scholarly journals The Significance of Augmented High-Grade Squamous Intraepithelial Lesion Detection on Pap Test Examination: Partial Results from the RODEO Study Team

2013 ◽  
Vol 57 (5) ◽  
pp. 489-494 ◽  
Author(s):  
Cristovam Scapulatempo ◽  
José Humberto T.G. Fregnani ◽  
Natália Campacci ◽  
Júlio Cesar Possati-Resende ◽  
Adhemar Longatto-Filho
Keyword(s):  
Pap Test ◽  
Lesion Detection ◽  
High Grade ◽  
Squamous Intraepithelial Lesion ◽  
Study Team ◽  
Intraepithelial Lesion

Liquid-Based Cytology: Evaluation of Effectiveness, Cost-Effectiveness, and Application to Present Practice

2004 ◽  
Vol 2 (6) ◽  
pp. 597-611 ◽  
Author(s):  
J. Thomas Cox
Keyword(s):  
Cost Effectiveness ◽  
Cervical Screening ◽  
Pap Test ◽  
Representative Specimen ◽  
Low Grade ◽  
High Grade ◽  
Squamous Intraepithelial Lesion ◽  
Split Sample ◽  
Intraepithelial Lesion ◽  
Liquid Based Cytology

This article reviews the data available as of 2004 on the effectiveness and cost-effectiveness of cervical screening with the two available cytologic methods, the conventional Papanicolaou (Pap; CP) smear and liquid-based cytology (LBC), and discusses the application of LBC to current practice. The majority of LBC studies are on the ThinPrep Pap Test (CYTYC, Boxsborough, MA) and the remainder are on SurePath (TriPath, Burlington, NC), which was previously known as AutoCyte Prep. LBC identified more low-grade squamous intraepithelial lesion (LSIL) Pap test results compared with paired conventional cytology in 17 of 21 ThinPrep and 9 of 12 SurePath “split-sample” studies considered to fulfill the criteria for inclusion in the British NHS Health Technology Assessment (HTA) evaluation of cervical cytology. In four of the six recent ThinPrep and one of two SurePath split-sample studies, more high-grade squamous intraepithelial lesion-positive (HSIL+) results were identified by LBC than by CP. All 15 “direct-to vial studies” meeting HTA criteria reported more LSIL+ results for LBC compared with CP, and all eight of the direct-to-vial studies reporting HSIL+ results separately showed increased detection of high-grade cytology interpretations. Fifteen studies met the criteria for evaluating sensitivity and specificity. Aggregate sensitivity for the CP was 71.5% and for LBC was 80.1%. Indirect comparisons of the two LBC methods did not detect a difference in sensitivity, and a meta-analysis of the six studies comparing specificity between CP and LBC found no difference. Other capabilities of LBC are improved specimen adequacy and the ability to do ancillary testing out of the liquid-based vial. In cost-effective analyses based on models of disease natural history and/or the clinical effectiveness of each screening modality, screening with CP was always dominated by screening with LBC. Primary cervical screening guidelines issued by the American Cancer Society in 2002 recommend repeating the cytology biannually if liquid-based and annually if conventional. The gain in sensitivity, apparent cost-effectiveness, and advantage of having a representative specimen for ancillary testing, support the use of LBC.

Adjunctive Human Papillomavirus Testing in the 2-Year Follow-up of Women With Low-Grade Cervical Cytologic Abnormalities: A Randomized Trial and Economic Evaluation

2003 ◽  
Vol 127 (9) ◽  
pp. 1169-1175 ◽  
Author(s):  
Alice Lytwyn ◽  
John W. Sellors ◽  
James B. Mahony ◽  
Dean Daya ◽  
William Chapman ◽  
...  
Keyword(s):  
Human Papillomavirus ◽  
Cervical Intraepithelial Neoplasia ◽  
Pap Test ◽  
Intraepithelial Neoplasia ◽  
Low Grade ◽  
High Grade ◽  
Hpv Testing ◽  
Squamous Intraepithelial Lesion ◽  
Intraepithelial Lesion

Abstract Context.—Although human papillomavirus (HPV) testing may aid in managing low-grade abnormality on screening cervical cytology, patient compliance with repeat testing programs requires consideration. Objectives.—To determine effectiveness and costs of repeated Papanicolaou (Pap) test and oncogenic HPV testing for detecting cervical intraepithelial neoplasia 2 or 3. Design.—We conducted a randomized controlled trial of combined Pap test and cervical HPV testing by Hybrid Capture 1 test compared with Pap test alone; tests were performed every 6 months for up to 2 years. The study end point was colposcopic examination performed on all women at 2 years, or earlier if an HPV test was positive or if a Pap test showed high-grade squamous intraepithelial lesion. Setting.—Sixty-six community family practices. Participants.—Two hundred fifty-seven women with atypical squamous cells of undetermined significance or low-grade squamous intraepithelial lesion on screening cervical cytology. Main Outcome Measures.—Detection of histologically confirmed cervical intraepithelial neoplasia 2 or 3, fully allocated costs, and loss to follow-up. Results.—Combined Pap test and HPV testing detected 11 (100%) of 11 cases of cervical intraepithelial neoplasia 2/3, whereas Pap test alone detected 7 (63.6%) of these 11 cases (P = .14); corresponding specificities were 39 (46.4%) of 84 and 45 (71.4%) of 63 (P = .005). The cost-effectiveness ratio was Can $4456 per additional case of high-grade cervical intraepithelial neoplasia. Sixty-nine (26.8%) of the 257 women (24.6% combined group vs 29.1% Pap test only group, P = .41) defaulted from testing or from colposcopy when referred with an abnormal result. Conclusions.—Combined testing was more costly but may detect more cases of cervical intraepithelial neoplasia 2/3 than Pap test alone. However, poor adherence limits usefulness of a management strategy that requires repeated follow-up.

High grade squamous intraepithelial lesion on high-risk HPV negative patients: Why we still need the Pap test

2018 ◽  
Vol 46 (11) ◽  
pp. 908-913 ◽  
Author(s):  
Hongxia Sun ◽  
Ramya P. Masand ◽  
Shobhanaben Jagdishbhai Patel ◽  
Vijayalakshmi Padmanabhan
Keyword(s):  
High Risk ◽  
Pap Test ◽  
High Grade ◽  
Squamous Intraepithelial Lesion ◽  
Intraepithelial Lesion ◽  
High Risk Hpv

Cytologic Features of High-Grade Squamous Intraepithelial Lesion in ThinPrep Papanicolaou Test Slides: Comparison of Cases That Performed Poorly With Those That Performed Well in the College of American Pathologists Interlaboratory Comparison Program in Cervicovaginal Cytology

2004 ◽  
Vol 128 (7) ◽  
pp. 746-748 ◽  
Author(s):  
Andrew A. Renshaw ◽  
Michael A. Schulte ◽  
Elizabeth Plott ◽  
Barbara Dubray-Benstein ◽  
Camilla J. Cobb ◽  
...  
Keyword(s):  
Interlaboratory Comparison ◽  
Pap Test ◽  
Test Cases ◽  
High Grade ◽  
Squamous Intraepithelial Lesion ◽  
Squamous Intraepithelial Lesions ◽  
Papanicolaou Test ◽  
Intraepithelial Lesion ◽  
Intraepithelial Lesions

Abstract Context.—Conventional Papanicolaou (Pap) test slides of high-grade squamous intraepithelial lesions (HSILs) that are frequently misdiagnosed are known to have relatively few dysplastic cells. Whether this is true of cases of HSIL in ThinPrep Pap Test specimens is not known. Objective.—To determine if cases of HSIL in ThinPrep specimens that are frequently missed have relatively few dysplastic cells. Design.—The cytologic features of 16 ThinPrep cases of HSIL that performed poorly in the College of American Pathologists Interlaboratory Comparison Program were compared with 22 ThinPrep Pap Test cases that performed extremely well. Results.—Significantly more cases that performed poorly had fewer than 250 dysplastic cells (13/16) than cases that performed well (3/22) (P < .001). Conclusion.—ThinPrep Pap Test cases with a diagnosis of HSIL that performed poorly in this program had significantly fewer dysplastic cells than those that performed well.

Cytologic Features of Low-Grade Squamous Intraepithelial Lesion in ThinPrep Papanicolaou Test Slides and Conventional Smears: Comparison of Cases That Performed Poorly With Those That Performed Well in the College of American Pathologists Interlaboratory Comparison Program in Cervicovaginal Cytology

2005 ◽  
Vol 129 (1) ◽  
pp. 23-25 ◽  
Author(s):  
Andrew A. Renshaw ◽  
Barbara Dubray-Benstein ◽  
Jennifer Haja ◽  
Jonathan H. Hughes
Keyword(s):  
Interlaboratory Comparison ◽  
Pap Test ◽  
Median Number ◽  
Low Grade ◽  
High Grade ◽  
Squamous Intraepithelial Lesion ◽  
Papanicolaou Test ◽  
Abnormal Cells ◽  
Intraepithelial Lesion ◽  
Intraepithelial Lesions

Abstract Context.—Both conventional and ThinPrep Papanicolaou smears with high-grade squamous intraepithelial lesions that are frequently missed are known to have relatively few abnormal cells. Whether this is also true of cases of low-grade squamous intraepithelial lesion is not known. Objective.—To compare the cytologic features of cases of low-grade squamous intraepithelial lesion that perform poorly with the features of cases that perform well. Design.—The cytologic features of 10 ThinPrep Pap Test and conventional smear cases of low-grade squamous intraepithelial lesion that performed poorly in the College of American Pathologists Interlaboratory Comparison Program were compared with 46 ThinPrep Pap Test and conventional smear cases that performed extremely well. The numbers of abnormal cells were categorized into less than 50, 51 to 100, 101 to 250, 251 to 500, and more than 500. Results.—The median number of abnormal cells for cases that performed poorly was less than 50, whereas the median number of abnormal cells for cases that performed well was between 101 and 250. Overall, cases that performed poorly were significantly more likely to have less than 50, less than 100, and less than 250 abnormal cells than cases that performed well (P < .001, P < .001, and P = .009, respectively). A minority of cases performed well even with very few abnormal cells and groups. The same findings were present when conventional smears and ThinPrep specimens were analyzed separately. Conclusions.—ThinPrep Pap Test cases and conventional smears with a diagnosis of low-grade squamous intraepithelial lesion that perform poorly in this program have significantly fewer abnormal cells than those that perform well. The median number of abnormal cells in cases that performed well is lower than that of comparable high-grade cases in the program.

Follow-up Findings in Young Females With High-Grade Squamous Intraepithelial Lesion Papanicolaou Test Results

2011 ◽  
Vol 135 (3) ◽  
pp. 361-364 ◽  
Author(s):  
Chengquan Zhao ◽  
Pal Kalposi-Novak ◽  
R. Marshall Austin
Keyword(s):  
Invasive Carcinoma ◽  
Pap Test ◽  
Adenocarcinoma In Situ ◽  
High Grade ◽  
Test Results ◽  
Squamous Intraepithelial Lesion ◽  
Transformation Zone ◽  
Young Females ◽  
Intraepithelial Lesion

Abstract Context.—New guidelines discourage cervical screening and procedures in young females, given available human papillomavirus vaccines, concerns regarding procedure-associated harms, and the rarity of cervical cancers. Objective.—To analyze histopathologic follow-up data on a large number of young females with high-grade squamous intraepithelial lesion (HSIL) Papanicolaou (Pap) test results. Design.—Hospital records were searched for HSIL Pap test results in females 20 years or younger between January 2002 and December 2007. Histopathologic and Pap test follow-up, age group variations, and impact of Pap test transformation zone/endocervical sampling were analyzed. Results.—Four hundred seventy-four females aged 20 years or younger had HSIL Pap test results during the study period. Three hundred thirty-five young females with at least one cervical biopsy were included. The average age was 18.6 years (range, 13–20 years). The average follow-up period was 24 months (range, 0.1–75 months), with a median of 22 months. Histopathologic detection rates were 44.2% for cervical intraepithelial neoplasia (CIN) 2/3 and 47.8% for CIN 1. The average period between the HSIL Pap test result and an initial diagnosis of CIN 2/3 was 5 months (range, 0.1–62 months), with a median of 2 months. Neither invasive carcinoma nor adenocarcinoma in situ was identified. Presence or absence of a transformation zone/endocervical sample did not significantly impact CIN 2/3 risk (44.5% versus 38.9%, P  =  .64). Conclusions.—Histopathologic CIN 2/3 was documented in 148 of 335 (44%) of biopsied young females with HSIL Pap results, likely reflecting both the reported high likelihood of HSIL regression in younger females and the challenge of colposcopic sampling of relatively short-lived smaller CIN 2/3 lesions. Although no cases of invasive carcinoma were identified in this study, updated guidelines pose new risks for maturing females with undetected cervical precancer.

Role of Ancillary Techniques in Cervical Biopsy and Endocervical Curettage Specimens as Follow-Up to Papanicolaou Test Results Indicating a Diagnosis of Atypical Squamous Cells, Cannot Exclude High-Grade Squamous Intraepithelial Lesion, or High-Grade Squamous Intraepithelial Lesion

2019 ◽  
Vol 64 (1-2) ◽  
pp. 155-165 ◽  
Author(s):  
Taylor M. Jenkins ◽  
Hadi Shojaei ◽  
Sharon J. Song ◽  
Lauren E. Schwartz
Keyword(s):  
Cervical Dysplasia ◽  
Pap Test ◽  
High Grade ◽  
Squamous Intraepithelial Lesion ◽  
Papanicolaou Test ◽  
Squamous Cells ◽  
Cervical Biopsy ◽  
Intraepithelial Lesion ◽  
Infected Cells ◽  
Tissue Specimens

The Papanicolaou (PAP) test is widely used to screen for cervical cancer. All high-grade lesions such as atypical squamous cells, cannot exclude high-grade squamous intraepithelial lesion (ASC-H), and high-grade squamous intraepithelial lesion, identified on a PAP test should be followed-up by a confirmatory cervical biopsy. In this review, we discuss the challenges in interpreting cervical tissue specimens and the various ancillary techniques used in the evaluation of cervical dysplasia. Ancillary studies include deeper levels, p16 immunohistochemistry (IHC), human papillomavirus (HPV) testing, and, importantly, cyto-histologic correlation. Of these, p16 IHC is consistently sensitive and specific for detecting HSIL. HPV RNA in situ hybridization (ISH) is a newer technique with excellent sensitivity and specificity for detecting virally infected cells and it may be more broadly applicable to both low- and high-grade squamous intraepithelial lesions.

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