Abnormal Cytological Findings Research Articles

Correlation between abnormal cytological findings and human papillomavirus infection of the uterine cervix in Bulgarian women

ABSTRACTThe aim of this study was to analyse the correlation between cases of human papillomavirus (HPV+/−) infection of the uterine cervix revealed through HPV typing and cytological results from Papanicolaou (Pap)-stained cervical smears. Cervical smears of 421 Bulgarian women attending routine gynaecological examinations during the three-year study period were stained by the Pap technique and classified by the Bethesda system. GenoFlow HPV Array Test Kit was used to analyse the HPV status in the collected cervical samples. The results showed that, of the 421 women, 177 (42%) were HPV(+) and 244 (58%) were HPV(−); 334 (79.3%) Pap smears were with normal morphology and 87 (20.7%) had high/low grade squamous intraepithelial lesion (LSIL/HSIL) changes. Of the 87 women with LSIL/HSIL changes, 54% (47/87) were HPV(−) and 46% (40/87) were HPV(+). There was no statistically significant correlation between the HPV(+) status and the cytological LSIL/HSIL findings (P > 0.05). Koilocytes were found in 30.4% (128/421) of the samples. Of the 128 women with koilocytosis, 59.4% (76/128) were HPV(−) and 40.6% (52/128) were HPV(+). There was no significant correlation (P > 0.05) between the presence of koilocytes in cervical smears and HPV infection. Our results suggest that HPV infection is frequent even in women with negative Pap-smear results, and polymerase chain reaction seems to be the only reliable test to diagnose this infection. However, the results from this study cannot be considered to fully support the replacement of cytology and colposcopy examination in cervical cancer screening with HPV genotyping tests only.

Application of Bethesda terminology to categorize buccal epithelial smears among petroleum station workers in Taif city, KSA

Background and Objectives: Exposure to Petroleum products has a well-established mutagenicity and carcinogenicity of some compo-nents such as benzene. Buccal mucosal cells are capable of metabolizing the carcinogenic compounds to reactive chemicals. We investigated the buccal epithelial cell cytological changes resulting from the occupational exposure to Petroleum derivatives such as benzene.Methods: Samples were obtained from 70 Petrol station workers in Taif city-KSA, examined using the Papanicolaou stained smears and categorized based on Bethesda Terminology System. Statistical analysis was carried out with the SPSS.Results: About 38.6% of petrol station workers exhibited buccal cytological changes ranging from atypical squamous cells of undetermined significance (ASC-US) to high-grade squamous intraepithelial lesions (HSIL). Atypical squamous cells, cannot exclude high-grade squamous intraepithelial lesion (ASC-H) was the most frequent cytological abnormality. Buccal smears with abnormal cytological findings dominated among smokers in contrast to non-smokers with a statistically significant difference (P = 0.026). No significant associations were detected between the category of buccal cytological changes and the duration of work or the participant's age.Conclusion: Bethesda Terminology System can be efficiently applied to buccal smears. Petrol products induce precancerous epithelial changes in buccal epithelial cells indicating a potential health risk for Petrol station workers, thus annual checkup for those workers should be set as primary prevention of occupational-related cancer. Cigarette smoke is a co-factor that exacerbates the effects of Petrol derivatives.

Vaginal Cytology Results in Follow-up of Endometrial Carcinoma After Hysterectomy.

Our study examined accumulated data on vaginal cytology follow-up results of women treated for endometrial carcinoma (EmCa) by hysterectomy in a large academic women's hospital practice. This study analyzed cases of EmCa treated by hysterectomy from January 2006 to December 2008 with documented follow-up vaginal cytology and/or vaginal biopsy results available prior to September 2013. Of 607 patients with EmCa who had documented hysterectomy findings, 420 had either follow-up vaginal biopsy or cytology results during a mean follow-up period of 42.5 months, and 414 (98.6%) had at least one vaginal cytology follow-up result. Of 414 patients followed with vaginal cytology results, 48 (11.6%) had biopsy results while 366 (88.4%) had only vaginal cytology results. Recurrent EmCa in the vagina was documented by biopsy in 11 patients, eight within 2 years of hysterectomy. Cytology findings of neoplastic glandular cells triggered diagnostic vaginal biopsies in two of 11 cases. Vaginal recurrences of EmCa were diagnosed in 11 (2.6%) of 420 patients with documented vaginal follow-up testing. Abnormal vaginal cytology findings directly led to vaginal biopsy diagnoses of EmCa in two of the 11 patients. Vaginal cytology is no longer a recommended routine surveillance option for detection of vaginal cuff recurrence of EmCa.

Diagnostic outcome of ureteroscopy in urothelial carcinoma of the upper urinary tract: Incidence of later cancer detection and its risk factors after the first examination.

BackgroundTo determine the incidence of later cancer detection and its risk factors after the first diagnostic ureteroscopy.MethodsOne hundred and sixty-six patients undergoing diagnostic ureteroscopy based on the suspicion of urothelial carcinoma of the upper urinary tract (UC of the UUT) between 1995 and 2012 were included. We examined the diagnostic outcome of the initial ureteroscopy. Thereafter, we collected follow-up data on patients who had not been diagnosed with UC of the UUT at the first examination, and evaluated the incidence of later cancer detection and its risk factors using Cox hazard models.ResultsOf the 166 patients, 76 (45.8 %) were diagnosed with UC of the UUT at the first diagnostic ureteroscopy. The remaining 90 (54.2 %) were diagnosed with other malignancies (n = 22), non-malignant disorders (n = 18), or without disorders (n = 50). Of these 90 patients, follow-up data were available in 65 patients (median: 41 months, range: 3–170). During the follow-up, carcinoma was detected in 6 patients (6/65, 9.2 %) at a median of 43.5 months (range: 10–59). Episodes of gross hematuria (p = 0.0048) and abnormal cytological findings (p = 0.0335) during the follow-up and a male sex (p = 0.0316) were adverse risk factors.ConclusionLater cancer detection of UC of the UUT was not uncommon after the first examination. The risk analysis revealed the aforementioned characteristics.

Incidence and Predictors of Abnormal Anal Cytology Findings Among HIV-Infected Adults Receiving Contemporary Antiretroviral Therapy

Anal cancer rates are higher for human immunodeficiency virus (HIV)-infected adults than for uninfected adults. Limited published data exist characterizing the incidence of precursor lesions detected by anal cytology. The Study to Understand the Natural History of HIV/AIDS in the Era of Effective Therapy was a prospective cohort of 700 HIV-infected participants in 4 US cities. At baseline and annually thereafter, each participant completed a behavioral questionnaire, and healthcare professionals collected anorectal swabs for cytologic examination and human papillomavirus (HPV) detection and genotyping. Among 243 participants with negative baseline results of anal cytology, 37% developed abnormal cytology findings (incidence rate, 13.9 cases/100 person-years of follow-up; 95% confidence interval [CI], 11.3-16.9) over a median follow-up duration of 2.1 years. Rates among men having sex with men, among women, and among men having sex with women were 17.9 cases/person-years of follow-up (95% CI, 13.9-22.7), 9.4 cases/person-years of follow-up (95% CI, 5.6-14.9), and 8.9 cases/person-years of follow-up (95% CI, 4.8-15.6), respectively. In multivariable analysis, the number of persistent high-risk HPV types (adjusted hazard ratio [aHR], 1.17; 95% CI, 1.01-1.36), persistent high-risk HPV types except 16 or 18 (aHR, 2.46; 95% CI, 1.31-4.60), and persistent types 16 or 18 (aHR, 3.90; 95% CI, 1.78-8.54) remained associated with incident abnormalities. The incidence of abnormal anal cytology findings was high and more likely to develop among persons with persistent high-risk HPV.

Abnormal cytologic findings during pregnancy

Abnormal cytologic findings during pregnancy

Investigation of Transition Types of HPV DNA Test Results over Time in Korean Women.

Understanding the history of human papilloma virus (HPV) infection is important for interpretation of a positive HPV DNA screening test, future work-up and treatment. We investigated the transition of HPV DNA test results in Korean women, and analyzed the association of cytology result with transition type. We retrospectively reviewed annual HPV DNA test results for 5,274 subjects between January 2005 and December 2012. Each subject had a minimum of five annual tests over the eight-year period. Based on the pattern of results, the transition type for each subject was assigned to one of the following: negative, persistent, latent, transient, and unclassifiable. Associations of cytology results with the HPV DNA transition types, number of positive results, and the durations of positive results were also analyzed. The proportion of abnormal cytology findings decreased in the following order of transition patterns: persistent, latent, transient, and negative. Among transient patterns, a duration of three years or more significantly correlated with cytology results of non-high grade squamous intraepithelial lesion (HSIL; p<0.001). In the persistent group, duration of five years or more correlated with both non-HSIL and HSIL (p<0.001). Latent group showed no correlation with duration. Irrespective of patterns, having five or more positive results was significantly associated with HSIL (p<0.001). Our findings may contribute to better understanding of HPV infection, interpretation of HPV DNA screening results, and prediction of prognosis according to transition type.

Quality evaluation of cone biopsy specimens obtained by large loop excision of the transformation zone.

BackgroundLarge loop excision of the transformation zone (LLETZ) has been used for the diagnosis and treatment of precancerous cervical lesions, and it is the first choice of treatment in the majority of cervical pathology services. The aim of this study was to evaluate the presence of thermal artifacts, the need for serial sections, the percentage of clear and involved resection margins and the relationship between endocervical gland involvement and the severity of the lesion in samples resected using LLETZ.MethodsA retrospective study was performed at Santa Casa de Misericordia School of Science (HSCMV), Vitoria, Espirito Santo, Brazil with a sample of 52 histopathology slides from patients submitted to conization because of abnormal cytology findings and a biopsy result of cervical intraepithelial neoplasia (CIN) 2, CIN 3 and adenocarcinoma in situ. Statistical analysis was performed using Student’s t-test.ResultsSerial sections were required to confirm diagnosis in four of 52 cases. Thermal artifacts were present in all cases, with grade I being the most common (94.2% of cases). Clear margins were found in 96.2% of cases. No association was found between glandular involvement and CIN 1 (P > 0.05); however, there was an association with CIN 2 and CIN 3 (P < 0.05).ConclusionThe amount of excised tissue was sufficient, thermal artifacts were slight, resection margins were clear in most of cases, and a possible association was found between glandular involvement and the severity of the lesion.

Correlation Between Cervical Cytology and Histopathological Cervical Biopsy Findings According to the Bethesda System / Stepen Korelacije Cervikalne Citologije Po Bethesda Klasifikaciji Sa Patohistološkim Nalazima Cervikalne Biopsije

ABSTRACT The Pap test (Pap smear) is a morphological cytodiagnostic test that reveals premorbid and early stages of cervical cancer through the use of cervicovaginal cytology. The present study was conducted at the Department of Gynecology and Obstetrics, Clinical Center Kragujevac, from January 01, 2013, to December 1, 2013, with patients who were part of the national screening program and who used a secondary cytological examination (Pap test) performed using a conventional method. The patients were grouped according to the results of a Pap smear and histopathological findings. The classification of cytological smears was performed in accordance with the Bethesda system. The hypotheses established in this study were statistically tested. The greatest number of cytological findings was NILM. However, the most frequent abnormal cytological findings in terms of percentage were ASC-US. After secondary cervical findings of 8.1% of the total number of women, biopsies were performed. In 68.57% of the biopsies performed, CIN was present in all of them, with the most frequent ones being LSIL (50.6%), HSIL (10.4%) and CA Invasiva (0.5%). This study, using the X2 test, confirmed that cervical cytology and biopsy results are dependent features (sig. = 0.036), between which there is a medium association (Cramer’s V = 0.176). In the ASC-US cytological findings, small percentages of CIN1 and CIN2 were detected. Cervical cytology in this study presented high sensitivity, specificity, positive and negative predictive value. As a relatively inexpensive, painless and easily approachable method, cervical cytology fully substantiates its implementation in diagnostic procedures as well as in organized screening programs.

Remarks by the Board of the Study Group for Cervical Pathology and Colposcopy on the "Comments on the Publication of Munich Nomenclature III by the Cytology Coordination Conference" by A. Schneider and P. Hillemanns (Geburtsh Frauenheilk 2014; 74: 242-243).

Remarks by the Board of the Study Group for Cervical Pathology and Colposcopy on the "Comments on the Publication of Munich Nomenclature III by the Cytology Coordination Conference" by A. Schneider and P. Hillemanns (Geburtsh Frauenheilk 2014; 74: 242-243).

Remarks on the "Comments on the Publication of Munich Nomenclature III by the Cytology Coordination Conference" by A. Schneider and P. Hillemanns (Geburtsh Frauenheilk 2014; 74: 242-243).

It is gratifying that the authors of the Comments, one of whom is working at a university hospital and the other of whom is working in a private practice, generally commented favorably on the revised classification for the cytological diagnosis of cervical Pap smears, which will come into general use on July 1 of this year. Some of the criticisms voiced in the Comments were probably due to the authorsʼ being unaware of the original publication by the Cytology Coordination Conference, published a few months previously in a gynecological journal (Frauenarzt 2013; 11: 2–7). Thus, the Munich Nomenclature III does not represent an attempt to translate the Bethesda System into German. That would be neither useful in terms of content nor possible with regard to perpetuating and continuing the Munich Nomenclature. Similarly, the view that the objective and the conclusions of the revised Nomenclature should have been evidence-based is erroneous. The criticism that Munich Nomenclature III with its traditional division into six main groups is too differentiated is superfluous. The Bethesda System makes use of 18 subgroups to describe the morphological variety of cytological findings, which are then grouped together into higher level categories for reasons of practicability (Solomon D, Nayar R. The Bethesda System for Reporting Cervical Cytology. Springer; 2004). The authors responsible for updating the Munich Nomenclature deliberately included recommendations on differential diagnoses as the aim was to do justice to each individual case. It was also done with the intention of integrating more meaningful diagnostic methods, which will be available in the foreseeable future and which will replace various unspecific methods and their incalculable potential for damage such as HPV tests. Combining abnormal cytological findings with recommendations for further procedures is not merely a traditional part of the Munich Nomenclature but also a common feature of classifications in other countries as well. Of course such recommendations in reports on diagnostic findings cannot replace the guidelines on patient care developed by different scientific committees. Such guidelines are developed using the evidence base of the respective country and are tailored to specific healthcare systems. For that reason alone it would not be possible to simply use a classification which is merely a translation of a foreign categorization into diagnosis-related groups. We are confident that the benefits of Munich Nomenclature III will quickly become apparent to all users and that the authors of the Comments will come to realize this in the course of their own daily diagnosis of Pap smears.

Manual Liquid-Based Cytology: A Clinical Pilot Study of the VitroPrep™ Cytology Processing Kit

Objective: It was the aim of this study to assess the utility of the manual liquid-based cytology (LBC) product VitroPrep™ Cytology Processing Kit (ChemQ Bioscience LLC, Research Triangle Park, N.C., USA). Study Design: This is a descriptive pilot study. Women underwent cervical sampling processed by the ThinPrep™ automated LBC system followed by cervical sampling for the VitroPrep manual system. The following criteria were assessed on a scale of 1-5 (1 = unsatisfactory, 2 = borderline, 3 = acceptable, 4 = good, 5 = excellent): monolayer cell adhesion, overall cellularity, background clarity, preservation of cellular morphology, red cell lysis, and elimination of mucus/debris. Cytological diagnosis was compared to results from ThinPrep samples. In addition, VitroPrep samples were taken prior to conization procedures and compared to pathology results. Descriptive statistics were performed. Results: Forty-two of 47 women who underwent dual cytologic sampling had satisfactory samples. All scores were 3-5, with >90% graded 4-5. The VitroPrep diagnosis correlated with the ThinPrep diagnosis in 90% (38/42) of cases. All specimens obtained from 15 women prior to conization were satisfactory and correlated abnormal cytologic findings with cervical intraepithelial neoplasia 1-3 pathology. Conclusions: The VitroPrep Cytology Processing Kit was able to provide adequate specimens for evaluation and diagnosis. This low-cost processing kit may provide a useful alternative in settings where automated LBC systems may not be feasible.

Outcomes of Laser Conization for Cervical Intraepithelial Neoplasia 2-3 and Microinvasive Cervical Cancer.

BackgroundCurrently, there is no standardized follow-up protocol for patients who undergo laser conization. Therefore, we retrospectively investigated the clinical outcomes of laser conization in patients with high-grade cervical intraepithelial neoplasia 2-3 (CIN 2-3) and microinvasive squamous cell carcinoma and assessed the risks of residual and recurrent lesions of the cervix uteri.MethodsThe medical and pathological records of 91 patients with CIN 2, 580 with CIN 3 and 73 with microinvasive cervical cancer (MIC) who underwent laser conization between January 2000 and December 2011 were retrospectively reviewed.ResultsPositive margins increased with the extent of disease and were observed in 5.5%, 8.9% and 16.4% patients with CIN 2, CIN 3 and MIC, respectively, while residual or recurrent disease was observed in 0%, 3.2% and 13.6% patients, respectively. Examination of specimens obtained through postconization biopsy or hysterectomy revealed that 1.5% and 20% patients with negative and positive margins, respectively, were diagnosed with residual or recurrent lesions. Among patients who were conservatively managed after conization, seven with CIN 3 exhibited residual or recurrent disease, as evidenced by abnormal cytological findings, within 2 years after conization.ConclusionsContinuous follow-up by cytology and colposcopy, particularly during the first 2 years after conization, can effectively detect early residual or recurrent disease in CIN 3 and MIC patients, regardless of their margin status.

Challenges and Recommendations to Recruiting Women Who Do Not Adhere to Follow-Up Gynecological Care.

PurposeNon-adherence to recommended follow-up visits after an abnormal cytological finding is associated with poorer outcomes and higher health care costs. The purpose of this paper is to describe the challenges when examining reasons for non-adherence to cervical cancer screening follow-up and to discuss the recommendations to overcome those challenges.MethodsWe conducted a telephone survey with two subgroups of women: 1) those which adhered to recommended follow-up care after an abnormal Pap test, and 2) those which did not adhere.ResultsThe follow-up accrual among non-adherent women lagged behind that of adherers. We were able to contact and conduct a survey with 51% of the adherers and 26% of the non-adherers. The challenges in studying non-adherent women were related to several distinct factors: 1) the definition of non-adherence, 2) the availability of alternate contact information, 3) the amount and type of financial incentives, and 4) the availability of staffing. We describe strategies employed to increase the accrual of non-adherent women.DiscussionThis paper describes four recommendations that may play a role in understanding and reducing non-adherence to follow-up gynecological care.

Abnormal Cervical Cytology Risk Factors in the Western Black Sea Region and the Importance of Health Insurance / Batı Karadeniz Bölgesinde Anormal Servikal Sitoloji Risk Faktörleri ve Sağlık Sigortasının Önemi

Objective: to evaluate the prevalence of abnormal cervical cytological findings in the Western Black Sea Region and investigate an association between socio-demographic risk factors and the presence of cytological abnormalities. Material and Method: The reports of 11,539 cervical smears diagnosed according to Bethesda System 2001 version in the Pathology department between January 2011 and december 2012 were reviewed retrospectively from the hospital records and cytopathology reports. Repeated smear results, unsatisfactory smear results, patients with known gynecologic malignancy history, smear results of patients with hysterectomy and smear results of patients whose socio-demographic information could not be obtained were excluded from the evaluation. The results of 7,740 patients who met the criteria for the study were evaluated. Results: The prevalence of cervical cytological abnormalities was 1.8 % in general. The prevalence rates for atypical squamous cells with undetermined significance (ASC-US), atypical squamous cells, cannot exclude a high-grade squamous intraepithelial lesion (ASC-H), low-grade squamous intraepithelial lesions (LSIL), high-grade squamous intraepithelial lesions (HSIL), and atypical glandular cells (AGC) were 1.16%, 0.11%, 0.29%, 0.15%, and 0.03% respectively. The prevalence of cytologically diagnosed cervical invasive neoplasia was 0.025%. Advanced age, low education level (primary school or less) and not having health insurance were found as to be risk factors for preinvasive and invasive lesions. Women who had a high school education and previously had a smear test had decreased risk for developing preinvasive and invasive lesions. Conclusion: This study shows prevalence of abnormal cervical cytology findings and associoted risk factors in the Western Black Sea Region of t urkey. The most important risk factor was identified as not having health insurance. urkey OZ

Human Papillomavirus Type-Specific Prevalence in the Cervical Cancer Screening Population of Czech Women

BackgroundInfection with high-risk human papillomavirus (HPV)types has been recognized as a causal factor for the development of cervical cancer and a number of other malignancies. Today, vaccines against HPV, highly effective in the prevention of persistent infection and precancerous lesions, are available for the routine clinical practice.ObjectivesThe data on the prevalence and type-specific HPV distribution in the population of each country are crucial for the surveillance of HPV type-specific prevalence at the onset of vaccination against HPV.MethodsWomen attending a preventive gynecological examination who had no history of abnormal cytological finding and/or surgery for cervical lesions were enrolled. All samples were tested for the presence of HPV by High-Risk Hybrid Capture 2 (HR HC2) and by a modified PCR-reverse line blot assay with broad spectrum primers (BS-RLB).ResultsCervical smears of 1393 women were analyzed. In 6.5% of women, atypical cytological findings were detected. Altogether, 28.3% (394/1393) of women were positive for any HPV type by BS-RLB, 18.2% (254/1393) by HR HC2, and 22.3% (310/1393) by BS-RLB for HR HPV types. In women with atypical findings the prevalence for HR and any HPV types were significantly higher than in women with normal cytological findings. Overall, 36 different HPV types were detected, with HPV 16 being the most prevalent (4.8%). HPV positivity decreased with age; the highest prevalence was 31.5% in the age group 21-25 years.ConclusionsOur study subjects represent the real screening population. HPV prevalence in this population in the Czech Republic is higher than in other countries of Eastern Europe. Also the spectrum of the most prevalent HPV types differs from those reported by others but HPV 16 is, concordantly, the most prevalent type. Country-specific HPV type-specific prevalences provide baseline information which will enable to measure the impact of HPV vaccination in the future.

Classical Molecular Tests Using Urine Samples as a Potential Screening Tool for Human Papillomavirus Detection in Human Immunodeficiency Virus-Infected Women

Human papillomavirus (HPV) is the main risk factor associated with the development of cervical cancer (CC); however, there are other factors, such as immunosuppression caused by the human immunodeficiency virus (HIV), that favor progression of the illness. This study was thus aimed at evaluating the functionality of classical PCR-based molecular tests for the generic identification of HPV DNA (GP5+/GP6+, MY09/MY11, and pU1M/2R primers, individually or in combination) using cervical and urine samples from 194 HIV-positive women. Infected samples were tested with type-specific primers for six high-risk types (HPV-16, -18, -31, -33, -45, and -58) and two low-risk types (HPV-6 and -11). HPV infection prevalence rates were 70.1% for the cervical samples and 63.9% for the urine samples. HPV-16 was the most prevalent viral type in the cervical and urine samples, with higher rates of multiple infections than single infections detected in such samples. HPV DNA detection by PCR (mainly with the pU1M/2R primer set) in urine samples was positively associated with abnormal cytological findings (atypical squamous cells of undetermined significance/squamous intraepithelial lesions [ASCUS/SIL]). It was determined that the operative characteristics for detection of cytological abnormalities were similar for cervical and urine samples. This suggested using PCR for the detection of HPV DNA in urine samples as a potential screening strategy for CC prevention in future prevention and control programs along with currently implemented strategies for reducing the impact of the disease, i.e., urine samples are economical, are easy to collect, have wide acceptability among women, and have operative characteristics similar to those of cervical samples.

Cervical Epithelial Brightness by Optical Coherence Tomography Can Determine Histological Grades of Cervical Neoplasia

The study aimed to determine if the difference in cervical epithelium brightness, as measured by optical coherence tomography (OCT), has potential as a distinguishing characteristic of normal, low-grade, high-grade (cervical intraepithelial neoplasia 2+), and cancer histological findings. Information from 476 women was available for analysis. Demographic information was collected through in-person interview. All participants were human papillomavirus positive and/or had abnormal cytological finding and underwent colposcopy or unaided visual inspection and examination by OCT by quadrant. All women had a minimum of 4 OCT-matched cervical biopsies and endocervical curettage. Two sample t tests were used to measure differences in OCT image brightness by histological grades. Mean OCT image brightness differed significantly between each preinvasive histological grade and invasive cancer (p < .01 for all comparisons). Brightness as measured by OCT was also able to differentiate between squamous metaplasia and cervical intraepithelial neoplasia 3/cancer; p values were .004 and .003, respectively. Epithelial brightness is an important component of cervical epithelium diagnosis by OCT, and we plan to add it to our diagnostic mathematical algorithm in all future versions of OCT software.

Cervical dysplasia: assessment and risk factors among women attending the Maternity Teaching Hospital in Erbil, Kurdistan-Iraq

Background and objective: Cervical cancer is the second most common female cancer in the world. It is the commonest cause of female cancer deaths in South-East Asia and Africa and accounts for 15% of all female cancers in developing countries. the aims of this study was to determine the frequency of abnormal cervical cytology among women underwent Pap smear and assess for the presence of risk factors related to abnormal Pap smear results. Methods: A hospital-based cross sectional study, using a questionnaire and involved 2,146 women at the Maternity Teaching Hospital in Erbil city from January to December 2009. All Pap smears cytological examinations were conducted using Bethesda classification system. Results: Histological reports were found to be normal in 88.4% of women; meanwhile, 248 (11.6%) women had abnormal cytological findings with a mean age of 36.84 years, significantly older than those with normal results (p &lt;0.05). The duration of marriage was also found to be significantly longer among those with abnormal Pap smear (18.34 years versus 15.72 years, (p &lt; 0.05). Conclusion: This study was able to indicate that during reproductive life, the older ages of women and longer duration of marriage were associated with an increased risk of abnormal Pap smear results.

Removal of endometrial polyps through a small-caliber diagnostic flexible hysteroscope using a Lin polyp snare system

To evaluate the efficacy of a newly developed snare system used for hysteroscopic polypectomy in a small-caliber diagnostic flexible hysteroscope. One hundred thirty-eight women (age 26–69 years) with endometrial polyps underwent hysteroscopic polypectomy using a Lin polyp snare system in a small-caliber diagnostic flexible hysteroscope without cervical dilation, analgesia, anesthesia, or use of a tenaculum. No electric current was used during the procedure. Indications of hysteroscopic examinations for these 138 women were infertility in 56, abnormal uterine bleeding in 43, menorrhagia in 17, abnormal ultrasound findings in 20, and abnormal intrauterine pathologic or cytologic findings in 2. Sixty-nine women had a single polyp, whereas the other 69 had multiple polyps. In 11 women, the polyps were only excised without removing the specimens. In 29 women, the polyps were removed partly by a snare first and the remaining polyps by a polyp grasper. In 49 women, the polyps were transected by a snare and the specimens were removed by a polyp grasper. In the other 49 women, the polyps were transected and removed only by using a snare. Most of the women had a satisfactory specimen, but there were 28 women with small specimens and 11 women with no specimen. The pathologic findings were endometrial polyps in 100 women, endometrium in 17, endometrial hyperplasia complex in three, atypical endometrial hyperplasia complex in three, adenomyoma in two, atypical polypoid adenomyoma in one, and endometrial carcinoma in one. The painful sensation was slight and all patients could tolerate the whole procedures. No special complication other than bleeding for several days was encountered. Endometrial polyps can be removed using a Lin polyp snare system equipped in a small-caliber flexible hysteroscopy without requiring cervical dilation, anesthesia, analgesia, or a tenaculum in the office. This procedure may substitute for blind dilation and curettage for intrauterine pathologic evaluation.