What is new in cervical precanceroses cytodiagnostics?

Česká verzia

Authors: J. Dušková
Authors place of work: Autorka je členkou Komise pro screening karcinomu děložního hrdla Ministerstva zdravotnictví ČR. ; Ústav patologie 1. LF UK a VFN a Katedra patologie IPVZ, Vysoká škola zdravotní, CGOP, s. r. o., Praha, Česká republika.
Published in the journal: Čes.-slov. Patol., 48, 2012, No. 1, p. 22-29
Category: Přehledový článek

Summary

Cytopathology investigation of the uterine cervix transformation zone smear (Pap test) has been accepted during the last 80 years worldwide as a potent tool in lowering the incidence of squamous cell cervical cancer; it can reveal a proportion of adenocarcinomas as well and contributes to the diagnostics of cervicovaginal infections.

The technique itself and diagnostic criteria have been internationally unified in the systems Bethesda I (1988) and Bethesda II (2002). Nevertheless, the cytodiagnostics of cervical precanceroses continues to develop vividly in the following fields of interest.

In processing the cervical sample:

Unified polychrome staining has been accepted as compulsory
Processing of the sample acquired has split into two branches - conventional preparation - CP and liquid based preparation – LBP.
In both types of processing (mainly in LBP) additional tests are employed.

In evaluation of the cytology features:

Differences of the petrified diagnostic features formulated formerly for CP in the LBP have been described.
Differentially-diagnostic pitfalls (look-alikes) are studied.
Sensitivity of precanceroses detection in a screening routine with the prevalence of negative findings has been improved with compulsory rescreening of 10-20% random selected negative cases as well as rapid pre- or postscreening of the whole material or involvement of automated pre- or postscreening using image analysis systems.
Some cytomorphology findings are followed with additional tests – especially HR HPV detection.
Cyto-bioptic correlations are constantly studied.

In terms of lowering the incidence of uterine cervix carcinoma:

Opportune screening is substituted with nationwide programs aimed at:
Involvement of as many women of the target group as possible.
Standardized investigation (CP or LBP) in an accredited laboratory with functioning systems of external and internal quality control.
Selective additional investigation with non-morphological tests.
Appropriate treatment of women with pathology findings.
Some newly designed nationwide screening models start with a non-morphological test (HPV) followed by a pap test and colposcopy.

Stern control of successful implementation of the achievements listed above is expressed in uterine cervix cancer incidence.

Keywords:
cervical cytology – Pap test – precanceroses – National programme of cervical cancer screening

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