Pap Test Results Research Articles

Significance of endometrial cells in cervical cytology

This study evaluated the clinical significance of endometrial cells in Papanicolaou test (Pap test). A retrospective study was performed from the cytological database of Seoul National University Hospital. The results of Pap tests of women aged 40 years or older between January 1998 and December 2007 were sorted. Medical records were reviewed to identify the presence of endometrial cells from cytology, and cytologic and histologic follow-ups were performed to determine the clinical significance of the lesions. Among 75,673 Pap cases, 832 cases presenting normal endometrial cells (nEMCs) were included in this study. Their follow-up data are as follows: 800 with nEMCs, 5 with atypical EMCs (aEMCs), and 27 with endometrial cancer cells (EMCCs) on cytologic and histologic follow-ups. Significant endometrial or cervical diseases were found in 0.5%, 40%, and 100% of the cases on the following-up the pathologic examination of the women with nEMCs, aEMCs, and EMCCs, respectively. Unlike aEMCs and EMCCs, nEMCs on Pap tests did not increase the risk of developing endometrial hyperplasia or endometrial cancer in women aged 40 years or older. There is no clinical benefit to perform routine endometrial work-up in women with nEMCs, as recommended in the 2001 Bethesda System. However, symptomatic women with nEMCs on Pap test should perform endometrial work-up regardless of menopausal status.

Abnormal pap tests among women living in a Hispanic migrant farmworker community: A narrative of health literacy.

This study explored narrative responses following abnormal Pap tests among Hispanic migrant farmworkers ( N = 18; ages 22-50 years) via in-depth interviews in Florida. Qualitative analyses utilized health literacy domains (obtain/process/understand/communicate) as a conceptual framework. Participants described how they (1) obtained information about getting a Pap test, (2) processed positive and negative reactions following results, (3) understood results and recommended health-promoting behaviors, and (4) communicated and received social support. Women had disparate reactions and understanding following an abnormal Pap result. Health literacy was a meaningful conceptual framework to understand assets and gaps among women receiving an abnormal Pap test result. Future interventions should incorporate health literacy domains and facilitate patient-provider communications and social support to assist women in decision-making and health-promoting behaviors, ultimately decreasing cancer disparities.

Perfil dos exames citopatológicos do colo do útero realizados na Casa da Mulher, Estado do Pará, Brasil

O câncer cervical costuma apresentar progressao lenta e silenciosa, mantendo-se entre os mais incidentes no Brasil. Seu rastreamento e realizado pelo exame de Papanicolaou, o qual, alem da deteccao precoce do câncer, permite a pesquisa de agentes infecciosos. Procedeu-se um estudo retrospectivo analitico sobre os resultados do exame de Papanicolaou realizado na Casa da Mulher em Belem, Estado do Para, Brasil, de setembro de 2012 a agosto de 2013, com dados dos livros de preventivos do câncer de colo do utero (PCCU). No periodo, foram realizados 2.202 exames PCCU na Casa da Mulher, a maior parte destes (52,36%) proveniente de mulheres na faixa dos 40 a 60 anos de idade. A faixa etaria na amostra apresentou fraca correlacao positiva (rs = 0,1429) com a frequencia de achados microbiologicos e fraca correlacao negativa (rs = -0,2571) com a frequencia de alteracoes citopatologicas. Os achados microbiologicos foram identificados em tres especies: Gardnerella vaginalis (23,48%), Candida sp. (12,44%) e Trichomonas vaginalis (0,68%). A prevalencia de anormalidades citologicas nos exames foi de 5,72%, nao diferindo significativamente (p = 0,7546) das relatadas em outras publicacoes. As atipias celulares de significado indeterminado corresponderam a 2,679%, ficando abaixo da faixa estimada pelo Instituto Nacional de Câncer. A proporcao total das lesoes neoplasicas potencialmente malignas (lesao escamosa intraepitelial de alto grau e carcinoma) foi de 1,09%, com maior frequencia na faixa etaria de 30 a 39 anos. O aumento da cobertura de PCCU na populacao feminina precisa ser alcancado e a promocao da saude deve ser efetivada por meio de parcerias intersetoriais, participacao popular e responsabilizacao coletiva pela qualidade de vida.

Challenges to Pap Smear Follow-up among Women in the Criminal Justice System.

Women involved in the United States criminal justice system face a variety of challenges in maintaining their health. Histories of sexual abuse, early initiation of sex, and substance abuse are reflected in more negative reproductive health outcomes, including cervical cancer, than those found among non-incarcerated women. Little is known about how to close this health gap. The present study assessed what incarcerated women perceived to be facilitators and inhibitors of obtaining recommended follow-up for abnormal Pap tests. In-depth individual interviews were conducted with 44 women in an urban county jail about experiences with Pap tests and how they followed-up on abnormal results. We analyzed data using the process of thematic content analysis. Four themes were found, Pap test abnormality as an all-inclusive phrase for women's health problems, unstable lives, the structural challenges of money, and competing demands. Women with criminal justice histories have numerous and complex challenges in following-up abnormal Pap test results, as well as other health problems. Understanding the context around the follow-up for abnormal Pap tests in this population may increase providers' ability to help women effectively obtain cancer prevention care that can be life-saving, as well as to more effectively provide care for other health problems.

Abstract 433: Utility of p16 immunohistochemistry in evaluating negative cervical biopsies following high-risk pap test results

Abstract The Lower Anogenital Squamous Terminology (LAST) Standardization Project for HPV-associated Lesions recommends the use of p16 immunohistochemistry as an adjunct to morphologic assessment of cervical biopsies interpreted as negative from patients that are at high risk for missed high-grade disease (defined as a prior cytologic interpretation of HSIL, ASC-H, ASC-US/HPV-16+, or AGC-NOS) (Darragh et al., 2012). However, few studies have specifically evaluated the utility of performing p16 on negative cervical biopsies and endocervical curettage specimens following high-risk Pap test results. A search of the Stanford Cytopathology database from 7/1/2002-6/30/2012 for cervical cytology cases with diagnoses of ASC-H, HSIL, AGC-NOS, and atypical endocervical cells NOS (AGC-EC) yielded 1517 cases. Of these, 703 cases had histologic follow-up. Biopsies were excluded if diagnosed as atypical, low grade squamous intraepithelial lesion (LSIL), high grade squamous intraepithelial lesion (HSIL), or insufficient, or if the time to follow up was greater than 1 year. Immunostain for p16 (CINtec) was performed on 350 cases from 339 patients (age 16-85 yrs, average 42+/-14) and scored as positive (diffuse strong), negative or equivocal. 6 cases were excluded due to insufficient tissue and 3 cases with equivocal staining were excluded from further analysis. For p16(+) and equivocal cases, HPV in situ hybridization (ISH) (Ventana HPV III Family 16 probe) was performed and the corresponding H&E section reviewed. Based on the H&E review, the diagnosis was revised. Follow-up data was also obtained. 12/341 cases (3.5%) were p16(+) corresponding to missed diagnoses of LSIL (1 cases), HSIL-CIN2 (2 cases), and SIL-indeterminate grade (6 cases). Two biopsies from one patient at different time points exhibited p16 staining of bland metaplastic cells undermining endocervical glands that morphologically did not meet criteria for SIL and were interpreted as atypical metaplasia. Follow-up biopsies showed HSIL. p16 immunostain increases the detection rate of SIL by 3.5% in benign appearing cervical biopsies and endocervical curettages from patients with a prior high-risk Pap test result. The benefit of p16 immunostain is highest for cases with a prior Pap diagnosis of HSIL. Cytoplasmic only staining and staining of surface mucosa, endocervical glands, and tubal metaplasia may lead to over-interpretation of p16 as positive. Reference: Darragh, T. M. et al. The Lower Anogenital Squamous Terminology Standardization Project for HPV-Associated Lesions: background and consensus recommendations from the College of American Pathologists and the American Society for Colposcopy and Cervical Pathology. Arch. Pathol. Lab. Med. 136, 1266-1297 (2012). Citation Format: Alana F. Shain, Shirley Kwok, Ann K. Folkins, Christina S. Kong. Utility of p16 immunohistochemistry in evaluating negative cervical biopsies following high-risk pap test results. [abstract]. In: Proceedings of the 107th Annual Meeting of the American Association for Cancer Research; 2016 Apr 16-20; New Orleans, LA. Philadelphia (PA): AACR; Cancer Res 2016;76(14 Suppl):Abstract nr 433.

Primary Care Physicians' Adherence to Expert Recommendations for Cervical Cancer Screening and Prevention in the Context of Human Papillomavirus Vaccination.

Expert recommendations do not recommend using Papanicolaou (Pap) or human papillomavirus (HPV) test results to determine whether unvaccinated women should receive HPV vaccine, nor do they recommend using vaccine receipt to inform cervical cancer screening practices. This study characterizes physicians' HPV vaccine recommendations and practices in the context of HPV and Pap testing. We surveyed family physicians and obstetrician-gynecologists randomly selected from the American Medical Association Masterfile in 2011 (n = 574). Physicians used a 5-point scale (never to always) to report the frequency of (1) using HPV testing results to decide whether to recommend HPV vaccine, and (2) recommending HPV vaccination to women (≤26 years) who had an abnormal Pap test. Physicians also reported (3) intention to change Pap screening frequency for vaccinated women. Across both specialties, 80% correctly reported rarely or never using HPV testing results to guide vaccine recommendations; 66% often or always recommended vaccination to patients with an abnormal Pap result; and 77% did not plan to change Pap screening frequency for vaccinated women. About 41% reported recommendation-consistent practices with all 3 measures. In multivariable analysis, obstetrician-gynecologist specialty and private practice type were associated with higher average overall adherence to recommendations. Contrary to expert recommendations, a considerable minority of physicians reported recommending HPV vaccination based on HPV and Pap test results. If these clinical practices persist, many young adult women will not realize the benefits of HPV vaccination. Additional efforts are needed to ensure all young women are screened and vaccinated appropriately.

Cervical polyps: Is histologic evaluation necessary?

ObjectiveThe aim of this study was to examine a series of clinically identified cervical polyps and determine the incidence of significant histologic and concurrent cytologic findings. MethodsConsecutive cervical polyps from January 2000 through September 2012 were retrieved from the hospital laboratory information system. Histologic evaluation of these polyps was performed, followed by a chart review of clinical findings and correlation with the immediately prior or concurrently collected cervical Papanicolaou (Pap) test results, when available. ResultsA total of 369 cervical polyps were identified and reviewed. The patient ages ranged from 18 to 87 years (mean 46.5years). Eight polyps demonstrated squamous dysplasia (6 Cervical Intraepithelial Neoplasia/CIN I, and 2 CIN II/III), while 6 had malignant or atypical/potentially malignant features (2 adenosarcoma, 2 atypical polyps concerning for Mullerian adenosarcoma, 1 endometrioid endometrial adenocarcinoma and 1 adenocarcinoma in-situ). An increased incidence of atypical squamous cells of undetermined significance (ASCUS) and atypical glandular cells not otherwise specified (AGC NOS) Pap diagnoses (12.7% and 6.1%, respectively) was found in women with benign polyps on biopsy. DiscussionWe demonstrated a higher rate of clinically significant histologic findings in cervical polyps (14 of 369 cases, 3.7%) compared to previously reported studies. The increase in ASCUS and AGC Pap results was most likely related to reactive and inflammatory changes present in benign polyps. Our results suggest that removal of all cervical polyps with subsequent histologic review is warranted.

Genotyping for Human Papillomavirus (HPV) 16/18/52/58 Has a Higher Performance than HPV16/18 Genotyping in Triaging Women with Positive High-risk HPV Test in Northern Thailand.

BackgroundTesting for high-risk human papillomavirus DNA (HPV test) has gained increasing acceptance as an alternative method to cytology in cervical cancer screening. Compared to cytology, HPV test has a higher sensitivity for the detection of histologic high-grade squamous intraepithelial lesion or worse (HSIL+), but this could lead to a large colposcopy burden. Genotyping for HPV16/18 has been recommended in triaging HPV-positive women. This study was aimed to evaluate the screening performance of HPV testing and the role of genotyping triage in Northern Thailand.MethodsA population-based cervical screening program was performed in Chiang Mai (Northern Thailand) using cytology (conventional Pap test) and HPV test (Hybrid Capture 2). Women who had abnormal cytology or were HPV-positive were referred for colposcopy. Cervical samples from these women were genotyped using the Linear Array assay.ResultsOf 5,456 women, 2.0% had abnormal Pap test results and 6.5% tested positive with Hybrid Capture 2. Of 5,433 women eligible for analysis, 355 with any positive test had histologic confirmation and 57 of these had histologic HSIL+. The sensitivity for histologic HSIL+ detection was 64.9% for Pap test and 100% for Hybrid Capture 2, but the ratio of colposcopy per detection of each HSIL+ was more than two-fold higher with Hybrid Capture 2 than Pap test (5.9 versus 2.8). Genotyping results were available in 316 samples. HPV52, HPV16, and HPV58 were the three most common genotypes among women with histologic HSIL+. Performance of genotyping triage using HPV16/18/52/58 was superior to that of HPV16/18, with a higher sensitivity (85.7% versus 28.6%) and negative predictive value (94.2% versus 83.9%).ConclusionsIn Northern Thailand, HPV testing with genotyping triage shows better screening performance than cervical cytology alone. In this region, the addition of genotyping for HPV52/58 to HPV16/18 is deemed necessary in triaging women with positive HPV test.

Associations of an abnormal Pap test result with attitudes and beliefs relevant to cervical cancer: a study of rural Appalachian women.

To compare women who recall being informed of an abnormal Pap to those not having this experience relative to attitudes and beliefs pertaining to screening for cervical cancer. Four hundred women were recruited from eight rural Appalachian counties, in 2013 and 2014. Women completed a paper-and-pencil survey after providing written informed consent. Bivariate associations and age-adjusted associations were calculated between the self-reported experience of being told of an abnormal Pap test result and eight attitudes/beliefs relative to the prevention of cervical cancer. Data analyses were performed in 2014. The mean age was 40.2years (range 30-64years). Eighteen women chose not to answer the question asking about ever having an abnormal Pap test result, leaving n=382. Of the 382 women who did answer, 122 (30.6%) indicated having an abnormal Pap test result and the remaining 260 (65.2%) indicated never having this experience. With the exception of one item assessing knowledge that HPV is the cause of cervical cancer, between-group differences in attitudes, beliefs, and intent to have a Pap test the next time one is due were not observed. Although we hypothesized that women ever having an abnormal Pap test may have actively sought to learn more about cervical cancer and its prevention, findings suggest that this is not the case. Informing women of an abnormal result could be coupled with a high-intensity counseling designed to improve attitudes and beliefs relative to women's role in protecting themselves from cervical cancer.

Digital holographic microscopy as screening tool for cervical cancer preliminary study.

The liquid-based cytology Papanicolaou (Pap) test has gradually replaced the conventional Pap test, as it seems to be more efficient, in part because it uses computer assistance. However, Pap test diagnoses are still subjective and are cost-consuming or time-consuming. The authors describe a new digital holographic microscopy instrument and accompanying software. This technology provides an instantaneous, 3-dimensional image reconstruction of cells directly from the uterine cervical sample vial. Analyses were performed using the proprietary digital holographic microscopy (DHM) instrument, computer, and software. Residual materials from 3 randomly chosen laboratories were analyzed and subjected to DHM, and the sensitivity and specificity of DHM were calculated for the detection neoplasia. In 41 specimens that yielded normal Pap test results, 1333 cells were analyzed using DHM; and, in 30 specimens that yielded abnormal Pap test results, 494 cells were analyzed using DHM. Available histologic correlation was as follows: 4 histologic samples were diagnosed as grade 1 cervical intraepithelial neoplasia (corresponding to 2 cytologic diagnoses of low-grade squamous intraepithelial lesion and 2 cytologic diagnoses of atypical squamous cells of undetermined significance), 4 histologic samples were diagnosed as grade 3 cervical intraepithelial neoplasia (corresponding to 2 cytologic diagnoses of low-grade squamous intraepithelial lesion and 2 cytologic diagnosis of atypical squamous cells, cannot rule out high-grade squamous intraepithelial lesion), and 11 lesions were diagnosed as benign. Receiver operating characteristic curve analysis indicated that the best criteria were the nuclear-to-cytoplasmic ratio (area under the curve, 0.88; 95% confidence interval, 0.68-1.00) and the greatest nuclear dimension (area under the curve, 0.85; 95% confidence interval, 0.66-1.00). This preliminary study demonstrated for the first time that the DHM technique is suitable for the processing of gynecologic cervical samples. Nevertheless, DHM criteria and parameters could be better defined. Hopefully, holographic analysis will be performed automatically and will provide an instantaneous, cost-effective diagnosis from a closed vial with the preservation of all cellular material. Cancer Cytopathol 2016;124:573-80. © 2016 American Cancer Society.

Diagnostic Impacts of Serum CA-125 Levels, Pap Smear Evaluation, and Endometrial Sampling in Women with Endometrial Clear Cell Carcinoma

Background: Endometrial clear cell carcinoma (ECCC) is a rare variant of endometrial cancer with an unfavorable prognosis. The aim of this study was to determine the relationships, if any, between preoperative serum cancer antigen 125 (CA-125) levels, the last Papanicolaou (Pap) smear, the results of endometrial biopsy and tumor histology, and disease-stage according to permanent histopathology. Materials and Methods: The data of 26 women with ECCC were collected from their medical records to compare demographics, preoperative serum CA-125 levels, Pap test results, histological diagnosis of the endometrial biopsy, and tumor histology, as well as the disease stage according to permanent histopathology. Results: The mean age at diagnosis was 64.0 years. There were 17 (65.3%) women with pure ECCC and 8 (30.7%) women with a mixed histology. Stage III-IV disease was diagnosed in 12 (46.2%) women and occurred more frequently in pure ECCC (n = 11, 91.7%). CA-125 values were significantly higher in advanced stage disease. Cytological evaluation indicated the presence of 71.4% (10/14) cytological abnormalities in pure ECCC. The overall sensitivity of endometrial sampling for the detection of malignancy was 92.3% (24/26), whereas the accurate diagnosis of ECCC was only 34.7% (8/23) with the Pipelle sampler. Conclusion: Pap test abnormalities are frequent in ECCC. Although it is less accurate in the diagnosis of ECCC than in the detection of malignancy, endometrial sampling is still the main procedure for the diagnosis of ECCC. Higher preoperative CA-125 concentrations imply the presence of advanced stage ECCC.

Follow-up of Women With Negative Pap Test Results and Abnormal Clinical Signs or Symptoms.

Abnormal signs or symptoms recorded on Papanicolaou (Pap) test requisitions may reflect disease not detected with Pap testing. Since 2009, these cases have been reviewed in our laboratory by a second cytotechnologist and a cytopathologist. The objective of this study was to document follow-up findings on these patients. A search for Pap test results of "Negative for intraepithelial lesion or malignancy, abnormal clinical signs or symptoms" was performed for cases from January 1, 2009, to October 10, 2013. Clinical information and follow-up findings were documented. 1,104 cases were identified. Signs and symptoms were abnormal bleeding 897 (81%), polyps 83 (8%), pelvic mass 54 (5%), visible cervical lesions 48 (4%), vaginal lesions 17 (2%) and endometrial masses 6 (0.5%). Six hundred sixty-seven (60%) had follow-up results, including 517 with histopathologic diagnoses. Two-hundred thirty-three (45%) had nonspecific benign diagnoses, 216 (42%) had benign tumor-like conditions, 28 (4%) had insufficient specimens, 16 (3%) had precancerous diagnoses and 23 (4%) had malignancies. Endometrial malignancy was identified in 14 (61%), ovarian in 6 (26%), and miscellaneous in 3 (13%). No cervical cancers were identified. We report follow-up findings from patients with abnormal clinical signs or symptoms, negative Pap test results, and follow-up recommendations highlighting reported abnormal signs or symptoms. Abnormal clinical signs and symptoms should routinely be considered in assessment and management of patients with negative cervical screening test results.

Resultados de la citología cervicovaginal en población universitaria. Un estudio descriptivo

Objetivo: Caracterizar los resultados de las CCV (citología cervicovaginal) de estudiantes atendidas en los servicios de Bienestar Universitario de la Universidad Industrial de Santander UIS (Bucaramanga).<br /><br />Material y método: Estudio descriptivo, de corte transversal. Población: estudiantes de la UIS en el periodo comprendido entre julio de 2004 y julio de 2010. Tamaño de muestra 1543 universitarias. Para obtener la información se tuvo acceso al sistema de información de los servicios de salud de Bienestar Universitario-UIS correspondientes a los resultados de las CCV tomadas en el periodo mencionado, sistema del cual se obtuvieron las variables relacionadas con características sociodemográficas, resultados citológicos entre otras Fueron calculadas frecuencias absolutas y relativas para cada variable. Se calculó la prevalencia de anormalidad en la CCV, sus intervalos de confianza del 95%. Todos los análisis fueron realizados en Stata 12.<br /><br />Resultados: Conocimiento de las alteraciones en los resultados de las citologías: anormalidad: 33%; principal microorganismo cándida albicans: 13.7%, presencia de ASCUS:11%, VPH: 2.5%, cambios celulares reactivos:15.2%. El 43.9% inició sus relaciones sexuales entre los 17 y 18 años, y el 23.8% inició a los 16 o menos años, el 93% manifestó que el rango de compañeros sexuales está entre 0 y 1 y el 46% de las estudiantes utilizan métodos anticonceptivos, los más utilizados son los anovulatorios <br /><br />Conclusiones: Se hallaron más factores protectores que predisponentes para presentar alteraciones citológicas y cáncer de cérvix, pero los resultados de anormalidad son significativos en la población joven, que ameritan continuar el fortalecimiento de programas enfocados a la salud sexual y reproductiva.<br /><br /><strong></strong>

Patient-provider communication with HIV-positive women about abnormal Pap test results

ABSTRACTIn this article, the authors examine communication between women living with human immunodeficiency virus (WLH) and health care providers (HCPs) regarding abnormal Pap tests. During the period of March 2011 through April 2012, 145 WLH were recruited from Ryan White funded clinics and community-based AIDS service organizations located in the southeastern United States. WLH who had an abnormal Pap test (69%, n = 100/145) were asked if their HCP shared and explained information about abnormal Pap tests. The authors performed chi-square tests and multivariable logistic regression analyses using Stata I/C 13. HCPs shared information about abnormal Pap tests with 60% of participants, and explained the information they shared to 78% of those. Health literate participants were more than three times as likely to have read the information received about abnormal Pap tests (adjusted odds ratio [aOR] = 3.49, 95% confidence interval [CI] 1.19–10.23), and almost five times as likely to have understood the cancer information they read (aOR = 4.70, 95% CI 1.55–14.24). Knowing other women who had had an abnormal Pap test was not significantly associated with cancer information seeking or processing after controlling for confounding factors. The present findings underscore the need to increase WLH’s health literacy as an intermediate step to improving patient–provider communication among WLH. Lay sources of cancer information for WLH warrant further study.

The Value of Papanicolaou Tests in the Diagnosis of Endometrial Carcinoma: A Large Study Cohort From an Academic Medical Center.

To determine on a large scale whether routine cervical Papanicolaou (Pap) tests play a role in endometrial carcinoma diagnosis. A retrospective search of an academic women's hospital pathology archive for cases of surgically resected endometrial carcinoma with Pap smears within 36 months before the histologic diagnosis was performed. Demographic features, Pap test results, and tumor features were recorded. We identified 554 (30.5%) of 1,817 cases of endometrial carcinoma with documented Pap test results within 36 months before histologic diagnosis. Among these 554 patients, 405 (73.0%) had Pap test results within 5 months before histologic diagnosis. In total, 154 (38%) cases demonstrated abnormal glandular cells, and 25 (6.2%) had only benign endometrial cells in women 40 years or older. The presence of glandular abnormality on the Pap test is significantly correlated with tumor size, tumor type, depth of invasion, presence of cervical involvement, and presence of lymphovascular invasion (P < .05). The rate of detecting abnormal glandular cells was higher in cases with a high International Federation of Gynecology and Obstetrics (FIGO) stage than in cases with a low FIGO stage (47.5% vs 35.5%; P < .05). The Pap test may play a role in the detection of endometrial carcinoma, especially for those with cervical involvement, lymphovascular invasion, and/or advanced stage.

DNA methylation in human papillomavirus-infected cervical cells is elevated in high-grade squamous intraepithelial lesions and cancer.

ObjectiveDNA methylation has been shown to be a potential biomarker for early cancer detection. The aim of this study was to evaluate DNA methylation profiles according to liquid-based Pap (LBP) test results and to assess their diagnostic value in a Korean population.MethodsA total of 205 patients with various Papanicolaou test results were enrolled to this study (negative, 26; atypical squamous cells of undetermined significance, 39; low grade squamous intraepithelial lesion, 44; high grade squamous intraepithelial lesion (HSIL), 48; and cancer, 48). DNA methylation analysis of four genes, ADCYAP1, PAX1, MAL, and CADM1, was performed on residual cervical cells from LBP samples using a quantitative bisulfite pyrosequencing method. To evaluate the diagnostic performance of the four methylated genes for cancer detection, receiver operating characteristic (ROC) curves were drawn. Sensitivities and specificities were also tested at cutoffs determined from the ROC curves.ResultsCervical cancer cells showed dramatically increased methylation levels for the four genes analyzed. ADCYAP1 and PAX1 also trended toward elevated methylation levels in HSIL samples, although the levels were much lower than those in cancer cells. The sensitivities of methylated ADCYAP1, PAX1, MAL, and CADM1 for the detection of cancer were 79.2%, 75.0%, 70.8%, and 52.1%, and the specificities were 92.0%, 94.0%, 94.7%, and 94.0%, respectively. Methylated ADCYAP1 and PAX1 demonstrated relatively better discriminatory ability than did methylated MAL and CADM1 (area under the curves 0.911 and 0.916 vs. 0.854 and 0.756, respectively).ConclusionDNA methylation status, especially in the ADCYAP1 and PAX1 genes, showed relatively good specificity, ranging from 90% to 94%. The possible additive and complementary roles of DNA methylation testing with respect to conventional cervical cancer screening programs will need to be validated in prospective population-based studies.

The effect of sexual behavior on the abnormal Pap test result

The effect of sexual behavior on the abnormal Pap test result

Cervical Cancer Screening Among Homeless Women of New York City Shelters.

Introduction Homeless persons have minimal opportunities to complete recommended cancer screening. The rates and predictors of cervical cancer screening are understudied among homeless women in the US. Methods We enrolled 297 homeless women 21-65years old residing in 6 major New York City shelters from 2012 to 2014. We used a validated national survey to determine the proportion and predictors of cervical cancer screening using cytology (Pap test). Results Mean age was 44.72 (±11.96) years. Majority was Black, heterosexual, single, with high school or lower education; 50.9% were smokers and 41.7% were homeless more than a year. Despite a 76.5% proportion of self-reported Pap test within the past 3years, 65% of women assumed their Pap test results were normal or did not get proper follow up after abnormal results. Forty-five-point-nine percent of women did not know about frequency of Pap test or causes of cervical cancer. Lower proportion of up-to-date Pap test was associated with lack of knowledge of recommended Pap test frequency (p<0.01) and relationship between HPV and an abnormal Pap test (p<0.01). Conclusions Self-reported Pap testing in homeless women was similar to a national sample. However, the majority of women surveyed were not aware of their results, received limited if any follow up and had significant education gaps about cervical cancer screening. We recommend improved counseling and patient education, patient navigators to close screening loops, and consideration of alternative test-and-treat modalities to improve effective screening.

The Prevalence and Distribution of High Risk Human Papillomavirus Genotypes in Patients with Dysplastic Lesions: a Population Study

Abstract Background. Cervical cancer (CC) is a major public health problem worldwide. Knowledge of human papillomavirus (HPV) genotype prevalence and distribution is important for the introduction of an effective vaccination program and the corresponding epidemiological monitoring. The aim of this study was to identify and analyze the distribution of high-risk HPV genotypes. Methods. Data were collected from 136 patients for the detection of circulating HPV genotypes, where Pap test results revealed the presence of koilocytes or high risk (HR) dysplastic lesions, elements that raise the suspicion of HPV infection. Results. HPV infection was identified in 72 (55.4%) of the patients tested, 34 (47.3%) with single infection, and 38 (52.7%) with multiple infections. Twenty-two different types of HPV were identified: 14 high risk HPV types, 7 low risk HPV types, 1 probable high risk HPV type. HPV 16 was the most frequently detected (55.6%) one, it was involved in single (15 cases) and multiple (25 cases) infections, primarily associated with type 18 (12 cases), and type 52 (11 cases). The presence of HPV 18 (29.2%) and HPV 52 (23.6%) was identified after HPV type 16. Conclusions. Oncogenic HPV genotypes 16, 18, and 52 were most frequently associated in women with dysplastic lesions, which require the use of polyvalent HPV vaccines when assessing cross-protective effects of specific immunoprophylaxis programs.

Association of cervical precancer with human papillomavirus types other than 16 among HIV co-infected women

HIV-seropositive women face high risk for infection with oncogenic human papillomavirus (oncHPV) types, abnormal Pap test results, and precancer, but cervical cancer risk is only modestly increased. Human papillomavirus (HPV)16 is highly oncogenic but only weakly associated with HIV status and immunosuppression, suggesting HPV16 may have a greater innate ability to evade host immune surveillance than other oncHPV types, which in turn should result in a greater relative increase in the prevalence of other oncHPV types among women with cervical precancer. We sought to assess whether the underrepresentation of HPV16 among HIV-seropositive relative to HIV-seronegative women remains among those with cervical precancers. HIV-seropositive and HIV-seronegative women in the Women's Interagency HIV Study were screened for cervical intraepithelial neoplasia (CIN) grade ≥3 (CIN3(+)). DNA from >40 HPV types was detected by polymerase chain reaction in cervicovaginal lavage specimens obtained at the visit at which CIN3(+) was diagnosed. HPV16 was detected in 13 (62%) of 21 HIV-seronegative women with CIN3(+) but only 44 (29%) of 154 HIV-seropositive women with CIN3(+) (P = .01). The lower prevalence of HPV16 in CIN3(+) among HIV-seropositive women persisted after controlling for covariates (odds ratio [OR], 0.25; 95% confidence interval [CI], 0.08-0.78). The prevalence of other members of the HPV16-related alpha-9 oncHPV clade as a group was similar in HIV-infected and uninfected women with CIN3(+) (OR, 1.02; 95% CI, 0.53-1.94). The prevalence of non-alpha-9 oncHPV types was increased in HIV-seropositive vs HIV-seronegative women with CIN3(+) (OR, 3.9; 95% CI, 1.3-11.8). The previously demonstrated increase in CIN3(+) incidence among HIV-seropositive women is associated with lower HPV16 and higher non-alpha-9 oncHPV prevalence. This is consistent with prior reports that HIV has a weak effect on infection by HPV16 relative to other oncHPV and supports use of nonavalent HPV vaccine in HIV-seropositive women.