Papanicolaou Smear Findings Research Articles

Declining prevalence of cytological squamous intraepithelial lesions of the cervix among women living with well-controlled HIV - Most women living with HIV do not need annual PAP smear screening.

Cervical screening by means of annual Papanicolaou (PAP) smears has been recommended for all women living with HIV. We analysed the results of our annual PAP smear screening program to identify low-risk subgroups for less rigorous screening. The study comprised 369 women followed at the Helsinki University Hospital 2002-2013, with a total of 2033 PAP smear results. We analyzed the temporal changes in PAP smear findings. Logistic regression analysis for binominal dependent variables was used for assessing risk factors for ever having cytological squamous intraepithelial lesions (hereafter referred as SIL) using generalized estimating equations taking into account multiple observations of each patient. Most women had well-controlled HIV, especially towards the end of the study. PAP smear results improved substantially. At the time of each individual's last PAP smear, 90.0% of the findings displayed normal results. Conversely, the rate of SIL decreased from 16.8% to 4.6% from 2002 to 2013. In multivariate analysis the risk of SIL was significantly lower in women with consecutive normal PAP smear findings during the first two years of follow up [odds ratio (OR) 0.21, 95% confidence interval (CI) 0.10-0.45, p<0.001] and with CD4 counts >500cells/μL (OR 0.11, 95% CI 0.05-0.26, p<0.001). Widespread use of combination antiretroviral therapy (cART) and systematic cervical screening has reduced the rate of abnormal PAP smears. It seems feasible to identify low-risk women by combining HIV-related information and PAP smear results. Screening low-risk women living with HIV at three-year intervals similar to HIV-negative women appears justified.

Outcome analysis of locally advanced adenocarcinoma/adenosquamous carcinoma and squamous cell carcinoma of cervix after definitive radiotherapy.

e16503 Background: To compare tumor characteristics, treatment response, failure patterns, and clinical outcome of patients with cervix locally advanced adenocarcinoma (AC)/adenosquamous carcinoma (ASC) and squamous cell carcinoma (SCC). Methods: Medical records for 36 patients with stage IIB–IVA histologically proven cervix AC/ASC and 199 patients with SCC who received definitive radiotherapy (RT) or concurrent chemoradiotherapy (CCRT) between 1995 and 2009 were retrospectively reviewed. The clinicopathologic features, radiation dose, treatment response, recurrent pattern, metastases pattern, and survival outcome between histologic groups were evaluated. Results: Compared with the SCC subgroup of patients, patients with AC/ASC were significantly younger (mean age, 56 vs. 62 years, p=0.007), more of them without clinical symptoms were diagnosed by abnormal Papanicolaou smear findings (16.7% vs. 5.5%, p = 0.019), and less responded to treatment (complete response, 72.2% vs. 86.9%, p = 0.024). After a median follow-up of 59.3 months, patients with AC/ASC had worse 5-year recurrence-free survival (RFS) (33.7% vs. 58.7%, p = 0.046), worse 5-year distant metastasis-free survival (40.2% vs. 70.3%, p = 0.002), and trends toward worse 5-year local recurrence-free survival (62.4% vs. 75.7%, p = 0.127) and worse 5-year overall survival (OS) (40.1% vs. 58.0%, p = 0.062) than those with SCC. In univariate analysis, early FIGO stage and complete treatment response were found to be significantly associated with both RFS and OS. Histology of non-AC/ASC and Point A biologically equivalent doses in 2-Gy fractions &gt;85Gy were significantly associated with better RFS, and CCRT was significantly associated with better OS. In multivariate analysis, complete treatment response remained significant factor for predicting better RFS, and early FIGO stage, CCRT and complete treatment response remained significant factors for predicting better OS. Conclusions: Cervix AC/ASC may behave more aggressively than does SCC. For this subgroup of cervical cancer, more comprehensively effective treatment is warranted.

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Chlamydia trachomatis in women

The authors present results of a planned prospective study of infections with Chlamydia trachomatis in women. Direct immunofluorescence test (DIF) for proving Chlamydia trachomatis antigens in endocervical smear (by means of monoclonal antibodies), ELISA test for proving IgG antibodies against Chlamydia trachomatis in sera and RVK method for proving antibodies against group Chlamydia-antigen were applied to test 288 women (aged 19-67), previously thoroughly anamnestically and clinically examined Chlamydia trachomatis infection was found in 29.51% of the cases, equally distributed in all age groups. The authors analyzed frequency of Chlamydia positive findings according to clinical diagnoses, parity, relevant data from gynecological history, as well as results of vaginal secretion tests and Papanicolaou smear findings.

Cervicovaginal (Papanicolaou) smear findings in patients with malignant mixed Müllerian tumors.

Malignant mixed Müllerian tumor is a rare neoplasm that occurs most frequently in elderly patients. It is characterized by a mixture of malignant epithelial and sarcomatous components. Little has been published about Papanicolaou smear findings pertaining to malignant mixed Müllerian tumors. We present our experience, with an emphasis on cytologic detail. Nine patients (median age, 65 yr) met our study criteria. All available smears and surgical specimens were reviewed. Four smears were positive for malignancy, with a sensitivity of 44% (3 adenocarcinoma, and 1 squamous-cell carcinoma, small-cell type). The results of our study showed that Papanicolaou smear findings pertaining to malignant mixed Müllerian tumors are seen in patients with advanced-stage disease with involvement of the lower uterine segment or cervix. The usual finding is large numbers of high-grade epithelial malignant cells in a necrotic background. The mesenchymal component rarely sheds cells visible on Papanicolaou smear.

Computed Tomography Guided Core Needle Biopsy Diagnosis of Pelvic Actinomycosis

Background. Pelvic actinomycosis is a chronic suppurative inflammatory disease caused by the anaerobic Gram-positive bacilli Actinomyces israelii. The propensity of this disease to simulate gynecological malignancies has been described previously. The great majority of these patients were diagnosed with actinomycotic diseases during or after exploratory laparotomy, but rarely preoperatively. We reviewed the literature pertaining the management of pelvic actinomycosis.Case. A nulliparous woman with a long history of intrauterine contraceptive device (IUD) and recent Papanicolaou smear findings consistent with the presence of actinomyces presented with chronic vague lower abdominal pain, weight loss, poor appetite, and recent increase in abdominal girth associated with a large immobile pelvic mass. Transcutaneous computed tomography guided core needle biopsy established the diagnosis of pelvic actinomycosis obviating immediate surgical intervention. Intravenous and subsequent long-term oral penicillin therapy was constituted and resulted in a significant decrease in the size of the pelvic mass.Conclusion. In patients presenting with pelvic masses and a history of IUD placement, actinomycotic infection should be considered and diagnosis attempted by imaging guided needle biopsy. Furthermore, this case suggested that correct nonsurgical diagnosis of pelvic actinomycosis followed by prolonged antibiotic therapy might eliminate the need for extensive extirpative surgery and assist in maintaining future fertility.

Effectiveness of the Papanicolaou Smear and Speculoscopy as Compared With the Papanicolaou Smear Alone: A Community-Based Clinical Trial

Objective: To evaluate the screening effectiveness of speculoscopy, a magnified chemiluminescent visual examination combined with the Papanicolaou smear as compared with the Papanicolaou smear alone.Methods: This was a prospective, practice-based study. The study participants were women aged 16–60 years who were regularly scheduled for Papanicolaou smears. All women were subject to a Papanicolaou smear and speculoscopy. Positive speculoscopy findings and/or Papanicolaou smear findings of a squamous intraepithelial lesion (SIL) were investigated further with colposcopy and biopsy.Results: A total of 5692 women were evaluated, and 799 (14%) were positive by one or both screening tests. Of the 410 biopsy specimens that were obtained, 32 showed high-grade SIL, 191 low-grade SIL, 145 reactive and reparative cells, and 42 were found to be within normal limits. The addition of speculoscopy to the routine Papanicolaou smear resulted in finding 11 of the 32 (34%) women with high-grade SIL and 154 of the 191 (81%) women with low-grade SIL.Conclusion: Speculoscopy, when combined with the Papanicolaou smear as a screening test, yields a higher percentage of women with biopsy-confirmed cervical pathology than the use of the Papanicolaou smear as a sole screening test.

Value of wet mount and cervical cultures at the time of cervical cytology in asymptomatic women

To correlate Papanicolaou smear findings with the wet mount and cervical culture results in asymptomatic patients, and to review the value of doing wet mount and/or cervical cultures in these patients at the time of Papanicolaou smear. Asymptomatic women presenting for routine Papanicolaou smears at Sinai Samaritan Medical Center, Milwaukee, Wisconsin, between January 1991 and January 1994 were studied by preparing wet mount (saline and potassium hydroxide preparations) and cervical cultures for Chlamydia trachomatis and Neisseria gonorrhoeae at the same visit. Fisher exact test and Pearson chi 2 statistics were applied. Nine hundred sixty-three patients were studied. Nearly 50% of our asymptomatic young urban women had a vaginal and/or cervical infection. Papanicolaou smears with inflammation were associated with bacterial vaginosis (P < .0001), excess white blood cells (P < .0001), trichomoniasis (P < .0001), abnormal wet mounts in general (P < .0001), and positive cervical cultures for C trachomatis and/or N gonorrhoeae (P < .001). Papanicolaou smears showing atypical cells of undetermined significance were associated with bacterial vaginosis (P < .001) and abnormal wet mounts in general (P < .03). Seventy-five percent of patients with positive cervical cultures had abnormal wet mounts. Eighty-three percent of the patients whose initial Papanicolaou smear showed inflammation and whose initial wet mount was abnormal had a normal Papanicolaou smear when the wet mount became normal. Preparing wet mounts at the time of Papanicolaou smear in asymptomatic young urban women will help in the interpretation of minimally abnormal smears and will probably decrease the need for repeat smears and colposcopy. Simultaneous cervical cultures would not add much information for such interpretation.

Papanicolaou smear abnormalities in ambulatory care sites for women infected with the human immunodeficiency virus

We attempted to determine the prevalence of cervical dysplasia in human immunodeficiency virus-infected women in ambulatory care settings and to correlate Papanicolaou smears with demographic and clinical variables. Papanicolaou smears of 135 women attending three ambulatory care clinics were reviewed. Chart review identified demographic and clinical variables, including CD4 count. Prevalence of abnormal smears was compared with baseline community rates. Demographic and clinical variables were correlated with Papanicolaou results with the chi 2 test. Fivefold to eightfold increased rates of abnormal smears in human immunodeficiency virus-infected women were observed. Prevalence of abnormal smears increased from 21% in women with CD4 counts greater than 600/mm3 to 45% in women with CD4 counts less than 400/mm3. Age, ethnicity, or mode of human immunodeficiency virus transmission was not significantly correlated with Papanicolaou smear findings. Increased rates of abnormal Papanicolaou smears and significant correlation with CD4 counts were observed in human immunodeficiency virus-infected women at ambulatory care sites. We recommend comprehensive gynecologic care, including semiannual Papanicolaou smears, for all human immunodeficiency virus-infected women.