Pap Smear Research Articles

Promising role of molecular biomarkers in cytological samples for early detection of cervical cancer: a systematic review

Introduction: Cervical cancer is a preventable and treatable disease. Early detection is crucial for improving patient prognosis and quality of life. The Pap smear has limitations in sensitivity and specificity. Molecular biomarkers in cytological samples can improve early detection. Method: A literature review was conducted on the evaluation of molecular biomarkers in cytological samples for the early detection of cervical cancer. Studies were searched in PubMed, Scopus, and Web of Science. Results: We identified 6 studies that evaluated various molecular biomarkers, including HPV DNA, DNA methylation, miRNAs, and proteins. The studies demonstrated that molecular biomarkers have a higher sensitivity and specificity than the Pap smear for detecting cervical cancer. Conclusion: The evaluation of molecular biomarkers in cytological samples is a promising tool for the early detection of cervical cancer. Further research is needed to standardize detection techniques, validate their clinical utility in different populations and contexts, and reduce the cost of testing.

Cervical co-infection with high-risk Human Papillomavirus and Herpes simplex

Background: Herpes Simplex Virus (HSV) is a common sexually transmitted virus that infects millions of individuals worldwide. The current study sought to determine the prevalence of Herpes simplex and Human Papillomavirus (HPV) coinfection in Saudi women. Methodology: From May 2020 to May 2021, 300 women's cervical smears were collected and sent to a cytopathology laboratory. Because of gynecologic concerns, the women in the study were referred for Pap smears. Cervical materials were then evaluated for the presence of HSV using Polymerase Chain Reaction (PCR) molecular techniques. Results: HSV was detected in 2% of patients (66.7% HSV-1 and 33.3% HSV-2). HSV-1 and HPV co-infection was found in 50% of patients, including HPV subtypes 16 and 52. HSV-2 and HPV infection, including HPV subtype 16, was found in 50% of the cases. Conclusion: The prevalence of HSV is minimal among Saudi women seeking gynecologic care. Coinfections of HSV and HPV, particularly HPV subtype 16, are prevalent.

Management of High Risk Pap Smears in Pregnancy: A Case of a Near Miss

Management of High Risk Pap Smears in Pregnancy: A Case of a Near Miss

Knowledge, Attitude, and Prevalence Towards Cervical Cancer Screening Among Women in a Nigerian Urban Municipality

BACKGROUND: Cervical cancer is a significant global health concern, particularly in less developed regions, ranking as the fourth most common cancer among women. Nigeria faces its crisis, with approximately 15,000 women diagnosed annually, resulting in a two-thirds fatality rate. An alarming 40 million Nigerian women remain at risk, underscoring the urgency of improved screening and disease surveillance, compounded by the absence of a national cancer policy and limited awareness. Cervical cancer can be reduced by more than 90% through regular screening. It is caused by sexually transmitted HPV and risk factors include multiple sexual partners, smoking, long-term oral contraceptive use, and immunosuppression. AIM: The study aimed to ascertain the knowledge, attitude, and practices toward cervical cancer screening and the factors that influence the practice of screening among women of the reproductive age group in Calabar Municipality. METHODS: Using a cross-sectional study design, 414 women were enrolled from two public hospitals, four private hospitals, and a non-governmental women’s center through a meticulous multi-stage sampling technique, employing semi-structured questionnaires. Socio-demographic variables were collected, and a 31-item questionnaire was used to assess the level of knowledge, attitudes, and practices toward cervical cancer. Data were analyzed using IBM SPSS version 26; p-values less than 0.05 were considered significant. RESULTS: The mean ages of respondents were 28.01 ± ((8.8357), 293 were single, while 107 were married. 69.67% had received at least tertiary education. 51.9% were employed, and the rest were unemployed. All 414 respondents were familiar with cervical cancer, but 65.7% lacked adequate knowledge of screening. Approximately 60% were aware of screening tests, with health workers as their primary information source. Most women displayed a favorable attitude toward screening; 97.3% expressed willingness if the procedure was explained and accessible, 96.4% if it was free and safe, and 97.6% supported screening for women under 30 years. Unfortunately, only 8% had undergone screening, with Pap smears as the commonest screening method for 84.8% of those who had received screening. Out of 381 respondents who had never been screened, 101 did not think they were at risk, 89 did not know where to get screened, 75 believed their religion protected them, and 37 found it expensive. In bivariate analysis, age, marital status, employment status, and knowledge of screening significantly correlated with good practice (p<0.05). CONCLUSION: The underutilization of screening services in an urban setting is concerning, signaling the potential for cancer care disparities in rural areas. Urgent interventions are needed to foster more favorable attitudes and practices, particularly in developing countries like Nigeria, where cervical cancer remains a leading women's health concern. With Nigeria's limited healthcare financing and fragile health system, cervical cancer screening promotion is crucial. Community-based strategies should be utilized to promote screening, and medical outreaches organized to eliminate healthcare barriers. The government should increase funding for the health sector and provide more screening centers while empowering healthcare providers.

Cervical Cancer Screening Barriers Among Citizens of Jeddah.

The cervix, a cylindrical structure made of stroma and epithelium, is the lowest point of the uterus. A tissue-proven biopsy of the cervix with histological confirmation is necessary for aberrant cytologic results of Papanicolaou (Pap) smears to rule out cervical cancer. This study investigates barriers to cervical cancer screening among women. A cross-sectional study including 665 Saudi Arabian women residing in Jeddah between the ages of 21 and 65 years was carried out from May to November 2023. A four-part online survey was used to gather the data, which included questions about demographics, cervical cancer screening status, screening barriers, and predictors of cervical cancer screening. The most common barrierto Pap test screening was "have not been to a doctor/no regular provider"(39.7%, N = 251), followed by "lack of provider recommendation/or limited or no information in the community" (30.4%, N = 192) and "low priority/did not perceive need/being healthy" (27.7%, N = 175). The study provides valuable insights into the factors influencing cervical cancer screening in Jeddah, Saudi Arabia. The low prevalence of screening indicates a need for increased awareness and targeted interventions to improve uptake.

Cervical Cancer Screening: Integrative Review of National and International Guidelines

Cervical cancer is one of the most preventable and treatable malignancies, yet it still has high incidence and mortality rates, especially in less developed countries. Despite this, vaccines against HPV (the main cause of cervical cancer) are effective and promote a significant reduction in infections and neoplastic lesions of the cervix, as well as the early detection of HPV with or without its initial lesions. This paper is an integrative review, with the aim of demonstrating the main national and international guidelines for the diagnosis of HPV. Using the databases PubMed, MEDLINE, and SciELO, a search was carried out using the descriptors "Cervical Neoplasms", "Screening" and "Guidelines", selecting at the end 12 articles. The results showed that the recommendations for the early diagnosis of HPV have undergone several strategic changes over time, especially on the following points: use of co-testing (combined test with cytology and HPV test) and self-test. Previously in other countries, only cervical cytology (Pap smear) was offered. However, cervical cytology has to be repeated frequently due to its limited sensitivity and reproducibility and, even though it is freely available, studies point to the difficulty of achieving and maintaining diagnostic coverage for cervical cancer. Among the factors hindering success is health illiteracy, which is mainly due to social inequality and the lack of educational actions by the government, demonstrating the need to plan effective strategies in this regard.

Projeto de extensão Mulher Saudável: ações educativas no ambiente ocupacional e sua interface com a saúde ginecológica

The study focuses on the importance of cervical and breast cancer as public health issues for working women, highlighting the Woman Healthy Extension Project in a pediatric hospital in Curitiba-PR. The project conducts screenings and educational activities to prevent these cancers, raising the central question: "Do educational activities in the workplace impact gynecological health?" Using an integrative literature review, the study analyzed seven articles from November 2022 to March 2023. It emphasizes that extension projects contribute to academic development, promoting a critical perspective. The lack of preventive practices in gynecological health is related to various factors, underscoring the importance of discussing exams such as Pap smears and mammography. The study concludes that integrating extension projects into the curriculum promotes health education, benefiting female workers through the prevention and early diagnosis of gynecological cancers.

Cytomorphological study of pap smear and its efficacy to detect various cervical lesions

: Cervical lesions require screening for early diagnosis to differentiate between non-neoplastic and neoplastic lesions of cervix. The present research aimed to evaluate the prevalence of various cervical lesions and detect the efficacy as a screening test of pap smear for early diagnosis of cervical lesions. : The current retrospective study was conducted in the Department of Pathology, SSMC, Rewa, M.P. Total 658 cervical pap smears were retrieved, re-examined and re-classified according to the revised Bethesda system for reporting of cervical cytology, 2014. Out of 658 pap smears, 234 biopsies were available, which were re-examined histopathologically and correlation was done with their corresponding cytological findings.: Out of 658 pap smears, negative for intraepithelial lesion or malignancy (NILM) was found in 74.47% smears, while the prevalence of epithelial cell abnormalities (ECA) was 24.32%. Amongst ECA, most common (11.86%) cervical lesion was low-grade squamous intraepithelial lesion (LSIL). Diagnostic sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy for the diagnosis of pre-invasive and invasive cervical lesions was found 70.54%, 81.9%, 82.72%, 69.35% and 75.6% respectively.: The current study showed that pap smear cytology is able to detect various cervical lesions with a diagnostic accuracy of 75.6%. So, women belonging to reproductive or postmenopausal age-group should be routinely screened for cervical lesions by non-invasive pap smear method. Conclusively, early diagnosis of cervical lesions is possible, thus reducing the incidence of invasive cervical carcinoma.

Deep Reinforcement Learning for Efficient Digital Pap Smear Analysis

In August 2020, the World Health Assembly launched a global initiative to eliminate cervical cancer by 2030, setting three primary targets. One key goal is to achieve a 70% screening coverage rate for cervical cancer, primarily relying on the precise analysis of Papanicolaou (Pap) or digital Pap smears. However, the responsibility of reviewing Pap smear samples to identify potentially cancerous cells primarily falls on pathologists—a task known to be exceptionally challenging and time-consuming. This paper proposes a solution to address the shortage of pathologists for cervical cancer screening. It leverages the OpenAI-GYM API to create a deep reinforcement learning environment utilizing liquid-based Pap smear images. By employing the Proximal Policy Optimization algorithm, autonomous agents navigate Pap smear images, identifying cells with the aid of rewards, penalties, and accumulated experiences. Furthermore, the use of a pre-trained convolutional neuronal network like Res-Net50 enhances the classification of detected cells based on their potential for malignancy. The ultimate goal of this study is to develop a highly efficient, automated Papanicolaou analysis system, ultimately reducing the need for human intervention in regions with limited pathologists.

From Diagnosis to Treatment: Exploring the Latest Management Trends in Cervical Intraepithelial Neoplasia.

Cervical intraepithelial neoplasia (CIN) stands as a precancerous condition with the potential to progress to invasive cervical cancer. This comprehensive review explores the intricacies of CIN management, beginning with its definition, classification, and etiology. It emphasizes the significance of early detection and outlines the latest trends in diagnosis, including Pap smears, human papillomavirus (HPV) testing, and colposcopy. Grading and staging, pivotal in treatment selection, are elucidated. Current management approaches, encompassing watchful waiting, surgical interventions, emerging minimally invasive techniques, and immunotherapy, are detailed. The factors influencing treatment decisions, informed consent, and patient education are discussed. Potential complications following treatment, the importance of long-term follow-up, and the role of HPV vaccination in prevention are underscored. Finally, the review looks to the future, discussing advances in detection, novel treatments, and the promise of precision medicine. In conclusion, early detection and management remain the cornerstone of CIN care, offering hope for a future where cervical cancer is a preventable and treatable condition.

Conventional PAP Smear or Liquid-Based Cytology, The Better Screening Tool for Cervical Cancer: a Comparative Study at a Tertiary Care Center in North-East India

Conventional PAP Smear or Liquid-Based Cytology, The Better Screening Tool for Cervical Cancer: a Comparative Study at a Tertiary Care Center in North-East India

Understanding the Dynamics of Human Papillomavirus and Diagnostic Discrepancies in Cervical Pathology: A Single Center Experience.

Cervical cancer (CC) is the most prevalent gynecological malignancy and a leading cause of death among women. It is primarily caused by human papillomavirus (HPV) infection, with 99.7% of cases showing high-risk HPV genotypes. This study sheds light on HPV dynamics as well as the discrepancies of different CC screening modalities results while highlighting factors that may have contributed to such a scenario. Moreover, we underscore the importance of the non-viral etiology of CC as well. We examined the current trends of HPV infection and its effects on cervical health in women treated at a tertiary care center in Belgrade, Serbia. Patients with abnormal colposcopy findings like dysplasia and re-epithelization were more likely to test negative for HPV (p < 0.001). Interestingly, women with a positive Pap smear tested HPV negative significantly more often (p = 0.041). Finally, HPV-positive individuals were more likely to have CIN I and II histologies (p < 0.001), while CIN III occurred equally in women with and without the virus. It may be inferred that inconsistencies in detecting HPV and the presence of cervical lesions may eventually result in adjustments to screening guidelines, as is crucial to adopt a meticulous approach to promote periodical CC screening, as initial samples may test negative for HPV.

Self-supervised learning-based cervical cytology for the triage of HPV-positive women in resource-limited settings and low-data regime

Screening Papanicolaou test samples has proven to be highly effective in reducing cervical cancer-related mortality. However, the lack of trained cytopathologists hinders its widespread implementation in low-resource settings. Deep learning-assisted telecytology diagnosis emerges as an appealing alternative, but it requires the collection of large annotated training datasets, which is costly and time-consuming. In this paper, we demonstrate that the abundance of unlabeled images that can be extracted from Pap smear test whole slide images presents a fertile ground for self-supervised learning methods, yielding performance improvements compared to off-the-shelf pre-trained models for various downstream tasks. In particular, we propose Cervical Cell Copy-Pasting (C3P) as an effective augmentation method, which enables knowledge transfer from public and labeled single-cell datasets to unlabeled tiles. Not only does C3P outperforms naive transfer from single-cell images, but we also demonstrate its advantageous integration into multiple instance learning methods. Importantly, all our experiments are conducted on our introduced in-house dataset comprising liquid-based cytology Pap smear images obtained using low-cost technologies. This aligns with our long-term objective of deep learning-assisted telecytology for diagnosis in low-resource settings.

Self-reported participation in cervical cancer screening among Polish women in 2004-2019.

We aimed to assess self-reported participation in cervical cancer screening among Polish women between 2004 and 2019 and to identify the groups with the lowest participation rate. Data on declared participation in cervical cancer screening were obtained from the European Health Interview Survey from 2004 to 2019. In 2019, 86.7% of Polish women aged ≥ 15 years declared that they had ever undergone a Pap test. Compared to 2004, the coverage of ever-screened women improved by 16.6 percentage points. The proxy population coverage was 72.9%. The highest proportion of women who underwent a Pap smear in the last three years was observed among those aged 35-44 years and 25-34 years (84.0% and 83.2%, respectively), and the lowest among women aged ≥ 75 years (20.5%). The proportion screened within the last three years also varied by education (up to lower secondary education 26.4%, up to post-secondary non-tertiary education 62.8%, and the highest level of education 83.7%), urbanization (large cities 66.7%, suburbs, and smaller cities 62.8%, and rural areas 59.0%), income (poorest households 42.5%, wealthiest households 70.6%), and declared health status (best 68.9%, worst 41.4%). The lowest participation in screening was observed in the southeastern regions and the highest in the northwestern regions of Poland. In Poland, in 2019, the approximate coverage of cervical cancer screening was high compared to other European countries and has improved over the last 15 years. A complete screening registry is required to confirm questionnaire-based self-reported data. Targeted interventions should be implemented to address low participation in the identified regions and socioeconomic groups.

Grading pancreatic adenocarcinomas on fine needle aspiration cytology. The outstanding issues.

The three-tier grading scheme described in "The Papanicolaou Society of Cytopathology (PSC) System for reporting Pancreaticobiliary Cytopathology" (TPSCRPBC) which remained unchanged following the WHO Reporting System for Pancreaticobiliary Cytopathology (WRPBC) was evaluated on pancreatic adenocarcinomas (PACs) reported on endoscopic ultrasound-guided fine needle aspiration cytology (EUS-FNAC). The Papanicolaou and May Grunwald Giemsa-stained smears from 116 cases of PACs were graded using the three-tier grading scheme laid down by TPSCRPBC/WRPBC. Cases exhibiting multiple grades were assigned primary, secondary and tertiary grades. Each case was assigned a grade score, either by adding the primary and secondary grades, by adding the primary and tertiary grades when the tertiary grade was 3 or by doubling the grade when only one grade existed. Necrosis was estimated semi-quantitatively. The inter-observer reproducibility in grading was evaluated using Kappa and Kendall's tau-c. Correlations between the various grades, the stage of the tumour and the amount of necrosis were assessed using Spearman rho and Kendall's tau-b. 31.89% of cases showed one grade, and 68.11% showed at least two grades. 16.38% showed three grades. The two commonest grade scores were 3 and 5. The inter-observer reproducibility for grading and grade scoring was satisfactory. A positive correlation was noted between the grades and the amount of necrosis. No significant correlation was found between the grades, grade scores and the stage of the tumours. The TPSCRPBC/WRPBC grading scheme can be suitably applied to PACs with good inter-observer reproducibility. Cases often show multiple grades in the same tumour.

A Retrospective Case Control Study to Evaluate the Frequency of Pap Smear Abnormalities among HIV-seropositive and HIV-seronegative Women

A Retrospective Case Control Study to Evaluate the Frequency of Pap Smear Abnormalities among HIV-seropositive and HIV-seronegative Women

Cytological features of human papillomavirus-infected immature squamous metaplastic cells from cervical intraepithelial neoplasia grade 2.

In reflex cytology, the presence of prominent nucleoli in immature metaplastic squamous cells (IM) may be underdiagnosed due to variations in interpretation. The aim of this study is to identify human papillomaviruses (HPVs) that infect IM clusters in cervical intraepithelial neoplasia 2 (CIN2) on Papanicolaou (Pap) smears to determine the cytological features of lesion-derived cells. Thirty-two patients with a simultaneous diagnosis of CIN2 on biopsy and high-grade squamous intraepithelial lesions (HSIL) on cytology as well as with IM clusters on HSIL smears were included. CIN2 tissues and HSIL and IM clusters on Pap smears were isolated by manual microdissection, and HPV types were identified by PCR-based genotyping. The nuclear area within the IM clusters was also measured. The median nuclear area of HPV-negative IM clusters was 48 μm2 , with a coefficient of variation (CV) of 0.20; those of HPV-positive clusters were 66 μm2 and 0.34, respectively. The cut-off values of the nuclear area and CV for HPV positivity were 62 μm2 and 0.25, respectively. IM clusters composed of cells with a nuclear area of more than twice that of neutrophils or cells with a wide variation in nuclear sizes are likely to be neoplastic cells caused by HPV.

CANCER STEM CELLS IN CERVICAL CANCER AS BENEFICIAL GOALS AND BIOMARKERS: A COMPREHENSIVE

The fourth most prevalent gynaecological malignancy affecting females globally is cervical cancer (CC). HPV (high-risk) infection has been related to the majority of CC cases. Owing to efficient screening through Pap smear and vaccination delivery, the commonness and death rate of CC have significantly decreased. Nevertheless, not all societies have access to this equally. A better therapeutic outcome may be achieved by targeting CSCs, which might play a significant impact in carcinogenesis, metastasis, recurrence, and radio / chemo –resistance of CC. The majority of tumours are made up of a tiny subset of tumour cells called CSCs that have the capability to self-renew and develop into a variety of tumour cell types. Cervical CSCs (CCSC) are challenging to recognise, which has prompted the hunt for other markers. The potential indicators of CSCs in CC are described in the current review. These CCSC indicators might be used as molecular goals to improve the effectiveness and lessen the negative effects of chemotherapy in HR-HPV-positive CC.

OPTIMALIASASI PERAN KADER DALAM DETEKSI DINI KANKER SERVIKS

The cervix is a female organ that connects the vagina and uterus. Cervical cancer is a malignant tumor that grows in the cervix, can originate from cells of the cervix or both. This cancer is one of the reproductive disorders most feared by women. In Indonesia, the second type of cancer is 32,469 cases or 9.3% of the total cancer cases. Early detection of cervical cancer with an IVA (Visual Infection with Acetic Acid) test needs to be carried out routinely by women at least once a year for women who are sexually active. Community service is a way to increase public knowledge and awareness about how to detect early women's reproductive health. The method used in community service is by holding training on cervical ca knowledge and training cadre communication to ensure the community routinely detects early women's reproductive health, conducting interviews, FGDs, observing IVA Tests. The results obtained from community service, community knowledge increased to 98%, behavior with IVA Test participants in the cadre area increased by 50%, cadres also actively provided re-education with communication during training at events that were often held in their place, such as recitations, Posyandu is also a social gathering for mothers. During the IVA test observation, one person was found to be positive. IVA test every month or Pap smear every year

Human Papillomavirus among Women Undergoing Papanicolaou Smear Test in the Department of Gynaecologic Oncology of a Tertiary Care Centre.

In invasive cervical specimens or precursors, high-risk human papillomavirus Deoxyribonucleic acid may be detected to identify females at risk of developing cervical cancer. This study aimed to find out the prevalence of human papillomavirus among women undergoing Papanicolaou smear tests in a tertiary care centre. A descriptive cross-sectional study was conducted among women undergoing the Papanicolaou smear test in the Department of Gynaecologic Oncology, Nepal Armed Police Force Hospital, between 1 June 2022 and 15 November 2022. Ethical approval was obtained from the Ethical Review Board. A convenience sampling method was used. The point estimate was calculated at a 95% Confidence Interval. Among the 199 women, 6 (3.02%) (0.64-5.40, 95% Confidence Interval) had human papillomavirus infection. The mean age of the infected females was 31.17±5.57 years. Human papillomavirus DNA for 16 and 18 were detected in 4 (66.67%) and 2 (33.33%) females, respectively. The prevalence of human papillomavirus in females was found to be lower than other studies done in similar settings. cytology; histology; human papillomavirus; Nepal; prevalence.