Factors associated with reduced accuracy in Papanicolaou tests for patients with invasive cervical cancer

Zhao, Lichao; Wentzensen, Nicolas; Zhang, Roy R.; Dunn, S. Terence; Gold, Michael A.; Wang, Sophia; Schiffman, Mph Mark; Walker, Joan L.

doi:10.1002/cncy.21443

Cited by 17 publications

(27 citation statements)

References 34 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Furthermore, cellularity, cell coating and spreading patterns on the slide seem to seriously affect the screening process. Small to large empty spaces between cell aggregates and isolated, scattered cells affect the screener's observation under bright‐field microscopes by decreasing the level of orientation on the entire slide . This leads consequently to an increased level of uncertainty during the slides' scanning affecting drastically the complete detection of cytomorphologically abnormal cells.…”

Section: Discussionmentioning

confidence: 99%

Implementation of a real‐time reference and calibration grid platform for improved screening – mapping in Pap test slides

Tsiambas

Riziotis

2016

Pathology International

View full text Add to dashboard Cite

Cervical cancer screening based on the Papanicolaou (Pap) test is a widely applied but not always efficient practice for detecting Human Papillomavirus (HPV) mediated lesions, partially due to a non-systematic and inadequate screening process. Our aim was to introduce an inexpensive easy-to-use direct screening platform for improved detection of abnormal cells indicative of underlying cervical neoplasia as well as persisting HPV infection. By employing a novel, efficient technique of laser-based micromachining, we achieved the fabrication of spatial grids on commercially available coverslips allowing visual segmentation of the slide for efficient screening. Abnormal and formerly diagnosed as negative for intraepithelial lesion or malignancy (NILM) Pap test slides (n = 200) were analyzed by conventional and grid-based screening. Grid-based microscopy led to a more reliable diagnosis compared to the conventional by identifying an increased number of abnormal cells (P = 0.001). It decreased borderline ASCUS, AGC diagnosis, increasing LSIL, HSIL and in situ AdenoCa detection rates closely related with biopsy (P = 0.015; kappa = 0.978). Concerning the set of NILM diagnoses in rapid re-screening, the method upgraded six cases (n = 6) to LSIL (P = 0.001). The proposed technical solution offers a calibration and orientation visual aid during the on-site screening process providing significant advantages compared to expensive digital imaging techniques.

show abstract

Section: Discussionmentioning

confidence: 99%

Implementation of a real‐time reference and calibration grid platform for improved screening – mapping in Pap test slides

Tsiambas

Riziotis

2016

Pathology International

View full text Add to dashboard Cite

show abstract

“…The 45 adenocarcinoma cases described here were extracted from our previous descriptions of this population . The de‐identified ThinPrep slides were retrospectively reviewed for key cytologic elements (see below) without knowledge of the original cytologic interpretation.…”

Section: Methodsmentioning

confidence: 99%

Cytologic patterns of cervical adenocarcinomas with emphasis on factors associated with underdiagnosis

Conrad

Liu

Wentzensen

et al. 2018

Cancer Cytopathology

Self Cite

View full text Add to dashboard Cite

Background: New cervical cancers continue to be diagnosed, despite the success of Pap tests. In an effort to identify pitfalls limiting the diagnosis of adenocarcinoma, we reviewed the cytologic characteristics of endocervical adenocarcinomas in our population. Methods: ThinPrep® slides from 45 women with concurrent histologically confirmed cervical adenocarcinomas were retrospectively and semiquantitatively reviewed for 25 key cytologic traits. The original sign-out diagnosis, available clinical findings and high-risk human papillomavirus (HR HPV) results were also noted. Results: Abundant tumor cellularity, nuclear size 3–6 x normal, abundant 3-dimensional tumor cell groups, round cell shape, and cytoplasmic neutrophils characterized the 23 cases correctly identified as adenocarcinomas. Key reasons for undercalls included low tumor cellularity and low-grade columnar morphology. These also tended to correlate with low-grade or unusual adenocarcinoma variants on histology. Overall, 73% of the adenocarcinoma cases had a concurrent positive HR HPV test. Conclusions: Most endocervical adenocarcinomas can be accurately diagnosed in cases with classical features, but some cases continue to be problematic when evaluated based on cytologic features alone. Reflex HPV testing may help increase Pap test sensitivity for challenging cases with atypical glandular cells of undetermined significance. Occasional cases with negative HR HPV test results remain of concern.

show abstract

“…For the reviewers who participated in the consensus meetings, an adequate sample had to contain 8,000-12,000 squamous epithelial cells, to be preserved and displayed, and to exclude endocervical cells and metaplastic squamous cells, which were considered in this assessment. Other factors, such as obscuring thick areas, purulence, cytolysis, desiccation, and staining, were also deliberated in the analysis of up to 75% of the smears [23] . In agreement with our findings, in 2014 Zhao et al [23] evaluated 3,003 Pap smears to assess the limitations of cytological examination and found that scant cellularity and the presence of obscuring blood were the most frequent factors in the evaluated smears.…”

Section: Discussionmentioning

confidence: 99%

“…Other factors, such as obscuring thick areas, purulence, cytolysis, desiccation, and staining, were also deliberated in the analysis of up to 75% of the smears [23] . In agreement with our findings, in 2014 Zhao et al [23] evaluated 3,003 Pap smears to assess the limitations of cytological examination and found that scant cellularity and the presence of obscuring blood were the most frequent factors in the evaluated smears.…”

Section: Discussionmentioning

confidence: 99%

“…The major advantage of the 100%-RR method is in evaluating the performance of the examiner [8,21] . The 100%-RR may take up to 2 min, but it does not need any significant additional time during the process [21][22][23] . A disadvantage of the 100%-RR is the possible occurrence of errors because the reviewer lowers his/her concentration knowing that abnormal results have been removed, leaving some or all false-negative smears [8,21] .…”

mentioning

confidence: 99%

See 1 more Smart Citation

Assessment of 100% Rapid Review as an Effective Tool for Internal Quality Control in Cytopathological Services

Filho

Freitas²,

Pessoa³

et al. 2017

Acta Cytologica

View full text Add to dashboard Cite

Objective: The aim of this study was to evaluate the 100% rapid review (100%-RR) as an effective tool for internal quality control (IQC) in gynecological cytopathology services. Study Design: A total of 8,677 swabs were analyzed; the negative results were submitted to 100%-RR. Divergent cases were discussed in a consensus meeting to reach a conclusion on the final diagnosis. The data were entered into SAS statistical software, and the agreement of the 100%-RR results with the final diagnosis was tested with the weighted kappa statistic. Results: Of the 8,155 smears characterized as negative, 255 (3.13%) were abnormal smears, and 552 (6.77%) unsatisfactory smears were deemed negative. Regarding the results on the 8,155 smears subjected to 100%-RR when compared with the final diagnosis, there was agreement in 7,063 (86.60%) of them, and there were 1,092 (13.40%) discordant results (65.6%, unsatisfactory; 5.47%, atypical squamous cells of undetermined significance [ASC-US]). The κ index had an agreement of 0.867, with κ = 0.734 (p < 0.0001). Compared with the final diagnosis, the sensitivity of 100%-RR was 99.91% and its specificity was 99.4% for severe abnormalities. The sensitivity for high-grade squamous intraepithelial lesions was 88.2%, with a specificity of 100.00%. For abnormalities considered borderline, such as ASC-US, the sensitivity was 94.50% and the specificity was 99.5%. Conclusion: The 100%-RR was considered efficient when used as an IQC method.

show abstract

Factors associated with reduced accuracy in Papanicolaou tests for patients with invasive cervical cancer

Cited by 17 publications

References 34 publications

Implementation of a real‐time reference and calibration grid platform for improved screening – mapping in Pap test slides

Implementation of a real‐time reference and calibration grid platform for improved screening – mapping in Pap test slides

Cytologic patterns of cervical adenocarcinomas with emphasis on factors associated with underdiagnosis

Assessment of 100% Rapid Review as an Effective Tool for Internal Quality Control in Cytopathological Services

Contact Info

Product

Resources

About