Application Analysis of High Risk HPV Detection Combined with Cervical Cytology, Colposcopy and Pathology in Cervical Lesions of Women in Tiandeng County

Purpose: To understand the application of high-risk HPV detection combined with cervical cytology, colposcopy and pathology in cervical lesions of women in Tiandeng County. Method: Women in the outpatient and inpatient departments of our hospital from January 2021 to October 2022 were collected for high-risk HPV testing, TCT, colposcopy and pathological examination according to their personal wishes, to understand the application of relevant examinations in cervical lesions. Result: In 2021, the number of patients was 5801, among whom 1743 patients had received cervical cancer examination in the past, accounting for 30.05% of the total number of patients, and 5795 who had volunteered for TCT examination this time, accounting for 99.90% of the total;A total of 289 cases of atypical squamous cells with unclear significance (ASC-US) were detected, excluding 11 cases of high-grade squamous intraepithelial lesions (ASC-H), 122 cases of low-grade squamous intraepithelial lesions (LSIL), 16 cases of high-grade squamous intraepithelial lesions (HSIL), 2 cases of squamous cell carcinoma (SCC), and 4 cases of atypical adenocyte (AGC);Atypical cervical adenocytosis and cervical carcinoma in situ were not detected. The number of people who volunteered for high-risk HPV testing was 4237, and the number of positive cases was 740, accounting for 17.47% of the screening population;Among 740 HPV-positive patients, 488 high-risk HPV-positive patients were selected for TCT examination, and 87 patients were found to be TCT positive;From 401 high-risk HPV-positive and TCT negative patients, 287 patients with possible lesions were screened out for colposcopy;The results showed that 60 patients may have certain cervical lesions and need further pathological examination and the results showed that 28 patients had CTN1 and 18 patients had CIN2 - 3. In 2022, 8840 patients received medical treatment, among which 3188 patients had received cervical cancer examination in the past, accounting for 36.06% of the total number of patients, and 8314 patients voluntarily underwent TCT examination, accounting for 94.05% of the total number of patients. 434 cases of atypical squamous cells with ambiguous meaning (ASC-US) were detected, excluding 13 cases of high-grade squamous intraepithelial lesions (ASC-H), 217 cases of low-grade squamous intraepithelial lesions (LSIL), 35 cases of high-grade squamous intraepithelial lesions (HSIL), 1 case of squamous cell carcinoma, and 4 cases of atypical adenocarcinoma (AGC);Atypical cervical adenocytosis and cervical carcinoma in situ were not detected. The number of volunteers for high-risk HPV testing was 3871 cases, and the number of positive cases was 654 cases, accounting for 16.89% of the screening number. 527 high-risk HPV-positive patients were selected from 654 HPV-positive patients for TCT examination, and the number of TCT-positive patients was found to be 49. From 478 high-risk HPV-positive patients with TCT negative, 276 patients with possible lesions were screened out for colposcopy;The results showed that 66 patients may have certain cervical lesions and need further pathological examination;and then the results showed that 31 cases of CTN1 and 6 cases of CIN2 - 3. Conclusion: Gynecological high-risk HPV examination can provide better etiological sources for cervical cancer screening;Cervical cytology examination has high sensitivity;Colposcopy examination has high specificity;Pathological examination can be used as an effective supplement for cervical cytology examination and colposcopy;So high-risk HPV combined with cytology examination, colposcopy examination and pathological examination has high clinical application value;It is worth popularizing and applying.

Study of Prevalence of Abnormal Cervical Cytology in Al-Shatby Maternity University Hospital

Introduction: Cervical cancer is the most common cause of preventable cancer related deaths;cervical cancer has a long pervasive phase (cervical dysplasia);the prevalence of cervical dysplasia varies according to the socioeconomic characteristics and geographic areas of the population studied. Low-grade lesions regress spontaneously in a significant number of patients, while high grade lesions will progress to an invasive cancer if left untreated. Cervical cancer screening is an important component of the World Health Organization (WHO) strategy for combating cervical cancer. The incidence and prevalence of cervical cancer has reduced remarkably over the last three decades in developed countries where there are effective, well-coordinated screening programs, and treatment of cervical dysplasia, while in developing countries it has been increasing and has constituted major health problems among women where there are no well-coordinated and effective screening programs, also resources are very low and no insurance can cover this programs. Aim of the work: The aim is to assess the prevalence of abnormal cervical cytology in Al Shatby Maternity University Hospital patients using Pap smear. Materials and methods: Inclusion criteria: 1) Married woman from 3 years or more;2) Women age from 21 to age 65 years. Exclusion criteria: 1) Previously known cervical cancer patient;2) Virgin females;3) Woman with active vaginal bleeding. Results: 83% of patients were -ve intraepithelial neoplasia {37.7% was normal cytology and 45.3% was inflammatory}. 17% was +ve intraepithelial neoplasia (abnormal cytology), {11.1% ASCUS, 2.9% LSIL, 1.3% HSIL, 1.1% ASC-H, 0.3% AGS-NO, 0.3% AGS-Favour Neoplastic}. Prevalence of abnormal cervical cytology in age group less than30 years was 8.4% which is lower than prevalence in the middle age group which was 19.9%. Prevalence of abnormal cervical cytology in women with normal vaginal delivery was higher than those with caesarean delivery. 39.8% of our patients were passive and active smokers 61.2% of their Pap smear was abnormal cytology. 78.9% of abnormal cytology was among patients from low socioeconomic class (rural areas). Abnormal cervical cytology in patients with high parity was 69% which is higher than abnormality found in lower parity. 60.2% of abnormal cervical cytology was in patients who became sexually active before age of 20 years. Prevalence of abnormal cervical cytology was higher in patients with multiple sexual partners (56.5%) than patients with single sexual partner (13.3%). Conclusion: Cervical cytology remains the gold standard for cervical cancer screening and the use of Bethesda system is a simple and accurate method for diagnosis and management of cases with abnormal cervical cytology.

Asymptomatic Bacterial Vaginosis in Cervical Cytology: A Preliminary Report of Incidental Finding in Routine Cervical Cancer Screening

Background: Bacterial vaginosis is a complex pathogenic group of bacteria which can cause a wide range of symptoms in affected women in Obstetric and Gynaecological practice. Its occurrence usually indicates alteration in the normal vaginal flora expected in majority of the women of reproductive age. Amongst the maintenance agents of the vaginal health, lactobacilli occupy a prominent place. Asymptomatic bacterial vaginosis is postulated to be linked to the development of cervical intraepithelial neoplasia by some researchers while some differ in this regard. Objective: To determine the rate of occurrence of asymptomatic bacterial vaginosis and associated factors in women who underwent cervical cytology for cervical cancer screening. Study Design: A cross sectional study involving microscopic examination of cervical smears of eligible clients presenting for routine Pap smear. Setting: The study was carried out in a well woman’s facility established and manned by female medical doctors in Enugu state with the assistance of trained nursing staff. Various female cancers and other communicable and non-communicable disease screening are performed at the centre. The services are available to the general public including various parts of the state and other nearby states. Methods: This preliminary study was carried out on women presenting for cervical cancer screening between February and July 2018 in a well woman’s centre in Enugu. Information on the socio-demographic and gynaecological history of the study participants were obtained and recorded in designated proformas. Smears that showed changes suggestive of bacterial vaginosis on microscopy were set aside for further evaluation. Such changes included: a conspicuous absence of normal flora of lactobacilli;filmy background of coccobacilli replacing the lactobacilli, individual squamous cells covered by a layer of bacteria (clue cells);viable squamous cells showing reactive changes identified as increased nuclear size, perinuclear halo and binucleation. Data entry and analysis were done using statistical package for social sciences (SPSS) computer software version 21.0. Results: 285 eligible women had cervical smear done during the first six months of the 2-year project at the centre. 50.9% were above reproductive age (>45 years), 38.2% were in second half of reproductive age (31 - 45), 10.9% were in the early reproductive age (15 - 30). 13% of the women were nulliparous, 51.9% were para 1 - 4, and 35.1% were grand multiparous. Of the 285 Pap smear slides viewed, 31 had bacterial vaginosis by the above criteria. This gave a prevalence of 10.8% in the reviewed cytological smears. There was an association of bacterial vaginosis with reproductive age. There was however, no association with age at coitarche and parity. There was also, no association of bacterial vaginosis with contraceptive use. There was no association between abnormal cervical cytology and asymptomatic bacterial vaginosis with absent lactobacilli. Conclusion: Prevalence of bacterial vaginosis is significant in our study population who were asymptomatic. Cervical smear should be taken advantage of as a tool for both cervical pre-cancer and bacterial vaginosis screenings since same sample can simultaneously be used for both conditions during cytology. Bacterial vaginosis may be unlikely involved in pathogenesis of cervical intraepithelial neoplasia. Recommendation: Researchers should harmonise the standards/criteria for the diagnosis of bacterial vaginosis because there are varied criteria for the diagnosis in the literature. Given, the dual advantage of pap smear in diagnosing cervical pre cancer stages and infections, more elaborate studies are needed to determine the usefulness of treatment or otherwise of bacterial vaginosis which constitutes significant incidental findings.

A Study on Clinical Management of Glandular Changes in Cells on Cervical Cytology

A cytological cervical smear abnormality of glandular origin raises a high suspicion of underlying invasive or pre invasive cancers. Objective: To look into the diagnosis and management of women presenting with glandular changes on cervical cytology and to further implement a good management plan for these women. Methods: This study is a retrospective review of all patients referred to North Cumbria Integrated Care (NCIC) NHS foundation trust, United Kingdom with glandular changes on their cervical smear result between January 2015 and December 2020. Data was collected from the hospital colposcopy data base. Results: This study comprised of a sample size of 65 women. 11 of these (17%) were referred with borderline changes in their endocervical cells and 54 (83%) referred with a ?glandular neoplasia of endocervical type. There were colposcopically significant lesions (high grade lesions or suspected adenocarcinoma) for 52 (80%) of the women. All but one (98%) had Large loop excition of transformation zone (LLETZ) after colposcopy. Histologically, 8 (12%) women were diagnosed with adenocarcinoma, 29 (45%) were diagnosed with high grade cervical glandular intraepithelial neoplasia (HGCGIN), 9 (14%) had high grade cervical intraepithelial neoplasia (CIN2/3), 2 (3%) had low grade cervical glandular intraepithelial neoplasia (LGCGIN), 4 (6%) had a normal histology and 10 (15%) had lesions of mixed origin. After their first LLETZ treatment, 24 (37.5%) needed repeat LLETZ, 8 (12%) had a hysterectomy and one woman had radical trachelectomy.

Guidelines for cervical cancer screening in China

In response to the incidence of cervical intraepithelial neoplasia and cervical cancer in China and global screening strategies,a collaborative effort was undertaken by seven Chinese medical associations to develop this guideline for cervical cancer screening.The guideline recommends high-risk human papillomavirus(hr-HPV)testing as the preferred method for primary screening,which should have been approved by authoritative institutions and clinically validated for primary screening.In areas without access to HPV testing,cytology can be used as an alternative.However,it is recommended to replace cytology with HPV-based screening as conditions permit.Cotesting(HPV testing in combination with cytology)is recommended for areas with sufficient medical resources,opportunistic screening populations,and partial special populations.The guideline recommends that individuals with a cervix initiate cervical cancer screening at the age 25 years and undergo HPV testing alone or cotesting every five years,or cytology alone every three years.Women over the age of 65 who have had documented adequate negative prior screening in the past may terminate screening.Corresponding screening programs are proposed for different special populations.The development of these guidelines is an important step in the effort to eliminate cervical cancer in China.