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 inpatien...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.展开更多
Objective:To evaluate the efficiency of p16/Ki-67 dual stain used as a triage in cervical cancer screening.Methods:In this study,we did 468 p16/Ki-67 dual stain in human papillomavirus(HPV)16/18-positive or 12 other h...Objective:To evaluate the efficiency of p16/Ki-67 dual stain used as a triage in cervical cancer screening.Methods:In this study,we did 468 p16/Ki-67 dual stain in human papillomavirus(HPV)16/18-positive or 12 other high-risk HPV(OHR-HPV)positive Thinprep cytologic test(TCT)atypical squamous cells of undetermined significance(ASCUS)/lower-grade squamous intraepithelial lesion(LSIL)women.We evaluated the sensitivity,specificity,positive predictive value(PPV)and negative predictive value(NPV)of the triage test.Results:The sensitivity,specificity,PPV and NPV of p16/Ki-67 dual stain in HPV 16/18-positive women were91.5%/68.4%,77.0%/75.0%,73.9%/59.1%and 92.8%/81.8%.In 12 OHR-HPV positive TCT ASCUS/LSIL women,the results were 79.1%/95.0%,88.5%/66.7%,88.5%/70.4%and 89.2%/94.1%.The risk of precancerous lesions in p16/Ki-67 dual stain positive cases was much higher than before,and the negative cases had lower risk.Besides,there was no cervical intraepithelial neoplasia(CIN)III case missed after triaged by p16/Ki-67 dual-stained cytology.In p16/Ki-67 dual-stained cytology positive women with benign pathology or CIN I,the 1-year progression rate is 20.5%and in p16/Ki-67 dual-stained cytology negative women,the 1-year progression rate is5.6%.Conclusions:hr-HPV genotyping test plays an important role in cervical cancer screening.p16/Ki-67 dual stain may be a promising triage test.As for chronic cervicitis or CIN I patients,a positive p16/Ki-67 dual-stained cytology suggests a high risk in progression and need to be followed up closely.展开更多
Objectives: To evaluate the sensitivity and accuracy of the HPV DNA test in conjunction with thin prep cytology test as a screening method of human papillomavirus (HPV) infection. To study either the cervical erosion ...Objectives: To evaluate the sensitivity and accuracy of the HPV DNA test in conjunction with thin prep cytology test as a screening method of human papillomavirus (HPV) infection. To study either the cervical erosion is related to high risk HPV infection or to determine the mean age distribution that is more prone to HPV infection. Material and Methods: The study is a retrospective cohort implemented to determine the real performance of liquid based medium and HPV DNA testing combined in second clinical hospital of Jilin University Changchun, China. The study group included total 150 patients from January 1, 2011 to December 30, 2012. A computerized search identified patients with thin prep test results and high risk HPV DNA testing during a 2-year period was recruited. The patients were chosen after proper speculum examination followed by thin prep cytology (TCT) and HPV DNA test. Cytologic specimens were obtained with endocervical brush, which was rinsed into the vial of Cytyc. The residual samples after the cytology report were taken for reflex HPV DNA test. The manufacture protocol was followed for HPV DNA testing using Hybrid Capture II. Colposcopic biopsy was performed for the diagnosis purpose, in patients who had atypical squamous cells of undeter-mined significance (AUS-US), low grade intraepithelial lesion (LSIL) or high-grade intraepithelial lesion (HSIL) in cytology and with positive results of highrisk HPV DNA. The diagnostic criteria were based on the Bethesda System (TBS). Findings: The high risk HPV positive women with abnormal cytology had a CIN I risk of 73 (86%), whereas 35 (23.3%) high-risk HPV positive women out of 109 (72.7%) normal cytology who underwent histological biopsy had CIN I 16 (10.7%). The risk for cervical intraepithelial neoplasia (CIN) in women with high-risk HPV positive with normal cytology was higher among women invited for the first time 31 - 40 years of age 12 (8%) than among older women 1 (0.7%). Out of 44 (29.3%) women who had I degree erosion with 6 (14%) positive HPV DNA test 38 (86%) had a normal histology biopsy showing no statically significant between them. Conclusion: The data confirm that HR-HPV DNA testing is much more sensitive than cytology alone and that HPV DNA testing helps in identifying women with high risk of serious cervical disease in an efficient and medically acceptable manner. The other most significant advantage of this cervical cancer screening method is that women who are HPV DNA positive can easily and quickly referred for colposcopic examination (within one year), which could identify the precancerous and cancer stage. And those who are HPV DNA negative can safely have much longer screening intervals saving considerable costs. With mean age being 38 ± 10 years, age older than 30 years should undergo HPV DNA testing with cytology triage in primary screening. But in woman younger than 30 years using HPV DNA assay, as an initial screening step can increase the prevalence of abnormal smears and the positive predictive value of HPV followed by TCT. However, close follow-up is essential if the initial biopsy is negative because a considerable number of women may have HPV infection positive in subsequent studies.展开更多
OBJECTIVE: To reduce false-negative rates of population based cervical screening programs employing conventional cytology in combination with automated DNA image cytometer. METHODS: Involved cervical samples from a to...OBJECTIVE: To reduce false-negative rates of population based cervical screening programs employing conventional cytology in combination with automated DNA image cytometer. METHODS: Involved cervical samples from a total of 3603 women were taken by a cervix brush and then placed into a fixative solution. The cells were separated from mucus by mechanical and chemical treatment after which they were deposited onto microscope slides by a cytospin. Two slides were prepared from each case;one slide was stained by Papanicolaou stain for conventional cytology examination, while the other slide was stained by a DNA specific and stoichiometric stain. The latter slide was used to determine the relative amount of DNA in the cell nuclei in order to assess the ploidy status of the epithelial cells. Enrolled in the study, 157 women were followed by colposcopy examination where punch biopsies were taken from the visible lesions or from suspicious areas. The results of the conventional cytology were then compared to the DNA image cytometer for all samples. RESULTS: Histopathology diagnosed 51 lesions from the 132 biopsied cases as CIN2 or higher, including 27 CIN2, 16 CIN3 and 8 invasive cancers. Conventional cytology correctly identified 29 of the 51 high grade CIN and in-vasive cancer, while DNA image cytometer correctly identified 38 high grade CIN and invasive cancer using the crite-rion that at least three cells were found on the slide that contained DNA amount in excess of 5c. 42 out of 51 high grade CIN and invasive cancer were found by conventional cytology in combination with DNA image cytometer. Sensitivities were 56.8%, 74.5% and 82.4%, while specificities were 86.2%, 81.5% and 81.5% in conventional cytology, DNA image cytometer and combination both cytology and DNA image cytometer respectively. CONCLUSION: The study demon-strated that screening for high grade neoplastic lesions and cervical cancer by DNA image cytometer or combination of conventional cytology and DNA image cytometer is more sensitive than conventional screening approach.展开更多
Background: The detection of vaginal intraepithelial neoplasia (VAIN) in cervical samples is not a common finding. Therefore, we aimed to report VAINs detected in liquid-based cytology (LBC) from women examined at Hos...Background: The detection of vaginal intraepithelial neoplasia (VAIN) in cervical samples is not a common finding. Therefore, we aimed to report VAINs detected in liquid-based cytology (LBC) from women examined at Hospital das Clínicas of Faculty of Medicine, Sao Paulo State University. Materials and Methods: We evaluated LBC samples from women referred to gynecology examination for different reasons (previous abnormal PapTest, follow up of treated cervical lesion, ecc) and women examined for regular screening proposals, and compared with biopsy diagnoses, including the controversial diagnoses of vaginal intraepithelial neoplasia (VAIN). Results: From 1866 patients, 1423 (76.3%) cases were negative and 443 (23.7%) were positive for any cellular alteration. Age of patients ranged from 12 to 86 years. We detected 25 histologically confirmed VAIN (1.3% p = 0.0002 by Fisher’s exact test IC 95% 0.0090 - 0.0198) and 1.1% VAIN (p = 0.0031 by Fisher’s exact test IC 95% 0.0077 - 0.0179). Conclusion: The identification of VAIN in routine is feasible;the professionals involved with cytological examination should be aware of these lesions in Pap test samples.展开更多
Introduction: Cervical cancer is the most common cause of preventable cancer<span style="font-family:;" "=""><span style="font-family:Verdana;"> related deaths;cervical c...Introduction: Cervical cancer is the most common cause of preventable cancer<span style="font-family:;" "=""><span style="font-family:Verdana;"> related deaths;cervical cancer has a long pervasive phase (cervical dysplasia);the prevalence of cervical dysplasia varies according to the socioeconomic </span><span style="font-family:Verdana;">characteristics and geographic areas of the population studied. Low-grade</span><span style="font-family:Verdana;"> 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 </span><span style="font-family:Verdana;">women where there are no well-coordinated and effective screening pro</span><span style="font-family:Verdana;">grams, 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 -</span></span><span style="font-family:;" "=""><span><span style="font-family:Verdana;">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% </span><span style="font-family:Verdana;">of abnormal cytology was among patients from low socioeconomic class (rural</span> <span style="font-family:Verdana;">areas). Abnormal cervical cytology in patients with high parity was 69% which</span><span style="font-family:Verdana;"> 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.</span></span></span>展开更多
Objectives: To evaluate the predictive value of cervical intraepithelial neoplasia (CIN)III/ carcinoma in situ (CIS) by correlating analysis between abnormal cervical cytologic findings and pathological diagnosis of v...Objectives: To evaluate the predictive value of cervical intraepithelial neoplasia (CIN)III/ carcinoma in situ (CIS) by correlating analysis between abnormal cervical cytologic findings and pathological diagnosis of vaginoscopic biopsies or conization.Methods: Routine cervical cytology screening was performed in 31,634 cases by fluid-based thin-layer method (ThinPrep cytology test, TCT), 948 patients had both abnormal squamous cell appearance by TCT and pathological diagnosis of vaginoscopic biopsies and /or cervical conization. The predictive value of CINIII/CIS were studied retrospectively by correlating analysis of different cytology abnormalities and pathology diagnosis.Results: Cytologically, 1,260 out of 31,634 TCT tests showed abnormal squamous cells appearance, including atypical squamous cell of undetermined significance (ASCUS) 675 cases(2.13%), low squamous intraepithelial lesion (L-SIL) 379 cases(1.20%), high squamous intraepithelial lesion (H-SIL)176 cases(0.56%),cancer 30 cases (0.09%). Among 948 patients with pathological diagnosis, there were CINII-III in 70 cases(7.38%) and CINIII/CIS in 56 cases.(5.91%). The relative risks (RR) of different precancerous TCT results in predicting CIN III/CIS validated by pathology are as follow: AUSCUS 14.7% (95% confidence interval (CI) 8.0-27.0), Lsil 13.9% (95% CI 6.3-30.9), Hsil 126.1 (95% CI 60.6-218.6). The RR of AUSCUS group is not significantly different from that of L-SIL group(P =0.951). However, the RR of CINⅢ/CIS morbidity between the H-SIL or cancer group and the ASCUS or L-SIL group are significantly different (all P value <0.01).Conclusion: Vaginoscopic biopsy could verify pathological CINⅡ-Ⅲ and CINⅢ/CIS from cases with abnormal TCT results. There is significantly greater risk of being CINⅢ/CIS validated by vaginoscopic biopsy in the H-SILpatients,while ASCUS and L-SIL group have the coequal risk.展开更多
<strong>Background:</strong><span style="font-family:Verdana;"> Bacteria</span><span style="font-family:Verdana;">l</span><span style="font-family:;"...<strong>Background:</strong><span style="font-family:Verdana;"> Bacteria</span><span style="font-family:Verdana;">l</span><span style="font-family:;" "=""><span style="font-family:Verdana;"> 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. </span><b><span style="font-family:Verdana;">Objective: </span></b><span style="font-family:Verdana;">To determine the rate of occurrence of asymptomatic bacterial vaginosis and associated factors in women who underwent cervical cytology for cervical cancer screening. </span><b><span style="font-family:Verdana;">Study Design</span></b><span style="font-family:Verdana;">: A cross sectional study involving microscopic examination of cervical smears of eligible clients presenting for routine Pap smear. </span><b><span style="font-family:Verdana;">Setting: </span></b><span style="font-family:Verdana;">The study was carried out in a </span></span><span style="font-family:Verdana;">well</span><span style="font-family:Verdana;"> 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</span><span style="font-family:Verdana;">-</span><span style="font-family:;" "=""><span style="font-family:Verdana;">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. </span><b><span style="font-family:Verdana;">Methods: </span></b><span style="font-family:Verdana;">This preliminary study was carried out on women presenting for cervical cancer screening between February and July 2018 in a </span></span><span style="font-family:Verdana;">well</span><span style="font-family:;" "=""><span style="font-family:Verdana;"> 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. </span><b><span style="font-family:Verdana;">Results: </span></b><span style="font-family:Verdana;">285 eligible women had cervical smear done during the first six</span></span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">month</span><span style="font-family:Verdana;">s</span><span style="font-family:Verdana;"> of the 2</span><span style="font-family:Verdana;">-</span><span style="font-family:Verdana;">year project at the centre. 50.9% were above reproductive age (>45</span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">years), 38.2% were in second half of reproductive age (31</span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">-</span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">45), 10.9% were in the early reproductive age (15</span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">-</span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">30). 13% of the women were nulliparous, 51.9% were para</span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">1</span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">-</span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">4, and 35.1% were grand</span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">multiparous. Of the 285 Pap smear slides viewed, 31 had bacteria</span><span style="font-family:Verdana;">l</span><span style="font-family:;" "=""><span style="font-family:Verdana;"> 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. </span><b><span style="font-family:Verdana;">Conclusion:</span></b><span style="font-family:Verdana;"> Prevalence of bacteria</span></span><span style="font-family:Verdana;">l</span><span style="font-family:Verdana;"> 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. Bacteria</span><span style="font-family:Verdana;">l</span><span style="font-family:Verdana;"> vaginosis may be unlikely involved in pathogenesis of cervical intraepithelial neoplasia.</span><span style="font-family:;" "=""> </span><b><span style="font-family:Verdana;">Recommendation: </span></b><span style="font-family:Verdana;">Researchers should harmonise the standards/criteria for the diagnosis of bacteria</span><span style="font-family:Verdana;">l</span><span style="font-family:Verdana;"> 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 constitute</span><span style="font-family:Verdana;">s</span><span style="font-family:Verdana;"> significant incidental finding</span><span style="font-family:Verdana;">s</span><span style="font-family:Verdana;">.</span>展开更多
Background: Cervical cancer is the most common gynaecological cancer among women in the developing countries. It is preventable by early detection and treatment of the precursor lesions. Cervical cytology became the s...Background: Cervical cancer is the most common gynaecological cancer among women in the developing countries. It is preventable by early detection and treatment of the precursor lesions. Cervical cytology became the standard screening test for cervical cancer and premalignant lesions with the introduction of the Papanicolau (Pap) smear. Aim: to determine the uptake, indications and results of cervical cytology in a tertiary health center in Nigeria. Materials and Methods: a 5-year descriptive study of the results of cervical cytology among women who attended the gynaecological outpatient clinic of the Hospital. Results: a total of 597 cases of cervical Pap smears were received at the histopathology department during the study period out of which 20 (3.4%) were inadequate for cytological evaluation. The patients age ranged from 15 to 80 (mean 38.8 SD = 11.4) years. The average annual uptake of the Cervical smear was 9.3% of the total number of patients seen in the gynaecological clinic during the study period and the main indications were routine medical check-up, 256 (42.9%) and cervicitis 76 (12.7%). About 398 (66.7%) were normal smears while 152 (26.3%) were abnormal. Non-specific inflammatory changes were present in 113 (74.3%) cases. Cytology was positive for intraepithelial lesions in 6.8% (39/577) cases. Eighteen percent (7/39) of them were high-grade lesions while squamous cell carcinoma was detected in 12.8% (5/39) cases. Conclusion: the uptake of cervical cytology of 8.7% is low and the main indication was routine check up. Premalignant lesions were detected in 6.8% of cases.展开更多
Objective: To identify the diagnostic concordance in the interpretation of cervical smears. Material and Methods: Cross-sectional study from October 2011 to January 2013. 50 samples were read by every 4 cyto-technolog...Objective: To identify the diagnostic concordance in the interpretation of cervical smears. Material and Methods: Cross-sectional study from October 2011 to January 2013. 50 samples were read by every 4 cyto-technologists who are the total staffs that read and interpret cytological specimens from a public health institution of the city of San Luis Potosí, México. The cytological diagnosis was confirmed by a certified pathologist. Checklist was developed to determine the quality of the interpretation composed of three sections: adequate sample, inadequate sample and cytological diagnosis. The diagnostic report was made by Bethesda System 2001 classification. Diagnostic concordance was measured through the Kappa coefficient. To establish the differences in cytological diagnosis between each cyto-technologist, chi square test was applied. Results: The concordance is acceptable in the classification of samples as inadequate (k = 0.66). The negative diagnosis was a significant concordance between each cytotechnologist and pathologist;however, no case had very good concordance. In the epithelial abnormalities, only the cytotechnologist 2 had significant concordance with the pathologist, however, its concordance is low. In the case of glandular abnormalities, only cytotechnologist 1 had no significant concordance with the pathologist. The percentage of true negatives was 30%, true positives 20%, false negatives 50% and false positives 0 %. There are significant differences between the readings of cyto-technologist 1 and 2 (p < 0.008), between 1 to 4 (p < 0.001), between 2 and 3 (p < 0.05), and finally between 3 and 4 (p < 0.003). Conclusions: The concordance between cyto-technologists and pathologists is below the required minimum level set by national and international standards.展开更多
A cytological cervical smear abnormality of glandular origin raises a high suspicion of underlying invasive or pre invasive cancers. <b><span style="font-family:Verdana;">Objective:</span>&...A cytological cervical smear abnormality of glandular origin raises a high suspicion of underlying invasive or pre invasive cancers. <b><span style="font-family:Verdana;">Objective:</span></b><span style="font-family:Verdana;"> 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. </span><b><span style="font-family:Verdana;">Methods: </span></b><span style="font-family:Verdana;">This study is a retrospective review of all patients referred to North Cumbria Integrated Care</span><span><span><span style="font-family:;" "=""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">(NCIC) NHS foundation trust,</span></span></span><span><span><span style="font-family:;" "=""> </span></span></span><span><span><span style="font-family:;" "=""><span style="font-family:Verdana;">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. </span><b><span style="font-family:Verdana;">Results:</span></b><span style="font-family:Verdana;"> This study comprised of a sample size of 65 women.</span></span></span></span><span><span><span style="font-family:;" "=""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">11 of these (17%) were referred with borderline changes in their endocervical cells and 54</span></span></span><span><span><span style="font-family:;" "=""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">(83%) referred with a</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"> ?</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">glandular neoplasia of endocervical type. There were colposcopically significant lesions</span></span></span><span><span><span style="font-family:;" "=""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">(high grade lesions or suspected adenocarcinoma) for 52</span></span></span><span><span><span style="font-family:;" "=""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">(80%) of the women. All but one (98%) had Large loop excition of transformation zone</span></span></span><span><span><span style="font-family:;" "=""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">(LLETZ) after colposcopy. Histologically,</span></span></span><span><span><span style="font-family:;" "=""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">8</span></span></span><span><span><span style="font-family:;" "=""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">(12%) women were diagnosed with adenocarcinoma,</span></span></span><span><span><span style="font-family:;" "=""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">29</span></span></span><span><span><span style="font-family:;" "=""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">(45%) were diagnosed with high grade cervical glandular intraepithelial neoplasia (HGCGIN), 9</span></span></span><span><span><span style="font-family:;" "=""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">(14%) had high grade cervical intraepithelial neoplasia (CIN2/3), 2</span></span></span><span><span><span style="font-family:;" "=""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">(3%) had low grade cervical glandular intraepithelial neoplasia</span></span></span><span><span><span style="font-family:;" "=""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">(LGCGIN), 4</span></span></span><span><span><span style="font-family:;" "=""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">(6%) had a normal histology and 10</span></span></span><span><span><span style="font-family:;" "=""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">(15%) had lesions of mixed origin.</span></span></span><span><span><span style="font-family:;" "=""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">After their first LLETZ treatment,</span></span></span><span><span><span style="font-family:;" "=""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">24</span></span></span><span><span><span style="font-family:;" "=""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">(37.5%) needed repeat LLETZ, 8</span></span></span><span><span><span style="font-family:;" "=""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">(12%) had a hysterectomy and one woman had radical trachelectomy.</span></span></span>展开更多
Objective To examine and follow up cervical cytology of pregnant and postpartum women and study their cytopathologic characteristics, so as to determine screening and managing programs for abnormal cervical cytology. ...Objective To examine and follow up cervical cytology of pregnant and postpartum women and study their cytopathologic characteristics, so as to determine screening and managing programs for abnormal cervical cytology. Methods Totally 5296 patients in pregnancy and postpartum, in which 3729 by computer-assisted cytology test and 1567 by liquid-based monolayers cytology test, were examined and diagnosed by the Bethesda System made in 2001. Those proven epithelial abnormalities patients were followed up until the lesions regressed to normal. The remaining patients, who exhibited persistent abnormalities or progression, were given further examinations. Results The positive rate of cervical cytological test was 8.72% (462/5296), including squamous carcinoma (SCA) 1 case(0.02%), high grade squamous intraepithelial lesion (HSIL) 34 cases(0.64%), low grade squamous intraepithelial lesion (LSIL) 145 cases(2.74%),atypical glandular cells (AGC) 5 cases(0.09%),atypical squamous cells cannot exclude HSIL (ASC-H) 14 cases(0.26%), atypical squamous cells of undetermined significance (ASC-US) 263 cases(4.97%). The 419 proven cytological abnormality cases were followed up successfully. The total transnegative rate in three months was 73.74% (309/419), in which 303 cases (72.32%) persisted normal status for more than six months after regression. And the transnegative rate of ASC-US, ASC-H, AGC, LSIL, and HSIL were 79.56%, 64.29%, 100%, 72.14% and 44.12%, respectively. Forty-six cases received biopsy directed by colposcopy. The distribution of coincidence of cytopathologic and histopathologic diagnosis was: SCA 1 case (100%), HSIL 10 cases (76.92%), LSIL 13 cases (65%),ASC-H 2 cases (50%), ASC-US 3 cases (37.50%), total 29 cases (63.04%). Conclusions We should cast more attention to screening cervix lesions in pregnant and postpartum women. Their cytopathologic characteristics are liable to make the clinician give a false positive diagnosis. So we propose to follow up them closely and to lower the indication of biopsy.展开更多
Objective: To provide a decision-making basis for sustainable and effective development of cervical cancer screening.Methods: This cross-sectional study assesses the service capacity to conduct cervical cancer screeni...Objective: To provide a decision-making basis for sustainable and effective development of cervical cancer screening.Methods: This cross-sectional study assesses the service capacity to conduct cervical cancer screening with a sample of 310 medical staff, medical institutions and affiliated township health centers from 20 countylevel/district-level areas in 14 Chinese provinces in 2016.Results: The county-level/district-level institutions were the main prescreening institutions for cervical cancer screening. More medical staff have become engaged in screening, with a significantly higher amounts in urban than in rural areas(P<0.05). The number of human papillomavirus(HPV) testers grew the fastest(by 225% in urban and 125% in rural areas) over the course of the project. HPV testing took less time than cytology to complete the same number of screening tasks in both urban and rural areas. The proportion of mid-level professionals was the highest among the medical staff, 40.0% in urban and 44.7% in rural areas(P=0.406), and most medical staff had a Bachelor’s degree, accounting for 76.3% in urban and 52.0% in rural areas(P<0.001). In urban areas, 75.0% were qualified medical staff, compared with 68.0% in rural areas, among which the lowest proportion was observed for rural cytology inspectors(22.7%). The medical equipment for cervical pathology diagnosis in urban areas was better(P<0.001). HPV testing equipment was relatively adequate(typing test equipment was 70% in urban areas, and non-typing testing equipment was 70% in rural areas).Conclusions: The service capacity of cervical cancer screening is insufficient for the health needs of the Chinese population. HPV testing might be an optimal choice to fill the needs of cervical cancer screening given current Chinese medical health service capacity.展开更多
Prevalence of cervical Human Papillomavirus infection and type distribution vary with different environments. Knowledge of this will help in some cervical cancer interventions such as vaccine administration. This stud...Prevalence of cervical Human Papillomavirus infection and type distribution vary with different environments. Knowledge of this will help in some cervical cancer interventions such as vaccine administration. This study aimed at determining the prevalence of cervical HPV infection among women attending a tertiary hospital in Awka, Nigeria. To evaluate cervical HPV Infections, cervical samples were collected over a period of 1 year from 405 consenting women. Multiplex PCR and cytology were used in the study. Semi-structured questionnaire was used to obtain the demographic characteristics of the participants. Statistical analysis was done using IBM SPSS statistics version 21. The findings showed that of the 405 women, 387 (94.4%) had normal cytology, and 18 (4.4%) had Low-grade Squamous Intraepithelial Lesion (LSIL). There was no High-grade Squamous Intraepithelial Lesion (HSIL). HPV prevalence of (79) 19.5% was obtained overall in the 405 women, (75 of 387) 19.4% with normal cytology, (4 of 18) 22.2% with LSIL. Age specific prevalence peaked at age group 30 - 39 and a second peak at 60 - 69. HPV types obtained were HPV 16 31 (7.7%), HPV 18 24 (5.9%), HPV 35 3 (0.7%), HPV 33 9 (2.2%), HPV 68 3 (0.7%) and multiple infections (9) 2.2%. HPV 16 was the only type found in LSIL. Regular HPV typing and screening of our women for HPV infection and Pap’s smear can go a long way in the reduction of cervical cancer.展开更多
BACKGROUND As shown in the statistics from the World Health Organization,it is estimated that approximately 75000 new cases of cervical cancer occur every year in China.In 2008,33000 people died of cervical cancer in ...BACKGROUND As shown in the statistics from the World Health Organization,it is estimated that approximately 75000 new cases of cervical cancer occur every year in China.In 2008,33000 people died of cervical cancer in China.It is proven that most women are at risk of cervical cancer.The progression from human papillomavirus(HPV)infection to cervical cancer can be several years or decades,which offers a unique opportunity to prevent cancer.AIM To observe the changes in ThinPrep cytology tests(TCT)and HPV infection in patients who were detected to be positive via TCT screening of cervical cancer and further explore the biopsy results.METHODS This paper performed a follow-up study on 206 cervical cancer screening-positive patients of 12231 total cases from our previous research.We conducted an observational study on the TCT results based on the interpretation of The Bethesda System.RESULTS Over a 5-year period,10 cases received consistent follow-up.The proportions of cases in which glandular epithelial lesions were detected increased over the follow-up period.The differences between the years were statistically significant(P<0.01).Over the 5 years,the proportion of patients whose squamous epithelial lesions transformed into glandular epithelial lesions increased yearly.Annual positive rates of HPV infection were:year 1,73%(24/33);year 2,43%(6/14);year 3,36%(9/25);year 4,50%(9/18);and year 5,25%(6/24).The positive detection rate after biopsy over a 9-year period was 29%.CONCLUSION The follow-up study for 5 years to 9 years revealed a tendency to change from squamous epithelial lesions to glandular epithelial lesions and an improvement of the disease(which had not been reported previously).The HPV test indicated a high negative conversion ratio of the viral infection.However,the follow-up cases were not found to have persistent infection of high-risk HPV.Therefore,early intervention of cervical cancer screening is necessary.Low re-examination compliance,patient education,and preventive measures should be enhanced.展开更多
Background: The concomitant use of fractal and Euclidian measurements has led to the development of new methodologies of cell evaluation, including a diagnosis of cervical cells that set up differences between normali...Background: The concomitant use of fractal and Euclidian measurements has led to the development of new methodologies of cell evaluation, including a diagnosis of cervical cells that set up differences between normality and various degrees of lesion, to carcinoma. Aim: To confirm the diagnostic capacity of the methodology based on fractal and Euclidian geometry for the mathematical diagnosis through a blind study of normal cells and with different types of lesion, as atypia of undetermined significance (ASCUS), low grade squamous intra-epithelial lesion (LGSIL) and high grade squamous intra-epithelial lesion (HGSIL). Methods: 100 cells of Papanicolaou tests were analyzed and divided into 4 groups according to conventional parameters: 25 normal, 25 ASCUS, 25 LGSIL and 25 HGSIL. By means of the Box-counting Fractal Space, we calculated the fractal dimension and occupying spaces of the border and surface in pixels of the cell nucleus and cytoplasm. The diagnostic parameters of the previously developed methodology were applied and compared with the conventional diagnosis, setting up sensibility, specificity, negative likelihood ratio and Kappa coefficient. Results: The values of the occupation of the border and surface of the cell nucleus and cytoplasm were consistent with the values found by the diagnostic methodology previously found. The subtraction of the nucleus and cytoplasm frontiers presented values between: 189 and 482 for normality;159 and 432 for ASCUS;126 to 401 for LGSIL and 39 to 122 for HGSIL. A sensitivity and specificity of 100%, and a Kappa coefficient of 1 were obtained. Conclusions: The capacity of the methodology to diagnose quantitatively the different stages in the evolution of the cervical cells observed in Papanicolaou tests was confirmed, from normality to HGSIL.展开更多
Developing countries suffer the highest burden of cervical cancers but have the lowest resources. Effective cervical cytology screening programme, along with a network of diagnostic and therapeutic colposcopy centres,...Developing countries suffer the highest burden of cervical cancers but have the lowest resources. Effective cervical cytology screening programme, along with a network of diagnostic and therapeutic colposcopy centres, like developed countries, is almost impossible to be reproduced in developing countries. Visual inspection methods [e.g., Visual inspection with Lugol's iodine(VILI) and Visual Inspection with Acetic Acid(VIA)] which are cheaper, require less expertise and have the advantage of possible treatment in one setting have been shown to be effective alternatives. The sensitivity to detect CIN2+, by VIA and VILI, have been shown to be 80% and 91% respectively, with a specificity rate of 92% and 85% respectively. Screening by human papillomavirus(HPV) testing has high sensitivity(96.4%) but low specificity(94.1%) to detect CIN2+, when compared to Pap Smear(sensitivity, 55.4% and specificity, 96.8%). A single lifetime HPV testing in a large unscreened population has been shown to significantlyreduce cervical cancer incidence and mortality when compared to cervical cytology, VIA or no screening. HPV testing of self-collected vaginal specimens also helps to overcome religious and socio-cultural barriers towards pelvic examination amongst women in developing countries. Current HPV testing methods are expensive, skill/infrastructure demanding and takes time to produce results. A cheaper HPV test, called careH PV?, which is able to provide results within 2.5 h and requires minimal skill/infrastructure to operate, was designed for use in developing countries. One stop screen and treat facilities using VIA or rapid HPV testing, and cryotherapy, can overcome non-compliance to follow-up which is a major issue in developing countries. Cure rates of 81.4% for CIN1, 71.4% for CIN2 and 68.0% for CIN3 at 6 mo after treatment have been reported. Incorporating telemedicine with cervicography of VIA or VILI or even telecolposcopy, has great potential in cervical cancer screening, especially in countries with vast geographical areas.展开更多
文摘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.
文摘Objective:To evaluate the efficiency of p16/Ki-67 dual stain used as a triage in cervical cancer screening.Methods:In this study,we did 468 p16/Ki-67 dual stain in human papillomavirus(HPV)16/18-positive or 12 other high-risk HPV(OHR-HPV)positive Thinprep cytologic test(TCT)atypical squamous cells of undetermined significance(ASCUS)/lower-grade squamous intraepithelial lesion(LSIL)women.We evaluated the sensitivity,specificity,positive predictive value(PPV)and negative predictive value(NPV)of the triage test.Results:The sensitivity,specificity,PPV and NPV of p16/Ki-67 dual stain in HPV 16/18-positive women were91.5%/68.4%,77.0%/75.0%,73.9%/59.1%and 92.8%/81.8%.In 12 OHR-HPV positive TCT ASCUS/LSIL women,the results were 79.1%/95.0%,88.5%/66.7%,88.5%/70.4%and 89.2%/94.1%.The risk of precancerous lesions in p16/Ki-67 dual stain positive cases was much higher than before,and the negative cases had lower risk.Besides,there was no cervical intraepithelial neoplasia(CIN)III case missed after triaged by p16/Ki-67 dual-stained cytology.In p16/Ki-67 dual-stained cytology positive women with benign pathology or CIN I,the 1-year progression rate is 20.5%and in p16/Ki-67 dual-stained cytology negative women,the 1-year progression rate is5.6%.Conclusions:hr-HPV genotyping test plays an important role in cervical cancer screening.p16/Ki-67 dual stain may be a promising triage test.As for chronic cervicitis or CIN I patients,a positive p16/Ki-67 dual-stained cytology suggests a high risk in progression and need to be followed up closely.
文摘Objectives: To evaluate the sensitivity and accuracy of the HPV DNA test in conjunction with thin prep cytology test as a screening method of human papillomavirus (HPV) infection. To study either the cervical erosion is related to high risk HPV infection or to determine the mean age distribution that is more prone to HPV infection. Material and Methods: The study is a retrospective cohort implemented to determine the real performance of liquid based medium and HPV DNA testing combined in second clinical hospital of Jilin University Changchun, China. The study group included total 150 patients from January 1, 2011 to December 30, 2012. A computerized search identified patients with thin prep test results and high risk HPV DNA testing during a 2-year period was recruited. The patients were chosen after proper speculum examination followed by thin prep cytology (TCT) and HPV DNA test. Cytologic specimens were obtained with endocervical brush, which was rinsed into the vial of Cytyc. The residual samples after the cytology report were taken for reflex HPV DNA test. The manufacture protocol was followed for HPV DNA testing using Hybrid Capture II. Colposcopic biopsy was performed for the diagnosis purpose, in patients who had atypical squamous cells of undeter-mined significance (AUS-US), low grade intraepithelial lesion (LSIL) or high-grade intraepithelial lesion (HSIL) in cytology and with positive results of highrisk HPV DNA. The diagnostic criteria were based on the Bethesda System (TBS). Findings: The high risk HPV positive women with abnormal cytology had a CIN I risk of 73 (86%), whereas 35 (23.3%) high-risk HPV positive women out of 109 (72.7%) normal cytology who underwent histological biopsy had CIN I 16 (10.7%). The risk for cervical intraepithelial neoplasia (CIN) in women with high-risk HPV positive with normal cytology was higher among women invited for the first time 31 - 40 years of age 12 (8%) than among older women 1 (0.7%). Out of 44 (29.3%) women who had I degree erosion with 6 (14%) positive HPV DNA test 38 (86%) had a normal histology biopsy showing no statically significant between them. Conclusion: The data confirm that HR-HPV DNA testing is much more sensitive than cytology alone and that HPV DNA testing helps in identifying women with high risk of serious cervical disease in an efficient and medically acceptable manner. The other most significant advantage of this cervical cancer screening method is that women who are HPV DNA positive can easily and quickly referred for colposcopic examination (within one year), which could identify the precancerous and cancer stage. And those who are HPV DNA negative can safely have much longer screening intervals saving considerable costs. With mean age being 38 ± 10 years, age older than 30 years should undergo HPV DNA testing with cytology triage in primary screening. But in woman younger than 30 years using HPV DNA assay, as an initial screening step can increase the prevalence of abnormal smears and the positive predictive value of HPV followed by TCT. However, close follow-up is essential if the initial biopsy is negative because a considerable number of women may have HPV infection positive in subsequent studies.
文摘OBJECTIVE: To reduce false-negative rates of population based cervical screening programs employing conventional cytology in combination with automated DNA image cytometer. METHODS: Involved cervical samples from a total of 3603 women were taken by a cervix brush and then placed into a fixative solution. The cells were separated from mucus by mechanical and chemical treatment after which they were deposited onto microscope slides by a cytospin. Two slides were prepared from each case;one slide was stained by Papanicolaou stain for conventional cytology examination, while the other slide was stained by a DNA specific and stoichiometric stain. The latter slide was used to determine the relative amount of DNA in the cell nuclei in order to assess the ploidy status of the epithelial cells. Enrolled in the study, 157 women were followed by colposcopy examination where punch biopsies were taken from the visible lesions or from suspicious areas. The results of the conventional cytology were then compared to the DNA image cytometer for all samples. RESULTS: Histopathology diagnosed 51 lesions from the 132 biopsied cases as CIN2 or higher, including 27 CIN2, 16 CIN3 and 8 invasive cancers. Conventional cytology correctly identified 29 of the 51 high grade CIN and in-vasive cancer, while DNA image cytometer correctly identified 38 high grade CIN and invasive cancer using the crite-rion that at least three cells were found on the slide that contained DNA amount in excess of 5c. 42 out of 51 high grade CIN and invasive cancer were found by conventional cytology in combination with DNA image cytometer. Sensitivities were 56.8%, 74.5% and 82.4%, while specificities were 86.2%, 81.5% and 81.5% in conventional cytology, DNA image cytometer and combination both cytology and DNA image cytometer respectively. CONCLUSION: The study demon-strated that screening for high grade neoplastic lesions and cervical cancer by DNA image cytometer or combination of conventional cytology and DNA image cytometer is more sensitive than conventional screening approach.
文摘Background: The detection of vaginal intraepithelial neoplasia (VAIN) in cervical samples is not a common finding. Therefore, we aimed to report VAINs detected in liquid-based cytology (LBC) from women examined at Hospital das Clínicas of Faculty of Medicine, Sao Paulo State University. Materials and Methods: We evaluated LBC samples from women referred to gynecology examination for different reasons (previous abnormal PapTest, follow up of treated cervical lesion, ecc) and women examined for regular screening proposals, and compared with biopsy diagnoses, including the controversial diagnoses of vaginal intraepithelial neoplasia (VAIN). Results: From 1866 patients, 1423 (76.3%) cases were negative and 443 (23.7%) were positive for any cellular alteration. Age of patients ranged from 12 to 86 years. We detected 25 histologically confirmed VAIN (1.3% p = 0.0002 by Fisher’s exact test IC 95% 0.0090 - 0.0198) and 1.1% VAIN (p = 0.0031 by Fisher’s exact test IC 95% 0.0077 - 0.0179). Conclusion: The identification of VAIN in routine is feasible;the professionals involved with cytological examination should be aware of these lesions in Pap test samples.
文摘Introduction: Cervical cancer is the most common cause of preventable cancer<span style="font-family:;" "=""><span style="font-family:Verdana;"> related deaths;cervical cancer has a long pervasive phase (cervical dysplasia);the prevalence of cervical dysplasia varies according to the socioeconomic </span><span style="font-family:Verdana;">characteristics and geographic areas of the population studied. Low-grade</span><span style="font-family:Verdana;"> 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 </span><span style="font-family:Verdana;">women where there are no well-coordinated and effective screening pro</span><span style="font-family:Verdana;">grams, 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 -</span></span><span style="font-family:;" "=""><span><span style="font-family:Verdana;">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% </span><span style="font-family:Verdana;">of abnormal cytology was among patients from low socioeconomic class (rural</span> <span style="font-family:Verdana;">areas). Abnormal cervical cytology in patients with high parity was 69% which</span><span style="font-family:Verdana;"> 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.</span></span></span>
文摘Objectives: To evaluate the predictive value of cervical intraepithelial neoplasia (CIN)III/ carcinoma in situ (CIS) by correlating analysis between abnormal cervical cytologic findings and pathological diagnosis of vaginoscopic biopsies or conization.Methods: Routine cervical cytology screening was performed in 31,634 cases by fluid-based thin-layer method (ThinPrep cytology test, TCT), 948 patients had both abnormal squamous cell appearance by TCT and pathological diagnosis of vaginoscopic biopsies and /or cervical conization. The predictive value of CINIII/CIS were studied retrospectively by correlating analysis of different cytology abnormalities and pathology diagnosis.Results: Cytologically, 1,260 out of 31,634 TCT tests showed abnormal squamous cells appearance, including atypical squamous cell of undetermined significance (ASCUS) 675 cases(2.13%), low squamous intraepithelial lesion (L-SIL) 379 cases(1.20%), high squamous intraepithelial lesion (H-SIL)176 cases(0.56%),cancer 30 cases (0.09%). Among 948 patients with pathological diagnosis, there were CINII-III in 70 cases(7.38%) and CINIII/CIS in 56 cases.(5.91%). The relative risks (RR) of different precancerous TCT results in predicting CIN III/CIS validated by pathology are as follow: AUSCUS 14.7% (95% confidence interval (CI) 8.0-27.0), Lsil 13.9% (95% CI 6.3-30.9), Hsil 126.1 (95% CI 60.6-218.6). The RR of AUSCUS group is not significantly different from that of L-SIL group(P =0.951). However, the RR of CINⅢ/CIS morbidity between the H-SIL or cancer group and the ASCUS or L-SIL group are significantly different (all P value <0.01).Conclusion: Vaginoscopic biopsy could verify pathological CINⅡ-Ⅲ and CINⅢ/CIS from cases with abnormal TCT results. There is significantly greater risk of being CINⅢ/CIS validated by vaginoscopic biopsy in the H-SILpatients,while ASCUS and L-SIL group have the coequal risk.
文摘<strong>Background:</strong><span style="font-family:Verdana;"> Bacteria</span><span style="font-family:Verdana;">l</span><span style="font-family:;" "=""><span style="font-family:Verdana;"> 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. </span><b><span style="font-family:Verdana;">Objective: </span></b><span style="font-family:Verdana;">To determine the rate of occurrence of asymptomatic bacterial vaginosis and associated factors in women who underwent cervical cytology for cervical cancer screening. </span><b><span style="font-family:Verdana;">Study Design</span></b><span style="font-family:Verdana;">: A cross sectional study involving microscopic examination of cervical smears of eligible clients presenting for routine Pap smear. </span><b><span style="font-family:Verdana;">Setting: </span></b><span style="font-family:Verdana;">The study was carried out in a </span></span><span style="font-family:Verdana;">well</span><span style="font-family:Verdana;"> 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</span><span style="font-family:Verdana;">-</span><span style="font-family:;" "=""><span style="font-family:Verdana;">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. </span><b><span style="font-family:Verdana;">Methods: </span></b><span style="font-family:Verdana;">This preliminary study was carried out on women presenting for cervical cancer screening between February and July 2018 in a </span></span><span style="font-family:Verdana;">well</span><span style="font-family:;" "=""><span style="font-family:Verdana;"> 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. </span><b><span style="font-family:Verdana;">Results: </span></b><span style="font-family:Verdana;">285 eligible women had cervical smear done during the first six</span></span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">month</span><span style="font-family:Verdana;">s</span><span style="font-family:Verdana;"> of the 2</span><span style="font-family:Verdana;">-</span><span style="font-family:Verdana;">year project at the centre. 50.9% were above reproductive age (>45</span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">years), 38.2% were in second half of reproductive age (31</span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">-</span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">45), 10.9% were in the early reproductive age (15</span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">-</span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">30). 13% of the women were nulliparous, 51.9% were para</span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">1</span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">-</span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">4, and 35.1% were grand</span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">multiparous. Of the 285 Pap smear slides viewed, 31 had bacteria</span><span style="font-family:Verdana;">l</span><span style="font-family:;" "=""><span style="font-family:Verdana;"> 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. </span><b><span style="font-family:Verdana;">Conclusion:</span></b><span style="font-family:Verdana;"> Prevalence of bacteria</span></span><span style="font-family:Verdana;">l</span><span style="font-family:Verdana;"> 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. Bacteria</span><span style="font-family:Verdana;">l</span><span style="font-family:Verdana;"> vaginosis may be unlikely involved in pathogenesis of cervical intraepithelial neoplasia.</span><span style="font-family:;" "=""> </span><b><span style="font-family:Verdana;">Recommendation: </span></b><span style="font-family:Verdana;">Researchers should harmonise the standards/criteria for the diagnosis of bacteria</span><span style="font-family:Verdana;">l</span><span style="font-family:Verdana;"> 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 constitute</span><span style="font-family:Verdana;">s</span><span style="font-family:Verdana;"> significant incidental finding</span><span style="font-family:Verdana;">s</span><span style="font-family:Verdana;">.</span>
文摘Background: Cervical cancer is the most common gynaecological cancer among women in the developing countries. It is preventable by early detection and treatment of the precursor lesions. Cervical cytology became the standard screening test for cervical cancer and premalignant lesions with the introduction of the Papanicolau (Pap) smear. Aim: to determine the uptake, indications and results of cervical cytology in a tertiary health center in Nigeria. Materials and Methods: a 5-year descriptive study of the results of cervical cytology among women who attended the gynaecological outpatient clinic of the Hospital. Results: a total of 597 cases of cervical Pap smears were received at the histopathology department during the study period out of which 20 (3.4%) were inadequate for cytological evaluation. The patients age ranged from 15 to 80 (mean 38.8 SD = 11.4) years. The average annual uptake of the Cervical smear was 9.3% of the total number of patients seen in the gynaecological clinic during the study period and the main indications were routine medical check-up, 256 (42.9%) and cervicitis 76 (12.7%). About 398 (66.7%) were normal smears while 152 (26.3%) were abnormal. Non-specific inflammatory changes were present in 113 (74.3%) cases. Cytology was positive for intraepithelial lesions in 6.8% (39/577) cases. Eighteen percent (7/39) of them were high-grade lesions while squamous cell carcinoma was detected in 12.8% (5/39) cases. Conclusion: the uptake of cervical cytology of 8.7% is low and the main indication was routine check up. Premalignant lesions were detected in 6.8% of cases.
文摘Objective: To identify the diagnostic concordance in the interpretation of cervical smears. Material and Methods: Cross-sectional study from October 2011 to January 2013. 50 samples were read by every 4 cyto-technologists who are the total staffs that read and interpret cytological specimens from a public health institution of the city of San Luis Potosí, México. The cytological diagnosis was confirmed by a certified pathologist. Checklist was developed to determine the quality of the interpretation composed of three sections: adequate sample, inadequate sample and cytological diagnosis. The diagnostic report was made by Bethesda System 2001 classification. Diagnostic concordance was measured through the Kappa coefficient. To establish the differences in cytological diagnosis between each cyto-technologist, chi square test was applied. Results: The concordance is acceptable in the classification of samples as inadequate (k = 0.66). The negative diagnosis was a significant concordance between each cytotechnologist and pathologist;however, no case had very good concordance. In the epithelial abnormalities, only the cytotechnologist 2 had significant concordance with the pathologist, however, its concordance is low. In the case of glandular abnormalities, only cytotechnologist 1 had no significant concordance with the pathologist. The percentage of true negatives was 30%, true positives 20%, false negatives 50% and false positives 0 %. There are significant differences between the readings of cyto-technologist 1 and 2 (p < 0.008), between 1 to 4 (p < 0.001), between 2 and 3 (p < 0.05), and finally between 3 and 4 (p < 0.003). Conclusions: The concordance between cyto-technologists and pathologists is below the required minimum level set by national and international standards.
文摘A cytological cervical smear abnormality of glandular origin raises a high suspicion of underlying invasive or pre invasive cancers. <b><span style="font-family:Verdana;">Objective:</span></b><span style="font-family:Verdana;"> 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. </span><b><span style="font-family:Verdana;">Methods: </span></b><span style="font-family:Verdana;">This study is a retrospective review of all patients referred to North Cumbria Integrated Care</span><span><span><span style="font-family:;" "=""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">(NCIC) NHS foundation trust,</span></span></span><span><span><span style="font-family:;" "=""> </span></span></span><span><span><span style="font-family:;" "=""><span style="font-family:Verdana;">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. </span><b><span style="font-family:Verdana;">Results:</span></b><span style="font-family:Verdana;"> This study comprised of a sample size of 65 women.</span></span></span></span><span><span><span style="font-family:;" "=""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">11 of these (17%) were referred with borderline changes in their endocervical cells and 54</span></span></span><span><span><span style="font-family:;" "=""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">(83%) referred with a</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"> ?</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">glandular neoplasia of endocervical type. There were colposcopically significant lesions</span></span></span><span><span><span style="font-family:;" "=""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">(high grade lesions or suspected adenocarcinoma) for 52</span></span></span><span><span><span style="font-family:;" "=""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">(80%) of the women. All but one (98%) had Large loop excition of transformation zone</span></span></span><span><span><span style="font-family:;" "=""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">(LLETZ) after colposcopy. Histologically,</span></span></span><span><span><span style="font-family:;" "=""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">8</span></span></span><span><span><span style="font-family:;" "=""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">(12%) women were diagnosed with adenocarcinoma,</span></span></span><span><span><span style="font-family:;" "=""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">29</span></span></span><span><span><span style="font-family:;" "=""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">(45%) were diagnosed with high grade cervical glandular intraepithelial neoplasia (HGCGIN), 9</span></span></span><span><span><span style="font-family:;" "=""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">(14%) had high grade cervical intraepithelial neoplasia (CIN2/3), 2</span></span></span><span><span><span style="font-family:;" "=""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">(3%) had low grade cervical glandular intraepithelial neoplasia</span></span></span><span><span><span style="font-family:;" "=""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">(LGCGIN), 4</span></span></span><span><span><span style="font-family:;" "=""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">(6%) had a normal histology and 10</span></span></span><span><span><span style="font-family:;" "=""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">(15%) had lesions of mixed origin.</span></span></span><span><span><span style="font-family:;" "=""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">After their first LLETZ treatment,</span></span></span><span><span><span style="font-family:;" "=""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">24</span></span></span><span><span><span style="font-family:;" "=""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">(37.5%) needed repeat LLETZ, 8</span></span></span><span><span><span style="font-family:;" "=""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">(12%) had a hysterectomy and one woman had radical trachelectomy.</span></span></span>
文摘Objective To examine and follow up cervical cytology of pregnant and postpartum women and study their cytopathologic characteristics, so as to determine screening and managing programs for abnormal cervical cytology. Methods Totally 5296 patients in pregnancy and postpartum, in which 3729 by computer-assisted cytology test and 1567 by liquid-based monolayers cytology test, were examined and diagnosed by the Bethesda System made in 2001. Those proven epithelial abnormalities patients were followed up until the lesions regressed to normal. The remaining patients, who exhibited persistent abnormalities or progression, were given further examinations. Results The positive rate of cervical cytological test was 8.72% (462/5296), including squamous carcinoma (SCA) 1 case(0.02%), high grade squamous intraepithelial lesion (HSIL) 34 cases(0.64%), low grade squamous intraepithelial lesion (LSIL) 145 cases(2.74%),atypical glandular cells (AGC) 5 cases(0.09%),atypical squamous cells cannot exclude HSIL (ASC-H) 14 cases(0.26%), atypical squamous cells of undetermined significance (ASC-US) 263 cases(4.97%). The 419 proven cytological abnormality cases were followed up successfully. The total transnegative rate in three months was 73.74% (309/419), in which 303 cases (72.32%) persisted normal status for more than six months after regression. And the transnegative rate of ASC-US, ASC-H, AGC, LSIL, and HSIL were 79.56%, 64.29%, 100%, 72.14% and 44.12%, respectively. Forty-six cases received biopsy directed by colposcopy. The distribution of coincidence of cytopathologic and histopathologic diagnosis was: SCA 1 case (100%), HSIL 10 cases (76.92%), LSIL 13 cases (65%),ASC-H 2 cases (50%), ASC-US 3 cases (37.50%), total 29 cases (63.04%). Conclusions We should cast more attention to screening cervix lesions in pregnant and postpartum women. Their cytopathologic characteristics are liable to make the clinician give a false positive diagnosis. So we propose to follow up them closely and to lower the indication of biopsy.
基金supported by the National Health Commission of the People’s Republic of China (formerly the Health and Family Planning Commission of China) (No. 201502004)
文摘Objective: To provide a decision-making basis for sustainable and effective development of cervical cancer screening.Methods: This cross-sectional study assesses the service capacity to conduct cervical cancer screening with a sample of 310 medical staff, medical institutions and affiliated township health centers from 20 countylevel/district-level areas in 14 Chinese provinces in 2016.Results: The county-level/district-level institutions were the main prescreening institutions for cervical cancer screening. More medical staff have become engaged in screening, with a significantly higher amounts in urban than in rural areas(P<0.05). The number of human papillomavirus(HPV) testers grew the fastest(by 225% in urban and 125% in rural areas) over the course of the project. HPV testing took less time than cytology to complete the same number of screening tasks in both urban and rural areas. The proportion of mid-level professionals was the highest among the medical staff, 40.0% in urban and 44.7% in rural areas(P=0.406), and most medical staff had a Bachelor’s degree, accounting for 76.3% in urban and 52.0% in rural areas(P<0.001). In urban areas, 75.0% were qualified medical staff, compared with 68.0% in rural areas, among which the lowest proportion was observed for rural cytology inspectors(22.7%). The medical equipment for cervical pathology diagnosis in urban areas was better(P<0.001). HPV testing equipment was relatively adequate(typing test equipment was 70% in urban areas, and non-typing testing equipment was 70% in rural areas).Conclusions: The service capacity of cervical cancer screening is insufficient for the health needs of the Chinese population. HPV testing might be an optimal choice to fill the needs of cervical cancer screening given current Chinese medical health service capacity.
文摘Prevalence of cervical Human Papillomavirus infection and type distribution vary with different environments. Knowledge of this will help in some cervical cancer interventions such as vaccine administration. This study aimed at determining the prevalence of cervical HPV infection among women attending a tertiary hospital in Awka, Nigeria. To evaluate cervical HPV Infections, cervical samples were collected over a period of 1 year from 405 consenting women. Multiplex PCR and cytology were used in the study. Semi-structured questionnaire was used to obtain the demographic characteristics of the participants. Statistical analysis was done using IBM SPSS statistics version 21. The findings showed that of the 405 women, 387 (94.4%) had normal cytology, and 18 (4.4%) had Low-grade Squamous Intraepithelial Lesion (LSIL). There was no High-grade Squamous Intraepithelial Lesion (HSIL). HPV prevalence of (79) 19.5% was obtained overall in the 405 women, (75 of 387) 19.4% with normal cytology, (4 of 18) 22.2% with LSIL. Age specific prevalence peaked at age group 30 - 39 and a second peak at 60 - 69. HPV types obtained were HPV 16 31 (7.7%), HPV 18 24 (5.9%), HPV 35 3 (0.7%), HPV 33 9 (2.2%), HPV 68 3 (0.7%) and multiple infections (9) 2.2%. HPV 16 was the only type found in LSIL. Regular HPV typing and screening of our women for HPV infection and Pap’s smear can go a long way in the reduction of cervical cancer.
基金Supported by the Hainan Provincial Natural Science Foundation of China,No.822RC870 and No.819MS148.
文摘BACKGROUND As shown in the statistics from the World Health Organization,it is estimated that approximately 75000 new cases of cervical cancer occur every year in China.In 2008,33000 people died of cervical cancer in China.It is proven that most women are at risk of cervical cancer.The progression from human papillomavirus(HPV)infection to cervical cancer can be several years or decades,which offers a unique opportunity to prevent cancer.AIM To observe the changes in ThinPrep cytology tests(TCT)and HPV infection in patients who were detected to be positive via TCT screening of cervical cancer and further explore the biopsy results.METHODS This paper performed a follow-up study on 206 cervical cancer screening-positive patients of 12231 total cases from our previous research.We conducted an observational study on the TCT results based on the interpretation of The Bethesda System.RESULTS Over a 5-year period,10 cases received consistent follow-up.The proportions of cases in which glandular epithelial lesions were detected increased over the follow-up period.The differences between the years were statistically significant(P<0.01).Over the 5 years,the proportion of patients whose squamous epithelial lesions transformed into glandular epithelial lesions increased yearly.Annual positive rates of HPV infection were:year 1,73%(24/33);year 2,43%(6/14);year 3,36%(9/25);year 4,50%(9/18);and year 5,25%(6/24).The positive detection rate after biopsy over a 9-year period was 29%.CONCLUSION The follow-up study for 5 years to 9 years revealed a tendency to change from squamous epithelial lesions to glandular epithelial lesions and an improvement of the disease(which had not been reported previously).The HPV test indicated a high negative conversion ratio of the viral infection.However,the follow-up cases were not found to have persistent infection of high-risk HPV.Therefore,early intervention of cervical cancer screening is necessary.Low re-examination compliance,patient education,and preventive measures should be enhanced.
文摘Background: The concomitant use of fractal and Euclidian measurements has led to the development of new methodologies of cell evaluation, including a diagnosis of cervical cells that set up differences between normality and various degrees of lesion, to carcinoma. Aim: To confirm the diagnostic capacity of the methodology based on fractal and Euclidian geometry for the mathematical diagnosis through a blind study of normal cells and with different types of lesion, as atypia of undetermined significance (ASCUS), low grade squamous intra-epithelial lesion (LGSIL) and high grade squamous intra-epithelial lesion (HGSIL). Methods: 100 cells of Papanicolaou tests were analyzed and divided into 4 groups according to conventional parameters: 25 normal, 25 ASCUS, 25 LGSIL and 25 HGSIL. By means of the Box-counting Fractal Space, we calculated the fractal dimension and occupying spaces of the border and surface in pixels of the cell nucleus and cytoplasm. The diagnostic parameters of the previously developed methodology were applied and compared with the conventional diagnosis, setting up sensibility, specificity, negative likelihood ratio and Kappa coefficient. Results: The values of the occupation of the border and surface of the cell nucleus and cytoplasm were consistent with the values found by the diagnostic methodology previously found. The subtraction of the nucleus and cytoplasm frontiers presented values between: 189 and 482 for normality;159 and 432 for ASCUS;126 to 401 for LGSIL and 39 to 122 for HGSIL. A sensitivity and specificity of 100%, and a Kappa coefficient of 1 were obtained. Conclusions: The capacity of the methodology to diagnose quantitatively the different stages in the evolution of the cervical cells observed in Papanicolaou tests was confirmed, from normality to HGSIL.
基金Supported by fellowships from the Prime Minister of AustraliaAsia Endeavour Award,Ministry of Higher Education,Malaysiaand University Technologi MARA,Malaysia
文摘Developing countries suffer the highest burden of cervical cancers but have the lowest resources. Effective cervical cytology screening programme, along with a network of diagnostic and therapeutic colposcopy centres, like developed countries, is almost impossible to be reproduced in developing countries. Visual inspection methods [e.g., Visual inspection with Lugol's iodine(VILI) and Visual Inspection with Acetic Acid(VIA)] which are cheaper, require less expertise and have the advantage of possible treatment in one setting have been shown to be effective alternatives. The sensitivity to detect CIN2+, by VIA and VILI, have been shown to be 80% and 91% respectively, with a specificity rate of 92% and 85% respectively. Screening by human papillomavirus(HPV) testing has high sensitivity(96.4%) but low specificity(94.1%) to detect CIN2+, when compared to Pap Smear(sensitivity, 55.4% and specificity, 96.8%). A single lifetime HPV testing in a large unscreened population has been shown to significantlyreduce cervical cancer incidence and mortality when compared to cervical cytology, VIA or no screening. HPV testing of self-collected vaginal specimens also helps to overcome religious and socio-cultural barriers towards pelvic examination amongst women in developing countries. Current HPV testing methods are expensive, skill/infrastructure demanding and takes time to produce results. A cheaper HPV test, called careH PV?, which is able to provide results within 2.5 h and requires minimal skill/infrastructure to operate, was designed for use in developing countries. One stop screen and treat facilities using VIA or rapid HPV testing, and cryotherapy, can overcome non-compliance to follow-up which is a major issue in developing countries. Cure rates of 81.4% for CIN1, 71.4% for CIN2 and 68.0% for CIN3 at 6 mo after treatment have been reported. Incorporating telemedicine with cervicography of VIA or VILI or even telecolposcopy, has great potential in cervical cancer screening, especially in countries with vast geographical areas.