Abnormal Papanicolaou Test Research Articles

HPV Vaccine Acceptance Among Mid-Adult Women

To determine correlates of human papillomavirus (HPV) vaccine acceptance in mid-adult women. A convenience sample of 472 mid-adult women completed a 2-part, 69-item survey that included demographic, knowledge, and behavioral variables as potential correlates of vaccine acceptance. Univariable and multivariable logistic regression models were used to identify correlates for vaccine acceptance. Mid-adult women who received the HPV vaccine were more likely to be younger than 55 years (P < .001); have had an abnormal Papanicolaou test (odds ratio [OR], 2.15; 95% CI, 1.18-3.92); understand that HPV causes cervical cancer (OR, 2.39; 95% CI, 1.08-5.30); feel at risk for HPV infection (OR, 2.14; 95% CI, 1.00-4.57), and feel it is important for their partner (OR, 25.20; 95% CI, 9.66-65.72) and children (OR, 3.54; CI, 0.51-24.56) to get the HPV vaccine. Monogamous mid-adult women (OR, 0.46; 95% CI, 0.21-1.00); women who did not want any vaccines (OR, 0.26; 95% CI, 0.07-0.92); and women who felt it was too late to get the vaccine (OR, 0.18; 95% CI, 0.08-0.44) were less likely to want the HPV vaccine. These clinical predictors of HPV vaccine acceptance will help clinicians recognize mid-adult women who may be more receptive to vaccination.

Cervical cancer screening and management practices among providers in the National Breast and Cervical Cancer Early Detection Program (NBCCEDP)

This study was conducted to describe clinicians serving women in the National Breast and Cervical Cancer Early Detection Program (NBCCEDP) with regard to demographic and practice characteristics and their usual practices in cervical cancer screening and abnormal cytology management, as well as human papillomavirus (HPV) test use. The authors analyzed data from a nationally representative survey conducted in 2004 of providers practicing 7 specialties that commonly offer cervical cancer screening. The program providers were compared with nonprogram providers. Program providers were found to be significantly more likely than nonprogram providers to be midlevel providers and to serve low-income, racial/ethnic minorities who are insured by Medicaid. In addition, they had significantly more patients with abnormal Papanicolaou tests and were more likely to offer onsite colposcopy (57% vs 40%). Program providers were less likely to use liquid-based cytology (LBC) as their sole method for cytology. Approximately 20% of program and nonprogram providers used HPV DNA testing as an adjunct to screening cytology and two-thirds used HPV tests to manage patients with abnormal cytology results. However, many also used HPV testing for reasons not approved by the U.S. Food and Drug Administration (FDA), such as for screening women age <30 years. As of mid-2004, program providers served racially and ethnically diverse, low-income patients who are at high risk for cervical cancer compared with nonprogram providers, as intended by this program. Because many providers offered on-site colposcopy, used LBC, and used HPV tests for patients with abnormal cytology results, they are well equipped to reduce the risk of cervical cancer. Many program providers used the HPV test for reasons that were not approved of by the FDA or reimbursed by the NBCCEDP. The results of this survey have informed training materials for program providers, reimbursement policies for LBC and HPV tests, and interventions to discourage inappropriate HPV testing.

Hysterectomy Among Women With HIV

To describe hysterectomy rates and indications among women with HIV and to compare them with at-risk HIV-seronegative women. Reports of hysterectomy were collected from 3752 participants in a prospective cohort study of women with HIV and comparison uninfected women. Available operative notes were retrieved and abstracted. Comparisons were made using the Fisher exact, chi, Wilcoxon 2-sample, and Student's t tests. Incident hysterectomy was performed for 106 (4.5%) of 2361 HIV-seropositive women, most often for cervical neoplasia, and for 24 (2.9%) of 837 HIV-seronegative women (P = 0.04). The incidence of hysterectomy was 7.7 per 1000 person-years for HIV-seropositive women and 5.3 per 1000 person-years for HIV-seronegative women (P = 0.09). HIV-seropositive and HIV-seronegative women undergoing incident hysterectomy were similar, except for a higher likelihood of an abnormal preoperative Papanicolaou test result in the former (P = 0.001). Surgical indications did not differ by serostatus. Women with HIV are more likely than uninfected women to require a hysterectomy, most often for cervical neoplasia.

Incidence and Duration of Cervical Human Papillomavirus 6, 11, 16, and 18 Infections in Young Women: An Evaluation from Multiple Analytic Perspectives

To estimate the incidence and duration of cervical human papillomavirus (HPV)-6, HPV-11, HPV-16, and HPV-18 infections in a population of young American women. The study population consisted of U.S. women who at baseline were 16 to 23 years of age, reported zero to five lifetime sexual partners, never having been pregnant, and never having had a prior abnormal Papanicolaou test and were enrolled in the placebo arm of a randomized multicenter clinical trial of a HPV-16 L1 virus-like particle vaccine. Women underwent type-specific endocervical/ectocervical swab HPV DNA testing at approximately 6-month intervals for up to 48 months of follow-up. To contribute person-time in the analyses of type-specific HPV incidence, a woman must have had at least three satisfactory swab specimens available and been negative for the relevant HPV type (HPV-6, HPV-11, HPV-16, or HPV-18) on her first two trial swabs. The duration of incident HPV infections was estimated using Kaplan-Meier survival analysis methods. Person-years of exposure ranged by type-specific analysis from 2,645 to 3,188, with an incidence rate per 100 person-years of 3.6 for HPV-6, 0.4 for HPV-11, 5.4 for HPV-16, and 2.1 for HPV-18. With censoring at the time of treatment for cervical intraepithelial neoplasia, where done, the mean duration of incident infections was 9.3, 8.4, 18.2, and 16.4 months, respectively, for HPV-6 (n = 103), HPV-11 (n = 13), HPV-16 (n = 142), and HPV-18 (n = 62). When the duration of HPV infections was truncated at the time of cervical intraepithelial neoplasia detection (any grade), where applicable, mean duration figures were 8.4, 8.1, 14.0, and 15.1 months for HPV-6, HPV-11, HPV-16, and HPV-18 infections, respectively. Previous studies of the mean duration of cervical HPV infection have been based on prevalent infections and/or featured relatively short duration of follow-up. This study tested women for HPV infection over a period of up to 48 months and observed a mean duration of incident HPV-16/HPV-18 infections approximately twice that of HPV-6/HPV-11.

Understanding and overcoming barriers to human papillomavirus vaccine acceptance

New vaccines designed to prevent human papillomavirus (HPV) infection have the potential to reduce the incidence of serious illness and death worldwide among women, substantially reduce the emotional suffering associated with abnormal Papanicolaou (Pap) test results and the diagnosis of cervical cancer, and save significant health care dollars. However, these benefits may not be fully realized until the vaccine is accepted by patients, parents, and health care practitioners. Furthermore, there may be unique issues related to the acceptance of a vaccine designed to prevent a sexually transmitted infection that is poorly understood by many women. Among the acceptance issues are: individual comfort with a sexually transmitted infection (STI) vaccine; parental comfort with vaccination of their preadolescent/early adolescent daughters; physician comfort with recommending a human papillomavirus vaccine to women and parents of preadolescents; and physician communication skills related to talking with women and parents about the vaccine. Potentially difficult as it might be to implement a vaccination program, vaccination and prevention of HPV-associated disease are still infinitely preferable to observation and treatment. This article will review some of the potential barriers to HPV Vaccine acceptance, with a particular focus on factors relevant to female patients, parents, and health care providers.

Feasibility of Management of High-Grade Cervical Lesions in a Single Visit

The incidence of cervical cancer is higher among low-income and minority women who have never undergone a conventional Papanicolaou test or who do not follow up after testing. Screening has been shown to reduce cervical cancer incidence rates. To determine the feasibility and acceptability of immediately treating women with severely abnormal Papanicolaou test results by using a single-visit cervical cancer screening and treatment program and to compare treatment rates and 12-month follow-up rates with those of women who received usual care. Randomized controlled trial conducted among 3521 women aged 18 years or older recruited between January 1999 and April 2002 at US community health centers located in predominantly Latino underserved areas. Women randomized to usual care (n = 1805) were discharged immediately after examination. Women randomized to the single-visit group (n = 1716) remained at the clinic until the results of their conventional Papanicolaou test were available. Large loop electrosurgical excision procedure was performed in single-visit patients with either a diagnosis of a high-grade squamous intraepithelial lesion (HGSIL)/atypical glandular cells of undetermined significance (AGUS) or suspicion of carcinoma. All other patients with abnormal Papanicolaou test results were referred to abnormal cytology clinics or elected to receive follow-up care outside the study's medical system. Treatment rates for HGSIL/AGUS at 6 months, follow-up rates at 6 months for lower-grade lesions, and 1-year follow-up rates for all patients. The rate of abnormal Papanicolaou test results was 4.1%. One percent of results showed high-grade lesions. In the single-visit group, the mean visit time was 2.8 hours and the mean time for delivery and processing of the Papanicolaou tests was 66 minutes. Six months after randomization, 14 (88%) of 16 single-visit and 10 (53%) of 19 usual care patients with HGSIL/AGUS had completed treatment. Fifty percent in the single-visit program and 53% of usual care with less abnormal Papanicolaou tests completed treatment within 6 months. Overall, 36% in each group presented for a follow-up Papanicolaou test 1 year later. Women in the single-visit group with high-grade lesions (10/16; 63%) were significantly more likely to attend follow-up for Papanicolaou tests 12 months later than women with similar lesions in the usual care group (4/19; 21%). For cervical cancer screening, the single-visit program was feasible and the degree of acceptability was high in this underserved population. Single visit programs provide an opportunity to increase the rate of immediate treatment and follow-up of women with severely abnormal Papanicolaou test results. This strategy did not improve follow-up rates for women with less-abnormal results. Trial Registration http://ClinicalTrials.govIdentifier: NCT00237562.

A 21-Year-Old Woman With Atypical Squamous Cells of Undetermined Significance

DR REYNOLDS: Ms G is a 21-year-old woman with a history of abnormal Papanicolaou (Pap) tests. Ms G first became sexually active at age 19. That year, she had her first gynecologic examination when she visited a doctor to ask for an oral contraceptive pill prescription. Her examination and cytology test were normal. She had annual Pap screening until age 21, when her cytology test (conventional) showed atypical squamous cells of undetermined significance (ASC-US). Her clinician, a nurse practitioner at student health, recommended a repeat cytology test in 6 months. Her repeat test again showed ASC-US, and she was referred to a gynecologist who performed a colposcopy. On colposcopy, the entire squamocolumnar junction could be seen and her cervix showed grade 1 acetowhite changes. Biopsy revealed metaplasia. A liquid-based cytology test done at the time of the colposcopy was normal. Testing for human papillomavirus (HPV) DNA was not performed. Ms G has never been diagnosed with a sexually transmissible infection. She has never been pregnant. She does not take medications or smoke tobacco. She is a recent college graduate and is working as a writer.

Clinicopathologic features of six cases of primary cervical lymphoma

Primary lymphoma of the uterine cervix is rare, with less than 60 cases reported. We present a series of 6 patients with cervical lymphoma and review the literature. Between 1988 and 2003, we identified 6 women with primary lymphoma of the uterine cervix treated at our institutions. Data for analysis were obtained from hospital charts, office records, and tumor registry files. We also reviewed 20 published reports on cervical lymphoma, providing information on 58 additional patients. The median age at diagnosis was 52 years (range 40-76). Three patients had an abnormal Papanicolaou test within 6 months of the diagnosis. Mean tumor size was 8.3 cm (range 3-14 cm). On the basis of the Ann Arbor system of staging where "E" denotes extranodal tumor origin, 2 patients had stage IE, 1 had stage IIIE, and 3 had stage IVE disease. The median follow-up for these 6 women was 33 months (range 12-120). Adding the 6 patients in our series to the 58 patients obtained from published reports, 43 had stage IE, 14 had stage IIE, 2 had stage IIIE, and 5 had stage IVE disease. There was no consistent pattern of treatment identified from our literature review. Primary lymphoma of the uterine cervix is a rare malignancy. Most patients present with stage IE disease. Women with localized disease typically respond to various combinations of surgery, chemotherapy, and radiotherapy. Combination chemotherapy with tailored radiotherapy appears to be the preferred treatment option in women with advanced disease.

Human Papillomavirus Infection in Women

The role of human papillomavirus (HPV) testing in women is reviewed. Currently, the Digene human papillomavirus test is used as an adjunct in women with an abnormal Papanicolaou test, atypical squamous cells of undetermined significance, and as a primary screen in sexually active women over the age of 30. The limitations of the current testing system, cytologic screening, and colposcopy are present. The future role of a human papillomavirus vaccine and medical therapy to enhance clearance of the viruses are discussed.

Effect of delivery route on natural history of cervical dysplasia

This study was undertaken to determine the (1) impact of delivery route on the natural history of cervical dysplasia and (2) overall regression rates of cervical dysplasia in pregnant women. A retrospective analysis was performed on 705 pregnant women with abnormal Papanicolaou tests who presented for prenatal care at the Kapiolani Medical Center Women's Clinic in Honolulu, Hawaii, between 1991 and 2001. Data collection included demographics, delivery route, and cervical pathology. Two hundred one patients met the inclusion criteria. Regression rates for vaginal and cesarean section groups were as follows: atypical squamous cells (64% vs 70%, P = .32), low-grade squamous intraepithelial lesion (58% vs 42%, P = .073), and high-grade squamous intraepithelial lesion (53% vs 25%, P = .44). Of the total population, 30% of lesions persisted postpartum, 58% regressed, and 12% progressed. Mode of delivery does not influence the natural history of dysplastic lesions. Gravid and nongravid women have similar regression rates.

Psychological and Sociocultural Perspectives on Follow-up of Abnormal Papanicolaou Results

To understand women's motivation to attend follow-up of an abnormal Papanicolaou (Pap) test by applying a general theoretical framework for voluntary behavior. Semistructured, face-to-face interviews were conducted among 120 low-income, African-American, Caucasian, or Hispanic outpatients, aged 25-50 years, who presented for routine gynecologic care. Interview questions assessed social, cognitive, environmental, and emotional factors surrounding follow-up for an abnormal Pap test. Content analysis was performed. The majority of women (74%) described their attitude toward returning for a follow-up visit as favorable. Overall, knowledge regarding the significance of an abnormal result was poor, and misconceptions were common. Perceived barriers, consequences, and social influences associated with attending follow-up were qualitatively different across the 3 racial/ethnic groups. For example, African-American and Hispanic women expressed embarrassment more frequently than Caucasian women and were less likely to anticipate obstacles to attending follow-up. Furthermore, African-American women were the least likely to be influenced by others' opinions and to perceive difficulty in adhering to follow-up recommendations. For nearly all women, adequate communication with their provider was a key component of anticipated adherence. Clinicians may exert a positive influence on adherence among patients who experience an abnormal Pap test by engaging patients in a dialogue that accommodates the patient's sociocultural environment, explores concerns regarding the partner's reaction, emphasizes the importance of follow-up, provides a clear understanding of the process and timeline surrounding follow-up recommendations, and encourages the patient to anticipate obstacles to adherence and assists with solutions.

Effect of antiretroviral therapy on the incidence of genital warts and vulvar neoplasia among women with the human immunodeficiency virus

Objective The purpose of this study was to determine the incidence and predictors of genital warts and vulvar intraepithelial neoplasia among women with the human immunodeficiency virus. Study design This was a multicenter prospective cohort study comprised of women without warts or vulvar intraepithelial neoplasia at baseline who underwent CD4 count, human immunodeficiency virus RNA measurement, examination, Papanicolaou test, and biopsy, as indicated, every 6 months. Human papillomavirus DNA typing was examined at baseline. Results The incidence of warts among women who were human immunodeficiency virus seronegative was 1.31 versus 5.01 per 100 person-years among women who were seropositive ( P<.001). Incidence of vulvar intraepithelial neoplasia among women who were seronegative was 1.31 versus 4.67 per 100 person-years among women who were seropositive ( P<.001). In multivariable analysis, warts were associated with highly active antiretroviral therapy (relative hazard, 0.76), CD4 count (relative hazard, 0.91/100 cell/cm 2 increase), acquired immunodeficiency syndrome (relative hazard, 1.25), abnormal Papanicolaou test results (relative hazard, 2.18), high- or medium-risk human papillomavirus types (relative hazard, 1.91), low-risk human papillomavirus types (relative hazard, 1.48), smoking (relative hazard, 1.43), having 1 child (relative hazard, 1.54), and age (relative hazard, 0.74/10 years). Vulvar intraepithelial neoplasia was linked to highly active antiretroviral therapy (relative hazard, 0.65), CD4 count (relative hazard, 0.92), abnormal Papanicolaou test results (relative hazard, 16.03), high- or medium-risk human papillomavirus types (relative hazard, 1.37), and age (relative hazard, 0.85/10 years). Conclusion Warts and vulvar intraepithelial neoplasia are common among women with human immunodeficiency virus. Highly active antiretroviral therapy decreases their incidence.

Effect of folic acid fortification of foods on folate intake in female smokers with cervical dysplasia

Objective We investigated the effect of folic acid fortification of enriched cereal grains on folate intake in women of predominantly childbearing age at high risk for cervical cancer. Methods Subjects in this cross-sectional study were 77 women randomized between November 1999 and December 2000 in the Women's Intervention to Stay Healthy (WISH), a clinical trial evaluating the effect of a tobacco control intervention on the progression of cervical dysplasia. All subjects were cigarette smokers, had a previously abnormal Papanicolaou test, and were positive for high-risk human papillomavirus at entry. Dietary intake was assessed with food-frequency questionnaires completed at the baseline visit for WISH. The effect of folic acid fortification on folate intake was assessed by using pre- and postfortification folate databases to estimate folate intake. Results Mean folate intake assessed with the postfortification database was 63% higher than intake assessed with the prefortification database: 417 versus 256 μg/d of dietary folate equivalents ( P < 0.0001). The proportion of subjects below the estimated average requirement for folate was smaller after fortification than before fortification: 40.3% versus 75.3% ( P < 0.0001). Several foods, including white bread, cheese dishes, spaghetti, and rice, became major sources of folate as a result of fortification. Conclusions Folic acid fortification resulted in an increased intake of folate in these subjects. However, even with fortification, folate intake in a large proportion of these women remained below recommended levels. These results should be considered before decisions regarding future levels of folic acid fortification are made.

Pathologic quiz case: an asymptomatic 79-year-old woman with an abnormal Papanicolaou test. Adenoid basal carcinoma of the cervix.

Pathologic quiz case: an asymptomatic 79-year-old woman with an abnormal Papanicolaou test. Adenoid basal carcinoma of the cervix.

Patient distress and satisfaction with optical spectroscopy in cervical dysplasia detection

Objective The aim of this investigation was to evaluate the impact of optical spectroscopy, a new approach for the detection of cervical dysplasia, on patient well-being and satisfaction. Study design Patient distress and satisfaction with optical spectroscopy compared with the Papanicolaou test and colposcopically directed biopsy were measured in a volunteer sample of 314 women with no history of abnormal Papanicolaou test findings. Results Participants reported significantly less pain and anxiety ( P<.001) during optical spectroscopy than during the Papanicolaou test or colposcopically directed biopsy. Generally, participants found spectroscopy equal to the Papanicolaou test and to biopsy on a variety of questions that measured satisfaction. There were statistically significant differences between spectroscopy and the Papanicolaou test or biopsy on issues such as the discomfort and fear caused by the test, the amount of time taken, the room lighting, and perceptions of accuracy. Conclusion That patients reported less distress during spectroscopy than during a Papanicolaou test, colposcopy, or biopsy suggests the possibility of improved adherence to cervical cancer screening and follow-up in settings in which it is used.

Human papillomavirus: epidemiology and public health.

Approximately 15 types of human papillomavirus (HPV) infection cause virtually all cases of cervical cancer. Human papillomavirus 16 is the major type, accounting for approximately 50% of cases. The major steps of cervical carcinogenesis include HPV infection, viral persistence and progression to precancer (as opposed to viral clearance), and invasion. Human papillomavirus is the most common sexually transmitted infection. However, most HPV infections become undetectable by even sensitive HPV DNA testing within 1 to 2 years. The prevalence of infection peaks at young ages and declines thereafter, perhaps as the result of HPV type-specific acquired immunity. Most HPV infections are neither microscopically evident nor visible, making HPV DNA detection the diagnostic reference standard. Poorly defined immunologic factors are the major determinants of viral outcome. Smoking, multiparity, and long-term oral contraceptive use increase the risk of persistence and progression. Other sexually transmitted infections (eg, Chlamydia trachomatis), chronic inflammation, and nutritional factors might also play a role. Overt, long-term viral persistence in the absence of precancer is uncommon. New prevention strategies can be derived from the evolving knowledge of HPV carcinogenesis. Human papillomavirus vaccination is the ultimate prevention strategy, and large-scale trials are already underway. In the meantime, HPV DNA diagnostics are more sensitive although less specific than cytology, permitting a consideration of lengthened screening intervals. In terms of public health education, clinicians and patients will need to shift discussions of the mildly abnormal Papanicolaou test to consideration of HPV infection as a common sexually transmitted infection that rarely causes cervical cancer.

Intracervical sonographic-pathologic correlation: preliminary results.

To determine whether current-generation endoluminal ultrasonic transducer technology could visualize dysplastic and malignant cervical lesions. Inclusion criteria for patients enlisted in the study were abnormal Papanicolaou test results, an abnormality seen at colposcopy, and consent for a cone biopsy. In addition, we included 4 women who were undergoing hysterectomy but had no evidence of cervical abnormalities at the time of surgery, for a total of 28 women. We used a 20-MHz annular array intravascular transducer. We correlated all sonographic and pathologic results with regard to being normal or abnormal using the Pearson product moment correlation coefficient, and we evaluated interobserver variation by having 5 blinded sonologists interpret each examination and calculating kappa statistics. We performed intracervical sonography on 24 women with abnormal Papanicolaou test results and on 4 women without abnormalities. Nineteen of the 24 women with proven disease had abnormal sonographic images. Five women with pathologically proven cervical intraepithelial neoplasia I had normal sonographic images. Lesions ranged in size from 0.3 to 7 mm. Two carcinomas (5 and 7 mm diameter), multiple nabothian cysts, cervicitis, and 2 giant cell foreign body reactions were visible on sonography. The correlation coefficient for abnormal sonographic and pathologic findings was 0.87 (P < .005). We obtained a kappa value of 0.75 for interobserver variation. Intracervical sonography was able to visualize dysplastic lesions and carcinomas as hypoechoic defects with surrounding echogenic areas of glandular cervical mucosa. Lesions were shown with sufficient resolution and interobserver variation to suggest that the technique may be clinically applicable, particularly for planning surgical therapy. However, design of a transducer that can be easily sterilized between examinations, similar to current endovaginal probes, would be necessary to make intracervical sonography a clinically feasible examination.

The accuracy of Colposcopic impression among patients undergoing directed biopsy

Objective : This study was performed to compare the agreement of colposcopic impressions to predict the severity of disease at directed biopsy results. Method : We reviewed 537 patients who had abnormal Papanicolaou tests suggestive of over the benign cellular change in cytology and colposcopically directed biopsy at the Department of Obstetrics and Gynecology, College of Medicine, KyungHee University from March, 1991 to May, 2001. Among them, 44 patients were excluded because of unsatisfactory colposcopy. Colposcopist assessed border, coloration, topography, vascular change to grade cervical lesion severity. Pap smear was stratified as benign cellular change, HPV(koilocytosis)/CIN I, CIN II, CIN III and cancer purposely to compare with biopsy results. CoIposcopic impression was stratified as squamous metaplasia, low-grade lesion, high-grade lesion, and cancer by combination of colposcopic grading system of modified Colposcopic index(Reid and Scalazi, 1985) and Coppleson's grading method. Result : The results of cytology, colposcopic impressions were analyzed with regard to the histologic findings of the biopsy specimen. The accuracy rate, agreement with degree, underestimation, overestimation of cytology were 55.4%, 91.2%, 18.3%, 26.4%, respectively. Also, the accuracy rate, sensitivity, specificity, positive predictive value, negative predictive value of colposcopic impression were 75.6%, 94.6%, 82.7%, 84.3%, 89.7%, respectively. Overestimation rate, underestimation rate of colposcopic impression were 15.2%, 8.4%, respectively. And likelihood ratio of colposcopy of normal cervix, low-grade SIL, high-grade SIL were 0.11, 3.25, 12.57, respectively. Conclusion : These results suggested that colposcpic impressions is very useful for the diagnosis and differentiation of the various cervical lesions. And the colposcopy shows a larger appreciable difference when distinguishing high-grade SIL and cancer from low-grade SIL than when distinguishing low-grade SIL from normal cervix and inflammation.

Microsatellite alterations in exfoliated cervical epithelia deoxyribonucleic acid as a marker for high-grade dysplasia

Objective: The purpose of this study was to evaluate the feasibility of the use of deoxyribonucleic acid microsatellite alterations in cervical epithelia in the prediction of high-grade dysplasia and to compare it with a strategy based on human papillomavirus testing. Study Design: Our prospective study subjects were from a cohort of 498 women with minimally abnormal Papanicolaou test results including atypical squamous cells of undetermined significance and low-grade squamous intraepithelial lesion who had documented repeated Papanicolaou and human papillomavirus tests. Of these, 52 eligible patients having conizations or hysterectomies as their histologic outcomes were subjected to tests of loss of heterozygosity on a panel of 5 microsatellites (D3S1110, THRB, D3S1228, D6S291, D3S1289) within the deoxyribonucleic acid of exfoliated cervical epithelia. These genetic alterations were analyzed through fluorescence polymerase chain reaction by comparison of allele ratios of exfoliated cells with those of normal control tissue. Predictive values for high-grade cervical dysplasia and cancer between this deoxyribonucleic acid marker and human papillomavirus status were compared. Results: With the use of loss of heterozygosity in at least one locus for predicting high-grade cervical neoplastic lesion, the sensitivity, specificity, positive predictive value, and negative predictive value were 96.7%, 59.1%, 76.3%, and 92.9%, which were superior to those of the human papillomavirus test (80%, 59.1%, 72.7%, and 92.9%). As a triage for atypical squamous cells of undetermined significance, its sensitivity and negative predictive value were up to 100%. Conclusion: The promising results on determining microsatellite alteration in dysplastic lesions might imply that it is possible to detect the earliest changes by potential molecular markers with exfoliated cervical epithelial cells. (Am J Obstet Gynecol 2001;185:108-15.)

Comparison of endocervical curettage and endocervical brushing

Objective: To compare endocervical brushing with endocervical curettage with respect to diagnostic yield by histology and patient discomfort. Methods: Nonpregnant women referred for colposcopy because of abnormal Papanicolaou test results were randomized to endocervical sampling with either a metal curette (endocervical curettage [ECC]) or an endocervical brush. Extensive endocervical canal brushing was performed. All samples were submitted for histologic study. Results were evaluated against the histologic findings in electroconization specimens in a masked fashion. Pain scores were recorded using Melzack’s Present Pain Intensity Scale. Results: During the study period, 315 patients were randomized to the techniques: 157 to ECC and 158 to endocervical brushing. Of the 315 patients, 147 also underwent electroconization. Overall false-positive rates were 28.6% for endocervical brushing and 30.8% for ECC. False positives were due to contamination of the endocervical sample by lesional epithelium near the external os. The proportion of scanty specimens obtained by endocervical brushing (7.6%) was higher than that obtained by ECC (2.5%) ( P = .041). One sample obtained by brushing was insufficient for diagnosis; none obtained by ECC were insufficient. There were no statistically significant differences in the median pain scores between the two groups. Conclusion: The techniques were similar in terms of diagnostic yield and patient discomfort. Endocervical brushing had lower false-positive rates than those reported in the literature for cytologic analysis. Although ECC remains the method of choice for evaluation of the endocervical canal, brushing is an acceptable alternative.