Detection Of Cervical Lesions Research Articles

Clinical Implication of a Typical Glandular Cells; a Five Years Experience of a Single Institution in Portugal

Objective: The study aimed to evaluate the clinical significance of atypical glandular cells (AGC) in cervical cytological reports and its correspondent subtypes. Material and methods: Retrospective study of AGC cervical cytological diagnoses, from January 2009 to December 2013, at a tertiary centre. A global analysis of AGC and its correspondent subtypes was performed, according to age, onset of sexual life, Human Papilloma Virus deoxyribonucleic acid (HPV-DNA) status, diagnostic procedures and follow-up histological outcomes. Results: Cervical AGC cytology had a prevalence of 0.3% among women with an average age of 46.8 ± 14.5 years. The distribution showed 81% of AGC-not otherwise specified (AGC-NOS) and 10.7% of AGC-favor neoplastic (AGC-FN). AGC-NOS had a higher prevalence of benign pathology. AGC-FN showed an association to in situ adenocarcinoma, a superior incidence of endometrial carcinoma and a tendency towards a higher prevalence of squamous cervical intraepithelial neoplasia. Glandular and squamous coexisting cytological abnormalities accounted for 8.3% and were mostly associated with squamous lesion. HPV-DNA testing demonstrated a sensitivity of 50% with a specificity of 100% for detection of cervical lesions. Discussion: Close follow-up of AGC is required once pre-malignancy and malignant disease was identified in 20.8% of patients. A precise study of cervix and endometrium assumes equal importance, significant pathology was found in both locations.

Expression of matrix metalloproteinase-2 and 9 in cervical intraepithelial neoplasia and cervical carcinoma among different age groups of premenopausal and postmenopausal women.

The objective was to study the gelatinolytic activity of matrix metalloproteinase-2 (MMP-2) and matrix metalloproteinase-9 (MMP-9) in preinvasive and invasive carcinoma of the uterine cervix. The expressions were analysed against different age groups, as to demonstrate whether the expression of MMP-2 and MMP-9 is an early or a late event during the progression of cervical cancer. Additionally, the diagnostic accuracy of MMP-2 and MMP-9 was evaluated with ROC curve. A total number of 180 samples of cervical tissue were studied for MMP-2 and MMP-9 gelatinolytic activity. The cases were selected as to include 63 normal cases, 94 CIN cases and 23 cervical carcinoma cases. Among 94 CIN cases, 40 were CIN1, 26 were CIN2 and 28 were CIN3, as reported by histopathology. The gelatinolytic activities of MMP-2 and MMP-9 were evaluated by gelatin zymography in premenopausal and postmenopausal groups. MMP-2 expressions (latent and active) were very low in control samples, followed by increase in CIN1, decrease in CIN2 and further increase in advance stages. MMP-9 had also shown the same expression pattern that of MMP-2. While comparing the expression of MMP-2 and MMP-9 in different age groups, we found initial CIN stages were prevalent in early age that expressed considerable amount of MMP-2 and MMP-9, and advance stages of carcinoma cervix were prevalent at an elderly age. Both MMP-2 and MMP-9 have role in cancer progression and remodelling of the ectocervix. Although expression level varies intricately, a distinctive ROC curve demonstrated MMP-2 active form and MMP-9 form could be used in diagnostic purpose in detection of cervical lesion and cancer.

P3.047 Oncogenic HPV Prevalence in HIV Infected Women Assisted in Public Health in BUENOS AIRES (CABA)

<h3>Background</h3> The scientific evidence shows that HIV-infected women have increased risk of precancerous lesions than uninfected women. The objective was search the prevalence of HPV and assess the cyto-colposcopic and Hybrid Capture test correlation for high-risk HPV in HIV infected women in CABA. <h3>Methods</h3> 269 HIV infected women over 18, not pregnant and without IGT lesions were included between October 2010 to July 2012. Clinical and gynaecological chart were reviewed and sampling for PAP, colposcopy and screening of high-risk HPV were performed. The detection of high-risk HPV was performed with the hybrid capture assay (Digene). <h3>Results</h3> Prevalence of HPV and epidemiological profile were available in the 269 women. 45% had HIV VL below 50 copies and 80% had CD4 upper than 350 cells/cc. A PAP in the last year before this study was available in 30% of cases. The correlation of screening techniques with the three methods proposed: diagnostic cytology, capture hybrid and colposcopy was made in 169 women Prevalence of HPV infection was 39% (104 positive/165 negative). Correlation between Cyto-colposcopic and Hybrid Capture test was: hybrid capture (-) cytology/colposcopy (+) = 2/169 hybrid capture (+) cytology/colposcopy (-) = 15/169 hybrid capture (+) cytology/colposcopy = 32/169 hybrid Capture (-) cytology colposcopy (-) = 84/169 hybrid Capture (+) indeterminate cytology and colposcopy (-) = 19/169 hybrid Capture (-) indeterminate cytology and colposcopy (-) = 17/169 <h3>Conclusions</h3> Despite that it was not a large sample, the negative predictive value of hybrid captures for HPV detection was 98% in this population. We recommend the incorporation of the hybrid capture as screening technique in all women with HIV regardless of the age and all those with negative cytology and positive hybrid capture for the early detection of cervical lesions.

High-Risk Human Papillomavirus Messenger RNA Testing in Physician- and Self-Collected Specimens for Cervical Lesion Detection in High-Risk Women, Kenya

Little is known about the performance of physician-versus self-collected specimens for high-risk human papillomavirus (hrHPV) messenger RNA (mRNA) testing or risk factors for hrHPV mRNA positivity in physician- versus self-collected specimens. We compared the performance of hrHPV mRNA testing of physician- and self-collected specimens for detecting cytological high-grade squamous intraepithelial lesions or more severe (≥HSIL) and examined risk factors for hrHPV mRNA positivity in female sex workers in Nairobi. From 2009 to 2011, 344 female sex workers participated in this cross-sectional study. Women self-collected a cervicovaginal specimen. A physician conducted a pelvic examination to obtain a cervical specimen. Physician- and self-collected specimens were tested for hrHPV mRNA and sexually transmitted infections using APTIMA nucleic acid amplification assays (Hologic/Gen-Probe Incorporated, San Diego, CA). Cervical cytology was conducted using physician-collected specimens and classified according to the Bethesda criteria. Overall hrHPV mRNA prevalence was similar in physician- and self-collected specimens (30% vs. 29%). Prevalence of ≥HSIL was 4% (n = 15). Overall sensitivity of hrHPV testing for detecting ≥HSIL was similar in physician-collected (86%; 95% CI, 62%-98%; 13 cases detected) and self-collected specimens (79%; 95% CI, 55%-95%; 12 cases detected). Overall specificity of hrHPV mRNA for ≥HSIL was similar in both physician-collected (73%; 95% CI, 68%-79%) and self-collected (75%; 95% CI, 70%-79%) specimens. High-risk HPV mRNA positivity in both physician- and self-collected specimens seemed higher in women who were younger (<30 years), had Trichomonas vaginalis or Mycoplasma genitalium infections, or had more than 8 years of educational attainment. Self-collected specimens for hrHPV mRNA testing seemed to have similar sensitivity and specificity as physician-collected specimens for the detection of ≥HSIL among high-risk women.

HPV self-sampling or the Pap-smear: A randomized study among cervical screening nonattenders from lower socioeconomic groups in France

Today in France, low attendance to cervical screening by Papanicolaou cytology (Pap-smear) is a major contributor to the 3,000 new cervical cancer cases and 1,000 deaths that occur from this disease every year. Nonattenders are mostly from lower socioeconomic groups and testing of self-obtained samples for high-risk Human Papilloma virus (HPV) types has been proposed as a method to increase screening participation in these groups. In 2011, we conducted a randomized study of women aged 35-69 from very low-income populations around Marseille who had not responded to an initial invitation for a free Pap-smear. After randomization, one group received a second invitation for a free Pap-smear and the other group was offered a free self-sampling kit for HPV testing. Participation rates were significantly different between the two groups with only 2.0% of women attending for a Pap-smear while 18.3% of women returned a self-sample for HPV testing (p ≤ 0.001). The detection rate of high-grade lesions (≥CIN2) was 0.2‰ in the Pap-smear group and 1.25‰ in the self-sampling group (p = 0.01). Offering self-sampling increased participation rates while the use of HPV testing increased the detection of cervical lesions (≥CIN2) in comparison to the group of women receiving a second invitation for a Pap-smear. However, low compliance to follow-up in the self-sampling group reduces the effectiveness of this screening approach in nonattenders women and must be carefully managed.

Survey of the Types of Cervical Lesions and HPV Genotypes Found in HPV-vaccinated Women

Introduction: The introduction of population-wide HPV (human papillomavirus) vaccination in young women has lead to a global re-evaluation of the overall need and frequency requirements for cytologic cervical screening. As a result, the gynecological algorithms for the detection of cervical lesions have been in flux in recent years in an attempt to optimize the various screening modalities while simultaneously balancing cost and effectiveness. In this study, we investigated the types of cervical lesions and HPV genotypes actually found in HPV-vaccinated women from a practical, real-world clinical perspective. Materials and Methods: Data was collected on a series of 297 consecutive women with HPV immunization. The following parameters were gathered: age, dates(s) of immunization(s), type(s) of vaccine, cytology results, and surgical biopsy results, if available. The presence of pre-vaccination HPV infection was also noted whenever possible. Specimens with abnormal cytologic results (as defined by an abnormal Pap smear result, including an ASCUS with a positive reflex high-risk HPV) subsequently underwent molecular screening for HR HPV using either the Hologic or the Roche method. All samples were then reflexed to the LiPA assay for specific genotyping. Results: Of the 297 women, 27 patients (9.1%) had an abnormal cytologic result. Two specimens had insufficient material remaining for molecular testing, and one specimen failed to run due to excessive clotting. Of the 24 remaining specimens, 21 (87.5 %) showed a positive HR HPV result on initial screening with the Hologic or Roche tests. Twenty-three samples were then successfully genotyped. Frequencies for the genotypes covered by HPV vaccination (HPV 16, 18, 6, and 11) were 17.4%, 4.3%, 4.3%, and 0%, respectively. Of note, the one patient with HPV 18 infection had received an incomplete immunization series, and one of the patients with HPV 16 had definite pre-existing cervical dysplasia before immunization. The most common HR HPV genotypes were HPV 39, 59, and 66 (17.4% each). The average number of HPV strains per patient was 2.6. Conclusions: Immunized women are not exempt from HR HPV infection. Although our data supports Gardasil ’s efficacy against HPV 16 and 18 infections, the current vaccination scheme offers only limited protection against cervical cancer. Our study clearly demonstrates that co-infection with multiple HPV strains, including combinations of both high-risk and low-risk types, is extremely common in immunized women; hence, continued careful screening by cervical cytology and/or HPV testing is critical in continuing to limit the morbidities of cervical cancer.

Human papillomavirus DNA detection in women with normal and abnormal cervical Pap cytology

Cervical cancer is the second most common cancer in women worldwide and nearly all cases are human papillomavirus (HPV) related. Pap cytology screening has been very successful in lowering cervical cancer incidence and mortality in the US. With the increasing use of HPV DNA tests as a reflex test for ASC-US and co-testing of women over 30 for primary screening, there have been many reports of the HPV positive rates and clinical follow-up findings for women with various abnormal Pap diagnoses. This review describes the reported HPV detection rates for HSIL, LSIL, ASC-US, ASC-H, AGC, and negative Pap cytology and highlights the effect of HPV positivity on the follow-up detection of cervical lesions.

Implementing Human Papillomavirus Testing in a Public Health Hospital: Challenges and Opportunities

Objectives: Robust evidence now supports human papillomavirus (HPV) testing as a more effective option to screening and as more sensitive than cytology in detecting high-grade cervical intraepithelial neoplasia . Our goal was to analyze the performance of the Hybrid Capture II (HC2) assay for high-risk HPV (hrHPV) in women undergoing gynecological examination at a public health hospital as part of the evaluation of HPV screening as an alternative or complement to cytology. Study Design: This analysis is a subset of a cross-sectional study carried out at a large public hospital serving a predominantly low-resource population. A total of 705 women were enrolled; the sensitivity and specificity of each test were estimated and compared. Results: The analysis identified 272 hrHPV-positive women (mean age 36.3 years) and 433 hrHPV-negative women (mean age 41.2 years). HPV testing showed a significantly increased sensitivity of the HC2 assay versus cytology (84.5 vs. 69.7%; p < 0.0001) but a lower specificity (49.90 vs. 88.78%; p < 0.0001). Conclusion: The combination of both methods seems to be useful in improving detection of cervical lesions.

Plasma levels of insulin-like growth factor-1 and insulin-like growth factor binding protein-3 in women with cervical neoplasia

The goal of this study was to investigate the relationship between plasma levels of insulin-like growth factors-1 (IGF-1) and IGF-binding protein-3 (IGFBP-3) and the risk for cervical intraepithelial neoplasia (CIN) and cervical cancer. Plasma levels of IGF-1 and IGFBP-3 of 44 cervical cancer patients, 82 CIN patients and 40 neoplasm-free patients were investigated. Then the associations of the plasma levels of IGF-1 and IGFBP-3 with cervical neoplasm or its clinicopathologic parameters were analyzed. The mean IGF-1 concentrations were significantly different among the control, CIN, and cervical cancer groups; the levels were higher in the CIN group compared to the controls. According to the quartile category, the plasma IGF-1 level was significantly higher (p=0.0015) in the CIN group than in the controls. The IGFBP-3 level showed no association between the controls and CIN groups (p=0.842). Although the mean IGF-1/IGFBP-3 molar ratio had borderline significance (p=0.08) among the study population, the quartile comparison showed a significantly higher IGF-1/IGFBP-3 molar ratio in the CIN group compared to the control group (p=0.041). Plasma levels of IGF-1 and the IGF-1/IGFBP-3 molar ratio might be useful for the development early detection of cervical lesions and used as an adjuvant diagnostic tool for cervical neoplasia after more larger scale research.

Early detection of cervical lesions by use of human papillomavirus DNA testing

Early detection of cervical lesions by use of human papillomavirus DNA testing

Rapid cervicovaginal smear screening: method of quality control and assessing individual cytotechnologist performance

To validate the method of rapid screening (RS) in the detection of cervical lesions and false-negative results as well as in quality control of cytotechnologist performance. The RS method was validated on Papanicolaou-stained and initially conventionally analysed vaginal, cervical and endocervical (VCE) smears collected in an opportunistic programme for the detection of cervical carcinoma. The study included 3680 VCE smears from the Department of Gynaecologic Cytology, University Department of Gynaecology and Obstetrics, Zagreb University Hospital Center, Zagreb and from the Department of Clinical Cytology, Osijek University Hospital, Osijek. Histologically verified abnormal findings accounted for 10% of the study samples. Thirteen cytotechnologists, with no previous experience in RS, performed the test. Each slide was examined using the 'step' technique for 1.5 minutes, the findings were classified as negative or abnormal, and the abnormal ones were also classified according to differential cytological diagnosis. The results were compared with those obtained on initial screening. Abnormal findings from a group of initially negative findings were reanalysed using conventional methods to make definitive cytological diagnosis. RS yielded a sensitivity of 83.7%, specificity of 93.7%, positive predictive value of 62.4%, negative predictive value of 97.9% and diagnostic accuracy of 92.6%. Relative to the initial abnormal differential cytological diagnosis, the diagnostic value of RS increased with lesion severity [54.8%, 68.0% and 91.3% for cervical intraepithelial neoplasia (CIN) I, CIN II and CIN III respectively]. RS detected 38 additional positive findings; 94.2% of these were atypical squamous cells of undetermined significance (ASCUS)/abnormal glandular cells undetermined significance (AGUS) and CIN I. The rate of additional positive findings was 1.14% (38/3135). The false-negative rate of initial screening was 9.4% (38/406), and individual cytotechnologist sensitivity was 60.0-100.0%. RS could be introduced as an efficient method of quality control to improve the sensitivity of cytological screening as well as for quality control of cytotechnologist performance.

Split-Sample Analysis of Discarded Cells from Liquid-Based Pap Smear Sampling Devices

To examine cells that were retained on sampling devices used to collect ThinPrep (Cytyc Corp., Boxborough, Massachusetts, U.S.A) Pap smears in order to evaluate both the number and significance of cells that are routinely discarded with these devices after liquid-based specimens are collected.One hundred Pap smears from 100 women were prospectively procured after gynecologic Pap smears were collected for the ThinPrep Pap test. The sampling end of the collection devices was cut off and placed in a vial that contained SUREPATH preservative fluid (TriPath Imaging, Inc., Burlington, North Carolina, U.S.A). The residual cell samples were processed using the SurePath PREPSTAIN slide processor (TriPath). A single liquid-based slide was prepared from the sampling devices from each of the 100 specimens collected. The slides produced from the discarded devices were reviewed for the following: squamous cells, endocervical component, epithelial cell abnormalities and miscellaneous findings. The slides prepared from the "throw-away" (TA) material were subsequently compared with the primary ThinPrep Pap smear slide.Twenty-five percent of the TA samples had an equal or greater number of squamous cells per high-power microscopic field when compared to the primary ThinPrep slide, with 8% of the TA slides demonstrating greater overall cellularity. An endocervical component was present on 27 of 66 cervical samples (40.9%). Three of five cases (60%) interpreted as atypical squamous cells of undetermined significance had similar cells on the TA slides. Two cases of atypical glandular cells of undetermined significance had no abnormal cells on the TA slides. Twelve of 14 cases (85.71%) of low grade squamous intraepithelial lesion contained similar cells on the TA slides. Two of four cases (50%) of high grade squamous intraepithelial lesion also had similar abnormal cells on the TA slides. Miscellaneous findings included 1 case of benign endometrial cells and 4 Candida infections present on both preparations, along with 1 case of Trichomonas vaginalis organisms present on the ThinPrep slide only. In 1 specimen, several multinucleated histiocytic giant cells were present only on the TA slide.Specimens prepared from TA collecting devices used for the ThinPrep Pap test are less sensitive than the primary specimen for the detection of cervical lesions. This is in contrast to split-sample studies involving ThinPrep and conventional smears. Our study documented the presence of normal and abnormal cells discarded from ThinPrep sampling devices in a high percentage of cases. Discarded abnormal cells on the TA slides were, however, few when compared to the primary specimen, with only 1 exception involving a high grade lesion.

Contribution of combined colposcopy and cytology in cervical pathology

The regular Papanicolaou (Pap) smear is the cornerstone of women's preventive healthcare. The introduction of the regular Pap smear as a screening tool for cervical cancer has markedly decreased the number of deaths from cervical cancer. During the past decade, however, the rate of death from cervical cancer has remained relatively static. This screening method is known to have a high percentage of false negative results. To improve the detection of cervical lesions using the Pap smear in screening, a number of adjunct procedures have been developed. The purpose of this study is to evaluate the utility of a magnified chemoluminescent screening examination (Colposcopy) combined with the Pap smear in detecting cervical abnormalities. We investigated a cohort of 58 subjects who have been forwarded for colposcopic evaluation due to referral cytology suggestive of persistent inflammatory process not otherwise specified, and cervical intraepithelial or invasive neoplasia, in Chania Colposcopic clinic. The higher the lesion detected by cytology, the more severe the corresponding colposcopic impression viewed. The data presented here are in harmony with previous reports and share our experience in a Regional Community Hospital Colposcopy Clinic. An integrated cytology-colposcopy program facilitates the assessment and identification of women harboring cervical pathological conditions.

Quantitative analysis of human papillomavirus type 16 in cervical neoplasm: A study in Chinese population

Background: Human papillomavirus (HPV) infection was recognized as a major causal factor for the development and progression of squamous intraepithelial lesions (SIL). It is possible to use HPV test for the detection of cervical lesions as an adjunct to cervical cytology. Objectives: To evaluate the relation between HPV 16 viral load and the severity of cervical lesions in a Chinese population. Methods: Study population was recruited from the colposcopy and general outpatient clinic. The presence of HPV 16 E6 and E7 in cytological specimens was detected using HPV 16 specific polymerase chain reaction (PCR). The viral load in the specimens that were positive for HPV 16 specific PCR, was quantified by using real-time PCR assay. Results: The study recruited 394 women, in which 148 were high-grade SIL (HG-L), 121 were low-grade SIL (LG-L) and 125 were Normal. Sufficient DNA integrity was proven in 347 samples. Among 121 positive cases for HPV 16, 70 were HG-L, 34 were LG-L and 17 were Normal. Using quantitative real-time PCR, the percentages of samples with greater DNA copies were found to increase with the severity of diseases. There was also a significant difference in DNA copies among the three groups (HG-L versus Normal, p < 0.001; HG-L versus LG-L, p < 0.001). Area under receiver operating characteristic (ROC) curve of the HG-L versus LG-L and Normal was 0.836 indicating that quantitative PCR had a good diagnostic value in differentiating HG-L from the LG-L and Normal groups. Conclusions: Our data suggested HPV 16 viral load was significantly related to the severity of cervical lesions. Evaluation of viral burden could be a potential clinical tool in management of cervical lesions.

Computerized measurement of intercapillary distance using image analysis in women with cervical intraepithelial neoplasia: correlation with severity

Computerized measurement of intercapillary distance using image analysis in women with cervical intraepithelial neoplasia: correlation with severity

Validade da citologia cervicovaginal na detecção de lesões pré-neoplásicas e neoplásicas de colo de útero

Introdução: O exame colpocitológico ou teste de Papanicolaou permite o diagnóstico precoce do câncer de colo do útero. O êxito no rastreamento desta doença dependerá, além de outros fatores, da acuidade diagnóstica do exame colpocitológico. Objetivos: Avaliar a acurácia diagnóstica da citologia cervicovaginal na detecção de lesões cervicais através da comparação citoistopatológica. Material e métodos: Avaliou-se o grau de concordância entre os exames citológico e histopatológico de 373 pacientes atendidas em um hospital universitário no período de 1990 a 1997 e foram calculados os indicadores: sensibilidade, especificidade, valores preditivos positivos e negativos e as taxas de falsos positivos e falsos negativos do exame. Resultados: A taxa bruta de concordância citoistopatológica foi de 65,1%. A sensibilidade do exame foi alta (96,0%), no entanto sua especificidade foi baixa (51,5%), significando a inclusão de muitos resultados falsos positivos. A taxa de falsos positivos foi de 48,4%, enquanto a de falsos negativos foi de 4%. Discussão: Apesar de a sensibilidade do teste ser alta, sua especificidade é baixa, significando que muitas mulheres seriam falsamente diagnosticadas como doentes, levando a um número elevado de resultados falsos positivos e custos desnecessários, além do potencial caráter iatrogênico que esta ação poderia assumir. No entanto, um exame altamente sensível é o teste de escolha para programas de rastreamento de câncer cervical na população feminina. Conclusões: Para garantir a acuidade diagnóstica do teste de Papanicolaou são essenciais atividades de controle de qualidade nos laboratórios, tanto do procedimento colpocitológico quanto do histopatológico, permitindo, assim, o êxito na detecção precoce e no tratamento das lesões cervicais.

Molecular variants of human papillomavirus types 16 and 18 preferentially associated with cervical neoplasia

In order to determine geographically related intratypic variation in human papillomavirus (HPV) type 16 and 18 isolates that could be associated with lesion development, data were analysed from an ongoing cohort study of the natural course of infection of HPVs and cervical neoplasia. Testing for HPVs was carried out by PCR and molecular variants of these HPVs were characterized by sequence analysis of the long control region and by dot blot hybridization of the E6 and L1 genes. Tests for HPV were done in multiple first-year specimens from 1690 women enrolled in a cancer screening program from 1993 to 1997. Subjects were followed-up by cytology and cervicography for detection of cervical lesions. Seven variants of HPV-16 and four of HPV-18 were detected in one or more specimens from 65 subjects. The same variant was found in specimens taken on different visits from each case of persistent infection. Overall, non-European variants tended to persist more frequently [odds ratio (OR)=4.5; 95% confidence interval (CI), 1.6-12.4] than European (E) variants (OR=2.5; 95% CI, 1.3-4.9), relative to the risk of persistence for non-oncogenic HPVs. In addition, non-E variants were more strongly associated with risk of both prevalent (age- and race-adjusted OR=172.2; 95% CI, 47.1-630.1) and incident [relative risk (RR)=22.5; 95% CI, 6.0-83.9] high-grade lesions than E variants (prevalent lesions OR=46.3; 95% CI, 15.5-138.0 and incident lesons RR=6.1; 95% CI, 1.3-27.4), relative to the risk for HPV-negative women. Although consistent, the latter differences were not statistically significant. If confirmed in other populations, measurement of intratypic variation of HPV-16 and -18 has the potential to serve as an ancillary tool in cervical cancer screening.

The Italian experience of a Pap test and speculoscopy based screening programme.

The main objective of the study was to evaluate if speculoscopy, a magnified chemiluminescent examination, combined with a Pap smear, could improve the detection of early cervical lesions compared with the Pap smear alone. Pap tests and speculoscopies were performed in two family planning centres located in the surrounding areas of Modena. Colposcopic investigations and biopsies of the uterine cervix were performed in a second level centre (Gynaecological Prevention Centre of Modena Policlinico). Histological specimens were analysed at the Section of Pathological Anatomy of Modena Policlinico. The study population comprised 1000 women aged 25-64 years, invited to undergo a Pap smear every three years in accordance with the screening programme for cervical cancer started in Modena in 1997. Midwives performed the Pap smear and speculoscopy in succession. Women with a positive Pap test and/or positive speculoscopy underwent colposcopy and, if colposcopic findings were positive, targeted punch biopsies were performed. A total of 1000 patients were subjected to cytology and speculoscopy examinations. Among these women, 10 had abnormal Pap smear findings whereas 144 had an abnormal speculoscopic pattern. Only three of 59 patients with a histological diagnosis of cervical intraepithelial neoplasia grade I (CIN I)/human papillomavirus and only three of seven patients with CIN II/CIN III had a positive Pap test. Speculoscopy combined with a Pap test can significantly increase the detection of cervical lesions when included in a screening programme.

Pap Smear Screening among Urban Southwestern American Indian Women

Background. American Indian women have among the highest incidence and mortality rates of cervix cancer in the United States. The incidence of cancer of the cervix among American Indians is 19.5/100,000 versus 7.8/100,000 in U.S. whites, and comparison by geographic region/tribe indicates that the rate is four to six times higher in some tribes. Papanicolaou cytological testing (Pap smear) permits the detection of cervical lesions before they become cancerous, effectively reducing the incidence of cervical cancer by 75–90%. The American Cancer Society recommends a Pap smear every year beginning at age 18 years or when sexually active, and more frequent screening in high-risk populations.Methods. A random household cross-sectional survey was conducted in Phoenix, Arizona, to assess cervical cancer screening rates among 519 adult urban American Indian women. Logistic regression was used to identify predictors of Pap smear use.Results. Three-quarters (76.1%) of urban women American Indian surveyed received a Pap smear within the past 3 years, but only 49.5% received a Pap smear within the last year. Women over age 50 years were significantly less likely to have received a recent Pap smear in comparison to younger women.Conclusions. The results of this study indicate that limited access to health care and lack of knowledge about the procedure were important barriers to Pap smear use. Improving cervix cancer screening participation rates is an important step in reducing the disease burden in this high-risk population.

Improvement of Pap smear sensitivity using a visual adjunctive procedure: a co-operative Italian study on speculoscopy (GISPE).

The present study evaluates whether speculoscopy, a magnified chemiluminescence examination, combined with Pap smear can improve the detection of cervical lesions, as compared with Pap smear alone. The investigation was a prospective practice-based research carried out as a multicentre cohort study throughout the Italian territory. The participants were 3,300 asymptomatic women age > or = 18 years undergoing routine pelvic and cytological screening. All participants were subjected to Pap smear, speculoscopy and colposcopy investigations in succession. The 646 women with positive colposcopy underwent biopsy. Of the 267 women with positive histology 25 were high-grade intraephitelial lesions (HGSIL) and 242 were low-grade intraephitelial lesions (LGSIL). The histological findings were correlated with the results of Pap smear and speculoscopy alone and combined (PPS). Pap smear alone detected 76% of HGSIL, speculoscopy alone identified 84% of HGSIL, and PPS indicated 100% HGSIL. Of the 242 women with LGSIL, Pap smear alone detected 37% of the cases, speculoscopy alone detected 54% of the cases, and PPS identified 91% of the cases. Together, the two tests missed 9% of the LGSIL. The combination PPS was found to increase sensitivity from 40% to 92%, but to lower specificity from 94% to 23%. Speculoscopy combined with Pap smear can yield a higher percentage of women with biopsy-confirmed cervical pathology than the use of Pap smear as a sole screening test. This is particularly true of patients with LGSIL. The mechanisms of pathological detection and the use of speculoscopy should be investigated further.