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Barakzai SK, Nguyen A, Sehgal S, Matsuo K, Shi W, Veran-Taguibao S, Wilson ML, Gordon BJ. The clinical relevance of human papillomavirus negative status in unsatisfactory cervical cytology. Arch Gynecol Obstet 2023; 307:1021-1025. [PMID: 36484851 DOI: 10.1007/s00404-022-06870-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 11/25/2022] [Indexed: 12/13/2022]
Abstract
PURPOSE The aim of this study was to evaluate the clinical relevance of high-risk human papillomavirus (HR-HPV) negativity at the time of unsatisfactory cervical cytology. METHODS In this retrospective observational study, records were reviewed for patients who had unsatisfactory cervical cytology with HR-HPV testing performed from January 2015 through September 2019 at a large teaching hospital. Pathology results of follow-up cervical cytology and biopsies were assessed. RESULTS Of 1282 patients with unsatisfactory cervical cytology and negative HR-HPV testing, repeat cytology was negative for intraepithelial lesion (NIL) in 952 (75%) patients, unsatisfactory in 273 (22%) patients, and abnormal in 41 (3%) patients. Median follow-up time was 91 days. The concordance of HR-HPV status between initial unsatisfactory cervical cytology and subsequent satisfactory cervical cytology was 96.3% for HR-HPV negative patients and 68.8% for HR-HPV positive patients. Compared to women who were HR-HPV negative, women who were HR-HPV positive on initial unsatisfactory cytology were at higher risk of subsequent cervical intraepithelial neoplasia (CIN) 2 or greater (odds ratio = 4.91, 95% confidence interval: 1.34-18.03 for E6/E7 mRNA positivity alone; odds ratio = 46.13, 95% confidence interval: 13.45-158.01 for HR-HPV genotype 16 or 18/45 positivity). CONCLUSION In the 3 month follow-up of patients with unsatisfactory cervical cytology and negative HR-HPV testing, approximately 3% had abnormal cytology but no cases of HPV related pathology of CIN 2 or greater were found. There was high concordance of negative HR-HPV testing results with those on follow-up satisfactory cervical cytology.
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Affiliation(s)
- Syem K Barakzai
- Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA, USA.
| | - Ailene Nguyen
- Department of Internal Medicine, University of Southern California, Los Angeles, CA, USA
| | - Sanchala Sehgal
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Koji Matsuo
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA, USA
- Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, USA
| | - Wenjing Shi
- Department of Pathology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | | | - Melissa L Wilson
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Brian J Gordon
- Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA, USA
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Li Q, Zhang HW, Sui L, Hua KQ. Diagnostic discrepancy between colposcopy and vaginoscopy: A case report. World J Clin Cases 2021; 9:5943-5947. [PMID: 34368312 PMCID: PMC8316953 DOI: 10.12998/wjcc.v9.i21.5943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 05/07/2021] [Accepted: 06/07/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Colposcopy currently plays a vital role in the diagnosis and treatment of lower genital diseases. Exposure and biopsy are two key steps in colposcopy. When the whole transformation zone or all lesions cannot be observed, we judge colposcopy as unsatisfactory. Unsatisfactory colposcopic examination may lead to the misdiagnosis of more severe diseases. The combination of colposcopy and vaginoscopy may contribute to accurate diagnosis and clinical decisions.
CASE SUMMARY Here, we introduce a case of posthysterectomy deep vaginal apex not fully exposed by colposcopy, and the biopsy result was a vaginal precancerous lesion. We adopted vaginoscopy to extend the observed area and expose the lesion thoroughly, and the biopsy result was vaginal squamous cancer.
CONCLUSION The patient received a precise diagnosis and early surgery due to the combination of colposcopy and vaginoscopy.
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Affiliation(s)
- Qing Li
- Diagnosis and Treatment Center of Cervical Disease, OBG Hospital of Fudan University, Shanghai 200000, China
| | - Hong-Wei Zhang
- Diagnosis and Treatment Center of Cervical Disease, OBG Hospital of Fudan University, Shanghai 200000, China
| | - Long Sui
- Diagnosis and Treatment Center of Cervical Disease, OBG Hospital of Fudan University, Shanghai 200000, China
| | - Ke-Qin Hua
- Department of Gynecology, Obstetrics and Gyncology Hospital of Fudan University, Shanghai 200090, China
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Abstract
According to the Bethesda System for Reporting Thyroid Cytopathology (BSRTC), cyst fluid only (CFO) cases are classified in the non-diagnostic category. To date, no large study focusing on CFO has been conducted. To reassess the diagnostic significance of CFO, we compared CFO nodules with non-diagnostic nodules excluding CFO (ND-other). We reviewed the conventional thyroid smears of 715 CFO and 766 ND-other nodules. We compared the timing of and findings at re-aspiration, the histology of resected specimens, and the proportion of malignant nodules between the two groups. Re-aspiration was performed in 9.0% of CFO and 23.8% of ND-other cases. In 12.5% of CFO and 49.4% of ND-other cases, the interval between the first and second aspirations was <3 months. Despite this, there were no cases in which cytological interpretation was complicated by the first aspiration. Overall, 77 CFO nodules (10.8%) were surgically resected; 14 were malignant. In all cases in which re-aspiration cytology revealed malignancy, the initial ultrasound interpretation was a high or intermediate suspicion pattern. The proportion of malignancies subsequently diagnosed in nodules initially classified as CFO and ND-other was 2.0% and 5.6%, respectively (p<0.01). As CFO and ND-other thyroid nodules have different clinical management and malignancy rates, we would like to assert that CFO and ND-other nodules should be separated, and that the former should be considered diagnostic. In terms of clinical management, we recommend that only CFO cases with concerning features on ultrasound undergo re-aspiration.
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Affiliation(s)
- Nami Takada
- Department of Laboratory, Kuma Hospital, Kobe, Japan
| | | | - Ayana Suzuki
- Department of Laboratory, Kuma Hospital, Kobe, Japan
| | | | - Seiji Kuma
- Department of Diagnostic Pathology, Kuma Hospital, Kobe, Japan
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Jeong H, Hong SR, Chae SW, Jin SY, Yoon HK, Lee J, Kim EK, Ha ST, Kim SN, Park EJ, Jung JJ, Sung SH, Lim SC. Comparison of Unsatisfactory Samples from Conventional Smear versus Liquid-Based Cytology in Uterine Cervical Cancer Screening Test. J Pathol Transl Med 2017; 51:314-319. [PMID: 28415159 PMCID: PMC5445207 DOI: 10.4132/jptm.2017.03.17] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Revised: 03/09/2017] [Accepted: 03/14/2017] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Cervical cytology for uterine cervical cancer screening has transitioned from conventional smear (CS) to liquid-based cytology (LBC), which has many advantages. The aim of this study was to compare the proportion of unsatisfactory specimens from CS versus LBC at multiple institutions including general hospitals and commercial laboratories. METHODS Each participating institution provided a minimum of 500 Papanicolaou (Pap) test results for analysis. Pap tests were classified according to the participating institution (commercial laboratory or general hospital) and the processing method (CS, ThinPrep, SurePath, or CellPrep). The causes of unsatisfactory results were classified as technical problems, scant cellularity, or complete obscuring factors. RESULTS A total of 38,956 Pap test results from eight general hospitals and three commercial laboratories were analyzed. The mean unsatisfactory rate of LBC was significantly lower than that of CS (1.26% and 3.31%, p = .018). In the LBC method, samples from general hospitals had lower unsatisfactory rates than those from commercial laboratories (0.65% vs 2.89%, p = .006). The reasons for unsatisfactory results were heterogeneous in CS. On the other hand, 66.2% of unsatisfactory results in LBC were due to the scant cellularity. CONCLUSIONS Unsatisfactory rate of cervical cancer screening test results varies according to the institution and the processing method. LBC has a significantly lower unsatisfactory rate than CS.
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Affiliation(s)
- Hoiseon Jeong
- Department of Pathology, Korea University Ansan Hospital, Korea University College of Medicine, Seoul, Korea
| | - Sung Ran Hong
- Department of Pathology, Cheil General Hospital and Women’s Health Care Center, Dankook University College of Medicine, Seoul, Korea
| | - Seoung-Wan Chae
- Department of Pathology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - So-Young Jin
- Department of Pathology, Soonchunhyang University Hospital, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Hye Kyoung Yoon
- Department of Pathology, Inje University Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Juhie Lee
- Department of Pathology, Kyung Hee University School of Medicine, Seoul, Korea
| | - Eun Kyung Kim
- Department of Pathology, Eulji General Hospital, Seoul, Korea
| | - Sook Tai Ha
- T&C Diagnostic Pathology Clinic, Seoul, Korea
| | | | | | | | - Sun Hee Sung
- Department of Pathology, Ewha Womans University Mokdong Hospital, Ewha Womans University School of Medicine, Seoul, Korea
| | - Sung-chul Lim
- Department of Pathology, Chosun University School of Medicine, Gwangju, Korea
- Corresponding Author Sung-Chul Lim, MD, PhD Department of Pathology, Chosun University School of Medicine, 309 Pilmun-daero, Dong-gu, Gwangju 61452, Korea Tel: +82-62-230-6343 Fax: +82-62-226-5860 E-mail:
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Jeong H, Hong SR, Chae SW, Jin SY, Yoon HK, Lee J, Kim EK, Ha ST, Kim SN, Park EJ, Jung JJ, Sung SH, Lim SC. Comparison of Unsatisfactory Samples from Conventional Smear versus Liquid-Based Cytology in Uterine Cervical Cancer Screening Test. J Pathol Transl Med 2017. [PMID: 28415159 DOI: 10.4132/jptm.2017.03.17.] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Cervical cytology for uterine cervical cancer screening has transitioned from conventional smear (CS) to liquid-based cytology (LBC), which has many advantages. The aim of this study was to compare the proportion of unsatisfactory specimens from CS versus LBC at multiple institutions including general hospitals and commercial laboratories. METHODS Each participating institution provided a minimum of 500 Papanicolaou (Pap) test results for analysis. Pap tests were classified according to the participating institution (commercial laboratory or general hospital) and the processing method (CS, ThinPrep, SurePath, or CellPrep). The causes of unsatisfactory results were classified as technical problems, scant cellularity, or complete obscuring factors. RESULTS A total of 38,956 Pap test results from eight general hospitals and three commercial laboratories were analyzed. The mean unsatisfactory rate of LBC was significantly lower than that of CS (1.26% and 3.31%, p = .018). In the LBC method, samples from general hospitals had lower unsatisfactory rates than those from commercial laboratories (0.65% vs 2.89%, p = .006). The reasons for unsatisfactory results were heterogeneous in CS. On the other hand, 66.2% of unsatisfactory results in LBC were due to the scant cellularity. CONCLUSIONS Unsatisfactory rate of cervical cancer screening test results varies according to the institution and the processing method. LBC has a significantly lower unsatisfactory rate than CS.
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Affiliation(s)
- Hoiseon Jeong
- Department of Pathology, Korea University Ansan Hospital, Korea University College of Medicine, Seoul, Korea
| | - Sung Ran Hong
- Department of Pathology, Cheil General Hospital and Women's Health Care Center, Dankook University College of Medicine, Seoul, Korea
| | - Seoung-Wan Chae
- Department of Pathology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - So-Young Jin
- Department of Pathology, Soonchunhyang University Hospital, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Hye Kyoung Yoon
- Department of Pathology, Inje University Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Juhie Lee
- Department of Pathology, Kyung Hee University School of Medicine, Seoul, Korea
| | - Eun Kyung Kim
- Department of Pathology, Eulji General Hospital, Seoul, Korea
| | - Sook Tai Ha
- T&C Diagnostic Pathology Clinic, Seoul, Korea
| | | | | | | | - Sun Hee Sung
- Department of Pathology, Ewha Womans University Mokdong Hospital, Ewha Womans University School of Medicine, Seoul, Korea
| | - Sung-Chul Lim
- Department of Pathology, Chosun University School of Medicine, Gwangju, Korea
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Conrad R, Wentzensen N, Zhang RR, Wang S, Schiffman M, Gold M, Walker J, Zuna RE. Distribution of cell types differs in Papanicolaou tests of squamous cell carcinomas and adenocarcinomas. J Am Soc Cytopathol 2016; 6:10-15. [PMID: 31042628 DOI: 10.1016/j.jasc.2016.08.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Revised: 08/05/2016] [Accepted: 08/05/2016] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Successful cervical cancer screening has led to decreasing numbers of malignant Papanicolaou tests in most laboratories. A previous study demonstrated a greater trend to unsatisfactory Papanicolaou tests in women with squamous carcinoma when compared with adenocarcinoma cases. However, adenocarcinomas were less frequently recognized as malignant. MATERIALS AND METHODS In an effort to elucidate differences in Papanicolaou tests from these tumor types, the relative distribution of cells was blindly and semi-quantitatively assessed in ThinPrep Papanicolaou slides from 332 women with biopsy-proven squamous carcinoma (237 cases), adenocarcinoma (45), and noninvasive lesions (50). RESULTS Significant differences (P < 0.0001) among the three categories were observed in total cellularity, amount of blood and diathesis, normal endocervical cells, and normal squamous cells. When slides from squamous carcinomas and adenocarcinomas were compared, the amount of blood (P < 0.4) and presence of diathesis (P > 0.004) were more prominent in squamous carcinomas. The number of endocervical cells (P < 0.0001) was greater in adenocarcinomas, but adenocarcinomas were less likely to be recognized as malignant. CONCLUSIONS This systematic evaluation reinforces earlier suggestions that the presence of blood and tumor diathesis allow easier recognition of squamous carcinoma. A more detailed analysis of adenocarcinoma's cellular characteristics in Papanicolaou tests is needed to understand the reasons for undercalls in this tumor type.
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Affiliation(s)
- Rachel Conrad
- Department of Pathology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Nicolas Wentzensen
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Roy R Zhang
- Department of Pathology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Sophia Wang
- Department of Cancer Etiology, City of Hope, Beckman Institute, Duarte, California
| | - Mark Schiffman
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Michael Gold
- Department of Obstetrics and Gynecology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Joan Walker
- Department of Obstetrics and Gynecology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Rosemary E Zuna
- Department of Pathology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma.
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Cheriyan T, Harris B, Cheriyan J, Lafage V, Spivak JM, Bendo JA, Errico TJ, Goldstein JA. Association between compensation status and outcomes in spine surgery: a meta-analysis of 31 studies. Spine J 2015; 15:2564-73. [PMID: 26431997 DOI: 10.1016/j.spinee.2015.09.033] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2015] [Revised: 08/04/2015] [Accepted: 09/14/2015] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Numerous studies have demonstrated poorer outcomes in patients with Workers' compensation (WC) when compared with those without WC following treatment of various of health conditions, including spine disorders. It is thus important to consider compensation status when assessing treatment outcomes in spine surgery. However, reported strengths of association have varied significantly (1.31-7.22). PURPOSE The objective of this study was to evaluate the association of unsatisfactory outcomes on compensation status in spine surgery patients. STUDY DESIGN/SETTING A meta-analysis was performed. PATIENT SAMPLE Patient sample is not applicable in this study. OUTCOME MEASURE Demographics, type of surgery, country, follow-up time, patient satisfaction, return to work and non-union events were the outcome measures. METHODS Both prospective and retrospective studies that compared outcomes between compensated and non-compensated patients in spine surgery were included. Two independent investigators extracted outcome data. The meta-analysis was performed using Revman software. Random effects model was used to calculate risk ratio (RR, 95% confidence interval [CI]) for dichotomous variables. RESULTS Thirty-one studies (13 prospective; 18 retrospective) with a total of 3,567 patients were included in the analysis. Follow-up time varied from 4 months to 10 years. Twelve studies involved only decompression; the rest were fusion. Overall RR of an unsatisfactory outcome was 2.12 [1.74, 2.58; p<.001] in patients with WC when compared with those without WC after surgery. The RR of an unsatisfactory outcome in patients with WC, compared with those without, was 2.09 [1.38, 3.17]; p<.01 among studies from Europe and Australia, and 2.14 [1.48, 2.60]; p<.01 among US studies. The RR of decompression-only procedures was 2.53 [1.85, 3.47]; p<.01,and 1.79 [1.45, 2.21]; p<.01 for fusion. Forty-three percent (209 of 491) of patients with WC did not return to work versus 17% (214 of 1250) of those without WC (RR 2.07 [1.43, 2.98]; p<.001). Twenty-five percent (74 of 292) and 13.5% (39 of 287) of patients had non-union in the compensated and non-compensated groups, respectively. This was not statistically significant (RR 1.33 [0.92, 1.91]; p=.07). CONCLUSIONS Workers' compensation patients have a two-fold increased risk of an unsatisfactory outcome compared with non-compensated patients after surgery. This association was consistent when studies were grouped by country or procedure. Compensation status must be considered in all surgical intervention studies.
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Affiliation(s)
- Thomas Cheriyan
- Division of Spine Surgery, Hospital for Joint Diseases, New York Langone Medical Center, New York, NY 10003, USA.
| | - Bradley Harris
- Division of Spine Surgery, Hospital for Joint Diseases, New York Langone Medical Center, New York, NY 10003, USA
| | - Jerry Cheriyan
- Department of Surgery, Marshfield Clinic, 1000 North Oak Avenue, Marshfield, WI 54449, USA
| | - Virginie Lafage
- Division of Spine Surgery, Hospital for Joint Diseases, New York Langone Medical Center, New York, NY 10003, USA
| | - Jeffrey M Spivak
- Division of Spine Surgery, Hospital for Joint Diseases, New York Langone Medical Center, New York, NY 10003, USA
| | - John A Bendo
- Division of Spine Surgery, Hospital for Joint Diseases, New York Langone Medical Center, New York, NY 10003, USA
| | - Thomas J Errico
- Division of Spine Surgery, Hospital for Joint Diseases, New York Langone Medical Center, New York, NY 10003, USA
| | - Jeffrey A Goldstein
- Division of Spine Surgery, Hospital for Joint Diseases, New York Langone Medical Center, New York, NY 10003, USA
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