References
Arbyn M, Ronco G, Anttila A et al. (2012). Evidence regarding human papillomavirus testing in secondary prevention of cervical cancer. Vaccine 30 (suppl. 5):F88-99. Arbyn M, Roelens J, Cuscheiri K et al. (2013). The APTIMA HPV assay versus the Hybrid Capture 2 test in triage of women with ASC-US or LSIL cervical cytology: a meta-analysis […]
Potential risks of treatment of high-grade CIN
Local ablation or excision of the transformation zone has been highly successful in treating high-grade CIN and greatly reduces the risk of progression to invasive carcinoma but it is not itself without risk (Kyrgiou 2014). It is probable that the increase in second trimester miscarriages due to premature rupture of membranes reported after excision biopsy […]
Uses of HPV testing in triage of cervical cytology
Uses of HPV testing alongside cytology Triage of ASC-US and/or LSIL cytology Test of cure after treatment of high-grade CIN Resolution of uncertainties Primary HPV testing or co-testin The principles of all these methods alongside cytology are similar: HPV is more sensitive than cytology for CIN2+ Early detection of CIN2 is not an end […]
Measurement of accuracy
Measurement of accuracy Measurement of accuracy of screening combines sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of a positive test with respect to a positive outcome (Figure 5.5). The following factors must be considered when assessing measurements of accuracy. The nature of the positive and non-positive test for any given circumstance […]
8. Collecting and processing cellular samples from the cervix
Guidelines for taking cellular samples Guidelines are available for taking samples for conventional cytology or liquid-based cytology, which are equally effective as long as the guidelines are adhered to (NHSCSP 2006); Arbyn et al. 2007). Clinical conditions required for taking a sample Cytology samples should be taken at mid-cycle: menstrual samples may obscured by […]
References
Andermann A, Blancquaert I, Beauchamp S, Déry V (2008). Revisiting Wilson and Junger in the genomic age: a review of screening criteria over the past 40 years. Bulletin of the World Health Organization. 86: 241-320. Bruni L, Diaz M, Castellsague M et al (2010). Cervical human papillomavirus prevalence in 5 continents: meta-analysis of 1 million […]
9c. Cytological abnormalities
Criteria for distinguishing normal from abnormal cells In essence, a cervical screening programme depends on the ability of the cytologist to detect abnormal cells amongst the thousands of normal cells on a Papanicolaou-stained cervical smear or liquid-based cytology preparation using a light microscope. With screening experience and knowledge about the pathological process, the cytologist should […]
9d. Management of women with normal and abnormal cytology
Figures 9d-1 to 4 in this chapter are taken from Chapter 2 in the European guidelines for quality assurance in cervical cancer screening: http://screening.iarc.fr/doc/ND7007117ENC_002.pdf). Central register In an organised programme a central register should hold patient details (name. date of birth, address), registered GP name and address, vaccination status, screening history (previous tests and […]
Screening interval, age group and birth cohort
The International Agency for Research in Cancer (1986) reported a summary of the effectiveness, in terms of reduction of risk of invasive cancer, of screening at difference intervals in different age groups (Figure 6.5; IARC 1986). This international study provided evidence that 3-yearly screening, from 20 or 25 to 64 years of age, produced the […]
Organisms seen in cervical cytology
Vaginal microbiology In cytology we are able to visualise a wide range of organisms, and in the case of viruses, we are able to see their cytopathic effects. Physiologically, the vaginal vault contains a mixture of both aerobic and non-aerobic bacteria, most importantly lactobacilli, which helps to maintain an acid environment, usually around pH […]