High-grade Smear Research Articles

Association between grade of referral smear and high-grade disease among women with biopsy samples showing cervical intraepithelial neoplasia grade 2.

To determine whether the grade of referral smear reflects the frequency of cervical intraepithelial neoplasia (CIN) grade 3 (CIN3) or worse lesions among patients with CIN2 on punch biopsy. In a retrospective study, data were reviewed from women with a punch biopsy sample showing CIN2 and a known referral smear who underwent large loop excision of the transformation zone (LLETZ) between January 1, 2013, and January 1, 2016, at Galway University Hospital, Ireland. Data were analyzed by patient age (≤30 and >30years), referral smear (low and high grade), and LLETZ histology (≤CIN2 and ≥CIN3). Overall, 264 women were included. LLETZ histology of CIN3 or worse was more common among women with high-grade referral smears (63/144 [43.8%]) than among those with low-grade smears (26/120 [21.7%]; relative risk 2.02, 95% confidence interval 1.37-2.96; P<0.001). Among patients younger than 30years, underlying CIN3 and above was again more frequent among women with high-grade (44/95 [46.3%]) versus low-grade smears (12/56 [21.4%]; relative risk 2.16, 95% confidence interval 1.25-3.73; P=0.004). No difference was recorded in the older age group. Although LLETZ can be performed for a CIN2 biopsy and high-grade smear, consideration should be given among young women (<30years) with low-grade smears whose biopsy histology is incidentally CIN2.

English

English

Smear Tactics

INTRODUCTION: Cervical cancer holds significant social and financial implications not only on Irish society, but across the globe, as it is the fourth most common cancer affecting women worldwide (IARC). This project identified the incidence, presentation, time to diagnosis and association of risk factors with cervical cancer in women referred to colposcopy in Dublin, Ireland over the last 6 years. Special attention was given to analysis of women presenting to colposcopy with initial low-grade smears as recent literature has advocated for stricter guidelines referring only those women presenting with high-grade smears to colposcopy. METHODS: A retrospective study (n=148) spanning 1/1/2009–3/15/15 was conducted in the colposcopy clinic of Tallaght Hospital, serving Dublin, Ireland. Statistical analyses utilized SPSS (22.0). RESULTS: The median time to identification of cervical cancer in women presenting with abnormal smears is 64.5 days. It was found 23.6% of patients presenting with low-grade smears had cervical cancer. More women using contraceptives were found to have adenocarcinoma than squamous cell carcinoma. Associations between squamous cell carcinoma and high parity, smoking and abnormal bleeding were also observed. CONCLUSION: Nearly 24% of women presenting with initial low-grade cytology developed cervical cancer. Early treatment of these cases resulted in over €7,000,000 saved, strengthening the argument against recent European and American proposals to enforce stricter guidelines allowing only women with severe or high-grade abnormalities to be referred to colposcopy clinics. Instead, evidence put forth in this study indicates that a referral to colposcopy following a low-grade smear is indeed an appropriate clinical action with immense economic benefits.

A retrospective observational study for the outcomes of women presenting to a colposcopy clinic with a high-grade Pap smear - Implications for a 'see and treat' approach to management.

The current Australian National Health and Medical Research Council guidelines discourage the use of 'see and treat' colposcopic management due to concerns regarding over-treatment. However, this approach has been shown to have benefits in several studies, including cost savings, elimination of loss to follow up and decreased patient anxiety. To provide Australian data on treatment outcomes for women presenting with a high-grade Pap smear to a large metropolitan colposcopy unit and to determine whether a 'see and treat' approach would meet specified standards. Retrospective review of women referred to the Royal Prince Alfred Hospital colposcopy unit with a high-grade smear. Patient data, colposcopy findings, treatment and pathology results were collated and analysed to determine treatment outcomes using the current 'biopsy and treat' approach. The feasibility of 'see and treat' was assessed by determining which women with high-grade colposcopy findings had high-grade disease confirmed on biopsy or excisional specimens. One hundred and thirty-seven women underwent either excisional or ablative treatment. Of those undergoing excisional procedures, 81.3% had high-grade dysplasia or invasive cancer, 11.6% had CIN1 and 7.1% had no dysplasia on histopathology. One hundred and twenty-one with high-grade colposcopy findings had histopathology results available. Using a 'see and treat' approach, 92.6% would have had confirmed dysplasia of any grade, while 91.7% had confirmed high-grade dysplasia. 'See and treat' colposcopy is feasible in the Australian setting when applied to selected patients with high-grade cytology and high-grade colposcopic findings.

Evidence Supporting See-and-Treat Management of Cervical Intraepithelial Neoplasia

BACKGROUND: Studies of see-and-treat management of cervical intraepithelial neoplasia (CIN) vary in their inclusion criteria, resulting in a broad range of overtreatment rates. OBJECTIVES: To determine overtreatment rates in see-and-treat management of women referred for colposcopy because of suspected CIN, in order to define circumstances supporting see-and-treat management. SEARCH STRATEGY: MEDLINE, EMBASE, and the Cochrane Library were searched from inception up to 12 May 2014. SELECTION CRITERIA: Studies of see-and-treat management in women with a reported cervical smear result, colposcopic impression, and histology result were included. DATA COLLECTION AND ANALYSIS: Methodological quality was assessed with the Newcastle-Ottawa scale. We used the inverse variance method for pooling incidences, and a random-effects model was used to account for heterogeneity between studies. Overtreatment was defined as treatment in patients with no CIN or CIN1. MAIN RESULTS: Thirteen studies (n = 4611) were included. The overall overtreatment rate in women with a high-grade cervical smear and a high-grade colposcopic impression was 11.6% (95% CI 7.8-15.3%). The overtreatment rate in women with a high-grade cervical smear and low-grade colposcopic impression was 29.3% (95% CI 16.7-41.9%), and in the case of a low-grade smear and high-grade colposcopic impression it was 46.4% (95% CI 15.7-77.1%). In women with a low-grade smear and low-grade colposcopic impression, the overtreatment rate was 72.9% (95% CI 68.1-77.7%). AUTHOR'S CONCLUSIONS: The pooled overtreatment rate in women with a high-grade smear and high-grade colposcopic impression is at least comparable with the two-step procedure, which supports the use of see-and-treat management in this subgroup of women. TWEETABLE ABSTRACT: See-and-treat management is justified in the case of a high-grade smear and a high-grade colposcopic impression.

See-and-treat: striking a balance between over- and under-treatment.

Secondary prevention of cervical cancer based on cervical cytology generally employs a multi-visit approach: screening with cytology, diagnosis with colposcopically directed biopsy, and treatment. Updated screening and management guidelines emphasise the precision of diagnosis and use estimates of risk to avoid overtreatment or undertreatment. The need to return for multiple visits presents an obstacle for many women and may prevent them from completing the process from screening to treatment. A recent analysis of a population-based screening registry in New Mexico found that 16.3% of women with cervical smear tests indicating high-grade squamous intraepithelial lesions had no follow up within a 12-month period. Those with low-grade smears had higher rates of loss to follow up. Furthermore, among those with a high-grade smear who had a biopsy confirming cervical intraepithelial neoplasia (CIN) 3 or worse, only 60.0% received excisional treatment within 1 year (Kinney et al. Gynecol Oncol 2014;132:628–35). The see-and-treat approach can reduce loss to follow up between biopsy and treatment. Women with abnormal cytology are examined colposcopically and treated with an outpatient loop electrosurgical excision procedure in a single visit, so bypassing a visit for biopsy. There is tension between the multivisit approach with its inherent risk of undertreatment from loss to follow up and see-and-treat, in which the lack of a colposcopically directed biopsy often leads to overtreatment. Overtreatment may take two forms, treatment of a cervix with less than final histology results of no CIN or CIN1, and treatment of high-grade squamous intraepithelial lesions that, if observed over time would have spontaneously regressed. Ebisch et al. in this issue of BJOG analyse the impact of cytology and colposcopic impression on overtreatment, i.e. ultimate histology of no CIN or CIN1 (BJOG 2015;doi: 10.1111/1471-0528.13530). They extracted data from 13 studies and show a relatively low (11.6%) rate of overtreatment in women with both high-grade cytology and a high-grade colposcopic impression. The overtreatment rate in this group of women was significantly lower than in those with high-grade cytology and a low-grade colposcopic impression (29.3%) or those with low-grade smear regardless of whether the colposcopic impression was high-grade (46.4%) or low-grade (72.9%). The management guidelines of the American Society for Colposcopy and Cervical Pathology (ASCCP) recommend see-and-treat as an acceptable option in cases of a high-grade smear, when possible perinatal risks from excision are not a consideration. (Massad et al. J Low Genit Tract Dis 2013;17:S1–27). Colposcopic impression is not part of the ASCCP metric, but human papillomavirus status, if known and in the rare case that it is negative, may be considered. Ebisch's data suggest that colposcopic impression may indeed have a role to play when a high-grade smear is associated with a low-grade colposcopic impression. In these women, as part of shared decision-making, biopsy may be the better option. Clearly see-and-treat is an important option in selected women; it can reduce incomplete care. Can we further reduce overtreatment? Additional research is needed to evaluate the possible role of biomarkers such as human papillomavirus genotypes or immunostains, or newer imaging modalities. More and larger studies evaluating the role of the colposcopic impression are also needed. Full disclosure of interests available to view online as 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.

Evidence supporting see‐and‐treat management of cervical intraepithelial neoplasia: a systematic review and meta‐analysis

Studies of see-and-treat management of cervical intraepithelial neoplasia (CIN) vary in their inclusion criteria, resulting in a broad range of overtreatment rates. To determine overtreatment rates in see-and-treat management of women referred for colposcopy because of suspected CIN, in order to define circumstances supporting see-and-treat management. MEDLINE, EMBASE, and the Cochrane Library were searched from inception up to 12May2014. Studies of see-and-treat management in women with a reported cervical smear result, colposcopic impression, and histology result were included. Methodological quality was assessed with the Newcastle-Ottawa scale. We used the inverse variance method for pooling incidences, and a random-effects model was used to account for heterogeneity between studies. Overtreatment was defined as treatment in patients with no CIN or CIN1. Thirteen studies (n=4611) were included. The overall overtreatment rate in women with a high-grade cervical smear and a high-grade colposcopic impression was 11.6% (95%CI 7.8-15.3%). The overtreatment rate in women with a high-grade cervical smear and low-grade colposcopic impression was 29.3% (95%CI 16.7-41.9%), and in the case of a low-grade smear and high-grade colposcopic impression it was 46.4% (95%CI 15.7-77.1%). In women with a low-grade smear and low-grade colposcopic impression, the overtreatment rate was 72.9% (95%CI 68.1-77.7%). The pooled overtreatment rate in women with a high-grade smear and high-grade colposcopic impression is at least comparable with the two-step procedure, which supports the use of see-and-treat management in this subgroup of women. See-and-treat management is justified in the case of a high-grade smear and a high-grade colposcopic impression.

Overtreatment in a See-and-Treat Approach to Cervical Intraepithelial Lesions

To determine the overtreatment rate at colposcopy in women who underwent a see-and-treat protocol. We identified 3,192 patients (mean age 36 years, standard deviation 8.7) who underwent a see-and-treat protocol in Radboud University Nijmegen Medical Center between January 1981 and December 2010. Overtreatment, defined as cervical intraepithelial neoplasia 1 or less at final histopathology analysis, was investigated in relation to the age of the women, time of referral, cervical smear result, colposcopic impression, and histopathology result. A total of 579 women (18.1%, 95% confidence interval [CI] 16.7-19.5) were overtreated. The lowest overtreatment rate (4.5%, 95% CI 3.5-5.5) was seen in women with both a high-grade cervical smear result and a high-grade colposcopic impression. Women aged younger than 40 years were less likely to be overtreated (13.1%, 95% CI 11.7-14.5) than women aged 40-49 years (24.2% 95% CI 21.2-27.4, number needed to harm nine) and aged 50 years and older (42.2%, 95% CI 36.5-47.7, number needed to harm three). The overtreatment rate is low for patients with both a high-grade smear result and a high-grade colposcopic impression, justifying a see-and-treat approach for these patients. In women with either a high-grade smear result or a high-grade impression on colposcopy, a see-and-treat approach may still be preferable but has higher overtreatment rates. Given the side effects of cervical surgery on pregnancy outcome, young women, in particular those who have either a low-grade smear result or low-grade impression on colposcopy, are better served by a two-step approach. In older women, a see-and-treat policy may be preferable.

LLETZ Specimen Fragmentation: Impact on Diagnosis, Outcome, and Implications for Training.

This study was designed to assess fragmentation of Large loop excision of the transformation zone (LLETZ) specimens, its influence on short-term cytological outcome, and the risk factors for specimen fragmentation, as we well as trainee performance on clinical outcome. This retrospective study was performed at a cancer center. Women who underwent LLETZ for suspected high-grade cervical intra-epithelial neoplasia (CIN) over a 5-year period were included. Patients were identified through a regional database. Data were obtained from hospital and regional databases. Fisher's exact test was used. 75% of all specimens were obtained intact. When the LLETZ specimen was intact, 89% of smear tests were reported as negative, against 86% when the specimen was fragmented. Fragmentation was significantly associated with high-grade smear results at 6 months. Trainee status was significantly related to specimen fragmentation. Fragmentation of LLETZ specimens is associated with an increased likelihood of obtaining a high-grade smear at 6months post treatment. Enhancing the colposcopy training may help improve clinical outcome.

How are women with high grade Pap smear abnormalities managed? A population based study

Objective This population based study investigates the patterns of care women with high grade cervical dysplasia receive. Methods The study population includes women with a first time diagnosis of a high grade dysplasia (ASC-H, AGUS, HSIL, malignancy, carcinoma) from 2000 to 2005 as identified in a centralized cervical smear database. Record linkages were then carried out to other databases of health care services to characterize management. Results Women (43,712) with a high grade dysplasia had a mean age of 37.6. HSIL and AGC accounted for 55% and 33% of abnormalities, respectively. The mean time to referral to colposcopy services ranged from 6 to 24 weeks. Women (1195) were diagnosed with an underlying cervical cancer with a mean time to diagnosis of 26, 26, 17, 6, and 3 weeks for the cytologic abnormality of ASC-H, AGUS, HSIL, malignancy, and carcinoma, respectively. Women (559) were diagnosed with endometrial cancer. The mean time to diagnosis from index Pap was 16, 5.3 and 1.5 weeks for AGC, malignancy, and carcinoma on Pap test, respectively. The percentage of patients with a high grade Pap smear who had no follow-up all up to a 2-year window from index Pap was 5.4, 74, 19, 1.22, and 0.18% for ASC-H, AGUS, HSIL, malignancy and carcinoma on Pap, respectively. Conclusions The mean time to referral to colposcopy and rates of loss to follow-up for high grade smears are influenced by cytologic nomenclature. Explicit language is recommended for national guidelines to reduce the prolonged time in the workup of patients who may have serious premalignant and malignant lesion of the reproductive tract.

Review of negative and low‐grade cervical smears in women with invasive cervical cancer after the first 3 years of the national cervical screening programme in Slovenia

The purpose of the study was to perform a national review of negative, low-grade and inadequate smears reported during the latest screening period before cervical cancer diagnosis in 2006, after the first 3 years of the screening programme. Among 162 new cervical cancer cases there were 47 (29%) without previous cytology, 47 (29%) with one high-grade smear prior to diagnosis and 68 (42.0%) with at least one previous negative, low-grade, atypical or inadequate smear 1-40 months before diagnosis. Of the latter 68 cases, 37 patients with 59 smears (together with 118 control slides) were included in the review as 31 had smears reported at laboratories no longer operating. Findings were related to the last cytology report before diagnosis as well as to histological type and stage of the cancer. In our study group, 19 (51%) of 37 patients had squamous cell carcinoma, 15 (41%) adenocarcinoma and 3 (8%) adenosquamous carcinoma, compared with 121 (75%), 26 (16%), 12 (7%), respectively, and 3 (2%) other types, for all carcinomas. Twenty-one of 37 women also had high-grade cytology prior to diagnosis of cancer. Women with previous cytology (with or without recent high-grade smears) were more likely to have stage I cancers than those without cytology (P < 0.0001). The expert group upgraded 17/33 smears in the patients with squamous carcinomas, which was more than in those with adeno- and adenosquamous carcinomas (5/24, P < 0.05). As expected, a higher proportion of smears preceding adenocarcinomas were true negative. Under-diagnosed smears were not related to cancer stage or last cytology report before diagnosis.

An audit of colposcopy appointment processes in women with abnormal cervical cytology

This study was conducted to audit the waiting times and default rates of colposcopy using the standard requirements of the National Health Service Cervical Screening Programme (NHSCSP) 2004 guidelines. The records of 291 women with abnormal cervical smears referred to the colposcopy clinic between January and December 2008 at Chiang Mai University Hospital, Thailand, were reviewed. The proportion of women with abnormal cervical smears of any grade receiving colposcopy appointments within 8 weeks of referral (96.9%) achieved the minimum requirements (≥ 90%). However, the waiting times for women with high-grade squamous intraepithelial lesion, glandular cell abnormality and invasive lesion smears were longer than recommended by NHSCSP guidelines. The default rate of 15.8% in this study was slightly higher than recommended by the guidelines (< 15%). Having no health insurance, being known to have HIV infection and waiting times longer than 4 weeks were independent predictors of default from an initial colposcopy appointment. The waiting times for colposcopy among women with high-grade smear abnormality and the default rate failed to meet standard requirements. Designing an effective protocol for colposcopy appointment processes is warranted.

Follow-up of abnormal pap smear results: A population-based study.

6076 Background: This population based study investigates the patterns of care women with high-grade cervical dysplasias receive in Ontario. Methods: The study population includes women with a first-time diagnosis of a high-grade dysplasia from 2000-2005 as identified in a centralized cervical smear database. Record linkages were then carried out to other centralized databases which include data on inpatient and outpatient procedures to characterize patterns of care provided to women with high-grade abnormal cervical smears. High-grade smears are defined ASC-H, AGUS or AGC, HSIL or diagnosis of malignancy or carcinoma on pap smear. Results: 43,712 women had a mean age of 37.6. Percent break down by diagnosis: ASC-H, AGUS, HSIL, malignancy, carcinoma: 8.9, 33, 55, 1.9, 0.17. Mean time to referral to colposcopy in weeks: ASC-H, AGUS, HSIL, malignancy, carcinoma: 16, 24, 13, 8.6, 6. Of those with a final diagnosis of cervical cancer (n = 1,195) mean time to diagnosis from index pap in weeks: ASC-H, AGUS, HSIL, malignancy, carcinoma: 26, 26, 17, 6, 3. Of those with a final diagnosis of endometrial cancer (n = 559), mean time to diagnosis from index pap in weeks: AGUS, malignancy, carcinoma: 16, 5.3, 1.5. Percentage of patients with high-grade pap smear who had no follow-up all with up to a 2-year window from index pap: ASC-H, AGUS, HSIL, malignancy, carcinoma: 16, 59, 9, 17, 28. Conclusions: Time to management of women with severe changes on pap smear is lengthy. Overall, 30% of these women are lost to follow-up and those with atypical glandular cells had the highest loss to follow up rates. Guidelines for the management of high-grade cervical smear lesions should specify time frames for reasonable follow-up of abnormal results. A consideration for revision of nomenclature used by cytopathologists should be undertaken as a strategy to reduce loss to follow-up of potentially serious cervical lesions. No significant financial relationships to disclose.

O62 “Select and Treat” in women with high grade smear: Is this an appropriate strategy. Does completeness of excision determine the outcome?

International Journal of Gynecology & ObstetricsVolume 107, Issue S2 p. S111-S111 Free communication (oral) presentations O62 “Select and Treat” in women with high grade smear: Is this an appropriate strategy. Does completeness of excision determine the outcome? N. Aslam, N. AslamSearch for more papers by this authorV. Kandavel, V. KandavelSearch for more papers by this authorS. Panda, S. PandaSearch for more papers by this authorC. Balachandar, C. BalachandarSearch for more papers by this author N. Aslam, N. AslamSearch for more papers by this authorV. Kandavel, V. KandavelSearch for more papers by this authorS. Panda, S. PandaSearch for more papers by this authorC. Balachandar, C. BalachandarSearch for more papers by this author First published: 20 November 2009 https://doi.org/10.1016/S0020-7292(09)60434-3AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article. Volume107, IssueS2Abstracts of XIX FIGO World Congress of Gynecology and ObstetricsOctober 2009Pages S111-S111 RelatedInformation

Performance of Nucleic Acid Amplification Tests for Diagnosis of Tuberculosis in a Large Urban Setting

A diagnosis of tuberculosis (TB) relies on acid-fast bacilli (AFB) smear and culture results. Two rapid tests that use nucleic acid amplification (NAA) have been approved by the US Food and Drug Administration for the diagnosis of TB based on detection of Mycobacterium tuberculosis from specimens obtained from the respiratory tract. We evaluated the performance of NAA testing under field conditions in a large urban setting with moderate TB prevalence. The medical records of patients with suspected TB during 2000-2004 were reviewed. Analysis was restricted to the performance of NAA on specimens collected within 7 days after the initiation of treatment for TB. The assay's sensitivity, specificity, and positive and negative predictive values (PPV and NPV, respectively) were evaluated. The proportion of patients with confirmed or suspected TB whose respiratory tract specimens were tested by use of NAA increased from 429 (12.9%) of 3334 patients in 2000 to 527 (15.6%) of 3386 patients in 2004; NAA testing among patients whose respiratory tract specimens tested positive for AFB increased from 415 (43.6%) of 952 patients in 2000 to 487 (55.5%) of 877 patients in 2004 (P < .001 for both trends). Of the 16,511 patients being evaluated for pulmonary TB, 4642 (28.1%) had specimens that tested positive for AFB on smear. Of those 4642 patients, 2241 (48.3%) had NAA performed on their specimens. Of those 2241 patients, 1279 (57.1%) had positive test results. Of those 1279 patients, 1262 (98.7%) were confirmed to have TB. For 1861 (40.1%) of the 4642 patients whose specimens tested positive for AFB on smear, the NAA test had a sensitivity of 96.0%, a specificity of 95.3%, a PPV of 98.0%, and an NPV of 90.9%. For 158 patients whose specimens tested negative for AFB on smear, the NAA test had a sensitivity of 79.3%, a specificity of 80.3%, a PPV of 83.1%, and an NPV of 76.0%, respectively. For the 215 specimens that tested positive for AFB by smear, we found a sensitivity, specificity, PPV, and NPV of 97.5%, 93.6%, 95.1%, and 96.8%, respectively. A high-grade smear was associated with a better test performance. NAA testing was helpful for determining whether patients whose specimens tested positive for AFB on smear had TB or not. This conclusion supports the use of this test for early diagnosis of pulmonary and extrapulmonary TB.

Does Experience in Colposcopy Improve Identification of High Grade Abnormalities?

Abstract Objective This study investigates whether experience in colposcopy improves identification of high grade abnormalities. The sensitivity and positive predictive value (PPV) of colposcopy in identifying high grade intra-epithelial lesions (HSIL) performed by relatively inexperienced as compared to experienced colposcopists are evaluated. Study design Of 18,421 colposcopies performed at the Royal Women's Hospital, Melbourne, Australia, between 1999 and 2004 by 5 senior and 11 junior colposcopists, the colposcopic impression was correlated with the histopathology result of the biopsy taken at 6020 colposcopies, with respect to the experience of the colposcopist. Results Colposcopy had a 60% sensitivity and 60% PPV in identifying HSIL in this study. In case of a high-grade referral smear the sensitivity and PPV in identifying HSIL were, respectively 76% and 73%, compared with 26% and 48% in case of a low-grade referral smear, no difference in overall colposcopic performance between experienced and inexperienced colposcopists was observed. However, the sensitivity of identifying HSIL was significantly higher with inexperienced colposcopists, and the PPV was significantly higher with experienced colposcopists. Conclusion In this study experience did not improve colposcopic performance, but differences in colposcopic strategy between the two groups were noted. The rather low overall sensitivity and PPV of colposcopy in identifying HSIL, especially in case of a low-grade referral smear, indicate that the role of colposcopy in the detection and treatment of cervical abnormalities is to assess size, site, and extent of an abnormality, rather than to assess the severity of this abnormality. Histology must remain the gold standard for treatment.

Value of Normal Colposcopy After an Abnormal Cervical Smear Report

Colposcopy is a secondary screening test used after a cytological specimen is reported as abnormal. A negative or normal colposcopy is not an infrequent outcome, and clinicians need to be aware of the clinical value of a normal and satisfactory colposcopic assessment.To address this problem, the underlying causes need to be fully understood. To this end, we have analyzed a retrospective dataset relating to new referrals to an urban colposcopy service. We have reviewed 1,927 consecutive new colposcopic attendances during a 4-year period (1996-2000). Of these cases, 1,589 (82.4%) had documented satisfactory colposcopy in that the whole transformation zone was identified, and any lesion seen within it was suitable for outpatient-directed biopsy. These cases form the basis of this dataset. Seven hundred seventy-one colposcopies were classified as normal (48%). The presenting smear was atypical squamous cells of undetermined significance (ASCUS) (41.3%), high-grade squamous intraepithelial lesion (HiSIL) (42.2%), low-grade squamous intraepithelial lesion (LoSIL) (13.1%), and unsatisfactory in 3.4%. One hundred five patients (13.6%) eventually underwent loop diathermy excision (loop electrocautery excision procedure). The indications to treat were as follows: a high-grade smear (N=31; 29.5%), a colposcopic suspicion of any cervical intraepithelial neoplasia in the presence of any smear result (N=35; 33%), or a persisting minor cytological abnormality (N=39; 37%). Patients were treated either at their first visit if they had a high-grade smear or up to the 10th visit. Forty-eight (45%) of the treated patients had high-grade disease. No cases of invasive disease were recorded. Normal colposcopy in the presence of a low-grade cervical smear is associated with a very low risk of having or developing high-grade disease. The negative predictive value of normal colposcopy is a valuable clinical utility and underpins the importance of appropriate colposcopic training and the development of competencies that enable the confident exclusion of dysplasia.

Impact of prolonged referral interval on colposcopic outcomes in women with moderate or severe dysplasia

Objective To ascertain the impact of long referral to first colposcopy interval on disease outcome in women with high-grade cervical smear tests. Methods Data from 316 women categorized into Group 1 (seen 180 days after referral) and Group 2 (seen within 180 days of referral) were analyzed using χ 2 test with Yates correction. Odds ratios (OR) and 95% confidence intervals (CI) were calculated. Results Women in Group 1 were less likely to need treatment (33.8% [25/74] vs 55.8% [135/242]; OR = 0.45; 95% CI, 0.25–0.78; P = 0.0004) and less likely to have high-grade disease (24.3% [18/74] vs 45.9% [111/242]); OR = 0.37; 95% CI, 0.21–0.68; P = 0.001) than women in Group 2. There was no significant difference between the groups in proportion of women with invasive disease. Conclusion In women with high-grade smears the need for excisional treatment and the risk of invasive disease may be reduced by prolonged referral interval.

A study of sputum conversion in new smear positive pulmonary tuberculosis cases at the monthly intervals of 1 st , 2 nd &amp; 3 rd month under directly observed treatment, short course (dots) regimen

Aims and Objectives:To determine sputum conversion rate at monthly intervals of 1st, 2nd and 3rd month in new smear positive cases (cat-1) under treatment under RNTCP.Material and Methods:The study was conducted at DOTS Center, Gauhati Medical College and Hospital; Guwahati between July 2005 to June 2006.The study is a prospective study and consists of 100 cases of new smear positive pulmonary tuberculosis cases (category 1) irrespective of age and sex.Results and Observations:The age & sex distribution of 100 patients showed that majority of the patients (74%) belonged to 2nd, 3rd and 4th decades & 75% were males and 25% were female with male to female ratio 3:1 respectively. The chest x-ray of 100 Smear Positive patients shows that only 60 (60%) patients had x-ray evidence of pulmonary Koch. In the present study, sputum conversion i.e. from smear positive to smear negative at the end of the 1st month is 71%, at the end of 2nd month is 84% and at the end of 3rd month is 92%.Summary & Conclusion:In conclusion, the overall sputum conversion rate under Directly Observed Treatment, Short Course (DOTS) chemotherapy in 100 sputum smear positive Pulmonary Tuberculosis in DOTS centre, Gauhati Medical College & Hospital was 92%.The chest x-ray evidence of pulmonary Koch in 100 patients is 60%.The sputum conversion at the end of 1st month is 71%, at the end of 2nd month it is 84% and at the end of 3rd month the same is 92%. In the present study, the infectivity decreases from the baseline with significant P value for sputum conversion of 3+, 2+ and 1+ sputum positivity. Directly Observed Treatment is an effective intervention for improving adherence to tuberculosis treatment programme in a resource-poor country. A significant decrease in conversion rate was observed with the initial high grade smear positive cases.More Prospective studies on larger number of patients are necessary to sub-stantiate our findings in this study.

Cervical cancer in women aged less than 25: East Kent experience

SummaryThe National Health Service Cervical Screening Programme (NHSCSP) guidelines raised the initiation of screening age from 20 to 25 years of age in 2004, on the basis that only 1.3% of cervical cancers occur in this age group. Between 2003 and 2005, cervical cancer was diagnosed in six women under 25 years in East Kent, 6.25% of 96 cervical cancers cases. All except one patient in our series presented with a cervical smear abnormality. High-grade cervical smear abnormalities were identified and treated in 187 women under 25 years during this period. Adoption of the guidelines may increase the incidence of invasive disease in young women, the stage at diagnosis and radicality of treatment required.