Liquid-based Cytology Pap Smears Research Articles

Cervical cancer screening and prevention among female gynecologic oncologists in Indonesia

Background: Cervical cancer has become a significant health problem in developing countries. We researched cervical cancer screening and prevention among all female gynecologic oncologists (FGO) registered with the Indonesian Society of Gynecologic Oncologists (INASGO). Methods: Participant data and cervical cancer screening and prevention data were collected using an online questionnaire. A total sampling technique was conducted, and 18 of 20 FGOs responded to the survey. All data were analyzed descriptively. Results: Fourteen FGOs (77.8%) had their first cervical screening at the age of 31-40 years old, primarily using Pap smears (77.8%) and Pap-human papillomavirus (HPV) co-testing (22.2%). Half of the included FGOs (50%) had irregular cervical cancer screening due to lack of time (66.7%), followed by forgetting (33.3%). Most FGOs preferred liquid-based cytology (77.8%) over conventional Pap smears (22.2%). Half of the FGOs preferred the HPV genotyping and half the HPV non-genotyping test. Most of the FGOs had screenings performed by female gynecologists (77.8%), male gynecologists (11.1%), and female general practitioners (5.6%). Most FGOs underwent screenings at health facilities outside their workplace (88.9%) and were funded by themselves (94.4%). Most FGOs were vaccinated with the HPV vaccine (77.8%), and most were with the quadrivalent (85.7%) over the bivalent vaccine (14.3%). All respondents were completely (three doses) vaccinated. Conclusion: Most of the FGOs in Indonesia have been vaccinated against HPV and screened for cervical cancer, although half are still not regularly screened. The liquid-based cytology Pap smear and the quadrivalent HPV vaccine are the preferred cervical screening and prevention methods among FGOs in Indonesia

S2765 Rapid Development of Cervical Adenocarcinoma in a Young Woman With Crohn’s Disease

Introduction: Inflammatory bowel disease (IBD), further characterized into Crohn’s disease or ulcerative colitis, is a chronic condition that involves immune-mediated inflammation and subsequent damage to the gastrointestinal tract. Treatment involves immunosuppression, increasing risk for infections and malignancies. Elevated cervical cancer rates are seen in these patients, and thus guidelines recommend annual cervical cancer screening in women receiving immunosuppressive therapy. Case Description/Methods: A 46-year-old female with Crohn’s disease (diagnosed at 18) presented with left lower quadrant pain and bloating. Her disease was steroid-refractory and did not respond to mesalamine, azathioprine, or adalimumab. She was in remission for four years on infliximab, however, it was discontinued after a spontaneous mediastinal abscess. She was later treated with vedolizumab and eventually ustekinumab. She had a history of recurrent infections with a negative primary immunodeficiency workup. Computed tomography (CT) abdomen/pelvis revealed two large pelvic masses. Surgical pathology confirmed stage IVA cervical adenocarcinoma, human papillomavirus (HPV) independent, with involvement of the bilateral ovaries and fallopian tubes. CT abdomen/pelvis and Papanicolau smear with HPV co-testing performed less than a year prior to her cancer diagnosis were negative for evidence of malignancy. Discussion: Human papillomavirus (HPV) is the most common cause of cervical cancer. It has been hypothesized that HPV underlies the elevated cervical cancer risk in immunosuppressed patients. This case is notable as it involves an HPV-independent cervical cancer, found at an advanced stage, in a relatively young patient on immunosuppression. To the best of our knowledge, no similar reports have been described in the literature. Liquid based cytology pap smear and high risk HPV cotesting have demonstrated high sensitivity for cervical cancer screening. HPV-negative cervical cancers comprise only a small proportion of cervical neoplasms and are almost entirely adenocarcinomas. These cancers are often diagnosed at an advanced stage. ACG guidelines currently recommend annual screening for patients on immunosuppressive therapy. As in the case we have described, immunosuppressed patients can still develop advanced cancers between screening intervals. When caring for immunosuppressed IBD patients, there should be a low threshold for additional evaluation if patients develop signs or symptoms concerning for underlying malignancy.

Fast and Noninvasive Diagnosis of Cervical Cancer by Coherent Anti-Stokes Raman Scattering.

Cervical cancer is the fourth most common cancer in women worldwide, and early detection of its precancerous lesions can decrease mortality. Cytopathology, HPV testing, and histopathology are the most commonly used tools in clinical practice. However, these methods suffer from many limitations such as subjectivity, cost, and time. Therefore, there is an unmet clinical need to develop new noninvasive methods for the early detection of cervical cancer. Here, a novel noninvasive, fast, and label-free approach with high accuracy is presented using liquid-based cytology Pap smears. CARS and SHG/TPF imaging was performed at one wavenumber on the Pap smears from patients with specimens negative for intraepithelial lesions or malignancy (NILM), and low-grade (LSIL) and high-grade (HSIL) squamous intraepithelial lesions. The normal, LSIL, and HSIL cells were selected on the basis of the ratio of the nucleus to the cytoplasm and cell morphology. Raman spectral imaging of single cells from the same smears was also performed to provide integral biochemical information of cells. Deep convolutional neural networks (DCNNs) were trained independently with CARS, SHG/TPF, and Raman images, taking into account both morphotextural and spectral information. DCNNs based on CARS, SHG/TPF, or Raman images have discriminated between normal and cancerous Pap smears with 100% accuracy. These results demonstrate that CARS/SHG/TPF microscopy has a prospective use as a label-free imaging technique for the fast screening of a large number of cells in cytopathological samples.

Experience of cervical Pap smear screening in tertiary care hospital

Background: Cervical cancer is the leading cause of death in women in developing countries like India. It is preventable by regular screening by Pap smear and can be detected at pre-invasive stage. Thus, reducing the morbidity and mortality related with cervical cancers. Objective: This study aims at detecting the prevalence and current trends of various epithelial cell abnormalities (ECAs) in females attending a tertiary care hospital. Materials and Methods: This is a retrospective study conducted in a tertiary care hospital between July 2015 and May 2019. A total of 15,270 cases comprising 11,494 conventional and 3776 liquid-based cytology Pap smears were included in the study. Clinical data and history of the patients were retrieved. All cases were reported according to Bethesda system 2014. Results: Among 15,270 cases, 793 Pap smears were unsatisfactory, 14,153 Pap smears were negative for intraepithelial lesion/malignancy, and 325 cases had ECA. Conclusion: Large hospital-based studies are required for proper implementation of health services and for the selection of a feasible as well as sensitive screening test for early detection of cervical dysplasias which can be helpful in decreasing the burden of cervical cancer in our community.

Infections of Chlamydia trachomatis and Mycoplasma hominis as Risk Factors for Abnormal Cervical Cells

Background: Cervical cancer is the fourth most common cancer among women across the world. Recent studies have shown that cervical cancer is not only caused by persistent infection of human papillomavirus (HPV), but sexually transmitted infections (STIs) also play a role in the pathogenesis of abnormal cervical cells. STIs frequently occur with no specific symptoms, such as the infections caused by Chlamydia trachomatis and Mycoplasma hominis. Asymptomatic STIs could lead to persistent infection. Persistent infections caused by STIs have been hypothesised to increase the access of HPV into the deeper cervical tissue and cause cervical cell abnormalities. Therefore, we conducted this study to assess the association between C. trachomatis and M. hominis infections and abnormal cervical cells. Methods: A cross-sectional study was performed on 58 outpatients at the Department of Obstetrics and Gynecology, Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia. Abnormal cervical cells were detected by a liquid-based cytology Pap smear, and bacterial identification was done by conducting conventional duplex polymerase chain reaction (PCR). Results: 58 patients, 14 (24.1%) showed abnormal cervical cells, whereas 44 (75.9%) patients showed normal cervical cells. The conventional duplex PCR demonstrated a positive result for C. trachomatis and M. hominis bacterial infections in only 1 (7.1%) and 2 (14.3%) patients with abnormal cervical cells, respectively. The statistical analysis revealed no significant association between the bacterial infections and the abnormal cervical cytology in the patients (p > 0.05). Conclusions: Infections caused by C. trachomatis and/or M. hominis were not associated with abnormal cervical cells.