- 1. Introduction and an overview of the evolution of the Pap smear to cervical cancer screening as it is today
- Evolution of the Pap smear to cervical cancer screening today
- 2. Anatomy, histology and function of the uterine cervix
- Function of the cervix
- Squamous epithelium
- The columnar epithelium of the endocervix
- Metaplastic change in the cervix and its physiological basis
- 3. Cervical cancer epidemiology and aetiology of cervical carcinoma
- Aetiology of cervical cancer
- Mechanisms of HPV and other risk factors in oncogenesis
- References
- 4. Pathogenesis of cervical cancer
- Risk of progression of CIN3 to invasive carcinoma
- Adenocarcinoma and adenocarcinoma in situ
- Clinical presentation, stages and treatment of cervical cancer
- References
- 5. The principles of screening and measurement of accuracy
- Distinguishing progressive from reversible lesions
- Potential risks of treatment of high-grade CIN
- Measurement of accuracy
- References
- 6. The effect of screening on incidence and mortality
- Screening interval, age group and birth cohort
- Importance of quality control on the effect of screening
- Detection of early-stage occult cancers
- References
- 7. Use of HPV tests in cervical cancer screening and the effect of vaccination
- Uses of HPV testing in triage of cervical cytology
- HPV primary screening
- References
- 8. Collecting and processing cellular samples from the cervix
- Processing cytology samples in the laboratory
- References
- 9a. Terminology and criteria for adequacy
- Criteria for adequacy of a cervical cytology sample
- Guidelines for reporting negative cytology
- Guidelines for reporting abnormal cytology
- Atypical and borderline changes
- References
- 9b. Normal cytology and benign reactive changes
- Organisms seen in cervical cytology
- Reactive cytological changes
- References
- 9c. Cytological abnormalities
- Squamous cell abnormalities of the cervix
- Atypical squamous cells of undetermined significance (ASC-US)
- High-grade squamous intraepithelial lesion (HSIL)
- Distinction between moderate and severe dyskaryosis
- Four major presentations of HSIL
- Atypical squamous cells cannot exclude HSIL (ASC-H)
- Squamous cell carcinoma (SCC)
- Glandular abnormalities of the cervix
- References
- 9d. Management of women with normal and abnormal cytology
- 10. Pitfalls in cervical cytology
- Potential false negatives
- Potential false positives
- Avoidance of over-reporting of atypical/borderline cytology
- References
- 11. Quality assurance, quality control and quality standards
- QA and QC of the complete cervical screening process
- Collecting, preparing and fixing the cellular samples
- Processing the sample in the laboratory
- Cytological screening
- Reporting the cytology
- External quality assurance (EQA) procedures
- References
- 12. Cytology in a multidisciplinary setting
- Cytology review at the MDT meeting
- HPV test results discussed at the MDT meeting
- Colposcopic findings discussed at the MDT meeting
- Cervical biopsies presented at MDT meetings
- Summary of patient management in a multidisciplinary setting
- References
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.
Colposcopy is less sensitive in the detection of AIS/CGIN and occult adenocarcinoma (Jordan et al. 2008; Talaat et al. 2012)..
Lesions high in the canal, especially in older women, may be difficult to detect because the squamocolumnar junction recedes into the canal.
The low PPV (but high sensitivity) of HPV testing for test of cure after treatment of high-grade CIN is a challenge to colposcopy in women at relatively high risk of cancer when small areas of persistent CIN may not be visible on the surface of the cervix.
Practical implications of colposcopy findings at MDT meeting
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