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: Reviews Article

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

Zdroje

1. Lambl VD. Über Harnblasekrebs. Ein Beitrag zur mikroskopischen Diagnostik am Krankenbette. Vierteljahrschr Prakt Heilk 1856; 49: 1–32.

2. Papanicolaou GN. New cancer diagnosis. Proceedings of the Third Race Betterment Conference. Michigan: Battle Creek; 1928: 528–534.

3. [Autoři neuvedeni]. The 1988 Bethesda System for reporting cervical/vaginal cytologic diagnoses. developed and approved at the National Cancer Institute workshop in Bethesda, MD, December 12-13, 1988. Diagn Cytopathol 1989; 5(3): 331–334.

4. Salomon D, Nayar R. The Bethesda system for reporting cervical cytology. Definitions, kriteria, and explanatory notes. 2nd ed. Springer; 2004: 191 pages.

5. Dušková J. Cytologické vyšetření v diagnostice patologických stavů děložního hrdla a jeho limity. Moderní gynekologie a porodnictví 2010; 19(3): 266–275.

6. Giorgi Rossi P et al. Risk of CIN2 in women with a pap test without endocervical cells vs. those with a negative pap test with endocervical cells: a cohort study with 4.5 years of follow-up. Acta Cytol 2010; 54(3): 265–271.

7. Dušková J. MONITOR aneb nemělo by vám uniknout, že riziko CIN2 u žen, jejichž Pap test neobsahoval endocervikální buňky, není v porovnání s těmi, které endocervikální buňky ve stěru měly, větší a není tedy třeba krátit doporučovaný kontrolní interval vyšetření. Cesk Patol 2011; 47(2): 72.

8. Kamal MM, Kulkarni MM, Wahane RN. Ultrafast Papanicolaou stain modified for developing countries: efficacy and pitfalls. Acta Cytol 2011; 55(2): 205–212.

9. Sivartaman G, Iyengar RK. Rehydrated air-dried Pap smears as an alternative to wet – fixed smears. Acta Cytol 2002; 46(4): 713–717.

10. Dušková J, Drozenová J, Hajná R. ASCUS v atrofii. Cesk Patol 2008, 44: 9–14.

11. Shidham VB, Mehrotra R, Varsegi G, et al. p16 immunocytochemistry on cell blocks as an adjunct to cervical cytology: Potential reflex testing on specially prepared cell blocks from residual liquid-based cytology specimens. Cytojournal 2011; 8: 1.

12. Meijer CJ. Berkhof J, Castle PE, et al. Guidelines for human papillomavirus DNA test requirements for primary cervical cancer screening in women 30 years and older. Int J Cancer 2009; 124(3): 516–520.

13. Kritéria a podmínky programu pro screening karcinomu děložního hrdla v ČR. Věstník MZČR, částka 7, září 2007: 147–151.

14. Konsensus pro řešení abnormálních nálezů ve screeningu cervikálních karcinomů. Členové panelu: Dvořák V, Freitag P, Ondruš J, Rob L, Svoboda B, Rokyta Z, Dušková J., Michal M, Dvořáčková J. Gynekologie po promoci 2009; (2): 53–58.

15. http://nih.techriver.net/

16. Xiao Y, Zhong Y, Greene W, Dong F, Zhong G. Chlamydia trachomatis infection inhibits both Bax and Bak activation induced by staurosporine. Infect Immun 2004; 72(9): 5470–5474.

17. Nasser H, Hayek S. Balasubramaniam M, Kuntzman TJ. Infectious organisms on Papanicolaou smears should not influence the diagnosis of atypical squamous cells of undetermined significance. Acta Cytol 2011; 55(3): 251–254.

18. Klomp JM, Boon ME, Dorman MZ, et al. Trends in inflammatory status of the vaginal flora as established in the Dutch national screening program for cervical cancer over the last decade. Acta Cytol 2010; 54(1): 43–49.

19. Dušková J. Falešně negativní PAP test? Cytopatolog v roli člena skupiny znalců při pozdní diagnóze cervikálního karcinomu. Cesk Patol 2010; 46(3): 62–64.

20. Wilbur DC. The cytology of the endocervix, endometrium, and upper female genital tract. In: Bonfiglio TA, Drozan YS, eds. Gynecologic Cytopathology. Philadelphia. Lippincott-Raven; 1997: 107–156.

21. Moriarty AT, Wilbur DC. Those gland problems in cervical cytology: faith or fact? Observation of the Bethesda 2001 terminology conference. Diagn Cytopathol 2003; 28: 171–174.

22. Singh N, Titmuss E, Chin Aleong J, et al. A review of post-trachelectomy isthmic and vaginal smear cytology. Cytopathology 2004; 15(2): 97–103.

23. Ghorab Z, Ismiil N, Covens A, et al. Postradical vaginal trachelectomy follow-up by isthmic-vaginal smear cytology: a 13-year audit. Diagn Cytopathol 2009; 37(9): 641–646.

24. Ajit D, Gavas S, Jagtap S, Chinoy RF. Cytodiagnostic problems in cervicovaginal smears from symptomatic breast cancer patients on tamoxifen therapy. Acta Cytol 2009; 53(4): 383–388.

25. Galliano GE, Moatamed NA, Lee S, et al. Reflex high risk HPV testing in atypical squamous cells, cannot exclude high grade intraepithelial lesion: a large institution’s experience with the significance of this often ordered test. Acta Cytol 2011; 55(2): 167–172.

26. Anschau F, Guimarčes Gonćalves MA. Discordance between cytology and biopsy histology of the cervix: what to consider and what to do. Acta Cytol 2011; 55(2): 158–162.

27. http://www.cervix.cz/

28. Bergeron C. With the same terminology: where and why will there still be differences in rates? 35th European Congress of Cytology, Lisboa 2009. Cytopathology 2009; Suppl.1: 1.

29. https://www.cms.gov/CLIA/downloads/CMS-2252-P.pdf

30. https://www.cms.gov/CLIA/downloads/Informational_Supplement.pdf

31. http://www.cancerscreening.nhs.uk/cervical/publications/nhscsp15-version4.pdf