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Cervical Abnormalities (cervical + abnormality)
Selected AbstractsRole of Pap Test terminology and age in the detection of carcinoma invasive and carcinoma in situ in medically underserved California womenDIAGNOSTIC CYTOPATHOLOGY, Issue 4 2004Lydia P. Howell M.D. Abstract Our goals were to evaluate Pap Test findings classified by the Bethesda system, and follow up biopsies from participants in the California Breast and Cervical Cancer Control Program (Ca-BCCCP) for: 1) correlation in the detection of carcinoma in situ (CIS) and carcinoma invasive (CI), and 2) age-related trends, with discussion in the context of the 2001 ASCCP Management Guidelines. Women (n = 52,339) who had their initial screening Pap Tests with Ca-BCCCP between January 1995,December 1999 were followed for diagnostic services through December 2000. Descriptive and analytical methods were used in the analysis. Of the Pap results, 81.9% were negative, 10.6% showed infection, 4.7% showed an epithelial abnormality as defined by the Bethesda system (atypical squamous cells of undertermined significance (ASCUS), low-grade squamous intraepithelial lesion (LSIL), or high-grade squamous intraepithelial lesion (HSIL)), 0.1% showed squamous-cell cancer (SCC), and 2.7% showed other or unsatisfactory. Subsequent to the initial Pap Test, follow-up results of carcinoma in situ (CIS) and carcinoma invasive (CI) accounted for 0.36% and 0.05% of the population, respectively. Among HSIL Pap Tests (n = 285), 40.7% had follow-up showing CIS. Among SCC Pap Tests, 17.9% had follow-up results of CIS and 28.6% CI. Of the 191 patients with CIS as a follow-up finding, the initial Pap smear showed: HSIL 60.7%, SCC 2.6%, LSIL 10.5%, ASCUS 13.6%, and negative or infection 9.9%. Of the 27 patients with CI, the initial Pap Test showed: HSIL 40.7%, SCC 29.6%, LSIL 7.4%, ASCUS 7.4%, and negative or infection 11.1%. Pap diagnoses of other or unsatisfactory accounted for 2.6% of the Pap results from patients with CIS and 3.7% of Pap results from patients with CI. Except for LSIL, there was an increasing age trend in the number of cases in each of Pap results, with the exception of age 65+ yr. However, the ratio of LSIL and ASCUS to negative cases decreased with age. (P < 0.0001 and 0.0293, respectively). HSIL Pap results indicate a reasonably high probability of CIS and CI. However, approximately 1/3 of patients with CIS and 1/4 of patients with CI presented with Pap diagnoses of less severity than HSIL. When a negative Pap Test result is chosen as reference group, there is a negative age trend for LSIL and ASCUS, and no age trend for other results. These findings all have important implications in the design of follow-up strategies, and support the 2001 ASCCP Consensus Guidelines for the Management of Women with Cervical Abnormalities. Diagn. Cytopathol. 2004;30:227,234. © 2004 Wiley-Liss, Inc. [source] ASC-US and high-risk HPV testing: Performance in daily clinical practiceDIAGNOSTIC CYTOPATHOLOGY, Issue 11 2006Suzanne M. Selvaggi M.D.Article first published online: 13 OCT 200 Abstract Data are beginning to accrue on high-risk HPV DNA testing in patients with ASC-US on cervical cytology. We report on our experience at the University of Wisconsin Hospital and Clinics. From February 2002 through December 31, 2005 (3 yr, 11 mo), the cytopathology laboratory processed 49,599 Pap Tests, of which 1,792 (3.6%) were diagnosed as ASC-US. Six hundred and seventy two (37.5%) of these cases were processed for high-risk HPV genotypes using the Digene Hybrid® Capture II method. Of these cases, 266 (39.6%) were positive for high-risk HPV genotypes, 11 (1.6%) were equivocal, and 395 (58.8%) were negative. Biopsy follow-up was available for 127 (47.7%) of the 266 cases, of which 66 (52%) were negative, 46 (36.2%) showed CIN I, 9 (7.1%) were CIN II, and 6 (4.7%) were CIN III. Of the remaining 139 (52.3%) cases, 86 (62%) had follow-up Pap Tests, of which 57 (66.3%) were negative, 15 (17.4%) were ASC-US, 12 (15%) were low-grade squamous intraepithelial lesions, and 2 (2.3%) were high-grade squamous intraepithelial lesions; 53 (38.1%) were lost to follow-up. In combination, 90 (42.25%) of the 213 cases with follow-up showed atypia or above after a diagnosis of ASC-US; of which 58 (64%) were low-grade lesions and 17 (19%) were high-grade lesions. Our laboratory's reported high-risk HPV positivity is comparable to recent reports in the literature on its use in daily clinical practice. In addition, cervical abnormalities were found in a significant proportion of the cases. Diagn. Cytopathol. 2006;34: 731,733. © 2006 Wiley-Liss, Inc. [source] Human papillomavirus infection and cervical abnormalities in Nairobi, Kenya, an area with a high prevalence of human immunodeficiency virus infectionJOURNAL OF MEDICAL VIROLOGY, Issue 5 2008Rika Yamada Abstract Human papillomavirus (HPV) infection and cervical abnormalities, and their association with human immunodeficiency virus (HIV) infection were studied in 488 women who visited a health center in Nairobi. PCR-based HPV and cervical cytology tests were carried out on all participants, and peripheral CD4+ T cells and plasma HIV RNA were quantitated in HIV positive women. HIV were positive in 32% (155/488) of the women; 77% of these were untreated, and the others had been treated with anti-retroviral drugs within 6 months. Cervical HPV infection was detected in 17% of HIV negative and 49% of HIV positive women. Low-grade squamous intraepithelial lesions were observed in 6.9% of HIV negative and 21% of HIV positive women, while high-grade squamous intraepithelial lesions and cancer were seen in 0.6% and 5.8%, respectively. Multivariate analysis revealed that HIV and HPV infections were associated with each other. Cervical lesions were significantly associated with high-risk HPVs and with HIV infection, depending on HPV infection. HPV infection increased in accordance with lower CD4+ T cell counts and higher HIV RNA levels, and high-grade lesions were strongly associated with high-risk HPV infection and low CD4+ T cell counts. Immunosuppression as a result of HIV infection appears to be important for malignant progression in the cervix. Nationwide prevention of HIV infection and cervical cancer screening are necessary for the health of women in this area. High-risk HPV infection and low CD4+ T cell counts are the risk factors for cervical cancer. J. Med. Virol. 80:847,855, 2008. © 2008 Wiley-Liss, Inc. [source] Is there a correlation between vaginal chlamydia infection and cervical smear abnormalities?JOURNAL OF OBSTETRICS AND GYNAECOLOGY RESEARCH (ELECTRONIC), Issue 1 2006A community-based study in the Al-Ain district, United Arab Emirates Abstract Aim:, The purpose of this study was to determine the correlation between vaginal chlamydia infection and cervical abnormalities. The data on the prevalence of chlamydia infection and cervical abnormalities have been presented elsewhere and in this article we provide the results of a correlation analysis. Methods:, In this cross-sectional, community-based survey, women attending primary and secondary care in the Al-Ain medical district, United Arab Emirates, were offered cervical screening using the Papanicolaou smear, and chlamydia testing. A total of 793 women underwent cervical screening and 728 were tested for chlamydia. A commercially available kit was used to determine the prevalence of chlamydia. The correlation between cervical abnormalities and chlamydia infection was tested using the chi-squared test or Fisher's exact test, as appropriate. Results:, The prevalence of abnormal smears was 1.51% (95% confidence interval [CI], 0.66,2.4). Twelve subjects had abnormal smears, including smears showing atypical squamous cells of undetermined significance. The prevalence of chlamydia infection in this population was 2.5% (95% CI, 1.2,3.3). Statistical analysis showed no association (,2 0.6, P = 0.4) between the prevalence of chlamydia infection and cervical abnormalities. Conclusion:, Although there have been earlier reports of an association between vaginal chlamydia and cervical abnormalities, our study does not provide evidence to support this association. [source] ,What does it mean?' uncertainty, trust and communication following treatment for pre-cancerous cervical abnormalitiesPSYCHO-ONCOLOGY, Issue 6 2007Ilona Juraskova Abstract The early detection of pre-cancerous cervical conditions has risen dramatically, prompting more in-depth investigations regarding psychological implications inherent within the diagnosis and treatment of this condition. This study aimed to identify factors that influence women's experience of diagnosis and treatment of cervical abnormalities and factors that facilitate positive adjustment. Using a semi-structured telephone interview, we interviewed 21 women (age 24,54) treated at a colposcopy clinic. Systematic recruitment of women with varying degrees of cervical abnormality (CIN 1,3) and time since treatment was undertaken to ensure representation of all relevant experiences and allow the identification of long-term factors. Coding of audio-taped, transcribed interviews and searching for themes was achieved by using NUD*IST software. The results identified uncertainty, trust and communication as the key factors for women following diagnosis and treatment. The primary concern following diagnosis was related to cancer but changed to a more prominent concern with future reproductive issues in the post-treatment period. The majority of women acknowledged the importance of the doctor's empathic communication style. These findings have important implications for future studies and clinical practice. Copyright © 2006 John Wiley & Sons, Ltd. [source] Outcome in women with no endocervical component on cervical cytology after treatment for high-grade cervical dysplasiaAUSTRALIAN AND NEW ZEALAND JOURNAL OF OBSTETRICS AND GYNAECOLOGY, Issue 4 2009Alice HUANG Background:, Cervical cancer and its precursors still remain an important cause of morbidity and mortality despite adequate screening programs. It is now established practice in Australia that a Pap smear without an endocervical component, which is otherwise negative, does not warrant an earlier repeat smear. This study aims to determine if the lack of an endocervical component in women with previously treated high-grade abnormalities of the cervix increases the risk of subsequent cytological abnormalities. Method:, Data were retrieved from an electronic database in the Oncology and Dysplasia Unit at The Royal Women's Hospital in Melbourne, Australia. Women who underwent treatment for high-grade cervical abnormalities from 2000,2004 were included in the study. Women with negative cytology immediately after their operations were first identified, and the incidence of subsequent cytological abnormalities was calculated and then separated according to their endocervical status. Results:, Of the 1260 women in the study population, seven developed high-grade abnormalities (six with an endocervical component and one without) and 107 developed low-grade abnormalities (98 with an endocervical component and nine without). Conclusion:, The lack of an endocervical component was not statistically significantly associated with a higher incidence of either high-grade or low-grade abnormalities. Therefore, women who have had previous treatments for high-grade abnormalities do not need to have earlier repeat smears or intervention if the cytology lacks an endocervical component. [source] Comparison of a self-administered tampon ThinPrep test with conventional pap smears for cervical cytologyAUSTRALIAN AND NEW ZEALAND JOURNAL OF OBSTETRICS AND GYNAECOLOGY, Issue 3 2005Mardi BUDGE Abstract Aim: To assess a self-administered tampon specimen as an alternative method of detecting cytological abnormalities and its acceptability in comparison with a conventional Papanicolou (pap) smear. Design: Comparative observational study. Setting/population: Two hundred and seventeen women were recruited from the colposcopy clinic of an outer urban public teaching hospital and from sexual health clinics at suburban and major metropolitan hospital clinics. Methods: Participants inserted and immediately withdrew a tampon, then placed it into a vial of ThinPrep PreservCyt fluid. This was analysed by a local private pathology laboratory. Results were compared to a pap smear performed the same day or within the previous 6 months. All women with an abnormal result (tampon or pap smear) underwent a colposcopy, with or without biopsy as necessary. Participants completed a questionnaire after performing the tampon test. Outcome measures: Probabilities of tampon test detecting (i) a high grade abnormality (pHG), (ii) any cervical intraepithelial neoplasia (CIN) changes (pCINany), and (iii) any abnormalities (pabn) compared to the conventional pap smear and, if abnormal, compared to the biopsy taken at colposcopy. Acceptability of the tampon test and conventional pap smear were also measured. Results: Probabilities of the tampon test compared to pap smear: pabn sensitivity 33%, specificity 89%, PPV 59%, NPV 73%; pCINany sensitivity 23%, specificity 97%, PPV 71%, NPV 79%; pHG sensitivity 19%, specificity 98%, PPV 63%, NPV 89%. Acceptability for tampon test was 91.21% and for pap smear, 45.85%. Conclusions: Although the self-administered tampon ThinPrep method is a poor detector of cervical abnormalities compared to pap smear, it is highly acceptable to women. It has a relatively good negative predictive value (NPV). Our study suggests that if a more acceptable, sensitive method of cervical screening was found, which removed some of the existing barriers to conventional pap testing, screening rates for cervical cancer may improve. [source] Estimates for cervical abnormalities in VanuatuAUSTRALIAN AND NEW ZEALAND JOURNAL OF PUBLIC HEALTH, Issue 6 2007Nina Fotinatos Abstract Objective: To use the Pap smear to establish a recent prevalence of cervical abnormalities within a select population in Vanuatu, a developing country. Methods: Cervical smears (n=907) were collected from Ni-Vanuatu women from both urban and rural islands within Vanuatu between August 2001 and September 2005. Results: The prevalence of low-grade epithelial abnormalities for the total population was 2.9% and the prevalence of the high-grade epithelial abnormalities/cancer was 2.0%. There was a significant difference (p<0.05) in prevalence of high-grade epithelial abnormalities/cancer between the urban and rural populations sampled, with a higher prevalence in the urban population. Conclusions: The prevalence of pre-cancer and cancer in Vanuatu is high compared with Victorian (Australian) statistics yet comparable with other developing countries with no cervical screening programs available. Implications: This study will hopefully assist in future planning of women's health programs and relevant preventive strategies to combat cervical cancer in Vanuatu. [source] Cervical biopsy-based comparison of a new liquid-based thin-layer preparation with conventional Pap smearsDIAGNOSTIC CYTOPATHOLOGY, Issue 4 2004Maria da Gloria Mattosinho de Castro Ferraz M.D. Abstract The objective of this study is to compare the diagnostic efficacy of universal collection medium (UCM) liquid-based cytology (LBC) (Digene Corp., MD) and the conventional Pap smear in a comparative study, using histologic results as the gold standard. This was a cross-sectional study. Conventional Pap smears and UCM LBC specimens, obtained from women in a low socioeconomic outpatient population referred to a tertiary center for gynecologic care, were compared. For the purpose of this study, when cervical specimens were collected for cytology, all women underwent colposcopy and biopsy was done if a cervical abnormality was observed. Cytologic evaluation of UCM LBC and conventional Pap smears were carried out separately, masked to the results of the other method. Agreement beyond chance between the two cytologic methods was ascertained by means of the unweighted , statistic. Sensitivity, specificity, and predictive values with 95% confidence intervals were calculated for both methods. McNemar's test was used to determine the level of association between the two cytology procedures. A total of 800 women were evaluated. Assessment of the overall agreement between the two cytologic methods yielded a , of 0.777 (P < 0.0001). After adjustment for histologic diagnosis, the computed , in each stratum was as follows: normal = 0.733; CIN 1 = 0.631; CIN 2/3 = 0.735; cancer = 0.652. The sensitivity and specificity of UCM LBC for detection of cervical intraepithelial lesions and cancer were 75.3% and 86.4%, respectively, not statistically different from the 81.8% and 85.2% seen with the conventional method. This study demonstrates that the UCM LBC method is as accurate as the conventional Pap smear cytology in detecting cervical intraepithelial lesions and cancer even so the UCM samples were systematically prepared from a second sampling of the cervix. Diagn. Cytopathol. 2004;30:220,226. © 2004 Wiley-Liss, Inc. [source] ,What does it mean?' uncertainty, trust and communication following treatment for pre-cancerous cervical abnormalitiesPSYCHO-ONCOLOGY, Issue 6 2007Ilona Juraskova Abstract The early detection of pre-cancerous cervical conditions has risen dramatically, prompting more in-depth investigations regarding psychological implications inherent within the diagnosis and treatment of this condition. This study aimed to identify factors that influence women's experience of diagnosis and treatment of cervical abnormalities and factors that facilitate positive adjustment. Using a semi-structured telephone interview, we interviewed 21 women (age 24,54) treated at a colposcopy clinic. Systematic recruitment of women with varying degrees of cervical abnormality (CIN 1,3) and time since treatment was undertaken to ensure representation of all relevant experiences and allow the identification of long-term factors. Coding of audio-taped, transcribed interviews and searching for themes was achieved by using NUD*IST software. The results identified uncertainty, trust and communication as the key factors for women following diagnosis and treatment. The primary concern following diagnosis was related to cancer but changed to a more prominent concern with future reproductive issues in the post-treatment period. The majority of women acknowledged the importance of the doctor's empathic communication style. These findings have important implications for future studies and clinical practice. Copyright © 2006 John Wiley & Sons, Ltd. [source] | ||||||||||