The effect of the quality of Papanicolaou smears on the detection of cytologic abnormalities

Mintzer, Melanie; Curtis, P.; Resnick, Jacqueline C.; Morrell, Daphne

doi:10.1002/(sici)1097-0142(19990625)87:3<113::aid-cncr3>3.3.co;2-m

Cited by 12 publications

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“…Cervical cancers in the early stage of development, or carcinomas in situ, are highly treatable because the cancer cells are located in a layer of cells in or around the cervix and have not spread to other parts of the body. Once the cancer cells metastasize to other parts of the body the disease is more difficult to treat and cervical cancer treatment becomes more complex 2 .…”

Section: Introductionmentioning

confidence: 99%

Profile of PAP smear cytology and its histopathological correlation at tertiary care center – A retrospective study

Vaghela

Santwani

2014

Int J of Biomed & Adv Res

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Section: Introductionmentioning

confidence: 99%

Profile of PAP smear cytology and its histopathological correlation at tertiary care center – A retrospective study

Vaghela

Santwani

2014

Int J of Biomed & Adv Res

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“…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.…”

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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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“…Such findings are consistent with the hypothesis that samples with endocervical cells are more likely to detect atypia. However, more recent research [15][16][17][18][19][20][21][22][23][24][25][26][27][28] has shown that the absence of endocervical cells is not necessarily associated with a higher risk of cervical abnormality.…”

Section: What Is An Adequate Sample?mentioning

confidence: 89%

Management of Papanicolaou test results that lack endocervical cells

Elumir-Tanner

Doraty²

2011

Canadian Medical Association Journal

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Mrs. McTavish is a 25-year old patient whose Papanicolaou (Pap) test results have come back from the laboratory. The smear is described as satisfactory for evaluation; however, it is noted that an inadequate number of endocervical cells were present in the sample. The results of the patient's past Pap tests have been satisfactory for evaluation and negative for abnormality. She is otherwise well. Her physical examination, including pelvic examination, showed nothing unusual. R ates of cervical cancer have been declining in Canada since the implementation of the Papanicolaou (Pap) smear, with reduction in both incidence (from 11.1 per 100 000 in 1970-1972 to 5.2 per 100 000 in [1994][1995][1996] and mortality (7.9 per 100 000 in 1953-1955 to 1.9 per 100 000 in [1995][1996][1997].1 Further improvements will depend on the continuance of screening for cervical cancer and the effectiveness of screening tools. The Bethesda System -the conventional system for reporting cervical cytologic diagnoses -provides feedback about specimen adequacy using the categories "satisfactory" or "unsatisfactory."2 Primary health care providers may receive Pap test results that are identified as satisfactory but accompanied by a note that indicates a sample from the transformation zone is lacking. Some provincial and national guidelines are unclear about how clinicians should respond to this type of report. Because of this uncertainty, we sought to review the current evidence on the topic. How should a care provider proceed with screening when faced with an otherwise satisfactory Pap smear that lacks sampling from the transformation zone? If physicians continue with regular screening intervals without special attention to the lack of endocervical cells, are cervical abnormalities being missed? Literature reviewWe searched MEDLINE from 1975 to the end of July 2010 using the following combination of keywords and subject headings: "unsatisfactory Pap smear," "endocervical component," "endocervical status," "endocervical cells and Pap smear," "Pap smear and quality" and "abnormal Pap smear." Bibliographies from the identified articles were manually searched. Summary sites such as Towards Optimal Practice (Alberta) and Cancer Care Manitoba were also reviewed in July 2010. We identified 462 citations, and reviewed 53 full-text articles. Papers were excluded if they were written in a language other than English, if they did not discuss the topic of Pap smear quality and presence or absence of endocervical cells, and if there were insufficient data to draw conclusions. Twenty-four articles were included in our review and are summarized in Appendix 1 (available at www .cmaj .ca/cgi /content /full /cmaj .101156 /DC1).The level of evidence was determined by the hierarchy developed by the Canadian Task Force on the Periodic Health Examination, 3 according to which the highest level of evidence (Level I) derives from at least one randomized controlled trial, and the lowest level derives from the opinion of experts (Level III). The evidence identified...

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The effect of the quality of Papanicolaou smears on the detection of cytologic abnormalities

Cited by 12 publications

References 0 publications

Profile of PAP smear cytology and its histopathological correlation at tertiary care center – A retrospective study

Profile of PAP smear cytology and its histopathological correlation at tertiary care center – A retrospective study

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

Management of Papanicolaou test results that lack endocervical cells

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