Cervical Papanicolaou tests in the female-to-male transgender population: should the adequacy criteria be revised in this population? An Institutional Experience

Plummer, Regina; Kelting, Sarah; Madan, Rashna; O’Neil, Maura; Dennis, Katie; Fan, Fang

doi:10.1016/j.jasc.2021.01.004

Cited by 9 publications

(37 citation statements)

References 17 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Our study cohort demonstrated a high percentage of abnormal cervicovaginal cytology tests in transmasculine persons receiving testosterone, including previous reported high rates of unsatisfactory Pap tests, mainly due to scant squamous cell cellularity. In contrast to previous studies, [10][11][12][13]15 we found a higher percentage of HSIL in our population, when compared with our institutional data and cohort of cisgender women with atrophic changes. The increased rate of HSIL could be due to the relatively small sample size, but other factors may play a role.…”

Section: Discussioncontrasting

confidence: 99%

“…Due to the limited number of cases with HPV co-testing in this cohort, we combined our cases with those from studies in the literature [11][12][13] for statistical analysis to better determine the accuracy of HPV testing in the detection of HSIL in transmasculine individuals receiving testosterone. A total of 72 HPV tests with either concurrent negative cytology or histologic follow-up were included (Table 3).…”

Section: Resultsmentioning

confidence: 99%

“…Testosterone is one of the strategies that transmasculine individuals can elect to align physical traits to their gender identity. A few reports have shown that cytopathologic findings in cervicovaginal cytology specimens (Pap tests) from transmasculine individuals receiving testosterone are more likely to be unsatisfactory and show atrophic changes 10–13 . In addition to cancer screening, Pap tests can also reveal important information regarding vaginal infections and vaginal flora.…”

Section: Introductionmentioning

confidence: 99%

“…A few reports have shown that cytopathologic findings in cervicovaginal cytology specimens (Pap tests) from transmasculine individuals receiving testosterone are more likely to be unsatisfactory and show atrophic changes. [10][11][12][13] In addition to cancer screening, Pap tests can also reveal important information regarding vaginal infections and vaginal flora. To the best of our knowledge, only one study in the literature evaluated the vaginal flora in transmasculine individuals receiving testosterone.…”

mentioning

confidence: 99%

See 3 more Smart Citations

Cervicovaginal cytology, HPV testing and vaginal flora in transmasculine persons receiving testosterone

Lin

Zhou

Elishaev

et al. 2022

Diagnostic Cytopathology

View full text Add to dashboard Cite

Background Testosterone is one of the strategies that transmasculine persons can elect in order to align physical traits to their gender identity. Previous studies have shown morphologic changes in the genital tract associated with testosterone. Here, we aim to evaluate cervicovaginal cytology specimens (Pap tests) and high‐risk HPV (HR‐HPV) testing from transmasculine individuals receiving testosterone. Methods This is a retrospective cohort of 61 transmasculine individuals receiving testosterone from 2013 to 2021. Cytologic diagnoses from 65 Pap tests were correlated with HPV status and histologic follow‐up and compared with the institutional data and a cohort of cisgender women with atrophic changes. Results The median age was 28 years and median time of testosterone use was 3 years. Transmasculine persons showed significantly higher rates of HSIL (2%) and unsatisfactory (16%) when compared with the institutional data and atrophic cohort of cisgender women. After reviewing slides of 46 cases, additional findings were noted: atrophy was present in 87%, glycogenated cells were seen in 30%, and Lactobacilli were substantially decreased in 89%. Among 32 available HPV tests, 19% were positive for HR‐HPV and 81% were negative. On histologic follow‐up, all HR‐HPV‐positive cases with abnormal cytology showed HSIL, while none of the HPV‐negative cases revealed HSIL. Conclusion Our study cohort demonstrated a high percentage of abnormal Pap tests in transmasculine persons receiving testosterone. Testosterone seems to induce changes in squamous cells and shifts in vaginal flora. HR‐HPV testing can be a useful adjunct in the workup of abnormal Pap tests from transmasculine individuals.

show abstract

Section: Discussioncontrasting

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

mentioning

confidence: 99%

See 2 more Smart Citations

Cervicovaginal cytology, HPV testing and vaginal flora in transmasculine persons receiving testosterone

Lin

Zhou

Elishaev

et al. 2022

Diagnostic Cytopathology

View full text Add to dashboard Cite

show abstract

“…The individuals' ages ranged from 22 to 33 years, with a median age of 28 years. On the “retrospective” review of the slides, the unsatisfactory diagnoses remained unchanged since the number of squamous epithelial cells was lower than the adequacy threshold of 2000 on each individual slide suggested by Plummer et al 20 One of these cases (test# 121, Table S1) had a follow‐up biopsy which was diagnosed as LSIL. HPV testing was performed for 8 of the 12 cases with unsatisfactory Pap tests, and 2/73 (2.7%) tested positive for HR strains, as shown in Table 1.…”

Section: Resultsmentioning

confidence: 96%

Clinical history of female‐to‐male transgender patients is needed to avoid misinterpretation of cervical Papanicolaou tests

et al. 2023

View full text Add to dashboard Cite

Objective: Cervical cancer screening is as important in female-to-male transgender (FTMT) patients as it is in cisgender female patients. The aim of this study was to examine the impact of clinical information regarding gender identity and testosterone therapy on the cytological interpretations.Methods: A list of FTMT patients and cisgender female patients who had received a cervical Papanicolaou (Pap) test for cancer screening was obtained. The cytological diagnoses, rendered at the time of collection, were recorded. A retrospective slide review with knowledge of the pertinent clinical information, including testosterone therapy status, was performed. The data sets were statistically compared.Results: Of 122 cervical Pap tests in 111 FTMT individuals, 23 (19%) had surgical follow-ups; 73 (60%) had HPV testing, of which 12 (16%) were positive for high-risk strains; and 79 (65%) were known to be receiving testosterone. On the "original" review, 12 (9.8%) tests were diagnosed as unsatisfactory. Seventy-one (58%) Pap tests were initially diagnosed as negative for intraepithelial lesion or malignancy (NILM) without atrophy and 32 (26%) with atrophy. Seven (5.7%) of the tests were initially diagnosed as abnormal. On the "retrospective" review, the rate of unsatisfactory tests remained the same, and atrophy was observed in 76 (62%) tests. The number of abnormal tests was reduced to 4 (3.3%) after the retrospective review. Almost all comparative studies returned a P-value of ≤0.05. Conclusion:Our findings indicate that clinical information regarding whether a subject is transgender and/or is receiving testosterone therapy is crucial to avoiding Pap test overcalls.

show abstract

Cervicovaginal Papanicolaou tests in transgender men: Cytomorphologic alterations, interpretation considerations, and clinical implications

Torous

2023

Cancer Cytopathology

View full text Add to dashboard Cite

BackgroundThe transgender population faces unique psychosocial and physical obstacles to cervical cancer screening. Additionally, most individuals undergo masculinizing testosterone hormone therapy, and the physiologic changes can cause cytomorphologic alterations that may mimic lesions. Although the literature on cervicovaginal cytology is growing in this patient population, it is still limited.MethodsThe pathology information system was queried for all Papanicolaou (Pap) tests from transgender men from January 2013 to February 2023. The original diagnostic categories were catalogued. Cases were reviewed to evaluate the cytomorphologic alterations. Clinical data were also sought, including whether the sample was self‐collected. Two comparison groups were established: one was a postpartum atrophic group and the other was an all‐comer group.ResultsA total of 51 cases from 43 individuals were identified, with a mean age of 31 years. Approximately a third of cases (18 of 51; 35%) were self‐collected. The abnormal rate was low, with 5.9% of cases rendered atypical squamous cells of undetermined significance on original review and no lesions identified. The Pap unsatisfactory rate according to original reports was 3.9%. This increased to 13.7% when the cases were rereviewed, which was significantly higher than the all‐comer comparison group. The unsatisfactory rate did not correlate with self‐collection. Atrophy was a prevalent cytomorphologic alteration, with the vast majority of cases (92%) showing at least mild atrophy. Small blue cells and transitional cell metaplasia were seen in many cases (53% and 43%, respectively).ConclusionsThere are clinical and morphologic considerations that are distinct to the transgender patient population. Laboratory personnel and diagnosticians need to be aware of these in order to optimize patient care.

show abstract

Cervical Papanicolaou tests in the female-to-male transgender population: should the adequacy criteria be revised in this population? An Institutional Experience

Cited by 9 publications

References 17 publications

Cervicovaginal cytology, HPV testing and vaginal flora in transmasculine persons receiving testosterone

Cervicovaginal cytology, HPV testing and vaginal flora in transmasculine persons receiving testosterone

Clinical history of female‐to‐male transgender patients is needed to avoid misinterpretation of cervical Papanicolaou tests

Cervicovaginal Papanicolaou tests in transgender men: Cytomorphologic alterations, interpretation considerations, and clinical implications

Contact Info

Product

Resources

About