References
Andrae B, Andersson T M-L, Lambert PC et al. (2012). Screening and cervical cancer cures: population based cohort study. BMJ e900. Doi: 10.1136/bmj.e900. Austin RM, Zhao C (2012). Type 1 and type 2 cervical adenocarcinomas: some cervical cancers are more difficult to prevent with screening. Cytopathology 23:6-12. Bansal N, Wright JD, Cohen CJ, Herzog TJ […]
Squamous epithelium
Squamous epithelium of the cervix and vagina is non-keratinising and is composed of a continuous layer of stratified (multi-layered) flat, polygonal cells with centrally located nuclei. The stratified squamous epithelium of the cervix can be divided into three layers: the superficial, intermediate and parabasal/basal layer. Stratified squamous epithelium has a mainly protective function but also […]
12. Cytology in a multidisciplinary setting
The role and structure of the multidisciplinary team The effectiveness of cervical cancer screening, however the primary test is carried out (cytology, HPV testing, colposcopy, VIA), depends on the following: Detecting and removing precancerous lesions before they become (fully) invasive (CIN2, CIN3, AIS, occult cancer) Deciding how to manage lesions that are likely to be […]
Cervical biopsies presented at MDT meetings
MDT meeting provide an opportunity to review biopsy diagnoses in the context of other findings and confirm or, if necessary, revise the reports before management is decided. The accuracy of cervical punch biopsies depends on that of sampling, processing and interpretation of the samples. In a meta-analysis carried out in 2012, pooled sensitivity for CIN2+ […]
Colposcopic findings discussed at the MDT meeting
In a meta-analysis (Mitchell et al. 1998), colposcopy was highly sensitive (96% weighted average) in the diagnosis of a normal versus abnormal cervix and 85% for normal/LSIL versus high-grade CIN. Specificity was lower (48% and 69% respectively). Through its high sensitivity, colposcopy effectively provides a method of increasing the specificity of HPV+ or ASC-US+ results. […]
Cytology review at the MDT meeting
Whatever the setting, the confidence of the colposcopist or gynaecologist and their reliance on a cytology report depends on the sensitivity and PPV. Cytology slide review allows potential false positive features to be recognised before treatment is carried out. Equivocal cytology reports may be given more definitive reports on review allowing the correct treatment to […]
HPV test results discussed at the MDT meeting
HPV test results are not black and white and depend on which test has been carried out and what cut-off level was used (Cubie & Cuschieri 2013). Although high-risk HPV positivity may support an equivocal cytology result (e.g. ASC-H or HSIL vs. immature metaplasia) it cannot prove its nature in the absence of other evidence […]
Summary of patient management in a multidisciplinary setting
None of methods used to diagnose high-grade CIN, AIS and occult cancer are perfect but when their findings are reviewed, balanced against each other and considered by an expert multidisciplinary team, their combined use provides the basis for highly effective cervical cancer screening. MDT meetings are enhanced by all team members being aware of the […]
Cervical cytology
Authors: Amanda Herbert The cervical chapters comprise the following material: Introduction Anatomy, histology and function of the cervix Cervical cancer epidemiology and aetiology Cervical cancer worldwide and in Europe HPV as a causative agent and other risk factors Pathogenesis of cervical cancer and its precursors CIN and squamous cell carcinoma AIS and adenocarcinoma Presentation, stage […]