Clinical Relevance of ASC-H Cytologies: Experience in a Single Tertiary Hospital

2016 ◽  
Vol 60 (3) ◽  
pp. 217-224 ◽  
Author(s):  
Cristina Díaz del Arco ◽  
Mª Carmen Sanabria Montoro ◽  
Dolores García López ◽  
Eva Rodríguez Escudero ◽  
Mª Jesús Fernández Aceñero
Keyword(s):  
Predictive Value ◽  
False Negative ◽  
Tertiary Hospital ◽  
Pap Smears ◽  
Low Grade ◽  
High Grade ◽  
Squamous Intraepithelial Lesion ◽  
Negative Results ◽  
Intraepithelial Lesion ◽  
Clinical Records

Objectives: To review the cases of atypical squamous cells (ASC), cannot exclude squamous intraepithelial lesion (ASC-H) diagnosed at a single institution and to discuss the interpretation challenges and clinical management of these cases. Study Design: The ASC-H cases diagnosed at our institution from 2006 to 2015 were studied retrospectively; of 159,000 Pap smears, there were 959 cases of ASC of undetermined significance (ASC-US) and 148 cases of ASC-H. We have reviewed the clinical records of the ASC-H cases, and data have been analyzed using SPSS 20.0. Results: Median age was 43.1 years; 49.6% of the patients had previous cervical cytologies, and 55.9% of them were negative. Following ASC-H diagnosis, another smear was obtained in 97.1% of the cases and in 67.6% a biopsy was performed. Biopsy revealed low-grade dysplasia in 18.8% of the cases, high-grade dysplasia in 27.8%, and infiltrating carcinoma in 2.3%. Patients with significant lesions in histology were younger than patients with negative results (p = 0.08). A diagnosis of ASC-H/squamous intraepithelial lesion in the repeated cytology had a sensitivity of 74.2%, specificity of 39.6%, positive predictive value of 44.8%, and negative predictive value of 70% for the diagnosis of dysplasia. Conclusions: ASC-H diagnosis is associated with a high incidence of histological high-grade lesions. A repeat cytology can aid in the selection of high-risk patients, but there may be false-negative results.

scholarly journals Low-Grade Squamous Intraepithelial Lesion or High-Grade Squamous Intraepithelial Lesion? Concordance Between the Interpretation of Low-Grade Squamous Intraepithelial Lesion and High-Grade Squamous Intraepithelial Lesion in Papanicolaou Tests: Results From the College of American Pathologists PAP Education Program

2018 ◽  
Vol 143 (1) ◽  
pp. 81-85 ◽  
Author(s):  
Barbara A. Crothers ◽  
Mohiedean Ghofrani ◽  
Chengquan Zhao ◽  
Leslie G. Dodd ◽  
Kelly Goodrich ◽  
...  
Keyword(s):  
Education Program ◽  
Repeated Measures ◽  
False Negative ◽  
Misclassification Rate ◽  
Low Grade ◽  
High Grade ◽  
Squamous Intraepithelial Lesion ◽  
Significant Difference ◽  
Intraepithelial Lesion ◽  
Diagnostic Concordance

Context.— Obtaining diagnostic concordance for squamous intraepithelial lesions in cytology can be challenging. Objective.— To determine diagnostic concordance for biopsy-proven low-grade squamous intraepithelial lesion (LSIL) and high-grade squamous intraepithelial lesion (HSIL) Papanicolaou test slides in the College of American Pathologists PAP Education program. Design.— We analyzed 121 059 responses from 4251 LSIL and HSIL slides for the interval 2004 to 2013 using a nonlinear mixed-model fit for reference diagnosis, preparation type, and participant type. We evaluated interactions between the reference diagnosis and the other 2 factors in addition to a repeated-measures component to adjust for slide-specific performance. Results.— There was a statistically significant difference between misclassification of LSIL (2.4%; 1384 of 57 664) and HSIL (4.4%; 2762 of 63 395). There was no performance difference between pathologists and cytotechnologists for LSIL, but cytotechnologists had a significantly higher HSIL misclassification rate than pathologists (5.5%; 1437 of 27 534 versus 4.0%; 1032 of 25 630; P = .01), and both were more likely to misrepresent HSIL as LSIL (P < .001) than the reverse. ThinPrep LSIL slides were more likely to be misclassified as HSIL (2.4%; 920 of 38 582) than SurePath LSIL slides (1.5%; 198 of 13 196), but conventional slides were the most likely to be misclassified in both categories (4.5%; 266 of 5886 for LSIL, and 6.5%; 573 of 8825 for HSIL). Conclusions.— More participants undercalled HSIL as LSIL (false-negative) than overcalled LSIL as HSIL (false-positive) in the PAP Education program, with conventional slides more likely to be misclassified than ThinPrep or SurePath slides. Pathologists and cytotechnologists classify LSIL equally well, but cytotechnologists are significantly more likely to undercall HSIL as LSIL than are pathologists.

scholarly journals Cervical pap smear- A prospective study in a tertiary hospital

2015 ◽  
Vol 5 (10) ◽  
pp. 820-823 ◽  
Author(s):  
S Pudasaini ◽  
KBR Prasad ◽  
SK Rauniyar ◽  
R Pathak ◽  
K Pande ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Pap Smear ◽  
Cost Effective ◽  
Tertiary Hospital ◽  
Pap Smears ◽  
Low Grade ◽  
Squamous Intraepithelial Lesion ◽  
Effective Screening ◽  
Intraepithelial Lesion ◽  
A Prospective Study

Background: Cervical cancer is a leading cause of mortality and morbidity among women worldwide and most common gynaecological cancer in developing countries. Papanicolaou smear is a simple and cost effective screening test for cervical cancer. The aim of this study is to evaluate and interpret the cervical pap smear cytology in a tertiary hospital. The interpretation and reporting of the pap smear is based on 2001Bethesda system.Materials and methods: This is a prospective study conducted in a tertiary hospital, Nepal Medical College over a period of two and a half years (January 2013 to June 2015). All cervical pap smears received in the department of Pathology in the study period were included.Results: A total of 4160 cervical pap smears were reported in the study period. Majority of the cases were Negative for Intraepithelial lesion or malignancy (87.9%). Bacterial vaginosis, atrophy and reactive cellular changes associated with inflammation were seen in 5.3%, 2.4% and 1.5% cases respectively.   Epithelial cell abnormalities (0.5%) include Atypical squamous cells of undetermined significance, Low grade squamous intraepithelial lesion and High grade intraepithelial lesion. 88% of Low grade squamous intraepithelial lesion was seen in reproductive age group (20-45 years).Conclusion: Cervical cancer is the most common gynaecological cancer in the developing countries. Pap smear is the simple and cost effective screening tool to detect pre invasive cervical epithelial lesions.

scholarly journals Misinterpretation Rates of High-Grade Squamous Intraepithelial Lesion in the College of American Pathologists Gynecologic PAP Education and PAP Proficiency Test Program

2016 ◽  
Vol 140 (11) ◽  
pp. 1221-1224 ◽  
Author(s):  
Chengquan Zhao ◽  
Barbara A. Crothers ◽  
Mohiedean Ghofrani ◽  
Zaibo Li ◽  
Rhona J. Souers ◽  
...  
Keyword(s):  
Proficiency Test ◽  
False Negative ◽  
False Negative Rate ◽  
Daily Practice ◽  
Low Grade ◽  
High Grade ◽  
Squamous Intraepithelial Lesion ◽  
Related Factors ◽  
Test Taking ◽  
Intraepithelial Lesion

Context.— Misinterpretation of high-grade squamous intraepithelial lesion (HSIL) is an important problem in daily practice and in the College of American Pathologists (CAP) PAP Proficiency Test (PAP-PT). Objective.— To investigate factors related to misinterpretation of HSIL through responses in a proficiency test versus an educational environment. Design.— We retrospectively evaluated 28 000 responses in the PAP Education Program (PAP-Edu) and 59 140 responses in PAP-PT from 1147 field-validated HSIL slides from 2007 to 2014. The related factors, such as program types, preparation types, participant types, and program years, were evaluated. Results.— Overall, 4.0% (2379 of 59 140) of responses for HSIL slides from PAP-PT were misinterpreted as either low-grade squamous intraepithelial lesion (LSIL) or negative, significantly more than those from PAP-Edu (3.2%; 898 of 28 000). However, the false-negative rate (misinterpreted as negative) was 0.9% (519 of 59 140) for PAP-PT, lower than that for PAP-Edu (1.0%; 266 of 28 000). The misinterpretation rates in PAP-PT trended down with time. Misinterpretation rates did not vary significantly by preparation methods. The misinterpretation rate for HSIL in the pathologists' responses was lower than that in cytotechnologists' responses in PAP-PT. More HSIL was misinterpreted as LSIL than as benign in both programs. Cytotechnologists interpreted HSIL as LSIL twice as much as pathologists. The most common false-negative misinterpretations were negative for intraepithelial lesion or malignancy and reparative change. Conclusions.— The higher LSIL misinterpretation rate by cytotechnologists may be related to the differences in reporting responsibilities and proficiency test grading criteria. The trend of gradually decreasing misinterpretation rates of a reference diagnosis of HSIL in the PAP-PT program may be related to higher test-taking confidence and better preparation through educational programs. The fact that pathologists performed better than cytotechnologists in PAP-PT, but not in PAP-Edu, may reflect a heightened approach and attentiveness in the test-taking environment for pathologists.

scholarly journals Value of Nucleolar Organizer Regions count in cervical pathology

1970 ◽  
Vol 2 (3) ◽  
pp. 180-185
Author(s):  
Shiva Raj KC ◽  
OP Talwar
Keyword(s):  
Precancerous Lesions ◽  
Squamous Metaplasia ◽  
Nucleolar Organizer Regions ◽  
Pap Smears ◽  
Low Grade ◽  
High Grade ◽  
Squamous Intraepithelial Lesion ◽  
Significant Difference ◽  
Intraepithelial Lesion ◽  
Intraepithelial Lesions

Background: ‘AgNOR’ represents Nucleolar Organiser Regions stained with silver which are related to cell proliferation rate and tumor malignant potential. The objective of this study was to evaluate the role of AgNOR in differentiating benign and precancerous lesions from cancerous lesions in both cervical smears and histology. Materials and Methods: This was a prospective study conducted at Manipal Teaching Hospital, from July 2005 to June 2007. Women of suspected cervical pathology and who underwent pap smears test followed by subsequent biopsy were included. There were 53 cases were included out of which 11 cases were of high grade squamous intraepithelial lesion and 12 cases of low grade squamous intraepithelial lesion, and 10 cases each of carcinoma, chronic cervicitis with and without squamous metaplasia. Results: In Low grade squamous intraepithelial lesion meanAgNOR dots was < (2.9 in pap smears and 1.9 in histology) in high grade lesion (3.45 in pap smears and 3.00 in histology). In carcinoma meanAgNOR dots was 5.18 and 4.05 in pap smears and histology respectively. Subjective AgNOR Pattern Assessment in pap smears and in histology was increasing with significant difference from intraepithelial lesions to carcinoma. Conclusion: In cervical pathology, the number and shape of AgNOR dots change from benign to precancerous to malignant tumors. Similarly, AgNOR Pattern Assessment is useful in differentiating benign to intraepithelial lesions to carcinoma cases. DOI: http://dx.doi.org/10.3126/jpn.v2i3.6017 JPN 2012; 2(3): 180-185

Liquid-based cervical cytology ThinPrep screening in Hungary

2014 ◽  
Vol 155 (18) ◽  
pp. 708-714
Author(s):  
Mihály Bak ◽  
Mária Séberné Éll ◽  
Melinda Bóka ◽  
Zsuzsanna Veleczki ◽  
Tibor Nyári ◽  
...  
Keyword(s):  
Positive Predictive Value ◽  
Human Papilloma Virus ◽  
Predictive Value ◽  
Human Papilloma Virus Infection ◽  
Cervical Cytology ◽  
Low Grade ◽  
High Grade ◽  
Squamous Intraepithelial Lesion ◽  
Papilloma Virus ◽  
Intraepithelial Lesion

Introduction: Liquid-based cervical cytology has been developed as an alternative for conventional Papanicolaou cervical cytology. Aim: The aim of this study was to determine the quality assurance of liquid-based cervical cytology. Method: 4573 cervical cytology smears were classified according to the Bethesda (2001) system. Human papilloma virus infection was detected and subtyped from reflex test using real-time polymerase chain reaction. Results: 4573 smears were classified according to the Bethesda (2001) system. Negative diagnosis was made in 2323 cases (50.8%), non neoplastic in 2017 cases (44.1%), and positive for intraepithelial lesions or malignancy in 233 cases (5.1%). Unsatisfactory smear for diagnosis was found in 43 cases (0.9%), low-grade squamous intraepithelial lesion in 87 cases (1.9%), high-grade squamous intraepithelial lesion in 24 cases (0.5%), and carcinoma in 23 cases (0.5%). Fifty-nine of the cases were histologically verified and 4 falsely negative cases were detected. The sensitivity, specificity and the positive predictive value were 93.2%, 100% and 100%, respectively. Compared to an identical time periods of the previous three years, the low- and high-grade squamous intraepithelial lesion increased from 0.82% to 2.51%. Eighty one human papilloma virus tests were performed with a positive predictive value of 99%. Conclusions: The auditing values of the liquid-bases cervical cytology results meet the proposed threshold values. Liquid-bases cervical cytology is an alternative cervical cytology and it seems to be significantly better than conventional Papanicolaou cervical cytology in all parameters. Orv. Hetil., 2014, 155(18), 708–714.

Low Utility in Colposcopy-directed Biopsies for Non-high Grade Cytological Abnormalities on PAP Smear

2020 ◽  
Vol 16 (1) ◽  
pp. 18-22
Author(s):  
Eronmwon E. Gbinigie ◽  
Joshua Fogel ◽  
Maggie Tetrokalashvili
Keyword(s):  
Pap Smear ◽  
Multinomial Logistic Regression ◽  
Cervical Dysplasia ◽  
Outcome Variable ◽  
Low Grade ◽  
High Grade ◽  
Squamous Intraepithelial Lesion ◽  
Intraepithelial Lesion ◽  
Cytologic Abnormalities ◽  
Cytology Screening

Background: Clinicians commonly perform colposcopy directed biopsies on patients with low grade squamous intraepithelial lesion (LSIL) on PAP cytology even when not consistent with clinical guidelines. Objective: We study the association of PAP cytology screening results with cervical intra-epithelia neoplasia (CIN) 2-3 high-grade dysplasia, as confirmed by colposcopy-directed biopsy. Methods: A retrospective study of 263 women with an abnormality on the PAP smear. Multinomial logistic regression was performed with predictors of PAP cytology screening results with the outcome variable of colposcopy-directed biopsy. Results: High grade squamous intraepithelial lesion (HSIL) had significantly increased relative risk for CIN 2-3 (RR: 9.85, 95% CI: 1.84, 52.79, p=0.008). LSIL was not significantly associated with CIN 2-3. In the comparisons of negative with CIN-1, both HSIL and LSIL were not significantly associated with a negative biopsy. Conclusion: HSIL is associated with cervical dysplasia of CIN 2-3 while LSIL is not associated with cervical dysplasia of CIN 2-3. We do not recommend routine biopsies in patients with LSIL cytologic abnormalities unless additional compelling factors exist.

scholarly journals Adenoid Basal Carcinoma of Cervix: A Rare Case Report

2020 ◽  
Vol 3 (2) ◽  
pp. 392-394
Author(s):  
Alina Karna ◽  
Nisha Sharma
Keyword(s):  
Pap Smear ◽  
Total Abdominal Hysterectomy ◽  
Abdominal Hysterectomy ◽  
Low Grade ◽  
High Grade ◽  
Squamous Intraepithelial Lesion ◽  
Adenoid Cystic ◽  
Carcinoma Of Cervix ◽  
Rare Case Report ◽  
Intraepithelial Lesion

Adenoid basal carcinoma of the uterine cervix is a rare low-grade tumor and its cell origin is still obscure. Adenoid basal carcinoma can be confused with adenoid basal hyperplasia, adenoid cystic carcinoma, and basaloid squamous cell carcinoma of the cervix. We present here a case of a 59 year-old-female who initially presented with a high-grade squamous intraepithelial lesion on Pap smear. Total abdominal hysterectomy with bilateral salpingo-oophorectomy was performed. Histopathology revealed focal invasive adenoid basal carcinoma with extensive areas of a high-grade squamous intraepithelial lesion involving the endocervical gland. The immunohistochemical stain was positive for p16.

Sign in / Sign up

Export Citation Format

Share Document