2001 Consensus Guidelines for the Management of Women With Cervical Cytological Abnormalities

Wright, Thomas

doi:10.1001/jama.287.16.2120

Cited by 1,074 publications

(477 citation statements)

References 83 publications

(99 reference statements)

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“…More recently, and with the introduction of more sophisticated methods such as liquid-based preparations, and molecular testing for HR-HPV, there was a great shift in the management of cervical dysplasia with excellent surveillance results. However, the ASCUS diagnosis remains a challenge to the cytologist and the clinician and not all clinicians have a similar approach to its management despite the clear proposed guidelines by the American Society for Colposcopy and Cervical Pathology (ASCCP) [18,19]. These guidelines included either HR-HPV reflex testing, repeat PAP at 6 and 12 months, or colposcopy, with reflex HPV being the preferred approach.…”

Section: Discussionmentioning

confidence: 99%

Infectious Organisms on Papanicolaou Smears Should Not Influence the Diagnosis of Atypical Squamous Cells of Undetermined Significance

Nasser

Hayek²,

Balasubramaniam³

et al. 2011

Acta Cytologica

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Background: Atypical squamous cells of undetermined significance (ASCUS) remain the center of diagnostic controversy and patients’ stress despite recent advances in cervical cancer screening and the introduction of human papilloma virus (HPV) testing. The role of infectious agents in the induction of such changes is not well understood. Aim: We aim at reviewing the effect of the different infectious organisms in Papanicolaou (PAP) smears on the ASCUS diagnosis. Material: 133 ASCUS cases associated with variable infectious organisms (ASCUS-infection group) with secondary HPV testing and appropriate follow-up studies were reviewed. A control group of 310 ASCUS cases without any organisms (ASCUS-only group) was selected for comparison. Results: The ASCUS-infection group had a significantly higher proportion of HPV-positive tests than the ASCUS-only group (p = 0.0027). There was no significant difference on follow-up PAPs and biopsies between the two groups (p = 0.4272). They showed an overall mean of 75% negative, 20% low-grade lesions, and 5% high-grade lesions/carcinoma in situ on follow-up. Conclusion: Our study demonstrates no significant effect of infections on the cytological changes diagnostic of ASCUS. The cytologist should make this diagnosis neglecting any background infections even when predominant.

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Section: Discussionmentioning

confidence: 99%

Infectious Organisms on Papanicolaou Smears Should Not Influence the Diagnosis of Atypical Squamous Cells of Undetermined Significance

Nasser

Hayek²,

Balasubramaniam³

et al. 2011

Acta Cytologica

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“…Screening for high-risk HPV types in cervical samples, using DNA hybrid capture and nucleic acid amplification technology, is being explored for its utility both as a # In the recently introduced US Bethesda terminology system, these stages correspond to atypical squamous cells (ASC-US or ASC-H: cells which are abnormal but not frankly reactive or dysplastic); low-grade squamous intra-epithelial lesions (LGSIL; mild dysplasia and the changes associated with HPV infection, known as koilocytosis); and high-grade squamous intra-epithelial lesions (HGSIL; moderate and severe dysplasia, carcimona in situ) [34]. primary screening tool (particularly in women over 30 where HPV prevalence is lower), and as an adjunctive test in the management of women referred for abnormal cervical cytology [34,[45][46][47][48]. Such approaches may decrease the numbers of women who undergo unnecessary aggressive treatment for low-grade cytological lesions identified through traditional Pap screening, and may improve detection rates of CIN 2+ without increasing the colposcopy referral rate.…”

Section: Prevention Of Cervical Cancer Secondary Prevention : Cytologmentioning

confidence: 99%

Vaccines for cervical cancer

Lowndes¹

2006

Epidemiol. Infect.

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SUMMARYThis review focuses on current and future prevention of invasive cervical cancer (ICC), the second most common cancer among women worldwide. Implementation of population-based cytological screening programmes, using the 'Pap ' smear to detect pre-cancerous lesions in the cervix, has resulted in substantial declines in mortality and morbidity from ICC in North America and some European countries. However, cases of, and deaths from, ICC continue to occur. Primary prevention of infection with high-risk human papillomavirus (HPV) types, the central causal factor of ICC, could further reduce incidence of and mortality from ICC. This is particularly the case in developing countries, which bear 80% of the burden of ICC, and where effective Pap screening programmes are extremely difficult to implement. Very promising results from several trials of synthetic HPV type-specific monovalent (HPV 16) and bivalent (HPV 16 and 18) vaccines have recently been published, showing high efficacy against type-specific persistent HPV infection and development of type-specific pre-cancerous lesions. Large-scale phase III trials of a number of such vaccine candidates are currently underway, and there is real hope that an effective vaccine capable of protecting against infection with HPV types 16 and 18 (which together account for y70% of cervical cancer cases worldwide), and thereby of preventing development of a very significant proportion of cases of ICC, could be available within the next 2 years.

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“…Human papillomavirus (HPV) test-based triage of women with atypical squamous cell of undetermined significance Pap results for referral to colposcopy versus routine screening is now widely accepted in both consensus clinical guidelines and general clinical practice [1,2,3]. Observations from the Atypical Squamous Cells of Undetermined Significance/Low-Grade Squamous Intraepithelial Lesion Triage Study (ALTS) that a very high percentage of women with low-grade squamous intra-epithelial lesion (LSIL) Pap results tested positive for HPV appeared initially to limit the utility of HPV testing in clinical management of women with LSIL Pap results [4].…”

Section: Introductionmentioning

confidence: 99%

HPV Test Results Stratify Risk for Histopathologic Follow-Up Findings of High-Grade Cervical Intra-Epithelial Neoplasia in Women with Low-Grade Squamous Intra-Epithelial Lesion Pap Results

2010

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Objective: Age-adjusted evaluations have explored the possible utility of human papillomavirus (HPV) test results in women with low-grade squamous intra-epithelial lesion (LSIL) Paps. We document LSIL correlation data with HPV test results and histopathologic follow-up from a large academic women’s hospital practice. Study Design: LSIL Pap tests with intermediate-/high-risk HPV DNA testing between July 1, 2005 and April 30, 2008 were studied along with follow-up histopathologic diagnoses. Patients were divided into age groups, and tissue diagnoses were correlated with HPV test results. Results: 1,083 (80.2%) of a total of 1,351 LSIL Pap samples tested HPV positive. HPV prevalence declined in older age groups. 719 women with LSIL Pap and HPV test results had at least 1 follow-up cervical biopsy result. 89 of 612 patients with HPV-positive LSIL (14.5%) had a follow-up histopathological diagnosis of cervical intra-epithelial neoplasia (CIN) 2/3. Only 4 of 107 patients with HPV-negative LSIL (3.7%) had CIN 2/3. Conclusions: In the largest study to date to document histopathological follow-up of older women with LSIL and HPV test results, no histopathological CIN 2/3 diagnoses were identified in women 50 years and older with HPV-negative LSIL. HPV test results stratified women with LSIL cytology findings into lower- and higher-risk groups for follow-up histopathologic CIN 2/3 outcomes.

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2001 Consensus Guidelines for the Management of Women With Cervical Cytological Abnormalities

Cited by 1,074 publications

References 83 publications

Infectious Organisms on Papanicolaou Smears Should Not Influence the Diagnosis of Atypical Squamous Cells of Undetermined Significance

Infectious Organisms on Papanicolaou Smears Should Not Influence the Diagnosis of Atypical Squamous Cells of Undetermined Significance

Vaccines for cervical cancer

HPV Test Results Stratify Risk for Histopathologic Follow-Up Findings of High-Grade Cervical Intra-Epithelial Neoplasia in Women with Low-Grade Squamous Intra-Epithelial Lesion Pap Results

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