Recommendations for Use of p16/Ki67 Dual Stain for Management of Individuals Testing Positive for Human Papillomavirus

OBJECTIVES

The Enduring Consensus Cervical Cancer Screening and Management Guidelines Committee developed recommendations for dual stain (DS) testing with CINtec PLUS Cytology for use of DS to triage high-risk human papillomavirus (HPV)-positive results.

METHODS

Risks of cervical intraepithelial neoplasia grade 3 or worse were calculated according to DS results among individuals testing HPV-positive using data from the Kaiser Permanente Northern California cohort and the STudying Risk to Improve DisparitiES study in Mississippi. Management recommendations were based on clinical action thresholds developed for the 2019 American Society for Colposcopy and Cervical Pathology Risk-Based Management Consensus Guidelines. Resource usage metrics were calculated to support decision-making. Risk estimates in relation to clinical action thresholds were reviewed and used as the basis for draft recommendations. After an open comment period, recommendations were finalized and ratified through a vote by the Consensus Stakeholder Group.

RESULTS

For triage of positive HPV results from screening with primary HPV testing (with or without genotyping) or with cytology cotesting, colposcopy is recommended for individuals testing DS-positive. One-year follow-up with HPV-based testing is recommended for individuals testing DS-negative, except for HPV16- and HPV18-positive results, or high-grade cytology in cotesting, where immediate colposcopy referral is recommended. Risk estimates were similar between the Kaiser Permanente Northern California and STudying Risk to Improve DisparitiES populations. In general, resource usage metrics suggest that compared with cytology, DS requires fewer colposcopies and detects cervical intraepithelial neoplasia grade 3 or worse earlier.

CONCLUSIONS

Dual stain testing with CINtec PLUS Cytology is acceptable for triage of HPV-positive test results. Risk estimates are portable across different populations.

The relationship of human papillomavirus and cytology co-testing results with endometrial and ovarian cancer diagnoses

BACKGROUND

To investigate whether routine cervical screening using human papillomavirus (HPV) and cytology co-testing effectively identifies women with endometrial (EC) or ovarian (OvC) cancer.

METHODS

In 2003, Kaiser Permanente Northern California implemented triennial co-testing in women aged ≥30 years. Index screening results (n = 2,385,729) were linked to subsequent EC (n = 3434) and OvC (n = 1113) diagnoses from January 1, 2003 to December 31, 2017. EC were categorized as type 1 or 2, and, selectively, EC and OvC diagnoses were stratified on whether symptoms were present at the time of the co-test. Fractions and absolute risks of EC or OvC of each co-testing result were calculated.

RESULTS

Most EC (82.18%) and OvC (88.68%) were preceded by a negative HPV and negative cytology co-test. More EC were preceded by atypical squamous cells of undetermined significance (ASC-US) or more severe (ASC-US+) cytology and negative HPV test (n = 290) (8.44% of EC) compared to a negative cytology and a positive HPV test (n = 31) (0.89% of EC) (p < 0.001). The absolute risk of any EC diagnosis following ASC-US+ and negative HPV test was 0.48%. Atypical glandular cells (AGC) cytology and a negative HPV result preceded 6.92% of any EC diagnosis, with an absolute risk of 4.02%, but preceded only 1.13% of type 2 EC cases, with an absolute risk of 0.24%, in asymptomatic women. AGC cytology and a negative HPV result preceded 1.44% of OvC, with an absolute risk of 0.28%.

CONCLUSIONS

Abnormal cervical screening tests, even AGC cytology, rarely precedes and poorly predict women with EC or OvC.

Clinical Outcomes after Conservative Management of Cervical Intraepithelial Neoplasia Grade 2 (CIN2) in Women Ages 21-39 Years

Cervical intraepithelial neoplasia grade 2 (CIN2) frequently regresses, is typically slow-growing, and rarely progresses to cancer. Some women forgo immediate treatment, opting for conservative management (heightened surveillance with cytology and colposcopy), to minimize overtreatment and increased risk of obstetric complications; however, there are limited data examining clinical outcomes in these women. We performed a retrospective cohort analysis of younger women diagnosed with initially untreated CIN1/2, CIN2 and CIN2/3 lesions at Kaiser Permanente Northern California between 2003 and 2015. Clinical outcomes were categorized into five mutually exclusive hierarchical groups: cancer, treated, returned to routine screening, persistent high-grade lesion, or persistent low-grade lesion. Median follow-up for the 2,417 women was 48 months. Six women were diagnosed with cancer (0.2%), all with history of high-grade cytology, and none after a negative cotest. Thirty percent of women were treated, and only 20% returned to routine screening; 50% remained in continued intensive follow-up, of which 86% had either low-grade cytology/histology or high-risk human papillomavirus (HPV) positivity, but not necessarily persistence of a single HPV type. No cancers were detected after a single negative cotest in follow-up. Almost half of initially untreated women did not undergo treatment, but remained by protocol in colposcopy clinic for 2 or more years in the absence of persisting CIN2⁺ Their incomplete return to total negativity was possibly due to sequential new and unrelated low-grade abnormalities. The prolonged colposcopic surveillance currently required to return to routine screening in the absence of persisting CIN2⁺ might not be necessary after a negative cotest.Significance: Many younger women under conservative management following an initial CIN2 result remain in a clinical protocol of prolonged intensified surveillance without a subsequent diagnosis of CIN2 or more severe diagnoses. More research is needed to determine whether such prolonged management might be unnecessary following a negative cotest for those women with an initial CIN2 but otherwise only low-grade findings. Cancer Prev Res; 11(3); 165-70. ©2018 AACR.

HIV and HCV prevalence among trawler crew

A survey of 51 people who work on trawlers was carried out to describe injecting and sexual behaviour and the prevalence of HIV and HCV antibody. All crew members who were departing from an Australian port during the last week of February 1996 to work on trawlers were asked to complete a brief, self-administered questionnaire and provide a finger prick blood sample. Questionnaires were received from 51 (77%) and blood samples from 45 (68%) of the 66 crew from 15 vessels. Almost half the respondents reported ever injecting illicit drugs. No respondents had HIV antibody while 27% had HCV antibody detected. Among 20 injecting drug user (IDU) respondents, the prevalence of HCV was 55% (95% CI 32%-77%). Twelve respondents reported new sex partners in the past month of whom half reported no condom use with these sex partners. The survey emphasises the diversity of the IDU population in Australia. Yet it would appear that regardless of the sub-population surveyed that HCV is endemic among IDUs in Australia. Effective HCV prevention programs targeted specifically for these (and other) sub-populations of IDUs should be devised.

The effect of the evanescent wave upon acoustic measurements in the human ear canal

When making acoustic measurements in a human ear canal, it is often necessary to monitor the output of a sound source with a microphone positioned within a few millimeters of that sound source. This microphone will not only measure the pressure due to the propagated acoustic wave, which we wish to measure, but also the pressure due to the evanescent wave. The pressure due to the evanescent wave can be viewed as a source of error in the measurement of the propagating acoustic wave. This paper attempts to quantify the magnitude of this error. Theoretical predictions are made of the relative level of the evanescent sound pressure in a number of source and microphone arrangements applicable to ear canal measurements. It is shown that these theoretical predictions represent an upper limit of evanescent sound pressure that can be measured experimentally. The maximum measurement error due to the presence of the evanescent wave in human ear canals below 10 kHz is predicted to be 3 dB in adults and 1.3 dB in 1 month old infants, when the loudspeaker and microphone ports are spaced more than 2 mm apart.

Radial movement of lysosomes along microtubules in permeabilized macrophages

In murine bone marrow-derived macrophages, lysosomes often form tubulovesicular compartments, whose extended distribution in the cytoplasm depends on the integrity of cytoplasmic microtubules. When macrophages with fluorescently labeled lysosomes were plated onto coverslips opsonized with IgG, they engaged that surface in a phagocytic response (frustrated phagocytosis). The tubular lysosomal compartment of these cells collected in a central, perinuclear region, despite the continued presence of a radiating array of cytoplasmic microtubules. Using methods developed in the study of melanophores, we permeabilized macrophages engaged in frustrated phagocytosis, then re-activated lysosome extension along microtubules. Permeabilization was selective for plasma membranes, in that high molecular weight probes such as trypan blue or IgG could enter cells, while fluorescent probes previously loaded into lysosomes via endocytosis remained contained therein. Addition of 2 mM ATP, GTP or UTP to these permeabilized cell models produced centrifugal extension of tubular lysosomes. Selective depletion of ATP, using Escherichia coli glycerol kinase, inhibited ATP-dependent extension but not that which occurred with GTP or UTP, indicating that the mechanism of radial movement can use any of these three nucleotide triphosphates. Extension was independent of pH between 6.8 and 7.4, and was inhibited by AMP-PNP and by GMP-PNP. Depolymerization of cytoplasmic microtubules with nocodazole prevented subsequent ATP-inducible lysosome extension, whereas preincubation of cells with cytochalasin D did not inhibit the response. These results are consistent with the in vitro mechanochemical properties of kinesin (Cohn et al., 1989), and support earlier evidence, obtained in living cells, that kinesin is the mechanochemical motor of lysosome extension along microtubules in macrophages.

A revision of Entobdella Blainville (Monogenea: Capsalidae) with particular reference to E. hippoglossi and E. squamula: the use of ratios in taxonomy and key to species

Morphologic and morphometric characters for 14 Entobdella species were reviewed. Entobdella brattstroemi, E. curvunca, E. rosaceus, E. squamula, and E. steingroeveri were found to be morphologically indistinguishable from E. hippoglossi, the type species, and are declared synonyms. A redescription of E. hippoglossi is presented. Allometry and the use of ratios to differentiate species are discussed. The nine valid Entobdella spp. belong to two monophyletic subgroups: the "hippoglossi" group (E. hippoglossi, E. soleae, and E. pugetensis) and the "diadema" group (E. diadema, E. bumpusii, E. corona, E. guberleti, E. apiocolpos, and E. australis). A key to species is included.

Terrestrial and freshwater invertebrates in the neuston of the Bay of Fundy, Canada

More than 106 families of insects representing 12 orders, spiders, mites, and millipedes were collected in the neuston of the Bay of Fundy in spring, summer, and autumn. Homoptera, Diptera, and Hymenoptera were dominant in number of families and (or) number of individuals. Seasonal and annual variations in taxonomic composition and in abundance were considerable. The abundant detritus of terrestrial and fluvial origin in the neuston, especially in summer, may be a potentially important food source for surface-feeding animals.

Models of family-centered care in one acute care institution

Focus on the emotional responses and needs of critically ill patients has grown to encompass a focus on their families as well. Moos notes that the family as well as the patient faces a number of adaptive tasks in the crisis of serious illness. These include managing the hospital environment, keeping reasonable emotional balance, negotiating relationships with the treatment staff, preserving self-image, preserving a relationship with the patient, and preparing for an uncertain future. The complexity of these tasks and the coping skills needed to master them speaks to the role of the psychiatric clinical nurse specialist in the acute care setting. This article has highlighted some activities of psychiatric clinical nurse specialists working with families in the acute care setting. Included have been support groups, indirect models, contracting, professional families, VIP/VRP families, families in the intensive care setting, and families in transition from intensive care to floor care. All emphasize the importance and needs of the family as well as the patient during hospitalization in an acute care setting.