Suspicious Cervix Research Articles

Could Clinically Suspicious Cervix Predict Cervical Premalignant and Malignant Lesions in Postmenopausal Women?

Could Clinically Suspicious Cervix Predict Cervical Premalignant and Malignant Lesions in Postmenopausal Women?

Cervical Cancer to See the Evaluation of the Effectiveness of Colposcopy in Iraqi Women

Background: One of the leading causes of female death in developing nations is cervical cancer, which accounts for one-fourth of all cases globally. Objective: This paper was focused to assess the outcomes of cervical cancer to see the evaluation of the effectiveness of colposcopy in Iraqi women. Patients and methods: This paper was represented as a cross-sectional study to assess the outcomes of cervical cancer to see the evaluation of the effectiveness of colposcopy in Iraqi women where to include from 25th August 2021 to 16th July 2022 into, 50 patients for ages between 25-50 years. This paper was analysed and examine of clinical features for cervical cancer by the SPSS program. Discussion: The specificity of the Swede score was scoring with seven or above was 87% in the current investigation, while the sensitivity for high-grade lesions was 92%. The threshold was lowered to 5, which boosted the sensitivity reached 72.42% and the specificity to 82%. Using a threshold of 5 for the Swedish score, the accuracy of the value of positive prediction is 75.48%. The accuracy considerably increased to 93.28% if the cutoff for the Swede score was set at 7. The results were similar to those that Bowring et al., as well as Strander et al., had previously reported. Conclusion: This study shows the Swede score was good as screening modalities as performance assessed of patients who have lower abdominal pain and discharge per vaginam as well as dyspareunia, abnormal uterine bleeding which colposcopy conducted into pointing of suspicious cervix with the unhealthy case. In comparison between the Swede score >5 and >7, our study noticed Swede score have a sensitivity of 92%, Specificity of 87%, and Accuracy of 93.28% were more perfect in compare with >5.

Expression of E4 Protein and HPV Major Capsid Protein (L1) as A Novel Combination in Squamous Intraepithelial Lesions.

We aim to describe the relationship between the immunohistochemical expression patterns of HPV E4 markers and the presence of HPV major capsid protein (L1) in cervical tissues obtained by biopsy of patients with abnormal liquid-based cytology (LBC) results, HR HPV infections, or clinically suspicious cervix. A novel HPV-encoded marker, SILgrade-E4 (XR-E4-1), and an HPV (clone K1H8) antibody were used to demonstrate the expression in terminally differentiated epithelial cells with a productive HPV infection in the material. A semiquantitative analysis was performed based on light microscope images. The level of E4 protein decreased with the disease severity. Patients with LSIL-CIN 1 and HSIL-CIN 2 diagnoses had significantly lower levels of HPV major capsid protein (L1) than those without confirmed cervical lesions. Our analysis confirms a higher incidence of L1 in patients with molecularly diagnosed HPV infections and excluded lesions of LSIL-CIN 1 and HSIL-CIN 2. Further studies on the novel biomarkers might help assess the chances of the remission of lesions such as LSIL-CIN 1 and HSIL-CIN 2. Higher levels of E4 protein and L1 may confirm a greater probability of the remission of lesions and incidental infections. In the cytological verification or HPV-dependent screening model, testing for E4 protein and L1 expression may indicate a group with a lower risk of progression of histopathologically diagnosed lesions.

Evaluation of Cervix at Risk with Pap Smear and with Colposcopy

Background: Unhealthy cervix is a very common finding in Bangladesh due to poor genital hygiene, malnutrition, and multiparity. Cervical Cancer is a serious health problem in Bangladesh and other developing countries. Cervical Cancer is a preventable cancer due to long preinvasive state and available cervical screening program like pap smear, colposcopy etc. Upon detection the treatment of pre-invasive lesions is highly effective. The objective of our study is to observe and evaluate suspicious cervix upon specimen collection by pap smear and viewing them by colposcopy when required. 
 Materials and methods: This is a descriptive type of observational cross-sectional study conducted in the Department of Obstetrics and Gynecology of BBMH, Chittagong over a period of six months from December 2020 to June 2021. A total of 64 women were selected, who came to hospital outdoor for the treatment of persistent vaginal discharge, post coital bleeding, postmenopausal bleeding. A thorough general, systemic and pelvic examination was done. Pap smear was conducted and colposcopy was done for women who had persistent inflammation on pap smear cases. Multiple variables like age of marriage and first intercourse, parity contraception was taken in consideration. The data obtained were recorded and statistically analyzed. 
 Results: Out of 64 women the minimum age was 30 and maximum was 62 years with a mean age of 32.6 ± 7.2 years. Of the 64 women with unhealthy, inflammatory pap smear cases, 33 (51.6%) patients were colposcopically positive for CIN. Then histopathological evaluation of the biopsy material of those 33 women were done. It revealed 12 (36.3%) with abnormal cytology. Patients with positive CIN experienced early marriage, early age of child birth, and also had higher parities than patients without CIN.
 Conclusion: This study should that cervical lesion is one of the commonest problems among the females worldwide, including Bangladesh. This revealed the importance of emphasizing on proper screening of carcinoma cervix to decline incidence and mortality in developed and developing countries.
 JCMCTA 2022 ; 33 (1) : 71-76

Evaluation of colposcopy in screening of suspicious-looking cervix using swede score and its correlation with the histopathological findings

Background: Cervical cancer is a global health problem. It ranks as the fourth-most common leading cause of female cancer in the world and the second leading cause of female cancer in India. Different methods are used for its screening as it has a long latent phase. Colposcopy-guided biopsy of suspicious unhealthy-looking areas is taken as the gold standard in the diagnosis of intraepithelial lesions. However, a new scoring system of colposcopy called the Swede score has a high specificity and can omit the need of biopsy. Objective: The objective of this study is to evaluate the diagnostic efficacy of colposcopy using Swede score in unhealthy cervix and to determine the degree of correlation between colposcopy scores and histopathological findings. Materials and Methods: The study was conducted in the Department of Obstetrics and Gynecology, Santosh Medical College and Hospital, Ghaziabad, Uttar Pradesh, India, from January 1, 2020, to June 30, 2021. Ninety-eight patients fulfilling the inclusion and exclusion criteria were selected for the study. Results: It was evident that colposcopy using a Swede score of >5 and even more of >7 is definitely more sensitive and accurate in the screening of unhealthy-looking suspicious cervix in the Indian population and can be considered to use for performing a direct excisional procedure or cryotherapy as a “see and treat” method at this cutoff point, avoiding the need for cervical biopsy for histopathological confirmation. Conclusion: Swede score performed well in this hospital-based study on a selected population coming to gynecology OPD with complaints of lower abdominal pain, discharge per vaginum, dyspareunia, abnormal uterine etc. referred to the colposcopy clinic in view of unhealthy- looking suspicious cervix.

The impact of the CervicalCheck controversy on provision of colposcopy services in Ireland: A cohort study

ObjectivesIn 2018, an inquiry into the Irish Cervical Cancer screening programme (CervicalCheck) was initiated, following publicised cases of non-disclosure regarding internal audit results of cytology screening in women diagnosed with cervical cancer. The inquiry attracted widespread media coverage and the government offered women free, out of programme screening. We investigated whether the controversy led to an increase in referrals based on clinical suspicion and the impact on waiting times for abnormal cytology. Study designA retrospective cross-sectional analysis was performed, including all colposcopy referrals to The National Maternity Hospital, Dublin, before (March 2016–2018) and after (March 2018–2020) the media coverage. Chi-squared (χ2) and independent one-tailed t-tests were used to perform between-group analyses. ResultsPost-controversy, suspicious cervix referrals increased (10.1 %–14.2 %; p = 0.037 × 10−27), as did colposcopic impression of CIN (p = 0.000000016). While an increase in CIN1 histology (18.5 %–30.3 %) was diagnosed, a decrease in high-risk CIN2 (10 % to 8.6 %), CIN3 (6.2 % to 2.9 %), AIS (1.2 % to 0.3 %) and invasive cancer (2.8 % to 1.2 %; p = 0.0058 × 10−9) were diagnosed. Across all grades of cytological abnormality, significantly fewer patients were reviewed in the recommended waiting time post-controversy. Half of delayed abnormal cytology referrals had high-grade changes. ConclusionsThis study highlights the profound impact that the CervicalCheck Controversy had on the women attending colposcopy and clinicians performing the screening tests, and the direct impact on women with confirmed cytological abnormalities. The increase in suspicious cervix referrals reflects a lack of confidence in both clinical practice and screening test results. The importance of public trust in the effective delivery of screening services cannot be ignored. Increased resources are required to ensure all women are seen within recommended time frames. Heightened anxiety and increased surveillance does not necessarily lead to better clinical outcomes for patients but can result in unnecessary distress for low-risk patients and delays to diagnosis for high-risk patients with concerning abnormalities.

COLOPOSCOPY AND OFFICE HYSTEROSCOPY FOR CERVICAL ASSESSMENT FOR EVALUATION OF SUSPICIOUS CERVIX

Background: Cervical cancer is the second most common cancer among women in developing countries. Cervical cancer is a deadly disease once it reaches the invasive stages but out of all the female genital tract cancers. It is the only preventable cancer if detected in its early stages, and the disease is almost 100% curable with accurate screening and early detection. Objective: To evaluate efficacy of both office cervicoscopy and colposcopy directed biopsy in evaluation of clinically suspicious cervix. Patients and methods: Prospective cohort study on 200 patients with clinically suspicious cervix attending the outpatient Department of Obstetrics and Gynecology, at the Hospital of Al-Azher Assiut University. Results: Colposcopy had a sensitivity of 60% and a specificity of 91.1%. Office cervicoscopy showed a sensitivity of 75% and a specificity of 89.3%. Conclusions: Office cervicoscopy is more sensitive than stationary colposcopy for detection of cervical lesions in cases with suspicious cervix as an example of high risk group for cervical cancer. Its small caliber allows easy, simple and fast diagnostic out-patient evaluation of the cervix.

Office Cervicoscopy versus Colposcopy for Evaluation of Suspicious Cervix ‎in Assiut Governorate

Background: In developed countries, cervical cancer is the second most prevalent cancer between females. When it enters the invasive phase, but outside of all female genital tract cancers, cervical cancer is a deadly disease. If diagnosed in its early stages, it is the only preventable cancer, and the disease is almost 100% curable with accurate screening and early detection. The aim of the work: To determine the effectiveness of both office cervicoscopy and colposcopy-directed biopsy in the assessment of clinically suspicious cervix. Patients and Methods: A prospective randomized controlled study, held on 200 patients randomly selected used closed envelopes with clinically suspicious cervix attending the outpatient clinic of Obstetrics and Gynecology Department, Al-Azhar University Hospital [Assiut]. Results: In case of inflammatory cases, the sensitivity with the pathology results were 97.7%, and 98.1% for colposcopy and office cervicoscopy respectively and specificity were 84.3%, and 94.7% for colposcopy and office cervicoscopy respectively. In case of abnormal vasculature, the sensitivity with the pathology results were 33.3%, and 85% for colposcopy and officecervicoscopy respectively and specificity were 80%, and 94.4% for colposcopy and office cervicoscopy, respectively. Conclusion: Colposcopy and office cervicoscopy have the same sensitivity and specificity for the detection of cervical polyps. But, in case of inflammatory and abnormal vasculature, office cervicoscopy was more sensitive with higher specificity than colposcopy more over office cervicoscopy had a great benefit in the assessment of endocervical canal and uterine cavity so, office cervicoscopy and colposcopy are complementary to each other.

ROLE OF CYTOLOGY AND COLPOSCOPY DIRECTED BIOPSY IN EVALUATION OF CLINICALLY SUSPICIOUS CERVIX

Background: Cervical cancer is the second most common cancer among women in developing countries. Cervical cancer is a deadly disease once it reaches the invasive stages but out of all the female genital tract cancers, it is the only preventable cancer if detected in its early stages and the disease is almost 100% curable with accurate screening and early detection. Traditional screening for cervical cancer is done with papanicolaou smear test, colposcopic examination and colposcopic directed biopsy for histopathology. Obejective: To evaluate efficacy of both cytology and colposcopy directed biopsy in evaluation of clinically suspicious cervix. Patients and Methods: Cross sectional study on 300 patients with clinically suspicious cervix attending the outpatient Department of Obstetrics and Gynecology, at the Hospital of Al-Azher Assiut University. Results: Pap smear had a sensitivity of 25.5% and a specificity of 87% which was attributed to the high number of false negative smears. Accuracy of pap smear was 76.7%. Colposcopy showed a sensitivity of 82% and a specificity of 81%. Sensitivity was more than pap smear but specificity was less than pap smear. * Accuracy of colposcopy was found to be 81% which was comparatively more than that of pap smear (77%). Conclusion: It is evident that colposcopy is definitely more sensitive and accurate than pap smear. By combining pap smear with colposcopy, we can maximize the sensitivity and specificity of cancer cervix screening. Both the result of cytology and colposcopy should be compared to those of histopathology, that histopathology remain the main method of diagnosing the precursors of neoplastic cervical lesion.

ROLE OF CYTOLOGY AND COLPOSCOPY DIRECTED BIOPSY IN EVALUATION OF CLINICALLY SUSPICIOUS CERVIX

Background: Cervical cancer is the second most common cancer among women in developing countries. Cervical cancer is a deadly disease once it reaches the invasive stages but out of all the female genital tract cancers, it is the only preventable cancer if detected in its early stages and the disease is almost 100% curable with accurate screening and early detection. Traditional screening for cervical cancer is done with papanicolaou smear test, colposcopic examination and colposcopic directed biopsy for histopathology. Obejective: To evaluate efficacy of both cytology and colposcopy directed biopsy in evaluation of clinically suspicious cervix. Patients and Methods: Cross sectional study on 300 patients with clinically suspicious cervix attending the outpatient Department of Obstetrics and Gynecology, at the Hospital of Al-Azher Assiut University. Results: Pap smear had a sensitivity of 25.5% and a specificity of 87% which was attributed to the high number of false negative smears. Accuracy of pap smear was 76.7%. Colposcopy showed a sensitivity of 82% and a specificity of 81%. Sensitivity was more than pap smear but specificity was less than pap smear. * Accuracy of colposcopy was found to be 81% which was comparatively more than that of pap smear (77%). Conclusion: It is evident that colposcopy is definitely more sensitive and accurate than pap smear. By combining pap smear with colposcopy, we can maximize the sensitivity and specificity of cancer cervix screening. Both the result of cytology and colposcopy should be compared to those of histopathology, that histopathology remain the main method of diagnosing the precursors of neoplastic cervical lesion.

Diagnosing Cervical Lesions Through LLETZ – A Reliable and Effective Tool

Background: Cervical dysplasia is the most common gynecological disorder of modern era. It initiates around the squamocolumnar junction of the cervix commonly due to the infection of human papilloma virus. Large loop excision of transitional zone is globally a standard procedure of choice both for diagnosing and treating cervical dysplasia. Pap smear is a fast and easy assessment tool for detecting cervical lesions, but it is relatively unreliable.
 Methodology: Fifty patients of age group 35 to 65 years patients having normal looking cervix with abnormal pap smear or suspicious looking cervix with or without abnormal pap smear, were selected for the study after informed consent. The procedure for LLTEZ was performed under strict aseptic measures in the procedural room and the biopsy specimen was sent for histopathological examination. The pathological findings were presented as percentages.
 Results: 66% cervical biopsy specimens were suggestive of chronic cervicitis and 24% samples were suggestive of chronic cervicitis with squamous metaplasia. Mild dysplasia in 4% samples, moderate and severe dysplasia were seen in 2% samples.
 Conclusion: LLETZ is an efficient procedure to deal with cervical dysplasia. It must be recommended for the work-up of uncertain gynecological presentations. The expertise of professionals must be improved through training to obtain maximum benefits.

Office Cervicoscopy versus Stationary Colposcopy in Suspicious Cervix: A Randomized Controlled Trial.

Study Objective:The objective of the study was to estimate the diagnostic accuracy and doctor satisfaction of small caliber office cervicoscopy versus stationary colposcopy in diagnosis of ectocervical as well as endocervical lesions in women clinically presented with suspicious cervix.Patients and Methods:Eligible 112 cases with clinically suspicious cervix were randomized into Group A (56 cases) and Group B (56 cases) who were subjected to small caliber office cervicoscopy and stationary colposcopy, respectively. The outcome was the diagnostic accuracy and safety of both tools for detection of ectocervical and endocervical cervical lesions.Results:There was no statistically significant difference between both groups regarding parity, previous abortion, age at marriage, duration of marriage, and age at menarche and menopause. On unaided naked eye examination of the cervix (UNEE), there were no statistically significant differences between both groups. Diagnostic indices were similar in both groups apart from the finding that office cervicoscopy was more sensitive for detection of endocervical abnormalities. Doctors were significantly more satisfied with stationary colposcopy than office cervicoscopy.Conclusions:Office cervicoscopy is a good complementary tool added to stationary colposcopy for detection of cervical lesions in cases with suspicious cervix as an example of high-risk group for cervical cancer. Due to its small caliber, cervicoscopy offers a better evaluation of the endocervical canal, especially in cases of Type 2 and 3 transformation zone with a possibility of examination of the endometrial cavity.

Office cervicoscopy versus stationary colposcopy in cases with suspicious cervix: a randomized controlled trial

Office cervicoscopy versus stationary colposcopy in cases with suspicious cervix: a randomized controlled trial

Urine test for HPV genotypes as a predictor of precancerous cervical lesions and for cervical cancer screening.

To assess the sensitivity of a urine test for high-risk HPV DNA genotypes in the detection of high-grade squamous intra-epithelial lesion (HSIL) and its correlation with pathologic precancerous lesions. The present prospective cross-sectional study included women referred to Kasr AlAiny Medical School, Cairo, Egypt, for cervical smear anomalies, a history of cervical smear anomalies, or for suspicious cervix between May 1, 2015, and April 30, 2017. Paired urine tests and cervical smears were performed. HPV DNA was detected in urine using polymerase chain reaction and cervical smears were performed with a cervical spatula and a cytobrush. Agreement between urine test results and pathology was examined. In total, 1375 women were included. Urine test for high-risk HPV DNA demonstrated 97.8% (95% confidence interval [CI] 92.1%-99.7%) sensitivity and 100% (95% CI 99.7%-100.0%) specificity for HSIL. Overall, 87 women had a positive urine test for high-risk HPV; of these, 82 (94.3%, 95% CI 87.1%-98.1%) had pathologic findings of cervical intra-epithelial neoplasia 2 or 3 (CIN2/3). Similarly, 89 women had HSIL cytology; again, 82 had CIN2/3 (92.1%; 95% CI, 84.3%-96.4%). There was good agreement between a positive urine test for high-risk HPV DNA genotypes and pathologic findings of CIN2/3.

Abstract 3744: Office cervicoscopy in the diagnosis of HPV infection

Abstract Introduction: Since the association between certain oncogenic (high-risk) strains of HPV and cervical cancer is well established. Searching for HPV became a basic step in all screening programs. Laboratory HPV testing is costly and unavailable in developing countries. Objective: To compare the diagnostic indices of office cervicoscopy against cytology and punch biopsy for detection of underlying HPV lesions in women with suspicious cervix. Design: An analytic cross-sectional research design Setting: Early cervical cancer Detection Unit of the Women's Health University Hospital. Assiut, Egypt. Patients and methods: A total of 274 non-pregnant women with clinical diagnosis of suspicious cervix were included in this study. After cervical smearing with Ayre's spatula, they were subjected to cervicoscopy utilizing 2.6 mm telescope and a 3.2 mm outer sheath office hysteroscope. Evaluation of the vulva, vagina, ectocervix, endocervical canal and the endometrial cavity were done. The cervix was then painted with saline, acetic acid and Schiller's iodine stains successively as used during colposcopic examination. Abnormal lesions were biopsied using punch biopsy forceps. Cytologic evaluation relied on both classic and non-classic (secondary) criteria for the diagnosis of HPV including "mild koilocytosis," mild dyskeratocytosis," hyperchromatic nuclei, bi- and multinucleation, and cleared cytoplasm. Punch biopsies were taken from every case based on cervicoscopic localization after staining. Results:. The main complaint was abnormal vaginal discharge in 197 cases (71.4%) . Pap smear sampling was negative for HPV in 188 cases (68.6%) and positive in 86 cases (31.4%). Cervicoscopic findings suggestive of HPV infection were positive in 77 cases ( 28.1% ) and negative in 197 cases (71.9% ). Gold stand histopathology diagnosed HPV in 53 cases only (19.3%). All diagnostic indices of cervicoscopy significantly improved after combination with cytology positive results except false positive results.. Conclusions: Cervicoscopy as a simple, cheap and office procedure can be used as a quick screening tool of HPV infection in women with suspicious cervix. It has the advantage of screening of the rest of the genital tract. In the absence of laboratory HPV testing, cervicoscopy in conjunction with cytology screening of high-risk cases should be encouraged. Note: This abstract was not presented at the meeting. Citation Format: Atef Darwish. Office cervicoscopy in the diagnosis of HPV infection [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2017; 2017 Apr 1-5; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2017;77(13 Suppl):Abstract nr 3744. doi:10.1158/1538-7445.AM2017-3744

Experience with colposcopy at Aminu Kano Teaching Hospital, Kano, North-Western Nigeria

Background: The first 2 years' experience of a colposcopy clinic at our teaching hospital was analyzed. Establishment of the clinic was supervised by consultants trained in colposcopy. Objective: To review the performance of the clinic from its inception in 2010. Materials and Methods: A study of 90 patients who were referred for colposcopy was conducted. Data were extracted from patients' folders and records in the colposcopy and histopathology register and analyzed using EPI INFOTM 7. Results: Fifty-one women were referred on account of abnormal Papanicolaou (Pap) smears indicating either low grade squamous lesion (44%) or high grade lesion (12.2%). Thirteen patients (14.4%) had persistent inflammatory smears while 26 patients (28.9%) where referred on account of suspicious cervix. Abnormal colposcopic findings were reported in 48 patients who subsequently had colposcopically directed punch biopsy. The result of the biopsy showed that 18 patients had cervical intraepithelial neoplasia (CIN) I. Only two of these had high grade lesion; the remaining had low grade lesion (81% concordance). Nineteen women had either CIN II or CIN III. Only two cases were reported as low grade lesions and one case as suspected invasive cervical cancer on colposcopy. The remaining had high grade lesion (85% concordance %). Overall, the colposcopic impression was in agreement with the histological diagnosis in 87% of the cases. Conclusion: Our initial experience with colposcopy shows good correlation/agreement between colposcopic impression and histological diagnosis. This has improved the detection rate of premalignant and malignant disease of the cervix in our center.

English

INTRODUCTION: Cytology, today, is widely used for detection of lesions in the cervix. The realization that invasive cancer of the cervix is preceded by recognizable precancerous histological and cytological changes was one of the most basic contributions that aroused greater interest in the possibility of preventing cancer by early cytological detection. OBJECTIVE: The objective of the study is to investigate the incidence of different epithelial abnormalities of the cervix in menopausal and perimenopausal women and compare them with the incidence found in reproductive age group. METHODOLOGY: It is a cross sectional observational study. This study was undertaken to study the cytological features of various lesions in the uterine cervix of different age group patients attending the Gynecological out-patient department of Aparna Maternity and General Hospital, Nagole, Hyderabad from January 2011 to January 2013. INCLUSION CRITERIA: Women of reproductive, perimenopausal (from 40 years) and menopausal age group coming to Out Patient Department for Gynecological checkup. EXCLUSION CRITERIA: Women with following history were excluded from the study: Menstruating / active vaginal bleeding, Inaccessible cervix (due to cervical stenosis or cervix is in flush with vagina), Pregnant women, Hysterectomized women. RESULTS: In this study, satisfactory cervical smear for evaluation were obtained in 953 cases (95.3%). These smear contained squamous epithelial cells spreaded over more than 10% of the slide surface and there were accompanied endocervical cell clusters. In 42 cases (4.2%), the cervical smears were satisfactory, but limited by lack of an endocervical component. In the remaining five patients (0.5%), the cervical smears were sparsely cellular and obscured by blood and mucinous material. In these five cases, smears were unsatisfactory for evaluation. The study shows the incidence of the clinical lesions in the female genital tract. The incidences of SIL and Frank cancer are, highly associated with the suspicious cervix of about 21 %. CONCLUSION: The present study reveals the incidence of different epithelial abnormalities of the cervix in menopausal women compared there with incidence found in women of reproductive age. The present study revealed a high incidence of LSIL and Frank cancer in Menopausal women. Both SIL and cervical carcinoma are associated with multiparity and were commonly observed in women with suspicious cervix and those presenting with bleeding problems. Hence to conclude, cytological screening is mandatory for early detection of SIL, treatment of which would assist in checking in progression of the diseases.

Clinical validation of high risk HPV DNA testing versus ThinPrep cytology for primary cervical cancer screening

Abstract Objective(s) To compare the validity of the high risk HPV DNA testing using the hybrid capture II technique (HC-II) to ThinPrep cytology for primary cervical cancer screening. Design Cross sectional pilot study. Setting Department of Obstetrics and Gynecology, Taiba Hospital, Sabah Al Salem, Kuwait. Methods Consecutive 1923 cervical smear samples were taken for ThinPrep cytological screening and hr-HPV DNA testing using HC-II assay. Histological diagnoses were obtained from a total of 426 women who had positive results on screening and a group of women with negative screening and suspicious cervix underwent colposcopy and directed biopsies, and those with cervical precancerous lesions or cancer received appropriate treatment. Main outcome measures Sensitivity, specificity, positive predictive value and negative predictive value of screening methods. Results HPV was found positive in 15.5% of cases. 19/22 cases (86.4.1%) with a biopsy diagnosis of CIN2+ had a HC-II positive test. For CIN3, HC-II was positive in all cases (100%). Assuming a similar specificity level, the relative sensitivity of the HC-II test was higher when histologically confirmed high grade lesions (CIN2+ or CIN3+) were observed. HC-II test had the best sensitivity when defining cases as CIN2+ or CIN3+ (98.7% and 100%, respectively). When using the ASCUS+ cytological cutoff, the differences in CIN2+ and CIN3+ sensitivity between HC-II test and ThinPrep cytology were statistically not significant. Specificity of the ThinPrep cytology for any low and high grade histological lesions was clearly >95% when cytological diagnosis LSIL+ cutoff was used and nearly 100% when HSIL+ cutoff was used. All these specificity estimates were high compared with HC-II test. The specificity of the ThinPrep cytology decreased with about 10% when ASCUS+ was the cutoff. At cutoff ASCUS+, specificity of HC-II was comparable or only slightly lower than with ThinPrep ASCUS+ cytology with no statistically significant differences. Conclusions ThinPrep smears and hr-HPV DNA detection by HC-II performed very well with regard to identifying high grade lesions. HPV DNA testing is a promising new technology for cervical cancer prevention and can be used for primary screening in conjunction with cervical cytology for women aged 30 years and older.

AgNOR Count and its Correlation with Colposcopy in Suspicious Cervix

To evaluate the correlation of AgNOR count and colposcopy in cases of suspicious cervix. A hundred women presenting in OPD with complaints of postcoital bleeding, discharge per vaginum, pain in the lower abdomen, or intermenstrual bleeding were subjected to colposcopy. After colposcopy, a cervical biopsy was done. Routine paraffin sectioning was done for these biopsy specimens. Histopathologic diagnosis was first established on these sections using the routine (H & E) stain. Then, further sections were cut from prepared blocks and were subjected to AgNOR staining technique. AgNOR count was taken as the mean number of black dots per 100 cells observed under a 100× oil immersion objective. In our study, 60% cases were colposcopy positive and 40% were colposcopy negative. The sensitivity of colposcopy in diagnosing all grades of dysplasias was 95.4% and the specificity was 67.86% in our study. The positive predictive value was 70% and the negative predictive value was 95%. The mean AgNOR score in our study was 1.21±0.51 in chronic cervicitis, 2.44±0.56 in mild dysplasia, 3.48±0.35 in moderate dysplasia, and 4.58±0.43 and 5.91±0.51 in squamous cell carcinoma, showing a progressive increase in the score. AgNOR count showed an increase from CIN to SCC in our study. The correlation coefficient between the colposcopy and AgNOR count found in our study is 0.892 and p value is <0.0001 which is highly significant. The results of the colposcopy and AgNOR when used together can provide strength to the clinician and histopathologist in diagnosing early carcinoma in cases of suspicious cervix.

The Clinically Suspicious Cervix-How Often Is It Cancer?

To evaluate the outcome of women referred to colposcopy with the clinical finding of suspected cancer ("clinically suspicious cervix"). A prospective cohort study of women referred to a dedicated colposcopy clinic serving a regional population with a clinically suspicious cervix was conducted. All referral letters were reviewed, and women were identified prospectively when the letter stated "referral for a clinically suspicious cervix." Relevant data were collected subsequently by case note review. One hundred four women were identified, and 95 attended for colposcopy from September 2006 to January 2008. Nine women defaulted. Seventy-six (80%) had a normal cervix or a benign cervical pathological result. Cervical intraepithelial neoplasia was detected in 15 patients (16%), and only 4 women (4%) had invasive cancer confirmed. We believe that women referred with a clinically suspicious cervix should be assessed in a general gynecology clinic rather than colposcopy because most will not have cancer. The small number of women with a clinical cancer can then be referred onto colposcopy, whereas women with benign pathological result can be treated appropriately in the general clinic.