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Comparative study of the results from conventional cervico-vaginal oncotic cytology and liquid-based cytology
Stabile, Sueli Aparecida Batista;Evangelista, Dilson Henrique Ramos;Talamonte, Valdely Helena;Lippi, Umberto Gazi;Lopes, Reginaldo Guedes Coelho;
Einstein (S?o Paulo) , 2012, DOI: 10.1590/S1679-45082012000400013
Abstract: objective: to compare two oncotic cervical cytology techniques, the conventional and the liquid-based cytology, in low risk patients for uterine cervical cancer. methods: comparative prospective study with 100 patients who came to their annual gynecological exam, and were submitted simultaneously to both techniques. we used the mcnemar test, with a significance level of p<0.05 to compare the results obtained related to adequacy of the smear quality, descriptive diagnosis prevalence, guided biopsy confirmation and histology. results: adequacy of the smear was similar for both methods. the quality with squamocolumnar junction in 93% of conventional cytology and in 84% of the liquid-based cytology had statistical significance. as for the diagnosis of atypical cells they were detected in 3% of conventional cytology and in 10% of liquidbased cytology (p=0.06). atypical squamous cells of undetermined significance were the most prevalent abnormality. the liquid-based cytology performance was better when compared with colposcopy (guided biopsy), presenting sensitivity of 66.7% and specificity of 100%. there was no cytological and histological concordance for the conventional cytology. conclusions: liquid-based cytology had a better performance to diagnose atypical cells and the cytohistological concordance was higher than in the conventional cytology.
Implementation and evaluation of a National External Quality Control Program for Cervical Cytology in Mexico
Flisser,Ana; García-Malo,Felipe; Canepa,María de los Angeles; Doncel,Susana; Espinoza,Raquel; Moreno,Ramiro; Avila,Isidro; Pérez-Palacios,Gregorio; Tapia-Conyer,Roberto; de la Fuente,Juan Ramón;
Salud Pública de México , 2002, DOI: 10.1590/S0036-36342002000500007
Abstract: objective. to evaluate cytology laboratories and the performance of cytotechnologists for establishing efficient external quality control for mexico's national program for the prevention and control of cervical cancer. material and methods. during january and february 1998, an on-site evaluation of all cytology laboratories of the ministry of health found that only 70% of the microscopes were in adequate working conditions, reagents were out of date, and working conditions were sub-optimal. a program for external quality control based on proficiency testing was established for cytotechnologists. fifty slide sets with 20 papanicolaou slides and 10 photographic slides were prepared. the sets were given to the cytotechnologists for evaluation and again one year later by courier. results. twenty-one percent of microscopes were repaired and 9% replaced; reagents were distributed and laboratory facilities improved. only 16% of cytotechnologists passed the initial proficiency test. cytotechnologists received a refresher training course: one year later 67% of them passed the proficiency test. to ascertain that each slide was correctly diagnosed, 41 sets were rescreened by expert cytopathologists or cytologists and their diagnoses compared to the original ones. thirty-seven sets had 86% to 96% concordance. conclusions. this new system for external quality control of cervical cytology allowed the opportune and reliable evaluation of the performance of cytotechnologists.
Implementation and evaluation of a National External Quality Control Program for Cervical Cytology in Mexico  [cached]
Flisser Ana,García-Malo Felipe,Canepa María de los Angeles,Doncel Susana
Salud Pública de México , 2002,
Abstract: Objective. To evaluate cytology laboratories and the performance of cytotechnologists for establishing efficient external quality control for Mexico's National Program for the Prevention and Control of Cervical Cancer. Material and Methods. During January and February 1998, an on-site evaluation of all cytology laboratories of the Ministry of Health found that only 70% of the microscopes were in adequate working conditions, reagents were out of date, and working conditions were sub-optimal. A program for external quality control based on proficiency testing was established for cytotechnologists. Fifty slide sets with 20 Papanicolaou slides and 10 photographic slides were prepared. The sets were given to the cytotechnologists for evaluation and again one year later by courier. Results. Twenty-one percent of microscopes were repaired and 9% replaced; reagents were distributed and laboratory facilities improved. Only 16% of cytotechnologists passed the initial proficiency test. Cytotechnologists received a refresher training course: one year later 67% of them passed the proficiency test. To ascertain that each slide was correctly diagnosed, 41 sets were rescreened by expert cytopathologists or cytologists and their diagnoses compared to the original ones. Thirty-seven sets had 86% to 96% concordance. Conclusions. This new system for external quality control of cervical cytology allowed the opportune and reliable evaluation of the performance of cytotechnologists.
PREOPERATIVE CERVICAL CYTOLOGY IN ENDOMETRIAL CARCINOMA
M. Modares Gilani
Acta Medica Iranica , 1999,
Abstract: Wc studied the correlation between preoperative cervical cytology, postoperative clinicopathologic findings, and sites of metastasis from SO surgically staged patients with endometrial carcinoma Tliirty-faur patients (68%), liad normal cervical cytology, ami 16(32%) had malignant preoperative cervical cytology. Malignant cervical smears were statistically correlated with surgical stage (P = 0.001), histopathology (P =0.010), tumor grade (P = 0.012), depth of myomctrial tumor invasion (P = 0.001), cervical involvement (P - 0.01), lymph node metastases (P = 0.002), and andcxal metastases (P = 0.012). Our study imiicatcs that positive preoperative cervical cytology itself docs not appear to be an independent prognostic factor and probably shouhl not influence treatment decisions in endometrial cancer.
Diagnosis of Rosai-Dorfman Disease by Fine Needle Aspiration Cytology in a Case with Cervical Lymphadenopathy and Nasal Mass  [cached]
Madhusmita Jena
Online Journal of Health & Allied Sciences , 2011,
Abstract: We report a case of Rosai-Dorfman Disease, a rare non neoplastic proliferative disorder of the cells of macrophage-histiocyte family, in a case with cervical lymphadenopathy and nasal mass diagnosed by fine needle aspiration cytology.
Diagnostic methods and techniques in preventing cervical carcinoma Part I: Conventional cytology and new cytological methods  [PDF]
Ines Krivak Bolan?a,,Jasmina Vrane?
Medicinski Glasnik , 2010,
Abstract: Cancer of the cervix is one of the most predictable and preventabletypes of cancer, however, it is still one of the most common malignancies. Due to a lack of information available to women about the causes of the disease, accessibility of screening programs, andlimitations to the existing screening techniques, cervical canceris the second most common type of cancer in women worldwide.Detection and follow-up of pre-cancer stages of the disease are basedon the Pap test, which is now well established as a basic method of secondary prevention. Relative low sensitivity of the Pap test has initiated the development of additional technologies and methods towards enhanced screening quality and error elimination not only in the process of sample taking and analysis but also in screening and interpretation. Immunocytochemical methods and liquid based cytology are the new diagnostics possibilities in secondary prevention. In order to decrease morbidity, thus mortality too, it is necessary that the primary prevention (vaccination) be also implemented.
Clinical evaluation of HPV DNA test combined with liquid-based cytology in the diagnosis of cervical disease  [PDF]
Raghvendra Thakur, Jasma Mally, Rajina Shrestha, Xuehua Zheng, Mengli Zhang, Yanjun Wu, Neelima Bajracharya, Guiying Zheng
Open Journal of Obstetrics and Gynecology (OJOG) , 2013, DOI: 10.4236/ojog.2013.33068
Abstract:

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

Comparative Accuracy of Anal and Cervical Cytology in Screening for Moderate to Severe Dysplasia by Magnification Guided Punch Biopsy: A Meta-Analysis  [PDF]
Wm. Christopher Mathews, Wollelaw Agmas, Edward Cachay
PLOS ONE , 2011, DOI: 10.1371/journal.pone.0024946
Abstract: Background The accuracy of screening for anal cancer precursors relative to screening for cervical cancer precursors has not been systematically examined. The aim of the current meta-analysis was to compare the relative accuracy of anal cytology to cervical cytology in discriminating between histopathologic high grade and lesser grades of dysplasia when the reference standard biopsy is obtained using colposcope magnification. Methods and Findings The outcome metric of discrimination was the receiver operating characteristic (ROC) curve area. Random effects meta-analysis of eligible studies was performed with examination of sources of heterogeneity that included QUADAS criteria and selected covariates, in meta-regression models. Thirty three cervical and eleven anal screening studies were found to be eligible. The primary meta-analytic comparison suggested that anal cytologic screening is somewhat less discriminating than cervical cytologic screening (ROC area [95% confidence interval (C.I.)]: 0.834 [0.809–0.859] vs. 0.700 [0.664–0.735] for cervical and anal screening, respectively). This finding was robust when examined in meta-regression models of covariates differentially distributed by screening setting (anal, cervical). Conclusions Anal cytologic screening is somewhat less discriminating than cervical cytologic screening. Heterogeneity of estimates within each screening setting suggests that other factors influence estimates of screening accuracy. Among these are sampling and interpretation errors involving both cytology and biopsy as well as operator skill and experience.
High-Grade Cervical Lesions Among Women Attending A Reference Clinic In Brazil: Associated Factors And Comparison Among Screening Methods  [PDF]
Neide T. Boldrini, Luciana B. Freitas, Amanda R. Coutinho, Flavia Z. Loureiro, Liliana C. Spano, Angélica E. Miranda
PLOS ONE , 2014, DOI: 10.1371/journal.pone.0102169
Abstract: Background Although screening for cervical cancer is recommended for women in most countries, the incidence of cervical cancer is greater in developing countries. Our goal was to determine the prevalence and factors associated with high-grade lesions/cervical cancer among women attending a reference clinic in Brazil and evaluate the correlation of histology with cytology, colposcopy and the high-risk HPV (HR-HPV) tests. Methods A cross-sectional study of women attending a colposcopy clinic was carried out. The patients were interviewed to collect demographic, epidemiological and clinical data. Specimens were collected for cervical cytology, Chlamydia trachomatis and HPV testing using the Hybrid Capture (HC) and PCR tests. Colposcopy was performed for all patients and biopsy for histology when cell abnormalities or cervical intraepithelial neoplasia (CIN) were present. Results A total of 291 women participated in the study. The median age was 38 years (DIQ: 30–48 years). The prevalence of histologically confirmed high-grade lesions/cervical cancer was 18.2% (95%, CI: 13.8%–22.6%), with 48 (16.5%) cases of CIN-2/CIN-3 and 5 (1.7%) cases of invasive carcinoma. In the final logistic regression model, for ages between 30 and 49 years old [OR = 4.4 (95%: 1.01–19.04), history of smoking [OR = 2.4 (95%, CI: 1.14–5.18)], practice of anal intercourse [OR = 2.4 (95%, CI: 1.10–5.03)] and having positive HC test for HR-HPV [OR = 11.23 (95%, CI: 4 0.79–26, 36)] remained independently associated with high-grade lesions/cervical cancer. A total of 64.7% of the cases CIN-3\Ca in situ were related to HPV-16. Non-oncogenic HPV were only found in CIN-1 biopsy results. Compared to histology, the sensitivity of cytology was 31.8%, the specificity 95.5%; the sensitivity of colposcopy for high-grade lesions/cervical cancer was 51.0%, specificity was 91.4% and the concordance with HPV testing was high. Conclusions The results confirm an association of HR-HPV with precursor lesions for cervical cancer. These data emphasize that cytological screening to detect precursor lesions is still important in some regions and that HR-HPV should be included for screening.
Towards improving cervical cancer screening in Nigeria: A review of the basics of cervical neoplasm and cytology
CC Dim
Nigerian Journal of Clinical Practice , 2012,
Abstract: Cervical cancer screening is the key to reducing the incidence and mortality of cervical cancer in developing countries. In the absence of a national screening program, healthcare givers in Nigeria are encouraged to routinely inform and screen eligible women. This review aims at equipping health workers for this task by re-educating them on the basics of the disease and its screening by cytology. Relevant texts and online databases including Pubmed, African Journal Online, and Google Scholar, were searched for relevant literature on the subject area. Persistent infection by a high-risk human papilloma virus, especially types 16 and 18, is necessary for the development of cervical cancer. The exfoliation of cells from the metaplastic squamous cells of transformation zone of the cervix is the basis of cervical cytology. Organized Pap screening reduces the incidence and mortality of cervical cancer, but screening protocols vary. Nevertheless, annual screening is not recommended except for high-risk women such as HIV-positive women. Abnormal Pap smear results are currently reported using either the Bethesda System or the British Society for Clinical Cytology classification, and colposcopy with or without biopsy are necessary when indicated. In conclusion, the use of cervical cytology to detect precancerous lesions followed by an appropriate treatment when necessary is the key to reducing invasive cervical cancer. The task of provider-initiated counseling and testing for cervical cancer by health practitioners requires update on the current etio-pathology of cervical cancer, and its screening as reviewed.
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