"See and treat" approach is appropriate in women with high-grade lesions on either cervical cytology or colposcopy

This study was undertaken to evaluate the overtreatment rate of women with abnormal cervical cytology undergoing colposcopy followed by loop electrosurgical excision procedure (LEEP), the so-called "see and treat" approach. Overtreatment was defined as LEEP specimens containing cervical intraepithelial neoplasia (CIN) 1 or less. In this study, medical records of 192 women with abnormal Pap smears undergoing the "see and treat" approach in Chiang Mai University Hospital between October 2008 and October 2010 were reviewed. The preceding Pap smears were as follows: 124 (64.6%) with high-grade squamous intraepithelial lesion (HSIL); 35 (18.2%) with atypical squamous cells cannot exclude high-grade squamous intraepithelial lesion (ASC-H); 20 (10.4%) with low-grade squamous intraepithelial lesion (LSIL); 9 (4.7%) with squamous cell carcinoma (SCCA); and 4 (2.1%) with atypical squamous cells of undetermined significance (ASC-US). Histologic results obtained from loop electrosurgical excision procedure (LEEP) were as follows: CIN 2-3, 106 (55.2%); invasive cancer, 41 (21.4%); CIN 1, 15 (7.8%); adenocarcinoma in situ (AIS), 1 (0.5%); and no lesion, 29 (15.1%). Overall, 22.9% of LEEP specimens contained CIN 1 or less. Significant predictors for overtreatment were type of preceding smears and colposcopic impression. If the "see and treat" approach was strictly carried out in women who had either smears or colposcopic findings revealing high-grade disease, the overtreatment rate was only 7%. Hemorrhagic complication was 6.2% and all could be treated at an outpatient department. In conclusion, the overtreatment rate of the "see and treat" approach in women with various degree of abnormal Pap smears is 23% which would be diminished to the acceptable rate of lower that 10% if strictly performed in those with either smears or colposcopic impressions revealing high-grade abnormality. Peri-operative LEEP complications were mild and acceptable.     

Clinicopathologic Importance of Women with Squamous Cell Carcinoma Cytology on Siriraj Liquid-Based Cervical Cytology

Objectives: The purposes of this study were to determine the prevalence and predictive value to detectsignificant neoplasia and invasive lesions, and to evaluate the correlation between clinical and histopathology ofwomen with squamous cell carcinoma (SCCA) on Siriraj liquid-based cervical cytology (Siriraj-LBC). Methods:The computerized database of women who underwent Siriraj-LBC at Siriraj Hospital, Mahidol Universityfrom January 2007 to December 2010 were retrieved. The hospital records of women with SCCA cytology werereviewed. Results: The prevalence of SCCA cytology was 0.07%. A total of 86 women, mean age was 58.1 years.Sixty-one women (70.9%) were post-menopausal. Overall significant pathology and invasive gynecologic cancerwere detected in 84 women (97.7%) and 71 women (82.5%), respectively. The positive predictive values fordetection of significant neoplasia and invasive lesion were 97.7% and 82.6%, respectively. The cervical cancerwas diagnosed in 69 women and among these 58 women were SCCA. Thirteen women (15.1%) had cervicalintraepithelial neoplasia (CIN) 3 and two women (2.3%) had cervicitis. The sensitivity and specificity of colposcopyfor cervical cancer detection in SCCA cytology were 83.3% and 75%, respectively. Median follow up period was17.6 months and 64 patients were alive without cytologic abnormality. Conclusions: The final histopathology ofSCCA cytology in our populations demonstrated a wide variety, from cervicitis to invasive cancer and the mostcommon diagnosis was invasive cervical cancer. Colposcopy with biopsy and/or endocervical curettage and loopelectrosurgical excision procedure should be undertaken to achieve histologic diagnosis.     

Reflex Human Papillomavirus Test Results as an Option for the Management of Korean Women With Atypical Squamous Cells Cannot Exclude High‐Grade Squamous Intraepithelial Lesion

Background.

Current guidelines recommend initial colposcopy with biopsy regardless of human papillomavirus (HPV) test results in women with atypical squamous cells, cannot exclude high-grade squamous intraepithelial lesion (ASC-H). The purpose of this study was to evaluate the value of HPV testing in women with ASC-H based on colposcopic pathology results.

Materials and Methods.

A multicenter cross-sectional study was carried out at three academic hospitals and involved 40,847 Korean women who underwent cervical cancer screening with cytology and HPV tests with or without subsequent colposcopic biopsies between January 2007 and December 2013.

Results.

ASC-H was diagnosed in 276 women (0.7%). Only 6 of 68 (8.8%) women with ASC-H who were HPV negative had cervical intraepithelial neoplasia grade ≥2 (CIN ≥2) lesions, whereas 47.4% of the women with ASC-H who were HPV positive had CIN ≥2 lesions. No cases of invasive cervical cancer were diagnosed among women with ASC-H who were HPV negative. Logistic regression analysis was performed using the group with normal Papanicolaou test results and HPV-negative status as the reference group. Women with ASC-H who were HPV positive had a significantly increased risk of CIN ≥2 lesions, whereas no significant increase was observed in patients with ASC-H and HPV-negative status.

Conclusion.

If the result of the HPV test was negative, the risk of CIN ≥2 lesions in Korean women with ASC-H cytology was low. Reflex HPV testing should be an option for the management of women with cytology showing ASC-H to decrease unnecessary colposcopic biopsies, which are expensive and invasive.

Implications for Practice:

Current American Society for Colposcopy and Cervical Pathology guidelines recommend universal colposcopy for the management of women with atypical squamous cells, cannot exclude high-grade squamous intraepithelial lesion (ASC-H) on cytology, regardless of human papillomavirus (HPV) test results. The present study suggested that HPV cotesting in patients with ASC-H cytology can provide more detailed and useful information regarding the risk of high-grade cervical intraepithelial neoplasia (CIN) lesions and the need for further treatment. When the result of the HPV test was negative, the risk of CIN lesions of grade ≥2 in women with ASC-H cytology was low. Consequently, reflex HPV testing, rather than immediately performance of invasive and expensive colposcopy with biopsy, should be an option for the management of women with ASC-H.     

1997例宫颈管刮术结果分析

目的　探讨宫颈管刮术 (ECC)在诊断宫颈癌及癌前病变中的价值 ,以及阴道镜检时常规行ECC的必要性。方法　对宫颈癌高发地区 35～ 4 5岁妇女共 1997人行宫颈细胞学涂片、阴道镜检查及多点活检 ,活检后常规行ECC。结果　ECC的总阳性率为 1.6 % ,其中细胞学阴性者的ECC阳性率为 0 .3% ,细胞学阳性者为 5 .3% ,细胞学异常程度越高 ,ECC阳性率越高。阴道镜检不满意者的ECC阳性率为 9.1% ,阴道镜检满意者为 1.3% ,二者差异有显著性 (P <0 .0 1)。阴道镜检阴性者ECC阳性率为 0 .6 % ,镜下诊断为低度鳞状上皮内病变 (LSIL)者的ECC阳性率为 0 .9% ,高度鳞状上皮内病变 (HSIL)者为 2 4 .1% ,镜检阴性及LSIL者的ECC阳性率显著低于HSIL者。宫颈活检病理为LSIL者的ECC阳性率为 3.3% ,HSIL者为 2 2 .2 % ,鳞癌者为 5 0 .0 % ,三者间差异有显著性。 316例细胞学阳性而阴道镜检未见异常 ,其中 8例 (2 .5 % )ECC阳性 ,8例中 3例细胞学为高度病变。结论　细胞学诊断为HSIL或有更严重的病变时 ,应常规行ECC ;阴道镜检为高度病变者应行ECC ;细胞学阳性而阴道镜检不满意的患者须行ECC。     

醋酸涂抹法在宫颈癌筛查中的应用价值

背景与目的：目前,宫颈癌发病率在我国一些经济落后地区仍较高。原因之一是在这些地区难以开展宫颈细胞学涂片检查宫颈癌的普查工作。本研究通过分析应用醋酸涂抹法检测宫颈上皮内瘤样病变(cervical intraepithelial neoplasia,CIN)及宫颈癌的敏感性和特异性,从而评价其在宫颈癌筛查中的应用价值。方法：对山西省襄垣县年龄为35-45岁的1997名妇女进行宫颈癌普查,首先应用5％醋酸涂抹法,同时对每名妇女均进行高危型人乳头状瘤病毒(human papillomavirua,HPV)DNA的检查、液基细胞学及阴道镜检查,在阴道镜下对病变区或每个正常象限的宫颈鳞柱上皮交界处的2、4、8、10点取活检,并行宫颈管刮出物病检,病理检查结果为金标准。结果：病理检查证实CINⅡ级43例,CINⅢ级31例,宫颈浸润癌12例。2例妇女仅颈管刮出物阳性,其中l例为CINⅡ级,另l例为CINⅢ级。醋酸涂抹法诊断结果为：正常1445例(72．4％),低度病变525例(26．3％),高度病变2l例(1．0％),宫颈癌6例(0．3％)。醋酸涂抹法诊断为低度病变或其以上病变者中,经病理检查证实为CINⅡ级及其以上病变的检出敏感性为70．9％(6l／86),特异性为74．3％(1420／1911),对小病灶的敏感性为64．9％(37／57),而大的病灶达88．9％(24／27)。阴道镜对高度病变的检出率为8l.4％(70／86),特异性为76．5％(1462／1911)。结论：醋酸涂抹法具有较高的特异性和敏感性。对CINⅡ级及其以上病变,醋酸涂抹法和阴道镜检查具有相似的特异性。由于醋酸涂抹法简便、费用低廉,对于经济落后地区不失为宫颈癌筛查中一种有效可行的初筛方法。     

Prevalence of High-grade Cervical Lesion in Women with LSIL and HSIL Cytology and Prevalence of Invasive Cancer in Women Cytologically Positive for Malignancy

Aim: To determine the prevalence of high-grade cervical lesion (CIN 2 or worse, CIN 2+) and the prevalenceof invasive cancers in women with LSIL, HSIL and positive for malignancy on cytology, respectively.Methods: A retrospective study of patients undergoing colposcopy in Rajavithi hospital between 2003-2004was performed. The final diagnosis was based on colposcopy and histology. Results: Among 250 women withLSIL and 152 women with HSIL, 28 (11.20%) and 112 (75.70%), respectively, had histology-confirmed highgradecervical lesions. Invasive cancer was diagnosed in 12 (7.9%) of women with HSIL but in none of the LSILcases. Among 19 women with positive smears for malignancy, only 7 ( 36.8 % ) had histology-confirmedinvasive cancer. Conclusion: The present study confirms that women with HSIL have high prevalence ofhigh-grade cervical lesions and malignancy. Women with LSIL may be managed less aggressively because of thenegligible risk of more advanced lesions. Smears positive for malignancy are inconsistent predictors of invasivecancer.     

Switch from cytology-based to human papillomavirus test-based cervical screening: implications for colposcopy

Human papillomavirus (HPV) testing is more sensitive than cytology; some cervical cancer prevention programs will switch from cytology to carcinogenic HPV test-based screening. The objective of our study is to evaluate the clinical implications of a switch to HPV test-based screening on performance and workload of colposcopy. Women in the population-based, 7-year Guanacaste cohort study were screened at enrollment using cytology. We also took another specimen for HPV DNA testing and collected magnified cervical photographic images (cervigrams). A final case diagnosis (≥cervical intraepithelial neoplasia [CIN] grade 3, CIN2, 相似文献   

Prevalence of High Grade Squamous Intraepithelial Lesion (HSIL) and Invasive Cervical Cancer in Patients with Low Grade Squamous Intraepithelial Lesion (LSIL) at Cervical Pap Smear

Objective: To assess the prevalence and factors associated with a histologic diagnosis of high grade squamous intraepithelial lesion (HSIL) and invasive cervical cancer in patients with low grade squamous intraepithelial lesion (LSIL) cervical pap smear findings. Methods: Medical records (including cytology reports, colposcopic impression, and pathologic results from cervical biopsy, endocervical curetting, cervical conization or hysterectomy) of 226 women with LSIL from conventional cervical pap smears during January 2001 to December 2005, who subsequently underwent colposcopic evaluation at our institution, were reviewed. Results: Mean age of the patients was 39.0 years. The incidences of LSIL, HSIL, microinvasive cervical cancer were 58.8%, 15.0%, 1.3% respectively. No associations were found between age, parity, contraception, anti-HIV or menstrual status and the detection of HSIL/invasive cervical cancer. Conclusion: Approximately 16.3 % of LSIL pap smear cases turn out to be HSIL or invasive cervical cancer from histologic diagnosis.     

Is Age an Independent Predictor of High-Grade Histopathology in Women Referred for Colposcopy after Abnormal Cervical Cytology?

This study was conducted to determine whether advancing age is an independent predictor of increased risk ofhigh-grade pathologies among women referred for colposcopy after abnormal cervical cytology. Medical recordswere reviewed for women with abnormal cervical cytology who underwent colposcopy at Khon Kaen UniversityHospital. Logistic regression was used to determine the independent impact of age on the risk of high-gradepathologies. Mean age of the women was 42.8 years. Of 482 women, 97 (20.1%) were postmenopausal, and 92(19.1%) were nulliparous. The rate of high-grade pathologies included cervical intraepithelial neoplasia 2-3, 99(20.5%), adenocarcinoma in situ, 4 (0.8%), cervical cancer, 30 (6.2%), and endometrial cancer, 1 (0.2%). Theprevalence of significant lesions was 26.9% (95% CI, 23.1%-31.2%). In total, 31 women had cancers (6.4%; 95%CI, 4.4%-9.0%). When controlling for smear types and parity, age was noted to be a significant independentpredictor of high-grade histopathology. Women older than 35-40 years were approximately 2 times as likelyto have severe histopathology as the younger women. This study illustrates the substantial risk of underlyingsignificant lesions especially invasive cancer in Thai women with abnormal cervical cytology. Age was a significantindependent factor predicting the risk of high-grade pathologies.     

Histologic Outcomes in HPV-Positive and Cervical Cytology- Negative Women - Screening Results in Northern Thailand

The objective of this study was to determine the prevalence of significant lesions defined as high gradesquamous intraepithelial lesions (HSIL), adenocarcinoma in situ (AIS) and invasive carcinoma in women whohad HPV-positive and cytology negative co-testing screening results. This retrospective study was conducted inChiang Mai University Hospital between May, 2013 and August, 2014. Hybrid capture 2 (HC2) was used forHPV testing and conventional Pap smears for cytologic screening. A repeat liquid-based cytology (LBC) wasperformed in women with such co-testing results followed by colposcopy. Random biopsy was performed in casesof normal colposcopic findings. Further investigations were carried out according to the biopsy or the repeatLBC results. During the study period, 273 women met the criteria and participated in the study. The mean ageof these women was 46.4 years with 30% of them reporting more than one partner. The median interval time tocolposcopy was 165 days. About 40% showed an abnormality in the repeat cytology. Significant cervical lesionswere found in 20 (7.3%) women, including 2 invasive cancers. Of interest was that only 2 of 20 significant lesionswere diagnosed by colposcopic examination while the remainder were initially detected by cervical biopsy andabnormal repeat cytology. In conclusion, the prevalence of significant cervical lesions in HPV positive andcytology negative women in Northern Thailand was 7.3%. Further diagnostic work up with repeat cytologyfollow by colposcopy is recommended. Random biopsy should be performed even when the colposcopic findingsare normal.     

Factors predicting occult invasive carcinoma in women undergoing a 'see and treat' approach

This study was undertaken to evaluate the incidence and independent predictors of unexpected invasive cancer of cervix in women with high-grade squamous intraepithelial lesions (HSIL) on Pap smear who had undergone a 'see and treat' approach. Women with HSIL on cervical cytology undergoing colposcopy, followed by loop electrosurgical excision procedure (LEEP) at Chiang Mai University Hospital between January 2001 and April 2006 were analyzed. During the study period, 446 women were identified. Mean age was 45.6 years (range, 25-75 years). One hundred and twenty-one (27.1%) women were postmenopausal. Unsatisfactory colposcopy was observed in 357 (80.0%) women. Of the 446 women, 76 (17.04%, 95% CI= 13.67 to 20.86) had invasive lesions on LEEP specimens. Multivariate analysis revealed that unsatisfactory colposcopy and premenopausal status were statistically significant independent predictors for invasive lesions in a 'see and treat' LEEP with an adjusted odds ratio of 4.68 (95%CI=1.82 to 12.03, P<0.01) and 2.10 (95%CI=1.12 to 3.94, P=0.02), respectively. In conclusion, occult invasive lesion of the cervix was noted in 17% of women with HSIL Pap smear who underwent a 'see and treat' approach at our institute. Unsatisfactory colposcopy and premenopausal status were significant independent predictors of having such lesion.     

Human papillomavirus DNA testing for cervical cancer screening in low-resource settings

BACKGROUND: In many low-resource settings, there are barriers to cytologic screening for cervical cancer. This study evaluates human papillomavirus (HPV) DNA testing as an alternative screening method. METHODS: Cervical samples from 2944 previously unscreened South African women aged 35-65 years were tested for high-risk types of HPV with the use of the Hybrid Capture I (HCI) assay. Women also had a Pap smear, direct visual inspection of the cervix, and Cervicography(TM). Women positive on any screening test were referred for colposcopy. Samples from women with biopsy-confirmed, low-grade squamous intraepithelial lesions (SILs) (n = 95), high-grade SILs (n = 74), or invasive cervical cancer (n = 12) and a random sample of women with no cervical disease (n = 243) were retested for HPV DNA with the use of the more sensitive Hybrid Capture II (HCII) assay. All P values are two-sided. RESULTS: High-risk HPV DNA was detected in 73.3% and 88.4% of 86 women with high-grade SIL or invasive cancer and in 12.2% of 2680 and 18.1% of 243 women without evidence of cervical disease, with the use of the HCI and HCII assays, respectively. HPV DNA testing with the HCII assay was more sensitive than cytology for detecting high-grade SIL and invasive cancer (McNemar's test, P =.04), and testing with the HCI assay was of equivalent sensitivity (P =.61). Cytology had a statistically significantly better specificity (96.8%) than either the HCI assay (87.8%) or the HCII assay (81.9%) (P<.01). Receiver operating characteristic curves identified test cutoff values that allow HPV DNA testing to identify 57% of women with high-grade SIL or cancer, while classifying less than 5% of women with no cervical disease as HPV DNA positive. CONCLUSIONS: HPV DNA testing has a sensitivity equivalent to, or better than, that of cytology. Since HPV DNA testing programs may be easier to implement than cytologic screening, HPV testing should be considered for primary cervical cancer screening in low-resource settings.     

Clinical Significance of Atypical Squamous Cells of Undetermined Significance among Patients Undergoing Cervical Conization

Background: Atypical squamous cells of undetermined significance (ASCUS) feature a wide variety of cervical cells, including benign and malignant examples. The management of ASCUS is complicated. Guidelines for office gynecology in Japan recommend performing a high-risk human papillomavirus (HPV) test as a rule. The guidelines also recommend repeat cervical cytology after 6 and 12 months, or immediate colposcopy. The purpose of this study was to determine the clinical significance of ASCUS. Materials and Methods: Between January 2012 and December 2014, a total of 162 patients underwent cervical conization for cervical intraepithelial neoplasia grade 3 (CIN3), carcinoma in situ, squamous cell carcinoma, microinvasive squamous cell carcinoma, and adenocarcinoma in situ at our hospital. The results of cervical cytology prior to conization, the pathology after conization, and high-risk HPV testing were obtained from clinical records and analyzed retrospectively. Results: Based on cervical cytology, 31 (19.1%) of 162 patients were primarily diagnosed with ASCUS. Among these, 25 (80.6%) were positive for high-risk HPV, and the test results of the remaining 6 patients (19.4%) were uncertain. In the final pathological diagnosis after conization, 27 (87.1%) and 4 patients (12.9%) were diagnosed with CIN3 and carcinoma in situ, respectively. Conclusions: Although ASCUS is known as a low-risk abnormal cervical cytology, approximately 20% of patients who underwent cervical conization had ASCUS. The relationship between the cervical cytology of ASCUS and the final pathological results for CIN3 or invasive carcinoma should be investigated statistically. In cases of ASCUS, we recommend HPV tests or colposcopic examination rather than cytological follow-up, because of the risk of missing CIN3 or more advanced disease.     

Hierarchical clustering of human papilloma virus genotype patterns in the ASCUS-LSIL triage study

Anogenital cancers are associated with ～13 carcinogenic human papilloma virus (HPV) types in a broader group that cause cervical intraepithelial neoplasia (CIN). Multiple concurrent cervical HPV infections are common, which complicates the attribution of HPV types to different grades of CIN. Here we report the analysis of HPV genotype patterns in the atypical squamous cells of undetermined significance-low-grade squamous intraepithelial lesion triage study with the use of unsupervised hierarchical clustering. Women who underwent colposcopy at baseline (n = 2,780) were grouped into 20 disease categories based on histology and cytology. Disease groups and HPV genotypes were clustered with the use of complete linkage. Risk of 2-year cumulative CIN3+, viral load, colposcopic impression, and age were compared between disease groups and major clusters. Hierarchical clustering yielded four major disease clusters: cluster 1 included all CIN3 histology with abnormal cytology; cluster 2 included CIN3 histology with normal cytology and combinations with either CIN2 or high-grade squamous intraepithelial lesion cytology; cluster 3 included older women with normal or low-grade histology/cytology and low viral load; and cluster 4 included younger women with low-grade histology/cytology, multiple infections, and the highest viral load. Three major groups of HPV genotypes were identified: group 1 included only HPV16; group 2 included nine carcinogenic types, plus noncarcinogenic HPV53 and HPV66; and group 3 included noncarcinogenic types, plus carcinogenic HPV33 and HPV45. Clustering results suggested that colposcopy missed a prevalent precancer in many women with no biopsy/normal histology and high-grade squamous intraepithelial lesion. This result was confirmed by an elevated 2-year risk of CIN3+ in these groups. Our novel approach to study multiple genotype infections in cervical disease with the use of unsupervised hierarchical clustering can address complex genotype distributions on a population level.     

The accuracy of cervical cancer and cervical intraepithelial neoplasia diagnosis with loop electrosurgical excisional procedure under colposcopic vision

Objective

The colposcopic vision guided loop electrosurgical excisional procedure (LEEP) was studied for the effective diagnosis of cervical cancer and cervical intraepithelial neoplasia (CIN).

Methods

A total of 199 patients participated in this study. Individual cases were from gynecologic outpatients at Thammasat University Hospital, Thailand. These had diagnoses for CIN and were selected for treatment with colposcopic guided LEEP. The average age of patients in this study was 45. Menopausal women represented 31%, (61/199) of the patients. The most frequently found Pap smear result among these women (44%, 88/199), was that of high-grade squamous intraepithelial lesion. The next most frequent Pap smear result (32%, 64/199) was low-grade squamous intraepithelial lesion. Patients'' medical records and outcomes were evaluated for consistency of pathological examination between colposcopic directed biopsy and LEEP. Discrepancies between initial diagnosis and the final diagnosis were also analyzed.

Results

The colposcopic guided LEEP accurately determined 100% of the cervical cancer cases and 84.8 % of the high-grade squamous intraepithelial lesion cases. Involvement of the ectocervical or endocervical margin regions was found to be 5% and 10% respectively, in this study. Excessive bleeding complication, either during the excision and/or postoperative recovery was found in 3% and 6% of cases, respectively.

Conclusion

LEEP under colposcopic vision is a recommended technique for ambulatory management of precancerous lesion and early diagnosis of cervical cancer. This technique significantly reduces rate of positive ectocervical cone margin involvement.     

Accuracy of Visual Inspection with Acetic Acid (VIA) for Early Detection of Cervical Dysplasia in Tehran,Iran

Objective: To evaluate the accuracy of visual inspection with 5% acetic acid (VIA) when used to detect cervical ‍cancer and its precursors. ‍Methods: The study population included women attended Family Planning and Gynecological Clinic in Bagher ‍Abad Health Center and Mirza Koochak Khan Hospital for regular cervical screening tests. After obtaining informed ‍consent from each woman, VIA was performed. One hundred with a positive VIA test and 100 women with a ‍negative VIA test were randomly selected for this study. Cytology and colposcopy examination were performed for ‍all 200 cases and cervical biopsies were conducted for those individuals showing abnormal colposcopic findings. ‍Results: Nine cases in VIA-positive group and two cases in VIA-negative group had an abnormal cytology. Ninety ‍five women in the VIA-positive group and 25 in the VIA-negative group had abnormal colposcopic findings. From ‍biopsy examination, 67 (71%) of cases in the VIA-positive group and 3 (12%) cases in the VIA-negative group had ‍a final diagnosis of dysplasia. Among biopsied samples, only 7 cases of VIA-positive group showed abnormal result ‍and the remaining were normal. Based on these results, VIA test sensitivity and specificity were 95.7% and 44.0% ‍respectively, while they were 10% and 92% for cytology tests. ‍Conclusions: The results of this study indicate that although VIA is a sensitive screening test for detection of ‍cervical dysplasia, it can not be used by itself. Applying VIA along with Pap smears helps to detect a higher number ‍of cases with cancer precursor lesions.     

Northern Thai Women with High Grade Squamous Intraepithelial Lesion on Cervical Cytology Have High Prevalence of Underlying Invasive Carcinoma

The aim of this study was to determine the underlying pathology of women with high grade squamous intraepitheliallesion (HSIL) on cervical cytology. A total of 681 women with HSIL cytology undergoing colposcopic examination atChiang Mai University Hospital (CMUH) between January 2000 and December 2005 were evaluated for the underlyingcervical pathology. The final pathology was diagnosed from the most severe lesions obtained by punch biopsy, loopelectrosurgical procedure, cold knife conization or hysterectomy. Underlying high grade cervical lesions includingcervical intraepithelial neoplasia grade 2, 3 and adenocarcinoma in situ were noted in 502 (73.7%) women. Invasivecervical carcinoma was identified in 141 (20.7%). The remaining 38 (5.6%) had either low grade or no intraepitheliallesions. No significant difference in the prevalence of underlying high grade and invasive lesions was noted betweenwomen with cytologic diagnosis of HSIL from CMUH and other hospitals. In conclusion, northern Thai women withHSIL cytology are at significant risk of having underlying severe cervical lesions, and especially invasive carcinomawhich is detected in approximately one-fifth of the cases.     

Risk of High-Grade Cervical Lesions in Atypical Squamous Cells of Undetermined Significance (ASC-US) Cytology: Comparison between HIV-Infected and HIV-Negative Women

Background and objective: Women with human immunodeficiency virus (HIV) infection have an increased risk of HPV infection, cervical neoplasia. This study was undertaken to compare the risk of having high-grade cervical lesions defined as cervical intraepithelial neoplasia grade 2 or worse (CIN2+) in HIV-infected versus HIV-uninfected women who had atypical squamous cells of undetermined significance (ASC-US) on cervical cytology. Methods: Fifty-seven HIV-positive women aged 25-65 years with ASC-US cytology undergoing colposcopic examination between January 2008 and December 2020 at Chiang Mai University Hospital were reviewed. By matching 1:5 ratio, 285 HIV-negative women with ASC-US cytology in the same period were recruited as controlled subjects for comparison. The patient characteristics, HIV status, CD4 cell count within 6 months of colposcopy, antiretroviral therapy, parity, contraception, smoking history, number of sexual partners, and histopathology on cervical biopsy were analyzed. Results: Mean age ± SD of the HIV-positive and HIV-negative groups was 44.28 ± 8.53 years and 44.28 ± 9.68 years, respectively. HIV-positive women were significantly less likely to use contraceptive methods (36.8 % versus 48.8 % in HIV-negative women; P = 0.002). HIV-infected women significantly had more sexual partners than HIV-uninfected women. Both groups had similar risk for CIN 2+ (5.3 % in HIV-positive women compared with 4.9 % in HIV-negative women; odds ratio [OR] = 1.08, 95% confidence interval [CI] = 0.30 –3.87). After adjustment for no contraception use and number of sexual partners, the risk of CIN2+ in HIV-infected women remained unchanged; adjusted OR= 1.15, 95% CI = 0.27-4.92, P= 0.846). Conclusion: The risk of underlying high-grade cervical lesions in women with ASC-US on cervical cytology was approximately 5 %, regardless of HIV status.     

Management of borderline change in endocervical cells: a more dependable approach

Background:

There are limited data and guidance from the UK on borderline nuclear change in endocervical cells (BNCs). The objective of this study is to determine the clinical outcome of women with BNCs, to determine the accuracy of colposcopy and propose a more robust management algorithm.

Methods:

This is a retrospective review of all BNC referrals between January 2006 and December 2011 at the Northumbria Healthcare Trust. Histological diagnosis was based on high-grade histology (CIN 2 or worse). Any high-grade histology in the first year of follow-up was included in the final diagnosis.

Results:

Of the 9001 new referrals, 167 women had BNCs. Thirty-seven (22%) were diagnosed with high-grade histology on initial assessment. Sixty women had satisfactory and negative colposcopy, out of which 7 (12%) were detected with high-grade histology/cytology in the first year of follow-up. Overall, 50 high-grade histology (30%), including two invasive carcinomas were detected.

Conclusions:

Current follow-up of BNCs relies heavily on colposcopic assessment. A significant proportion of women with negative colposcopy was found to have high-grade histology in the first year of follow-up. We propose a more robust management algorithm to lower the probability of missed high-grade histology in this subgroup of women.