Transformation Zone Component Research Articles

Does Absence of Transformation Zone Component in Anal Cytology Sample Affects Detection of Squamous Intraepithelial Lesions?

Does Absence of Transformation Zone Component in Anal Cytology Sample Affects Detection of Squamous Intraepithelial Lesions?

Management of Cervical Stenosis - Mechanical Dilatation Adjunct with Hormonal Therapy

Madam C was a 39-year-old primiparous lady having history of one IVF pregnancy delivered by Caesarean section (CS). She was found cervical intra-epithelial neoplasia (CIN) 2-3 with loop electro-excision procedure (LEEP) performed 6 months after her delivery while she was still breastfeeding. 1.8cm-thick, 2cmwide cervix was resected and diagnosed CIN 1. Two 6-monthly cervical smears were negative for CIN in the presence of transformation zone component. She presented to us 17 months after LEEP for severe lower abdominal pain which required pethidine for relief. She experienced hypomenorrhea with mainly brownish spotting, and intermenstrual spotting and dyspareunia since returning of menses 9 months after LEEP. Physical examination showed cervix was flushed with vault. Transabdominal (TAS) and transvaginal ultrasound scans (TVS) showed enlarged uterine cavity and endocervical canal filled with blood, up to 3.64cm. The clinical diagnosis was haematometra due to cervical stenosis after LEEP.

Performance of Transformation Zone and Nucleated Squamous Cell Component in Anal Cancer Screening in Correlation with Histologic Follow-up: An Institutional Experience

Performance of Transformation Zone and Nucleated Squamous Cell Component in Anal Cancer Screening in Correlation with Histologic Follow-up: An Institutional Experience

Absence of Endocervical / Transformation Zone Component in Cervical Papanicolaou Smears in Northeastern Region of Peninsular Malaysia: Prevalence and Risk Factors

Background:Negative result from a satisfactory Papanicolaou (Pap) smear without endocervical cells and transformation zone (EC/TZ) components does not increase the chances of cervical cancer. However, a preparation of without EC/TZ components cannot rule out cervical cancer. Therefore, we aimed to study the factor associated with absence of EC/TZ components in Pap smear in Pasir Puteh District.Materials and Methods: A comparative cross-sectional study between groups of presence and absence of EC/TZ components in Pap smear test results was conducted among 114 samples of Pap smear screening who fulfilled study criteria in Pasir Puteh district, Kelantan state of Malaysia. Data were collected from Pap smear registry between 15th December 2019 and 15thJanuary 2020. Descriptive statistics, simple and multiple logistic regressions were used for data analysis.Results and Discussion: The prevalence of Pap smear samples with absence of EC/TZ components was 14.2% (95%CI: 0.11, 0.16). Multiple variable analysis using multiple logistic regression revealed BMI and nurses’ working duration as the significant factors associated with absence of EC/TZ components with an adjusted odds ratio (AOR) of 1.08 (95%CI:1.01, 1.16); p<0.05) and 0.85 (95%CI:0.76, 0.96; p<0.05) respectively.Conclusion:Majority of cervical cancer lesion happened in EC/TZ zone. Therefore, it is important to make sure staffs who conduct Pap smear test have received adequate training and used good sampling equipment in difficult patient to ensure the yield of the smear is satisfactory with presence of EC/TZ zone.International Journal of Human and Health Sciences Vol. 04 No. 03 July’20 Page : 178-183

Presencia del componente de la zona de transformación del cuello uterino en citologías anormales en la Clínica de Maternidad Rafael Calvo de Cartagena (Colombia) entre 2009 y 2012

Introducción: se ha determinado que es más probable la detección de lesiones de alto grado del cuello uterino en extendidos citológicos con presencia de componente de la zona de transformación; no obstante, la relación entre las tasas de muestreo de esta zona y la detección de alteraciones citológicas es controversial. Objetivo: determinar la presencia del componente de la zona de transformación en citologías cervicales convencionales anormales. Materiales y métodos: se realizó un estudio de corte transversal de todos los extendidos cervicovaginales anormales de la Unidad de Patología Cervical de la E.S.E. Clínica de Maternidad Rafael Calvo de Cartagena (Colombia) entre 2009 y 2012. Se realizó una segunda lectura de la presencia de componente de la zona de transformación y su coexistencia con células anormales en el mismo campo microscópico, a diferentes aumentos, comparando la concurrencia de ambos tipos celulares en lesiones intraepiteliales escamosas de alto y bajo grado. Resultados: se incluyeron 1.287 citologías anormales, 74,7% con componente de la zona de transformación. A mayor grado de lesión se encontró mayor porcentaje de extendidos con dicho componente. La coexistencia de células endocervicales y anormales en el mismo campo microscópico fue mayor en las lesiones de alto grado en comparación con las de bajo grado (p=0,000, X2). Conclusiones: hay mayor frecuencia de extendidos citológicos anormales con presencia de células de la zona de trasformación del cérvix. Su presencia es más frecuente en los extendidos con lesiones de alto grado, donde las células endocervicales o metaplásicas se encuentran íntimamente relacionadas con las anormales.

The value of a transformation zone component in anal cytology to detect HSIL.

In a cytology-based screening program intended to prevent anal cancer, the anal transformation zone (TZ) should be adequately sampled because it is the site most susceptible to the development of the cancer precursor, high-grade squamous intraepithelial lesion (HSIL). An adequate TZ component is defined as comprising at least 10 rectal columnar or squamous metaplastic cells. In the current study, the authors examined whether the presence of a TZ component in anal cytology correlated with the detection of histological HSIL. In a natural history study of anal human papillomavirus infection in homosexual men, all participants underwent liquid-based cytology and high-resolution anoscopy (HRA) with or without biopsy at each visit. True-negative cytology (negative cytology with non-HSIL biopsy or negative HRA), false-negative cytology (negative cytology with HSIL biopsy), and true-positive cytology (abnormal cytology with HSIL biopsy) were compared with regard to the presence or absence of a TZ component. Of 617 participants, baseline results included 155 true-positive results, 191 true-negative results, and 31 false-negative results. The absence of an adequate TZ component was found to be significantly higher for false-negative (32.3%) than for either true-positive (11.0%; P = .0034) or true-negative (13.1%; P = .0089) results. Significantly more false-negative cases lacked a TZ component compared with either true-positive or true-negative cases. TZ cells may be an important indicator of sample quality for anal cytology because, unlike cervical sampling, the anal canal is not visualized during cytology sampling. Cancer Cytopathol 2016;124:596-601. © 2016 American Cancer Society.

Developing Guidelines for Cervical Cancer Prevention in the Face of Diagnostic Complexity

Adoption of new cervical cancer screening guidelines by the American Cancer Society and others in 2012 required new guidelines for the management of abnormal screening and follow-up tests. The American Society for Colposcopy and Cervical Pathology led a consensus conference including 26 professional organizations and agencies that developed new management guidelines. These guidelines are risk-based and derive from analysis of approximately 1.4 million women screened by the Kaiser Permanente Northern California medical group, with risk assessment in collaboration with NCI. New guidelines provide guidance for the conservative management of young women, for women with unsatisfactory Papanicolaou (Pap) tests and tests with limited transformation zone component, for women with discordant Pap and human papillomavirus (HPV) co-testing results, and for the incorporation of HPV 16/18 genotyping results into management decisions. The increasing number of available tests and the increasingly nuanced understanding of risk mean that clinicians will need to offset the complexity of diagnostic and treatment algorithms with technology and specialization.

Reprocessing unsatisfactory ThinPrep papanicolaou tests using a modified SurePath preparation technique.

The frequency of unsatisfactory gynecologic specimens has increased in the study laboratory over the last few years due to the advent of personal lubricants. Similarly, lysed blood, protein, and necrotic debris present a challenge in terms of negative cell transference caused by a clogged filter. In the current study, the authors evaluated the potential use of a modified SurePath reprocessing technique to decrease the frequency of unsatisfactory specimens. An aliquot for human papillomavirus testing was set aside and the remaining specimen in the ThinPrep vial was submitted for sedimentation. A methanol wash was performed using preservative that was added to the remaining sediment. The specimen was vortexed and a protein wash of Tris-buffered deionized water was added before processing. The specimens were stained using the ThinPrep staining protocol. Both the original specimen and the reprocessed specimens were manually reviewed by 1 cytotechnologist and 2 pathologists to determine specimen adequacy. A total of 1937 ThinPrep Papanicolaou tests were reprocessed and examined. Of these, 1093 (56%) specimens were satisfactory, 624 of which (57%) demonstrated evidence of a transformation zone component. Epithelial cell abnormalities were identified in 116 specimens (10.6%), including 11 high-grade squamous intraepithelial lesion specimens (1.0%); 5 specimens with a classification of atypical squamous cells, cannot rule out a high-grade lesion (0.5%); 21 low-grade squamous intraepithelial lesion specimens (1.9%); and 79 specimens classified as atypical squamous cells of undetermined significance (7.2%). The modified SurePath processing technique was adept at handling nearly all of the challenges that biological and environmental conditions (blood, protein, lubricant, etc) present in liquid-based filter preparations. A total of 1093 (56%) of 1937 unsatisfactory ThinPrep Papanicolaou tests were converted to a satisfactory state, resulting in 116 abnormalities (10.6%) being diagnosed that otherwise would have gone undetected

2012 Updated Consensus Guidelines for the Management of Abnormal Cervical Cancer Screening Tests and Cancer Precursors

A group of 47 experts representing 23 professional societies, national and international health organizations, and federal agencies met in Bethesda, MD, September 14-15, 2012, to revise the 2006 American Society for Colposcopy and Cervical Pathology Consensus Guidelines. The group's goal was to provide revised evidence-based consensus guidelines for managing women with abnormal cervical cancer screening tests, cervical intraepithelial neoplasia (CIN) and adenocarcinoma in situ (AIS) following adoption of cervical cancer screening guidelines incorporating longer screening intervals and co-testing. In addition to literature review, data from almost 1.4 million women in the Kaiser Permanente Northern California Medical Care Plan provided evidence on risk after abnormal tests. Where data were available, guidelines prescribed similar management for women with similar risks for CIN 3, AIS, and cancer. Most prior guidelines were reaffirmed. Examples of updates include: Human papillomavirus-negative atypical squamous cells of undetermined significance results are followed with co-testing at 3 years before return to routine screening and are not sufficient for exiting women from screening at age 65 years; women aged 21-24 years need less invasive management, especially for minor abnormalities; postcolposcopy management strategies incorporate co-testing; endocervical sampling reported as CIN 1 should be managed as CIN 1; unsatisfactory cytology should be repeated in most circumstances, even when HPV results from co-testing are known, while most cases of negative cytology with absent or insufficient endocervical cells or transformation zone component can be managed without intensive follow-up.

2012 Updated Consensus Guidelines for the Management of Abnormal Cervical Cancer Screening Tests and Cancer Precursors

A group of 47 experts representing 23 professional societies, national and international health organizations, and federal agencies met in Bethesda, MD, September 14-15, 2012, to revise the 2006 American Society for Colposcopy and Cervical Pathology Consensus Guidelines. The group's goal was to provide revised evidence-based consensus guidelines for managing women with abnormal cervical cancer screening tests, cervical intraepithelial neoplasia (CIN) and adenocarcinoma in situ (AIS) following adoption of cervical cancer screening guidelines incorporating longer screening intervals and co-testing. In addition to literature review, data from almost 1.4 million women in the Kaiser Permanente Northern California Medical Care Plan provided evidence on risk after abnormal tests. Where data were available, guidelines prescribed similar management for women with similar risks for CIN 3, AIS, and cancer. Most prior guidelines were reaffirmed. Examples of updates include: Human papillomavirus-negative atypical squamous cells of undetermined significance results are followed with co-testing at 3 years before return to routine screening and are not sufficient for exiting women from screening at age 65 years; women aged 21-24 years need less invasive management, especially for minor abnormalities; postcolposcopy management strategies incorporate co-testing; endocervical sampling reported as CIN 1 should be managed as CIN 1; unsatisfactory cytology should be repeated in most circumstances, even when HPV results from co-testing are known, while most cases of negative cytology with absent or insufficient endocervical cells or transformation zone component can be managed without intensive follow-up.

Causes and Relevance of Unsatisfactory and Satisfactory but Limited Smears of Liquid-Based Compared With Conventional Cervical Cytology

Recent randomized controlled trials have shown a significant decrease in unsatisfactory rates for liquid-based cytology (LBC) compared with conventional Papanicolaou test (CP). The underlying causes and relevance of unsatisfactory results for LBC and CP have never been compared within the setting of a randomized controlled trial. To examine differences in causes and relevance of unsatisfactory and satisfactory but limited by (SBLB) results for LBC and CP. Data from the Netherlands ThinPrep Versus Conventional Cytology (NETHCON) trial were used, involving 89 784 women. Causes and relevance of unsatisfactory and SBLB results were analyzed. The primary cause for unsatisfactory results for CP and LBC was scant cellularity. Other causes for unsatisfactory CPs were virtually eliminated with LBC. The same was true for SBLB subcategories, with the exception of SBLB absence of transformation zone component and SBLB scant cellularity. The SBLB absence of transformation zone component showed a statistically significant 22% and SBLB scant cellularity a 12% nonsignificant increase with LBC. The detection rates of abnormalities found during 18 months of follow-up of unsatisfactory test results did not differ significantly between the 2 study arms, nor did they differ from the initial test positivity rates from the NETHCON trial. Liquid-based cytology shows an almost complete elimination of most causes for unsatisfactory CP, with scant cellularity remaining as the sole cause for unsatisfactory LBC. On the other hand, with LBC a significant increase of smears without a transformation zone component was noted. Women with an unsatisfactory test result are not at increased risk for cervical abnormalities either with LBC or with CP. Nederlands Trial Register, NTR1032, www.trialregister.nl .

Dissemination of Lean Methods to Improve Pap Testing Quality and Patient Safety

To determine if the implementation of Lean methods resulted in improved Pap test quality and diagnostic accuracy in 5 clinician practices. We performed a 1-year case-control study that included 5,384 control (preintervention) and 5,442 case (postintervention) women who had a Pap test procured by 1 of 5 clinicians. Using Lean methods, the clinicians increased their focus of Pap test procurement by creating a "one-by-one" workflow and recorded process completion using a Lean checklist. We compared the case and control Pap test quality and accuracy measures using the proportion of Pap tests lacking a transformation zone component, proportion of unsatisfactory Pap tests, frequency of newly detected cervical intraepithelial neoplasia following a previous benign Pap test, and proportion of Pap tests with a diagnosis of atypical squamous cells of unknown significance. After the intervention, there was a statistically significant decrease in the mean proportion of Pap tests lacking a transformation zone component, p =.011. Two of 5 clinicians showed a statistically significant decrease in their unsatisfactory Pap test frequency, although the overall Pap test unsatisfactory frequency for the case group was not statistically significant lower, p =.087. The case group showed a 114% increase in newly detected cervical intraepithelial neoplasia following a previous benign Pap test, p =.004. There was no statistically significant difference for the proportion of Pap tests with a diagnosis of atypical squamous cells of unknown significance, p =.908. Disseminating Lean methods across a group of clinicians resulted in improved Pap test quality and diagnostic accuracy.

P‐4 TRANSFORMATION ZONE COMPONENT IN LIQUID BASED CERVICAL CYTOLOGY

Introduction: Quality assurance guidelines for the UK cervical screening programme recommend that more than 80% of cervical samples from women aged 20–50 years should contain adequate numbers of Transformation zone (TZ) cells i.e. 10 or more endocervical or squamous metaplastic cells. This study was conducted to assess the frequency of TZ component in Liquid Based Cytology (LBC) both for ThinPrep (TP) and SurePath (SP) LBC. Also to assess the degree to which this is recorded by individual screeners and to determine the percentage of samples with evidence of TZ component for the different smear takers.Method: All LBC cervical specimens received at a tertiary cytology centre in the year 2004 from women aged 20–50 years were included in the study. Evidence of TZ sampling was recorded as: TP = TZ present (10 or more TZ cells)TA = TZ absentTS = TZ scanty (less than 10 TZ cells)TN = atrophic smears, TZ cells not recognisableResults: The total number of LBC cervical cases was 7445. TP = 4300 (mostly primary care) and SP = 3145 (mostly colposcopy). Overall TZ sampling rate in LBC was 82%. TP = 77.17%; SP = 88.24%. When scanty TZ was included, the standard was met for both systems (TP = 93.7%; SP = 88.24%). Presence/absence of TZ component was recorded in 6370 cases (85.1%); range 0%–97.79%. 56.7% of smear takers achieved the minimum standard for TZ sampling.Discussion: The percentage of ThinPrep samples containing adequate TZ cells was 77.17% compared to SurePath, which was 88.24%. This may be due to different patient populations i.e. primary care versus colposcopy. Screeners recorded TZ sampling in approximately 85% of samples. 56.7% of smear takers met the standard for TZ sampling.

Improving Papanicolaou Test Quality and Reducing Medical Errors by Using Toyota Production System Methods

Objective The objective of the study was to determine whether the Toyota production system process improves Papanicolaou test quality and patient safety. Study design An 8-month nonconcurrent cohort study that included 464 case and 639 control women who had a Papanicolaou test was performed. Office workflow was redesigned using Toyota production system methods by introducing a 1-by-1 continuous flow process. We measured the frequency of Papanicolaou tests without a transformation zone component, follow-up and Bethesda System diagnostic frequency of atypical squamous cells of undetermined significance, and diagnostic error frequency. Results After the intervention, the percentage of Papanicolaou tests lacking a transformation zone component decreased from 9.9% to 4.7% (P = .001). The percentage of Papanicolaou tests with a diagnosis of atypical squamous cells of undetermined significance decreased from 7.8% to 3.9% (P = .007). The frequency of error per correlating cytologic-histologic specimen pair decreased from 9.52% to 7.84%. Conclusions The introduction of the Toyota production system process resulted in improved Papanicolaou test quality.

Improving Papanicolaou test quality and reducing medical errors by using Toyota production system methods

The objective of the study was to determine whether the Toyota production system process improves Papanicolaou test quality and patient safety. An 8-month nonconcurrent cohort study that included 464 case and 639 control women who had a Papanicolaou test was performed. Office workflow was redesigned using Toyota production system methods by introducing a 1-by-1 continuous flow process. We measured the frequency of Papanicolaou tests without a transformation zone component, follow-up and Bethesda System diagnostic frequency of atypical squamous cells of undetermined significance, and diagnostic error frequency. After the intervention, the percentage of Papanicolaou tests lacking a transformation zone component decreased from 9.9% to 4.7% (P = .001). The percentage of Papanicolaou tests with a diagnosis of atypical squamous cells of undetermined significance decreased from 7.8% to 3.9% (P = .007). The frequency of error per correlating cytologic-histologic specimen pair decreased from 9.52% to 7.84%. The introduction of the Toyota production system process resulted in improved Papanicolaou test quality.

Liquid-based Papanicolaou smears without a transformation zone component: should clinicians worry?

OBJECTIVE: To evaluate whether ThinPrep smears without versus those with a transformation zone component were more likely to have falsely negative cytology findings. METHODS: Women aged 18–50 ( N = 4389) attended one of three Planned Parenthood clinics between 1997 and 2001 for screening by ThinPrep Papanicolaou and polymerase chain reaction-based human papillomavirus (HPV) DNA testing. Women with 1) any cytologic abnormality, 2) high-risk HPV types, and 3) a random sample with normal Papanicolaou and negative HPV tests were offered repeat cytology, colposcopy, and biopsy. Cytology and biopsy diagnoses at the colposcopy visit were reviewed according to the presence ( n = 3689) or absence ( n = 700) of a transformation zone component at screening. RESULTS: Among women with normal cytology at screening, histologic detection of at least cervical intraepithelial neoplasia grade 2 (odds ratio 1.3, 95% confidence interval 0.5, 3.3) at colposcopy did not differ significantly between transformation zone-positive and zone-negative smears. Histologically confirmed cervical intraepithelial neoplasia grade 1 was detected more often among smears lacking a transformation zone component (odds ratio 2.0, confidence interval 1.0, 3.8). Transformation zone-negative smears were more common among older women, current oral contraceptive users, those past the 14th day of their last menstrual period, and those negative for high-risk HPV types. CONCLUSION: Absence of a transformation zone component in a screening ThinPrep Papanicolaou test was not associated with missed high-grade lesions. Based upon our data, we do not recommend repeat screening of reproductive-aged women with negative liquid-based tests and no cytologic evidence of a transformation zone component.