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Mahajan P, Kaur P. Improving cervical cancer classification in PAP smear images with enhanced segmentation and deep progressive learning-based techniques. Diagn Cytopathol 2024; 52:313-324. [PMID: 38516853 DOI: 10.1002/dc.25295] [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: 09/27/2023] [Revised: 02/09/2024] [Accepted: 02/20/2024] [Indexed: 03/23/2024]
Abstract
OBJECTIVE Cervical cancer, a prevalent and deadly disease among women, comes second only to breast cancer, with over 700 daily deaths. The Pap smear test is a widely utilized screening method for detecting cervical cancer in its early stages. However, this manual screening process is prone to a high rate of false-positive outcomes because of human errors. Researchers are using machine learning and deep learning in computer-aided diagnostic tools to address this issue. These tools automatically analyze and sort cervical cytology and colposcopy images, improving the precision of identifying various stages of cervical cancer. METHODOLOGY This article uses state-of-the-art deep learning methods, such as ResNet-50 for categorizing cervical cancer cells to assist medical professionals. The method includes three key steps: preprocessing, segmentation using k-means clustering, and classifying cancer cells. The model is assessed based on performance metrics viz; precision, accuracy, kappa score, precision, sensitivity, and specificity. In the end, the high success rate shows that the ResNet50 model is a valuable tool for timely detection of cervical cancer. OUTPUTS In conclusion, the infected cervical region is pinpointed using spatial K-means clustering and preprocessing operations. This sequence of actions is followed by a progressive learning technique. The Progressive Learning technique then proceeded through several stages: Stage 1 with 64 × 64 images, Stage 2 with 224 × 224 images, Stage 3 with 512 × 512 images, and the final Stage 4 with 1024 × 1024 images. The outcomes show that the suggested model is effective for analyzing Pap smear tests, achieving 97.4% accuracy and approx. 98% kappa score.
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Affiliation(s)
- Priyanka Mahajan
- Department of Computer Engineering and Technology, Guru Nanak Dev University, Amritsar, India
| | - Prabhpreet Kaur
- Department of Computer Engineering and Technology, Guru Nanak Dev University, Amritsar, India
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2
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Tan SL, Selvachandran G, Ding W, Paramesran R, Kotecha K. Cervical Cancer Classification From Pap Smear Images Using Deep Convolutional Neural Network Models. Interdiscip Sci 2024; 16:16-38. [PMID: 37962777 PMCID: PMC10881721 DOI: 10.1007/s12539-023-00589-5] [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: 04/26/2023] [Revised: 10/08/2023] [Accepted: 10/10/2023] [Indexed: 11/15/2023]
Abstract
As one of the most common female cancers, cervical cancer often develops years after a prolonged and reversible pre-cancerous stage. Traditional classification algorithms used for detection of cervical cancer often require cell segmentation and feature extraction techniques, while convolutional neural network (CNN) models demand a large dataset to mitigate over-fitting and poor generalization problems. To this end, this study aims to develop deep learning models for automated cervical cancer detection that do not rely on segmentation methods or custom features. Due to limited data availability, transfer learning was employed with pre-trained CNN models to directly operate on Pap smear images for a seven-class classification task. Thorough evaluation and comparison of 13 pre-trained deep CNN models were performed using the publicly available Herlev dataset and the Keras package in Google Collaboratory. In terms of accuracy and performance, DenseNet-201 is the best-performing model. The pre-trained CNN models studied in this paper produced good experimental results and required little computing time.
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Affiliation(s)
- Sher Lyn Tan
- Institute of Actuarial Science and Data Analytics, UCSI University, Jalan Menara Gading, Cheras, 56000, Kuala Lumpur, Malaysia
| | - Ganeshsree Selvachandran
- School of Business, Monash University Malaysia, Jalan Lagoon Selatan, Bandar Sunway, 47500, Subang Jaya, Malaysia.
- Symbiosis Institute of Technology, Symbiosis International University, Pune, 412115, Maharashtra, India.
| | - Weiping Ding
- School of Information Science and Technology, Nantong University, Nantong, 226019, China.
| | - Raveendran Paramesran
- School of Information Technology, Monash University Malaysia, Bandar Sunway, 47500, Subang Jaya, Malaysia
- Department of Electrical Engineering, Faculty of Engineering, University of Malaya, Kuala Lumpur, Malaysia
| | - Ketan Kotecha
- Symbiosis Centre for Applied Artificial Intelligence, Symbiosis International (Deemed University), Symbiosis Institute of Technology, Pune, 412115, India
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3
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Song Y, Zhang A, Zhou J, Luo Y, Lin Z, Zhou T. Overlapping cytoplasms segmentation via constrained multi-shape evolution for cervical cancer screening. Artif Intell Med 2024; 148:102756. [PMID: 38325933 DOI: 10.1016/j.artmed.2023.102756] [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: 06/13/2023] [Revised: 12/03/2023] [Accepted: 12/29/2023] [Indexed: 02/09/2024]
Abstract
Segmenting overlapping cytoplasms in cervical smear images is a clinically essential task for quantitatively measuring cell-level features to screen cervical cancer This task, however, remains rather challenging, mainly due to the deficiency of intensity (or color) information in the overlapping region Although shape prior-based models that compensate intensity deficiency by introducing prior shape information about cytoplasm are firmly established, they often yield visually implausible results, as they model shape priors only by limited shape hypotheses about cytoplasm, exploit cytoplasm-level shape priors alone, and impose no shape constraint on the resulting shape of the cytoplasm In this paper, we present an effective shape prior-based approach, called constrained multi-shape evolution, that segments all overlapping cytoplasms in the clump simultaneously by jointly evolving each cytoplasm's shape guided by the modeled shape priors We model local shape priors (cytoplasm-level) by an infinitely large shape hypothesis set which contains all possible shapes of the cytoplasm In the shape evolution, we compensate intensity deficiency for the segmentation by introducing not only the modeled local shape priors but also global shape priors (clump-level) modeled by considering mutual shape constraints of cytoplasms in the clump We also constrain the resulting shape in each evolution to be in the built shape hypothesis set for further reducing implausible segmentation results We evaluated the proposed method in two typical cervical smear datasets, and the extensive experimental results confirm its effectiveness.
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Affiliation(s)
- Youyi Song
- School of Biomedical Engineering, Shenzhen University, Shenzhen, 518060, China
| | - Ao Zhang
- School of Biomedical Engineering, Shenzhen University, Shenzhen, 518060, China
| | - Jinglin Zhou
- School of Philosophy, Fudan University, Shanghai, 200433, China
| | - Yu Luo
- School of Computer Science and Technology, Guangdong University of Technology, Guangzhou, 510006, China
| | - Zhizhe Lin
- School of Information and Communication Engineering, Hainan University, Haikou, 570228, China
| | - Teng Zhou
- School of Cyberspace Security, Hainan University, Haikou, 570228, China.
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4
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Okayama K, Kakinuma M, Teruya K, Oda M, Fujii M, Kimura H, Sasagawa T, Okodo M. Predictive Value of Various Atypical Cells for the Detection of Human Papillomavirus in Cervical Smears. Int J Mol Sci 2024; 25:1212. [PMID: 38279211 PMCID: PMC10816237 DOI: 10.3390/ijms25021212] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 01/17/2024] [Accepted: 01/17/2024] [Indexed: 01/28/2024] Open
Abstract
It is thought that numerous genotypes of human papillomavirus (HPV) are associated with various atypical cells, such as multinucleated cells, koilocytes, binucleated cells, parakeratotic cells, and giant cells, in the cervix. We previously showed the specificity of HPV genotypes for koilocytes and multinucleated cells. Therefore, in this study, we analyzed the association among HPV genotypes and binucleated cells, parakeratotic cells, and giant cells in Papanicolaou (Pap) smears. We detected HPV genotypes and atypical cells in 651 cases of liquid-based cytology with an abnormal Pap smear. The HPV genotypes associated with atypical cells were evaluated using stepwise logistic regression with backward elimination and a likelihood ratio test for model construction. Polymerase chain reaction was used to determine the HPV genotypes in whole liquid-based cytology samples and microdissected cell samples from Pap smear slides. Binucleated cells were significantly associated with HPV genotype 42. Moreover, parakeratotic cells were significantly associated with certain HPV genotypes, such as HPV40. However, it was difficult to detect specific HPV genotypes by the manual microdissection-polymerase chain reaction method despite the presence of binucleated cells and parakeratotic cells. Thus, the presence of binucleated cells, parakeratotic cells, and giant cells in Pap smears may not be predictive of cervical lesions above low-grade squamous intraepithelial lesions or infection with highly carcinogenic HPV genotypes.
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Affiliation(s)
- Kaori Okayama
- Department of Health Science, Gunma Paz University Graduate School of Health Sciences, 1-7-1 Tonyamachi, Takasaki-shi 370-0006, Gunma, Japan
| | - Mao Kakinuma
- Department of Health Science, Gunma Paz University Graduate School of Health Sciences, 1-7-1 Tonyamachi, Takasaki-shi 370-0006, Gunma, Japan
| | - Koji Teruya
- Department of Health and Welfare, Faculty of Health Sciences, Kyorin University, 5-4-1 Shimorenjaku, Mitaka-shi 181-8621, Tokyo, Japan
| | - Mizue Oda
- Genki Plaza Medical Center for Health Care, 3-6-5 Iidabashi, Chiyoda-ku 102-0072, Tokyo, Japan
| | - Masahiko Fujii
- Genki Plaza Medical Center for Health Care, 3-6-5 Iidabashi, Chiyoda-ku 102-0072, Tokyo, Japan
- Department of Medical Technology, Faculty of Health Sciences, Kyorin University, 5-4-1 Shimorenjaku, Mitaka-shi 181-8621, Tokyo, Japan
| | - Hirokazu Kimura
- Department of Health Science, Gunma Paz University Graduate School of Health Sciences, 1-7-1 Tonyamachi, Takasaki-shi 370-0006, Gunma, Japan
| | - Toshiyuki Sasagawa
- Department of Obstetrics and Gynecology, Kanazawa Medical University, 1-1 Uchinadadaigaku, Kahoku-gun 920-0293, Ishikawa, Japan
| | - Mitsuaki Okodo
- Department of Medical Technology, Faculty of Health Sciences, Kyorin University, 5-4-1 Shimorenjaku, Mitaka-shi 181-8621, Tokyo, Japan
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Harris E. Test Using Routine Pap Smears Could Diagnose Ovarian Cancer Early. JAMA 2024; 331:190. [PMID: 38150241 DOI: 10.1001/jama.2023.25767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2023]
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Goyal A, Booth CN, Souers RJ, Tabbara SO, Roberson J, Henry MR, Sundling KE, Goodrich K, Nguyen L. Navigating Practice Issues Related to the Unsatisfactory Cervicovaginal Papanicolaou Test: Survey Results of Laboratories Participating in the 2020 College of American Pathologists PAP Education Program. Arch Pathol Lab Med 2024; 148:48-54. [PMID: 37074866 DOI: 10.5858/arpa.2022-0330-cp] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/01/2023] [Indexed: 04/20/2023]
Abstract
CONTEXT.— Unsatisfactory Papanicolaou (Pap) tests pose a unique set of challenges to the laboratory with regard to their processing, review, reporting, and performance of human papillomavirus (HPV) testing. There are no standardized guidelines for the review process and handling of unsatisfactory Pap tests. OBJECTIVE.— To assess the current practice patterns regarding various aspects of the unsatisfactory Pap test, from processing to reporting, across laboratories worldwide. DESIGN.— A supplemental questionnaire was mailed to laboratories participating in the 2020 College of American Pathologists (CAP) Gynecologic Cytopathology (PAP Education) Program, requesting data regarding the unsatisfactory Pap test. RESULTS.— Of 1520 participating laboratories, 619 (40.7%) responded, and the responses of 577 laboratories were included for further analysis. Only 64.6% (373 of 577) laboratories used the unsatisfactory Pap test criteria as specified by the 2014 Bethesda System. About three-quarters of the respondents (433 of 576; 75.2%) routinely rescreened unsatisfactory Pap tests. Routine repreparation of such Pap tests was performed by 54.9% (316 of 576) of laboratories, and 52.0% (293 of 563) used glacial acetic acid for repreparing excessively bloody specimens. HPV test results were reported for unsatisfactory Pap tests, always or sometimes, by 62.4% (353 of 566) of respondents. CONCLUSIONS.— This CAP survey reveals important information regarding the practice patterns pertaining to several aspects of the unsatisfactory Pap test. It also provides valuable insight into the quality assurance measures that can be implemented for such tests. Future studies can further aid in the standardization of all components of the handling of unsatisfactory Pap tests for overall quality improvement.
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Affiliation(s)
- Abha Goyal
- From the Department of Pathology and Laboratory Medicine, Weill Cornell Medicine/New York-Presbyterian Hospital, New York, New York (Goyal)
| | - Christine N Booth
- the Department of Pathology, Cleveland Clinic, Cleveland, Ohio (Booth)
| | - Rhona J Souers
- the Departments of Biostatistics (Souers) and Proficiency Testing (Goodrich), College of American Pathologists, Northfield, Illinois
| | - Sana O Tabbara
- the Department of Pathology, H. Lee Moffitt Cancer Center, Tampa, Florida (Tabbara)
| | - Janie Roberson
- the Department of Pathology, University of Alabama Birmingham Hospital, Birmingham (Roberson)
| | - Michael R Henry
- the Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota (Henry)
| | - Kaitlin E Sundling
- the Department of Pathology and Laboratory Medicine, Wisconsin State Laboratory of Hygiene and University of Wisconsin, Madison (Sundling)
| | - Kelly Goodrich
- the Departments of Biostatistics (Souers) and Proficiency Testing (Goodrich), College of American Pathologists, Northfield, Illinois
| | - Lananh Nguyen
- the Department of Laboratory Medicine & Pathobiology, University of Toronto, Toronto, Ontario, Canada (Nguyen)
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Gupta R, Kumar N, Bansal S, Singh S, Sood N, Gupta S. Artificial Intelligence-driven Digital Cytology-based Cervical Cancer Screening: Is the Time Ripe to Adopt This Disruptive Technology in Resource-constrained Settings? A Literature Review. J Digit Imaging 2023; 36:1643-1652. [PMID: 37029285 PMCID: PMC10406989 DOI: 10.1007/s10278-023-00821-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 11/28/2022] [Revised: 03/22/2023] [Accepted: 03/27/2023] [Indexed: 04/09/2023] Open
Abstract
Cervical cancer is still a public health scourge in the developing countries due to the lack of organized screening programs. Though liquid-based cytology methods improved the performance of cervical cytology, the interpretation still suffers from subjectivity. Artificial intelligence (AI) algorithms have offered objectivity leading to better sensitivity and specificity of cervical cancer screening. Whole slide imaging (WSI) that converts a glass slide to a virtual slide provides a new perspective to the application of AI, especially for cervical cytology. In the recent years, there have been a few studies employing various AI algorithms on WSI images of conventional or LBC smears and demonstrating differing sensitivity/specificity or accuracy at detection of abnormalities in cervical smears. Considering the interest in AI-based screening modalities, this well-timed review intends to summarize the progress in this field while highlighting the research gaps and providing future research directions.
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Affiliation(s)
- Ruchika Gupta
- Division of Cytopathology, ICMR-National Institute of Cancer Prevention and Research, I-7, Sector-39, Noida, 201301, India
| | - Neeta Kumar
- Department of General Pathology, Faculty of Dentistry, Jamia Millia Islamia Central University, New Delhi, India
| | - Shivani Bansal
- Division of Cytopathology, ICMR-National Institute of Cancer Prevention and Research, I-7, Sector-39, Noida, 201301, India
| | - Sompal Singh
- Department of Pathology, Hindu Rao Hospital and North Delhi Medical College, Delhi, India
| | - Neelam Sood
- Department of Laboratory Medicine, Deen Dayal Upadhyay Hospital, New Delhi, India
| | - Sanjay Gupta
- Division of Cytopathology, ICMR-National Institute of Cancer Prevention and Research, I-7, Sector-39, Noida, 201301, India.
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Chen F, Hsu Lin L, Hindi I, Sun W, Shafizadeh N, Szeto O, Brandler TC, Simsir A. HPV Cotesting of Unsatisfactory Papanicolaou Tests: Implications for Follow-up Intervals. Am J Clin Pathol 2023; 160:137-143. [PMID: 37052613 DOI: 10.1093/ajcp/aqad026] [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: 11/11/2022] [Accepted: 02/16/2023] [Indexed: 04/14/2023] Open
Abstract
OBJECTIVES The 2019 American Society of Colposcopy and Cervical Pathology management guidelines recommend that patients with an unsatisfactory Papanicolaou (Pap) test (UPT) and negative human papillomavirus (HPV) cotest undergo repeat age-based screening in 2 to 4 months. The rationale is that a negative HPV test in the setting of an UPT may reflect an inadequate sample and therefore should not be interpreted as truly "negative." For patients 25 years and older who are cotested, if HPV is positive for the 16 or 18 genotypes, direct referral for colposcopy is recommended. Our study aimed to determine if a negative HPV cotest result is predictive of the absence of a high-grade squamous intraepithelial lesion (HSIL) and whether these patients may be called back for repeat testing at an interval longer than 2 to 4 months. METHODS Follow-up cervical cytology and biopsy results in women with UPT and HPV cotests from January 2017 to December 2021 were collected. Original UPT and HPV cotest results were correlated with the follow-up Pap and biopsy results. RESULTS There were 1,496 (2.28%) UPT cases out of 65,641 total Pap tests. Among the 1,496 UPT cases, 1,010 (67.5%) had HPV cotesting; 676 (45.1%) were followed by repeat Pap or biopsy within 4 months and 850 (56.8%) within 12 months. The total follow-up rate was 81%, with a range of 3 days to 36 months. The HSIL rate in HPV-positive cases was 5.7% (3/53) vs 0.4% (2/539) (P = .006) in HPV-negative cases. In UPT, HPV cotesting showed negative predictive values for low-grade and high-grade squamous intraepithelial lesion detection of 98.5% and 99.6%, respectively, while positive predictive values were 19% and 5.7%. CONCLUSIONS A negative HPV cotest in individuals with UPT predicted the lack of HSIL in our study. Compliance with the recommended follow-up time of 2 to 4 months for women with UPT was low (45.1%). Our study suggests that women with UPT and negative HPV cotest may be safely called back at an interval longer than 4 months.
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Affiliation(s)
- Fei Chen
- Department of Pathology, NYU Langone Health, New York, NY, US
| | | | - Issa Hindi
- Department of Pathology, NYU Langone Health, New York, NY, US
| | - Wei Sun
- Department of Pathology, NYU Langone Health, New York, NY, US
| | | | - Oliver Szeto
- Department of Pathology, NYU Langone Health, New York, NY, US
| | | | - Aylin Simsir
- Department of Pathology, NYU Langone Health, New York, NY, US
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Tolosko JA, Beauchesne M, Rancatore E. Knowledge, attitudes, and practice of the Pap smear test in female college students attending a global university in the United States. J Am Assoc Nurse Pract 2023; 35:322-329. [PMID: 36862575 DOI: 10.1097/jxx.0000000000000846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 01/23/2023] [Indexed: 03/03/2023]
Abstract
BACKGROUND According to the World Health Organization, every minute, one woman is diagnosed with cervical cancer, and every 2 minutes, one woman dies of cervical cancer globally (World Health Organization, 2022). The biggest tragedy is 99% of cervical cancer is caused by a preventable sexually transmitted infection known as human papilloma virus (World Health Organization, 2022). LOCAL PROBLEM Many US universities indicate approximately 30% of their admissions are international students. The lack of Pap smear screening in this population has not been clearly identified by college health care providers. METHODS Fifty-one participants from a university located in the northeastern United States completed an online survey between September and October 2018. The survey was designed to identify disparities between United States residents and internationally admitted female students in their knowledge, attitudes, and practice of the Pap smear test. INTERVENTIONS One hundred percent of US students had heard of the Pap smear test as compared with 72.7% of international students ( p = .008); 86.8% of US students considered a Pap smear as opposed to 45.5% of international students ( p = .002), and 65.8% of US students previously had a Pap smear test as opposed to 18.8% of international students ( p = .007). RESULTS Results revealed statistically significant differences between US and internationally admitted female college students in knowledge, attitudes, and practice of the Pap smear test. CONCLUSIONS This project helps to bring awareness to college health clinicians the need for cervical cancer education and Pap smear screening for our college age international female population.
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Affiliation(s)
| | | | - Elaine Rancatore
- University Health Services at Northeastern University, Boston, MA
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10
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Özbay E, Özbay FA. Interpretable pap-smear image retrieval for cervical cancer detection with rotation invariance mask generation deep hashing. Comput Biol Med 2023; 154:106574. [PMID: 36738706 DOI: 10.1016/j.compbiomed.2023.106574] [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: 09/25/2022] [Revised: 01/10/2023] [Accepted: 01/22/2023] [Indexed: 01/24/2023]
Abstract
Cervical cancer is a common disease in women, affecting their lives negatively and often resulting in death. Pap-smear tests are preferred by doctors as the primary tool in the early diagnosis and treatment of the disease. Physicians can be facilitated in the detection of five different categories of cervical cancer and similar cellular disease cases with the Pap-smear image retrieval technology. In this study, an algorithm for retrieval of cervical cancer images using hash coding with a Convolutional Neural Network (CNN) has been implemented. A sensitive deep hashing method combining interpretable mask generation and rotation invariance is proposed for cervical cancer detection. The distinctive features of cervical cancer cells with complex morphological features are focused on with the proposed hybrid dilated convolution spatial attention module and insignificant features are eliminated. Moreover, the loss function of Cauchy rotation invariance in terms of cervical cancer cell target is presented. In this way, the differences in the input samples are revealed, allowing the CNN to learn from different angles and achieve certain rotation invariance. The versatility and performance of the proposed method, as well as the efficiency of the loss function, have been tested on the SIPaKMeD and Mendeley LBC datasets consisting of cervical cancer images. In the experimental results obtained, it is shown that the proposed spatial attention module and rotational invariance deep hashing network generate high performance in cervical cancer image retrieval problems.
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Affiliation(s)
- Erdal Özbay
- Firat University, Faculty of Engineering, Computer Engineering, 23119, Elazig, Turkey.
| | - Feyza Altunbey Özbay
- Firat University, Faculty of Engineering, Software Engineering, 23119, Elazig, Turkey.
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11
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Zhu P, Tatar O, Haward B, Griffin-Mathieu G, Perez S, Smith L, Brotherton J, Ogilvie G, Rosberger Z. Assessing Canadian women's preferences for cervical cancer screening: A brief report. Front Public Health 2022; 10:962039. [PMID: 35968487 PMCID: PMC9366717 DOI: 10.3389/fpubh.2022.962039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2022] [Accepted: 07/04/2022] [Indexed: 11/25/2022] Open
Abstract
Human papillomavirus (HPV) testing is recommended for primary screening for cervical cancer by several health authorities. Several countries that have implemented HPV testing programs have encountered resistance against extended screening intervals and older age of initiation. As Canada prepares to implement HPV testing programs, it is important to understand women's preferences toward cervical cancer screening to ensure a smooth transition. The objective of this study was to assess Canadian women's current preferences toward cervical cancer screening. Using a web-based survey, we recruited underscreened ( > 3 years since last Pap test) and adequately screened (< 3 years since last Pap test) Canadian women aged 21–70 who were biologically female and had a cervix. We used Best-Worst Scaling (BWS) methodology to collect data on women's preferences for different screening methods, screening intervals, and ages of initiation. We used conditional logistic regression to estimate preferences in both subgroups. In both subgroups, women preferred screening every three years compared to every five or ten years, and initiating screening at age 21 compared to age 25 or 30. Adequately screened women (n = 503) most preferred co-testing, while underscreened women (n = 524) preferred both co-testing and HPV self-sampling over Pap testing. Regardless of screening status, women preferred shorter screening intervals, an earlier age of initiation, and co-testing. Adequate communication from public health authorities is needed to explain the extended screening intervals and age of initiation to prevent resistance against these changes to cervical cancer screening.
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Affiliation(s)
- Patricia Zhu
- Lady Davis Institute for Medical Research, Jewish General Hospital, McGill University, Montreal, QC, Canada
- Department of Psychiatry, McGill University, Montreal, QC, Canada
| | - Ovidiu Tatar
- Lady Davis Institute for Medical Research, Jewish General Hospital, McGill University, Montreal, QC, Canada
- Research Center, Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, QC, Canada
- *Correspondence: Ovidiu Tatar
| | - Ben Haward
- Lady Davis Institute for Medical Research, Jewish General Hospital, McGill University, Montreal, QC, Canada
| | - Gabrielle Griffin-Mathieu
- Lady Davis Institute for Medical Research, Jewish General Hospital, McGill University, Montreal, QC, Canada
| | - Samara Perez
- Lady Davis Institute for Medical Research, Jewish General Hospital, McGill University, Montreal, QC, Canada
- Cedars Cancer Center, McGill University Health Center, Montreal, QC, Canada
| | - Laurie Smith
- BC Women's Hospital, Women's Health Research Institute, Vancouver, BC, Canada
| | - Julia Brotherton
- Melbourne School of Population and Global Health, University of Melbourne, Carlton, VIC, Australia
- Australian Centre for the Prevention of Cervical Cancer, East Melbourne, VIC, Australia
| | - Gina Ogilvie
- BC Women's Hospital, Women's Health Research Institute, Vancouver, BC, Canada
| | - Zeev Rosberger
- Lady Davis Institute for Medical Research, Jewish General Hospital, McGill University, Montreal, QC, Canada
- Department of Psychiatry, McGill University, Montreal, QC, Canada
- Departments of Psychology and Oncology, McGill University, Montreal, QC, Canada
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Kupas D, Harangi B. Classification of Pap-smear cell images using deep convolutional neural network accelerated by hand-crafted features. Annu Int Conf IEEE Eng Med Biol Soc 2022; 2022:1452-1455. [PMID: 36083935 DOI: 10.1109/embc48229.2022.9871171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
The classification of cells extracted from Pap-smears is in most cases done using neural network architectures. Nevertheless, the importance of features extracted with digital image processing is also discussed in many related articles. Decision support systems and automated analysis tools of Pap-smears often use these kinds of manually extracted, global features based on clinical expert opinion. In this paper, a solution is introduced where 29 different contextual features are combined with local features learned by a neural network so that it increases classification performance. The weight distribution between the features is also investigated leading to a conclusion that the numerical features are indeed forming an important part of the learning process. Furthermore, extensive testing of the presented methods is done using a dataset annotated by clinical experts. An increase of 3.2% in F1-Score value can be observed when using the combination of contextual and local features. Clinical Relevance - Analysis of images extracted from digital Pap-test using modern machine learning tools is discussed in many scientific papers. The manual classification of the cells can be time-consuming and expensive which requires a high amount of manual labor. Furthermore the result of the manual classification can also be uncertain due to interobserver variability. Considering these, any result that can lead to a more reliable highly accurate classification method is considered valuable in the field of cervical cancer screening.
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Shinde S, Kalbhor M, Wajire P. DeepCyto: a hybrid framework for cervical cancer classification by using deep feature fusion of cytology images. Math Biosci Eng 2022; 19:6415-6434. [PMID: 35730264 DOI: 10.3934/mbe.2022301] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Cervical cancer is the second most commonly seen cancer in women. It affects the cervix portion of the vagina. The most preferred diagnostic test required for screening cervical cancer is the pap smear test. Pap smear is a time-consuming test as it requires detailed analysis by expert cytologists. Cytologists can screen around 100 to 1000 slides depending upon the availability of advanced equipment. Due to this reason Artificial intelligence (AI) based computer-aided diagnosis system for the classification of pap smear images is needed. There are some AI-based solutions proposed in the literature, still an effective and accurate system is under research. In this paper, the deep learning-based hybrid methodology namely DeepCyto is proposed for the classification of pap smear cytology images. The DeepCyto extracts the feature fusion vectors from pre-trained models and passes these to two workflows. Workflow-1 applies principal component analysis and machine learning ensemble to classify the pap smear images. Workflow-2 takes feature fusion vectors as an input and applies an artificial neural network for classification. The experiments are performed on three benchmark datasets namely Herlev, SipakMed, and LBCs. The performance measures of accuracy, precision, recall and F1-score are used to evaluate the effectiveness of the DeepCyto. The experimental results depict that Workflow-2 has given the best performance on all three datasets even with a smaller number of epochs. Also, the performance of the DeepCyto Workflow 2 on multi-cell images of LBCs is better compared to single cell images of other datasets. Thus, DeepCyto is an efficient method for accurate feature extraction as well as pap smear image classification.
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Affiliation(s)
- Swati Shinde
- Department of Computer Engineering, Pimpri Chinchwad College of Engineering, Pune, Maharashtra, India
| | - Madhura Kalbhor
- Department of Computer Engineering, Pimpri Chinchwad College of Engineering, Pune, Maharashtra, India
| | - Pankaj Wajire
- Department of Computer Engineering, Pimpri Chinchwad College of Engineering, Pune, Maharashtra, India
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Beltrán-Guerrero LJ, García-Valdez R, Andrade-Amador V, Vázquez-Argüelles L, Félix-Alvarez CA, Alvarez-Villaseñor AS. [Comparison of the Pap smear with conventional technique versus modified technique]. Rev Med Inst Mex Seguro Soc 2022; 60:164-170. [PMID: 35759446 PMCID: PMC10395926] [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] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 01/05/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Despite the fact that the Papanicolaou technique is the most effective method of prevention and detection of cervical cancer, the precision of this tool remains controversial; Because of this, there are medical and scientific efforts to improve the quality of the procedure. OBJECTIVE Compare the quality of sampling between the conventional and modified technique. MATERIAL AND METHODS Descriptive and comparative observational study in 150 cervical cytology samples (75 conventional technique samples and 75 in modified technique) in women aged 25 to 64 years. Demographic variables, characteristics of the cervix and quality of the sample were analyzed. Descriptive statistics and association measures were performed. Study with risk greater than the minimum. All participants signed an informed consent. RESULTS The quality of the sample was satisfactory in 92.0% for the conventional technique vs 89.3% for the modified technique. The main cause of unsatisfactory samples was insufficient cellularity 6.7% in conventional technique vs 12% of the modified technique, with no significant difference between both techniques p = 0.575 (1.37; 0.45-4.1), findings that reject the working hypothesis. CONCLUSIONS There was no significant difference when using both tests, the samples with satisfactory quality were similar between both techniques.
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Affiliation(s)
- Laura Janeth Beltrán-Guerrero
- Instituto Mexicano del Seguro Social, Hospital General de Zona con Medicina Familiar No. 1, Servicio de Medicina Familiar. La Paz, Baja California Sur, México
| | - Ruth García-Valdez
- Instituto Mexicano del Seguro Social, Hospital General de Zona con Medicina Familiar No. 1, Servicio de Medicina Preventiva. La Paz, Baja California Sur, México
| | - Verónica Andrade-Amador
- Instituto Mexicano del Seguro Social, Hospital General de Zona con Medicina Familiar No. 1, Servicio de Colposcopía. La Paz, Baja California Sur, México
| | - Leticia Vázquez-Argüelles
- Instituto Mexicano del Seguro Social, Hospital General de Zona con Medicina Familiar No. 1, Servicio de Colposcopía. La Paz, Baja California Sur, México
| | - Carlos Alberto Félix-Alvarez
- Instituto Mexicano del Seguro Social, Coordinación de Educación en Salud, Centro de Investigación Educativa y Formación Docente. Ciudad Obregón, Sonora, México
| | - Andrea Socorro Alvarez-Villaseñor
- Instituto Mexicano del Seguro Social, Coordinación Auxiliar Médica de Investigación, Servicio de Colposcopía. La Paz, Baja California Sur, México
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Kamble SA, Dombale VD, Shah F. Merits and pitfalls of normal saline rehydrated air-dried cervical smears over conventional wet.fixed PAP smears: A comparative study. INDIAN J PATHOL MICR 2022; 65:100-104. [PMID: 35074972 DOI: 10.4103/ijpm.ijpm_1214_20] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023] Open
Abstract
BACKGROUND Cervical Papanicolaou (PAP) smear is the simplest, minimal invasive, and excellent screening method to reduce the female morbidity and mortality due to cervical carcinoma. Immediate alcohol fixation of the cervical smears is required to preserve nuclear details, delay in alcohol fixation leads to air drying artifacts. Rehydrating of the air-dried cervical pap smear with normal saline can help to overcome these artifacts and also have its own advantages. AIMS This study was design to evaluate the effects, merits and pitfalls of normal saline Rehydrated Air-Dried Cervical PAP Smears (RADPS) compared with the Conventional Papanicolaou Smear (C-PAPS). SETTINGS AND DESIGN Comparative study. METHODS AND MATERIAL Prospectively paired cervical smears of 100 women, who presented to the outpatient department of gynecology of our institute, were prepared. Alcohol fixed smears were labelled as conventional Papanicolaou smear (C-PAPS) and air-dried smears labelled as rehydrated air-dried PAP smears (RADPS). Eight cytomorphological parameters were considered for comparison and analyzed. STATISTICAL ANALYSIS USED Chisquare (χ2)/Fisher exact test. RESULTS Clear background with red blood cells (RBC) lysis was noted in 93% of RADPS and 54% of C-PAPS. Cytolysis was observed more in C-PAPS (18%) than in RADPS (08%). Air-drying artifacts observed in 30% of C-PAPS and 08% of RADPS. Cytoplasmic staining (92% of RADPS and 85% of C-PAPS) was superior in RADPS. Cell border, nuclear chromatin, and border were also better appreciated on RADPS as compared to C-PAPS. Statistically significant difference was observed with 3 parameters, i.e., air-drying artifacts, RBC background, and distinct cell borders. CONCLUSION Rehydration of air-dried smears can be adopted in regular practice, as an alternative or coupled with conventional wet fixation method to overcome the commonly faced problems of air-drying artifacts, especially in rural screening programs.
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Affiliation(s)
- Shilpa A Kamble
- Department of Pathology, B.K.L. Walawalkar Medical College and Hospital, Dervan, Chiplun, Ratnagiri, Maharashtra, India
| | - Vijay D Dombale
- Department of Pathology, B.K.L. Walawalkar Medical College and Hospital, Dervan, Chiplun, Ratnagiri, Maharashtra, India
| | - Forum Shah
- Department of Pathology, B.K.L. Walawalkar Medical College and Hospital, Dervan, Chiplun, Ratnagiri, Maharashtra, India
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Issa T, Babi A, Issanov A, Akilzhanova A, Nurgaliyeva K, Abugalieva Z, Azizan A, Khan SA, Chan CK, Alibekova R, Aimagambetova G. Knowledge and awareness of human papillomavirus infection and human papillomavirus vaccine among Kazakhstani women attending gynecological clinics. PLoS One 2021; 16:e0261203. [PMID: 34898639 PMCID: PMC8668105 DOI: 10.1371/journal.pone.0261203] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 11/26/2021] [Indexed: 11/19/2022] Open
Abstract
Cervical cancer remains one of the top causes of cancer-related morbidity and mortality all over the world. Currently, however, there are no published studies to assess the knowledge of HPV and cervical cancer in Kazakhstan. This study aimed to assess the awareness of HPV, the knowledge of HPV as a cause of cervical cancer, and the awareness of HPV vaccination among Kazakhstani women visiting gynecological clinics across the country. In addition, the study aimed to identify the factors associated with the awareness of HPV and the HPV vaccine and knowledge of HPV as a major cause of cervical cancer. This was a cross-sectional survey-based study with 2,272 women aged between 18–70 years attending gynecological clinics, who were administered paper-based questionnaires. Data analysis included descriptive statistics consisting of mean values, standard deviations, and frequencies, where applicable. Differences in categorical variables between groups were analyzed using the Chi-square test with a significance value of <0.005. Crude odds ratio (OR) and adjusted odds ratio (AOR) with 95% corresponding confidence intervals were calculated in regression analysis using univariate and multivariable logistic regression models. The mean age of participants was 36.33±10.09 years. More than half (53%) of the participants had been screened for cervical cancer. Among those who were aware of HPV, 46% knew that HPV causes cervical cancer and 52% were aware of the HPV vaccine. The key factors related to outcome variables were age, ethnicity, education, family, number of deliveries, and menarche. From a subgroup analysis, results from the HPV test and Pap smear test were factors related to dependent variables such as awareness of HPV and awareness of HPV vaccination.
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Affiliation(s)
- Torgyn Issa
- Department of Biomedical Sciences, School of Medicine, Nazarbayev University, Nur-Sultan, Kazakhstan
| | - Aisha Babi
- Department of Biomedical Sciences, School of Medicine, Nazarbayev University, Nur-Sultan, Kazakhstan
| | - Alpamys Issanov
- Department of Medicine, School of Medicine, Nazarbayev University, Nur-Sultan, Kazakhstan
| | - Ainur Akilzhanova
- Laboratory of Genomic and Personalized Medicine, Center for Life Sciences, National Laboratory Astana, Nazarbayev University, Nur-Sultan, Kazakhstan
| | - Kadisha Nurgaliyeva
- Republican Diagnostic Center, University Medical Center, Nur-Sultan, Kazakhstan
| | - Zauresh Abugalieva
- Republican Diagnostic Center, University Medical Center, Nur-Sultan, Kazakhstan
| | - Azliyati Azizan
- Department of Biomedical Sciences, School of Medicine, Nazarbayev University, Nur-Sultan, Kazakhstan
- College of Osteopathic Medicine, Touro University Nevada, Henderson, Nevada, United States of America
| | - Saleem A. Khan
- Department of Microbiology and Molecular Genetics, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
| | - Chee Kai Chan
- Department of Biomedical Sciences, School of Medicine, Nazarbayev University, Nur-Sultan, Kazakhstan
- College of Science and Technology, Wenzhou-Kean University, Wenzhou, China
| | - Raushan Alibekova
- Department of Medicine, School of Medicine, Nazarbayev University, Nur-Sultan, Kazakhstan
| | - Gulzhanat Aimagambetova
- Department of Biomedical Sciences, School of Medicine, Nazarbayev University, Nur-Sultan, Kazakhstan
- * E-mail:
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Plummer RM, Kelting S, Madan R, O'Neil M, Dennis K, Fan F. Cervical Papanicolaou tests in the female-to-male transgender population: should the adequacy criteria be revised in this population? An Institutional Experience. J Am Soc Cytopathol 2021; 10:255-260. [PMID: 33736951 DOI: 10.1016/j.jasc.2021.01.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [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: 12/19/2020] [Revised: 01/20/2021] [Accepted: 01/22/2021] [Indexed: 11/18/2022]
Abstract
INTRODUCTION It is recommended that female-to-male (FTM) transgender patients with a cervix follow the same cervical cancer screening guidelines as cisgender women. This study analyzes Papanicolaou tests, HPV results, and follow-up histology in FTM patients, and compares those results to other atrophic populations at our institution. MATERIALS AND METHODS A cohort of FTM patients receiving androgen therapy was identified through our institution's translational research database. We collected data on Papanicolaou tests, human papillomavirus (HPV) results, follow-up surgical procedures, and duration of androgen therapy. ThinPrep slides were reviewed for cellularity and cytomorphology. The results of these tests were compared with those of an atrophic control group consisting of postpartum and postmenopausal cisgender women. RESULTS We identified 71 FTM patients with 77 Papanicolaou tests collected over 6 years. Papanicolaou interpretations included: negative for intraepithelial lesion (69%), atypical cells of undermined significance (5%), low grade squamous intraepithelial lesion (1%), atypical glandular cells (1%), and unsatisfactory due to inadequate cellularity (23%). Five of 27 (18.5%) HPV tests were positive. Follow-up surgical specimens did not identify high-grade lesions. Unsatisfactory rates among FTM patients differed significantly from the atrophic group (P < 0.05), while epithelial abnormality rates and HPV positivity did not (P > 0.05). Most FTM Papanicolaou tests reviewed showed features of atrophy. CONCLUSIONS FTM patients receiving androgen have high Papanicolaou test unsatisfactory rates secondary to atrophy. Epithelial abnormality and HPV rates do not differ significantly from atrophic cisgender patients. Lowering the cellularity threshold for this population to 2000 like that of other atrophic groups should be considered.
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Affiliation(s)
- Regina M Plummer
- Department of Pathology and Laboratory Medicine, University of Kansas Medical Center, Kansas City, Kansas
| | - Sarah Kelting
- Department of Pathology and Laboratory Medicine, University of Kansas Medical Center, Kansas City, Kansas
| | - Rashna Madan
- Department of Pathology and Laboratory Medicine, University of Kansas Medical Center, Kansas City, Kansas
| | - Maura O'Neil
- Department of Pathology and Laboratory Medicine, University of Kansas Medical Center, Kansas City, Kansas
| | - Katie Dennis
- Department of Pathology and Laboratory Medicine, University of Kansas Medical Center, Kansas City, Kansas
| | - Fang Fan
- Department of Pathology and Laboratory Medicine, University of Kansas Medical Center, Kansas City, Kansas.
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Schwock J, Starova B, Khan ZF, Mirkovic J, Parra-Herran C, Ko HM, Rouzbahman M, Ghorab Z. Cytomorphologic Features of Gastric-Type Endocervical Adenocarcinoma in Liquid-Based Preparations. Acta Cytol 2020; 65:56-66. [PMID: 33152741 DOI: 10.1159/000511003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 07/14/2020] [Accepted: 08/17/2020] [Indexed: 01/25/2023]
Abstract
OBJECTIVE Gastric-type endocervical adenocarcinoma (GAS) is a recently described, uncommon, and aggressive tumor with distinct morphologic features and HPV-independent etiology. Data on GAS in liquid-based cytology (LBC) Papanicolaou (Pap) test preparations from a North American patient population are scant. We systematically assessed the cytomorphologic characteristics of GAS in LBC from patients in Ontario and examined if glandular cell nuclear area could represent a readily assessable feature which may aid in GAS detection. STUDY DESIGN Pap test slides preceding the diagnosis of GAS were retrieved locally or requested from outside laboratories. A structured review of 15 cytomorphologic features was performed using the available LBC Pap test slides of GAS and a set of usual-type endocervical adenocarcinomas (UEA). Morphometry of the glandular cell nuclear area was performed, and normalized values were compared to UEA and benign endocervical cells. RESULTS At least 1 Pap test (5 ThinPrep®, 11 SurePath®, and 1 direct smear) was available for 14 patients. Original LBC Pap test diagnoses were negative for intraepithelial lesion or malignancy (NILM) (7), adenocarcinoma/carcinoma (6), atypical glandular cells (2), and adenocarcinoma in situ (1). Review detected abnormal glandular cells in 6/7 NILM cases. Honeycomb-like sheets, nuclear enlargement, and microvesicular cytoplasm were the single most common architectural, nuclear, and cytoplasmic features, respectively. Microvesicular cytoplasm (100 vs. 17%), honeycomb-like sheets (87 vs. 8%), prominent nucleoli (93 vs. 25%), and anisonucleosis (93 vs. 50%) were most discriminatory for GAS versus UEA, respectively. Yellow mucin, intranuclear cytoplasmic pseudoinclusions, and goblet/Paneth-like cells were uncommon, but unique for GAS. Glandular cell nuclear area normalized to neutrophils was found to be significantly increased in GAS compared to benign endocervical cells. CONCLUSIONS GAS is under-recognized and may mimic reactive endocervical cells. Awareness of the tumor type and its cytomorphology is critical for early detection. Identification of glandular cells with uniform nuclear enlargement in conjunction with any of the other cytologic features may help avoid false-negative Pap results. Neutrophils may serve as convenient size reference and visual aid.
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Affiliation(s)
- Joerg Schwock
- Division of Pathology, University Health Network, Toronto, Ontario, Canada,
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada,
| | - Blerta Starova
- Department of Laboratory Medicine, William Osler Health System, Brampton, Ontario, Canada
| | - Zanobia F Khan
- Department of Pathology, Lakeridge Health, Oshawa, Ontario, Canada
| | - Jelena Mirkovic
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
- Department of Pathology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Carlos Parra-Herran
- Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Hyang Mi Ko
- Division of Pathology, University Health Network, Toronto, Ontario, Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | - Marjan Rouzbahman
- Division of Pathology, University Health Network, Toronto, Ontario, Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | - Zeina Ghorab
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
- Department of Pathology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
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Urrea Cosme Y, Córdoba Sánchez V, Sánchez GI, Baena A, Ruiz Osorio MA, Rodríguez Zabala D, Garcés-Palacio IC. Health-related quality of life of women after HPV testing as triage strategy for an abnormal Pap smear: a nested randomized pragmatic trial in a middle-income country. Qual Life Res 2020; 29:2999-3008. [PMID: 32617889 DOI: 10.1007/s11136-020-02563-w] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/13/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Information obtained in studies on the impact of human papilloma virus (HPV) testing on health-related quality of life is contradictory. OBJECTIVE To assess the impact on health-related quality of life of the HPV test, colposcopy, and cytology as triage strategies after a cytology with atypical squamous cells of undetermined significance (ASCUS) in Medellín, Colombia. METHODS We carried out a nested analysis on the randomized pragmatic trial (ASCUS-COL). Women with ASCUS were assigned randomly to one of the 3 arms (Pap smear, colposcopy, HPV). Participants completed a questionnaire at baseline, two weeks after receiving the results of the triage tests and one year after the second questionnaire. We used the SF-36 to assess health-related quality of life. RESULTS The sum score of the physical health component (PHC) and mental health component (MHC) increased significantly over time for the whole sample and there were no statistically significant differences between arms of PHC = survey 1: mean 52.4 (SD 8.21) vs. survey 3: mean 54.4 (SD 8.16) p < 0.0001 and of MHC = survey 1: mean 44.9 (SD 11.72) vs. survey 3: mean 48.1 (SD 11.20) p < 0.0001. A lower MHC occurred in women with lesser schooling, belonging to the public health care regimen, higher number of live births, and separated. A lower PHC was associated with the cytology arm, higher age, lesser schooling, and belonging to the subsidized regime. The risk of having depression went from 42% in the first survey to 26% in the third. CONCLUSION The triage strategies affected health-related quality of life in the same manner. ClinicalTrials.gov Identifier: NCT02067468.
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Affiliation(s)
- Yenny Urrea Cosme
- Grupo Atropos, Universidad de Antioquia UdeA, Calle 70 No. 52-21, Medellín, Colombia
| | | | - Gloria I Sánchez
- Grupo Infección y Cáncer, Facultad de Medicina, Universidad de Antioquia UdeA, Calle 70 No. 52-21, Medellín, Colombia
| | - Armando Baena
- Prevention and Implementation Group, International Agency for Research on Cancer / World Health Organization (IARC/WHO), 150 Cours Albert Thomas, 69372, Lyon Cedex 08, France
| | | | | | - Isabel C Garcés-Palacio
- Grupo de Epidemiología, Facultad Nacional de Salud Pública, Universidad de Antioquia UdeA, Calle 70 No. 52-21, Medellín, Colombia.
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Austin RM, Onisko A, Zhao C. Are CIN3 risk or CIN3+ risk measures reliable surrogates for invasive cervical cancer risk? J Am Soc Cytopathol 2020; 9:602-606. [PMID: 32839150 PMCID: PMC7387921 DOI: 10.1016/j.jasc.2020.07.133] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Revised: 06/17/2020] [Accepted: 07/06/2020] [Indexed: 10/24/2022]
Abstract
•Discuss ASCCP guideline. •CIN3 reliable surrogates for cervical cancer? •The Pittsburgh Cervical Cancer Screening Model.
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Affiliation(s)
- R Marshall Austin
- Department of Pathology, Magee-Womens Hospital, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Agnieszka Onisko
- Department of Pathology, Magee-Womens Hospital, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania; Faculty of Computer Science, Bialystok University of Technology, Bialystok, Poland
| | - Chengquan Zhao
- Department of Pathology, Magee-Womens Hospital, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
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Kussaibi H, Al Dossary R, Ahmed A, Muammar A, Aljohani R. Correlation of High-Risk HPV Genotypes with Pap Test Findings: A Retrospective Study in Eastern Province, Saudi Arabia. Acta Cytol 2020; 65:48-55. [PMID: 32784299 DOI: 10.1159/000509669] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 04/09/2020] [Accepted: 06/24/2020] [Indexed: 12/11/2022]
Abstract
INTRODUCTION High-risk human papillomavirus (HR HPV) is found to be responsible for 4.5% of cancer in general, primarily cervical cancer. We aim here to highlight the prevalence and genotypes of HR HPV and correlate its association with Pap tests' results, which are still not well known in the Eastern Province of Saudi Arabia. METHODS Over 7 years (2013-2019), the results of 164 Saudi women coinvestigated for HR HPV along with Pap tests were collected from the archive of King Fahd University Hospital. Only women who had atypical squamous cells of undetermined significance (ASCUS) on the Pap test and those at elevated risk of infection were cotested for HR HPV; otherwise, the Pap test was the only screening modality for cervical cancer. Data were organized and statistically analyzed using IBM SPSS v26. RESULTS Out of 164 Saudi women, 14.5% (n = 24/164) showed positive results for HR HPV (8 patients had HPV16 and 2 had both HPV16 and HPV18/45, while the remaining 14 had other HR HPV); among them, 41.5% (n = 10/24) had an abnormal Pap test (5 ASCUS and 5 LSIL), while 58.5% (n = 14/24) had a negative Pap test. On the other hand, 21% (n = 35/164) of patients, in the study, had an abnormal Pap test (24 ASCUS, 8 low-grade squamous intraepithelial lesion [LSIL], and 3 atypical glandular cell [AGC]). In 80% (n = 19/24) of ASCUS cases, HR HPV was not detected; however, 20% (n = 5/24) were positive for other HR HPV. Concerning LSIL cases, 62.5% (n = 5/8) were positive for HR HPV (1 case showed HPV16 and HPV18/45, 2 cases showed HPV16, and 2 cases showed other HR HPV), while in the remaining 37.5% (n = 3/8) LSIL cases, HR HPV was negative; similarly, all AGC cases were negative for HR HPV. Statistical analysis showed a significant correlation between HPV status and Pap test findings (p value <0.001). DISCUSSION/CONCLUSION HR HPV frequency and genotype distribution, in this study, might reflect a different regional infection pattern. The high association of HR HPV with negative cytology emphasizes the need to add the HR HPV test to screening modalities of cervix cancer.
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Affiliation(s)
- Haitham Kussaibi
- Department of Pathology, College of Medicine, Imam Abdulrahman Bin Faisal University (IAU), Dammam, Saudi Arabia,
| | - Reem Al Dossary
- Department of Microbiology, College of Medicine, Imam Abdulrahman Bin Faisal University (IAU), Dammam, Saudi Arabia
| | - Ayesha Ahmed
- Department of Pathology, College of Medicine, Imam Abdulrahman Bin Faisal University (IAU), Dammam, Saudi Arabia
| | - Aroub Muammar
- College of Medicine, Imam Abdulrahman Bin Faisal University (IAU), Dammam, Saudi Arabia
| | - Raghad Aljohani
- College of Medicine, Imam Abdulrahman Bin Faisal University (IAU), Dammam, Saudi Arabia
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22
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Jamsheed A, Gupta M, Gupta A, Bansal R, Khare A. Cytomorphological pattern analysis of tubercular lymphandenopathies. Indian J Tuberc 2020; 67:495-501. [PMID: 33077050 DOI: 10.1016/j.ijtb.2020.07.001] [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: 05/09/2020] [Accepted: 07/06/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND The spectrum of morphological pattern in tubercular lymphandenopathies was observed to study the various cytomorphological patterns and their correlation with acid fast bacilli. METHODS FNAC smears of 210 cases of granulomatous lymphadenitis stained with Giemsa, Pap and haematoxylin and eosin were used to analyze cytomorphological pattern and Zeihl Neelsen stained smears for acid fast bacilli (AFB) detection. RESULTS 193 cases with necrotising granulomatous inflammation or positive acid fast bacilli were included. Age group 21-30 years was most common (38.3%) followed by age group 11-20 years (30.05%). Females constituted 66.3% of patients and 33.7% were male. Overall the most common pattern in present study was pattern A (Epitheloid granuloma with caseous necrosis 33.7% followed by pattern B (caseous necrosis with few scattered epitheloid histiocytes and lymphocytes) 31.1% and pattern C (caseous necrosis with suppurative inflammation) 30.6%, followed by pattern D (Caseous necrosis only) (3.6%) and pattern E (non necrotising epitheloid granuloma with positive acid fast bacilli) (1.03%). Acid fast bacilli were demonstrable in 175 cases (90.7%). Amongst the acid fast bacilli positive cases highest bacillary load 3+ grade was seen in pattern C in 6/59 (10.16%) cases. CONCLUSION FNAC is a simple useful tool and should be attempted in all cases of lymphandenopathies. It helps in establishing a diagnosis of tubercular etiology based on its morphological patterns however demonstration of acid fast bacilli on aspirated material confirms the diagnosis.
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Affiliation(s)
- Afeefah Jamsheed
- Subharti Medical College, Swami Vivekanand Subharti University Meerut, India
| | - Mamta Gupta
- Department of Pathology, Subharti Medical College, Swami Vivekanand Subharti University, Meerut, India.
| | - Abhishek Gupta
- Department of Medicine, Subharti Medical College, Swami Vivekanand Subharti University, Meerut, India
| | - Rani Bansal
- Department of Pathology, Subharti Medical College, Swami Vivekanand Subharti University, Meerut, India
| | - Anjali Khare
- Department of Pathology, Subharti Medical College, Swami Vivekanand Subharti University, Meerut, India
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Paracchini L, Pesenti C, Delle Marchette M, Beltrame L, Bianchi T, Grassi T, Buda A, Landoni F, Ceppi L, Bosetti C, Paderno M, Adorni M, Vicini D, Perego P, Leone BE, D’Incalci M, Marchini S, Fruscio R. Detection of TP53 Clonal Variants in Papanicolaou Test Samples Collected up to 6 Years Prior to High-Grade Serous Epithelial Ovarian Cancer Diagnosis. JAMA Netw Open 2020; 3:e207566. [PMID: 32609349 PMCID: PMC7330718 DOI: 10.1001/jamanetworkopen.2020.7566] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
IMPORTANCE The low 5-year survival rate of women with high-grade serous epithelial ovarian cancer (HGS-EOC) is related to its late diagnosis; thus, improvement in diagnosis constitutes a crucial step to increase the curability of this disease. OBJECTIVE To determine whether the presence of the clonal pathogenic TP53 variant detected in matched primary tumor biopsies can be identified in DNA purified from Papanicolaou test samples collected from women with HGS-EOC years before the diagnosis. DESIGN, SETTING, AND PARTICIPANTS This cohort study was conducted among a single-center cohort of women with histologically confirmed diagnosis of HGS-EOC recruited at San Gerardo Hospital, Monza, Italy, from October 15, 2015, to January 4, 2019. Serial dilutions of DNA derived from tumor samples and DNA extracted from healthy women's Papanicolaou test samples were analyzed to define the sensitivity and specificity of droplet digital polymerase chain reaction assays designed to detect the TP53 variants identified in tumors. All available brush-based Papanicolaou test slides performed up to 6 years before diagnosis were investigated at the Mario Negri Institute, Milano, Italy. Data were analyzed from October 2018 to December 2019. MAIN OUTCOMES AND MEASURES The presence of tumor pathogenic TP53 variants was assessed by the droplet digital polymerase chain reaction approach in DNA purified from Papanicolaou test samples obtained from the same patients before diagnosis during cervical cancer screenings. RESULTS Among 17 included patients (median [interquartile range] age at diagnosis, 60 [53-69] years), Papanicolaou tests withdrawn before diagnosis presented tumor-matched TP53 variants in 11 patients (64%). In 2 patients for whom longitudinal Papanicolaou tests were available, including 1 patient with Papanicolaou tests from 25 and 49 months before diagnosis and 1 patient with Papanicolaou tests from 27 and 68 months before diagnosis, the TP53 clonal variant was detected at all time points. CONCLUSIONS AND RELEVANCE These findings suggest that noninvasive early molecular diagnosis of HGS-EOC is potentially achievable through detection of TP53 clonal variants in the DNA purified from Papanicolaou tests performed during cervical cancer screening.
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Affiliation(s)
- Lara Paracchini
- Department of Oncology, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Chiara Pesenti
- Department of Oncology, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Martina Delle Marchette
- Department of Obstetrics and Gynecology, Università degli Studi Milano-Bicocca, San Gerardo Hospital, Monza, Italy
| | - Luca Beltrame
- Department of Oncology, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Tommaso Bianchi
- Department of Obstetrics and Gynecology, Università degli Studi Milano-Bicocca, San Gerardo Hospital, Monza, Italy
| | - Tommaso Grassi
- Department of Obstetrics and Gynecology, Università degli Studi Milano-Bicocca, San Gerardo Hospital, Monza, Italy
| | - Alessandro Buda
- Department of Obstetrics and Gynecology, Università degli Studi Milano-Bicocca, San Gerardo Hospital, Monza, Italy
| | - Fabio Landoni
- Department of Obstetrics and Gynecology, Università degli Studi Milano-Bicocca, San Gerardo Hospital, Monza, Italy
| | - Lorenzo Ceppi
- Department of Obstetrics and Gynecology, Azienda Socio Sanitaria Territoriale -Monza, Desio Hospital, Desio, Italy
| | - Cristina Bosetti
- Department of Oncology, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Mariachiara Paderno
- Department of Obstetrics and Gynecology, Università degli Studi Milano-Bicocca, San Gerardo Hospital, Monza, Italy
| | - Marco Adorni
- Department of Obstetrics and Gynecology, Università degli Studi Milano-Bicocca, San Gerardo Hospital, Monza, Italy
| | - Debora Vicini
- Department of Obstetrics and Gynecology, Università degli Studi Milano-Bicocca, San Gerardo Hospital, Monza, Italy
| | - Patrizia Perego
- Department of Pathology, Università degli Studi Milano-Bicocca, San Gerardo Hospital, Monza, Italy
| | - Biagio Eugenio Leone
- Department of Pathology, Università degli Studi Milano-Bicocca, San Gerardo Hospital, Monza, Italy
| | - Maurizio D’Incalci
- Department of Oncology, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Sergio Marchini
- Department of Oncology, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Robert Fruscio
- Department of Obstetrics and Gynecology, Università degli Studi Milano-Bicocca, San Gerardo Hospital, Monza, Italy
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Bruehl FK, Dyhdalo KS, Hou Y, Clapacs E, Przybycin CG, Reynolds JP. Cytology and curetting diagnosis of endocervical adenocarcinoma. J Am Soc Cytopathol 2020; 9:556-562. [PMID: 32624383 DOI: 10.1016/j.jasc.2020.05.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 04/09/2020] [Revised: 05/06/2020] [Accepted: 05/11/2020] [Indexed: 12/29/2022]
Abstract
INTRODUCTION Papanicolaou testing is effective in identifying squamous intraepithelial lesions of the cervix. Endocervical adenocarcinoma (EAC) and adenocarcinoma in situ (AIS) are far less commonly identified. Endocervical curettings (ECCs) are usually obtained after colposcopic biopsy, sample the endocervical canal, and aid in the detection of endocervical glandular lesions. Here, we examine the utility of Papanicolaou testing and endocervical curetting for detecting AIS and EAC. MATERIALS AND METHODS Cases from 2007 to 2019 with a histologically confirmed diagnosis of AIS and EAC were identified and the clinical data and diagnostic material, including the cytology and surgical specimens, obtained. RESULTS A total of 108 cases of AIS and EAC were identified, Papanicolaou tests were performed in 97 of these cases, and ECC in 87. AIS or EAC were detected in 46.4% of Papanicolaou tests; 41.4% of ECC showed AIS or EAC. A total of 92.7% of cases were positive for high-risk human papillomavirus (HPV) and concurrent squamous intraepithelial lesion was present in 53.3% of cases. AIS or EAC were more commonly identified in cases without concurrent squamous intraepithelial lesions. CONCLUSIONS Papanicolaou testing and endocervical curettings have a low detection rate for AIS and EAC. The majority of AIS and EAC cases test positive for high-risk HPV. Papanicolaou test and ECC show different detection rates and are complementary tools in patients with AIS and EAC. In some settings, an ECC can increase the diagnostic sensitivity and specificity of the pathologic diagnosis.
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Affiliation(s)
- Frido K Bruehl
- Robert J. Tomsich Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, Ohio
| | - Kathryn S Dyhdalo
- Robert J. Tomsich Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, Ohio
| | - Yanjun Hou
- Robert J. Tomsich Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, Ohio
| | - Elisha Clapacs
- Robert J. Tomsich Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, Ohio
| | - Christopher G Przybycin
- Robert J. Tomsich Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, Ohio
| | - Jordan P Reynolds
- Robert J. Tomsich Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, Ohio.
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Ersoy E, Kashikar RM. Psammoma bodies in Papanicolaou tests and associated factors to predict an underlying malignancy: a clinicopathological analysis of 10 cases. J Am Soc Cytopathol 2020; 9:266-271. [PMID: 32376242 DOI: 10.1016/j.jasc.2020.04.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 01/24/2020] [Revised: 04/01/2020] [Accepted: 04/01/2020] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Psammoma bodies (PBs) are rarely encountered in Papanicolaou tests. They have been described in benign and malignant conditions of the gynecologic tract and peritoneum. The aim of our study was to reveal the associated factors with PBs in Papanicolaou tests to predict an underlying malignancy, particularly in the absence of atypical glandular cells (AGCs). MATERIALS AND METHODS From 1987 to 2018, all gynecologic cytology reports with PBs were identified from the computerized pathology database of Baystate Medical Center, Springfield, Massachusetts. Patients with previous history of gynecologic and/or peritoneal malignancy were excluded. Clinical information and follow-up data were obtained from chart review. RESULTS PBs were found in 10 of the 1,497,540 Papanicolaou tests (0.0006%). Six patients with age ranging from 19 to 58 years (mean age, 37.6 years) had benign outcome (eg, endometritis, ovarian serous cystadenofibroma). Four patients with age ranging from 31 to 54 years (mean age, 41.7 years) had borderline/malignant outcome (eg, ovarian borderline serous tumor, peritoneal serous psammocarcinoma). All patients with borderline/malignant outcome had family history of cancer and/or gene mutation (eg, sister with breast cancer, father with BRCA-1 mutation). PBs were accompanied by AGCs in 2 of 4 borderline/malignant cases. CONCLUSIONS PBs should not be ignored in Papanicolaou tests because of their possible association with an underlying malignancy. To our knowledge, this is the first study demonstrating that relevant family history of cancer and/or gene mutation may be a helpful clue regarding an underlying malignancy, especially in the absence of accompanied AGCs with PBs.
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Affiliation(s)
- Esma Ersoy
- Department of Pathology, University of Massachusetts Medical School-Baystate Medical Center, Springfield, Massachusetts.
| | - Rukmini M Kashikar
- Department of Pathology, University of Massachusetts Medical School-Baystate Medical Center, Springfield, Massachusetts
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Nelson B. Cervical and anal cancer prevention in jails and prisons: "A missed opportunity": Although cancers linked to the human papillomavirus are preventable through vaccination and screening, these protective measures largely have been overlooked in correctional health care systems. Cancer Cytopathol 2020; 128:227-228. [PMID: 32251554 DOI: 10.1002/cncy.22268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Hewer E, Schmitt AM. Ultrafast Toluidine Blue Staining for Rapid On-Site Evaluation of Cytological Smears. Acta Cytol 2020; 64:375-377. [PMID: 31962321 DOI: 10.1159/000505254] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 12/05/2019] [Accepted: 12/07/2019] [Indexed: 01/23/2023]
Abstract
Rapid on-site evaluation (ROSE) is one of cytopathology's "unique selling propositions." The quality, speed, and ease of handling of the staining used is a critical factor for the efficacy of the ROSE procedure. Here, we describe a modification of rapid toluidine blue staining that can be performed within 25 s, provides excellent nuclear morphology, and is compatible with subsequent Papanicolaou staining of the slides. Furthermore, exposure to hazardous chemicals is minimized, as no organic solvents other than the alcohol-based fixative and glycerin for temporary mounting and coverslipping are required. We have used this protocol successfully in our ROSE practice and have not observed any discrepancies between toluidine blue- and permanent Papanicolaou-stained slides.
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Affiliation(s)
- Ekkehard Hewer
- Institute of Pathology, University of Bern, Bern, Switzerland,
- Department of Diabetes, Endocrinology, Nutritional Medicine and Metabolism, Inselspital, University of Bern, Bern, Switzerland,
| | - Anja M Schmitt
- Institute of Pathology, University of Bern, Bern, Switzerland
- Department of Diabetes, Endocrinology, Nutritional Medicine and Metabolism, Inselspital, University of Bern, Bern, Switzerland
- Pathologikum, Gemeinschaftspraxis für Pathologie, Zurich, Switzerland
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Seay J, Carrasquillo O, Trevil D, Gonzalez M, Brickman A, Amofah A, Pierre L, Koru-Sengul T, Kobetz E. Implementing Two Randomized Pragmatic Trials of HPV Self-sampling among Underserved Women: Challenges and Lessons Learned. Prog Community Health Partnersh 2020; 14:55-62. [PMID: 32280123 DOI: 10.1353/cpr.2020.0008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Haitian and Hispanic immigrant women experience substantial disparities in cervical cancer screening. Recently, our team completed two randomized trials of human papillomavirus (HPV) self-sampling as a cervical cancer screening strategy among Haitian and Hispanic women, using a community-based participatory research (CBPR) approach. OBJECTIVE To reflect on lessons learned in the process of completing two large randomized cancer screening trials within underserved communities. METHODS Haitian and Hispanic women were randomized to HPV self-sampling versus navigation to Pap smear versus standard cervical cancer screening education in the first trial, and HPV self-sampling delivered in-person versus via mail in the second trial. LESSONS LEARNED During the two trials, our team encountered several challenges. The lessons learned from these challenges allowed for the strengthening of our community partnerships, study procedures, and our ability to conduct CBPR within an academic setting. CONCLUSIONS Lessons learned from our trials may be useful to other researchers engaging in CBPR within underserved communities.
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Tanjasiri SP, Mouttapa M, Sablan-Santos L, Weiss JW, Chavarria A, Lacsamana JD, May VT, Quitugua L, Tupua M, Schmidt-Vaivao D. Design and Outcomes of a Community Trial to Increase Pap Testing in Pacific Islander Women. Cancer Epidemiol Biomarkers Prev 2019; 28:1435-1442. [PMID: 31186260 DOI: 10.1158/1055-9965.epi-18-1306] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Revised: 02/08/2019] [Accepted: 06/05/2019] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Pap tests remain an essential cervical cancer detection method in the United States, yet they are underutilized among Pacific Islanders (PI) who experience elevated cervical cancer incidence and mortality. This study describes the design, methods, participants, and outcomes of a multiyear (2010-2016), community-based randomized intervention trial in southern California. Based upon strong collectivistic norms, the trial tested the efficacy of a unique social support intervention targeting Chamorro, Samoan, and Tongan women and their male husbands/partners. METHODS A single-session educational intervention was designed and tailored for ethnic- and gender-specific groups to increase men's social support for their female wives/partners to receive a Pap test, and for women to receive a Pap test. The comparison group received preexisting brochures on Pap testing (for women) or general men's health (for men). Pretest and 6-month follow-up data were analyzed. RESULTS Intervention and comparison groups were mostly equivalent on pretest demographics and outcome variables. Intervention women who were not compliant with Pap screening recommendations at pretest were significantly more likely to have scheduled and received a Pap test at 6-month follow-up. However, 6-month follow-up results indicated no intervention effect on changes in women's Pap testing knowledge, fatalistic attitudes, or perceived social support from their male partner. CONCLUSIONS Ethnic- and gender-tailored community interventions can successfully increase Pap test behaviors for PI women, although more research is needed on the specific pathways leading to behavior change. IMPACT Collaborative community-based interventions lead to increases in women's cancer prevention and early detection for Pacific Islander and other collectivistic communities.
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Affiliation(s)
| | - Michele Mouttapa
- Department of Public Health, California State University, Fullerton
| | | | - Jie W Weiss
- Department of Public Health, California State University, Fullerton
| | | | | | - Vanessa Tuiòne May
- Tongan Community Service Center/Special Service for Groups, Inc., Los Angeles, California
| | | | - Marina Tupua
- Samoan National Nurses Association, Long Beach, California
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Yuan L, Biscotti CV, Zhu H, Booth CN, Abdul-Karim FW, Zhang Y. Significance of atypical endometrial cells in women younger than 40 years of age. J Am Soc Cytopathol 2019; 9:33-37. [PMID: 31353256 DOI: 10.1016/j.jasc.2019.07.001] [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: 05/31/2019] [Revised: 06/27/2019] [Accepted: 07/02/2019] [Indexed: 11/19/2022]
Abstract
INTRODUCTION The presence of atypical endometrial cells in the Papanicolaou (Pap) test has been associated with an increased rate of endometrial malignancy, with reported rates ranging from 14% to 47%. However, most reported studies have focused on patients who were aged >40 years. The purpose of the present study was to investigate the clinical significance of identifying atypical endometrial cells in Pap test samples in women aged <40 years of age. MATERIALS AND METHODS A search of the cytology Pap test database was performed from 2000 to 2014 using the keywords "atypical endometrial cells" or "atypical glandular cells favor endometrial origin" in women aged <40 years. The available ThinPrep slides were reviewed. The patients' clinical presentation, follow-up endometrial biopsy findings, treatment, and clinical follow-up data were recorded. Endometrial carcinoma tissue sections were screened for Lynch syndrome. RESULTS The database search yielded 63 study cases. Of these 63 patients, 52 had subsequently undergone endometrial biopsy. Of the 52 patients with follow-up biopsy findings available, 9 (17.3%) had premalignant (5 with atypical hyperplasia) or malignant (4 with endometrioid adenocarcinoma) lesions. In addition, 16 patients (30.8%) had other endometrial pathologic features. The 9 patients with premalignant or malignant endometrial lesions (8 white, 1 black) were overweight or obese; 3 of the patients did not have any clinical symptoms. All 4 patients with endometrioid adenocarcinoma had negative Lynch syndrome screening findings. CONCLUSIONS Our results suggest that it is important to recognize the presence of atypical endometrial cells in the Pap tests from young patients, given its association with the finding of premalignant and malignant pathologic features in subsequent endometrial biopsies.
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Affiliation(s)
- Lisi Yuan
- Department of Pathology, Cleveland Clinic, Cleveland, Ohio
| | | | - Hui Zhu
- Department of Pathology, Cleveland Clinic, Cleveland, Ohio
| | | | | | - Yaxia Zhang
- Department of Pathology, Cleveland Clinic, Cleveland, Ohio; Department of Pathology and Laboratory Medicine, Hospital for Special Surgery, New York, New York.
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Landau MS, Pantanowitz L. Artificial intelligence in cytopathology: a review of the literature and overview of commercial landscape. J Am Soc Cytopathol 2019; 8:230-241. [PMID: 31272605 DOI: 10.1016/j.jasc.2019.03.003] [Citation(s) in RCA: 61] [Impact Index Per Article: 12.2] [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: 01/08/2019] [Revised: 03/17/2019] [Accepted: 03/20/2019] [Indexed: 06/09/2023]
Abstract
Artificial intelligence (AI) has made impressive strides recently in interpreting complex images, thanks to improvements in deep learning techniques and increasing computational power. Researchers have started applying these advanced techniques to pathology images, although most efforts have been focused on histopathology. Cytopathology, however, remains the original field of pathology for which AI models for clinical use were successfully commercialized, to assist with automating Papanicolaou test screening. Recent AI efforts have focused on whole slide images of both gynecologic and non-gynecologic cytopathology. This review summarizes the literature and commercial landscape of AI as applied to cytopathology.
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Affiliation(s)
- Michael S Landau
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
| | - Liron Pantanowitz
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
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Jenkins TM, Shojaei H, Song SJ, Schwartz LE. Role of Ancillary Techniques in Cervical Biopsy and Endocervical Curettage Specimens as Follow-Up to Papanicolaou Test Results Indicating a Diagnosis of Atypical Squamous Cells, Cannot Exclude High-Grade Squamous Intraepithelial Lesion, or High-Grade Squamous Intraepithelial Lesion. Acta Cytol 2019; 64:155-165. [PMID: 30982025 DOI: 10.1159/000498888] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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: 10/29/2018] [Accepted: 02/12/2019] [Indexed: 01/10/2023]
Abstract
The Papanicolaou (PAP) test is widely used to screen for cervical cancer. All high-grade lesions such as atypical squamous cells, cannot exclude high-grade squamous intraepithelial lesion (ASC-H), and high-grade squamous intraepithelial lesion, identified on a PAP test should be followed-up by a confirmatory cervical biopsy. In this review, we discuss the challenges in interpreting cervical tissue specimens and the various ancillary techniques used in the evaluation of cervical dysplasia. Ancillary studies include deeper levels, p16 immunohistochemistry (IHC), human papillomavirus (HPV) testing, and, importantly, cyto-histologic correlation. Of these, p16 IHC is consistently sensitive and specific for detecting HSIL. HPV RNA in situ hybridization (ISH) is a newer technique with excellent sensitivity and specificity for detecting virally infected cells and it may be more broadly applicable to both low- and high-grade squamous intraepithelial lesions.
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Affiliation(s)
- Taylor M Jenkins
- Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA,
| | - Hadi Shojaei
- Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Sharon J Song
- Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Lauren E Schwartz
- Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Crowell EF, Bazin C, Saunier F, Brixtel R, Caillot Y, Lesner B, Toutain M, Ferreri C, Garcia I, Mathieu MC, Vaussanvin J, Depardon J, Renouf A. CytoProcessorTM: A New Cervical Cancer Screening System for Remote Diagnosis. Acta Cytol 2019; 63:215-223. [PMID: 30921788 DOI: 10.1159/000497111] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [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: 01/02/2019] [Accepted: 01/20/2019] [Indexed: 12/26/2022]
Abstract
BACKGROUND Current automated cervical cytology screening systems still heavily depend on manipulation of glass slides. We developed a new system called CytoProcessorTM (DATEXIM, Caen, France), which increases sensitivity and takes advantage of virtual slide technology to simplify the workflow and save worker time. We used an approach based on artificial intelligence to identify abnormal cells among the tens of thousands in a cervical preparation. OBJECTIVES We set out to compare the diagnostic sensitivity and specificity of CytoProcessorTM and the ThinPrep Imaging System (HOLOGIC, Marlborough, MA, USA). METHODS A representative population of 1,352 cases was selected from the routine workflow in a private laboratory. Diagnoses were established using the ThinPrep Imaging System and CytoProcessorTM. All discordances were resolved by a consensus committee. RESULTS Compared to the ThinPrep Imaging System, CytoProcessorTM significantly improves diagnostic sensitivity without compromising specificity. The sensitivity of detection of "atypical squamous cells of undetermined significance (ASC-US) and more severe" and "low-grade squamous intraepithelial lesion and more severe" was significantly higher using CytoProcessorTM. Considering that cases with a truth diagnosis of ASC-US or more severe required clinical follow-up, 1.5% of the cases (21/1,360) would have been missed if the CytoProcessorTM diagnosis had been used for clinical decision-making. In contrast, 4% of the cases (54/1,360) were missed when the ThinPrep Imaging System diagnosis was used for clinical decision-making. There were 2.6 times fewer false negatives using CytoProcessorTM. The CytoProcessorTM workflow was 1.5 times faster in terms of worker time. CONCLUSIONS CytoProcessorTM is the first of a new generation of automated screening systems, demonstrating improved sensitivity and yielding significant gains in processing time. In addition, the fully digital nature of slide presentation in CytoProcessorTM allows the remote diagnosis of Papanicolaou tests for the first time.
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Liu T, de Haan K, Rivenson Y, Wei Z, Zeng X, Zhang Y, Ozcan A. Deep learning-based super-resolution in coherent imaging systems. Sci Rep 2019; 9:3926. [PMID: 30850721 PMCID: PMC6408569 DOI: 10.1038/s41598-019-40554-1] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Accepted: 02/19/2019] [Indexed: 11/28/2022] Open
Abstract
We present a deep learning framework based on a generative adversarial network (GAN) to perform super-resolution in coherent imaging systems. We demonstrate that this framework can enhance the resolution of both pixel size-limited and diffraction-limited coherent imaging systems. The capabilities of this approach are experimentally validated by super-resolving complex-valued images acquired using a lensfree on-chip holographic microscope, the resolution of which was pixel size-limited. Using the same GAN-based approach, we also improved the resolution of a lens-based holographic imaging system that was limited in resolution by the numerical aperture of its objective lens. This deep learning-based super-resolution framework can be broadly applied to enhance the space-bandwidth product of coherent imaging systems using image data and convolutional neural networks, and provides a rapid, non-iterative method for solving inverse image reconstruction or enhancement problems in optics.
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Affiliation(s)
- Tairan Liu
- Electrical and Computer Engineering Department, University of California, Los Angeles, CA, 90095, USA
- Bioengineering Department, University of California, Los Angeles, CA, 90095, USA
- California NanoSystems Institute (CNSI), University of California, Los Angeles, CA, 90095, USA
| | - Kevin de Haan
- Electrical and Computer Engineering Department, University of California, Los Angeles, CA, 90095, USA
- Bioengineering Department, University of California, Los Angeles, CA, 90095, USA
- California NanoSystems Institute (CNSI), University of California, Los Angeles, CA, 90095, USA
| | - Yair Rivenson
- Electrical and Computer Engineering Department, University of California, Los Angeles, CA, 90095, USA
- Bioengineering Department, University of California, Los Angeles, CA, 90095, USA
- California NanoSystems Institute (CNSI), University of California, Los Angeles, CA, 90095, USA
| | - Zhensong Wei
- Electrical and Computer Engineering Department, University of California, Los Angeles, CA, 90095, USA
| | - Xin Zeng
- Electrical and Computer Engineering Department, University of California, Los Angeles, CA, 90095, USA
| | - Yibo Zhang
- Electrical and Computer Engineering Department, University of California, Los Angeles, CA, 90095, USA
- Bioengineering Department, University of California, Los Angeles, CA, 90095, USA
- California NanoSystems Institute (CNSI), University of California, Los Angeles, CA, 90095, USA
| | - Aydogan Ozcan
- Electrical and Computer Engineering Department, University of California, Los Angeles, CA, 90095, USA.
- Bioengineering Department, University of California, Los Angeles, CA, 90095, USA.
- California NanoSystems Institute (CNSI), University of California, Los Angeles, CA, 90095, USA.
- Department of Surgery, David Geffen School of Medicine, University of California, Los Angeles, CA, 90095, USA.
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Hinson S, Molberg K, Mir M, Flores M, Zheng W, Lucas E. Age cutoff for reporting of benign-appearing endometrial cells in Papanicolaou specimens; should it be raised? A 10-year retrospective study from a large county hospital. J Am Soc Cytopathol 2019; 8:78-83. [PMID: 31287423 DOI: 10.1016/j.jasc.2018.09.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 07/04/2018] [Revised: 08/30/2018] [Accepted: 09/08/2018] [Indexed: 06/09/2023]
Abstract
INTRODUCTION The recommendation for reporting benign-appearing endometrial cells in Papanicolaou specimens was increased from 40 to 45 years in the 2014 edition of The Bethesda System. Recent studies suggest that increasing the reporting age to 50 years would have no significant negative impact. Reporting of benign endometrial cells may trigger unnecessary procedures and increase the cost of patient care. The goal of our study was to perform cytohistologic correlations and determine an optimal age cutoff for reporting endometrial cells in cervical cytology specimens. MATERIALS AND METHODS The pathology database was searched between 2006 and 2015 for Papanicolaou tests with benign-appearing endometrial cells that were followed by endometrial sampling within 1 year of the cytology result in women ≥45 years. In cases where more than one follow-up surgical specimen was available, only the most significant result was included. Endometrial carcinoma or atypical hyperplasia was considered a significant histologic result. The data were organized into 4 age groups, 45 to 49, 50 to 54, 55 to 59, and ≥60 years. RESULTS Among 453,420 Papanicolaou specimens, 1121 cases reported endometrial cells in women ≥45 years. Of these, 588 (52%) had an endometrial biopsy/curettage or hysterectomy. Benign diagnosis was reported for 558 (95%) and 12 (2%) samples were insufficient for diagnosis. Significant histologic findings were present in 18 (3%) of cases, of which all were endometrial carcinoma. The difference was statistically significant between the age groups 45 to 54 and ≥55 (1.5% versus 17% of cases had significant endometrial pathology, P < 0.05). CONCLUSIONS Increasing the current reporting age appears safe and may improve efficiency and cost savings.
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Affiliation(s)
- Stacy Hinson
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Kyle Molberg
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Mariam Mir
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Melinda Flores
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Wenxin Zheng
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Elena Lucas
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, Texas.
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Vassilakos P, Poncet A, Catarino R, Viviano M, Petignat P, Combescure C. Cost-effectiveness evaluation of HPV self-testing offered to non-attendees in cervical cancer screening in Switzerland. Gynecol Oncol 2019; 153:92-99. [PMID: 30718124 DOI: 10.1016/j.ygyno.2019.01.021] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [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: 11/20/2018] [Revised: 01/17/2019] [Accepted: 01/22/2019] [Indexed: 01/10/2023]
Abstract
OBJECTIVE About 30% of women who are eligible for cervical cancer (CC) screening remain un-screened or under-screened in Switzerland. HPV testing on self-collected vaginal samples (Self-HPV) has shown to be more sensitive than cytology while also reaching non-attendees. The objective of this study was to explore the cost-effectiveness of offering Self-HPV to non-attendees in Switzerland. METHODS A recursive decision-tree with one-year cycles was used to model the life-long natural HPV history. Markov cohort simulations were used to assess the expected outcomes from the model. The outcomes of three strategies were compared with the absence of screening: Self-HPV and triage with colposcopy (Self-HPV/colpo), Self-HPV and triage with Pap cytology (Self-HPV/PAP), cytological screening and triage with HPV (PAP/HPV). Sensitivity analyses for the key parameters of the model were conducted to check the robustness of findings. RESULTS Offering a Self-HPV screening to non-attendees could prevent 90% of CC and 94% of CC-related deaths in the study population. The current cytology-based program could reduce by 83% the number of CC cases and by 88% the number of CC-related deaths over the population's lifetime. Compared to the absence of screening, incremental cost-effectiveness ratios (ICER) were estimated to be, per saved Quality Adjusted Life Year (QALY), 12413US$ for the strategy Self-HPV/colpo, 11138US$ for the strategy Self-HPV/Pap and 22488US$ for the strategy PAP/HPV. CONCLUSIONS Offering Self-HPV as a CC screening strategy to non-attendees in Switzerland is a cost-effective solution that is associated with a reduction of CC cases and related deaths. Self-HPV is more cost-effective than the currently used cytology-based screening.
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Affiliation(s)
- Pierre Vassilakos
- Geneva Foundation for Medical Education and Research, route de Ferney 150, 1211 Geneva, Switzerland; Department of Gynaecology and Obstetrics, Geneva University Hospitals, Boulevard de la Cluse 30, 1205 Geneva, Switzerland
| | - Antoine Poncet
- Division of Clinical Epidemiology, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, 1205 Geneva, Switzerland
| | - Rosa Catarino
- Department of Gynaecology and Obstetrics, Geneva University Hospitals, Boulevard de la Cluse 30, 1205 Geneva, Switzerland.
| | - Manuela Viviano
- Department of Gynaecology and Obstetrics, Geneva University Hospitals, Boulevard de la Cluse 30, 1205 Geneva, Switzerland
| | - Patrick Petignat
- Department of Gynaecology and Obstetrics, Geneva University Hospitals, Boulevard de la Cluse 30, 1205 Geneva, Switzerland
| | - Christophe Combescure
- Division of Clinical Epidemiology, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, 1205 Geneva, Switzerland
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Peprah S, Coleman JS, Rositch AF, Vanden Bussche CJ, Moore R, D'Souza G. Utilization of Pap testing among women living with HIV enrolled in primary care in Baltimore, Maryland: A 10-year longitudinal study, 2005-2014. Papillomavirus Res 2018; 6:52-57. [PMID: 30420338 PMCID: PMC6231054 DOI: 10.1016/j.pvr.2018.10.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Revised: 08/03/2018] [Accepted: 10/01/2018] [Indexed: 11/30/2022]
Abstract
Frequent Pap testing is recommended among women living with HIV (WLWH) due to their elevated risk for cervical cancer. However, there are few recent longitudinal evaluations of utilization and determinants of Pap testing among WLWH. Medical and pathology records of WLWH seen at Johns Hopkins Hospital between 2005 and 2014 were assessed using Prentice, Williams, Peterson models. Of 554 WLWH in care for ≥ 18 months, 79% received Pap testing, however only 11% consistently received Pap testing at the recommended interval. Some women (5%) were consistently under-screened (tested at longer intervals) and 21% did not receive any Pap testing at during follow-up. WLWH with decreased likelihood of screening included older women, injection drug users, whites and those who had lived for longer with HIV. In contrast, only women with a prior abnormal Pap result were more likely to receive Pap testing. CD4 cell count and health insurance were not significant determinants. Although many WLWH in care received Pap testing, some WLWH were unscreened or underscreened. Determinants of Pap testing for WLWH include socio-demographic factors and a prior abnormal result; these present potential targets in an urban HIV care setting for closer monitoring and directed interventions to improve utilization among WLWH.
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Affiliation(s)
- Sally Peprah
- Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe Street, E6132B, Baltimore, MD 21205, United States
| | | | - Anne F Rositch
- Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe Street, E6132B, Baltimore, MD 21205, United States
| | | | - Richard Moore
- Johns Hopkins School of Medicine, Baltimore, MD, United States
| | - Gypsyamber D'Souza
- Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe Street, E6132B, Baltimore, MD 21205, United States.
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Shachner TR, Van Meter SE. Metastatic melanoma of the uterine cervix diagnosed on cervical Pap smear: Case report and literature review. Diagn Cytopathol 2018; 46:1045-1049. [PMID: 30354020 DOI: 10.1002/dc.24058] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [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: 05/27/2018] [Revised: 07/15/2018] [Accepted: 07/25/2018] [Indexed: 02/03/2023]
Abstract
Metastatic cancer involving the uterine cervix is exceedingly rare, and accounts for less than 1% of cancer deaths. The cervix is an uncommon location for metastatic lesions due to its limited blood supply and fibrous stroma and metastatic melanoma of the cervix is particularly infrequent. To the best of our knowledge and literature review, there have only been nine reported cases in the literature of metastatic melanoma involving the uterine cervix that were diagnosed via cervicovaginal Pap smears, including the case being reported in this paper. Diagnosing metastatic melanoma on cervicovaginal cytology specimens is challenging, not only because of its rarity, but also because of the inherent ability of melanoma to take on many different cytomorphologic appearances. In such cases, the differential diagnosis may include a high-grade squamous intraepithelial lesion, atypical glandular cells, adenocarcinoma and other poorly differentiated malignancies. We report a case of malignant melanoma to the cervix diagnosed by a routine cervical Pap smear in a young woman who was diagnosed with cutaneous melanoma 3 years prior. Because of the diagnosis rendered on her cervical Pap smear, she was subsequently found to have widespread metastatic disease. Although the cervical Pap smear is primarily intended to screen for squamous intraepithelial lesions, a high index of suspicion must be maintained for other less common entities, particularly when there is no evidence of a squamous intraepithelial lesion.
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Affiliation(s)
- Tracy R Shachner
- Department of Pathology, University of Tennessee Medical Center, Knoxville, Tennessee
| | - Stuart E Van Meter
- Department of Pathology, University of Tennessee Medical Center, Knoxville, Tennessee
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Conrad RD, Liu AH, Wentzensen N, Zhang RR, Dunn ST, Wang SS, Schiffman M, Gold MA, Walker JL, Zuna RE. Cytologic patterns of cervical adenocarcinomas with emphasis on factors associated with underdiagnosis. Cancer Cytopathol 2018; 126:950-958. [PMID: 30351473 PMCID: PMC6231976 DOI: 10.1002/cncy.22055] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Revised: 07/12/2018] [Accepted: 07/30/2018] [Indexed: 11/24/2022]
Abstract
BACKGROUND New cervical cancers continue to be diagnosed despite the success of Papanicolaou (Pap) tests. In an effort to identify pitfalls that limit the diagnosis of adenocarcinoma, the authors reviewed the cytologic characteristics of endocervical adenocarcinomas in their patient population. METHODS Liquid-based cytology slides from 45 women who had concurrent, histologically confirmed cervical adenocarcinomas were reviewed retrospectively and semiquantitatively for 25 key cytologic traits. The original sign-out diagnosis, available clinical findings, and high-risk human papillomavirus (HR HPV) results also were noted. RESULTS Abundant tumor cellularity, nuclear size from 3 to 6 times normal, abundant 3-dimensional tumor cell groups, round cell shape, and cytoplasmic neutrophils characterized the 23 cases that were identified correctly as adenocarcinomas. Key reasons for undercalls included low tumor cellularity and low-grade columnar morphology; these also tended to correlate with low-grade or unusual adenocarcinoma variants on histology. Overall, 73% of adenocarcinomas had a concurrent positive HR HPV test. CONCLUSIONS Most endocervical adenocarcinomas can be diagnosed accurately in cases with classical features, but some cases continue to be problematic when evaluated based on cytologic features alone. Reflex HPV testing may help increase Pap test sensitivity for challenging cases that have atypical glandular cells of undetermined significance. Occasional cases with negative HR HPV test results remain of concern.
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Affiliation(s)
- Rachel D. Conrad
- Department of PathologyUniversity of Oklahoma Health Sciences CenterOklahoma CityOklahoma
| | - Angela H. Liu
- Division of Cancer Epidemiology and GeneticsNational Cancer Institute, National Institutes of HealthBethesdaMaryland
| | - Nicolas Wentzensen
- Division of Cancer Epidemiology and GeneticsNational Cancer Institute, National Institutes of HealthBethesdaMaryland
| | - Roy R. Zhang
- Department of PathologyUniversity of Oklahoma Health Sciences CenterOklahoma CityOklahoma
| | - S. Terence Dunn
- Department of PathologyUniversity of Oklahoma Health Sciences CenterOklahoma CityOklahoma
| | - Sophia S. Wang
- Cancer EtiologyBeckman Institute, City of HopeDuarteCalifornia
| | - Mark Schiffman
- Division of Cancer Epidemiology and GeneticsNational Cancer Institute, National Institutes of HealthBethesdaMaryland
| | - Michael A. Gold
- Division of Gynecologic Oncology, Department of Obstetrics and GynecologyUniversity of Oklahoma Health Sciences CenterOklahoma CityOklahoma
| | - Joan L. Walker
- Division of Gynecologic Oncology, Department of Obstetrics and GynecologyUniversity of Oklahoma Health Sciences CenterOklahoma CityOklahoma
| | - Rosemary E. Zuna
- Department of PathologyUniversity of Oklahoma Health Sciences CenterOklahoma CityOklahoma
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Rojas-Zumaran V, Moya-Salazar J. [The ecologization of the Papanicolaou stain in the diagnosis of cervical cancer]. Rev Med Inst Mex Seguro Soc 2018; 56:217-225. [PMID: 30365481] [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] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Accepted: 01/02/2017] [Indexed: 06/08/2023]
Abstract
BACKGROUND Cervical cancer is the fourth most common cancer worldwide among women. OBJECTIVE To evaluate the implementation and efficiency of the Ecological Papanicolaou staining (Eco-Pap) in exfoliative cytology for the diagnosis of cervical cancer. METHODS A prospective, experimental, cross-sectional research was performed at the Hospital Nacional Docente Madre-Niño “San Bartolomé” during 2015. Three strategies for controlling toxic reagents were used: the use of progressive Harris haematoxylin, polychromatic cytoplasmic solution and direct mounting. Cellular details were analyzed by using the Quality Index Staining, the Bethesda system and the Quality Program for External Evaluation of Cytology. RESULTS We evaluated 72 901 cervical smears stained with Eco-Pap. The validation of Eco-Pap against the standard Papanicolaou staining had very good agreement (kappa = 0.89), showing a sensitivity and specificity of 88.3 and 98.7%, respectively (p < 0.05). The Eco-Pap had a high diagnostic yield and reduced environmental pollution caused by xylene (72 liters), hydrochloric acid and ammonia (each one with six liters), as well as mercury oxide. CONCLUSIONS The Eco-Pap is a new, efficient and innovative method which eliminates the use of toxic-carcinogenic reagents, generating ecological performance in the diagnosis of cervical cancer
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Affiliation(s)
- Víctor Rojas-Zumaran
- Hospital Nacional Docente Madre-Niño San Bartolomé, Servicio de Anatomía Patológica, Área de Citología. Lima, Perú
| | - Jeel Moya-Salazar
- Universidad Continental, Facultad de Ciencias de la Salud. Huancayo, Perú
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Moya-Salazar J, Rojas-Zumaran V. Eco-Pap: The Ecological Modification of the Papanicolaou Stain for Sustainable Cervical Cancer Diagnosis. Acta Cytol 2018; 63:35-43. [PMID: 30352442 DOI: 10.1159/000493113] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [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: 08/07/2018] [Accepted: 08/20/2018] [Indexed: 12/25/2022]
Abstract
OBJECTIVES To validate the ecological modification of the Papanicolaou stain (Eco-Pap) for the diagnosis of cervical cancer. STUDY DESIGN A prospective study was performed at the Mother and Child "San Bartolomé" Hospital, Lima, Peru. Reagent handling strategies were divided into three phases: we used (1) Harris progressive hematoxylin (for nuclear staining), (2) a polychromatic solution (a mix of EA-36/Orange G-6 to suppress the use of several alcohol baths), and (3) direct mounting (with Entellan® solution). The cellular details were analyzed by the staining quality index, an external quality control, and the Bethesda System 2014. RESULTS We evaluated 72,901 cervical smears stained with the Eco-Pap. The validation of the Eco-Pap against the conventional Pap stain was optimal (κ = 0.89; 95% CI: 0.87-0.92), showing a sensibility and specificity of 88.3% (95% CI: 85.1-90.0) and 98.7% (95% CI: 98-99.2), respectively. The Eco-Pap dramatically reduced the environmental pollution caused by 72 L of xylene, hydrochloric acid, and ammonia (6 L each) and mercury oxide. CONCLUSION The Eco-Pap is an innovative and efficient staining method reducing the use of toxic reagents with carcinogenic potential during cervical cancer screening by exfoliative cytology.
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Affiliation(s)
- Jeel Moya-Salazar
- Department of Pathology, Hospital Nacional Docente Madre-Niño San Bartolomé, Lima,
- Faculty of Health Sciences, Universidad Continental, Huancayo,
| | - Víctor Rojas-Zumaran
- Department of Pathology, Hospital Nacional Docente Madre-Niño San Bartolomé, Lima, Peru
- Faculty of Health Sciences, Universidad Continental, Huancayo, Peru
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Kilfoyle KA, Marais ACD, Ngo MA, Romocki L, Richman AR, Barclay L, Brewer NT, Rahangdale L, Smith JS. Preference for Human Papillomavirus Self-Collection and Papanicolaou: Survey of Underscreened Women in North Carolina. J Low Genit Tract Dis 2018; 22:302-310. [PMID: 30179994 PMCID: PMC6174678 DOI: 10.1097/lgt.0000000000000430] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
OBJECTIVES Self-collection of samples for human papillomavirus (HPV) testing (self-collection) has the potential to increase cervical cancer screening among underscreened women. We assessed attitudes toward at-home HPV self-collection compared with clinic-based Pap testing in this higher-risk population. MATERIALS AND METHODS Participants were low-income women in North Carolina overdue for cervical cancer screening. Women self-collected samples at home, returned samples by mail for HPV testing, and completed phone questionnaires about at-home HPV self-collection. Participants were referred to clinic-based Pap testing and invited to complete a second questionnaire about Pap testing. A cross-sectional questionnaire compared attitudes, experiences, and preferences for self-collection versus Pap testing and assessed predictors of preference for HPV self-collection. RESULTS Half (51%) of 221 women reported a preference for HPV self-collection, 19% preferred Pap testing, and 27% reported no preference. More women reported difficulty finding time to do the Pap test (31%) than the self-test (13%, p = .003) and being afraid of the self-test results (50%) than the Pap test results (36%, p = .02). There were relatively fewer reports of physical discomfort and pain from self-collection than Pap testing (discomfort: 18% self; 48% Pap; pain: 8% self; 30% Pap, p = .001). No differences were found in positive versus negative thoughts about the tests, trust in the tests' safety and accuracy, or willingness to do tests again. CONCLUSIONS Overall positive attitudes toward HPV self-collection compared with Pap testing among underscreened women suggest that self-collection is a promising option to increase cervical cancer screening in this high-risk population.
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Affiliation(s)
- Kimberly A. Kilfoyle
- Department of Obstetrics & Gynecology, Cambridge Health Alliance, Cambridge, MA, USA
| | - Andrea C. Des Marais
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - Mai Anh Ngo
- Department of Biostatistics, Synteract, Inc., Morrisville, NC, USA
| | | | | | - Lynn Barclay
- American Sexual Health Association, Research Triangle Park, NC, USA
| | - Noel T. Brewer
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA
| | - Lisa Rahangdale
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA
- Department of Obstetrics & Gynecology, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Jennifer S. Smith
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA
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Tareef A, Song Y, Huang H, Feng D, Chen M, Wang Y, Cai W. Multi-Pass Fast Watershed for Accurate Segmentation of Overlapping Cervical Cells. IEEE Trans Med Imaging 2018; 37:2044-2059. [PMID: 29993863 DOI: 10.1109/tmi.2018.2815013] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
The task of segmenting cell nuclei and cytoplasm in pap smear images is one of the most challenging tasks in automated cervix cytological analysis due to specifically the presence of overlapping cells. This paper introduces a multi-pass fast watershed-based method (MPFW) to segment both nucleus and cytoplasm from large cell masses of overlapping cervical cells in three watershed passes. The first pass locates the nuclei with barrier-based watershed on the gradient-based edge map of a pre-processed image. The next pass segments the isolated, touching, and partially overlapping cells with a watershed transform adapted to the cell shape and location. The final pass introduces mutual iterative watersheds separately applied to each nucleus in the largely overlapping clusters to estimate the cell shape. In MPFW, the line-shaped contours of the watershed cells are deformed with ellipse fitting and contour adjustment to give a better representation of cell shapes. The performance of the proposed method has been evaluated using synthetic, real extended depth-of-field, and multi-layers cervical cytology images provided by the first and second overlapping cervical cytology image segmentation challenges in ISBI 2014 and ISBI 2015. The experimental results demonstrate superior performance of the proposed MPFW in terms of segmentation accuracy, detection rate, and time complexity, compared with recent peer methods.
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Al-Awadhi R, Al-Shaheen A, Al-Juwaiser A, George SS, Sharma P, Kapila K. Prevalence of Infectious Organisms Observed in Cervical Smears Between 1997-2014 at Mubarak Al-Kabeer Hospital, Kuwait. Sultan Qaboos Univ Med J 2018; 18:e324-e328. [PMID: 30607273 PMCID: PMC6307630 DOI: 10.18295/squmj.2018.18.03.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 10/30/2017] [Revised: 01/24/2018] [Accepted: 03/25/2018] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES This study aimed to examine gynaecological infectious agents observed in conventional and modified Papanicolaou cervical smears (CS) at a tertiary care hospital in Kuwait. METHODS This retrospective study analysed 121,443 satisfactory CS samples collected between 1997-2014 at the Mubarak Al-Kabeer Hospital, Kuwait. Conventional CS samples were obtained between 1997-2005, while modified CS were obtained between 2006-2014 following the introduction of ThinPrep® testing (Hologic Corp., Bedford, Massachusetts, USA). All samples were initially screened by cytoscreeners before being analysed by cytopathologists to determine the presence of specific infectious agents. RESULTS Overall, 8,836 (7.28%) of the cervical samples had infectious agents; of these, 62.48% were conventional and 37.52% were modified CS samples. The most frequently observed infectious agents were Candida species (76.05%), Trichomonas vaginalis (9.72%), human papillomavirus (HPV; 9.3%), Actinomyces-like organisms (3.23%), Chlamydia trachomatis (1.27%) and the herpes simplex virus (HSV; 0.43%). There were significantly more cases of Candida species, HPV-associated changes, C. trachomatis, T. vaginalis and Actinomyces-like organisms detected in conventional compared to modified CS samples (P <0.050 each). However, there was no statistically significant difference in the frequency of HSV-associated changes (P = 0.938). The presence of two infectious agents in the same sample was identified in 0.87% of samples. CONCLUSION Among CS samples collected during an 18-year period, Candida species were most frequently detected, followed by T. vaginalis and HPV. The identification of potential infectious agents is a valuable additional benefit of Papanicolaou smear testing.
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Affiliation(s)
- Rana Al-Awadhi
- Department of Medical Laboratory Sciences, Faculty of Allied Health Sciences, Kuwait University, Kuwait
| | | | | | - Sara S. George
- Department of Pathology, Faculty of Medicine, Kuwait University, Kuwait
| | - Prem Sharma
- Department of Research & Biostatistics Unit, Faculty of Medicine, Kuwait University, Kuwait
| | - Kusum Kapila
- Department of Pathology, Faculty of Medicine, Kuwait University, Kuwait
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Afiuni-Zadeh S, Boylan KLM, Jagtap PD, Griffin TJ, Rudney JD, Peterson ML, Skubitz APN. Evaluating the potential of residual Pap test fluid as a resource for the metaproteomic analysis of the cervical-vaginal microbiome. Sci Rep 2018; 8:10868. [PMID: 30022083 PMCID: PMC6052116 DOI: 10.1038/s41598-018-29092-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Accepted: 07/04/2018] [Indexed: 01/30/2023] Open
Abstract
The human cervical-vaginal area contains proteins derived from microorganisms that may prevent or predispose women to gynecological conditions. The liquid Pap test fixative is an unexplored resource for analysis of microbial communities and the microbe-host interaction. Previously, we showed that the residual cell-free fixative from discarded Pap tests of healthy women could be used for mass spectrometry (MS) based proteomic identification of cervical-vaginal proteins. In this study, we reprocessed these MS raw data files for metaproteomic analysis to characterize the microbial community composition and function of microbial proteins in the cervical-vaginal region. This was accomplished by developing a customized protein sequence database encompassing microbes likely present in the vagina. High-mass accuracy data were searched against the protein FASTA database using a two-step search method within the Galaxy for proteomics platform. Data was analyzed by MEGAN6 (MetaGenomeAnalyzer) for phylogenetic and functional characterization. We identified over 300 unique peptides from a variety of bacterial phyla and Candida. Peptides corresponding to proteins involved in carbohydrate metabolism, oxidation-reduction, and transport were identified. By identifying microbial peptides in Pap test supernatants it may be possible to acquire a functional signature of these microbes, as well as detect specific proteins associated with cervical health and disease.
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Affiliation(s)
- Somaieh Afiuni-Zadeh
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, MN, USA
| | - Kristin L M Boylan
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, MN, USA
| | - Pratik D Jagtap
- Department of Biochemistry, Molecular Biology and Biophysics, University of Minnesota, Minneapolis, MN, USA
- Center for Mass Spectrometry and Proteomics, University of Minnesota, Minneapolis, MN, USA
| | - Timothy J Griffin
- Department of Biochemistry, Molecular Biology and Biophysics, University of Minnesota, Minneapolis, MN, USA
- Center for Mass Spectrometry and Proteomics, University of Minnesota, Minneapolis, MN, USA
| | - Joel D Rudney
- Department of Diagnostic and Biological Sciences, School of Dentistry, University of Minnesota, Minneapolis, MN, USA
| | | | - Amy P N Skubitz
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, MN, USA.
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Andersson S, Belkić K, Mints M, Östensson E. Is self-sampling to test for high-risk papillomavirus an acceptable option among women who have been treated for high-grade cervical intraepithelial neoplasia? PLoS One 2018; 13:e0199038. [PMID: 29912903 PMCID: PMC6005489 DOI: 10.1371/journal.pone.0199038] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Accepted: 05/30/2018] [Indexed: 11/25/2022] Open
Abstract
Objective Self-sampling to test for high risk human papilloma virus (HPV) is becoming an increasingly important component of cervical cancer screening. The aim of this observational study is to examine how women treated for high-grade cervical intraepithelial neoplasia (CIN) view HPV self-sampling. Methods Invited to participate in the present study were patients who had undergone treatment of high-grade CIN (grade 2 or higher) and were followed-up at 6-months at the Karolinska University Hospital, Stockholm. The participants were instructed as to how to perform HPV self-sampling. Thereafter, the participants completed a questionnaire about HPV self-sampling and other cervical cancer screening methods, as well as about self-perceived risk of cervical cancer without regular gynecologic follow-up and about specific knowledge regarding HPV, CIN and cervical cancer. Results Altogether 479 women enrolled in this study. The participation rate was 96.6%. Nearly 75% of the participants stated they would consider performing the HPV self-sampling prior to their next gynecologic follow-up. Confidence in HPV self-sampling was a significant independent predictor of willingness to perform HPV self-sampling. However, confidence in HPV self-sampling was significantly lower than confidence in Papanicolaou smears and in HPV testing with samples collected by health professionals. Higher specific knowledge about HPV, CIN and cervical cancer was also a significant independent predictor of willingness to perform HPV self-sampling, as was having travelled longer distance to attend gynecologic follow-up. Participants with lower income and without completed university education expressed significantly higher confidence in HPV self-sampling and lower confidence in Papanicolaou smears than the other women. Conclusions To the best of our knowledge, this is the first study to examine the views of women treated for high-grade CIN vis-à-vis HPV self-sampling. The latter is an acceptable option for the vast majority of this cohort of women.
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Affiliation(s)
- Sonia Andersson
- Department of Women’s and Children’s Health, Karolinska Institute, Stockholm, Sweden
| | - Karen Belkić
- Department of Women’s and Children’s Health, Karolinska Institute, Stockholm, Sweden
- Department of Oncology-Pathology, Karolinska Institute, Stockholm, Sweden
- School of Community and Global Health, Claremont Graduate University, Claremont, California, United States of America
- Institute for Prevention Research, Keck School of Medicine, University of Southern California, Alhambra, California, United States of America
| | - Miriam Mints
- Department of Women’s and Children’s Health, Karolinska Institute, Stockholm, Sweden
| | - Ellinor Östensson
- Department of Women’s and Children’s Health, Karolinska Institute, Stockholm, Sweden
- Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden
- * E-mail:
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48
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Tello-Mijares S, Bescós J. Region-based multifocus image fusion for the precise acquisition of Pap smear images. J Biomed Opt 2018; 23:1-9. [PMID: 29752797 DOI: 10.1117/1.jbo.23.5.056005] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Accepted: 04/20/2018] [Indexed: 06/08/2023]
Abstract
A multifocus image fusion method to obtain a single focused image from a sequence of microscopic high-magnification Papanicolau source (Pap smear) images is presented. These images, captured each in a different position of the microscope lens, frequently show partially focused cells or parts of cells, which makes them unpractical for the direct application of image analysis techniques. The proposed method obtains a focused image with a high preservation of original pixels information while achieving a negligible visibility of the fusion artifacts. The method starts by identifying the best-focused image of the sequence; then, it performs a mean-shift segmentation over this image; the focus level of the segmented regions is evaluated in all the images of the sequence, and best-focused regions are merged in a single combined image; finally, this image is processed with an adaptive artifact removal process. The combination of a region-oriented approach, instead of block-based approaches, and a minimum modification of the value of focused pixels in the original images achieve a highly contrasted image with no visible artifacts, which makes this method especially convenient for the medical imaging domain. The proposed method is compared with several state-of-the-art alternatives over a representative dataset. The experimental results show that our proposal obtains the best and more stable quality indicators.
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Affiliation(s)
- Santiago Tello-Mijares
- Universidad Autónoma de Madrid, Escuela Politécnica Superior, Video Processing and Understanding Lab, Spain
- Instituto Tecnológico Superior de Lerdo, Department of Postgraduate, Lerdo, Mexico
| | - Jesús Bescós
- Universidad Autónoma de Madrid, Escuela Politécnica Superior, Video Processing and Understanding Lab, Spain
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Traynor D, Duraipandian S, Martin CM, O'Leary JJ, Lyng FM. Improved removal of blood contamination from ThinPrep cervical cytology samples for Raman spectroscopic analysis. J Biomed Opt 2018; 23:1-8. [PMID: 29729092 DOI: 10.1117/1.jbo.23.5.055001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Accepted: 04/16/2018] [Indexed: 06/08/2023]
Abstract
There is an unmet need for methods to help in the early detection of cervical precancer. Optical spectroscopy-based techniques, such as Raman spectroscopy, have shown great potential for diagnosis of different cancers, including cervical cancer. However, relatively few studies have been carried out on liquid-based cytology (LBC) pap test specimens and confounding factors, such as blood contamination, have been identified. Previous work reported a method to remove blood contamination before Raman spectroscopy by pretreatment of the slides with hydrogen peroxide. The aim of the present study was to extend this work to excessively bloody samples to see if these could be rendered suitable for Raman spectroscopy. LBC ThinPrep specimens were treated by adding hydrogen peroxide directly to the vial before slide preparation. Good quality Raman spectra were recorded from negative and high grade (HG) cytology samples with no blood contamination and with heavy blood contamination. Good classification between negative and HG cytology could be achieved for samples with no blood contamination (sensitivity 92%, specificity 93%) and heavy blood contamination (sensitivity 89%, specificity 88%) with poorer classification when samples were combined (sensitivity 82%, specificity 87%). This study demonstrates for the first time the improved potential of Raman spectroscopy for analysis of ThinPrep specimens regardless of blood contamination.
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Affiliation(s)
- Damien Traynor
- Dublin Institute of Technology (DIT), Focas Research Institute, DIT Centre for Radiation and Environ, Ireland
| | - Shiyamala Duraipandian
- Dublin Institute of Technology (DIT), Focas Research Institute, DIT Centre for Radiation and Environ, Ireland
| | - Cara M Martin
- Coombe Women and Infants University Hospital, Department of Pathology, Dublin, Ireland
| | - John J O'Leary
- Coombe Women and Infants University Hospital, Department of Pathology, Dublin, Ireland
| | - Fiona M Lyng
- Dublin Institute of Technology (DIT), Focas Research Institute, DIT Centre for Radiation and Environ, Ireland
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50
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Rerucha CM, Caro RJ, Wheeler VL. Cervical Cancer Screening. Am Fam Physician 2018; 97:441-448. [PMID: 29671553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Screening in women has decreased the incidence and mortality of cervical cancer. Precancerous cervical lesions (cervical intraepithelial neoplasias) and cervical carcinomas are strongly associated with sexually-transmitted high-risk human papillomavirus (HPV) infection, which causes more than 99% of cervical cancers. Screening methods include cytology (Papanicolaou test) and HPV testing, alone or in combination. The American Academy of Family Physicians and the U.S. Preventive Services Task Force recommend starting screening in immunocompetent, asymptomatic women at 21 years of age. Women 21 to 29 years of age should be screened every three years with cytology alone. Women 30 to 65 years of age should be screened every five years with cytology plus HPV testing or every three years with cytology alone. Screening is not recommended for women younger than 21 years or in women older than 65 years with an adequate history of negative screening results. The U.S. Preventive Services Task Force is in the process of updating its guidelines. In 2015, the American Society for Colposcopy and Cervical Pathology and the Society of Gynecologic Oncology published interim guidance for the use of primary HPV testing.
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Affiliation(s)
| | - Rebecca J Caro
- Bassett Army Community Hospital, Fort Wainwright, AK, USA
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