Effect of Cellularity on the Sensitivity of Detecting Squamous Lesions in Liquid-Based Cervical Cytology

Studeman, Kimberley; Ioffe, Olga B.; Puszkiewicz, Jolanta; Sauvegeot, Jurgita; Henry, Michael R.

doi:10.1159/000326576

Cited by 41 publications

(32 citation statements)

References 10 publications

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“…For some specimen types, adequacy has been clearly defined (i.e., for cervicovaginal cytology [31,32] and FNA specimens of the thyroid [33,34,35]); in others, adequacy criteria have been proposed (pancreaticobiliary system cytology [36], EBUS/EUS-guided FNAs of mediastinal and hilar lymph nodes [37,38,39]) but are not yet defined or tested; in most other specimen types there are no well-defined, universally accepted adequacy criteria. Adequacy, in general, ensures that the specimen is representative of what is sampled.…”

Section: Diagnostic Categories and Morphologic Criteria Of The Paris mentioning

confidence: 99%

The Paris System for Reporting Urinary Cytology: The Quest to Develop a Standardized Terminology

et al. 2016

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The main purpose of urine cytology is to detect high-grade urothelial carcinoma (HGUC). With this principle in mind, The Paris System (TPS) Working Group, composed of cytopathologists, surgical pathologists, and urologists, has proposed and published a standardized reporting system that includes specific diagnostic categories and cytomorphologic criteria for the reliable diagnosis of HGUC. This paper outlines the essential elements of TPS and the process that led to the formation and rationale of the reporting system. The Paris System Working Group, organized at the 2013 International Congress of Cytology, conceived a standardized platform on which to base cytologic interpretation of urine samples. The widespread dissemination of this approach to cytologic examination and reporting of urologic samples and the scheme's universal acceptance by pathologists and urologists is critical for its success. For urologists, understanding the diagnostic criteria, their clinical implications, and the limitations of TPS is essential if they are to utilize urine cytology and noninvasive ancillary tests in a thoughtful and practical manner. This is the first international/inclusive attempt at standardizing urinary cytology. The success of TPS will depend on the pathology and urology communities working collectively to improve this seminal paradigm shift, and optimize the impact on patient care.

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Section: Diagnostic Categories and Morphologic Criteria Of The Paris mentioning

confidence: 99%

The Paris System for Reporting Urinary Cytology: The Quest to Develop a Standardized Terminology

et al. 2016

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“…19 However, questions related to cellularity, such as whether relatively hypocellular LBPT specimens (ie, specimens with between 5000 and 20,000 squamous cells) are entirely adequate and whether the same cellularity thresholds should be applied to different LBPTs (SurePath, ThinPrep, Monoprep) 20,21 still await answers. Some authors have suggested that a higher cellularity, with a threshold set at 10,000 22 and even 15,000 23 well observed squamous cells, is a better indicator of specimen adequacy.…”

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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“…It was concluded that cellularity does not provide assurance of adequacy and recommended that any cellularity criterion should be based on measurement of the prevalence of abnormal cells on abnormal slides. 25 Subsequently, only one study supported a MACC of 5000 cells, 26 and others demonstrated that detection of abnormality increased substantially as cell numbers increased to 10,000 25 or even higher. 12 Unfortunately, the last-mentioned study, which measured the prevalence of abnormal cells on abnormal slides was presented only as a poster at the American Society of Cytopathology and has not been subjected to peer-reviewed publication.…”

Section: Discussionmentioning

confidence: 99%

A study of cellular counting to determine minimum thresholds for adequacy for liquid-based cervical cytology using a survey and counting protocol

Kitchener

Gittins

Desai³

et al. 2015

Health Technology Assessment

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BackgroundLiquid-based cytology (LBC) for cervical screening would benefit from laboratory practice guidelines that define specimen adequacy for reporting of slides. The evidence base required to define cell adequacy should incorporate both ThinPrep™ (TP; Hologic, Inc., Bedford, MA, USA) and SurePath™ (SP; BD Diagnostics, Burlington, NC, USA), the two LBC systems used in the UK cervical screening programmes.ObjectivesThe objectives of this study were to determine (1) current practice for reporting LBC in England, Wales and Scotland, (2) a reproducible method for cell counting, (3) the cellularity of slides classified as inadequate, negative or abnormal and (4) the impact of varying cellularity on the likelihood of detecting cytological abnormalities.DesignThe study involved four separate arms to pursue each of the four objectives. (1) A questionnaire survey of laboratories was conducted. (2) A standard counting protocol was developed and used by three experienced cytopathologists to determine a reliable and reproducible cell counting method. (3) Slide sets which included a range of cytological abnormalities were each sent to three laboratories for cell counting to study the correlation between cell counts and reported cytological outcomes. (4) Dilution of LBC samples by fluid only (unmixed) or by dilution with a sample containing normal cells (mixed) was performed to study the impact on reporting of reducing either the total cell count or the relative proportion of abnormal to normal cells.SettingThe study was conducted within the cervical screening programmes in England, Wales and Scotland, using routinely obtained cervical screening samples, and in 56 participating NHS cervical cytology laboratories.ParticipantsThe study involved only routinely obtained cervical screening samples.InterventionsThere was no clinical intervention.Main outcome measuresThe main outcome measures were (1) reliability of counting method, (2) correlation of reported cytology grades with cellularity and (3) levels of detection of abnormal cells in progressively diluted cervical samples.ResultsLaboratory practice varied in terms of threshold of cellular adequacy and of morphological markers of adequacy. While SP laboratories generally used a minimum acceptable cell count (MACC) of 15,000, the MACC employed by TP laboratories varied between 5000 and 15,000. The cell counting study showed that a standard protocol achieved moderate to strong inter-rater reproducibility. Analysis of slide reporting from laboratories revealed that a large proportion of the samples reported as inadequate had cell counts above a threshold of 15,000 for SP, and 5000 and 10,000 for TP. Inter-rater unanimity was greater among more cellular preparations. Dilution studies demonstrated greater detection of abnormalities in slides with counts above the MACC and among slides with more than 25 dyskaryotic cells.ConclusionsVariation in laboratory practice demonstrates a requirement for evidence-based standards for designating a MACC. This study has indicated that a MACC of 15,000 and 5000 for SP and TP, respectively, achieves a balance in terms of maintaining sensitivity and low inadequacy rates.Future workThe findings of this study should inform the development of laboratory practice guidelines.FundingThe National Institute for Health Research Health Technology Assessment programme.

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Effect of Cellularity on the Sensitivity of Detecting Squamous Lesions in Liquid-Based Cervical Cytology

Cited by 41 publications

References 10 publications

The Paris System for Reporting Urinary Cytology: The Quest to Develop a Standardized Terminology

The Paris System for Reporting Urinary Cytology: The Quest to Develop a Standardized Terminology

Unsatisfactory SurePath liquid‐based Papanicolaou tests

A study of cellular counting to determine minimum thresholds for adequacy for liquid-based cervical cytology using a survey and counting protocol

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