Management Of Abnormal Pap Smears Research Articles

A Three-Year Analysis of the Impact of a Student-Run Gynecology Clinic on Access to Reproductive Health Care for Uninsured Women in East Harlem.

The East Harlem Health Outreach Partnership (EHHOP) is a medical student-run and attending-supervised clinic that provides primary care to predominantly Spanish-speaking, uninsured patients living in East Harlem, New York. In 2010, the clinic launched a Women’s Health Clinic (WHC), to offer comprehensive gynecologic and reproductive healthcare under the guidance of faculty gynecologists. In this cross-sectional study, we analyzed WHC data from January 2018 to March 2021. Over this period, 59 individual patients were seen over 39 clinical sessions through a total of 164 clinical encounters staffed by 43 medical students and 19 faculty preceptors from the Department of Obstetrics and Gynecology at Mount Sinai. The most common reasons for referral to the EHHOP WHC were abnormal uterine bleeding, contraception counseling, and management of abnormal Pap smears; the most common procedures performed were Pap smears, long-acting reversible contraception placements and removals, and colposcopies. We discuss the critical role that student-run, physician-supervised reproductive health clinics play in reducing disparities in gynecologic care for uninsured women.

Abnormal Pap Smear

Since the Papanicolaou (Pap) smear became implemented as a screening tool for cervical cancer, the mortality from cervical cancer has sharply declined in the United States. The discovery of the human papillomavirus (HPV) as the causative agent in the progression from dysplasia of the cervix to cervical cancer has changed the types of screening offered to women and the management of abnormal Pap smears. The management of abnormal Pap smears has changed depending on the age of the woman, with women under the age of 24 years being managed more conservatively given the low rates of cervical cancer in this age group and the high rates of regression of HPV and cytologic abnormalities. Colposcopy remains the first line in evaluation of an abnormal Pap smear, with excisional treatment reserved for high-grade dysplasias with a high risk of progression to cervical cancer. Treatment for cervical dysplasia is highly effective, but even after treatment, there is an increased risk of recurrence or progression to cervical cancer for up to 25 years, and these women should be followed closely. This review contains 18 figures, 3 tables, and 43 references. Key words: cervical cancer screening, high-grade cervical dysplasia, human papillomavirus, low-grade cervical dysplasia, management of abnormal Pap smears, Pap smear, recurrence of cervical dysplasia, treatment of dysplasia

Management of abnormal Pap smears in reproductive age group

Management of abnormal Pap smears in reproductive age groupDr. Nabnita PatnaikDOI: https://doi.org/10.33545/pathol.2020.v3.i1f.228

Cervical Cancer Screening

Since the Papanicolaou (Pap) smear became implemented as a screening tool for cervical cancer, the mortality from cervical cancer has sharply declined in the United States. The discovery of the human papillomavirus (HPV) as the causative agent in the progression from dysplasia of the cervix to cervical cancer has changed the types of screening offered to women and the management of abnormal Pap smears. The management of abnormal Pap smears has changed depending on the age of the woman, with women under the age of 24 years being managed more conservatively given the low rates of cervical cancer in this age group and the high rates of regression of HPV and cytologic abnormalities. Colposcopy remains the first line in evaluation of an abnormal Pap smear, with excisional treatment reserved for high-grade dysplasias with a high risk of progression to cervical cancer. Treatment for cervical dysplasia is highly effective, but even after treatment, there is an increased risk of recurrence or progression to cervical cancer for up to 20 years, and these women should be followed closely. This review contains 18 figures, 3 tables and 53 references Key words: cervical cancer screening, high-grade cervical dysplasia, human papillomavirus, low-grade cervical dysplasia, management of abnormal Pap smears, Pap smear, recurrence of cervical dysplasia, treatment of dysplasia

Compliance With ASCCP Guidelines for Evaluation and Management of Abnormal Pap Smears [28E

INTRODUCTION: American Society for Colposcopy and Cervical Pathology (ASCCP) 2012 revised guidelines were developed to improve the detection and management of cervical dysplasia. A recent study revealed that not all health care providers are knowledgeable or aware of the 2012 national cervical cancer screening guidelines (Teoh et al., 2015). The goal of this study was to determine if primary care providers and Gynecologists manage abnormal PAP smears according to ASCCP current guidelines. METHODS: This was a retrospective study conducted at a Midwestern, regional medical center. An electronic search was conducted for abnormal PAP smears during a 12-month period performed by Gynecologists, Internal Medicine, and Family Medicine providers. The patients’ charts were reviewed and entered into an electronic database. The results of the PAP smear and its optimal management according to the 2012 ASCCP guidelines were compared to the providers’ next step in the treatment and management of the abnormal PAP smear. Proportions and 95% confidence intervals were determined for age of patient, type of provider and field of medicine. RESULTS: 284 charts were reviewed. The proportion of PAP smears that were managed appropriately was 0.658 (95% CI 0.603-0.714). The proportion of ASCCP guideline managed PAP smears were similar for age of patient, type of provider (physician or Advanced Practice Provider) and field of medicine. CONCLUSION: In this study, providers were not always managing abnormal PAP smears according to the current ASCCP guidelines. These results may reflect that providers are unaware of the recent guidelines or the guidelines are too complicated.

Management of Abnormal Pap Smears in a Tertiary Care Hospital

Aim Cervical cytology is still the mainstay of cervical cancer screening programmes in developed countries, whereas this has not proved to be useful in low-resource settings.

Psychosocial Impact of Inclusion of HPV Test in the Clinical Management of Abnormal Pap Smears among Women in Medellin, Colombia.

Psychosocial Impact of Inclusion of HPV Test in the Clinical Management of Abnormal Pap Smears among Women in Medellin, Colombia.

Coût du dépistage et de la prise en charge des lésions précancéreuses du col utérin en France

Oncogenic human papillomaviruses (HPV) cause cervical cancer (CC). Screening prevents CC by detecting and removing cervical intraepithelial neoplasia (CIN) lesions that are detected through abnormal Pap smears. This study assessed the costs of CC screening, management of abnormal Pap smears, and treatment of CIN in France. Pap smears received by laboratory Pasteur-Cerba during a 7-month period were examined. Patients with abnormal Pap smears were identified and followed for 6 months after diagnosis. The management of abnormal Pap smears was documented. These data and other published studies were used to estimate the total number of pap smears, distribution of abnormal smears requiring further examinations, and number of CIN diagnosed. Economic analyses were performed to estimate total CC screening costs from the health care payer (HCP) and societal perspective. An estimated 6,111,787 Pap smears were performed in 2004, including 222,350 abnormal (3.9%) and 63,616 follow-up smears. In total, 58,920 cervical biopsies and 52,525 HPV tests were performed after an abnormal Pap smear. The cost associated with CC screening, including management of abnormal findings, was estimated at 174.2 million euro from the HCP perspective. Total treatment cost for all CIN was estimated at 22.3 million euro (HCP perspective). Overall cost for screening, diagnosis and management of Pap smears was estimated at 335.7 million euro of which 196.5 million euro where funded by the HCP. An HPV vaccine that prevents pre-cancerous or cancerous lesions of the cervix will decrease the socio-economic burden associated with the screening of these lesions.

Cervical Cancer Prevention: More than Just a Pap in a Diverse Urban Community

Cervical cytologic screening and early management of abnormal pap smears played an important role in reducing invasive cervical cancer incidence and mortality over the past decades. Despite widely available cost effective screening for cervical cancer in the United States, women in lower socioeconomic groups and minorities continue to suffer from a higher incidence and mortality from cervical cancer and national goals have not been met. The biological, psychosocial, and cultural barriers that contribute to these disparities will be reviewed. This article also reviews current screening methodologies, treatment algorithms and newer developments that hold additional promise for the future of cervical cancer prevention. Keywords: cervical cancer, pap test, human papillomavirus, infection

Abnormal cervical cytology: new names, familiar smears.

To discuss the newest 2001 changes in The Bethesda System of cervical cytology classification and management guidelines for abnormal Pap smears. Extensive review of scientific literature and consensus guidelines. Decision making about abnormal cervical cytology can be frustrating and controversial. It is imperative that nurse practitioners understand and practice the appropriate management protocol for cytological abnormalities. Alarmingly, many providers are unsure of management guidelines for abnormal cervical cytology. The information in this article offers providers a clear protocol for cervical cytology classification to facilitate the confident management of abnormal Pap smears.

Human Papillomavirus-16 E6 Variants in Cervical Squamous Intraepithelial Lesions from HIV-Negative and HIV-Positive Women

Am J Clin Pathol 2001;116(1):143–148 This group studied 48 human papillomavirus (HPV)-16–positive squamous intraepithelial lesions (SILs) from HIV-negative patients [16 low-grade SILs (LGSILs) and 32 high-grade SILs (HGSILs)] and 13 HPV-16-positive SILs from HIV-positive patients with AIDS (1 LGSIL; 12 HGSILs). After HPV typing, the entire HPV-16 E6 coding region was amplified and sequenced. They detected 12 HPV-16 E6 prototypes and four variants among the LGSILs in HIV-negative patients, and 15 HPV-16 E6 prototypes and 17 HPV-16 variants in the HGSIL group. The most prevalent variant of SIL types was European 350G, present in three and 13 cases, respectively. In three HGSILs and zero LGSILs, they found mixed infection by an HPV-16 E6 prototype and a variant. Two variants (one each in LGSIL and HGSIL) were of non-European lineage. The only LGSIL in HIV-positive patients had an HPV-16 E6 prototype; in the HGSILs, they found 8 HPV-16 E6-prototypes, four with mixed infection with HPV-31 and four variants, all European 350G. The higher proportion of HPV-16 E6 variants in HGSIL than in LGSIL in HIV-negative patients suggests a greater risk of progression. Comment: I present this article because it illustrates two things: First, while HPV typing is still looking for its role in the clinical management of abnormal Pap smears and cervical intraepithelial neoplasia, it is accepted by researchers as having a great prognostic significance in cervical disease. Second, the idea of HPV variants is puzzling to a simple practitioner like me. How much like HPV-16 does something have to be for it to be considered a variant rather than a distinct subtype? On what evidence was that decided? Will there be high-risk variants and low-risk variants of high-risk types and low-risk types? When I send an HPV type now for ASCUS triage, my report comes back as “low risk, either positive or negative and high risk, either positive or negative.” If the experts are sure “low-risk HPV” is a benign condition, why do they bother to report it? Is the technology we have now for HPV typing good enough to use in clinical decision making? Is it good enough to replace colposcopy, or, for that matter, the Pap smear? (TMJ)

Management of Abnormal Pap Smears (MAPS): Implications of Terminology Used in Cytopathology

Journal of Lower Genital Tract DiseaseVolume 4, Issue 4 p. 217-223 Management of Abnormal Pap Smears (MAPS): Implications of Terminology Used in Cytopathology Kari J. Syrjänen MD, PhD, FIAC, Kari J. Syrjänen MD, PhD, FIAC Department of Pathology, University of Siena, Siena, Italy, and MediCity Research Laboratory, Faculty of Medicine, University of Turku, Turku, FinlandSearch for more papers by this author Kari J. Syrjänen MD, PhD, FIAC, Kari J. Syrjänen MD, PhD, FIAC Department of Pathology, University of Siena, Siena, Italy, and MediCity Research Laboratory, Faculty of Medicine, University of Turku, Turku, FinlandSearch for more papers by this author First published: 25 December 2001 https://doi.org/10.1046/j.1526-0976.2000.44008.xCitations: 1 Reprint requests to: Kari Syrjänen, MD, PhD, FIAC, Kylliäisentie 9, FIN-21620 Kuusisto, Finland. Read the full textAboutPDF 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 onFacebookTwitterLinked InRedditWechat Citing Literature Volume4, Issue4October 2000Pages 217-223 RelatedInformation

Management of Abnormal Pap Smears (MAPS): Implications of Terminology Used in Cytopathology

Management of Abnormal Pap Smears (MAPS): Implications of Terminology Used in Cytopathology

Practice patterns in the management of abnormal Pap smears: Results of a national survey of ACOG fellows

Practice patterns in the management of abnormal Pap smears: Results of a national survey of ACOG fellows

The Bethesda system and evaluation of abnormal pap smears

The Bethesda Pap Smear system and its 1991 revisions aim to simplify Papanicolaou (Pap) smear reporting and make it more reproducible. It redefines the Pap smear request as a medical consultation. The pathologist consultant is required not only to provide the smear reading but also its clinical recommendation. The Bethesda system insists on a detailed Pap smear report assessing specimen adequacy and types of epithelial changes. Squamous cell abnormalities are grouped according to their biologic potential. Both cervical intraepithelial neoplasia, grade I (CIN I) (mild dysplasia) and human papillomavirus (HPV) lesions are grouped together as low-grade squamous intraepithelial lesions (LGSIL), while moderate and severe dysplasia (CIN II and III) belong to the high-grade squamous intraepithelial lesion (HGSIL) category. Atypical squamous cells of undetermined significance (ASCUS) and atypical glandular cells of undetermined significance (AGCUS) need further qualification as to whether they favor either a reactive or neoplastic process. Guidelines for management of abnormal Pap smears are discussed in detail. Semin. Surg. Oncol. 16:217–221, 1999. © 1999 Wiley-Liss, Inc.

The Bethesda system and evaluation of abnormal pap smears.

The Bethesda Pap Smear system and its 1991 revisions aim to simplify Papanicolaou (Pap) smear reporting and make it more reproducible. It redefines the Pap smear request as a medical consultation. The pathologist consultant is required not only to provide the smear reading but also its clinical recommendation. The Bethesda system insists on a detailed Pap smear report assessing specimen adequacy and types of epithelial changes. Squamous cell abnormalities are grouped according to their biologic potential. Both cervical intraepithelial neoplasia, grade I (CIN I) (mild dysplasia) and human papillomavirus (HPV) lesions are grouped together as low-grade squamous intraepithelial lesions (LGSIL), while moderate and severe dysplasia (CIN II and III) belong to the high-grade squamous intraepithelial lesion (HGSIL) category. Atypical squamous cells of undetermined significance (ASCUS) and atypical glandular cells of undetermined significance (AGCUS) need further qualification as to whether they favor either a reactive or neoplastic process. Guidelines for management of abnormal Pap smears are discussed in detail.

Review of outcomes of atypical squamous cells of undetermined significance papanicolaou smears for 1991 and 1992, with follow-up through 1995.

Our aim was to review 1,754 consecutive Papanicolaou (Pap) smears from 1991 to 1992 to evaluate initial findings and disease progression through December of 1995. The study used analysis of data in the Gundersen Lutheran Medical Center Colposcopy Clinic's computerized registry. A total of 1,754 patients were followed, and findings were analyzed for progression and age-related outcomes. At initial evaluation by a trained ACOG member colposcopist, 11% of patients with atypical squamous cells of undetermined significance (ASCUS) Pap smears had histologically confirmed cervical intraepithelial neoplasia (CIN) I lesion and 7% a CIN II or III lesion. After a negative initial evaluation for an ASCUS Pap smear, an additional 8.4% smears went on to to demonstrate histologically confirmed CIN II or III, and an additional 4.7% revealed a CIN I. An ASCUS Pap smear requires evaluation by a care provider trained in colposcopy and management of abnormal Pap smears.

MANAGEMENT OF MILD AND MODERATE CERVICAL DYSKARYOSIS.

Cost-effectiveness issues continue to make the management of abnormal Pap smears problematic. The present assumption is that women with severe, non-neoplastic abnormalities (severe dyskaryosis) should be referred for colposcopy, and that women with mild to moderate dyskaryosis should be followed with repeat smears. This Scottish study randomized 902 women with …

Management of Abnormal Pap Smear: The Role of Microcolpohysteroscopy

Journal of Gynecologic SurgeryVol. 3, No. 3 Management of Abnormal Pap Smear: The Role of MicrocolpohysteroscopyL. MENCAGLIA, A. PERINO, G. GILARDI, and J. HAMOUL. MENCAGLIASearch for more papers by this author, A. PERINOSearch for more papers by this author, G. GILARDISearch for more papers by this author, and J. HAMOUSearch for more papers by this authorPublished Online:27 Mar 2009https://doi.org/10.1089/gyn.1987.3.153AboutSectionsPDF/EPUB Permissions & CitationsPermissionsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookTwitterLinked InRedditEmail FiguresReferencesRelatedDetailsCited byConservative Treatment of CIN: A Review L. MENCAGLIA and G. GILARDI3 February 2009 | Journal of Gynecologic Surgery, Vol. 6, No. 4 Volume 3Issue 3Jan 1987 To cite this article:L. MENCAGLIA, A. PERINO, G. GILARDI, and J. HAMOU.Management of Abnormal Pap Smear: The Role of Microcolpohysteroscopy.Journal of Gynecologic Surgery.Jan 1987.153-163.http://doi.org/10.1089/gyn.1987.3.153Published in Volume: 3 Issue 3: March 27, 2009PDF download