Glandular Cells Of Undetermined Significance Research Articles

The Prevalence of Abnormal Cervical Cytology at Federal Teaching Hospital Gombe: A Cross-Sectional Study

Introduction: Cervical cancer continues to be a significant public health concern, ranking as the fourth most common cancer among women globally, with approximately 604,000 new cases and 342,000 deaths reported in 2020 (World Health Organization, 2020). The burden of cervical cancer disproportionately affects women in low- and middle-income countries (LMICs), where access to effective screening and treatment options is often limited. Early detection and treatment of cervical premalignant lesions are crucial in reducing the incidence and mortality associated with this preventable disease. The objectives of this study was to determine the prevalence of abnormal cervical cytology, the histological types and patient characteristics among patients attending the Gynaecology/postnatal clinic of Federal Teaching Hospital, Gombe State, Nigeria. Methods: A retrospective study of all cervical smears received and processed at the Pathology laboratory of Federal Teaching Hospital between January 2022 and December 2022. Results: The records of 596 smears of women between the ages of 20 and 65 years were retrieved and analyzed. Negative smears were predominant (62.6%) while 8.7% were inflammatory smears. Dyskaryotic smears were found in 155 smears (26.0%); this was made up atypical glandular cells of undetermined significance (AGCUS) in 1.8%, Atypical squamous cells of undetermined significance (ASCUS) in 10.23%, Low grade squamous intraepithelial lesion (LSIL) in 10.6% and High grade squamous intraepithelial lesion (HSIL) in 3.6%. Malignant cells were found in 0.5% of the smears while the remaining 2.1% were unsatisfactory. Conclusion: The relatively high frequency of dyskaryosis in this study lends credence to the need for us to widen our cervical screening coverage in order to achieve the highest possible coverage rate. This can be achieved through the use of public education by means of various media, women and religious organizations.

Analysis of the Differences between Bethesda Groups according to Conventional Smear and Liquid-Based Cytology Methods in Cervicovaginal Cytology: A Single-Center Experience with 165,915 Cases

Introduction: Liquid-based cytology (LBC) has replaced conventional smear (CS) in the world. In this study, through a series with a large number of cases, we aimed to make a comparison and general evaluation in all groups, primarily epithelial abnormalities, according to LBC and CS methods. This study was carried out in a private pathology laboratory located in a metropolitan city, where cytological materials sent from many clinics were examined. Material and Methods: There were 165,915 cases whose smears were examined between 2012 and 2020, most of them conventional (131,224 CS, 34,691 LBC). Cases were evaluated on the basis of the Bethesda 2014 classification and divided into sub-diagnostic categories after they were divided into two main groups as “with epithelial abnormalities” and “without.” χ2 and Fischer’s precision statistical tests were conducted using SPSS 23.0 package. In the CS process, cervical samples were obtained using an endocervical brush and a spatula. Cells were directly spread onto the slides and promptly fixed in 95% ethanol, followed by staining with the standard Papanicolaou stain. For LBC ThinPrep, cervical specimens were gathered using a cervix brush. The brush was washed in a vial and discarded. Finally, cells were isolated through vacuum filtration and transferred to the slide using air pressure. Results: Squamous cell abnormalities (atypical squamous cells of undetermined significance [ASC-US], atypical squamous cells – cannot exclude high-grade squamous intraepithelial lesion [ASC-H], low-grade squamous intraepithelial lesion [LSIL], high-grade squamous intraepithelial lesion [HSIL], squamous cell carcinoma, atypical glandular cells of undetermined significance) were reported in 5,696 (3.43%) cases. ASC (ASC-US + ASC-H)/SIL ratio (1.36/2.04) was found to be 0.67 (recommended Bethesda ratio is <3). ASC-US (p < 0.001), ASC-H (p < 0.001), and HSIL(p < 0.001) detection rate of LBC was found to be significantly higher than CS. ASC-US (1.8/1.2), ASC-H (0.08/0.008), and HSIL (0.6/0.3) case ratios of LBC/CS were found to be significantly higher in LBC. LSIL (1.72/1.66) rate was similar. Conclusion: LBC is superior to CS in detecting epithelial lesions. In addition to being used as a screening method, it is clear that it makes a great contribution to reducing cervical carcinomas due to HPV typing. Definitive comments regarding comparison of methods on reactive changes and microorganism detection are challenging. Preanalytical factors might account for these situations.

Cervical Pap Smear Abnormalities among Women with Diabetics Versus Non Diabetics Women at Omdurman Military Hospital, Sudan

Background: Cervical cancer is a common cancer in the world, Pap smear and human papilloma virus test are used for early detection and follow up of cervical cellular changes and cervical cancer, but here in Sudan they are still poorly used. Diabetes and cancer share some risk factors and they have both been found to happen in the same patients. The aim of this study is to evaluate abnormal pap smears from diabetics and non-diabetics.Methods: this is a case-control hospital base study, (109) cases and (109) controls, the patients who requested pap smear during study period and who matched the characteristics of the study. Controls are diabetes-free, but they have another complains because of which the pap smear is requested like genital infection complaints or gynecological complaints, cases have diabetes plus the infection or gynecological complaints because of which the pap smear is requested.Results:(74.3%) of the cases showed abnormal results (positive), (47.6%) of them Atypical Squamous Cells of Undetermined Significance and Atypical Glandular Cells of Undetermined Significance, (26.7%) of them inflammation and infection. (22.9%) of the controls showed positive results (4.6%) of them Atypical Squamous Cells of Undetermined Significance and Atypical Glandular cells of Undetermined Significance, (18.3%) of them signs of inflammation and infection signs. (25.7%) of the cases have had negative pap results for intraepithelial lesion, malignancy, or infections while (77.1%) of control.Conclusions: there is association between diabetes mellitus and abnormal finding of pap smear test and controlling of diabetes mellitus is important issue affecting pap smear findings. also, diabetes increases liability of diabetic women to get infections and cervical cellular changes.

Feasibility of implementing cytology-based cervical cancer screening national program in Lebanon: A pilot study.

To review our national cervical cancer screening program using existing Ministry of Public Health primary healthcare centers (PHCs) and report the impact of women's knowledge, attitude, behavior, and practices on screening uptake and outcome. A cross-sectional study on cervical cancer screening offered to sexually active Lebanese women aged 21 years and above visiting PHCs. Exclusions were history of complete hysterectomy, gynecologic cancers, and current pregnancy. Data were collected through a questionnaire and conventional cervical smear performed by trained healthcare providers and sent to one centralized cytopathology laboratory. Of 12 273 eligible women, 1.7% had an abnormal cervical smear test including 161 atypical squamous cells (ASC) of undetermined significance, 6 atypical glandular cells of undetermined significance, 16 low-grade squamous intraepithelial lesion (SIL), 17 ASC-cannot rule out high-grade SIL, 11 high-grade SIL, and one invasive carcinoma. Knowledge and attitudes significantly affected participation in screening; women lacking awareness had rarely undergone a cervical smear. In Lebanon, cytology-based cervical cancer screening is feasible within the PHCs. Positive screen incidence was low. Despite previous campaigns, a low level of knowledge persists, and affects women's com with the screening guidelines. Advocacy and awareness activities by key healthcare providers may help to improve participation.

Minimal prevalence of HPV vaccination and common occurrence of high-risk HPV types in pregnant women with HIV: data from a national study in Italy.

Among 733 pregnant women with HIV followed between 2013 and 2021, only 8 (1.1%) had prior HPV vaccination. One had low-grade squamous intraepithelial lesions [LSIL], and none had HPV type information. Among the 725 non-vaccinated women, 578 (79.7%) had information on cervical cytology. Rate of cytologic abnormalities in this group was 20.6% (0.2% atypical glandular cells of undetermined significance [AGC], 1.7% atypical squamous cells of undetermined significance [ASC-US], 11.1% LSIL, and 7.6% high-grade squamous intraepithelial lesions [HSIL]). Among 56 women with HPV type information, 75.0% carried high risk types, with similar occurrence in women with and without cytologic abnormalities, 30.4% had multiple high-risk types, and 75.9% carried at least one of the types included in the currently recommended 9-valent vaccine.

Cost-Effectiveness of Cervical Cancer Screening in Rural Bengaluru with Demographic Analysis of Epithelial Cell Abnormalities

Aim: Cervical cancer is the fourth-most common cancer in women worldwide and ranks third among all the malignancies for women. In contrast to developed countries, cervical cancer is a public health problem in developing countries like India and accounts for a quarter of the global disease burden. It is also one of the leading causes of cancer mortality in India, accounting for 17% of all cancer deaths among women aged between 30 and 69 years. The aim of this study is to perform a demographic analysis of cervical cancer by using Papanicolaou (PAP) test as a screening modality in Doddaballapur, rural Bengaluru, Karnataka. Materials and Methods: A cross-sectional descriptive study was conducted on cervical cancer screening utilizing PAP smear screening. Camps were organized in Doddaballapur, rural Bengaluru, organized by Non-Profit Organization, Sahaya Hastha Trust between December 2017 and 2018. The PAP smears were stained and evaluated for epithelial cell abnormality using Bethesda System criteria free of cost at The Oxford Medical College and Hospital, Bengaluru. Results: A total of 647 patients were evaluated in this prospective study and abnormal epithelial cell abnormalities (ECA) were observed in 24 (3.7%) cases. Among the 24 cases, 2 cases (8.3%) of squamous cell carcinoma, 11 cases (45.8%) of atypical squamous cell of undetermined significance, 5 cases (20.8%) of Atypical Squamous cells - cannot rule out high-grade squamous intraepithelial lesion (HSIL), 3 cases (12.5%) of low-grade squamous intraepithelial lesion (3), 2 cases (8.3%) of high-grade squamous intraepithelial lesion (HSIL), and a single case (4.2%) of atypical glandular cells of undetermined significance were noted. Of the remaining 623 smears (96.2%) diagnosed with negative for intraepithelial lesion or malignancy, 428 cases (68.7%) were reported as nonspecific inflammation, while 56 smears (8.9%) showed atrophic smears and 20 cases (3.1%) were unsatisfactory for evaluation. 119 cases (19.1%) displayed a specific infectious etiology; coccobacilli (bacterial vaginosis) being the most common 66 cases (55.5%), followed by Trichomonas vaginalis 46 cases (38.6%) and Candida infection has 7 cases (5.8%). Conclusions: In Dodabullapur, a rural Bengaluru suburb, 3.7% of cervical cancer patients had ECA. It is hypothesized that a low-cost screening program is exceptionally beneficial in lowering the disease burden of cervical cancer, especially among middle-aged women and those living in low-income areas. This humanitarian purpose might motivate women in rural regions to be educated with the sole goal of uplifting the impoverished.

Prevalence and genotype distribution of high-risk human papillomavirus infection among women with cervical cytological abnormalities in Chongqing, China, 2014-2020.

Persistent infection with high-risk human papillomavirus (HR-HPV) is the main leading cause of cervical precancerous lesions and cervical cancer. This study aims to explore the epidemiological characteristics of HR-HPV genotypes and their correlation with the ThinPrep cytological test (TCT) results among women in Chongqing, in China. In this retrospective study, cervical exfoliations of 14,548 women who visited Chongqing university cancer hospital were collected for detecting HR-HPV genotypes and TCT. Overall, the rate of HR-HPV infection was 14.26%. The three most common HR-HPV genotypes are HPV52 (4.39%), HPV58 (2.21%), and HPV16 (1.94%). In this study, the positive rate of cervical TCT was 4.54%. Atypical squamous cells of undetermined significance (ASC-US), atypical squamous cells that could not exclude high-grade squamous intraepithelial lesion (ASU-H), low-grade squamous intraepithelial lesions (LSIL), high-grade squamous intraepithelial lesions (HSIL), and atypical glandular cells of undetermined significance (AGC) were 2.99%, 0.20%, 0.92%, 0.29%, and 0.14%, respectively. Among the several types of cytological lesions, the HR-HPV infection rates of ASC-US, ASC-H, LSIL, HSIL, and (AGC) were 24.82%, 41.38%, 64.18%, 95.24%, and 23.81%, respectively. HPV52, HPV 58, and HPV16 are the most common infection subtypes in Chongqing. When implementing HPV vaccine programs in Chongqing, HPV58 and HPV52 should be attached importance as HPV16 and HPV18.

Prevalence of Positive Cervical Cancer Screening Tests Past the Age of 65 Years With Prior Adequate Negative Screening.

Cervical cancer screening recommendations suggest that cessation can be offered above the age of 65 years if specific prior negative screening criteria are met. We investigated the prevalence of abnormal results in individuals who continue screening despite satisfying the American Society for Colposcopy and Cervical Pathology guidelines for cessation. In this retrospective study, medical records 2008-2019 from a single urban hospital-based clinic were queried. Charts were manually reviewed to determine which patients met the American Society for Colposcopy and Cervical Pathology exit criteria but continued screening. Findings detected during the extended surveillance period beyond the age of 65 years were analyzed. Two hundred ninety-six patients met the criteria of additional screening despite meeting guidelines for cessation. Length of the continued additional surveillance period ranged from 1 to 15 years with a mean of 3.98 years and median of 3 years. Thirty-nine individuals had abnormalities during additional surveillance: 25 high-risk human papillomavirus (HR-HPV) positive only with negative cytology, 8 atypical squamous cells of undetermined significance, 3 low-grade squamous intraepithelial lesions, 2 atypical glandular cells of undetermined significance, and 1 high-grade squamous intraepithelial lesion. No cases of cervical cancer were detected. Total rate of abnormalities including HR-HPV positive only was 332.20 per 10,000 person-years, and cytologic abnormalities alone at 119.25 per 10,000 person-years. Most findings were HR-HPV positive with negative cytology, which studies suggest may confer low risk of progression in older individuals. In addition, no patient was found to develop cervical malignancy. Despite controversy regarding this recommendation, our data suggest screening cessation may be appropriate with adequate negative screening history.

English

BACKGROUND Cervical cancer is one of the most common forms of cancer. In India it is the second most common cancer after breast carcinoma. PAP smear is the best screening method to reveal spectrum of lesions in cervix ranging from inflammatory to the neoplastic process. Because of easy accessibility of cervix, cervical screening is helpful for ready diagnosis of 90 % to 96 % cytological abnormalities even in the pre-invasive stage. We wanted to evaluate the importance of PAP smear examination as a preliminary method accommodating histopathology and assess the spectrum of lesions. METHODS The study was done to identify the target age groups for the early detection of cancerous cervix by PAP smear examination. The study was done on patients who attended government general hospital (GGH), Ongole, from January 2018 to December 2019. Lesions were categorized based on 2014 Bethesda system as negative intraepithelial lesion for malignancy (NILM) / Inflammatory, benign, premalignant, and malignant. The clinicocytological and histopathological examination (HPE) of cervical biopsy of corresponding smears were compared and analysed in the present study. RESULTS Of the 584 cases studied by PAP smear examination, maximum number of patients were between 21 and 60 years of age. Maximum number of patients came with the complaint of white discharge. Highest number of cases reported were NILM / inflammatory (54.18 %), followed by atypical squamous cells of undetermined significance (ASCUS) (20.68 %), high-grade squamous intraepithelial lesion (HSIL) (13.84 %), squamous cell carcinoma (SCC) (6.84 %), low-grade squamous intraepithelial lesion (LSIL) (1.65 %), metaplasia (1.19 %), atypical glandular cells of undetermined significance (AGUS) (0.51 %), adenocarcinoma (0.17 %). CONCLUSIONS Cervical PAP smear screening is simple, cost effective and reliable method for early detection of cervical cancers. Classification of lesions based on Bethesda terminology is most informative and useful. Correlation of PAP smear cervical cytology with gold standard HPE provides greater efficacy in diagnosis. KEYWORDS PAP smears, NILM, ASCUS, AGUS, LSIL, HSIL

Cyto-histo correlation of conventional Pap smear with cervical biopsy in diagnosis of precancerous and cancerous lesions of cervix

Introduction: Carcinoma of uterine cervix is the third most common cancer among women worldwide and it contributes significantly to cancer related morbidity and mortality. The incidence of cervical carcinoma is incredibly high in developing countries (almost 80%) due to lack of proper knowledge. The extensive use of cervical screening with Pap smears has considerably increased the detection of precancerous and cancerous lesions of uterine cervix. Aims: To evaluate cyto-histo correlation of precancerous and cancerous lesions of uterine cervix and to calculate the sensitivity and specificity of Pap smear in diagnosing invasive malignancy. Materials and Methods: This was a retrospective observational study conducted in the Department of Pathology, Chirayu Medical College & Hospital, Bhopal from January 2013 to April 2018. All the cases reported in Pap smear as cervical intraepithelial lesions and invasive malignancies were retrieved. We also retrieved the same cases, if they had undegone cervical biopsy for correlation. Result: During the study period total 303 cases which were positive for intraepithelial lesions and malignancies were retrieved. Out of these 303 cases we excluded 23 cases because in these cases cervical biopsy had not been done. So in the final analysis 280 cases were included. Of the 280 Pap smears, maximum cases (33.92%) were reported as low grade squamous intraepithelial lesion (LSIL), followed by high grade squamous intraepithelial lesion (HSIL) (24.28%), atypical squamous cells of undetermined significance (ASCUS) (19.64%), atypical squamous cells – cannot rule out HSIL (ASC-H) (10%). We had 23 cases of invasive malignancy which includes 21 cases of squamous cell carcinoma (SCC) and 2 cases of adenocarcinoma. There were 11 cases of atypical glandular cells of undetermined significance (AGUS). We found that total numbers of concordant cases were 68.57% (192/280) and discordant cases were 31.43% (88/280). We also found that sensitivity and specif

Role of Cervical Cancer Biomarkers p16 and Ki67 in Abnormal Cervical Cytological Smear.

Cervical cancer is the most common cancer in India. Screening for cervical cancer helps in marked reduction of invasive cervical cancers. The low sensitivity of Papanicolaou cytology (Pap smear) and high-risk human papillomavirus (HR-HPV) in excluding high-grade intraepithelial lesion (ASC-H) leads to unnecessary referrals to colposcopy-guided biopsy. The combined cervical cytology screening and HR-HPV have its own limitations and still need further standardization. Using additional biomarkers like staining with p16 and Ki-67 might help in triaging abnormal pap smear. A prospective, cross-sectional study was performed over a period of 16 months in the Department of Obstetrics and Gynaecology, in collaboration with Department of Pathology. Study was conducted to know the efficacy of immunostaining with p16/Ki-67 in predicting the presence of significant lesion in cases of mild cytological atypia. PAP smears (conventional and LBC) along with P16, Ki-67 and available biopsies were correlated. Liquid-based cytology (LBC) was done in 2134 cases, out of which 46 cases showed abnormal cytological findings such as [22 atypical squamous cells of undetermined significance (ASCUS), 3 low-grade squamous intraepithelial lesion (LSIL), 8 atypical squamous cells cannot exclude high-grade lesion (ASC-H), 6 high-grade squamous intraepithelial lesion (HSIL), 5 squamous cell carcinoma (SCC), 2 adenocarcinoma, 1 atypical glandular cells of undetermined significance (AGUS)]. Immunostaining with p16 and Ki-67 was performed on 38 cases of abnormal cytological smears. Out of 38 abnormal cytology cases, 28 cases had shown co-staining for both p16 and Ki-67, suggestive of true HPV infection of the cells. Of the 38 cases, 07/14 ASCUS, 06/06 HSIL, 07/08 ASC-H, 05/05 squamous cell carcinoma and 02/02 adenocarcinoma also showed dual positivity for p16 and Ki-67. One case of AGUS was diagnosed, but the smear was unsatisfactory for immunocytochemical evaluation and excluded from the study. Three cases of LSIL were also diagnosed on cytological evaluation, and 1 of them however showed positivity for p16 and Ki-67 on immunocytochemistry (ICC). In the ASC-US group, the sensitivity and specificity of the immunostaining in diagnosing CIN2 + lesions were 87.51%, and in LSIL group, the sensitivity and specificity of the immunostaining in diagnosing CIN2 + lesions were 100%. p16/Ki-67 positivity also increased with cytological severity which in turn corresponded with histological findings: it reached from 50% in ASC-US to 100% in both HSIL and SCC categories. This immunostaining with p16 and Ki67 can be a useful method in the triaging of the ASC-US and the LSIL group as considering the high sensitivity and specificity values.

VP66.22: Transvaginal colour Doppler ultrasound as diagnostic modality in decision‐making for cervical cancer in pregnancy: a case report

A 38-year-old G42 (2012) diabetic was diagnosed with squamous cell carcinoma of the cervix and opted for preservation of pregnancy. Her Pap smear in the first trimester revealed atypical glandular cells of undetermined significance. Cervical punch biopsy done at 20 weeks showed squamous cell carcinoma, which was clinically staged as Stage IB2. Transvaginal colour Doppler sonography at 33 weeks revealed a 3cm hypoechoic mass in the posterior cervix, with absence of parametrial invasion. Colour Doppler ultrasound demonstrated abundant vascularisation. Counselling was done, and patient opted to deliver near term. After a course of corticosteroids, and a repeat scan revealing no progression of invasion, the patient underwent classical Caesarean section with Radical Hysterectomy, Bilateral Salpingo-oophorectomy, Bilateral Lymph Node Dissection at 36 weeks gestation. Patient delivered to a healthy baby boy who had an unremarkable postnatal course. Gross examination revealed a tumour at the posterior cervix, with no involvement of the uterine corpus and parametria. Biopsy showed invasive squamous cell carcinoma, large-cell non-keratinizing, with no parametrial infiltration. This case shows that although there is a risk of tumour progression, delaying definitive treatment may be done in early stage disease to improve fetal survival. The multidisciplinary team, guided by prenatal ultrasound, can assess tumour invasion and make decisions for timing of delivery and extent of surgery, in order to ensure the best maternal and fetal outcomes. Supporting information can be found in the online version of this abstract Supporting Information Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.

Study About the Causative Agents of Cervical Infections and Cytopathological Changes in Iraqi Women

Cervical infections are common problems among women, specially of reproductive age, in Iraq ,and are one of numerous risk factors for cervical intraepithelial neoplasia and cervical cancer .&#x0D; The aim of this study was to investigate the causative agents of cervicitis and their association with cytopathological changes among 67 cases of women, aged from 16 to 60 years, who attended the National Cancer Research Center / University of Baghdad, Iraq , during the period from April to December 2018 .&#x0D; The age group 36-40 had the highest percentage of cervical infections 13/16 (81.3%) while the age group 56-60 had the lowest percentage 2/6 (33.3%).&#x0D; Specific microbial inflammations were found in 51/67(76.1%) of the cases, as detected by microbiological examinations, while 49/67(73.13%) were of non-specific inflammations. The main causative agent of cervical infections was Candida albicans: 36/67(53.7%) fallowed by : Neisseria gonorhoeae 5/67(7.5%) , enteric bacteria 6/67( 8.9%) and Trichomonas vaginalis 4/67(5.9%),.&#x0D; The cyto-diagnosis , as detected by using pap smears examination, revealed some cases 6/67(8.9%) of suggestive of human papillomavirus HPV(Koilocytotic Atypia) with ASCUS (Atypical Squamous Cells of Undetermined Significance ) mixed with monillia infections and only two of these cases showed CIN1 (Cervical Intraepithelial Neoplasia ) 2/67( 2.98%).&#x0D; The other cytopathological finding was atypical dysplasia of endocervical epithelial cell which showed in cases 18/36(50%) of monillia infections, 2/4(50%) of Trichomonas infections,3/6(50%) of enteric infections and in 4/5(80%) of Neisseria infections .While atypical Metaplasia found in cases 6/36(16.7%) of monillia infections ,1/6(16.7) of enteric infections and 1/5(20%) of Neisseria infections. There was only 1/36(2.8%) of AGUS (Atypical Glandular Cells of Undetermined Significance) found in case of monillia infections. Benign looking of cervical cells , as resulted in pap smear tests , mostly found in cases of Trichomonas infections 2/4(50%) , while showed in 2/6(33.3%) of enteric infections and in11/36(30.6%) of monillia infections. There were no benign looking cells of cervical in cases of Neisseria infections. Meanwhile, no women had adenocarcinoma according to Bethesda classification during this study.&#x0D; Although there was no incidence of cervical malignant cells seen in our study and only few cases showed CIN1(premalignant disease of the cervix), cytological screening should gain much popularity and should be accessible to all in order to prevent such serious pathological problems.&#x0D; In Iraq, more attention should be paid for the important causation of cervicitis in women suffering from it because inflammatory and atypical changes on cervical cytology among women tested often indicate the presence of a sexually acquired infection.

Atypical glandular lesions of the cervix and risk of cervical cancer.

Cytology screening has been effective in reducing risks for cervical squamous cell carcinoma but less so for adenocarcinoma. We explored the association of atypical glandular cells or absence of glandular cells in cytology, and subsequent histological diagnoses and cancer risk. All women in Norway with atypical glandular cells of undetermined significance (AGUS), adenocarcinoma in situ (ACIS) and normal/benign cells, but absence of endocervical or metaplastic cells (NC-NEC) in their first cytology during 1992-2014 (NC-NEC; 2005-2014), recorded in the Cancer Registry of Norway, were included (n=142445). Histology diagnoses (stratified by age) within 1 and 3years after cytology were examined. The Nelson-Aalen cumulative hazard function for gynecological cancer risk was displayed. The majority of AGUS and particularly ACIS were followed with histology within 1 and 3years. Cervical intraepithelial neoplasia (CIN) lesions were more common in women <35 than in women ≥35years. Cervical adenocarcinoma followed 13% of ACIS after 1 and 3years. After ACIS and AGUS, cervical adenocarcinoma was the most frequent cancer subtype. Cumulative risks of cervical adenocarcinoma following ACIS, AGUS and NC-NEC were 3.5%, 0.9% and 0.05%, respectively, after 22, 22 and 9years of follow-up. There was a high-risk of glandular malignancies after AGUS and ACIS in cytology. If effective treatment of pre-cancer and early cancer is available, cytology screening provides some level of prevention of adenocarcinoma. Lack of glandular cells did not entail a higher cancer risk.

Breast and cervical cancer screening: A survey of university employees

Background: There is an increasing occurrence of non-communicable diseases worldwide. Among them, breast and cervical cancers are notable among females. These diseases often present late with adverse outcomes. Only early detection offered by screening of disease offers the hope of cure. Hence, we undertook a breast and cervical cancer screening education and exercise among female workers of a university community. Methods and Methods: This was part of a non-communicable disease survey among members of the university community. Structured questionnaires were administered on participants after a talk. Screening was carried out using the Papanicolau test for cervical cancer and clinical breast examination for breast cancer. Results: A total of 210 participants were screened. 42 (10.8%) and 23 (10.8%) had family history of breast cancer and previous breast lump, respectively. Only one participant (0.48%) had a breast lump. Abnormal Pap smear result was present in 59 (30.1%) (Inflammation [59.32%], high grade squamous intraepithelial lesion (HSIL) [10.17%], low grade squamous intraepithelial lesion (LSIL) [6.78%], atypical squamous cell of undetermined significance (ASCUS) [10.17%], Atypical squamous cells- cannot exclude HSIL’ (ASC-H) [11.86%] and atypical glandular cells of undetermined significance (AGUS) [1.69%]). Conclusion: The uptake of screening was low, the yield for cervical anomalies was also low, but a reasonable proportion of the participants had risk factors for breast and cervical cancers and so would benefit from further screening over time.

Cytologic patterns of cervical adenocarcinomas with emphasis on factors associated with underdiagnosis.

BackgroundNew cervical cancers continue to be diagnosed despite the success of Papanicolaou (Pap) tests. In an effort to identify pitfalls that limit the diagnosis of adenocarcinoma, the authors reviewed the cytologic characteristics of endocervical adenocarcinomas in their patient population.MethodsLiquid‐based cytology slides from 45 women who had concurrent, histologically confirmed cervical adenocarcinomas were reviewed retrospectively and semiquantitatively for 25 key cytologic traits. The original sign‐out diagnosis, available clinical findings, and high‐risk human papillomavirus (HR HPV) results also were noted.ResultsAbundant tumor cellularity, nuclear size from 3 to 6 times normal, abundant 3‐dimensional tumor cell groups, round cell shape, and cytoplasmic neutrophils characterized the 23 cases that were identified correctly as adenocarcinomas. Key reasons for undercalls included low tumor cellularity and low‐grade columnar morphology; these also tended to correlate with low‐grade or unusual adenocarcinoma variants on histology. Overall, 73% of adenocarcinomas had a concurrent positive HR HPV test.ConclusionsMost endocervical adenocarcinomas can be diagnosed accurately in cases with classical features, but some cases continue to be problematic when evaluated based on cytologic features alone. Reflex HPV testing may help increase Pap test sensitivity for challenging cases that have atypical glandular cells of undetermined significance. Occasional cases with negative HR HPV test results remain of concern.

High-risk HPV genotype distribution in HPV co-test specimens: study of a predominantly Midwestern population

High-risk HPV (HR-HPV) genoprevalence was assessed in cytologic specimens co-tested for HR-HPV in a predominantly Midwestern U.S. population, of which there are limited current data. These baseline data will aid in determining future shifts in HR-HPV genoprevalence. A total of 40,739 cervical/endocervical samples collected in PreservCyt (ThinPrep) media at Mayo Clinic, Rochester, MN, underwent HR-HPV co-testing between January 2014 and December 2016 in women aged 30-98 years. This included 37,656 negative for intraepithelial lesion (NIL), 1696 atypical squamous cells of undetermined significance (ASC-US), 159 atypical squamous cells, cannot exclude HSIL (ASC-H), 911 low-grade squamous intraepithelial lesion (LSIL), 188 high-grade intraepithelial lesion (HSIL), and 129 atypical glandular cells of undetermined significance (AGUS) cases. Roche cobas 4800 classified HR-HPV genotypes as 16, 18, or "other" (31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 66, 68). Of 40,739 co-tested specimens, 3786 were positive for at least one HR-HPV strain. "Other" only genotypes were most prevalent (74.3% of all HR-HPV cases). HPV16 and/or HPV18 were more common in the more significant diagnoses and were present in 59.1% of HSIL. HPV16-only was second most prevalent, with highest prevalence in HSIL (33.3%) and ASC-H (20.6%). HPV16 combined with "other" was third most prevalent, except in AGUS. HR-HPV (all genotypes) was most prevalent in those aged 30-39 years, decreasing with age (P < 0.0001). There was a trend toward HPV16 prevalence increasing with age (P = 0.4244). HR-HPV "other" combination was most prevalent in all diagnoses except HSIL, in which HPV16 and/or HPV18 (exclusive of "other" genotypes) were most prevalent.

Modern Approach to Cervical Cancer Screening Program – Georgian Experience

1. Abstract 1.1.Objective:The study aimed to pilot the modern approach to cervical cancer screening program, which means the application of liquid based cytology and chromogenic in situ hybridization(CISH) for human papillomavirus (HPV) genotyping on atypical cervical smears. 1.2.Materials and Methods:1293 cervical cytology samples have been analyzed in country of Georgia. The samples had been collected and processed by the usage of materials and equipment provided by Hologic. Prepared smears were post-fixed in 96% ethanol and stained accordingly with Papanicolau protocol. The Bethesda 2001 system terminology was employed for reporting and diagnoses of cervical smears. Patients with diagnosed atypia were recalled for obtaining of material for HPV genotyping. This has been performed by usage of CISH method. 1.3.Results:The negative for intraepithelial lesion or malignancy (NILM) category was equal to 1156 cases (89.40%). Other categories in decreasing order were atypical squamous cells of undetermined significance (ASCUS) with 104 cases (8.04%), low grade squamous intraepithelial lesion (L-SIL) with 8 cases (0.62%), high grade squamous intraepithelial lesion (H-SIL) with 1 cases (0.08%), atypical squamous cells, cannot exclude high grade intraepithelial lesion (ASC-H) with 21 case (1.63%) and atypical glandular cells of undetermined significance (AGUS) with 3 case (0.23%). Cellularity was lower in liquid based cytology (LBC) as compared with conventional smears (CS). Also, nuclear overlap was significantly less observed compared to CS. The smear background was notably cleaner and cell morphology was better evaluated in LBC. In terms of Trichomonas and Candida detection, LBC was superior compared to CS. Doderlein lactobacilli were seen in significantly lesser amounts and were mainly situated in close vicinity to the squamous epithelial cells. Due to lack of pretreatment, the degree of inflammation was better assessed in CS. 1.4.Conclusion:Our experience shows that LBC is superior to CS in the evaluation of cell morphology and detection of certain microorganisms such as Trichomonas and Candida. The degree of inflammation is better assessed with CS. CISH is effective and easy for implementation method for HPV genotyping on cervical smears. There has been revealed 76.12% concordance in average between genotyping results and cytopathology findings of routine screening.

Spousal migration and human papillomavirus infection among women in rural western Nepal.

In April 2014 we investigated the association of migration of a woman's husband with her high-risk human papillomavirus (HR-HPV) infection status and her abnormal cervical cytology status in the Achham district of rural Far-Western Nepal. Women were surveyed and screened for HR-HPV during a health camp conducted by the Nepal Fertility Care Center. Univariate and multivariable statistical tests were performed to determine the association of a husband's migration status with HR-HPV infection and cervical cytology status. In 265 women, the prevalence of HR-HPV was 7.5% (20/265), while the prevalence of abnormal cervical cytology, defined using the Bethesda system as atypical glandular cells of undetermined significance or worse, was 7.6% (19/251). Half of the study participants (50.8%, 130/256) had husbands who had reported migrating for work at least once. Women aged ≤34 years were significantly less likely to test positive for HR-HPV than women aged >34 years (OR 0.22, 95% CI 0.07 to 0.71). HR-HPV infection and abnormal cervical cytology status were not directly associated with a husband's migration. Older women were found to have a higher prevalence of HPV than younger women. It is possible that a husband's migration for work could be delaying HR-HPV infections in married women until an older age.

Liquid Based Cytology Cervical Cancer Screening Program—Georgian Experience

<strong>Objective:</strong>The study aimed to evaluate liquid based cytology as a tool for cervical cancer screening in Georgia.<strong>Materials and Methods:</strong>1293 cervical cytology samples have been analyzed in Georgia. The samples had been collected and processed by the usage of materials and equipment provided by Hologic. Prepared smears were post-fixed in 96% ethanol and stained accordingly with Papanicolau protocol. The Bethesda 2001 system terminology was employed for reporting and diagnoses of cervical smears.<strong>Results:</strong>The negative for intraepithelial lesion or malignancy (NILM) category was equal to 1156 cases (89.40%). Other categories in decreasing order were atypical squamous cells of undetermined significance (ASCUS) with 104 cases (8.04%), low grade squamous intraepithelial lesion (L-SIL) with 8 cases (0.62%), high grade squamous intraepithelial lesion (H-SIL) with 1 case (0.08%), atypical squamous cells, cannot exclude high grade intraepithelial lesion (ASC-H) with 21 cases (1.63%) and atypical glandular cells of undetermined significance (AGUS) with 3 cases (0.23%). Cellularity was lower in liquid based cytology (LBC) as compared with conventional smears (CS). Also, nuclear overlap was significantly less observed compared to CS. The smear background was notably cleaner and cell morphology was better evaluated in LBC. In terms of Trichomonas and Candida detection, LBC was superior compared to CS. Doderlein lactobacilli were seen in significantly lesser amounts and were mainly situated in close vicinity to the squamous epithelial cells. Due to lack of pretreatment, the degree of inflammation was better assessed in CS. <strong>Conclusion:</strong> Our experience shows that LBC is superior to CS in the evaluation ofcell morphology and detection of certain microorganisms such as Trichomonas and Candida. The degree of inflammation is better assessed with CS.