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The article focuses on a symposium on the association between surgical treatment of cervical intraepithelial neoplasia (CIN) and subsequent preterm birth held on February 16, 2015 in London, Great Britain. It is stated that CIN grades 2 and 3 that have been managed surgically were the main focus of the meeting.

Objective To explore whether the increased risk of preterm birth following treatment for cervical disease is limited to the first birth following colposcopy. Design Nested case-control study. Setting Twelve NHS hospitals in England. Population All nonmultiple births from women selected as cases or controls from a cohort of women with both colposcopy and a hospital birth. Cases had a preterm (20-36 weeks of gestation) birth. Controls had a term birth (38-42 weeks) and no preterm. Methods Obstetric, colposcopy and pathology details were obtained. Main outcome measures Adjusted odds ratio of preterm birth in first and second or subsequent births following treatment for cervical disease. Results A total of 2798 births (1021 preterm) from 2001 women were included in the analysis. The risk of preterm birth increased with increasing depth of treatment among first births post treatment [trend per category increase in depth, categories <10 mm, 10-14 mm, 15-19 mm, ≥20 mm: odds ratio ( OR) 1.23, 95% confidence interval (95% CI) 1.12-1.36, P < 0.001] and among second and subsequent births post treatment (trend OR 1.34, 95% CI 1.15-1.56, P < 0.001). No trend was observed among births before colposcopy ( OR 0.98, 95% CI 0.83-1.16, P = 0.855). The absolute risk of a preterm birth following deep treatments (≥15 mm) was 6.5% among births before colposcopy, 18.9% among first births and 17.2% among second and subsequent births post treatment. Risk of preterm birth (once depth was accounted for) did not differ when comparing first births post colposcopy with second and subsequent births post colposcopy (adjusted OR 1.15, 95% CI 0.89-1.49). Conclusions The increased risk of preterm birth following treatment for cervical disease is not restricted to the first birth post colposcopy; it remains for second and subsequent births. These results suggest that once a woman has a deep treatment she remains at higher risk of a preterm birth throughout her reproductive life. Tweetable abstract Risk of preterm birth following large treatments for cervical disease remains for second and subsequent births. [ABSTRACT FROM AUTHOR]

J. Bowring, R. Albrow, A. Fisher, G. Downey, J. Cullimore, J. Patnick, P.G. Walker and H.C. Kitchener A prospective study of human papillomavirus (HPV) testing to resolve uncertainty in colposcopy Objective: UK colposcopy services are seeing increased workloads, a large proportion of which are follow-up appointments. The English Cervical Screening Programme HPV Special Interest Group identified five subcategories of colposcopy clinic patients who often require prolonged follow-up regimes for low-grade abnormalities. Human papillomavirus (HPV) testing has a high negative predictive value, meaning that HPV-negative women are at very low risk of underlying disease. Our objectives were to quantify the number of HPV-negative women in each study subcategory and to evaluate the number who could potentially be discharged from colposcopy on the basis of their results. Methods: Four colposcopy clinics prospectively identified women according to five categories over 12 months. All women underwent cytological testing and high-risk HPV (hrHPV) testing using the Hybrid Capture 2 test. Management outcomes and decisions based on a knowledge of the HPV status were recorded. Results: Data available on 755 women showed that 422/755 (55.9%) and 260/755 (34.4%) had persistent cervical intraepithelial neoplasia grade 1 (CIN1) (Category 1) or a minor abnormality following treatment (Category 2), respectively. In Categories 1 and 2, 51.7% and 60.2%, respectively, were hrHPV negative. The rates with biopsies of CIN2 or worse (CIN2+) across the two categories were 3/355 (0.8%) and 21/291 (7.0%) for hrHPV-negative and hrHPV-positive women, respectively. Conclusion: The incorporation of hrHPV testing within organized cervical screening programmes has been widely accepted. hrHPV testing for the clinical scenarios outlined in this study detects women who are hrHPV negative and therefore at low risk of underlying disease, potentially reducing anxiety and inconvenience for women and costs to colposcopy services. [ABSTRACT FROM AUTHOR]

A. Castanon, S. Ferryman, J. Patnick and P. Sasieni Review of cytology and histopathology as part of the NHS Cervical Screening Programme audit of invasive cervical cancers Objective: To audit pathology slide reporting in the Cervical Screening Programme in England by reviewing cytology and histology slides from women subsequently diagnosed with invasive cervical cancer. Methods: Between April 2007 and March 2010, 6113 women diagnosed with cervical cancer were identified. Cervical cytology and histology slides taken within 10 years of diagnosis were identified and where possible reviewed after a nationally agreed protocol. Reviewers were not blinded to the original reading of each sample. Most cytology samples before 2005 were conventional, most after 2007 liquid based. Results: Of 13 745 cytology results from women developing cervical cancer, 55% were reviewed. The review result was identical for 55% of slides. Of 3759 originally normal slides, only 45% were normal on review: 11% were inadequate, 21% low grade (borderline or mild dyskaryosis) and 23% high grade (moderate dyskaryosis or worse). Of tests originally normal taken over 5.5 years before diagnosis, 14% were upgraded to high grade compared with 37% within 3.5 years of diagnosis. Of 5159 histology specimens recorded within 10 years of diagnosis of a cancer, 3895 were reviewed. Overall, 94% of samples reviewed retained the original diagnosis. One per cent (33/3012) of cancers were downgraded and 5% (6/112) of negative samples were upgraded to cancer upon review (four of which were taken within 2 months of diagnosis). In comparison, 15% (14/91) of cervical glandular intraepithelial neoplasia (CGIN) and 12% (38/314) of cervical intraepithelial neoplasia grade 3 (CIN3) were upgraded to cancer. Conclusions: In spite of the excellent quality of cytology in England, a high proportion of negative cytology taken up to three and a half years before diagnosis were considered to contain abnormal cells by reviewers informed of the subsequent cancer. Continuing these reviews, with a strong focus on education, will ensure a clear understanding of these slides and further reduce the risk of developing cervical cancer. [ABSTRACT FROM AUTHOR]

Objective: With moves to introduce human papillomavirus (HPV) triage at sentinel sites in England, it is essential that optimal storage and transport conditions are determined for efficient HPV detection using residual liquid-based cytology specimens. Methods: Two cytology laboratories with comparable workloads sent residual cervical cytology specimens collected in BD Surepath™ Preservative Fluid to the Specialist Virology Centre for HPV testing. Storage and transport of specimens was at ambient (site A) or refrigerated (site R) temperatures. The effect of temperature on the ability to detect high-risk human papillomavirus (HR-HPV) using Digene Hybrid Capture® 2 High-Risk HPV DNA Test (hc2) and Roche AMPLICOR® HPV Test (AMPLICOR) was assessed. All specimens with discordant results were tested using Roche Linear Array HPV Genotyping test. Results: A total of 796 residual cytology specimens, with cytology ranging from normal to severe dyskaryosis, were provided (399 from site A and 397 from site R). Ambient storage and transit of cervical specimens in SurePath medium did not appear to affect significantly the suitability of the specimen for HPV testing, as measured by the concordance of the HR-HPV screening assays for ambient versus refrigerated specimens and by the proportion of specimens which tested invalid. Conclusion: Residual cytology specimens in SurePath medium, stored and transported at ambient temperature, appear suitable for HR-HPV detection by AMPLICOR beyond the manufacturer’s recommended time and potentially up to four weeks. [ABSTRACT FROM AUTHOR]

Objective To evaluate human papillomavirus (HPV) testing in combination with cytology in the follow up of treated women. Design A prospective study. Setting Three UK centres: Manchester, Aberdeen and London. Population or sample Women treated for cervical intraepithelial neoplasia (CIN). Methods Women were recruited at 6 months of follow up, and cytology and HPV testing was carried out at 6 and 12 months. If either or both results were positive, colposcopy and if appropriate, a biopsy and retreatment was performed. At 24 months, cytology alone was performed. Main outcome measures Cytology and histology at 6, 12 and 24 months. Results Nine hundred and seventeen women were recruited at 6 months of follow up, with 778 (85%) and 707 (77.1%) being recruited at 12 and 24 months, respectively. At recruitment, 700 women had had high-grade CIN (grades 2 or 3) and 217 had CIN1. At 6 months, 14.6% were HPV positive and 10.7% had non-negative cytology. Of those with negative cytology, 9% were HPV positive. Of the 744 women who were cytology negative/HPV negative at baseline, 3 women with CIN2, 1 with CIN3, 1 with cancer and 1 with vaginal intraepithelial neoplasia (VAIN)1 were identified at 24 months. Nine of 10 cases of CIN3/cervical glandular intraepithelial neoplasia (CGIN) occurred in HPV-positive women. At 23 months, cancer was identified in a woman treated for CGIN with clear resection margins, who had been cytology negative/HPV negative at both 6 and 12 months. Conclusions Women who are cytology negative and HPV negative at 6 months after treatment for CIN can safely be returned to 3-year recall. [ABSTRACT FROM AUTHOR]

Objective To evaluate the capacity implications and health economic impact of new guidelines recommending referral to colposcopy after one mild result during cervical screening rather than after two consecutive mild results. Design A mathematical model of the country’s colposcopy services and the clinical pathways from smear result through to treatment is constructed. The model incorporates national questionnaire data on referral numbers and management practices, routine data and published research results. Setting All English NHS colposcopy services. Population Women aged 25 to 64 years. Methods The national average workload impact of the change in referral guidelines is predicted, and the impact in differing local circumstances is evaluated within the model. A long-term health economic model examines the resulting costs and predicted change in quality-adjusted life years (QALYs). Main outcome measures Colposcopy workload implications for single mild dyskaryosis referral and cost per QALY analysis. Results We found that single mild dyskaryosis referral implies, on average, a 21% increase in colposcopy workload for services not currently operating this policy. The health economic model predicted a cost per QALY gained as a result of the implementation of the new referral guidelines of around £7,500. Conclusions Referral after one mild result will increase workload at colposcopy; however, it may be possible to counterbalance the additional workload by altering other clinical practice. The change to referral guidelines would be considered cost-effective in comparison with many interventions routinely available on the NHS. [ABSTRACT FROM AUTHOR]

Aims: To develop a baseline picture of prostatic pathology reporting in the UK, identify areas of particular difficulty and assess the feasibility of a national external quality assurance scheme based on prostatic biopsy specimens using the same format as the National Health Service breast pathology scheme, as recommended by the National Institute for Clinical Excellence. Methods and results: Eight expert uropathologists and 32 randomly selected pathologists participated in four circulations each of 12 cases of prostatic biopsy specimens. A fixed text proforma was developed and responses were analysed for interobserver agreement using κ statistics. Consistency of reporting the main diagnostic categories of benign and invasive carcinoma was good (κ values 0.77 and 0.88, respectively), but only after excluding 19% of cases for which the experts did not reach 75% agreement. Areas of difficulty included the diagnosis of high-grade prostatic intraepithelial neoplasia and small foci of cancer. Prognostic factor reporting was more variable, with lower overall κs for the assessment of Gleason grading (experts 0.55, others 0.50), perineural invasion (experts 0.64, others 0.50) and number of positive cores (experts 0.74, others 0.61). Conclusions: Given the difficulties in diagnosis of prostatic biopsy specimens and the assessment of prognostic factors, the expansion of the scheme could deliver important educational benefits. [ABSTRACT FROM AUTHOR]

The current paper presents an annex in the second edition of the European Guidelines for Quality Assurance in Cervical Cancer Screening. It provides guidance on how to make a satisfactory conventional Pap smear or a liquid-based cytology (LBC) sample. Practitioners taking samples for cytology should first explain to the woman the purpose, the procedure and how the result will be communicated. Three sampling methods are considered as acceptable for preparing conventional Pap smears: (i) the cervical broom; (ii) the combination of a spatula and an endocervical brush; and (iii) the extended tip spatula. Smear takers should take care to sample the entire circumference of the transformation zone, to quickly spread the cellular material over a glass slide, and to fix the preparation within a few seconds to avoid drying artefacts. According to local guidelines, one of these three methods may be preferred. Sampling with a cotton tip applicator is inappropriate. Similar procedures should be followed for sampling cells for LBC, but only plastic devices may be used. The collected cells should be quickly transferred into a vial with fixative liquid according to the instructions of the manufacturer of the LBC system. Subsequently, the slide or vial and the completed request form are sent to the laboratory for cytological interpretation. [ABSTRACT FROM AUTHOR]

Colorectal cancer is a common cancer and common cause of death. The mortality rate from colorectal cancer can be reduced by identification and removal of cancer precursors, adenomas, or by detection of cancer at an earlier stage. Pilot screening programmes have demonstrated decreased colorectal cancer mortality; as a result many countries are developing colorectal cancer screening programmes. The most common modalities being evaluated are faecal occult blood testing, flexible sigmoidoscopy and colonoscopy. Implementation of screening tests has been hampered by cost, invasiveness, availability of resources and patient acceptance. New technologies such at computed tomographic colonography and stool screening for molecular markers of neoplasia are in development as potential minimally invasive tools. This review considers who should be screened, which test to use and how often to screen. [ABSTRACT FROM AUTHOR]

Discusses cervical cytopathology in Great Britain. Adequacy of the cervical smear; Reporting and classification in cervical cytology; Recommendations for disease management.

In this new era of relationship-based care, involvement in treatment planning and goal setting is a high priority for patient satisfaction. This study reports on the use of standardized patients (SPs) in training third-year dental students to gather dental, medical, and psychosocial information from patients and to involve the patient in the decision-making process leading to the dental treatment plan. Among the skill areas measured, students were most successful in gathering dental information, with 94 percent of the students obtaining the complete set. Students were least successful in identifying the patient's goals for treatment (81 percent of the students identified the patients' goals). Students were most challenged by discussing sensitive topics with patients such as grief-related depression (25 percent of the students recognized and discussed such topics). It is important that dental schools familiarize students with patient issues and teach them how to talk effectively to patients about personal issues and to incorporate those issues into a discussion of the treatment plan for the patient. Standardized patients can be used effectively toward this end. [ABSTRACT FROM AUTHOR]

Objective: It has been suggested that women over 50 with a satisfactory negative smear history are at low risk for dyskaryosis and might be suitable for withdrawal from the cervical screening programme. The objectives of this study are to document the pattern of dyskaryosis in the cervical smears of women over 50 and to relate the risk of dyskaryosis in these women to the prior smear history., Design: Available computerised smear data were analysed., Setting: Five regions in England and Scotland; Aberdeen, Dundee, Birmingham, Gateshead and Nottingham., Population: All women aged 50 or over who had a satisfactory smear between 1988 and 1996., Methods: Smear results were sorted into individual smear records. The first smear after the age of 50 was identified as well as all smears before and after the age of 50., Main Outcome Measurements: The smear history before and after the age of 50 was determined for all women. The relative risk of dyskaryosis as well as the time to dyskaryosis was calculated for women whose raw data were available., Results: The study included 170,436 women with at least one satisfactory smear after 50. No results of previous smears were available in 90,546 (54%) of women but 36,512 (21%) of women had a satisfactory negative smear history. Women with prior dyskaryosis or borderline nuclear abnormalities (BNA) had an increased risk of dyskaryosis after the age of 50 compared with women with a negative history (RR 4.39 and 3.08 respectively). It was notable that 1.8% of women with a negative history still demonstrated subsequent dyskaryosis., Conclusions: Women with either dyskaryosis or BNA before 50 are not suitable for withdrawal from cervical screening. Well-screened women with a negative smear history at the age 50 still have a residual risk of subsequently developing a new abnormality.