Screening For Cervical Neoplasia Research Articles

Comparison of the Accuracy of Visual Inspection with Acetic Acid, Visual Inspection with Lugol Iodine and coloscope in Screening for Cervical Neoplasia

Comparison of the Accuracy of Visual Inspection with Acetic Acid, Visual Inspection with Lugol Iodine and coloscope in Screening for Cervical Neoplasia

Endocervical Sampling in Women With Suspected Cervical Neoplasia: A Systematic Review and Meta-analysis of Diagnostic Test Accuracy Studies

ABSTRACT HPV-induced cervical neoplasia progresses through a predictable natural course of disease, starting with mild cervical intraepithelial neoplasia (CIN1) and developing into severe degrees (CIN3) and eventually to invasive cervical cancer. A positive finding on initial screening for cervical neoplasia results in further diagnostics involving sampling with an endocervical brush (EB) or endocervical curettage (ECC). There exists a considerable variation in the choice of test method for obtaining these endocervical or cervical canal samples. This meta-analysis aimed to retrospectively determine the diagnostic test accuracy (DTA) and patient discomfort of the EB and ECC for the detection of cervical neoplasia in women with any indication for colposcopy, biopsies, and endocervical sampling. All diagnostic studies and randomized clinical trials that included women with abnormal cytology results in cervical cancer screening or women with red flag symptoms undergoing colposcopy, biopsy, EB, or ECC were included. The target condition was cervical neoplasia, and the reference standard was the final histological result. A bivariate random-effects model was used to determine summary estimates of sensitivity and specificity with 95% confidence intervals (CIs). A meta-analysis assessing summary relative risk for inadequate samples was also conducted. A total of 7 studies were included in the meta-analysis with a total sample size of 1097 women. Three studies were randomized clinical trials, and 4 were cohort studies, and they took place between 1988 and 2013. A DTA meta-analysis for summary sensitivity and specificity found an overall pooled sensitivity of 81% (95% CI, 48–95) for EB and 70% (95% CI, 42–89) for ECC. The overall pooled specificity was 73% (95% CI, 36–93) for EB and 81% (95% CI, 56–94). The overall relative risk was found to be 2.53 (95% CI, 0.58–11.0; P = 0.215) for ECC compared with EB for inadequate samples. Two studies reported patient discomfort as an outcome, and only a single study reported a significant difference between ECC and EB in favor of ECC (visual analog scale score 2.55 vs 1.99). The results of this meta-analysis comparing the DTA of EB and ECC found no significant difference between EB and ECC in DTA, inadequate sampling rate, or adverse effects. The overall sensitivity was found to be slightly higher for EB than for ECC and the specificity to be slightly higher for ECC than EB, although these results were not statistically significant.

Epigenetic approaches for cervical neoplasia screening (Review).

Human papillomavirus (HPV) infection is the leading cause of cervical cancer. The Papanicolaou cytology test is the usually employed type of screening for this infection; however, its sensibility is limited. Only a small percentage of women infected with high-risk HPV develop cervical cancer with an array of genetic and epigenetic modifications. Thus, it is necessary to develop rapid, reproducible and minimally invasive technologies for screening. DNA methylation has gained attention as an alternative method for molecular diagnosis and prognosis in HPV infection. The aim of the present review was to highlight the potential of DNA methylation in cervical neoplasia screening for clinical applications. It was observed that the methylation human and viral genes was correlated with high-grade lesions and cancer. Methylation biomarkers have shown a good capacity to discriminate between high-grade lesions with a transformative potential and cervical cancer, being able to detect these modifications at an early stage. With further research, the epigenetic profiles and subtypes of the tumors could be elaborated, which would aid in therapy selection by opening avenues in personalized precision medicine. Response to therapy could also be evaluated through such methods and the accessibility of liquid biopsies would allow a constant monitoring of the patient's status without invasive sampling techniques.

Efficiency of HPV DNA Test versus Pap Smear in the Screening of Cervical Cancer

Introduction: Cancer cervix is a common genital cancer. Human papillomavirus is the main cause of cervical cancer because of the strong association of certain HPV genotypes and the development of cervical cancer and its precursor lesions, cervical intraepithelial neoplasia CIN 2 or CIN3.
 Methods: The study was conducted on 180 gynecological patients seen at the outpatient department of Manipal Hospital, Bangalore. A comparative study of HPV DNA test with Pap smear in the screening of cervical neoplasia was carried out over the period of 24 months from August 2011 to June 2013.
 Results: The incidence of cervical cancer and its associated mortality has declined in recent years, largely due to the widespread implementation of screening programs by Pap smear testing. The management and the prevention of cervical cancer should change with HPV DNA testing for high risk HPV, which is more sensitive than pap smear testing. Infection of cervix with HPV is necessary to cause cervical neoplasia and cervical cancer. Persistent infection with HPV is required for the development of cervical dysplasia and invasive cervical cancer.
 Conclusions: HPV testing alone for primary screening appears promising in women aged 30 years and older as this group is at greatest risk of developing CIN 3. As compared with Pap testing, HPV testing has greater sensitivity for detection of cervical intraepithelial neoplasia.

Comparison of the Accuracy of Papanicolaou Test Cytology, Visual Inspection With Acetic Acid, and Visual Inspection With Lugol Iodine in Screening for Cervical Neoplasia in Southeast Nigeria.

PurposeThis study aimed to compare the accuracy of Papanicolaou test cytology, visual inspection with 5% acetic acid (VIA), and visual inspection with Lugol iodine (VILI) in the detection of premalignant and malignant lesions of the cervix.Materials and MethodsThis was a cross-sectional comparative study of 200 consenting participants at the Federal Teaching Hospital, Abakaliki over a 6-month period. All the participants had Papanicolaou test cytology. Subsequently, they were classified into two groups of 100 each through systematic random sampling: group 1 had VIA and group 2 had VILI. Thereafter, all the participants had cervical punch biopsy at the 6 and 12 o’clock cervical positions. Cervical punch biopsy was also done on the suspicious lesions of the cervix irrespective of their positions. The tests of validity of the three methods were calculated using the histology of the biopsy specimen as the gold standard. P value ≤ .05 was considered to be statistically significant.ResultsAmong the VIA group, 19 (19%) had cervical epithelial abnormalities on Papanicolaou test cytology, and VIA was positive in 14 (14%). Histology results showed cervical neoplasia in 15 (15%) of the participants. Among the VILI group, 15 (15%) had cervical epithelial abnormalities on Papanicolaou test cytology, and VILI was positive in 19 (19%). Histology results showed cervical neoplasia in 15 (15%) of the participants. There was no significant difference in overall accuracy of Papanicolaou test cytology, VIA, and VILI. The overall accuracy of the Papanicolaou test cytology plus VIA was significantly more than Papanicolaou test cytology alone.ConclusionVIA or VILI can be used as a stand-alone cervical cancer screening test when compared with Papanicolaou test cytology, particularly in resource-limited settings. VIA can also complement Papanicolaou test cytology.

Correlation of visual inspection with cytological and histopathological findings in cervical neoplasia

Background: Cervical cancer is one of the commonest malignancies and a leading cause of morbidity and mortality among women. The aim of this study was to evaluate the diagnostic value of Papanicolaou (PAP) smear and visual inspection with acetic acid as methods of cervical cancer screening.Materials and Methods: This was a observational cross-sectional study conducted from the period of 2068.11.01 to 2069.11.01. The study population consisted of women with histologically confirmed cervical intraepithelial neoplasia or invasive carcinoma who had undergone prior PAP smear.Results: During the study period 160 patients underwent both PAP smear and cervical biopsy. Of these patients, 49 had a histological diagnosis of cervical intraepithelial neoplasia or invasive carcinoma. The histopathological and cytological diagnoses were compared. Visual inspection with acetic acid status was available for 31 of the 49 cases. The sensitivity of PAP smear was 61%, specificity 97%, positive predictive value 91%, negative predictive value 85% and diagnostic accuracy 86% for detection of cervical neoplasia. Visual inspection with acetic acid had a sensitivity of 74%, specificity 48%, Positive predictive value 64%, Negative predictive value 60% and diagnostic accuracy of 63%. Combining the two procedures increased sensitivity by 26%, Negative predictive value by 11% and diagnostic accuracy by 2 per cent.Conclusion: PAP smear has a higher specificity, Positive predictive value, Negative predictive value and diagnostic accuracy but lower sensitivity than visual inspection with acetic acid. Visual inspection with acetic acid by itself is not an effective screening method. A combination of PAP smear and visual inspection with acetic acidcan ensure adequate screening of cervical neoplasia.

Comparative accuracy of Pap smear and HPV screening in Ubon Ratchathani in Thailand

We evaluate the potential for using high-risk human papillomavirus (hr-HPV) testing-based screening for cervical intraepithelial neoplasia (CIN) in routine health services in Thailand; its accuracy in comparison to that of conventional cytology (CC); and the utility of HPV16/18 positive results and liquid-based cytology (LBC) triage for HPV-positive women in the detection of high-grade CIN. Women aged 30–60 years in Ubon Ratchathani province, Thailand were screened with CC and hr-HPV testing and those abnormal on either tests were referred for colposcopy and/or directed biopsies. The final diagnosis using COBAS was based on histology or colposcopy when histology was not available. Estimation of test accuracy parameters was done using latent class analysis using Bayesian models. Of the 5004 women were enrolled, 20 (0.4%) had abnormal CC and 174 (3.5%) women were HPV-positive. Among 185 women abnormal on CC or HPV-positive, 176 (95.1%) underwent colposcopy, of whom 101 (57.4%) had abnormal colposcopy findings. Ninety-seven women with abnormal and 69 with normal colposcopy had biopsies performed. All 21 women with histological CIN2 or worse had hr-HPV and none were abnormal on CC. The estimated sensitivity, specificity and positive predictive value were respectively 71.8%, 97.0% and 13.0% of HPV testing; 53%, 98.7% and 20.3% for triage of HPV-positive women with LBC; and 70.4%, 98.2% and 16.9% when test positivity was taken as HPV16/18 irrespective of LBC result or positive for hr-HPV non 16/18 types and LBC triage. Our study findings indicate poor performance of cytology screening and demonstrate the potential and utility of using HPV testing in public health services in Thailand as well as the utility of primary HPV testing and LBC triage in screening for cervical neoplasia.

Risk factors for high-risk human papilloma virus persistence after loop excision procedure as treatment of cervical dysplasia

Persistence of high-risk human papilloma virus types (HR-HPV) after surgical treatment of cervical intraepithelial neoplasia (CIN) is an important factor which influences the management and the recurrence risk. In this study, we assessed the efficiency of the loop electrosurgical excision procedure (LEEP) in HR-HPV removal. Cervical samples from 31 women, diagnosed with CIN and HR-HPV, were genotyped at six months after LEEP. We assessed the influence of various risk factors on HR-HPV persistence, using univariate and multivariate analysis: age, menopausal status, parity, abortions, oral contraception, smoking, sexual partners, initial cervical smear test and histopathological results. We detected persistent infections in 7 (22.6%) patients with 16, 18, 31, 39, 51 and 66 HPV types. Univariate analysis found that age over 30 years, multiparity, use of contraception and CIN2-3 were significant factors for persistence of HR-HPV after LEEP. Multivariate analysis showed that CIN2-3 was the only significant risk factor for HPV persistence (OR=10.7). Furthermore, although not significant, parity was also retained into final equation. HR-HPV persistence is a frequent phenomenon after LEEP. We highlight the importance of glandular involvement, residual tissue and difficulties of the resection procedure in multipara. HPV genotyping is a sensitive method to follow up this group of patients, as it can identify a type specific HPV infection. In our country with the known highest mortality rate in EU countries of cervical cancer, we need an organized cervical neoplasia screening with a validated HPV genotyping test.

Application analysis of the cervical cell pathology liquid production technology in cervical intraepithelial neoplasia screening

Objective To study the application value of the cervical cell pathology liquid production technology in cervical intraepithelial neoplasia(CIN)screening. Methods 4 212 patients were chosen and detected by TCT and the pap staining,TBS(the Bethesda system)to finish thin layer liquid based cytology grading diagnosis,including 558 patients with cervical biopsy,the pathological results were analyzed. Results for histopathological examination results of CIN1,CIN2,CIN3 and cervical cancer cases,a thin layer of liquid based cytology detection rate was 76.00%(57/75),78.21%(61/78),95.76%(113/118),100.00%(7/7),the comparison between the CIN3 CIN2 group,a thin layer of liquid based cytology detection rate had differences in significant statistical significance(χ2=14.53,P<0.01),with the histopathological detection of cervical lesions,thin layer of liquid based cytology detection rate was obviously rising trend.Cervical liquid based cytology screening cervical lesion(CIN and above),the sensitivity was 85.61%(238/278),83.73%(206/246),positive predictive value 76.28%(238/312),negative predictive value 72.79%(206/283). Conclusion The positive results and histopathological results coincidence rate of using thinprep cytologic test to screening for cervical intraepithelial neoplasia(CIN)is high,the precancerous lesions in screening and prevention has important significance,which is worth clinical promotion. Key words: Thinprep cytologic test; The pap staining; Cervical intraepithelial neoplasia(CIN)

Performance of Siriraj Liquid-Based Cytology: a Single Center Report Concerning over 100,000 Samples

To evaluate the performance of Siriraj liquid-based cytology (LBC) for cervical neoplasia screening after increasing use of this technology. Cytological reports of 103,057 Siriraj-LBC specimens obtained in 2007-2009 were compared with those of 23,676 specimens obtained in 2006. Comparing with the year 2006, the 2007-2009 patients were slightly older (43.4 ± 12.yr vs 42.7 ± 12.2 yr, p <0.001), and their specimens had much lower proportion of unsatisfactory slides (OR=0.06, 95%CI 0.04-0.09) with comparable detection rates (3.96% vs 3.70%, p=0.052) but different proportions of various cytological abnormalities (p<0.001). The 2007-2009 Siriraj-LBC had a negative predictive value (NPV) for cervical intraepithelial neoplasia 2+ (CIN2+) of 97.6% and an overall positive predictive value (PPV) of 43.9%. The PPV for CIN2+ varied with types of abnormal cytology, from 13.7% to 93.8% in atypical squamous cells of undetermined significance (ASCUS), low-grade squamous intraepithelial lesion (LSIL), atypical squamous cells cannot exclude HSIL (ASC-H), high-grade squamous intraepithelial lesion (HSIL), atypical glandular cells (AGC), to squamous cell carcinoma (SCC), respectively. The PPVs for CIN2+ in ASCUS and LSIL were comparable, but the PPV for CIN1 was higher for LSIL than for ASCUS (41.63% vs 16.32%). Siriraj-LBC has demonstrated a stable detection rate and NPV for CIN2+ of >95% since the first year of use. The comparable PPVs for CIN2+ of ASCUS and LSIL suggests that these two conditions may undergo similar management; other cytological abnormalities need immediate evaluation.

Role of Human Papillomavirus Testing in Screening of Cervical Neoplasia

Human papillomavirus (HPV) is the causative agent of cervical intraepithelial neoplasia and cervical cancer. HPV and cytology co-tests in women aged 30 years or older every 5 years as primary cervical screening is recommended for developed countries. In HPV-positive and cytology-negative women, follow-up with co-tests at 12 months is recommended. Nevertheless, if HPV-16 or HPV-18 is positive, direct colposcopy is recommended. In mild cytological abnormality and HPV-negative women, routine screening should be continued as per age-specific guidelines. Women with history of cervical intraepithelial neoplasia grade 2 or more should be followed at least 20 years even after age 65 years. In area with very limited resource, a single visit “screen-and-treat” visual inspection with acetic acid might be reasonable. Although the policies of cervical screening vary in different regions, the future screening strategies when the young HPV vaccinated population reaches the screening age will need to be renovated.

Screening of cervical neoplasia in HIV-infected women in India

To evaluate an accurate, affordable, and feasible method to screen and treat HIV-infected women so that cervical cancer can be prevented among them. A cross-sectional study was conducted in India in which eligible HIV-infected women underwent visual inspection with acetic acid (VIA), visual inspection with Lugol's iodine (VILI), cytology, human papillomavirus (HPV) testing, and colposcopy. We screened women with cytology, HPV testing, VIA, and VILI. All screened women had colposcopy and women with colposcopic abnormalities had directed biopsies. Women with suspected cervical intraepithelial neoplasia (CIN) on colposcopy were treated with cold coagulation or loop excision. Sensitivity, specificity, and predictive values of the screening tests were calculated. : Among 1128 women screened, 55 (4.9%) had CIN2-3 lesions. Sensitivity for VIA, VILI, cytology at atypical squamous cells of undetermined significance (ASCUS) threshold and HPV testing was 83.6, 89.1, 63.3, and 94.6%, and specificity was 88.8, 89.3, 94.5, and 77.4%, respectively, in detecting CIN2/3 lesions. Cytology had significantly lower sensitivity and higher specificity than VIA, VILI, and HPV testing. Sequential testing with VIA/VILI, HPV testing/VIA, HPV testing/VILI, and HPV testing/VIA/VILI had more balanced sensitivity and specificity than the single tests. Cold coagulation was well tolerated and cured 80% of CIN2-3 based on preliminary results at 6-month to 1-year follow-up periods. Sequential testing with VIA and VILI is the most feasible screening approach for cervical cancer screening in HIV-infected women in low-resource countries. When HPV testing becomes feasible and affordable, HPV testing followed by VIA/VILI may be considered.

Cervical cancer in women with unhealthy cervix in a rural population of a developing country

Background: Cervical cancer, the most common malignancy among Indian women, is the second most common and fi fth most fatal cancer in women world-wide. Aim: The study is aimed to determine the risk factors, incidence of cervical malignancy in women with grossly unhealthy cervix in a rural population and to get an overview of eff ectiveness of the existing screening programs. Subjects and Methods: This cross-sectional prospective pilot study was carried in a tertiary care hospital in a span of 6 months. A total of 300 females with grossly unhealthy cervix with suspicions of malignancy, who had never undergone cervical cytology or any other cervical neoplasia screening procedure, were included. Unaided visual inspection with Cusco’s speculum was performed followed by digital examination. Clinical staging was carried out in patients according to International Federation of Gynecology and Obstetrics (FIGO’S) Classifi cation. Cervical punch biopsy was taken under colposcopic guidance and histopathological examinations were done. Data were analyzed using SPSS, version 15.0 (Chicago Illinois, USA) and presented as simple percentages. Results: Among 300 females, 63.4% (190/300) were aged between 40 and 59 years. Nearly, 70.7% were illiterate and 52.6% had monthly family income between Rs. 2,000 and 5,000. Majority was married and 72.7% had parity between 1 and 3 and 58.7% had early marriages. Unaided visual examination of the women showed 62.7% of them had visible growth and 48.7% of them had bleeding erosions. Visible growths along with bleeding erosions were present in 11.3% cases. Histopathological examination of cervical biopsy specimens revealed mild, moderate and severe dysplasia in 14, 22 and 36 cases, respectively. A total of 212 patients had invasive squamous cell carcinoma. Only 16 patients had normal histopathology fi ndings. Nearly, 56.61% had Stage II disease; among them 27 had Stage IIa and 33 had Stage IIb disease, 26 patients had Stage I disease. Stage IIIa and IIIb have been found in 50 and 12 cases respectively. Four cases had cancer extending to urinary bladder and rectum (Stage IVa). Conclusions: Cervical carcinoma not only has a biomedical spectrum, but also has a wide cultural and socio-economic background. Extensive screening campaigns needs to be implemented with immediate eff ect to early diagnose cases to decrease the social burden of the disease. Keywords: Africa, cervical cancer, screening procedures

Mansonelliasis identified by a cervicovaginal smear at the university hospital center of Bobo-Dioulasso (Burkina Faso)

Mansonella perstans is a genus of filaria that is often asymptomatic or responsible for unspecific symptoms. M. perstans microfilariae are uncommon on cervicovaginal smears. We report the case of a woman with pruritis and eosinophilia. Microfilariae of M. perstans were observed on both cervicovaginal and blood smears. The patient was successfully treated with a combined single dose of 400 mg of albendazole and ivermectin (150 μg/kg). We described here an atypical and rare localization of M. perstans. The routine examination of cervicovaginal smears of women admitted to Bobo-Dioulasso Hospital for screening of cervical neoplasia should allow us to determine the frequency of this parasitosis and propose appropriate treatment.

Screening for cervical neoplasia in a health center in Western Andalusia

We have analyzed the annual burden of 736 smears collected in the screening of cervical neoplasia at primary care facility where we work. We could not detect any neoplasia. Of the 50 positive smears (6.79% of total), 4 cases showed HSIL (high grade intraepithelial lesion) (median age 32 years) and 10 cases had LSIL (low grade intraepithelial lesion) (median age 25.5 years). The median age of the 733 satisfactory smears was 40 years. Age was a significant predictor for having an altered cytology (OR = 0.96, 95% CI = 0.93 to 0.98, p = 0.001190). Candida albicans was the microorganism more frequently associated with non- neoplastic inflammatory changes.

Screening for cervical neoplasia: A community‐based trial comparing Pap staining, human papilloma virus testing, and the new bi‐functional celldetect® stain

Although cytological screening for cervical neoplasia has lowered mortality rates, current screening methods are plagued by sub-optimal sensitivity and/or specificity. The purpose of this study was to compare the performance of the new CellDetect® staining technology as a potential screening tool. This initial, non-blinded study, utilized samples are taken at a community-based clinic. The diagnostic results using CellDetect® were compared with the performance of Pap staining and human papilloma virus (HPV) testing on the same material, as well as the follow-up biopsies. These data were statistically analyzed in terms of sensitivity, specificity, predictive value (N.P.V and P.P.V), and inter-observer agreement. Bi-functional CellDetect® staining revealed morphological details and tinctorial properties that permitted recognition of neoplasia even at low magnification. Performance-wise, CellDetect® demonstrated non-inferiority for all statistical parameters to both Pap and HPV tests. Importantly, superior sensitivity compared with Pap staining was observed, as well as higher specificity than HPV testing with near equivalent sensitivity. We conclude that CellDetect® is a promising approach to early detection of cervical cancer because of its bi-functional capabilities that afford high sensitivity and specificity. The data suggest that this new methodology warrants further and more extensive clinical evaluation.

Screening for cervical neoplasia in Bangladesh using visual inspection with acetic acid

Objective To report the organization and early results of a visual inspection with acetic acid (VIA) screening program for cervical cancer prevention in Bangladesh. Methods Opportunistic VIA screening was offered by trained medical personnel to healthy women attending healthcare facilities in 44 districts. Colposcopy and/or directed biopsies were performed on VIA-positive women at Bangabandhu Sheikh Mujib Medical University (BSMMU) or medical college hospitals. The numbers of screened and VIA-positive women as well as the results of colposcopy, biopsy, and treatment of those with cervical intraepithelial neoplasia (CIN) attending BSMMU are reported. Results From January, 2005, to June, 2008, 104 098 women underwent VIA screening. Among them, 5013 (4.8%) women were positive, of whom 4371 (87.2%) attended colposcopy clinics in different hospitals. Of the 2188 who underwent colposcopy at BSMMU, 157 were diagnosed with CIN 2–3 and 123 with invasive cancer. For 2065 women (excluding the cancer cases), results for sensitivity, specificity, and positive predictive value of VIA to detect CIN 2–3 lesions were 93.6%, 58.3%, and 15.6%, respectively. Almost half the women with CIN 2 or 3 lesions had treatment. Conclusion A VIA-based program would facilitate the development of screening, diagnosis, and treatment of cervical neoplasia and improve awareness of cervical cancer prevention in Bangladesh.

Performance of anal cytology in a clinical setting when measured against histology and high-resolution anoscopy findings

The success of cervical cytology in screening for cervical neoplasia has led to the concept of anal cytology screening for anal neoplasia. Our objective is to study the performance of anal cytology as a screening tool. We assessed anal cytology against histology and high-resolution anoscopy in a clinical setting. Anal pap test was obtained prior to high-resolution anoscopy examinations and biopsies. The results were analysed against a number of patient variables. From 395 individuals (93% men), 584 anal pap tests were obtained. HIV status was positive in 212 (54%) and negative in 156 (39%) individuals. On the basis of 288 histology results, the sensitivity of anal cytology to detect disease was 70% [95% confidence interval (CI) 64-75], whereas the specificity was 67% (95% CI 38-88). For high-grade disease (anal intraepithelial neoplasia 2/3), sensitivity of anal cytology was 81% (95% CI 70-90), and the negative predictive value was 85% (95% CI 76-92). Sensitivity was dependent on the area of disease (86% for two or more quadrants vs. 69% for one or more quadrants, P = 0.002) and HIV positivity (76% in HIV positive vs. 59% in HIV negative, P = 0.009). Amongst HIV-positive patients, the sensitivity was 90% when CD4 cell count was 400 cells/microl or less compared with 67% when CD4 cell count was above 400 cells/microl (P = 0.005). Anal cytology performs similar to cervical cytology in a clinical setting. Sensitivity of anal smear is dependent on the area (quadrants) of disease present. Sensitivity of anal cytology is enhanced when CD4 cell count is less than 400 cells/microl in HIV-positive men. Our results may explain the variable sensitivity reported in the literature.

Living with uncertainty: Equivocal Pap test results and the evolution of ASC terminology

Communication of equivocal findings and their significance has been a significant challenge related to Pap testing throughout its history. Terminology to report these findings has changed considerably to accommodate the changes in understanding of cervical neoplasia, and to accommodate new management strategies, tests, and technologies. This article reviews the evolution of terminology for equivocal Pap test findings from the original Papanicolaou classification to the current the Bethesda System 2001 atypical squamous cells terminology, the implication and use of these terms, and the changing landscape of cervical neoplasia screening, which prompted these terminology changes. Emerging issues related to improving risk stratification through the introduction of additional terms and the impact of human papillomavirus testing may alter terminology of equivocal findings in the future.

Different outcome of invasive cervical cancer associated with high‐risk versus intermediate‐risk HPV genotype

Human papillomavirus (HPV) DNA sequences are associated with the large majority of invasive cervical carcinoma but the role of specific genotype(s) in the outcome of the disease is still debated. To determine the viral epidemiology in the French population of patients and the prognostic value of HPV genotypes in cervical cancer, we performed a retrospective study in 515 patients treated in our Institution from 1985 to 2005. Ninety-six percent of the cases were found associated with HPV DNA whereas 4% remained HPV negative. High-risk HPV 16/18 genotypes were found in 70% of the cases. HPV 18 was more frequently associated with adenocarcinoma (40.6%) than HPV 16 (10.4%) and found in tumours developed in younger women (mean age, 45.8 years) than HPV 16 (48.3 years) or other HPV types (53.6 years). In multivariate analysis, node involvement (p < 0.0001), parametria invasion (p = 0.009), tumour size (p = 0.01) and HPV status (p = 0.02) were associated with disease-free survival (median follow-up 95 months). Disease outcome was better in tumours associated with intermediate risk HPV types (HPV 31, 33, 35, 39, 52, 53, 58, 59, 73) than in tumours with high oncogenic types (HPV 16, 18, 45) (p = 0.03). Node status and tumour size remained prognostic factor for overall survival. Our data show that HPV genotype is one of the biological factors associated with the outcome of cervical cancer. One third of invasive carcinoma were not associated with HPV 16/18, indicating that the screening for cervical neoplasia should be maintained after prophylactic vaccination against these HPV genotypes.