CIN 2/3 and cervical cancer in an organised screening programme after an unsatisfactory or a normal Pap smear: a seven-year prospective study of the Norwegian population-based screening programme

Nygård, Jan F.; Sauer, Torill; Nygård, Mari; Skare, Gry Baadstrand; Thoresen, Steinar

doi:10.1258/096914104774061047

Cited by 34 publications

(42 citation statements)

References 61 publications

(74 reference statements)

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“…A similar conclusion was reached in a recent study in which women who had an unsatisfactory index Pap smear had a higher hazard rate for histologic CIN-2/CIN-3 or invasive squamous cell carcinoma, especially during the first 2 years of follow-up. 50 However, Adams et al 15 observed no differences in the incidence of squamous abnormalities detected on follow-up between patients who had unsatisfactory Pap smears because of inadequate squamous cellularity, as defined by the 2001 Bethesda System, and patients who had satisfactory and negative smears.…”

Section: Unsatisfactory Lb Pap Tests/alsharif Et Almentioning

confidence: 99%

Unsatisfactory SurePath liquid‐based Papanicolaou tests

Alsharif

McKeon

Gulbahce

et al. 2009

Cancer Cytopathology

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BACKGROUND:The introduction of liquid‐based Papanicolaou (Pap) tests (LBPTs) has reduced the incidence of unsatisfactory Pap tests (UPTs), but little is known about their causes and significance, especially in the case of SurePath LBPTs.METHODS:All unsatisfactory LBPTs from January 1, 2003 to December 31, 2006 were retrieved. The characteristics of patients, providers, and LBPTs; the reason for UPTs; and any cytologic or histologic follow‐up within 24 months were recorded. Negative Pap tests that were evaluated immediately after a UPT served as a control group.RESULTS:Of 243,006 Pap tests (95.5% SurePath LBPTs), 0.23% were unsatisfactory. Scant cellularity was the primary cause of SurePath UPT. Women in this UPT group were older, had more diagnostic Pap tests taken, less frequently were taking contraceptives or were pregnant, and were more likely to be menopausal or posthysterectomy. The 278 women who had UPTs had significantly higher rates of follow‐up Pap tests (65.1% vs 22.2%), abnormal Pap tests (5.4% vs 1.4%), biopsies (10% vs 1%), and abnormal biopsies (5% vs 1%) than the 284 women in the control group, including 7 women with cervical intraepithelial neoplasia 1 (CIN‐1), 1 woman with CIN‐2, 4 women with CIN‐3, and 2 women with endometrial hyperplasia. The UPT rates varied little between provider groups (physicians vs nonphysicians and gynecologists vs nongynecologists).CONCLUSIONS:The frequency of UPTs in a predominantly SurePath LBPT‐screened population was very low and was caused mainly by low cellularity. Similar to conventional Pap smears, unsatisfactory SurePath LBPTs had a higher risk of significant histologic abnormalities on follow‐up than negative satisfactory Pap tests and could have benefited from a repeat Pap test or other evaluation, according to current management guidelines. Cancer (Cancer Cytopathol) 2009. © 2009 American Cancer Society.

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Section: Unsatisfactory Lb Pap Tests/alsharif Et Almentioning

confidence: 99%

Unsatisfactory SurePath liquid‐based Papanicolaou tests

Alsharif

McKeon

Gulbahce

et al. 2009

Cancer Cytopathology

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“…Historically, clinicians have recognized that cytologic samples collected on days of active menstruation are typically bloody and often yield smears that are hypocellular, obscured, and lack endocervical cells (Vooijs et al, 1987). Furthermore, data demonstrating that unsatisfactory cytology specimens are associated with a higher than expected frequency of cervical intraepithelial neoplasia (CIN) and carcinoma (Ransdell et al, 1997;Nygard et al, 2004) in later follow-up, suggest that that these specimens may be linked to false negative results. However, efforts to coordinate return visits to re-screen women with unsatisfactory cytology often fail (McGarahan and Smith-McCune, 2005), and presumably, deferring screening for women who present near the time of menses would present similar problems.…”

mentioning

confidence: 99%

“…Previous analyses of cytology results obtained with conventional smears have documented that suboptimal specimens result in increased reporting of false negative and equivocal results (Gay et al, 1985;Mitchell et al, 1990;Pairwuti, 1991;Henry and Wadehra, 1996;Ransdell et al, 1997;Mintzer et al, 1999;Boon et al, 2003;Nygard et al, 2004). Although many factors affect the quality of cervical cellular specimens, the time of sampling with respect to a woman's last menstrual period (LMP) has demonstrated importance.…”

mentioning

confidence: 99%

Performance of cytology and human papillomavirus testing in relation to the menstrual cycle

2006

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Cervical smears prepared around the time of menses have been linked to unsatisfactory specimens and false negative results; however, it is unclear whether liquid-based cytology is similarly affected and data relating date of last menstrual period (LMP) to human papillomavirus (HPV) DNA testing are conflicting. Accordingly, we evaluated liquid-based cytology and HPV test results using Hybrid Capture 2 and PCR by LMP (days 0 -10; 11 -21; 22 -28). We studied 5060 participants in ALTS, the Atypical Squamous Cells of Undetermined Significance (ASCUS) Low Grade Squamous Intraepithelial Lesion (LSIL) Triage Study. On average, women had 3.4 examinations (median 4, range 1 -5) during a 2-year period of observation permitting an examination of intra-individual variation in cytology and HPV by LMP. Although uncommon, unsatisfactory cytology specimens were most likely on days 0 -10. For satisfactory specimens, the frequency with which cytologic categories were reported varied by time since LMP, although differences were modest and did not affect the chance of abnormal cytology or its severity among women diagnosed with CIN2 þ . The frequency of positive HC2 tests did not vary with date of LMP. Among HPV infected women, independent of eventual diagnosis and the number of viral genotypes present, mid-cycle specimens yielded the highest frequency of LSIL cytologic interpretations and the highest HPV load; however, the magnitude of these effects were small. Intraindividual correlations of cytology or HPV by LMP were generally weak. We conclude that mid-cycle specimens yield slightly higher HPV DNA loads and slightly increased LSIL interpretations, but the clinical impact is marginal. Standardizing collection times would slightly improve interpretation of trends in HPV load. Finally, these data are consistent with the view that the biological properties of the HPV-infected cervix vary with the date of the LMP. Historically, clinicians have recognized that cytologic samples collected on days of active menstruation are typically bloody and often yield smears that are hypocellular, obscured, and lack endocervical cells (Vooijs et al, 1987). Furthermore, data demonstrating that unsatisfactory cytology specimens are associated with a higher than expected frequency of cervical intraepithelial neoplasia (CIN) and carcinoma (Ransdell et al, 1997;Nygard et al, 2004) in later follow-up, suggest that that these specimens may be linked to false negative results. However, efforts to coordinate return visits to re-screen women with unsatisfactory cytology often fail (McGarahan and Smith-McCune, 2005), and presumably, deferring screening for women who present near the time of menses would present similar problems. Given this dilemma, it is important to determine whether the advantages of liquid-based cytology methods, such as increased cellular recovery and reduction of obscuring by blood (Bernstein et al, 2001), eliminate the association between the performance of cytology and LMP that has been demonstrated for smears.Similarly, the implement...

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“…29 Furthermore, women with unsatisfactory Pap tests have been shown to be at an increased risk of harboring abnormal cells. 4,30 Because some personal lubricants and vaginal medications advertise lasting up to 7 days (eg, Monistat 1), it may be worth questioning whether an unsatisfactory Pap test result is caused by the patient's use of one of these products. If so, the clinician might advise the patient to avoid using the product before returning for a repeat Pap test.…”

Section: Resultsmentioning

confidence: 99%

“…This can occur as a result of poor sampling technique, the presence of disease, or interference with processing by certain contaminants. 3,4 The improper use of speculum lubricant, leading to contamination of the external cervical os and/or specimen slide, has been shown to create background artifacts, obscure cellular detail, and increase the likelihood of an unsatisfactory result in conventional Pap smears. 5,6 It has also been associated with creating artifacts and reducing cellularity in liquid-based Pap tests.…”

mentioning

confidence: 99%