A 21-Year-Old Woman With Atypical Squamous Cells of Undetermined Significance

Sawaya, George F.

doi:10.1001/jama.294.17.2210

Cited by 16 publications

(12 citation statements)

References 49 publications

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“…Referral for immediate colposcopy is another alternative, which many experts consider to be overmanagement. 46,47 It may be the preferred choice when poor follow-up compliance is suspected or when explicit risk factors are present. Immediate referral for colposcopy should be no more than a very low percentage of cases of ASC-US.…”

Section: Management Of Women With Atypical Squamous Cellsmentioning

confidence: 99%

European guidelines for quality assurance in cervical cancer screening: recommendations for clinical management of abnormal cervical cytology, part 1

et al. 2008

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European guidelines for quality assurance in cervical cancer screening: recommendations for clinical management of abnormal cervical cytology, part 1The current paper presents the first part of Chapter 6 of the second edition of the European Guidelines for Quality Assurance in Cervical Cancer Screening. It provides guidance on how to manage women with abnormal cervical cytology. Throughout this article the Bethesda system is used for cervical cytology terminology, as the European guidelines have recommended that all systems should at least be translated into that terminology while cervical intraepithelial neoplasia (CIN) is used for histological biopsies (Cytopathology 2007; 18:213-9). A woman with a high-grade cytological lesion, a repeated low-grade lesion or with an equivocal cytology result and a positive human papillomavirus (HPV) test should be referred for colposcopy. The role of the colposcopist is to identify the source of the abnormal cells and to make an informed decision as to whether or not any treatment is required. If a patient requires treatment the colposcopist will decide which is the most appropriate method of treatment for each individual woman. The colposcopist should also organize appropriate follow-up for each woman seen. Reflex testing for high-risk HPV types of women with atypical squamous cells (ASC) of undetermined significance with referral for colposcopy of women who test positive is a first option. Repeat cytology is a second possibility. Direct referral to a gynaecologist should be restricted to special circumstances. Follow-up of low-grade squamous intraepithelial lesion is more difficult because currently there is no evidence to support any method of management as being optimal; repeat cytology and colposcopy are options, but HPV testing is not sufficiently selective, unless for older women. Women with high-grade squamous intraepithelial lesion (HSIL) or atypical squamous cells, cannot exclude HSIL (ASC-H) should be referred without triage. Women with glandular lesions require particular attention. In a subsequent issue of Cytopathology, the second part of Chapter 6 will be presented, with recommendations for management and treatment of histologically confirmed intraepithelial neoplasia and guidance for follow-up of special cases such as women who are pregnant, postmenopausal or immunocompromised.

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Section: Management Of Women With Atypical Squamous Cellsmentioning

confidence: 99%

European guidelines for quality assurance in cervical cancer screening: recommendations for clinical management of abnormal cervical cytology, part 1

et al. 2008

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“…However, recent study of population performances show that up to 77% of adolescents with ASCUS will be positive for high-risk HPV types. This has called into question the use of HPV triage in adolescent populations [42]. Repeat cytology 6 to 12 months is now often favored over HPV triage.…”

Section: Ascus and Lsil Triagementioning

confidence: 99%

HPV Infections in Adolescents

Moscicki

2007

Disease Markers

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Adolescents who are sexually active have the highest rates of prevalent and incident HPV infection rates with over 50–80% having infections within 2–3 years of initiating intercourse. These high rates reflect sexual behavior and biologic vulnerability. Most infections are transient in nature and cause no cytologic abnormality. However, a small number of adolescents will not clear the infection. Persistence of HPV is strongly linked to the development of high-grade squamous intra-epithelial lesions (HSIL) and invasive cancer. The HSIL detected, however, does not appear to progress rapidly to invasive cancer. Understanding the natural history of HPV in adolescents has shed light into optional treatment strategies which include watchful observation of atypical squamous cells of undetermined significance (ASCUS) and low grade (LSIL). The association between age of first intercourse and invasive cancer cannot be ignored. Consequently, initiating screening at appropriate times in this vulnerable group is essential. In addition, with the advent of the HPV vaccine, vaccination prior to the onset of sexual activity is critical since most infections occur within a short time frame post initiation.

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“…Swabs were taken and placed into a tube containing 3 mL cell preservation medium, and were stored at -20˚C until testing. Fourteen high-risk HPV genotypes (16,18,31,33,35,39,45,51,52,56,58,59, 66, 68) and two low-risk HPV types (6,11) in all cervical swabs were detected by using the PCR-based MAL-DI-TOF-MS assays [23,24] in the Center of BGI Health clinical laboratory (BGI, Shenzhen, China). GBI Shenzhen designed the MALDI-TOF-MS-based HPV multiplex assay and HPV genotyping assay with excellent specificity [24].…”

Section: Hpv Dna Testmentioning

confidence: 99%

“…We deduced that the Chlamydia trachomatis infection may aggravate cervical lesions triggered by high-risk HPV infection and play a possible synergistic action with high-risk HPV in cervical lesion progression [9]. Furthermore, management of women with ASC-US cytology confused clinicians in the past decades [28,38,39], until recently, a systematic review concluded that HPV DNA test shows higher accuracy and sensitivity than repeat cytology tests in triage women with ASC-US cytology [33]. The association between ASC-US cytology and Neisseria gonorrhoeae infection or bacterial vaginosis in our study provided a clue that evaluation of Neisseria gonorrhoeae DNA and/or bacterial vaginosis may be a supplementary tool to triage women with ASC-US cytology.…”

Section: Plos Onementioning

confidence: 99%

Associations of sexually transmitted infections and bacterial vaginosis with abnormal cervical cytology: A cross-sectional survey with 9090 community women in China

Liu

Luo

et al. 2020

PLoS ONE

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Background Although it is well acknowledged that persistent infection with high-risk human papillomavirus types in genital sites plays a crucial role in the development of squamous cell cervical carcinoma, there is no unanimous consensus on the association between non-HPV sexually transmitted infections and abnormal cervical cytology. Methods In the present study, we evaluated cervical cytology status, sexually transmitted infections and bacterial vaginosis status, and collected social-demographic information among recruited participants to explore the association of STIs and bacterial vaginosis with abnormal cervical cytology. Results 9,090 women's specimens were successfully tested, with a total of 8,733 (96.1%) women had normal cytology and 357 (3.9%) women exhibited abnormal cytology. The prevalence of HPV, Chlamydia trachomatis, Neisseria gonorrhoeae, and bacterial vaginosis was significantly higher in the �ASC-US group than the NILM group (P<0.05). Women with Neisseria gonorrhoeae infection (AOR = 5.30, 95% CIs = 1.30-21.51, P = 0.020) or bacterial vaginosis (AOR = 1.94, 95% CIs = 1.08-3.47, P = 0.026) exhibited an increased risk of abnormal cervical cytology after adjusted for carcinogenic HPV-positive status.

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A 21-Year-Old Woman With Atypical Squamous Cells of Undetermined Significance

Cited by 16 publications

References 49 publications

European guidelines for quality assurance in cervical cancer screening: recommendations for clinical management of abnormal cervical cytology, part 1

European guidelines for quality assurance in cervical cancer screening: recommendations for clinical management of abnormal cervical cytology, part 1

HPV Infections in Adolescents

Associations of sexually transmitted infections and bacterial vaginosis with abnormal cervical cytology: A cross-sectional survey with 9090 community women in China

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