Atrophic Pap Smears, Differential Diagnosis and Pitfalls: A Review

Tabrizi, Ali

doi:10.15296/ijwhr.2018.02

Cited by 8 publications

(1 citation statement)

References 19 publications

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“…In this study, 11.9% of the cases presented atrophy findings and 94.12% of these atrophic smear cases were diagnosed as atrophic vaginitis. There is limited data in the literature on this issue, as well [19,20] . The high rate of atrophic vaginitis cases was challenging.…”

Section: Discussionmentioning

confidence: 99%

Diagnostic Distribution of Cervicovaginal Smear in Bursa and Its Surrounding

Erkinüresin¹

2019

Haydarpasa Numune Med J

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Introduction: In this study, our aim was to analyze Pap smear cervical cancer screening results at our hospital. We also sought to compare our ASC/SIL rate with the relevant studies in the literature, which is one of the quality standard criteria for the pathology laboratory. Methods: In our study, digital reports of 6902 cases diagnosed according to the Bethesda Reporting System for Pap cervical cancer screening and other medical indications in the pathology department of our hospital between 1st January 2018 and 31st December 2018 were reviewed retrospectively. Results: When 6902 cervicovaginal smear cases were analyzed concerning epithelial abnormality, 6528 cases (94.6%) were reported as NILM, and seven cases (0.1%) were reported as an inadequate smear. Epithelial abnormality was detected in the remaining 367 (5.3%) cases. Out of 367 cases,279 (4.0%) of them were reported as ASC-US;42 cases (0.6%) as AGC-NOS;24 cases (0.3%) as LSIL;12 cases (0.2%) as ASC-H, seven cases (0.1%) as HSIL; one case (0.0%) as LSIL and AGC-NOS; one case (0.0%) as ASC-H and AGC-NOS and one case (0.0%) as squamous cell carcinoma (SCC). The ASC/SIL rate of our laboratory for the year 2018 was 9.125. Discussion and Conclusion: Our SCC rate was 0.02%, which was the second-lowest rate in the relevant literature. The reason for this may be the success of the cervicovaginal Pap smear screening program performed in our region. Our inadequate cervicovaginal smear rate concerning assessment was the lowest rate in the literature. Our ASC/SIL rate was 9.125, and this was the third highest ASC/SIL rate in the literature. The reason for our laboratory's 2018 ASC/SIL rate of 9.125 may be the concern of some of our pathologists of false-negative reports. We detected various differences between epithelial abnormality and infection prevalence in the cervicovaginal smears in our region and epithelial abnormality and infection prevalence in different regions of the world. Intra-departmental case presentations and in-service training could be organized to keep the ASC/SIL rate in the pathology laboratory under three. At the same time, pathologists' quarterly ASC/SIL rates could be calculated and reported to the pathologists.

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Section: Discussionmentioning

confidence: 99%

Diagnostic Distribution of Cervicovaginal Smear in Bursa and Its Surrounding

Erkinüresin¹

2019

Haydarpasa Numune Med J

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The necessity of continuing cervical cancer screening of elderly Korean women aged 65 years or older

Cho

Lee

et al. 2022

Diagnostic Cytopathology

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Background Although the incidence of cervical cancer has decreased since the 1980s in Korea, it remains high among the elderly women. This study evaluated the suitability of cervical cancer screening for elderly Korean women aged ≥65 years according to recommendations by the American Society of Cytopathology and American Society for Colposcopy and Cervical Pathology. Methods We retrospectively reviewed the records of patients who underwent cervical cancer screening, followed by liquid‐based Pap test, human papillomavirus (HPV) test, and colposcopic punch biopsy at two academic hospitals from May 2008 to May 2018. The participants were divided into two groups <65 and ≥65 years old. Logistic regression analysis was performed to evaluate the association between cytology tests, HPV tests and the occurrence of high‐risk lesions, ≥cervical intraepithelial neoplasia2 (CIN2). Results The mean patient age was 49.02 ± 15.437 (range 15–91) years. No patients aged <25 years showed atypical squamous cell‐cannot exclude high grade (ASC‐H), squamous cell carcinoma (SCC), or adenocarcinoma (ADC). The incidence of high‐grade squamous intraepithelial lesion (HISL) (39.7%) and ≥CIN 3 (40.2%) was significantly higher in patients ≥65 years of age than in other age groups. However, patients ≥65 years showed increased HSIL and HPV negativity and ASC‐H, HSIL, and HPV positivity in those with ≥CIN 2 (both p = .043). Conclusion Korean women aged ≥65 years should undergo cervical cancer screening. The relevance of HPV or Cytology test alone or co‐test for screening should be evaluated in this population.

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Differential diagnosis of high-grade squamous intraepithelial lesions and benign atrophy in older women using p16 immunocytochemistry

Yan

Wang

et al. 2021

gocm

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BackgroundFor cervical cancer screening, routine cytology has a high specificity but a lower sensitivity. In older women, atrophy, which may mimic HSIL, presents a diagnostic challenge. p16 is a widely used biomarker for histological diagnosis of HSIL. Our objective was to evaluate PathCIN® p16INK4aimmunocytology in identification of high grade dysplasiavs.benign atrophy.MethodsAs part of a multi-center screening program, 3351 women were co-tested by p16 immunocytology. Among women referred for colposcopy on basis of cytology and high-risk HPV status, those with atrophy were older than the population screened (52vs.43 years). Cases from older women with atrophy (n = 116) and controls without atrophy (n = 47) were identified by re-examination of Pap smears. The detection of CIN2+ was compared for p16, cytology and HR-HPV results.ResultsThe sensitivity of routine cytology (≥LSIL) was much lower for cases with atrophy (17%) than non-atrophic cases (75%). The sensitivity of p16 immunocytology and of HR-HPV testing was high (88%–100%) both with and without atrophy. The specificity of routine cytology (≥LSIL) was higher for cases with atrophy (79%) than non-atrophic cases (38%). The specificity of p16 immunocytology was high (88–95%) and the specificity of HR-HPV testing was low (31%–33%) both with and without atrophy. Combining p16 with HPV testing and/or routine cytology had no benefit, as compared to p16 staining alone.Conclusionsp16 immunocytology compares favorably with routine cytology and HPV testing in the differential diagnosis of HSIL and benign atrophy. It is more sensitive than cytology for atrophic specimens, and is more specific than HPV testing. p16 immunocytology may decrease the need for colposcopy referrals and could be a useful tool for early detection of cervical cancer in peri- and post-menopausal women, who are more likely to have HSIL coexisting with atrophy.

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Atrophic Pap Smears, Differential Diagnosis and Pitfalls: A Review

Cited by 8 publications

References 19 publications

Diagnostic Distribution of Cervicovaginal Smear in Bursa and Its Surrounding

Diagnostic Distribution of Cervicovaginal Smear in Bursa and Its Surrounding

The necessity of continuing cervical cancer screening of elderly Korean women aged 65 years or older

Differential diagnosis of high-grade squamous intraepithelial lesions and benign atrophy in older women using p16 immunocytochemistry

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