Conventional Papanicolaou Smear Research Articles

Aspergillus as a contaminant on conventional cervicovaginal papanicolaou smear

Majority of the cases of fungal infections to be detected in the cervicovaginal smears, are caused by Candida species. Aspergillus infections are not just rare, but should also raise alarm regarding the immune status of the patient. Here we report the case of an adult female with cervicovaginal smears showing non-Candida fungal elements, going on to prove contamination of the wooden spatula by Aspergillus fumigatus.

Small-cell neuroendocrine carcinoma of the cervix accompanied by adenocarcinoma and high-grade squamous intraepithelial lesion.

Few cytological reports have described small-cell neuroendocrine carcinoma (SCNEC) in the female genital tract. In the present study, we describe a cytological case of SCNEC accompanied by adenocarcinoma, as well as high-grade squamous intraepithelial lesion (HSIL). A Japanese woman (42 years old) presented with abnormal genital bleeding. A conventional Papanicolaou smear revealed an inflammatory condition with three neoplastic components: SCNEC as irregular aggregates of neoplastic small round cells with nuclear molding and granular chromatin; adenocarcinoma as columnar cell clusters with peripherally located large nuclei, and HSIL as sheets or clusters of dysplastic basal-type squamous cells with irregular hyperchromatic nuclei. Accordingly, a cytodiagnosis of SCNEC with adenocarcinoma and HSIL was made. Owing to the rarity of cervical SCNEC, cytological diagnosis may be difficult. Due to its aggressive clinical behavior, the presence of an SCNEC component should be verified in any cytodiagnosis of adenocarcinoma or HSIL.

Liquid-Based Cytology in the Detection of Premalignant Lesions in Patients with "Atypia in Squamous Cells" in Conventional Cytology.

The management of patients with "Atypical Squamous Cells" (ASC) in conventional papanicolaou smears (CPS) is based on the risk of high-grade squamous intraepithelial lesion (HSIL). The efficacy of liquid-based cytology (LBC) to detect this premalignant lesion is variable, with little evidence of its performance in Colombian patients. The aim of this study is to determine the performance of LBC in the detection of premalignant lesions, in patients with ASC in CPS. Were obtained patients who attended colposcopy clinic due the result of ASC in CPS. An LBC was taken, which was interpreted by two pathologists without access to other results. The performance of LBC to detect HSIL, was determined, considering as a gold standard: histopathological study/negative-satisfactory colposcopy. Were included 114 patients, with a mean age of 38.4 years (SD ± 13.3). LBC had abnormal results in 40.36% (n = 46), with a slightly higher proportion of low-grade squamous intraepithelial lesion (LSIL) than HSIL. The total of abnormal diagnoses by colposcopy and/or biopsy was 51.75% (n = 59), with a predominance of LSIL (36.84%). The sensitivity of the liquid-based cytology to detect premalignant lesions was 76.5%, specificity: 66.0%, positive predictive value: 28.3% and negative predictive value: 94.1%; The Cohen's kappa index of LBC for detecting HSIL was 0.2492 for the total population and 0.2907 for ≥30 years. Although LBC decreases abnormal cytology and increases the detection of HSIL, which improves diagnostic accuracy; sensitivity and predictive values for detecting HSIL are not significantly different between CPS and LBC.

Comparative evaluation of centrifuged liquid-based cytology method over conventional brush cytology in normal oral mucosa

Introduction: Liquid-based cytology (LBC) is a new monolayer slide preparation method introduced to overcome the limitations of conventional Papanicolaou (PAP) smears which is used in cancer screening. The study was aimed to compare the efficacy of modified technique, centrifuged LBC (CLBC) with that of conventional brush cytology in normal oral mucosa. Materials and Methods: Two smears were obtained from 100 cases of normal mucosa using a cytobrush. One smear was spread on to the slide by conventional technique, and the other smear was prepared by CLBC. Regular PAP staining was done for both the smears. Both the smears were evaluated for cellularity, cell distribution, cellular overlapping, cell elongation, and cellular background and were graded using the grading criteria. Mann–Whitney U-test was used, and P ≤ 0.05 was considered statistically significant. Results: The mean score of the criterias was found to be more desirable in CLBC than conventional technique, but there was no statistical significance found. Conclusions: LBC offers a significant advantage over conventional smear preparation in most of the criteria to advocate its use for routine diagnostic and mass screening procedures.

Cervical cancer detection in pap smear whole slide images using convNet with transfer learning and progressive resizing.

Cervical intraepithelial neoplasia (CIN) and cervical cancer are major health problems faced by women worldwide. The conventional Papanicolaou (Pap) smear analysis is an effective method to diagnose cervical pre-malignant and malignant conditions by analyzing swab images. Various computer vision techniques can be explored to identify potential precancerous and cancerous lesions by analyzing the Pap smear image. The majority of existing work cover binary classification approaches using various classifiers and Convolution Neural Networks. However, they suffer from inherent challenges for minute feature extraction and precise classification. We propose a novel methodology to carry out the multiclass classification of cervical cells from Whole Slide Images (WSI) with optimum feature extraction. The actualization of Conv Net with Transfer Learning technique substantiates meaningful Metamorphic Diagnosis of neoplastic and pre-neoplastic lesions. As the Progressive Resizing technique (an advanced method for training ConvNet) incorporates prior knowledge of the feature hierarchy and can reuse old computations while learning new ones, the model can carry forward the extracted morphological cell features to subsequent Neural Network layers iteratively for elusive learning. The Progressive Resizing technique superimposition in consultation with the Transfer Learning technique while training the Conv Net models has shown a substantial performance increase. The proposed binary and multiclass classification methodology succored in achieving benchmark scores on the Herlev Dataset. We achieved singular multiclass classification scores for WSI images of the SIPaKMed dataset, that is, accuracy (99.70%), precision (99.70%), recall (99.72%), F-Beta (99.63%), and Kappa scores (99.31%), which supersede the scores obtained through principal methodologies. GradCam based feature interpretation extends enhanced assimilation of the generated results, highlighting the pre-malignant and malignant lesions by visual localization in the images.

Role of cervical cytology in the detection of uterine glandular lesions

Background: Diagnosis of atypical glandular cells (AGCs) is challenging to the cytopathologist due to the overlapping features of various neoplastic and nonneoplastic lesions. The aim of this study was to assess the utility of conventional Papanicolaou (Pap) smears in detecting uterine glandular lesions. Materials and Methods: Archived records of all histopathologically diagnosed endometrial adenocarcinoma and endocervical adenocarcinoma during the study period were identified. Corresponding Pap smears, if available, were retrieved. In addition, all cytologically reported AGCs and adenocarcinoma during the same period were retrieved. Pap smears of histopathology discordance cases were reviewed. The prevalence of AGC and sensitivity and specificity of Pap smears in detecting glandular lesions were calculated. Results: The prevalence of AGC was 0.65%. There were 11 false negatives and 10 false positives initially, which were reduced to 6 and 5, respectively, after the review. The sensitivity and specificity of Pap smear in detecting AGC was 72.9% and 99.81% initially, which improved marginally to 81.8% and 99.9%, respectively. Conclusions: The prevalence of AGC in Pap smears is low with a moderate sensitivity and good specificity. As the association of clinically significant lesion is high, all cases with AGC diagnosis must be followed up with colposcopic and histopathologic examination of uterus and cervix.

Comparison of Liquid-Based Cytology and Conventional Papanicolaou Smear for Cervical Cancer Screening: An Experience From Pakistan.

IntroductionAfter the introduction of cervical cancer screening program with cervical cytology, a marked decline in deaths secondary to cervical cancer was observed in developed countries. Two methods are used for cervical cytology. The first one is the conventional Papanicolaou (PAP) and the second one is liquid-based cytology (LBC). Although various studies in western countries established the role of LBC in cervical cancer screening, no large-scale study was conducted in our population to compare the two techniques for cervical cancer screening. Therefore, in this study, we compared the diagnostic utility of these two techniques for detecting cervical epithelial lesions.MethodsA total of 3,929 patients, who presented to the Gynecology Clinic, Liaquat National Hospital, for cervical cancer screening from January 2015 until December 2019, over a period of five years, were included in the study. A total of 1,503 specimens were prepared by LBC, and 2,426 specimens were prepared by a conventional PAP smear method. All smears were interpreted using the Bethesda System of Reporting Cytopathology.ResultsThe mean age of the patients was 39.46±11.14 years. For cytological evaluation, 98.7% of specimens were adequate. The inadequacy rate was 1.3% for conventional PAP smear and 1.2% for LBC. While 97.2% of specimens were reported as negative for intraepithelial lesion or malignancy, 1.1% of specimens showed squamous epithelial lesions. There was a significant difference in the detection rate of squamous epithelial lesions using the two techniques. The detection rate of squamous intraepithelial lesions using LBC was 2.1%, which was higher than that of the conventional PAP smear (0.6%). The detection rates of glandular lesions using LBC and conventional PAP smear were 0.5% and 0.2%, respectively.ConclusionWe found a higher disease detection rate of squamous epithelial lesions using LBC compared to conventional PAP smear. Therefore, we recommend a widespread use of LBC for mass cervical cancer screening in our population.

Comparative study of conventional papanicolaou smears and liquid based direct-to-vial thin-layer preparation in the detection of microorganisms in cervical smears

Introduction: In addition to its primary benefit as a cancer screening test, other benefits of Pap test include detection of cervicovaginal microorganisms. Very few studies have been performed in our country to compare Liquid based cytology (LBC) and Conventional papanicolaou smear (CPS) for detection of cervicovaginal infection by microorganisms. Materials and Methods: Our study focuses on non neoplastic findings which correlate to the presence of Microorganisms- Trichomonas Vaginalis, Candida Species, Bacterial Species, Actinomycosis Species, and Herpes simplex virus. Papanicolaou smear by conventional and liquid based cytology have been used to study effectiveness of each method in diagnostic cytology. A comparative prospective study from March 2017 to May 2017 of 45 split samples for comparing effectiveness of liquid based Thin-layer preparation with that of conventional papanicolaou (Pap) smears to demonstrate microorganisms in cervicovaginal smears was undertaken. These two methods have been compared for reporting the presence of microorganisms, essential for a complete diagnostic evaluation of cervicovaginal specimens by the 2001 Bethesda system under the specific category of

Reliability of conventional Papanicolaou smear in diagnosing bacterial vaginosis among women with clinical genital infection.

Objective:Bacterial vaginosis (BV) is a common reproductive tract infection (RTI) reported among Indian women. BV can influence the persistence of high-risk oncogenic human papillomavirus, a causative factor for cervical cancer. BV and cervical cancer are major public health issues in a developing country like India. It becomes important for a resource-constrained country like India with poor healthcare access to implement control measures to screen and treat RTI in an attempt to prevent the risk for cervical cancer. Papanicolaou (Pap) smear is an established screening tool for cervical cancer and the diagnosis of RTIs, forms a part of its evaluation. The present study explores the validity of conventional Pap smear in diagnosing BV.Methodology:Pap smear and Gram stain smear were collected for 254 women with clinically evident cervicitis/cervicovaginitis (genital infection). Using the Nugent score on Gram stain as a gold standard, we determined the sensitivity and specificity of Pap smear to diagnose BV.Results:The overall prevalence of BV in the study population was 44% using the Nugent score. Pap smear showed sensitivity and specificity of 70.9%. (CI- 61.5% - 79.2%) and 56.8% (CI – 48.2%–65.2%), respectively. The positive predictive value of Pap smear to diagnose BV was 56.5% (CI – 47.8%–64.9%), and the negative predictive value was 71.2% (CI – 61.8%–79.4%).Conclusion:In the present study, conventional Pap smear demonstrates good accuracy to detect BV. Pap testing for cervical cancer screening can additionally serve as an effective screening tool for diagnosing BV among women with genital infection in healthcare settings.

Cytohistological correlation of conventional Papanicolaou smears in cervical neoplasia at a tertiary care hospital of Nepal

Background: Conventional Cervical Cytology is the most widely used cervical cancer screening test. The incidence of cervical carcinoma is incredibly high in developing countries due to lack of proper knowledge. The extensive use of cervical screening with Papanicolau smears had considerably increased the detection of precancerous and cancerous lesion of uterine cervix. Study was conducted to evaluate cytohistological correlation and to calculate concordance and discordance of Pap smear in detection of precancerous and cancerous lesions of uterine cervix.
 Materials and Methods: A total of 54 samples reported in Pap smear as cervical intraepithelial lesions and suspicious for invasive malignancies were selected and correlated with corresponding histopathological findings. It was an observational study done for a period of 18 months from November 2016 to May 2018 at UCMS-TH. All the statistical evaluation was done by using SPSS version 20.
 Results: During the study period 54 cases were evaluated. Atypical Squamous Cell of Undetermined Significance was the common abnormal findings in the Pap smear with frequency of 26 (48.1%). Out of total 54 cases of Pap smears, 30 (55.55%) were concordant while discrepancies occurred in 24(44.44%) cases with cervical biopsy.
 Conclusions: The study revealed a good correlation between cervical cytology and cervical biopsy. We also concluded that conventional Pap smear is a cost effective test for the early detection of precancerous and cancerous cervical lesions.

Diagnostic Accuracy of Conventional Cell Blocks Along with p16INK4 and Ki67 Biomarkers as Triage Tests in Resource-poor Organized Cervical Cancer Screening Programs

Background:Liquid based cytology with dual biomarkers has improved sensitivity and specificity in detecting high grade cervical intraepithelial neoplasia (CIN). In low resource settings, especially in organized camps, LBC is costly and immunohistochemistry on conventional pap smears is difficult to standardize with consumption of lots of reagents. In present study, to improve the accuracy of conventional pap smears and reduce the cost of biomarker testing, we evaluated conventional cell blocks (CCBs) preparations with biomarkers to detect high-grade CIN in resource-poor organized screening programs. We also studied feasibility of using CCB as primary screening test.Material and Methods:A total of 350 participants were included in the cross-sectional evaluation of the screening tests. A conventional Papanicolaou (Pap) smear was obtained, and another sample was then collected and placed in 10% neutral buffered formalin for CB preparation. All abnormal Pap tests and CBs were stained for the biomarkers p16INK4a and Ki67. Histopathology with p16INK4a expression was considered the gold standard. Diagnostic tests were compared using MacNemar’s test and receiver operating curves were plotted.Results:The sensitivity, specificity, and diagnostic accuracy of CCB cytology, CB + p16 cytology and CB + p16Ki67 cytology for detecting CIN2+ lesions were 85.71%, 100%, 97.44%; 100%, 93.75%, 94.87%; and 85.71%, 100%, 97.44%, respectively. The Ki67 index could further categorize low grade lesions into lesions with low proliferative index and with high proliferative index (Pearson chi-square p value <0.001).Conclusion:If CB preparation is standardized, CCB cytology with biomarkers can have better diagnostic accuracy than conventional cytology, can classify low grade lesions likely to progress and can be used in field settings as primary screening test.

Nationwide survey of cervical cytology laboratory practices in China

Cervical cancer rates in China remain high, with only limited opportunistic screening in urban centers and large mostly unscreened rural areas. Cervical cytology practices in China have been changing over the last decade with introduction of The Bethesda System reporting terminology, liquid-based cytology (LBC), and programs for cervical cytology screening of underserved rural populations. An effort was undertaken for the first time to collect nationwide data on cervical cytology laboratory practices in China, a possible first step toward increased standardization and potential development of nationwide cytology quality benchmarks. Data on cervical cytology practices from 1572 laboratories operating in 26 nationwide Provisional Level Administrative Divisions was collected in an online survey approved through the Obstetrics and Gynecology Hospital of Fudan University in Shanghai. Over 90% of cervical cytology laboratories in China now solely use Bethesda System reporting terminology. LBC is now the most commonly utilized form of cervical cytology, with lower-cost Chinese-manufactured LBC formulations used in almost 70% of laboratories. Nationwide, significantly higher abnormal cytology rates were reported with LBC than with the conventional Papanicolaou smear (CPS); however, the CPS remains a useful low-cost alternative as China strives to extend cervical screening to large underserved rural areas. Abnormal cytology rates were not significantly different when different levels of hospitals were compared. The survey identified nationwide opportunities for cytology quality improvement, including low rates of reporting of unsatisfactory cases and low rates for atypical glandular cells.

Comparative analyses between conventional Papanicolaou smear method and the liquid based SurePath method in body cavity fluid cytology

Comparative analyses between conventional Papanicolaou smear method and the liquid based SurePath method in body cavity fluid cytology

Enhanced Detection of Cervical Cancer and Precancer Through Use of Imaged Liquid-Based Cytology in Routine Cytology and HPV Cotesting.

Cervical screening strives to prevent cervical cancer (CxCa), minimizing morbidity and mortality. Most large US reports on cytology and human papillomavirus (HPV) cotesting of women aged 30 years and older are from one laboratory, which used conventional Papanicolaou (Pap) smears from 2003 to 2009. We quantified detection of CxCa and precancer (cervical intraepithelial neoplasia 3/adenocarcinoma in situ [CIN3/AIS]) in 300,800 cotests at Magee Womens Hospital since 2005. Screening histories preceding CxCa and CIN3/AIS diagnoses were examined to assess the contribution of cytology and HPV testing. Cotesting utilized Food and Drug Administration-approved imaged liquid-based cytology (LBC) and from-the-vial HPV tests. LBC identified more women subsequently diagnosed with CxCa and CIN3/AIS than HPV testing. HPV-negative/cytology-positive results preceded 13.1% of CxCa and 7.2% of CIN3/AIS diagnoses. LBC enhanced cotesting detection of CxCa and CIN3/AIS to a greater extent than previously reported with conventional Pap smear and HPV cotesting.

Prevalence of altered cervical cytological pattern: Aretrospective study in females visiting tertiary care hospital

Background: Cervical cancer is one of the major causes of morbidity and mortality in India. Pap smear is a simple, non-invasive, cost-effective and sensitive tool to detect various non-neoplastic and neoplastic lesions of cervix. The objective of this study was to estimate the prevalence of cervical cytological pattern in a tertiary care centre; by using conventional Papanicolaou (Pap) smears for the screening of inflammatory, premalignant and malignant lesions of the cervix. Methods: This cross-sectional study is based on 574 patients who attended the out‑patient Department of Obstetrics and Gynecology, during the period between Jan 2015 to Feb 2017. Pap smears were prepared from patients presenting with complaints like vaginal discharge, post‑coital bleeding, inter‑menstrual bleeding, dyspareunia, and pain in lower abdomen. Conventional Papanicolaoustained smears were classified as per Bethesda 2001 nomenclature. Results: Prevalence of altered cervical cytological pattern was 75.59% amongst females visiting hospital. A total of 574 cervical pap smears were studied, out of which 66 were inadequate. Out of 508 cases, 448 cases were of NILM [including 324 (63.78%) inflammatory lesions and 124 (24.41%) normal smears] and 60 (11.81%) cases of epithelial lesions. The epithelial lesions prevalence rate was ASCUS (5.7%), LSIL (1.4%) and HSIL (1.4%), AGUS (0.78%), SCC (0.6%) and endometrial carcinoma (0.2%). Conclusions: This study shows relatively high prevalence of epithelial abnormalities with increasing age, parity, women with clinical lesions on per speculum findings. Malignancy was more common in sixth and seventh decade and intraepithelial lesions/dysplasia was seen mostly in fourth and fifth decade. Inflammatory lesions were more common in younger age group. Pap smear should be advised as a routine screening procedure; as it is a simple, cheap, safe and practical diagnostic tool for early detection of cervical cancer in high risk group population. It also helps in diagnosis of inflammatory lesions including the identification of causative organism and atrophic changes.

Systemic cervical cytology training and quality control programs can improve the interpretation of Papanicolaou tests

There is no national cervical screening program or national standards for cervical cytology quality control in China. Since 2013, systematic training and quality control programs were implemented in the Papanicolaou testing process at Jinan KingMed Diagnostics. Pathologists were required to complete 1 year of cytology study in the KingMed Diagnostics Cytology School, including 6 months of a diagnostic course and 6 months of practical training in the clinical laboratory. In this study, we compared the Papanicolaou abnormal reporting rates before and after the implementation systematic training and quality control programs. Systematic cytology training and quality control (QC) programs were implemented in 2013. Results from 997,162 cases of liquid-based cytology (LBC) and 100,066 cases of conventional Papanicolaou smears (CPS) rendered between 2008 and 2015 at Jinan KingMed Diagnostics were collected and analyzed. After implementation of training and programs, the abnormal reporting rates of atypical squamous cells of unknown significance (ASC-US), low-grade squamous intraepithelial lesions (LSIL), atypical squamous cells cannot exclude HSIL (ASC-H), atypical glandular cells (AGC), and high-grade squamous intraepithelial lesions (HSIL) in LBC were significantly increased. Similar trends were also observed in CPS reporting, except for ASC-H, squamous cell carcinoma, and AGC, probably due to the small percentages of these categories. The study demonstrates the importance of the formal cytology training and QC programs to ensure standardized and effective cervical cancer screening in undeveloped countries, which account for the largest percentage of the world's annual incidence of cervical cancer and with a largely unscreened population.

Prevalence and Pattern of Abnormal Pap Smear among Pregnant Women Attending Antenatal Clinic in a Missionary Hospital in Abakaliki, Southeast Nigeria

BACKGROUND: Cervical cancer is the most common type of cancer affecting the genital tract among women in developing countries. Screening programmes have been well talked about in Nigeria, but they are not well organized. Hence, the incidence of cervical cancer does not appear to be reducing. A possible way of solving this problem is by doing an opportunistic pap smear among women attending antenatal clinics, since a good number of women do access antenatal care. OBJECTIVES: To determine the prevalence, knowledge, awareness, practice, risk factors and pattern of Pap smear among women attending antenatal clinic in Mile 4 hospital, Abakaliki. METHOD: This is a cross-sectional study carried out at the antenatal clinic of Mile 4 Hospital, Abakaliki, Nigeria. A total of 110 consecutive pregnant women who fulfilled the inclusion criteria and have given their consent were recruited into the study at the time of their first prenatal (booking clinic) visit for antenatal care. Data was collected using a questionnaire. Conventional Papanicolaou smear was taken using the standard procedure. The cytopathologic findings were documented in the questionnaire. RESULTS: Out of the 110 pregnant women who had cervical cytology by Pap smear, 7 had pre-invasive cervical lesion, giving a prevalence rate of 6.3%; 5 (71.4%) were low-grade squamous intraepithelial lesion (LGSIL) while 2 (28.6%) were high-grade squamous intraepithelial lesion (HGSIL). Fifty women (45.5%) had negative smears. Inflammatory smears were seen in 50 women (45.5%). Insufficient smear was seen in 3 women (2.7%). Fifty-six women had knowledge about cervical cancer (50.9%), while thirty-six women (32.7%) were aware of a screening program for cervical cancer and only 2 women (1.8%) had been screened in the past. Hence, from this study, the population screening rate was approximately 2%. The risk factors were age of coitarche <15 years, number of sexual partners, previous history of sexual transmitted infection, genital warts, human immune deficiency virus and use of contraceptives. CONCLUSION: The pap-smear findings among pregnant women in Abakaliki, Nigeria showed that the pre-invasive lesion of the cervix is relatively common. Pap smear should be made routine for all pregnant women.

Conventional Pap smear cervical cancer screening in 11 rural counties in Hainan Province, China: analysis of Bethesda system reporting rates for 218,195 women (predominantly ages 35-64 years) screened in China's National Cervical Cancer Screening Program in Rural Areas (NCCSPRA)

Recently the Chinese government has introduced support for cervical screening in rural areas. The College of American Pathologists (CAP)-certified Guangzhou Kingmed Diagnostics laboratory supported rural screening program in Hainan Providence utilizing low-cost conventional Papanicolaou smears (CPS). This was a retrospective study of CPS screening results from 2011 to 2014 in 11 rural counties in Hainan Province. Women, most previously unscreened, volunteered to attend free CPS screening. The targeted population was women aged 35-65 years. Among total 218,195 conventional Papanicolaou smears, the reported abnormal rate was 4.4% of all smears, with 0.5% for high-grade squamous intraepithelial lesion (HSIL), 0.9% for low-grade squamous intraepithelial lesion (LSIL), 2.6% for atypical squamous cells of undetermined significance, and 0.3% for atypical squamous cells, cannot exclude high-grade squamous intraepithelial lesion. Reporting rates for different TBS categories were generally within CAP benchmark ranges, except for low reporting rates for unsatisfactory smears and for atypical glandular cells. Abnormal cytology rates varied among counties. Comparing different age groups, the LSIL rate was significantly higher in women <50 years than in women ≥50 years (1.04% versus 0.64%). The HSIL rate was significantly higher in women ≥40 years than in women <40 years (5.3% versus 0.38%). A total of 2286 women with abnormal Papanicolaou smears had documented colposcopic and histopathologic follow-up. Cervical cancer was diagnosed in 23 of 2286 (1.01%) of screened and biopsied patients. Histopathologic HSIL results were confirmed in 80% of biopsied women with HSIL Papanicolaou tests. CPS offered a low cost method to introduce cervical screening in rural China. The international College of American Pathologists Laboratory Accreditation Program provided laboratory quality control standards not otherwise readily available. Educational training programs have been instituted to address areas identified for quality improvement.

Diagnostic efficacy of liquid-based cytology for solid pancreatic lesion samples obtained with endoscopic ultrasound-guided fine-needle aspiration: Propensity score-matched analysis.

There is a paucity of data on the diagnostic efficacy of liquid-based cytology (LBC) for pancreatic samples obtained by endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA). Using propensity score matching, we retrospectively analyzed the additional diagnostic value of LBC compared to a conventional Papanicolaou smear (CPS) for samples of solid pancreatic lesions obtained by EUS-FNA. This cohort study included 126 matched patients who underwent initial EUS-FNA for solid pancreatic lesions between January 2009 and August 2014. CPS was used for cytology of EUS-FNA samples obtained until May 2012 (63 patients). Subsequently, LBC was used for cytological analysis (63 patients). Diagnostic yields of CPS and LBC for malignancy were compared. Risk factors for cytological misdiagnosis with LBC were investigated. Overall rate of malignancy was 86% after matching. LBC had higher diagnostic sensitivity and accuracy than CPS (96.6% vs 84.0%, P = 0.03; and 96.8% vs 87.3%, P = 0.05). LBC was significantly more sensitive for diagnosing pancreatic head lesions (96.4% vs 78.1%, P = 0.04). The sensitivity for pancreatic ductal adenocarcinoma (PDAC) with LBC was higher (98.1% vs 83.0%, P = 0.009). Multivariate analysis revealed that malignant tumors other than PDAC (P = 0.004) and lesion size ≤20 mm (P = 0.046) were risk factors for LBC misdiagnosis in all participants. For solid pancreatic lesions, LBC of EUS-FNA samples contributes to the diagnosis of malignancy. Malignant tumors other than PDAC and small tumors are difficult to diagnose using EUS-FNA and LBC.

The prevalence and course of preinvasive cervical lesions during pregnancy in a Northern Nigerian Teaching Hospital.

Background:In spite of knowledge of the causes and prevention of cervical cancer, screening programs for cervical cancer have not yet been fully implemented in most developing countries including Nigeria. Documented data on the prevalence of preinvasive cervical lesion in pregnancy are scarce in our environment.Objectives:To determine the prevalence, risk factors, and course of preinvasive cervical lesion in pregnant women attending an antenatal clinic in Ahmadu Bello University Teaching Hospital (ABUTH) Zaria, Northern NigeriaStudy Design:This was a cross-sectional longitudinal study.Setting:The study was conducted in an antenatal clinic of ABUTH Zaria.Materials and Methods:A prospective cross-sectional longitudinal analysis was carried out at an Antenatal Clinic of ABUTH Zaria, Nigeria. A total of 250 consecutive pregnant women who fulfilled the inclusion criteria and have given their consent were recruited into the study at the time of their first prenatal (booking clinic) visit for antenatal care. Data from the pregnant women were obtained using a pro forma to evaluate sociodemographic characteristics and risk factors for preinvasive disease. Conventional Papanicolaou smear was taken using the standard procedure. The cytopathologic findings of initial and postpartum Pap smear were documented in the pro forma. Prevalence, persistence, progression, and regression rates of preinvasive diseases were determined.Results:Out of the 250 pregnant women who had cervical cytology by Pap smear during the study, 15 had preinvasive cervical lesion, giving a prevalence rate of 6%; 13 (87%) were low-grade squamous intraepithelial lesion (LGSIL) while 2 (13%) were high-grade squamous intraepithelial lesion (HGSIL). Negative smears were seen in 158 women (63.2%). Inflammatory and other conditions of the cervix which are technically negative smears made up the remaining 30.8%. At postpartum follow-up of the 13 women with LGSIL, 2 (15.4%) became negative while persistence of the disease was observed in 9 (69.2%) of the cases. Two women with LGSIL were lost to follow-up. Of the two women with HGSIL, persistence of the disease was seen in one woman (50%) and regression of the disease was seen in the other woman. Risk factors that were found to be associated with preinvasive cervical lesion were age at coitarche <16 years, number of sexual partners since coitarche, and previous history of sexually transmitted infection and human immunodeficiency virus. Parity, smoking, and use of contraception were found not to be significant risk factors.Conclusion:Preinvasive lesion of the cervix is relatively common among antenatal clients in our center. Antenatal clients with HGSIL should have a repeat smear at the end of the puerperium before treatment. Routine Pap smear should be offered to all antenatal clients in our setting.