Cytological changes preceding cervical cancer.

Robertson, J. H.; Woodend, Bertha E.; Elliott, Hunter

doi:10.1136/jcp.47.3.278

Cited by 33 publications

(16 citation statements)

References 5 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…37 Interestingly, false-negative low-grade squamous intraepithelial lesion (LSIL) cases have been strikingly absent in our retrospective reviews of Papanicolaou tests reported as negative preceding diagnoses of litigated cervical cancer. 3,38 This observation supports the more recent concept that LSIL is at best only rarely a progressive premalignant lesion 39 and that separate CIN 1 and CIN 3 lesions most likely represent distinct lesions developing because of different infections by various types of HPV. 40 Questions about the appropriateness of clinical follow-up are common in litigated cases of cervical cancer, whether any of the preceding Papanicolaou interpretations are challenged.…”

supporting

confidence: 78%

Observations From Pap Litigation Consultations

Austin

Zhao

2011

Pathology Case Reviews

View full text Add to dashboard Cite

Papanicolaou test litigation in the United States reflects widespread societal expectations that even occasional cervical screening should prevent nearly all cervical cancers in screened women. Scientific evidence clearly shows that these expectations are unfounded, especially for increasingly prevalent glandular cervical cancers and for more rapidly progressive cervical cancers in younger women. Reviews of Papanicolaou test slides involved in litigation repeatedly show 1 or more of 3 cytologic patterns: difficult-to-interpret abnormal glandular cell groups, difficult-tointerpret hyperchromatic crowded cell groups, and/or difficult-to-locate or -interpret abnormal immature metaplastic squamous cells. Multipleslide blinded reviews, supported by professional organization guidelines, should be used to identify and differentiate culpable medical errors from factors primarily associated with the inherent limitations of human screening and interpretation. In the authors' opinion, remaining US cases of cervical cancer are most likely to be prevented or minimized by more widespread utilization of cotesting with US Food and Drug AdministrationYapproved methods of liquid-based cytology and high-risk human papillomavirus DNA testing.T he Papanicolaou test is the most successful cancer screening test in medical history. 1 The twin goals of cervical screening are (1) to detect and ablate cervical precancer and (2) to detect and minimize the stage at diagnosis of cases of already invasive cervical cancer. 2 Papanicolaou test litigation consultations provide opportunities for valuable insights into both the natural history of cervical carcinogenesis and the limitations of current cervical screening methods and practices. 3 Although the demonstrated capability of cytology-based screening to detect and prevent or downstage invasive cervical cancer (CxCa) is significantly less for both glandular cervical cancers 4,5 and for more rapidly progressive cervical cancers in younger women, 6 there is, nevertheless, a strong public presumption that almost any cervical screening should essentially guarantee that almost all cervical cancers will be prevented. 3 This presumption that cervical screening should prevent almost all cervical cancers in screened women forms the basis for screened patients' consideration of legal recourse after a cervical cancer diagnosis. In our opinion, the same unfounded presumption that cervical screening should reliably prevent almost all cervical cancers strongly influences most consultants asked by plaintiffs to review durable slide evidence after a diagnosis of CxCa and to ascertain whether a culpable medical error occurred. The multiple-slide blinded rescreening (MSBR) method 3,7Y10 has been developed to improve the objectivity of retrospective reviews of litigated Papanicolaou cases and has had some success in helping to adjudicate and resolve disputed cases. Newer cervical screening technologies also have the potential to help achieve cervical screening performance and outcomes that more closely approach...

show abstract

supporting

confidence: 78%

Observations From Pap Litigation Consultations

Austin

Zhao

2011

Pathology Case Reviews

View full text Add to dashboard Cite

show abstract

“…41 Finally, studies reviewing the Papanicolaou smears of women with invasive carcinoma have identified high-grade (moderate to severe dyskaryosis) in the vast majority, further evidence that cancers are unlikely to be preceded by a long-standing interval of mild dysplasia or koilocytosis alone. 42 …”

Section: Intraepithelial Lesionsmentioning

confidence: 97%

Binary (Bethesda) system for cervical precursor lesions: A histologic perspective

Crum

1995

Diagnostic Cytopathology

View full text Add to dashboard Cite

In the half century following Papanicolaou's observation that cervical carcinomas were not only preceded by precursor lesions but could be detected by cytologic screening, ' investigators have proposed a multitude of histologic/cytologic terms for these precursor lesions, have devised methods for their identification and removal in the outpatient setting, and have identified a potential causative agent (the human papillomavirus). The first major histologic classification in recent memory was proposed in 1962 by the International Committee on Histologic Terminology for Lesions of the Uterine Cervix and was predicated on the assumption that an undifferentiated intraepithelial neoplasm (carcinoma in situ, CIS) was a biologically distinct process. Lesions exhibiting less extreme alterations were variably termed dysplasia or "borderline" lesions. During this era, treatment options were limited largely to cone biopsy or hysterectomy, and a strict histologic definition of what constituted a precursor was considered desirable both to accomplish the removal of significant precursors and to avoid potentially unnecessary surgery. Over the ensuing decade, several observations by investigators have challenged the concept that dysplasia and CIS were distinguishable as separate entities: 1) dysplasia and CIS shared similar chromosomal derangements; 2) so-called mature forms of CIS-lesions overlapping with the higher grades of dysplasia-were about as much at risk of progressing to invasive carcinoma as classic CIS;4 3) the risk of CIS lesions in women with dysplasia was 20-fold that of the general population: 5*6 4) a follow-up of mild-to-moderate dysplasia disclosed CIS or worse in 40% of subsequent smears;5 and 5 ) the pro- jected incidence of invasive carcinoma in a population with a cytologic diagnosis of dysplasia was as much as 100-fold higher than that with documented normal smears. These and other observations provided the impetus for a classification system which merged the entities of dysplasia and CIS into one, i.e., cervical intraepithelial neoplasia (CIN). ' Coincidentally, colposcopy evolved as a practical method to identify lesions, punch biopsy replaced cone biopsy to define lesions histologically, and cautery, cryotherapy, and laser and, eventually, loop excision became available to remove most CIN lesions in the office setting. 's9 Inasmuch as triagehherapy became simplified by the advent of colposcopy and outpatient removal, management of cervical precursor lesions became based upon the identification of any abnormality within the spectrum of CIN. This philosophy has been encouraged in part by the legal system, which highlighted cases of invasive carcinoma occurring in association with mild Papanicolaou smear abnormalities, and the general assumption that when invasive carcinomas were missed, it was due to a failure to pursue a compulsive triage of precursor lesion identification and removal. l o Superimposed upon the emerging philosophy that all potential precursors should be removed was the discovery of papi...

show abstract

“…While it has been claimed that 'mild dyskaryosis' is not a forerunner of invasive cervical lesions [13], it is well established that CIN 3 is a precursor of cervical squamous cell carcinoma, even if the rate with which it evolves into an invasive lesion has been difficult to assess for ethical reasons [14].…”

Section: Discussionmentioning

confidence: 99%

Prognostic Implications of Cervical Intraepithelial Neoplasia in a Single Cervical Smear

Bertelsen

Hartveit²

1998

Gynecol Obstet Invest

View full text Add to dashboard Cite

Our aim was to investigate the prognostic implications of a single cervical smear showing cervical intraepithelial neoplasia (CIN) in a group of women with a previous series of negative smears, and to estimate their risk of developing histologically confirmed CIN 3. A retrospective case-control study was set up. It consisted of 171 cases and 513 age-matched controls, all with at least 3 negative and no positive smears between 1981 and 1988 inclusive. In all cases CIN had been diagnosed on cytology in 1989, while the controls had remained negative. The women were followed up to the end of 1995. The outcome was recorded in terms of regression, progression, persistence or surgical treatment. In women with a single smear showing CIN 1 or 2, the risk of developing histologically proven CIN 3 was 14 and 26 times that in women with negative smears. Negative control smears in the short term did not exclude subsequent progression. Thus women with a single cervical smear indicating CIN 1 had a greatly enhanced risk of producing a lesion that demanded intervention. Such cases should be observed closely with repeat smears over a period of at least 6 years.

show abstract

Cytological changes preceding cervical cancer.

Cited by 33 publications

References 5 publications

Observations From Pap Litigation Consultations

Observations From Pap Litigation Consultations

Binary (Bethesda) system for cervical precursor lesions: A histologic perspective

Prognostic Implications of Cervical Intraepithelial Neoplasia in a Single Cervical Smear

Contact Info

Product

Resources

About