ 10, to 9% for 10 < RLU/CO values ≤ 100, to 23% for 100 < RLU/CO values ≤ 1,000 and to 48% when RLU/CO values were >1,000 (p < 0.05). The HPV viral load in ASCUS cases significantly correlates with the severity of cervical cancer precursors. These data may have prognostic value, as they significantly correlate with the probability of a CIN2+ .
Collapse
|
16
|
Ting J, Kruzikas DT, Smith JS. A global review of age-specific and overall prevalence of cervical lesions. Int J Gynecol Cancer 2011; 20:1244-9. [PMID: 21495248 DOI: 10.1111/igc.0b013e3181f16c5f] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Overall and age-specific cervical cytological and histological abnormalities prevalence data across geographical regions, in conjunction with human papillomavirus vaccination status, will be important for the future evaluation of HPV prophylactic vaccine effectiveness. METHODS A systematic review was conducted to summarize worldwide data on the prevalence of high- and low-grade squamous intraepithelial lesions, and cervical intraepithelial neoplasia (CIN) 2/3 or 1. RESULTS More than 12,400,000 women were included in 103 studies. Most studies were from Europe and Middle East (40%) or North America (14%), 14% were from Asia, 17% from Central and South America, and 15% from Africa. Age-specific data were limited from Asia, Central and South America, and Africa. Screening techniques and study exclusion criteria varied, depending on region and population surveyed. Age trends of high-grade cervical lesions seemed to peak at a relatively younger age in North America (<30 years), compared with 25 to 40 years in Europe and Middle East, Africa, Asia, and Central and South America. Age patterns of low-grade lesions generally declined after a peak in the younger age groups (20-30 years). Age-specific CIN 1 and CIN 2/3 prevalence were lower compared with low- and high-grade squamous intraepithelial lesions from the same studies, respectively. CONCLUSIONS Variation in the age patterns of high-grade lesions across regions is likely attributable to differences in age at screening initiation, frequency, coverage, and rates of follow-up of women with cervical abnormalities. Observed age patterns of low-grade lesions are generally consistent to those of human papillomavirus infection in women worldwide. Potential factors contributing to variations in the burden of cytological and histological abnormalities across studies include subjectivity in evaluating cytological slides and discrepancies in the processing, referral rates, and diagnostic interpretation of colposcopically directed biopsy.
Collapse
Affiliation(s)
- Jie Ting
- Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | | | | |
Collapse
|
17
|
Raab SS, Grzybicki DM. Cytologic-histologic correlation. Cancer Cytopathol 2011; 119:293-309. [DOI: 10.1002/cncy.20165] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2011] [Revised: 04/14/2011] [Accepted: 04/13/2011] [Indexed: 11/06/2022]
|
18
|
Kupets R, Paszat L. How are women with high grade Pap smear abnormalities managed? A population based study. Gynecol Oncol 2011; 121:499-504. [DOI: 10.1016/j.ygyno.2011.01.021] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2010] [Revised: 01/11/2011] [Accepted: 01/18/2011] [Indexed: 10/18/2022]
|
19
|
|
20
|
Kupets R, Paszat L. Physician and patient factors associated with follow up of high grade dysplasias of the cervix: A population-based study. Gynecol Oncol 2011; 120:63-7. [DOI: 10.1016/j.ygyno.2010.09.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2010] [Revised: 09/13/2010] [Accepted: 09/15/2010] [Indexed: 11/29/2022]
|
21
|
Impact of the 2002 American society for Colposcopy and Cervical Pathology guidelines on cervical cancer diagnosis in a geographically diverse population of commercially insured women, 1999-2004. J Low Genit Tract Dis 2010; 15:25-32. [PMID: 21192173 DOI: 10.1097/lgt.0b013e3181ed3c2b] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To report the impact of the release of the 2002 American Society for Colposcopy and Cervical Pathology guidelines on the management of abnormal cytological findings on time to diagnosis of cervical cancer in an insured population. METHODS This retrospective study identified women with cervical cancer (invasive and carcinoma in situ) through commercially insured administrative claims data. The cervical cancer case definition required a claim for cervical cancer and a claim with a diagnostic procedure (colposcopy, conization, biopsy, or hysterectomy). Time to diagnosis was defined as days between the initial Pap screening and the diagnostic procedure. RESULTS Between 1999 and 2004, there were 3,325 women aged 18 to 64 years who met the case definition for cervical cancer. Median time to diagnosis decreased from 42 days (interquartile range = 23-93 d) to 36.5 days (interquartile range = 20.5-80 d) for women with invasive cancer after the guideline change. The number of follow-up Pap screenings before biopsy also decreased (p = .0067). Among women with carcinoma in situ whose initial Pap screening was completed by a family practice clinician, time to diagnosis was projected to be more than 9 days longer compared with those whose screening was performed by a gynecologist. CONCLUSIONS The 2002 American Society for Colposcopy and Cervical Pathology guidelines for the management of abnormal cytological findings seem to have had a positive impact on the time to diagnosis and Pap screening use before biopsy for women diagnosed with cervical cancer.
Collapse
|
22
|
Gupta N, Srinivasan R, Nijhawan R, Rajwanshi A, Dey P, Suri V, Dhaliwal L. 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; 22:189-94. [PMID: 20629683 DOI: 10.1111/j.1365-2303.2010.00780.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To perform an audit of all cervical smears reported as atypical squamous cells (ASC) and low-grade squamous intraepithelial lesion (LSIL) as in the Bethesda system (TBS) 2001, and determine their histological follow-up and outcome when available, in order to define the threshold for colposcopic referral. MATERIAL AND METHODS A total of 25,203 cervical smears were screened over a period of 3 years (January 2006 - December 2008) and all ASC and LSIL smears were reviewed with the corresponding histological follow-up. All cervical intraepithelial neoplasia (CIN) grade 2 lesions and above (CIN2+) were considered as clinically significant lesions for analysis. RESULTS Out of 25,203 cervical smears, 424 (1.7%) were reported as ASC and 113 (0.4%) as LSIL. Additionally, three were reported as atypical cells, not otherwise specified. The ASC : SIL ratio was 2.18 : 1. Follow-up histology was available in 153 (36.8%) of the ASC cases and revealed CIN2+ lesions in 22 (14.4%). Follow-up histology was available in 50 (44.2%) of LSIL cases and revealed clinically significant abnormalities in five (10%), all of which were CIN2. CIN3 and invasive squamous carcinomas were seen in 5.9% and 1.4%, respectively, of cases of ASC, and not seen in LSIL. Reclassification of ASC smears into ASC-US (ASC-undetermined significance) and ASC-H (ASC- high grade SIL not excluded) revealed ASC-H in 2.6% of all ASC smears, with a clinically significant outcome in 45.4%. CONCLUSION In a low-resource setting where human papillomavirus testing is unaffordable, the threshold for colposcopic referral and follow-up histology should be ASC rather than SIL.
Collapse
Affiliation(s)
- N Gupta
- Department of Cytology and Gynecological Pathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | | | | | | | | | | | | |
Collapse
|
23
|
Natural history of infections with high-risk HPV in Chinese women with abnormal cervical cytology findings at baseline. Int J Gynaecol Obstet 2010; 110:137-40. [DOI: 10.1016/j.ijgo.2010.03.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2009] [Revised: 02/24/2010] [Accepted: 04/07/2010] [Indexed: 11/20/2022]
|
24
|
Wright TC, Cox JT, Massad LS, Twiggs LB, Wilkinson EJ. 2001 Consensus Guidelines for the Management of Women with Cervical Cytological Abnormalities. J Low Genit Tract Dis 2009; 6:127-43. [PMID: 17051012 DOI: 10.1097/00128360-200204000-00012] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Thomas C Wright
- Department of Pathology, College of Physicians and Surgeons, Columbia University, New York, NY 10032, USA.
| | | | | | | | | |
Collapse
|
25
|
Adherence characteristics after abnormal screening results between mammogram and Papanicolaou test groups. Cancer Nurs 2009; 32:437-45. [PMID: 19816157 DOI: 10.1097/ncc.0b013e3181ab5747] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The purpose of this study was to evaluate whether the adherence concerns related to follow-up were different between groups of women after abnormal screening results of mammography (Mam) and Papanicolaou (Pap) test. Taiwanese women with abnormal Mam screening results (n = 42) and abnormal Pap test results (n = 109) provided data via a self-administered survey. Data were collected in 2005. After providing informed consent, women completed the AFAR, an 18 item questionnaire that measured the Adherence concerns of Follow-up after Abnormal screening Results. The results showed that (1) for both Mam and Pap test groups, the most important adherence concern for clinical follow-up after abnormal screening results is disease related, followed by others' response and resource accessibility; and (2) in these 2 clinical follow-up groups, women in the Mam group were more likely to be concerned with all of the 18 adherence factors than those in the Pap test group (OR, 2.46-9.86). The most important adherence concern on clinical follow-up after abnormal screening results for Mam and Pap test women is disease related. Mammography women considered significantly more adherence concerns than Pap test women. These differences imply that improving follow-up after Mam or Pap screen may require different interventions.
Collapse
|
26
|
Cytryn A, Russomano FB, Camargo MJD, Zardo LMG, Horta NMSR, Fonseca RDCSDP, Tristão MA, Monteiro ACS. Prevalence of cervical intraepithelial neoplasia grades II/III and cervical cancer in patients with cytological diagnosis of atypical squamous cells when high-grade intraepithelial lesions (ASC-H) cannot be ruled out. SAO PAULO MED J 2009; 127:283-7. [PMID: 20169277 DOI: 10.1590/s1516-31802009000500007] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2008] [Accepted: 10/13/2009] [Indexed: 11/21/2022] Open
Abstract
CONTEXT AND OBJECTIVE The latest update of the Bethesda System divided the category of atypical squamous cells of undetermined significance (ASCUS) into ASC-US (undetermined significance) and ASC-H (high-grade intraepithelial lesion cannot be ruled out). The aims here were to measure the prevalence of pre-invasive lesions (cervical intraepithelial neoplasia, CIN II/III) and cervical cancer among patients referred to Instituto Fernandes Figueira (IFF) with ASC-H cytology, and compare them with ASC-US cases. DESIGN AND SETTING Cross-sectional study with retrospective data collection, at the IFF Cervical Pathology outpatient clinic. METHODS ASCUS cases referred to IFF from November 1997 to September 2007 were reviewed according to the 2001 Bethesda System to reach cytological consensus. The resulting ASC-H and ASC-US cases, along with new cases, were analyzed relative to the outcome of interest. The histological diagnosis (or cytocolposcopic follow-up in cases without such diagnosis) was taken as the gold standard. RESULTS The prevalence of CIN II/III in cases with ASC-H cytology was 19.29% (95% confidence interval, CI, 9.05-29.55%) and the risk of these lesions was greater among patients with ASC-H than with ASC-US cytology (prevalence ratio, PR, 10.42; 95% CI, 2.39-45.47; P = 0.0000764). Pre-invasive lesions were more frequently found in patients under 50 years of age with ASC-H cytology (PR, 2.67; 95% CI, 0.38-18.83); P = 0.2786998). There were no uterine cervical cancer cases. CONCLUSION The prevalence of CIN II/III in patients with ASC-H cytology was significantly higher than with ASC-US, and division into ASC diagnostic subcategories had good capacity for discriminating the presence of pre-invasive lesions.
Collapse
|
27
|
Wheeler CM. Natural history of human papillomavirus infections, cytologic and histologic abnormalities, and cancer. Obstet Gynecol Clin North Am 2009; 35:519-36; vii. [PMID: 19061814 DOI: 10.1016/j.ogc.2008.09.006] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Over 100 human papillomavirus (HPV) types have been identified to date, of which over 40 infect the genital tract, primarily through sexual transmission. The many different genital HPV types appear to infect, resolve, or persist, and cause abnormal cytology and cervical intraepithelial neoplasia. Several cofactors have been associated with HPV persistence and lesion progression, including smoking, long-term oral contraceptive use, other sexually transmitted infections, host immunogenetics, and viral factors, such as HPV type and HPV variants. Given the discovery of HPV as the single primary cause of invasive cervical cancer, primary and secondary interventions have been realized, including HPV testing in cervical screening programs and prophylactic HPV vaccines. Because first generation HPV vaccines only target the two most common HPV types found in cervical cancer (HPV 16 and 18), cervical screening programs must continue, and the relative roles of HPV vaccination in young women and HPV testing in older women (alone or in conjunction with cytology) will be determined over the next decades.
Collapse
Affiliation(s)
- Cosette Marie Wheeler
- Department of Molecular Genetics, House of Prevention Epidemiology, University of New Mexico Health Sciences Center, School of Medicine, 1816 Sigma Chi Road, Building 191, Albuquerque, NM 87106, USA.
| |
Collapse
|
28
|
Management of atypical squamous cells, low-grade squamous intraepithelial lesions, and cervical intraepithelial neoplasia 1. Obstet Gynecol Clin North Am 2009; 35:599-614; ix. [PMID: 19061819 DOI: 10.1016/j.ogc.2008.09.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
In the American Society for Colposcopy and Cervical Pathology 2006 Consensus Guidelines, several changes in the management of mildly abnormal cervical cytology and histology were made. The most notable changes involve the management of adolescents, pregnant women, and postmenopausal women. For adolescents, management of atypical squamous cells of undetermined significance and low-grade squamous intraepithelial lesions is conservative, eliminating the need for immediate colposcopy. For pregnant women, options have been made to allow for deferral of colposcopy until pregnancy completion, whereas for postmenopausal women, the new guidelines call for the option to rely on human papillomavirus DNA testing or repeat cytology to manage mild cytologic abnormalities. The guidelines for cervical intraepithelial neoplasia 1 now focus on conservative management. The goal of this article is to review the 2006 Guidelines, elaborating on the changes and providing the rationale for management decisions.
Collapse
|
29
|
Shahangian S, Snyder SR. Laboratory medicine quality indicators: a review of the literature. Am J Clin Pathol 2009; 131:418-31. [PMID: 19228647 DOI: 10.1309/ajcpjf8ji4zldque] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
We summarize information on quality indicators related to laboratory testing from published literature and Internet sources to assess current gaps with respect to stages of the laboratory testing process, the Institute of Medicine (IOM) health care domains, and quality measure evaluation criteria. Our search strategy used various general and specific terms for clinical conditions and laboratory procedures. References related to a potential quality indicator associated with laboratory testing and an IOM health care domain were included. With the exception of disease- and condition-related indicators originating from clinical guidelines, the laboratory medicine quality indicators reviewed did not satisfy minimum standard evaluation criteria for quality or performance measures (ie, importance, scientific acceptability, and feasibility) and demonstrated a need across the total laboratory testing process for consistently specified, useful, and evidence-based, laboratory-related quality and performance measures that are important to health outcomes and meaningful to health care stakeholders for which laboratories can be held accountable.
Collapse
|
30
|
Cuvelier CA, Bogers JPM, Bourgain C, Delvenne P, Drijkoningen M, Garbar C, Kevers M, Remmelinck M, Thienpont L, Verhest A, Weynand B, Willocx F. Belgian consensus guidelines for follow-up of women with cervical cytological abnormalities. Acta Clin Belg 2009; 64:136-43. [PMID: 19432026 DOI: 10.1179/acb.2009.023] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
In medical care cervical cancer screening is important because it enables the detection of precancer and cancer at an early stage. By adequate treatment after a screening-detected lesion it helps to reduce the mortality related to cervical cancer. Worldwide, many millions of women have smears taken at a more or less regular base and of these, approximately 7% are abnormal, and follow-up is thus required.As this represents an important cost in medical health care and has serious consequences for the affected women, it is important to have uniform and clear guidelines to allow an optimal follow-up and clinical management. A system for the uniform reporting of cervical cytology has been designed by the National Cancer Institute (U.S.A.) and resulted in the Bethesda System 1991. The present paper and the terminology used are based on the Bethesda System revised in 2001. It explains the guidelines, based on the 2001 Bethesda System and the 2004 consensus guidelines for the management of women with cervical cytological abnormalities, as developed by the members of the Board of the Belgian Society of Clinical Cytology, and adapted to the Belgian situation.
Collapse
Affiliation(s)
- C A Cuvelier
- N. Goormaghtigh Instituut voor Pathologische Anatomie, UZ Gent, Universiteit Gent, Belgium.
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
31
|
Ravinsky E, Baker P. Intermediate-grade squamous intraepithelial lesion may be a valid diagnostic/interpretive category. Diagn Cytopathol 2008; 37:81-5. [PMID: 19021235 DOI: 10.1002/dc.20973] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
We undertook this study to assess the characteristics of smears with features intermediate between high-grade squamous intraepithelial lesion (HSIL) and low-grade squamous intraepithelial lesion (ISIL). We also wanted to determine how these smears correlate with high risk biopsy diagnosis and to compare this with the biopsy correlation of LSIL and HSIL. Seventy-four squamous intraepithelial lesion (SIL) smears were identified as intermediate-grade SIL smears taken at colposcopy in a 1 year period. They were correlated with concurrent colposcopically guided biopsies. Thirty-five percent of cases with intermediate-grade SIL smears had a biopsy diagnosis of moderate dysplasia or higher as compared with 12% for LSIL 74% for HSIL. This confirmed our hypothesis that intermediate-grade SIL smears have a rate of biopsy diagnosis of moderate dysplasia or higher intermediate to that of LSIL and HSIL.
Collapse
Affiliation(s)
- Esther Ravinsky
- Department of Pathology, Faculty of Medicine, University of Manitoba and Head, Section of Cytology, Department of Pathology, Health Sciences Centre, Winnipeg, Manitoba, Canada.
| | | |
Collapse
|
32
|
Abstract
Women look to their internists and other primary care physicians to provide preventive health care. Periodic Pap tests are as much a part of a woman's ongoing health care as periodic lipid assessments, mammograms, screening for colon cancer, or any of the other recommended screening assessments. This article provides primary care physicians with the information needed to perform Pap tests at the appropriate intervals, or if not set up to do Pap tests themselves, to make the appropriate referrals. Also provided is the necessary information to counsel women with abnormal Pap tests who may need colposcopy or other follow-up evaluation. Finally, the role of the HPV vaccine in the prevention of cervical cancer is summarized.
Collapse
Affiliation(s)
- Alan G Waxman
- Department of Obstetrics and Gynecology, University of New Mexico Health Sciences Center, MSC 10 5580, 1 University of New Mexico, Albuquerque, NM 87131-0001, USA.
| | | |
Collapse
|
33
|
Dissemination of Lean Methods to Improve Pap Testing Quality and Patient Safety. J Low Genit Tract Dis 2008; 12:103-10. [DOI: 10.1097/lgt.0b013e31815ae9a1] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
34
|
2006 consensus guidelines for the management of women with abnormal cervical screening tests. J Low Genit Tract Dis 2007; 11:201-22. [PMID: 17917566 DOI: 10.1097/lgt.0b013e3181585870] [Citation(s) in RCA: 252] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To provide revised evidence-based consensus guidelines for managing women with abnormal cervical cancer screening test results. PARTICIPANTS A group of 146 experts, including representatives from 29 professional organizations, federal agencies, and national and international health organizations, met in Bethesda, MD, September 18-19, 2006, to develop the guidelines. MAJOR CHANGES IN GUIDELINES: The core recommendations for managing women with atypical squamous cells of undetermined significance and low-grade squamous intraepithelial lesions were changed minimally. Postcolposcopy management for women with these cytological abnormalities is now identical. Management recommendations for these conditions did change for "special populations," such as adolescents for whom a more conservative approach incorporating cytological follow-up for 2 years was approved. Core recommendations for managing women with high-grade squamous intraepithelial lesions and atypical glandular cells also underwent only minor modifications. More emphasis is placed on immediate "screen-and-treat" approaches when managing women with high-grade squamous intraepithelial lesion. Testing for high-risk human papillomavirus DNA is incorporated into the management of women with atypical glandular cells after their initial evaluation with colposcopy and endometrial sampling. The 2004 Interim Guidance for the use of human papillomavirus DNA testing as an adjunct to cervical cytology for screening in women 30 years and older was formally adopted with only very minor modifications. CONCLUSIONS The 2006 Consensus Guidelines reflect recent data from large clinical trials and advances in technology and are designed to assist clinicians of all subspecialties.
Collapse
|
35
|
Raab SS, Grzybicki DM, Zarbo RJ, Jensen C, Geyer SJ, Janosky JE, Meier FA, Vrbin CM, Carter G, Geisinger KR. Frequency and outcome of cervical cancer prevention failures in the United States. Am J Clin Pathol 2007; 128:817-24. [PMID: 17951205 DOI: 10.1309/97jhg6gly69bvf4y] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
We measured the frequency and outcome of cervical cancer prevention failures that occurred in the Papanicolaou (Pap) and colposcopy testing phases involving 1,646,580 Pap tests in 4 American hospital systems between January 1, 1998, and December 31, 2004. We defined a screening failure as a 2-step or greater discordant Pap test result and follow-up biopsy diagnosis. A total of 5,278 failures were detected (0.321% of all Pap tests); 48% and 52% of failures occurred in the Pap test and colposcopy phases, respectively. Missed squamous cancers (1 in 187,786 Pap tests), glandular cancers (1 in 19,426 Pap tests), and high-grade lesions (1 in 6,870 Pap tests) constituted 4.1% of all failures. Unnecessary repeated tests or diagnostic delays occurred in 70.8% and 63.9% of failures involving high- and low-grade lesions, respectively. We conclude that cervical cancer prevention practices are remarkably successful in preventing squamous cancers, although a high frequency of failures results in low-impact negative outcomes.
Collapse
|
36
|
Wright TC, Massad LS, Dunton CJ, Spitzer M, Wilkinson EJ, Solomon D. 2006 consensus guidelines for the management of women with abnormal cervical cancer screening tests. Am J Obstet Gynecol 2007; 197:346-55. [PMID: 17904957 DOI: 10.1016/j.ajog.2007.07.047] [Citation(s) in RCA: 478] [Impact Index Per Article: 28.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2007] [Revised: 06/28/2007] [Accepted: 07/29/2007] [Indexed: 12/25/2022]
Abstract
A group of 146 experts representing 29 organizations and professional societies met September 18-19, 2006, in Bethesda, MD, to develop revised evidence-based, consensus guidelines for managing women with abnormal cervical cancer screening tests. Recommendations for managing atypical squamous cells of undetermined significance and low-grade squamous intraepithelial lesion (LSIL) are essentially unchanged. Changes were made for managing these conditions in adolescents for whom cytological follow-up for 2 years was approved. Recommendations for managing high-grade squamous intraepithelial lesion (HSIL) and atypical glandular cells (AGC) also underwent only minor modifications. More emphasis is placed on immediate screen-and-treat approaches for HSIL. Human papillomavirus (HPV) testing is incorporated into the management of AGC after their initial evaluation with colposcopy and endometrial sampling. The 2004 Interim Guidance for HPV testing as an adjunct to cervical cytology for screening in women 30 years of age and older was formally adopted with only very minor modifications.
Collapse
Affiliation(s)
- Thomas C Wright
- Department of Pathology, College of Physicians and Surgeons of Columbia University, New York, NY 10032, USA.
| | | | | | | | | | | |
Collapse
|
37
|
Eggleston KS, Coker AL, Luchok KJ, Meyer TE. Adherence to recommendations for follow-up to abnormal Pap tests. Obstet Gynecol 2007; 109:1332-41. [PMID: 17540805 DOI: 10.1097/01.aog.0000266396.25244.68] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To evaluate whether timely adherence rates differ by race among women with abnormal Pap tests participating in a cost-free or reduced-cost program. METHODS Eligible subjects included women aged 47-64 years who received a referral for follow-up care after an abnormal Pap test from 1999 to 2002 in South Carolina (n=330). Adherence was measured as days to receipt of follow-up care after an abnormal Pap test. Cox proportional hazards modeling was used to estimate risk factors associated with time to adherence within 60 and 365 days by race. RESULTS African-American and non-Hispanic white women had similar adherence to follow-up. Among white women, those with high-grade lesions were less likely to adhere in a timely manner relative to those with low-grade lesions (hazard ratio 0.6, 95% confidence interval [CI] 0.4-1.0). For African-American women, rural residence (hazard ratio: 0.5, 95% CI 0.2-0.9) and history of abnormal Pap tests (hazard ratio 0.6, 95% CI 0.3-1.0) were associated with decreased adherence, whereas less education (hazard ratio 2.3, 95% CI 1.3-3.9) was associated with increased adherence. CONCLUSION Adherence rates do not differ by race. However, risk factors for adherence within race are variable. Interventions tailored to the differential needs of racial and ethnic groups may prove effective toward increasing timely adherence rates. LEVEL OF EVIDENCE II.
Collapse
Affiliation(s)
- Katherine S Eggleston
- University of Texas Health Science Center, School of Public Health, Houston, Texas 77025, USA.
| | | | | | | |
Collapse
|
38
|
Eggleston KS, Coker AL, Das IP, Cordray ST, Luchok KJ. Understanding Barriers for Adherence to Follow-Up Care for Abnormal Pap Tests. J Womens Health (Larchmt) 2007; 16:311-30. [PMID: 17439377 DOI: 10.1089/jwh.2006.0161] [Citation(s) in RCA: 100] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE Approximately 4000 women annually will die from preventable and treatable cervical cancer. Failure to adhere to follow-up recommendations after an abnormal Pap test can lead to development of cervical cancer. This paper summarizes the body of literature on adherence to follow-up after an abnormal Pap test in order to facilitate development of interventions to decrease morbidity and mortality due to cervical cancer. METHODS We conducted a comprehensive search of published literature addressing risk factors for adherence or interventions to improve adherence following an abnormal Pap test as the outcome. We included peer-reviewed original research conducted in the United States from 1990 to 2005. RESULTS Fourteen analytical and twelve experimental studies that met our criteria were reviewed. Lesion severity and health beliefs were consistently associated with adherence rates. Communication interventions, including telephone reminders, counseling, and educational sessions, increased follow-up compliance across intervention studies. Inconsistent evidence for associations among race, income, and age were found. CONCLUSIONS Further research is needed to reinforce current studies addressing health beliefs and social support. Interventions that focus on the interplay among psychological, educational, and communication barriers are necessary. These interventions should be adapted and applied across various racial/ethnic and socioeconomic groups to reach all women with a high-risk profile for invasive cervical cancer.
Collapse
Affiliation(s)
- Katherine S Eggleston
- University of Texas Health Science Center, School of Public Health, Houston, Texas 77025, USA.
| | | | | | | | | |
Collapse
|
39
|
O'Connor DM. Educational notes, disclaimers, and recommendations appended to cervical cytologic reports. J Low Genit Tract Dis 2006; 7:209-13. [PMID: 17051070 DOI: 10.1097/00128360-200307000-00009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
40
|
Lee SJ, Jung KL, Lee JW, Song SY, Kim BG, Lee JH, Park CS, Bae DS. Analyses of atypical squamous cells refined by the 2001 Bethesda System: the distribution and clinical significance of follow-up management. Int J Gynecol Cancer 2006; 16:664-9. [PMID: 16681744 DOI: 10.1111/j.1525-1438.2006.00403.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
This study was conducted to analyze the clinical significance of follow-up diagnostic methods of atypical squamous cells (ASC) (the 2001 Bethesda System) cases according to age. A computerized search of the cytology database was performed to retrieve all cases diagnosed as ASC from 2001 to 2003. The pathologic reports for all follow-up diagnoses were reviewed. We divided the patients into two groups according to their age, younger than 50 years of age and 50 years and older, and follow-up diagnoses were compared between the two groups. ASC was identified in 1035 (2.0%) of 49,882 women screened, and a total of 914 patients were eligible. In atypical squamous cells of undetermined significance (ASC-US) cases, colposcopically directed biopsy showed CIN I (CIN is cervical intraepithelial neoplasia) or higher grade lesions in 34.9% of cases younger than 50 years of age and in 17.4% of cases 50 years and older (P= 0.000). However, repeat Pap smears and human papillomavirus DNA testing showed no differences between the two groups. In contrast, the three methods did not exhibit significant difference between the two groups in patients with atypical squamous cells, cannot exclude high-grade squamous intraepithelial lesion (ASC-H) (P= 0.743). Colposcopically directed biopsy for the ASC-US was more useful in patients younger than 50 years of age than in those who were 50 years and older. It is suggested that age should be considered in deciding follow-up diagnostic methods in patients with ASC-US.
Collapse
Affiliation(s)
- S-J Lee
- Department of Obstetrics and Gynecology, Konkuk University Hospital, Konkuk University School of Medicine, Seoul, Korea
| | | | | | | | | | | | | | | |
Collapse
|
41
|
Richardson LC, Benard VB. Can high-grade cervical lesions be managed in a single clinic visit? NATURE CLINICAL PRACTICE. ONCOLOGY 2006; 3:420-1. [PMID: 16894384 DOI: 10.1038/ncponc0563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/20/2006] [Accepted: 05/24/2006] [Indexed: 05/11/2023]
Affiliation(s)
- Lisa C Richardson
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA 30341, USA.
| | | |
Collapse
|
42
|
Chichareon SB, Tocharoenvanich S. Risk factors of having high-grade cervical intraepithelial neoplasia/invasive carcinoma in women with atypical glandular cells of undetermined significance smears. Int J Gynecol Cancer 2006; 16:568-74. [PMID: 16681727 DOI: 10.1111/j.1525-1438.2006.00392.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
The objective of this study was to find the risk factors of having high-grade cervical intraepithelial neoplasia/invasive carcinoma in women with atypical glandular cells of undetermined significance (AGUS) smears. A retrospective study of the women with AGUS smears during the 3-year period was performed to determine the correlation between the suspected variables and the histopathologic diagnoses. Among 44,071 smears performed, 119 (0.27%) smears were reported as AGUS. Colposcopies were performed in 102 (88.7%) cases, and high-grade cervical intraepithelial neoplasia/invasive carcinoma was found in 18 (17.6%) cases. Among the following variables, which included age, menopausal status, hormonal contraception, history of previous Pap smears, medical diseases, clinical symptoms, and subclassification of AGUS, both hormonal contraception and AGUS favor neoplasia were risk factors with an odds ratio of 5.4 and 5.0, respectively. Although clinical symptoms seemed to be a significant variable in univariate analysis, it appeared as a confounding factor in multivariate analysis.
Collapse
Affiliation(s)
- S B Chichareon
- Gynecologic Oncology Unit, Department of Obstetrics and Gynecology, Faculty of Medicine, Prince of Songkla University, Hat-Yai, Songkhla, Thailand.
| | | |
Collapse
|
43
|
Raab SS, Grzybicki DM, Janosky JE, Zarbo RJ, Meier FA, Jensen C, Geyer SJ. Clinical impact and frequency of anatomic pathology errors in cancer diagnoses. Cancer 2006; 104:2205-13. [PMID: 16216029 DOI: 10.1002/cncr.21431] [Citation(s) in RCA: 110] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND To the authors' knowledge, the frequency and clinical impact of errors in the anatomic pathology diagnosis of cancer have been poorly characterized to date. METHODS The authors examined errors in patients who underwent anatomic pathology tests to determine the presence or absence of cancer or precancerous lesions in four hospitals. They analyzed 1 year of retrospective errors detected through a standardized cytologic-histologic correlation process (in which patient same-site cytologic and histologic specimens were compared). Medical record reviews were performed to determine patient outcomes. The authors also measured the institutional frequency, cause (i.e., pathologist interpretation or sampling), and clinical impact of diagnostic cancer errors. RESULTS The frequency of errors in cancer diagnosis was found to be dependent on the institution (P < 0.001) and ranged from 1.79-9.42% and from 4.87-11.8% of all correlated gynecologic and nongynecologic cases, respectively. A statistically significant association was found between institution and error cause (P < 0.001); the cause of errors resulting from pathologic misinterpretation ranged from 5.0-50.7% (the remainder were due to clinical sampling). A statistically significant association was found between institution and assignment of the clinical impact of error (P < 0.001); the aggregated data demonstrated that for gynecologic and nongynecologic errors, 45% and 39%, respectively, were associated with harm. The pairwise kappa statistic for interobserver agreement on cause of error ranged from 0.118-0.737. CONCLUSIONS Errors in cancer diagnosis are reported to occur in up to 11.8% of all reviewed cytologic-histologic specimen pairs. To the authors' knowledge, little agreement exists regarding whether pathology errors are secondary to misinterpretation or poor clinical sampling of tissues and whether pathology errors result in serious harm.
Collapse
Affiliation(s)
- Stephen S Raab
- Department of Pathology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania 15232, USA.
| | | | | | | | | | | | | |
Collapse
|
44
|
Irvin W, Evans SR, Andersen W, Jazaeri A, Taylor P, Stoler M, Pastore L, Rice L. The utility of HPV DNA triage in the management of cytological AGC. Am J Obstet Gynecol 2005; 193:559-65; discussion 565-7. [PMID: 16098895 DOI: 10.1016/j.ajog.2005.03.044] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2004] [Revised: 03/14/2005] [Accepted: 05/19/2005] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Given the demonstrated utility of human papilloma virus DNA triage in the management of atypical squamous cells of undetermined significance, this study sought to evaluate the potential role of human papilloma virus DNA testing in the evaluation and management of cytological atypical glandular cells. STUDY DESIGN Following institutional review board approval, 28 women presenting with cytological atypical glandular cells underwent repeat thin-prep cytology, Hybrid Capture 2 human papilloma virus DNA testing, colposcopic evaluation, Fisher electrosurgical conization, and endometrial sampling. Human papilloma virus test results in each patient were then correlated with histologic lesions, if present. RESULTS Sixteen of the 28 study patients had pathologic lesions (11/28 high-grade squamous intraepithelial lesion, 3/28 low-grade squamous intraepithelial lesion, 1/28 adenocarcinoma in situ, 1/28 simple endometrial hyperplasia). Human papilloma virus DNA testing was available in 24 of 28 subjects (86%). The sensitivity of human papilloma virus positivity to predict the presence of cervical intraepithelial neoplasia was 100% (confidence interval 77% to 100%), specificity 64% (confidence interval 35% to 85%), positive predictive value 76%, and negative predictive value 100%. Women who tested human papilloma virus positive were 12 times more likely to have cervical intraepithelial neoplasia than women who were human papilloma virus negative (Fisher P<.001). Human papilloma virus positivity was not predictive of endometrial pathology; women who were human papilloma virus positive were less likely to have endometrial pathology than were women who were human papilloma virus negative (risk ratio 1.6, 95% confidence interval 0.01-1.7). CONCLUSION Atypical glandular cells can represent a variety of lesions. The majority of the lesions will be squamous intraepithelial lesions of the cervix (50%), with high-grade squamous intraepithelial lesion present in 40% of subjects. Human papilloma virus DNA testing is a sensitive test for the presence of squamous intraepithelial lesion, with excellent negative predictive value for the absence of squamous intraepithelial lesion. The results of this study suggest human papilloma virus DNA testing might be an effective screening test in the initial evaluation and management of cytological atypical glandular cells.
Collapse
Affiliation(s)
- William Irvin
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Virginia Health System, Charlottesville, VA 22908, USA.
| | | | | | | | | | | | | | | |
Collapse
|
45
|
Closing Discussion by Dr Irvin. Am J Obstet Gynecol 2005. [DOI: 10.1016/j.ajog.2005.04.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
|
46
|
Affiliation(s)
- Barbara A Crothers
- Department of Pathology, Walter Reed Army Medical Center, Washington, DC 20307-5001, USA.
| |
Collapse
|
47
|
Hollensead SC, Lockwood WB, Elin RJ. Errors in pathology and laboratory medicine: consequences and prevention. J Surg Oncol 2005; 88:161-81. [PMID: 15562462 DOI: 10.1002/jso.20125] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Reducing errors and improving quality are an integral part of Pathology and Laboratory Medicine. The rate of errors is reviewed for the pre-analytical, analytical, and post-analytical phases for a specimen. The quality systems in place in pathology today are identified and compared with benchmarks for quality. The types and frequency of errors and quality systems are reviewed for surgical pathology, cytopathology, clinical chemistry, hematology, microbiology, molecular biology, and transfusion medicine. Seven recommendations are made to reduce errors in future for Pathology and Laboratory Medicine.
Collapse
Affiliation(s)
- Sandra C Hollensead
- Department of Pathology and Laboratory Medicine, University of Louisville SOM, Louisville, Kentucky 40202, USA
| | | | | |
Collapse
|
48
|
Fairman A, Tan J, Quinn M. Women with low-grade abnormalities on Pap smear should be referred for colposcopy. Aust N Z J Obstet Gynaecol 2004; 44:252-5. [PMID: 15191452 DOI: 10.1111/j.1479-828x.2004.00223.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
AIM To assess cytological, colposcopic and histological outcomes in women referred to a teaching hospital dysplasia clinic with low-grade changes on screening Pap smear. METHODS Analysis of a computerised database. RESULTS Repeating the Pap test was of little value. Fifteen percent of women with low-grade changes on the referral smear had biopsy proven high-grade change. There was little difference in biopsy proven high-grade change in women referred with an 'abnormal smear of uncertain significance' (23%) or 'an abnormal smear of uncertain significance-possible high-grade change' (24%). CONCLUSIONS Given these findings and the current medico-legal climate, immediate referral of women with low-grade changes on routine cytology is indicated, and seems a safer option than the more conservative approach of a repeat smear in 6 or 12 months. Further study of the usefulness of separating smears of uncertain significance into high-grade and low-grade categories is warranted. Consumer input into recommendations for management of Pap smear abnormalities is required.
Collapse
Affiliation(s)
- Amanda Fairman
- University Department of Obstetrics and Gynaecology, Melbourne, Victoria, Australia
| | | | | |
Collapse
|
49
|
Goldie SJ, Kim JJ, Wright TC. Cost-effectiveness of human papillomavirus DNA testing for cervical cancer screening in women aged 30 years or more. Obstet Gynecol 2004; 103:619-31. [PMID: 15051550 DOI: 10.1097/01.aog.0000120143.50098.c7] [Citation(s) in RCA: 157] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To evaluate the cost-effectiveness of human papillomavirus (HPV) DNA testing as a primary screening test in combination with cervical cytology in women aged 30 years or more. METHODS A state-transition mathematical model was used to simulate the natural history of HPV and cervical cancer in a cohort of U.S. women. Strategies included no screening and screening at different frequencies with conventional cytology, liquid-based cytology with HPV testing used for triage of equivocal results, and HPV DNA testing and cytology in combination after women had reached the age of 30. Outcomes measured included cancer incidence, life expectancy, lifetime costs, and incremental cost-effectiveness ratios. RESULTS The estimated reduction in lifetime risk of cervical cancer varies from 81% to 93% depending on the screening frequency, type of cytology, and test strategy. Every 3-year screening with liquid-based cytology administered to women at all ages and every 3-year screening using HPV DNA testing and cytology in combination administered to women aged 30 years or more provide equivalent or greater benefits than those provided by annual conventional cytology and have incremental cost-effectiveness ratios of US dollars 95300 and US dollars 228700 per year of life gained, respectively. In comparison, annual screening with HPV DNA testing and cytology in combination provides only a few hours of additional life expectancy and has a cost-effectiveness ratio of more than Us dollars 2000000 per year of life gained. CONCLUSIONS For women aged 30 years and more, every 2- or 3-year screening strategy that uses either HPV DNA testing in combination with cytology for primary screening or cytology with reflex HPV DNA testing for equivocal results will provide a greater reduction in cancer and be less costly than annual conventional cytology.
Collapse
Affiliation(s)
- Sue J Goldie
- Department of Health Policy and Management, Harvard School of Public Health, Boston, Massachusetts 02115-5924, USA.
| | | | | |
Collapse
|
50
|
Yabroff KR, Breen N, Vernon SW, Meissner HI, Freedman AN, Ballard-Barbash R. What Factors Are Associated with Diagnostic Follow-Up after Abnormal Mammograms? Findings from a U.S. National Survey. Cancer Epidemiol Biomarkers Prev 2004. [DOI: 10.1158/1055-9965.723.13.5] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Abstract
The purpose of this study was to identify factors associated with diagnostic follow-up after an abnormal mammogram in a national sample of women in the U.S. The sample was selected from the year 2000 National Health Interview Survey and included 1901 women aged 30 and above who reported ever having an abnormal mammogram. The outcome measure was receipt of at least some diagnostic follow-up after an abnormal mammogram. Bivariate and multivariate logistic regression analyses were used to explore the associations between sociodemographic characteristics, general health and health behaviors, cancer risk and risk perceptions, and health care utilization characteristics and follow-up. Approximately 9% of women who reported ever having abnormal mammograms reported not completing any additional diagnostic follow-up. Controlling for all other factors, women with less than a high school education were less likely to report follow-up after an abnormal mammogram than were women who had at least completed college (odds ratio = 0.56; 95% confidence interval: 0.32, 0.98). Younger women and women in poorer health were also less likely to report follow-up. Women who perceived a high versus low level of cancer in their family were more likely to report follow-up (odds ratio = 1.65; 95% confidence interval: 1.04, 2.62), controlling for all other factors. In a national sample of women with abnormal mammograms, a substantial number did not complete any diagnostic follow-up, potentially reducing the effectiveness of mammography screening programs in the U.S. Additional research on subsequent screening behaviors for women with incomplete follow-up and in-depth exploration of the roles of patient-provider interactions and health care system factors related to the index abnormal mammogram is warranted.
Collapse
Affiliation(s)
- K. Robin Yabroff
- 1Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland and
| | - Nancy Breen
- 1Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland and
| | - Sally W. Vernon
- 2University of Texas Houston, School of Public Health, Houston, Texas
| | - Helen I. Meissner
- 1Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland and
| | - Andrew N. Freedman
- 1Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland and
| | - Rachel Ballard-Barbash
- 1Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland and
| |
Collapse
|