Cervical Cytology Reports Research Articles

Detection of telomerase, its components, and human papillomavirus in cervical scrapings as a tool for triage in women with cervical dysplasia

Aim: To examine whether the detection of either telomerase and its components or high risk human papillomavirus (HPV) are of value in predicting the presence of cervical intraepithelial neoplasia (CIN)...

A clinical review of borderline glandular cells on cervical cytology.

To review the diagnoses and diagnostic pathway of women presenting with borderline glandular cells on cervical cytology. To outline the basis of clinical approach of these women. Retrospective review. Forty-three women referred to the hospital department over a 32-month period. Review of the casenotes for the demographic data, previous cervical cytology and/or histology report, indication for the smear resulting in borderline glandular cells, colposcopic findings, diagnostic and/or treatment procedures, final diagnosis and current status. The average age was 36.7 years. Twenty-four women (56%) had clinically significant lesions: seven women (16%) presented with cancers, of which one was endometrial in origin, and 17 (40%) with intraepithelial neoplasia (CIN and cervical glandular intraepithelial neoplasia (CGIN)). Sixty-seven percent of all clinically significant lesions were of squamous origin. Thirty-seven had histological diagnosis, while six went on to cytological surveillance. Colposcopy was the most significant predictor for clinically significant lesions (P < 0.05). Punch biopsies and loop excisions were diagnostic when based on abnormal colposcopic findings. Brush cytology was appropriate follow up for asymptomatic, premenopausal women with no colposcopic abnormality. In addition, endometrial sampling was recommended in the peri- and postmenopausal women. Borderline glandular cells have a high incidence of clinically significant lesions. Immediate referral for colposcopy and assessment is strongly recommended in women with two borderline glandular smears to avoid delays in potential cancer diagnosis.

Microinvasive cervical carcinoma: a retrospective study of cases presenting to the Oxford Colposcopy Unit between 1989 and 1996

This a retrospective analysis of 65 cases of microinvasive disease and 5-8 years of follow-up (mean 6.2 years), evaluating the effectiveness of cytology and colposcopy in the diagnosis of microinvasive disease and the role of conservative surgery in its management. Cervical cytology reports indicated disease more severe than CIN III in 23% of cases. A further 7% at colposcopy were thought to have possible invasive disease despite no indication from the smear report, this impression correlated with increasing depth of invasion (>1.40 mm).

Visual infection of the cerviz as a primary means of cervial cancer screening: results of a pilot study

To measure the effectiveness of unaided visual inspection (UVI) of the cervix as a primary means of cervical cancer screening. A cross sectional study. Five primary health care clinics in Mashonaland Province, Zimbabwe. 1,000 women aged between 25 and 55 years. Sensitivity and specificity of UVI. 1,000 women attending primary health care clinics were screened for cervical cancer by six qualified nurses. An unlubricated bivalve speculum was inserted into the vagina under good light to visualize the cervix and a cervical cytology specimen was obtained followed by visual inspection of the cervix stained by 4% acetic acid. All women found to have abnormal cervices by visual inspection and/or by cervical cytology report were scheduled for colposcopy examination at Harare Central Hospital. 236 (23.6%) women had an abnormal cervical appearance after application with 4% acetic acid, out of which 157 (15.7%) were reported abnormal by cytology. True disease as defined by positive colposcopy and positive cytology was confirmed in 38 (3.8%) women. The sensitivity of UVI using colposcopy and cytology as a reference standard was 68.4%, specificity was 3.4%. The results of this study suggest that naked eye inspection of the cervix after application of acetic acid is a practical alternative to cervical cytology in screening for cervical cancer in countries with few resources like Zimbabwe.

Clinical significance of histiocytes found on cervical cytology.

Our aim was to determine the incidence of cervical and endometrial pathology associated with the diagnosis of histiocytes on cervical cytology. A retrospective review was conducted from 1993 to 1995 of cervical cytology reports in which histiocytes were named in the descriptive diagnosis. Charts were reviewed and follow-up was performed on all patients for an additional 2 years. Histiocytes were diagnosed in 226 of 82,018 (0.27%) cytology reports. Histiocytes alone (110), histiocytes and endometrial cells (40), and histiocytes and inflammation (45) were reported in the patients with complete follow-up. Final pathological findings after 2 years of follow-up were normal in 169 cases; other findings included polyps (6), simple hyperplasia (10), complex hyperplasia (1), previously treated cervical cancer (4), and endometrial cancer (5). All patients with endometrial cancer had clinical signs and symptoms of disease. The diagnosis of histiocytes on cervical cytology is associated with neoplasia (7.8%) or cancer (2.6%) in some cases. However, significant neoplasia (i.e., carcinoma or atypical hyperplasia) was associated with clinical signs and symptoms. On cytological workup, the finding of histiocytes in the absence of symptoms appears not to be associated with significant pathology.

“See and Treat” Electrosurgical Loop Excision of the Cervical Transformation Zone

BACKGROUND See and treat electrosurgical loop excision of the cervical transformation zone (ELECTZ) is an excisional surgical procedure that enables simultaneous histologic diagnosis and treatment of premalignant cervical disease, thus eliminating the need for a preliminary cervical biopsy and an additional patient visit. Indications for the procedure include an abnormal cervical Papanicolaou (Pap) smear and a colposcopic impression of cervical intraepithelial neoplasia (CIN). The purpose of this study was to assess the see and treat ELECTZ procedure performed by family physicians. METHODS Women who were scheduled for colposcopic evaluation because of an abnormal cervical cytology report were enrolled from the practices of three family physician colposcopists located at three sites. The see and treat ELECTZ procedure was performed on patients with both abnormal Pap smear results and abnormal colposcopic findings. Procedural complications were documented. Subjects were evaluated at follow-up examinations during the first postoperative year to determine therapeutic cure. RESULTS See and treat ELECTZ was performed on 48 women. The histologic results from see and treat ELECTZ were normal for 36.1% of subjects. When subjects with a low-grade lesion on Pap smear were considered, 40.7% had normal loop histologic findings. Of women with a preoperative colposcopic impression of low-grade lesion, 54.2% had normal histologic results, and 12% of women with a high-grade colposcopic impression had normal histologic results (P<.001). When the colposcopic impression was reported as high-grade disease, 82% of loop specimens were reported as CIN 2 or 3. CONCLUSIONS Selective use of see and treat ELECTZ may be appropriate only when practiced by experienced colposcopists who are able to reliably differentiate low-grade from high-grade disease by means of colposcopy, and if cytologic and colposcopic findings unequivocally indicate high-grade cervical disease.

Atypical mitotic figures and the mitotic index in microinvasive carcinomas and in non-neoplastic changes of the uterine cervix

SummaryThis study sought to show whether an increased mitoticindex (MI; i.e. the number of mitoses among 1000 nuclei) and the occurrence of particular atypical mitotic figures (AMFs) are characteristic of cervical squamous malignancy.The study group consisted of 24 cervical tissue specimens with microinvasive carcinoma (MIC). The intraepithelial and invasive parts were considered separately. The control group consisted of 82 cervical tissue specimens without neoplasia which were derived from two sources: 31 women were biopsied because of an abnormal cervical cytology report but no neoplasia was found histologically and 51 women underwent an hysterectomy for non-cervical uterine disease. Mitoses were only classified in proliferative lesions (MI⩾2). The mitoses were classified into normal mitotic figures (NMFs), lag type mitoses (LTMs), multipolar mitoses (MPMs) and other atypical mitotic figures (OAMFs). Particular attention was given to the two group metaphase (2GM), a member of the LTMs. In order to be 9...

Cervical cytology reported as negative and risk of adenocarcinoma of the cervix: no strong evidence of benefit.

The relationship between negative cervical cytology reports and risk of adenocarcinoma of the cervix was evaluated in a case-control study of 113 cases and 452 controls. All cases and controls had received at least two negative cytology reports. There was no significant difference between the cases and controls in the number of negative cytology reports or in history of cervical abnormality; while a test for trend in the time since last negative cytology report was significant (P < 0.001), the estimated benefit was very modest. Although the estimates of relative protection were higher in women aged less than 35 years than in women aged 35-69 years, this difference was not statistically significant. These results suggest that cervical screening as practised in the 1970s and 1980s was much less effective in preventing adenocarcinoma than squamous carcinoma of the cervix.

Screening for cervical intraepithelial neoplasia and cancer in the Sheffield STD clinic.

I undertook a prospective study of the incidence of histologically confirmed cervical intraepithelial neoplasia (CIN) and cancer in women attending a sexually transmitted disease (STD) clinic, and correlated the findings to cervical cytology reports, age, and history of STD of the affected women. Of 2017 women screened, 75 (3.7%) had dyskaryotic cervical smears. Colposcopically directed biopsy tests gave an overall detection rate of 0.55% for CIN3, which was similar to the national average. The false negative rate was 2.9% and cytology tests alone underestimated the degree of pathological change in 12 (30%) of 40 women with mild dyskaryosis. Women under 20 years old made up 43% of those with CIN1 and 38% of those with CIN2. The detection rate of CIN3 was 0.65% for women aged 15-34, which was higher than the national average and suggested earlier onset of CIN3 in our clinic population. There was a high association between genital warts and cervical precancer. This preliminary study confirms the need for routine non-selective screening of women attending STD clinics by cervical cytology tests, colposcopic examination, and biopsy tests where indicated.

Presence of human papillomavirus DNA sequences in cervical intraepithelial neoplasia.

Twenty two patients referred to a district colposcopy clinic because of an abnormal cervical cytology report or a suspicious cervix and found to have a cervical epithelial abnormality were studied. The techniques of cytology, histology, immunohistochemistry, and DNA-DNA hybridisation were used to detect infection by human papillomavirus. Using an indirect immunoalkaline phosphatase technique human papillomavirus antigen was found in biopsy specimens from six of the 22 patients and DNA of papillomavirus type 6 in biopsy specimens from 13 of these women, including four out of six whose histological diagnosis was cervical intraepithelial neoplasia grade 3. In eight cases where cytological, colposcopical, and histological investigations all indicated the presence of wart virus infection, papillomavirus type 6 DNA was found in seven. Papillomavirus type 6 DNA was found in more than half of the proved cases of cervical intraepithelial neoplasia. The presence of this viral DNA in women with no cervical abnormality is to be studied.