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The human papillomavirus (HPV) is implicated in nearly all cases of cervical cancer. While most HPV infections resolve spontaneously, persistent infections can lead to high-grade lesions and cancer. Traditionally, cervical screening has relied on cervical cytology, but since 2016, HPV mRNA testing has been integrated to enhance the detection of high-grade lesions (CIN2+) in women with normal cytology. This study, conducted at the Department of Clinical Pathology at UNN from 2016 to 2019, evaluates the impact of HPV mRNA testing on quality assurance, with follow-up adhering to national guidelines through December 2022. Among 98,648 cervical samples analyzed, 61,635 women exhibited normal cytology. Of these, 752 (1.2%) tested positive for HPV mRNA, specifically targeting HPV types 16, 18, and 45. Upon the re-evaluation of the index cytology, 70.7% of these women retained normal cytology findings, while biopsies identified high-grade lesions (CIN2+) in 34% and severe lesions (CIN3+) in 14%. Notably, older women constituted a larger portion of the normal cytology group but a smaller percentage of those testing positive for HPV and exhibiting significant lesions. This underscores the effectiveness of HPV mRNA testing in promptly identifying high-grade lesions, highlighting its potential to significantly reduce cervical cancer incidence through targeted re-evaluation of a small, at-risk population. [ABSTRACT FROM AUTHOR]

Context: CytoPath®Easy kit (DiaPath S.p.A.) offers a major advantage compared to other commercially available kits available for the screening of cervical cancer, as it does not require additional equipment for sample processing. Using this methodology, collected epithelial cells are immersed in a preservative liquid before setting as a thin layer on a slide via gravity sedimentation. Aims: To evaluate the suitability of the CytoPath®Easy kit for the processing of cervical samples, detection of pre-neoplastic lesions, and nucleic preservation and extraction for HR-HPV diagnosis. Materials and Methods: A total of 242 self-sampled cervical specimens were utilized, with 192 collected in CytoPath®Easy vials and 50 collected and processed using the ThinPrepTM for comparative analysis. The samples underwent processing, Papanicolaou staining, and microscopic evaluation for morphological parameters. The extracted nucleic acids were assessed for purity and integrity, and the detection of high-risk human papillomavirus (HR-HPV) was carried out using the Alinitym HR HPV system kit (Abbott Laboratórios Lda). Results: Both methods demonstrated effective performance, enabling the morphological assessment of the cervical epithelium. Statistical analysis indicated that ThinPrepTM yielded significantly better results in terms of cellularity. Conversely, CytoPath®Easy exhibited superior performance in terms of the quantity of extracted DNA and its degree of purification. Concerning the time consumed during processing, both methods were comparable, with the CytoPath®Easy methodology standing out for its cost-effectiveness, as it does not necessitate additional instruments and consumables. Conclusions: The novel CytoPath®Easy methodology proves effective in preserving both nucleic acids and cell morphology characteristics, two crucial features for cervical cancer screening.

Objective: Atypical squamous cells of undetermined significance cytology (ASC-US) is a challenging and equivocal diagnosis for pathologists in cervical Pap smears. The data on ASC-US cervical cytology in Bahrain are deficient. This study reviewed and identified the reporting rates, high-risk human papillomavirus (HPV) testing results, histopathologic follow-up findings, and the cytologic progression of patients diagnosed with ASC-US in Bahrain. Material and Methods: A retrospective chart review was conducted on the medical records of 23,888 women who had Pap smear test results between January 2019 and March 2022 at the main referral tertiary hospital in Bahrain to identify the ASC-US cases. High-risk HPV (hrHPV) genotype was identified, and the histopathological results of the cervical biopsy was recorded. In addition, cytologic follow-up Pap smear tests conducted within 1 year of ASC-US diagnosis were tracked to monitor the progression or regression of ASC-US. Results: In this study, 259 out of 23,888 women reported to have ASC-UC cytology results with a reporting rate of 1.1%. The mean age of the ASC-US cases was 43 ± 11.6. Thirty percent of the ASC-US cases tested positive for hrHPV, and they were predominantly infected with the other hrHPV genotype (75%). When the histopathological changes of the cervix were analyzed, 82.1% had normal histopathologic findings. However, low-grade cervical intraepithelial neoplasia-1 was reported in 2 cases (7.1%), and high-grade cervical lesions (cervical intraepithelial neoplasia-2 and higher) were reported in 3 cases (10.7%). Regarding the cytologic follow-up, most of the ASC-US cases were negative for intraepithelial lesion or malignancy (NILM) (73.8%) or had persistent ASC-US (17.9%). The remaining minority of cases progressed into either low-grade squamous intraepithelial lesions (6%) or high-grade squamous intraepithelial lesions (2.4%). There was a statistically significant and relatively strong association between the cytology follow-up findings and the hrHPV test results (χ2 [2] = 8.869, P < 0.012, Cramer's V = 0.417). Conclusion: This is the first and largest study to characterize the ASC-US cytology cases in Bahrain. The reporting rates of ASC-US fell within the worldwide reported range. Although most of the ASC-US cases regressed into NILM, ASC-US showed progression into more advanced cervical cytologic diagnoses or contributed to the malignant transformation of cervical tissue, especially in the presence of hrHPV infection which was positive in 30% of the ASC-US cases. This emphasizes the role of cotesting (combination of hrHPV genotyping and Pap smear test) and the importance of colposcopic evaluation of those women with cytologic follow-up tests at 1 year of diagnosis. Implementing these recommendations in the cervical cancer screening practice in Bahrain will help in having a better management plan for women diagnosed with ASC-US cervical cytology. [ABSTRACT FROM AUTHOR]

(1) Background: The prediction of cervical lesion evolution is a challenge for clinicians. This prospective study aimed to determine and compare the predictive accuracy of cytology, HPV genotyping, and p16/Ki67 dual staining alone or in combination with personal risk factors in the prediction of progression, regression, or persistence of cervical lesions in human papillomavirus (HPV)-infected patients; (2) Methods: This prospective study included HPV-positive patients with or without cervical lesions who underwent follow-up in a private clinic. We calculated the predictive performance of individual tests (cervical cytology, HPV genotyping, CINtecPlus results, and clinical risk factors) or their combination in the prediction of cervical lesion progression, regression, and persistence; (3) Results: The highest predictive performance for the progression of cervical lesions was achieved by a model comprising a Pap smear suggestive of high-grade squamous intraepithelial lesion (HSIL), the presence of 16/18 HPV strains, a positive p16/Ki67 dual staining result along with the presence of at least three clinical risk factors, which had a sensitivity (Se) of 74.42%, a specificity of 97.92%, an area under the receiver operating curve (AUC) of 0.961, and an accuracy of 90.65%. The prediction of cervical lesion regression or persistence was modest when using individual or combined tests; (4) Conclusions: Multiple testing or new biomarkers should be used to improve HPV-positive patient surveillance, especially for cervical lesion regression or persistence prediction. [ABSTRACT FROM AUTHOR]

Introduction: Specific diagnosis of endometrial carcinomas on cervical cytology is difficult with few useful cytomorphological clues reported. This study reviews a cohort of cervical cytology to investigate the presence of keratinization in atypical glandular cells (AGC), an undescribed cytomorphological clue for identifying endometrial endometrioid carcinomas on cervical cytology. Methods: Cervical cytology slides from patients with a histologic diagnosis of endometrial endometrioid carcinoma were reviewed for the presence of keratinization associated with AGCs. Corresponding histology slides were reviewed for tumour grading and degree of squamous differentiation. Results: In total, 42 cases of cervical cytology specimens from 41 patients were retrieved, including 7 (16.7%) with keratinization associated with AGCs seen and 35 (83.3%) without. Comparison of histologic grading did not demonstrate an association with the presence of keratinization on cytology (p = 0.565). Corresponding histology slides were available for 37 cases. Cytologic and histologic keratinization were associated statistically (p = 0.002). Frank keratinization was seen on histologic slides of five cases, with four also showing cytologic keratinization. Area of squamous differentiation, including squamous morule formation, did not correlate with keratinization on cytologic preparation (p = 0.185). Conclusion: Histologic and cytologic keratinization are observed in endometrioid endometrial carcinomas. Such is reflected in cervical cytology by the presence of orangeophilic, rigid and acellular fragments within or associated with AGC clusters. Keratinization, when identified with AGCs, should be regarded as a cytologic clue suggestive of an endometroid carcinoma of endometrial origin. [ABSTRACT FROM AUTHOR]

Background/Aim: Among the four genomic subtypes of endometrial cancer, distinguishing between the DNA polymerase epsilon mutation (POLEmut) and no specific molecular profile (NSMP) subtypes requires genomic profiling owing to the lack of surrogate immunohistochemical markers. We have previously found that, histologically, the POLEmut-subtype exhibits surface epithelial slackening (SES). Therefore, to improve subtype identification, we aimed to extract cytological features corresponding to SES in POLEmut-subtype cervical cytology specimens. Materials and Methods: We analyzed 104 endometrial cancer cervical cytology specimens, with integrative diagnosis confirmation via histology, immunohistochemistry, and genomic profiling. Cytological features were evaluated for the presence of atypical glandular cells, atypical cell appearance in single cells and clusters, and cytological SES and the presence of tumor-infiltrating inflammatory cells in clusters. Results: Based on cervical cytology, the POLEmut- and p53mutsubtypes exhibited more frequent atypical cells in smaller clusters, giant tumor cells, and cytological SES patterns than the NSMP-subtype. Tumor-infiltrating lymphocytes were frequent in the POLEmut- and mismatch repair-deficient subtypes. Conclusion: Histologically-detected SES as well as other endometrial cancer features may be preserved in the atypical cell clusters observed in cervical cytology specimens. Cytological detection of SES and of smaller clusters of atypical cells and inflammatory cells with moderate atypia are suggestive of POLEmut-subtype. Integrative diagnosis including genomic profiling remains critical for diagnostic confirmation. [ABSTRACT FROM AUTHOR]

Cervical cancer is one of the most common cancers in daily life. Early detection and diagnosis can effectively help facilitate subsequent clinical treatment and management. With the growing advancement of artificial intelligence (AI) and deep learning (DL) techniques, an increasing number of computer-aided diagnosis (CAD) methods based on deep learning have been applied in cervical cytology screening. In this paper, we survey more than 80 publications since 2016 to provide a systematic and comprehensive review of DL-based cervical cytology screening. First, we provide a concise summary of the medical and biological knowledge pertaining to cervical cytology, since we hold a firm belief that a comprehensive biomedical understanding can significantly contribute to the development of CAD systems. Then, we collect a wide range of public cervical cytology datasets. Besides, image analysis approaches and applications including cervical cell identification, abnormal cell or area detection, cell region segmentation and cervical whole slide image diagnosis are summarized. Finally, we discuss the present obstacles and promising directions for future research in automated cervical cytology screening. [ABSTRACT FROM AUTHOR]

Context: The performance parameters of cervical cytology in any accredited cytology laboratory requires implementation of quality control exercise, which ensures acceptable performance by a laboratory. This study aims to assess the analytical aspect of quality control measures by evaluating the frequency and accuracy of epithelial abnormalities as detected in cervical Pap smears using histopathologic diagnosis as the gold standard. Methods: A retrospective diagnostic test study from 2018 to 2020 was conducted. Out of the total 6000 Pap smears, histopathologic correlation was available in 150 cases in the form of colposcopic-directed biopsy (CDB) and loop electrosurgical excision procedure (LEEP) tissue in 105 cases. The quality control measures analyzed were Atypical Squamous Cell: Squamous Intraepithelial Lesion (ASC:SIL) ratio, cyto-histo correlation, and study parameters like sensitivity, specificity, positive predictive value, and negative predictive value of Pap smears as against CDB and LEEP. Results: 4.5% smears were reported as inadequate, 92.3% as Negative for intraepithelial lesion or malignancy (NILM), followed by epithelial abnormality found in 3.21%. The ASC:SIL ratio was 1.3:1. Concordance rate against CDB was 100% in Squamous cell carcinoma (SCC), 82.35% in high-grade squamous intraepithelial lesion (HSIL), 82% in atypical squamous cells of undetermined significance (ASCUS), 65.6% in low-grade squamous intraepithelial lesion (LSIL), and 50% in Atypical Squamous Cell ,High grade Squamous Intraepithelial Lesion can not be ruled out (ASC-H). Total concordance rate was 84.15%. Sensitivity of Pap smear was 65% for LSIL and 82% for HSIL. Specificity, positive predictive value, and negative predictive value were 63.63%, 90%, and 75%, respectively. Concordance rate was 96% with LEEP. Conclusion: Quality control measures give an insight of performance of any accredited cytology laboratory. This exercise needs to be conducted on a regular basis, so that relevant steps can be taken in case of major discrepancy. [ABSTRACT FROM AUTHOR]

Copyright of Osmangazi Journal of Medicine / Osmangazi Tip Dergisi is the property of Eskisehir Osmangazi University and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Cancer of the cervix is preventable through vaccination against human papillomavirus and by screening and treatment of cervical precancers. Cervical cancer screening has evolved since the Pap smear was first discovered in the 1920s. Current guidelines from the US Preventive Services Task Force and the American Cancer Society incorporate the use of cervical cytology and high-risk human papillomavirus tests performed every 3 to 5 years for screening in average-risk asymptomatic patients. Testing should begin at age 21 to 25 years old and stop at 65 years old if sufficient cessation criteria has been met. [ABSTRACT FROM AUTHOR]

Liquid-based cytology (LBC) plays a crucial role in the effective early detection of cervical cancer, contributing to substantially decreasing mortality rates. However, the visual examination of microscopic slides is a challenging, time-consuming, and ambiguous task. Shortages of specialized staff and equipment are increasing the interest in developing artificial intelligence (AI)-powered portable solutions to support screening programs. This paper presents a novel approach based on a RetinaNet model with a ResNet50 backbone to detect the nuclei of cervical lesions on mobile-acquired microscopic images of cytology samples, stratifying the lesions according to The Bethesda System (TBS) guidelines. This work was supported by a new dataset of images from LBC samples digitalized with a portable smartphone-based microscope, encompassing nucleus annotations of 31,698 normal squamous cells and 1395 lesions. Several experiments were conducted to optimize the model's detection performance, namely hyperparameter tuning, transfer learning, detected class adjustments, and per-class score threshold optimization. The proposed nucleus-based methodology improved the best baseline reported in the literature for detecting cervical lesions on microscopic images exclusively acquired with mobile devices coupled to the µSmartScope prototype, with per-class average precision, recall, and F1 scores up to 17.6%, 22.9%, and 16.0%, respectively. Performance improvements were obtained by transferring knowledge from networks pre-trained on a smaller dataset closer to the target application domain, as well as including normal squamous nuclei as a class detected by the model. Per-class tuning of the score threshold also allowed us to obtain a model more suitable to support screening procedures, achieving F1 score improvements in most TBS classes. While further improvements are still required to use the proposed approach in a clinical context, this work reinforces the potential of using AI-powered mobile-based solutions to support cervical cancer screening. Such solutions can significantly impact screening programs worldwide, particularly in areas with limited access and restricted healthcare resources. [ABSTRACT FROM AUTHOR]

Copyright of Journal of China Medical University is the property of Journal of China Medical University Editorial Office and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Introduction: Wet-fixed smear study routinely used to identify several pre-cancerous and cancerous tumours. By contrasting cellular preservation and staining quality in rehydration smears with wet-fixed smears, the current study aims to establish the effects of rehydration on air-dried smears. Materials and Methods: One hundred paired samples are compared. Wet fixing was done in the first place. Air-dried samples are rehydrated for 30 s with regular saline and then placed in 95% ethanol for 30 min. Both smears will undergo screening, evaluation and grading for numerous cytomorphological factors after Pap staining. The 2014 Bethesda system was used to report the cervical smear results. Results: When evaluated for numerous cellular properties, statistically significant similarities can be seen between two groups, one with wet-fixed smears and the other with rehydrated air-dried smears. The results of the cytological diagnosis comparison between the two groups can be shown in the agreement. Rehydrated air-dried smear interpretation and staining quality are significantly superior to traditional wet smears. Conclusions: Rehydration air-dried techniques can be used instead of traditional wet fixation methods and are as effective when used alone or with traditional wet-fixed smears. [ABSTRACT FROM AUTHOR]

Context: The performance parameters of cervical cytology in any accredited cytology laboratory requires implementation of quality control exercise, which ensures acceptable performance by a laboratory. This study aims to assess the analytical aspect of quality control measures by evaluating the frequency and accuracy of epithelial abnormalities as detected in cervical Pap smears using histopathologic diagnosis as the gold standard. Methods: A retrospective diagnostic test study from 2018 to 2020 was conducted. Out of the total 6000 Pap smears, histopathologic correlation was available in 150 cases in the form of colposcopic-directed biopsy (CDB) and loop electrosurgical excision procedure (LEEP) tissue in 105 cases. The quality control measures analyzed were Atypical Squamous Cell: Squamous Intraepithelial Lesion (ASC:SIL) ratio, cyto-histo correlation, and study parameters like sensitivity, specificity, positive predictive value, and negative predictive value of Pap smears as against CDB and LEEP. Results: 4.5% smears were reported as inadequate, 92.3% as Negative for intraepithelial lesion or malignancy (NILM), followed by epithelial abnormality found in 3.21%. The ASC:SIL ratio was 1.3:1. Concordance rate against CDB was 100% in Squamous cell carcinoma (SCC), 82.35% in high-grade squamous intraepithelial lesion (HSIL), 82% in atypical squamous cells of undetermined significance (ASCUS), 65.6% in low-grade squamous intraepithelial lesion (LSIL), and 50% in Atypical Squamous Cell ,High grade Squamous Intraepithelial Lesion can not be ruled out (ASC-H). Total concordance rate was 84.15%. Sensitivity of Pap smear was 65% for LSIL and 82% for HSIL. Specificity, positive predictive value, and negative predictive value were 63.63%, 90%, and 75%, respectively. Concordance rate was 96% with LEEP. Conclusion: Quality control measures give an insight of performance of any accredited cytology laboratory. This exercise needs to be conducted on a regular basis, so that relevant steps can be taken in case of major discrepancy.

Background: The epidemiology of human papillomavirus (HPV) infection and the pattern of HPV genotype distribution are parameters needed to assess the risk of cervical cancer. Oncogenic HPV types are well-known pathogen for lower genital tract neoplasias, representing the primary cause of cancer death in Africa and the second in Cameroon. This study was conducted to identify the various genotypes particularly the high-risk HPV types in normal and abnormal cervical cytology from women in Yaoundé, Cameroon. Methodology: This was a hospital-based, analytical cross-sectional study carried out on 226 symptomatic women wherein cervico-vaginal samples were obtained during gynaecological examination for Pap smears, HPV-DNA and genotype detection with linear array HPV strip, conducted from November 2019 to January 2021. Results: From the 226 women whose cervical samples were collected for Pap smears, 71 (31.4%) had abnormal cytology results while 155 (68.6%) had normal results. The overall HPV prevalence in the study population was 34.1% (77/226). The HPV prevalence in women with abnormal Pap smears was 100% (71/71) and are distributed in following descending order; LSIL (21.1%, 15/71), HSIL (21.1%, 15/71), ASC-US (19.7%, 14/71), ICC (19.7%, 14/71) and others (18.4%, 13/71). HPV-DNA was positive in 6 (3.9%) of the 155 women with normal cytology results, 4 (2.6%) of whom were high-risk HPV. There is statistically significant difference in the HPV prevalence between women with abnormal and normal Pap smear results (OR=3289, 95% CI=182.62-59235, p<0.0001). The frequently identified oncogenic HPV types were type 16 (31.2%, 24/77), type 45 (14.3%, 11/77) and type 18 (10.4%, 8/77). Conclusion: It is evident from our study that symptomatic women with normal Pap smear can have HR-HPV infection and should therefore be screened for HPV and followed up with periodic Pap smears to detect any abnormal change in cervical cytology results, to prevent cervical cancer development. Women should be encouraged to take up cervical screening, through Pap smears, because it is a non-invasive and cost-effective method for early detection of preinvasive lesions. [ABSTRACT FROM AUTHOR]

The project named Victoria's cells was created to train health care personnel, especially in low‐income countries. This innovative approach is designed to associate benign and malignant cellular images and/or patterns with a range of shapes and color shades to evoke animals, common objects, and colorful aquariums. The project makes use of familiar images to capture the viewer's interest as an aid for cytological interpretation. Cervicovaginal cytology is processed with conventional and liquid‐based cytology. The images are visually compelling to highlight the importance of studying cells and their diagnostic significance. Infectious diseases as well as malignant cells are thereby easily recognized. The pictures are organized into different sections, including Victoria's zoo, Victoria's fantasy, and malignant mockery. Branching mycelia resemble a starfish; squamous metaplasia recalls a sea turtle's shell. Among others, different patterns of endometrial, endocervical, and squamous cells can resemble fish tanks populated by cells with the shapes of pufferfish, anglerfish, whales, scorpions, and garfish. The sea transitions to the earth, with a sly cat, a little elephant, a dog, and a koala. Other cellular preparations resemble a gymnast, a geisha, and a plunging diver as well as hummingbirds, a heron, a water lily, and a peony. The malignant mockery section is composed of squamous intraepithelial lesion patterns that resemble monsters, eyes, a foul tongue, eagles, and feathers. In conclusion, the recognition of visual images can make the study of cytology simpler and more enjoyable and serve the final objectives of prevention and cure. The recognition of visual images can make the study of cytology simpler and enjoyable and always leads to the final purpose of prevention and cure. [ABSTRACT FROM AUTHOR]

Background: High-risk human papillomavirus (HR-HPV) is the primary cause of cervical cancer, leading to over 311 000 global deaths, mainly in low- and middle-income countries. Kenyan women living with HIV (WLHIV) face a disproportionate burden of HR-HPV. Objectives: We determined the prevalence of HR-HPV infections and their association with cervical cytology findings among Kenyan WLHIV. Method: We conducted a cross-sectional study among WLHIV attending the HIV care and treatment clinic at the Kenyatta National Hospital (KNH), Kenya's national referral hospital. Study nurses collected a cervical sample with a cytobrush for HR-HPV genotyping using Gene Xpert® assays and HPV Genotypes 14 Real-TM Quant V67-100FRT. Bivariate analysis explored the associations. Results: We enrolled 647 WLHIV (mean age of 42.8 years), with 97.2% on antiretroviral therapy (ART) and 79% with a suppressed viral load (< 50 copies/mL plasma). The prevalence of any and vaccine-preventable HR-HPV was 34.6% and 29.4%, respectively, with HPV 52 being the most common genotype (13.4%). Among WLHIV with HR-HPV infections, 21.4% had abnormal cervical cytology. Women with multiple HR-HPV infections were more likely to have abnormal cytology compared to those with single HR-HPV infections (34.9 vs 9.3%, adjusted odds ratio [aOR] = 6.2, 95% confidence interval [CI]: 2.7–14.1, P = 0.001). Women with HR-HPV infection (single or multiple) were more likely to be on the second-line ART regimen compared to those without HR-HPV infections (53.1% vs 46.7%, aOR = 2.3, 95% CI: 1.3–4.1, P = 0.005). Conclusion: Among WLHIV at KNH, abnormal cytology was common and more frequent among women with multiple HR-HPV infections. [ABSTRACT FROM AUTHOR]

Objective: Bleeding is the most common complication of conization of cervix. Hemostatic sutures, intraoperative ferric subsulfate, or vasopressin can be used when intraoperative bleeding occurred, whereas oral tranexamic acid (TA) may be used for post-operative bleeding. In this study, we aimed to find out whether intraoperative cervical TA administration in patients undergoing conization caused changes in the amount of intraoperative bleeding and post-operative hemogram. Material and Methods: Patients who have undergone cervical conization between January 2019 and July 2019 in Zeynep Kamil Health Application and Research Center Gynecological Diseases and Birth Clinic were evaluated. One hundred and five patients were included to our study. One ampoule of 10% TA was applied cervically to 47 of these patients. Both groups were evaluated in terms of measuring the intraoperative amount of blood in the aspirator, changes in post-operative hb/htc/plt values compared to the pre-operative values, and the rate of post-operative bleeding. Results: In our study, the amount of intraoperative hemorrhage and pre-operative hemoglobin, hematocrit, and platelet values compared to the post-operative values were found to be similar in both groups. Conclusion: Although TA has been shown to be effective on hemorrhage in benign gynecologic operations, menorrhagia, and postpartum hemorrhages, no significant effect on hemorrhage in conization with cervical TA administration has been demonstrated. [ABSTRACT FROM AUTHOR]

Background A retrospective study of a single laboratory's results from patients in the United States to investigate high-risk human papillomavirus (HPV) genotype distribution according to cervical cytology and age was performed. Methods Anonymous results of 23 580 patients' cervical specimens sent to Medical Diagnostic Laboratories, LLC, for cervical cytology and HPV testing between August 2020 and August 2021 were analyzed. Results Overall, any of the 14 high-risk HPV genotypes identified were detected in 2302 of the 23 580 patients (9.8%), with HPV 52 (1.4%), HPV 39 (1.3%), HPV 51 (1.3%), and HPV 16 (1.2%) being the most frequent in all patients. Multiple high-risk HPV infection was observed in 1.3% of all patients. HPV 16 was most likely to be a single high-risk genotype detected as compared with detection with other high-risk HPV genotypes, in contrast to HPV 33, which is least likely to be a single high-risk genotype detected as compared with detection with other high-risk HPV genotypes. High-risk HPV detection was greatest in patients under 25 years old (<21-year-olds, 24.6%, and 21–25-year-olds, 25.4%). In patients with low-grade squamous intraepithelial lesions, the most frequently detected high-risk HPV genotypes were HPV 51 (10.5%) and HPV 39 (9.1%), and in patients with high-grade squamous intraepithelial lesions, the most frequently detected high-risk HPV genotypes were HPV 16 (25.6%) and HPV 52 (17.1%). Conclusions HPV genotyping and cervical cytology data analysis may contribute to and inform cervical cancer screening and HPV vaccination programs. [ABSTRACT FROM AUTHOR]

To evaluate the risk of false HPV‐negative results and possible related morphological abnormalities in HPV primary cervical cancer screening. Out of 53,661 HPV‐negative cases, 5469 (10.2%) randomly selected cytology slides were evaluated as a part of the quality assurance protocol. The Bethesda category negative for intraepithelial lesion or malignancy (NILM) in the HPV‐negative cases given was present in 95.4%. Due to cytology other than NILM, 0.4% of cases were referred to colposcopy and 4.2% to the follow‐up in one year. In the follow‐up HPV negativity and NILM cytology was present in 88.3% of attended women. Cases other than HPV negative and NILM were referred to colposcopy. One biopsy‐proven histological HSIL was found in the first round and one in follow‐up screening. More comprehensive genotyping of HSIL cases revealed genotypes 69 and 11. Only two HPV test negative cases with histological HSIL were revealed forming 0.04% of quality control group. In both cases, HPV genotype not included in screening tests was found. According to the results, the primary HPV test with cytology triage is an efficient and specific method for cervical cancer screening despite of the fact that some non‐high‐risk genotypes are missed. [ABSTRACT FROM AUTHOR]

Infection with high-risk (HR) Human Papillomavirus (HPV) is associated with the development of precancerous lesions or invasive carcinoma of the uterine cervix. Thus, the high viral load (VL) of HR-HPV DNA currently serves as a representative quantitative marker for cervical cancer. However, the clinical significance of low HPV DNA VL remains undetermined. This study aimed to evaluate the clinical association between the low HPV DNA VL and cytology/histologic diagnosis of cervical samples. We searched the electronic medical databases for the resultant analyses of HPV genotyping among patients who underwent treatment for any cervical lesion or who had undergone gynecological examinations with any positive HPV results according to the national cancer screening service between 2015 and 2016. HPV testing with genotyping and semi-quantitative VL measurement was conducted using an AnyplexTM II H28 Detection assay (H28 assay, Seegene, Seoul, Republic of Korea). The H28 assay is a multiplex semi-quantitative real-time PCR test using the tagging of oligonucleotide cleavage and extension (TOCE) technology. The VL was semi-quantified as high (3+; positive signal before 31 PCR cycles), intermediate (2+; positive between 31 and 39 PCR cycles), or low (1+; positive after 40 PCR cycles). Out of 5940 HPV VL analyses, 356 assays (5.99%) were reported as low VL (1+) of HPV DNA. Matched cytology diagnoses were mostly negative findings (n = 347, 97.5%), except for seven cases of atypical squamous cells of undetermined significance (1.9%) and two cases of atypical glandular cells (0.6%). During the follow-up periods, abnormal cytologic diagnoses were identified, including one case of high-grade squamous intraepithelial lesion (HSIL) and two low-grade squamous intraepithelial lesions (LSILs). The matched, confirmative histologic diagnosis of HSIL cytology was compatible with chronic inflammation, wherein the two LSILs had regular check-ups. None revealed clinically concerned outcomes associated with HPV-related squamous lesions. The cytology was most likely negative for malignancy when the VL of HPV DNA was low (1+). Additional strategic monitoring and management may thus be unnecessary. [ABSTRACT FROM AUTHOR]

Simple Summary: This review discusses the timeline and development of the recommended screening tests, diagnosis system, and therapeutics implemented in clinics for precancer and cancer of the uterine cervix. The incorporation of the latest automation, machine learning modules, and state-of-the-art technologies into these aspects are also discussed. Cancer arising from the uterine cervix is the fourth most common cause of cancer death among women worldwide. Almost 90% of cervical cancer mortality has occurred in low- and middle-income countries. One of the major aetiologies contributing to cervical cancer is the persistent infection by the cancer-causing types of the human papillomavirus. The disease is preventable if the premalignant lesion is detected early and managed effectively. In this review, we outlined the standard guidelines that have been introduced and implemented worldwide for decades, including the cytology, the HPV detection and genotyping, and the immunostaining of surrogate markers. In addition, the staging system used to classify the premalignancy and malignancy of the uterine cervix, as well as the safety and efficacy of the various treatment modalities in clinical trials for cervical cancers, are also discussed. In this millennial world, the advancements in computer-aided technology, including robotic modules and artificial intelligence (AI), are also incorporated into the screening, diagnostic, and treatment platforms. These innovations reduce the dependence on specialists and technologists, as well as the work burden and time incurred for sample processing. However, concerns over the practicality of these advancements remain, due to the high cost, lack of flexibility, and the judgment of a trained professional that is currently not replaceable by a machine. [ABSTRACT FROM AUTHOR]

Cytology identifies the women who are at higher risk of harboring high-grade cervical premalignant lesions or invasive cancer. However, a diagnostic test such as colposcopy is crucial for women with abnormal cytology for localization of the abnormality, confirmation of diagnosis, and appropriate management. To standardize this subjective technique and to minimize the interobserver variations, Swede scoring system was introduced. The revised colposcopic nomenclature of the International Federation of Cervical Pathology and Colposcopy in 2011 included various normal and abnormal colposcopic findings and gives a description of colposcopic features which improves its accuracy over the colposcopic indices. There is consensus agreement that cytology indicative of high-grade lesions (ASC-H and HSIL in the Bethesda system) should engender immediate referral for colposcopy and biopsy. The management of women who have equivocal or borderline cytology of low-grade abnormalities (ASCUS/LSIL) is still under deliberation. It is generally agreed to have an HPV triage for women with equivocal cytology. Based on the latest recommendations, the current chapter provides an extensive overview of the role of colposcopy in the management of women with various abnormalities reported on Pap smear. [ABSTRACT FROM AUTHOR]

The cervical cancer screening has been based conventionally on cytologic analysis. With advances in understanding the role of human papillomavirus, cotesting has been applied. But most of the patients subjected to colposcopy did not benefit, except in cases with HSIL [high-grade squamous intraepithelial lesion] cytology. Because of this, a step to increase the sensitivity to detect cancers and pre-cancers but with higher specificity with minimal overdiagnosis leading to prevention of unindicated cervical biopsies is highly desired. Such triaging step in cases with abnormal screening results is expected to minimize invasive interventions because of low false positivity. With availability of methodologies leading to quantitatively and qualitatively enhanced cell-blocks from residual liquid based cytology specimens, immunostaining can be performed for multiple immunomarkers with potential objectivity to triage initial screening test results. This is enhanced further with inclusion of AV marker in the cell-blocks and application of SCIP (subtractive coordinate immunoreactivity pattern) approach. The cell-blocks are also resource for performing other ancillary studies including molecular pathology and proteomics/metabolomics as potential tests in future. This review explores application of residual liquid based cytology specimen for cellblocking with application of ancillary studies in algorithmic manner as adjunct to ASCCP management guidelines for improved patient care. [ABSTRACT FROM AUTHOR]

The Pap smear is a well-known screening tool for squamous lesions of the uterine cervix. However, its screening role in glandular lesions is less effective. The incidence of squamous cell carcinoma of the cervix has dramatically decreased with the advent of Pap smear and recent understanding related to HPV carcinogenesis of cervical cancers including the advent of HPV vaccines. However, in recent years, the incidence of glandular abnormalities, diagnosed on Pap smears, has increased with greater sensitivity and precision. The incidence of atypical glandular cells (AGC) is approximately 0.18-0.74% of all cervical smears with a reported prevalence of 2.5% among all Pap smears. A high degree of suspicion, good clinical history, and the presence of diagnostic cytomorphological findings are essential for the proper interpretation of glandular cell abnormalities. A methodical approach to evaluate Pap smear greatly helps interpretation and avoids the diagnostic pitfalls. The Bethesda System for reporting cervical cytology has categorized glandular cell abnormalities into various categories as follows: A. Endocervical adenocarcinoma in situ (AIS) B. Atypical glandular cells (AGCs) a. Endocervical cells: a1 NOS or specify in comments; a2 Favor neoplastic b. Endometrial cells: NOS or specify in comments C. Adenocarcinoma (AdCa) a. Endocervical b. Endometrial c. Extrauterine d. NOS Subtle differences in quantitative and qualitative cytologic features are essential for distinguishing one category from another. In this chapter, we highlight an organized approach for the interpretation of glandular abnormalities in Pap smear for our readers. This is an overview of the Bethesda categories, the reason for classification, and differential diagnosis with key characteristic features. An approach to the methodical evaluation of hyperchromatic crowded groups is discussed with key cytomorphologic differences. An algorithmic approach is suggested to facilitate the interpretation of various AGC categories. [ABSTRACT FROM AUTHOR]

Background: The most common sexually transmitted infection in the world is human papillomavirus (HPV). HPV types 16 and 18 are responsible for 60–80% of cervical cancers and precancerous cervical lesions worldwide. Aim: In this study, it was aimed to evaluate the correlation of HPV genotype distribution with cervical cytology results in cervical smear samples and to contribute to HPV epidemiology. Materials and Methods: This study included 72 female patients. For detection of the HPV genotypes, a multiplex real-time polymerase chain reaction (PCR) method that could detect more than 25 different HPV types was used. The cervical cytology and histopathology results of the patients were also evaluated simultaneously. Results: The frequency of high-risk HPV was 35% (25/72). The most common types were HPV51 (10%), HPV16 (8%), and HPV66 (8%), respectively. The most common type HPV51 and multiple HPV types were seen in 21–34 age groups. HPV DNA was detected in 21 of 43 samples that had cervical smear diagnosis grouping. Twelve samples (26%) had normal cytology. Low grade squamous intraepithelial lesions were the most common cytological diagnosis in HPV DNA positive samples. The most common HPV types in the patients diagnosed low grade squamous intraepithelial lesions and high grade squamous intraepithelial lesions were HPV16 and HPV52. Conclusions: In this study, the frequency of high-risk HPV genotypes was 35% as similar to reports of the other studies conducted in our country. The most common types were HPV51, HPV16, and HPV66, respectively. The follow-up of patients with HPV51 infection in our area could help to improve the natural course of the disease and effective prevention programs.

Context: The use of the CINtec® PLUS Cytology Kit as a complementary method of diagnosis is intended to contribute to a risk assessment of CIN II+ cervical lesions development, thus avoiding unnecessary colposcopy in negative cases. This method has proved to be effective in the follow-up of cervical lesions, although there is need for consistency in the approach of equivocal or negative cytological results, with persistent positive High-Risk Human Papillomavirus (HR-HPV) test. Aims: The present study intends to retrospectively evaluate the capacity of the CINtec® to add information to the clinical practice within the screening and follow-up of cervical lesions. Additionally, this study intends to define criteria for CINtec® referral in order to maximize its utilization in the Portuguese context. Materials and Methods: For this purpose, 225 cases with CINtec® PLUS Cytology Kit and histology results were used, and data were analysed and compared according to the cytology and HR-HPV molecular test results. Results: The data of this study show that CINtec® PLUS Cytology Kit is a valid test for the diagnosis of persistent HPV lesions (p = 0.0005), with excellent sensitivity and reliable values of specificity. Relevant patient groups to apply the kit are in agreement with the manufacturer recommendations: women with ASC-US/LSIL result and NILM cytology with HPV-positive test, essentially over 30 years old. Conclusions: Although clinical data and previous cytological information must help guiding, authors considered that CINtec® is a really valid test for the prognosis of persistent HPV infections in the female population.

Introduction: Uterine clear cell adenocarcinoma (CCC) is a rare, aggressive malignancy with poor prognosis. The present study aimed to identify and describe its characteristic morphological features in cervical cytology. Methods: This was a 3‐year retrospective case‐control study. Cases included cervical samples of histopathologically proven endometrial and cervical CCC. Controls included cervical samples of histopathologically proven endometrial serous carcinoma (n = 15), endometrioid adenocarcinoma (n = 20), and endocervical adenocarcinoma (n = 15). Twenty‐eight cytomorphological features were evaluated; the strength of association was determined by odds ratio (OR) and Cramer's V, and the diagnostic accuracy of statistically significant features was assessed. Results: Cases consisted of histopathologically proven 25 (34.7%) endometrial and 13 (18.0%) cervical CCC. Corresponding cervical samples were available for a total of 14 (36.8%) patients, of which 13 (92.8%) were positive for epithelial cell abnormality. On univariate analysis, three cytomorphological variables were significant predictors of uterine CCC: presence of dense cytoplasm (OR = 88; V = 0.72), deep nuclear membrane irregularities (OR = 17.5; V = 0.55), and coarse chromatin (OR = 21.3; V = 0.46). Dense cytoplasm had the highest positive predictive value (92%) and high specificity (97.8%), whereas coarse chromatin had the highest sensitivity (92.3%) and negative predictive value (96.7%). Conclusions: The presence of dense cytoplasm and deep nuclear membrane irregularities in the tumour cells were strong predictors, and coarse chromatin a moderate predictor, of uterine CCC compared to its close cytological mimics. [ABSTRACT FROM AUTHOR]

Background: Although many cervical cytology diagnostic support systems have been developed, it is challenging to classify overlapping cell clusters with a variety of patterns in the same way that humans do. In this study, we developed a fast and accurate system for the detection and classification of atypical cell clusters by using a two‐step algorithm based on two different deep learning algorithms. Methods: We created 919 cell images from liquid‐based cervical cytological samples collected at Sapporo Medical University and annotated them based on the Bethesda system as a dataset for machine learning. Most of the images captured overlapping and crowded cells, and images were oversampled by digital processing. The detection system consists of two steps: (1) detection of atypical cells using You Only Look Once v4 (YOLOv4) and (2) classification of the detected cells using ResNeSt. A label smoothing algorithm was used for the dataset in the second classification step. This method annotates multiple correct classes from a single cell image with a smooth probability distribution. Results: The first step, cell detection by YOLOv4, was able to detect all atypical cells above ASC‐US without any observed false negatives. The detected cell images were then analyzed in the second step, cell classification by the ResNeSt algorithm, which exhibited average accuracy and F‐measure values of 90.5% and 70.5%, respectively. The oversampling of the training image and label smoothing algorithm contributed to the improvement of the system's accuracy. Conclusion: This system combines two deep learning algorithms to enable accurate detection and classification of cell clusters based on the Bethesda system, which has been difficult to achieve in the past. We will conduct further research and development of this system as a platform for augmented reality microscopes for cytological diagnosis. [ABSTRACT FROM AUTHOR]

Aim: The aim of this study was to evaluate the clinical performance for detecting cervical intraepithelial neoplasia (CIN) 2 or higher lesions among available human papillomavirus infection (HPV) genotyping tests in Korea. Methods: Eligible patients visited 13 tertiary hospitals for colposcopic biopsy following cervical cytology and HPV genotyping test between January and December 2018. Baseline characteristics including age, body mass index (BMI), and parity were collected from 3798 patients. The performance of the Roche Cobas HPV 4800 was evaluated against other domestic HPV assays to detect CIN2 or higher. Results: A total of seven types of HPV genotyping tests were analyzed in the research institutes. A total of 1358 patients (35.8%) tested Anyplex II HPV 28 and 701 patients (18.5%) tested Cobas 4800 HPV. The overall sensitivity in the detection of CIN2 or higher was 41.5% (38.9–44.1) in patients positive for HPV 16/18. The Cobas test for HPV 16/18 was concordant with other assays evaluated for detection of CIN2 or higher and showed sensitivity of 46.6%, which was not significantly different from other assays. Although Anyplex II HPV28 (Seegene) showed slightly decreased sensitivity for detecting CIN2 or higher lesion with HPV 16/18 positive (39.8%, p < 0.05) compared to Cobas 4800, in aspect of high‐risk HPV positive, Anyplex II HPV28 showed increased sensitivity (96.9%, p < 0.05). Conclusion: The performance of the HPV genotype test that were commonly used in Korea was concordant with Cobas HPV test. Further studies are needed to evaluate the safety, efficiency, and cost‐effectiveness of the various commercially available domestic HPV assays. [ABSTRACT FROM AUTHOR]

Small cell neuroendocrine carcinoma (SCNEC) of the cervix is a rare, highly aggressive tumour with poor prognosis and high propensity for distant metastases. The cytological features of SCNEC have rarely been described in cervical samples, and to the best of our knowledge, there are no previous reports using SurePath™ liquid‐based cytology. In the present report we present the cytomorphological features of histopathologically confirmed cases of cervical SCNEC in SurePath preparations. On cytological examination, all three cases demonstrated variable numbers of tumour cells, ranging from a few dispersed cells and tiny micro‐biopsies to large aggregates of small tumour cells with a high nucleus‐to‐cytoplasmic ratio, stippled chromatin, inconspicuous nucleoli, and scant cytoplasm. Immunocytochemistry for CD56 on the cervical preparation confirmed the diagnosis in one case. The presence of small tumour cells with characteristic stippled/salt‐and‐pepper type nuclear chromatin were the most consistent cytological features in these cases. Knowledge of these characteristic cytological features can help in suggesting a diagnosis of SCNEC in cervical samples which can then be confirmed by immunocytochemistry. [ABSTRACT FROM AUTHOR]

The cervical cytology of our patient transformed from squamous cell carcinoma to negative for intraepithelial lesion or malignancy, possibly due to the graftversus-tumor effect following allogeneic stem cell transplantation. [ABSTRACT FROM AUTHOR]

Introduction: Cervical cytology is a well‐stablished cervical cancer screening method. However, due to the anatomical continuity of the genital tract, it can also detect signs of endometrial disease. Our aim was to estimate the sensitivity of cervical cytology in endometrial cancer detection and prognosis in a large population over a 30‐year period in a large academic tertiary hospital in Spain. Methodology: We performed a search for women diagnosed with endometrial cancer from 1990 to 2020, who were surgically treated and had a previous cervical cytology result. Information Technologies Department databases from Bellvitge University Hospital and the Screenwide case–control study's database were used. Cervical cytology results were classified as abnormal when squamous lesions, glandular atypia or malignant cells were identified. Results: Overall, we evaluated 371 women with endometrial cancer and a documented cervical cytology performed within 3 years previous to surgical treatment. Overall, the sensitivity of cervical cytology for endometrial cancer detection was 25.6%. Several clinico‐pathological characteristics, such as non‐endometrioid histology and a higher stage, were correlated with higher sensitivity. Discussion: We observed a low sensitivity of cervical cytology to effectively diagnose endometrial cancer. However, recent technological advances using genomics and epigenomics may offer a promising perspective to detect endometrial cancer with high sensitivity in these cervical specimens. [ABSTRACT FROM AUTHOR]

Objective: To estimate the frequency of abnormal cervical cytology detected by Pap smear. Study Design: Cross Sectional Study. Setting: Department of Obstetrics and Gynaecology Gambat Institute of Medical Sciences Gambat, Khairpur Sindh. Period: November 2018 to June 2019. Material & Methods: A total of 160 women with the complaint of heavy vaginal discharge and moderate to servere lowere abdominal pain more than 6 weeks were included in this study. Per speculum examination of cervix was carried out with the help of cuscos speculum before PAP smear and finding were noted, After labeling the sample was sent to histopathology for cytological examination. Results: The average age of the patient’s was 37.68±7.46 years. Percentage of normal smears 10%, advance disease 1.3% and percentage of inflammatory smear is 63.8% while frequency of abnormal cervical cytology was observed in 25% in which CIN-1 was 12.5%, CIN-2 was 11.3% and CIN-3 was 1.3%. Conclusion: Our population have large numbers of undiagnosed cervical diseases. Therefore, Pap smear testing should be widely used throughout Pakistan to reduce the incidence of cervical cancer. [ABSTRACT FROM AUTHOR]

Context: Cervical cancer is the second most common cancer in women. The liquid based cervical cytology (LBCC) is a useful tool of choice for screening cervical cancer. Aims: To train a convolutional neural network (CNN) to identify abnormal foci from LBCC smears. Settings and Design: We have chosen retrospective study design from archived smears of patients undergoing screening from cervical cancer by LBCC smears. Materials and Methods: 2816 images, each of 256 × 256 pixels, were prepared from microphotographs of these LBCC smears, which included 816 “abnormal” foci (low grade or high grade squamous intraepithelial lesion) and 2000 'normal' foci (benign epithelial cells and reactive changes). The images were split into three sets, Training, Testing, and Evaluation. A convolutional neural network (CNN) was developed with the python programming language. The CNN was trained with the Training dataset; performance was assayed concurrently with the Testing dataset. Two CNN models were developed, after 20 and 10 epochs of training, respectively. The models were then run on the Evaluation dataset. Statistical Analysis Used: A contingency table was prepared from the original image labels and the labels predicted by the CNN. Results: Combined assessment of both models yielded a sensitivity of 95.63% in detecting abnormal foci, with 79.85% specificity. The negative predictive value was high (99.19%), suggesting potential utility in screening. False positives due to overlapping cells, neutrophils, and debris was the principal difficulty met during evaluation. Conclusions: The CNN shows promise as a screening tool; however, for its use in confirmatory diagnosis, further training with a more diverse dataset will be required.

Background: HPV and C.trachomatis are the most prevalent, viral and bacterial STI worldwide. Both commonly have an asymptomatic development and can evolve into a persistent infection which, added to coinfections, may be important cofactors for the oncogenic transformation.Objective: Evaluate the prevalence of oral and genital HPV and C.trachomatis infection in women with normal and abnormal cervical cytology.Study Design: The cross-sectional study included 200 swabs, 100 oral and 100 cervical from 50 women with normal and 50 with abnormal cervical cytology. HPV and C.trachomatis infections were detected using PCR with specific primers.Results: HPV DNA was detected in 27% (n = 27/100) of women with normal and abnormal cytology. Out of 100 genital samples we detected HPV DNA in 18% (n = 18/100) and 14% (n = 14/100) out of 100 oral samples. HPV genotypes detected were genotype 6 of low-risk and 16, 31, 52, 58 and 16-31 coinfection of high-risk. C.trachomatis DNA was detected in 49% (n = 49/100) of patients. Out of 100 genital samples we detected C.trachomatis in 35% (n = 35/100) and 31% (n = 31) out of 100 oral samples. There is statistically significant (p < 0.05) between cytology and HPV and C.trachomatis infection but there is no statistically significant between cytology and the other characteristics.Conclusions: Since the histology of oral mucosa resembles that of the uterine cervix, we can anticipate the presence of HPV and other STI which are detected in different lesions of genital areas and the oral mucosa. Therefore, is important C.trachomatis detection and specific treatment in asymptomatic women because this infection may increase the risk of HPV persistence and coinfection induces a pro-inflammatory environment that may promote the carcinogenesis. [ABSTRACT FROM AUTHOR]

Context: The use of the CINtec® PLUS Cytology Kit as a complementary method of diagnosis is intended to contribute to a risk assessment of CIN II+ cervical lesions development, thus avoiding unnecessary colposcopy in negative cases. This method has proved to be effective in the follow-up of cervical lesions, although there is need for consistency in the approach of equivocal or negative cytological results, with persistent positive High-Risk Human Papillomavirus (HR-HPV) test. Aims: The present study intends to retrospectively evaluate the capacity of the CINtec® to add information to the clinical practice within the screening and follow-up of cervical lesions. Additionally, this study intends to define criteria for CINtec® referral in order to maximize its utilization in the Portuguese context. Materials and Methods: For this purpose, 225 cases with CINtec® PLUS Cytology Kit and histology results were used, and data were analysed and compared according to the cytology and HR-HPV molecular test results. Results: The data of this study show that CINtec® PLUS Cytology Kit is a valid test for the diagnosis of persistent HPV lesions (p = 0.0005), with excellent sensitivity and reliable values of specificity. Relevant patient groups to apply the kit are in agreement with the manufacturer recommendations: women with ASC-US/LSIL result and NILM cytology with HPV-positive test, essentially over 30 years old. Conclusions: Although clinical data and previous cytological information must help guiding, authors considered that CINtec® is a really valid test for the prognosis of persistent HPV infections in the female population. [ABSTRACT FROM AUTHOR]

Introduction: Human papillomavirus (HPV) is the causative agent of precancerous lesions and cervical cancer, cervical cancer being the leading cause of deaths in Tanzanian women. Early detection and treatment of precancerous lesions are important in the prevention of cervical cancer cases. Material and methods: We conducted a cross‐sectional study among 3390 Tanzanian women aged 25‐60 years. Information on lifestyle habits was collected, and women underwent gynecological examination with collection of cervical cells for conventional cytological and HPV testing. Blood samples were tested for HIV. The association between cervical high‐grade cytology (HGC) and potential risk factors was examined using multivariable logistic regression adjusting for age and high‐risk HPV (HR‐HPV). Results: The prevalence of HGC was 3.6% and of low‐grade cytology was 8.3%. In women who were both HR‐HPV‐positive and HIV‐positive, the prevalence of HGC was 28.3%. It increased by age and was 47% among women aged 50‐60 years. Women, who had their sexual debut at age 9‐15 years and 16‐18 years, respectively, had 2.5 and 2.4 times increased odds of HGC compared with women whose sexual debut was at age 21 years and older. HIV‐positive women had increased odds of HGC in comparison with HIV‐negative women after adjustment for age (odds ratio [OR] 2.95, 95% CI 1.92‐4.54). HR‐HPV‐positive women had nearly 100‐fold increased odds of HGC compared with HR‐HPV‐negative women (OR 96.6, 95% CI 48.0‐194), and this estimate was higher among HIV‐positive women (OR 152.2, 95% CI 36.1‐642.0). Conclusions: Increasing age, early age at first intercourse, HR‐HPV, and HIV infections were associated with a substantially increased risk of HGC. [ABSTRACT FROM AUTHOR]

Background: The most common sexually transmitted infection in the world is human papillomavirus (HPV). HPV types 16 and 18 are responsible for 60–80% of cervical cancers and precancerous cervical lesions worldwide. Aim: In this study, it was aimed to evaluate the correlation of HPV genotype distribution with cervical cytology results in cervical smear samples and to contribute to HPV epidemiology. Materials and Methods: This study included 72 female patients. For detection of the HPV genotypes, a multiplex real-time polymerase chain reaction (PCR) method that could detect more than 25 different HPV types was used. The cervical cytology and histopathology results of the patients were also evaluated simultaneously. Results: The frequency of high-risk HPV was 35% (25/72). The most common types were HPV51 (10%), HPV16 (8%), and HPV66 (8%), respectively. The most common type HPV51 and multiple HPV types were seen in 21–34 age groups. HPV DNA was detected in 21 of 43 samples that had cervical smear diagnosis grouping. Twelve samples (26%) had normal cytology. Low grade squamous intraepithelial lesions were the most common cytological diagnosis in HPV DNA positive samples. The most common HPV types in the patients diagnosed low grade squamous intraepithelial lesions and high grade squamous intraepithelial lesions were HPV16 and HPV52. Conclusions: In this study, the frequency of high-risk HPV genotypes was 35% as similar to reports of the other studies conducted in our country. The most common types were HPV51, HPV16, and HPV66, respectively. The follow-up of patients with HPV51 infection in our area could help to improve the natural course of the disease and effective prevention programs. [ABSTRACT FROM AUTHOR]

Introduction: Gastric‐type endocervical adenocarcinoma (GAS) is an uncommon type of endocervical adenocarcinoma that is not associated with human papillomavirus infection. This diagnosis is relatively rare and may portend a worse prognosis than usual‐type endocervical adenocarcinoma. Subtle morphological features make it an under‐recognised diagnostic challenge. Study of the cytological features of individual cases is valuable in order to increase awareness of this entity. Methods: The pathology database of our institution was searched for the diagnosis of GAS and all cytological and surgical specimens for each patient were reviewed. The original cytological interpretation was compared to a retrospective central review interpretation. Clinical history and follow‐up results were obtained from the electronic medical record. Results: Four cases of GAS were identified. The findings on initial cervical cytology varied, with GAS found in both patients with negative cervical cytology and those with atypical glandular cells. Cytological findings included endocervical cells arranged in three‐dimensional clusters and honeycomb sheets with abundant vacuolar cytoplasm, and in two patients, moderate nuclear atypia with irregular nuclear membranes, coarse chromatin, hyperchromatic nuclei, and prominent nucleoli. In one patient, GAS was incidentally discovered via thorough sampling of a cystic lesion in the superior portion of the endocervical canal. Conclusions: GAS is an aggressive human papillomavirus‐independent type of endocervical adenocarcinoma with subtle morphological features and, as our study shows, varying clinical presentation. Given the aggressive nature of GAS and the difficulties in initial diagnosis, increased awareness of this entity among pathologists is crucial. Gastric‐type endocervical adenocarcinoma (GAS) is an uncommon type of endocervical adenocarcinoma that is not associated with human papillomavirus infection. Four cases of GAS are presented, and findings in cervical cytology are reviewed and compared to those described in the literature. [ABSTRACT FROM AUTHOR]

Context: Papanicolaou (Pap) smear is an effective exfoliative cytological investigation done for early recognition of cervical cancer. It also plays role in diagnosis of inflammatory lesions of cervix. Aims: The aim of this study is (1) to compare the cytomorphological features in conventional Pap smear (C-PAPS) and rehydrated air-dried Pap smear (RADPS) and (2) to evaluate the efficacy of RADPS in cytodiagnosis of cervical lesion by comparing with cytomorphological features of conventional wet-fixed Pap smear. Subjects and Methods: Paired cervical smears were prepared for 247 patients. One was labeled as C-PAPS and another was labeled as RADPS. Comparison of both smears was done for various cytomorphological parameters. Results: Out of 247 smears, 2.4% RADPS and 7.3% C-PAPS were reported as unsatisfactory. Red blood cell (RBC) background was present in 2% of RADPS and 42% of C-PAPS. Cytolysis and air-drying artifact were observed more in C-PAPS amounting to 2% and 4% in RADPS and 11% and 15% in C-PAPS. Cytoplasmic staining (97% RADPS vs. 94% C-PAPS) was superior in RADPS. Cell border, nuclear border, and chromatin of squamous and endocervical cells were better appreciated on RADPS compared to C-PAPS, and also statistically significant difference was observed. Conclusion: Rehydrated air-dried technique can be satisfactory alternative for conventional wet fixation method which can be followed routinely or in conjugation with C-PAPS, especially in cervical screening programs.

Introduction: The Pap stained cervical smear is a screening tool for cervical cancer. Commercial systems are used for automated screening of liquid based cervical smears. However, there is no image analysis software used for conventional cervical smears. The aim of this study was to develop and test the diagnostic accuracy of a software for analysis of conventional smears. Materials and Methods: The software was developed using Python programming language and open source libraries. It was standardized with images from Bethesda Interobserver Reproducibility Project. One hundred and thirty images from smears which were reported Negative for Intraepithelial Lesion or Malignancy (NILM), and 45 images where some abnormality has been reported, were collected from the archives of the hospital. The software was then tested on the images. Results: The software was able to segregate images based on overall nuclear: cytoplasmic ratio, coefficient of variation (CV) in nuclear size, nuclear membrane irregularity, and clustering. 68.88% of abnormal images were flagged by the software, as well as 19.23% of NILM images. The major difficulties faced were segmentation of overlapping cell clusters and separation of neutrophils. Conclusion: The software shows potential as a screening tool for conventional cervical smears; however, further refinement in technique is required.

Purpose of Investigation: Despite the general principle that persistent high risk human papillomavirus (hr-HPV) infection may progressively cause cervical cancer (CxCa), demographic aspects may still identify groups at high risk for HPV infection and consequently for precancerous lesions. The role of demographic parameters on cervical status, the diagnostic accuracy of cytology, HPV genotyping, and their possible combinations, were investigated in this study. Materials and Methods: 11,072 women from diverse locations across Greece participated in the study. Liquid Based Cytologic (LBC) assessment was followed, when necessary, by HPV-genotyping and histologic confirmation. Demographic characteristics were also assessed. Results: Life style parameters such as age, number of sexual partners, condom use, parity and marital status, education level, and combination of smoking/condom use, were significant factors for CIN2+ lesions (p < 0.05). For LSIL+ detection, cytology had maximum sensitivity: 96.90%, HPV-typing: 72.55% and co-testing: 98.97%, for HSIL+ detection: 98.49%, 92.22%, and 99.55% respectively. Conclusions: There are notable relationships between lifestyle, demographic details, and cervical status. Despite the differences in sensitivity and specificity levels, co-testing might offer some marginal improvement in the detection of particular pre-cancerous conditions. [ABSTRACT FROM AUTHOR]

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Objectives: In 2012, the US Preventive Services Task Force decreased the recommended frequency of cervical cytology screening to once every 3 years and recommended against testing women younger than 21 years regardless of sexual history. We evaluated the impact of this in 21 to 29-year-old women at a tertiary care academic medical center in 2011 and 2017.Methods: We retrospectively analyzed Papanicolaou test results at two time points in 21- to 29-year-old women.Results: There was a decrease in the number of high-grade lesions in 21- to 25-year-old women (odds ratio [OR], 0.36) from 2011 to 2017. Within the 26- to 29-year-old patient group, there was a trend toward a higher percentage of high-grade squamous intraepithelial lesion (HSIL) in 2017 compared to 2011 on cytology, which did not reach statistical significance (OR, 1.46). However, follow-up histologic specimens showed a higher percentage of HSIL in 2017 compared to 2011 in this age group (OR, 2.16).Conclusions: Our findings suggest that the cervical cancer screening guidelines introduced in 2012 have not had a detrimental impact on the outcomes of cervical cancer screening for 21- to 25-year-old women. However, we need to continue monitoring the effects of decreased screening in 26- to 29-year-old women. [ABSTRACT FROM AUTHOR]

Background: Cervical cancer remains a global health problem especially in remote areas of developing countries which have limited resources for cervical cancer screening. In this study, we evaluated the performance of a low-cost, smartphone attachable paper-based microscope when used for classifying images of cervical cytology.Methods: Cervical cytology samples included: 10 Normal, 10 Low-grade squamous intraepithelial lesion (LSIL), 10 High-grade squamous intraepithelial lesion (HSIL), and 10 Malignant Pap Smears. The agreement between conventional microscopy vs. Foldscope imaging was calculated using a weighted kappa coefficient. A confusion matrix was created with three classes: Normal, LSIL, and HSIL/malignant, to evaluate the performance of the Foldscope by calculating the accuracy, sensitivity, and specificity.Results: We observed a kappa statistic of 0.68 for the agreement. This translates into a substantial agreement between the cytological classifications by the Foldscope vs. conventional microscopy. The accuracy of the Foldscope was 80%, with a sensitivity and specificity of 85 and 90% for the HSIL/Mal category, 80 and 83.3%, for LSIL, and 70 and 96.7% for Normal.Conclusions: This study highlights the usefulness of the Foldscope in cervical cytology, demonstrating it has substantial agreement with conventional microscopy. Its use could improve cytologic interpretations in underserved areas and, thus, improve the quality of cervical cancer screening. Improvements in existing limitations of the device, such as ability to focus, could potentially increase its accuracy. [ABSTRACT FROM AUTHOR]

Cytology inspection is a basic examination for the prevention of cervical cancer, which is still done manually and is a labor-intensive and time-consuming process with high inter-observer variability. With the rapid development of deep learning, automatic cytology inspection methods have achieved gratifying results, but the research on the effective detection of abnormal cells remains insufficient. In this paper, we propose a novel Dual-path Proposal Discriminative detection Network (DPD-Net) for abnormal cell detection in cervical cytology images. Specifically, considering the distinctive characteristics of abnormal nuclei such as increased sizes and unclear boundaries, we first design a dual-path architecture, where the cell path acts as the primary detector and the nucleus path serves as the auxiliary detector to provide supplementary information. In addition, the proposal information isolation may result in ambiguous classification boundaries. To transcend individual features and delve deeper into cellular relationships as implicit features, the proposal relation modules are added to explore relation information and refine features adaptively. Finally, to tackle problems of intra-class variation and inter-class similarity, we calculate the proposal contrastive losses in two paths respectively to guide a better distinction between the features of normal and abnormal cells. The proposed method is evaluated on our in-house cervical liquid-based cytology dataset (CLBC) and a public pap smear cytology dataset (CRIC) and gains satisfactory results, outperforming other state-of-the-art methods. Comprehensive experiments demonstrate the superiority of the proposed DPD-Net and the effectiveness of each proposed component. Our code is available at https://github.com/chaisiyii/DPD-Net. • We design a dual-path network (DP) to parallelly detect abnormal cells and nuclei. • We add proposal relation modules (PRM) to two paths to refine features adaptively. • We add the proposal contrastive loss (PCL) to lead a discriminative feature learning. • We conduct intensive experiments on two cervical cytology datasets: CLBC, CRIC. [Display omitted] [ABSTRACT FROM AUTHOR]

Objective: Several studies have shown that there is an upward shift in the classification of cervical cytology when high-risk human papillomavirus (hrHPV) status is known to be positive. The Netherlands implemented primary hrHPV screening with reflex cytology as the primary screening test in 2017. Prior to implementation of the new programme, we investigated whether knowledge of hrHPV status influences cytology rating. Methods: Using a set of 200 cytology slides that had been previously tested, two pairs of cytotechnicians rated 100 slides per pair twice: first without knowledge of hrHPV status and then, after a wash-out period of two months, with knowledge of hrHPV status. Results: We found that hrHPV positive slides were more likely to be rated up over the referral threshold (i.e. from negative for intraepithelial lesion or malignancy to atypical squamous cells of undetermined significance+) than hrHPV negative slides at the second review when hrHPV status was known (relative risk = 3.2; 95% confidence interval: 1.3–7.9). Conclusions: If the same upward shift in ratings were to be observed in the national programme, it may have implications for referrals of women with low-grade lesions. [ABSTRACT FROM AUTHOR]

Accurate cell segmentation is essential for computer-aided diagnosis of cervical precancerous lesions in cytology images. Automated segmentation poses a great challenge due to the presence of fuzzy and overlapping cells, noisy background, and poor cytoplasmic contrast. Deep learning diagnosis technology has showed its advantages in segmenting complex medical images. We present a new framework based on deep convolutional neural networks (DCNNs) to automatically segment overlapping cells in digital cytology. A double-window based cellular detection method is derived to correctly localize individual cells, in which TernausNet is adopted to classify the image pixels into nucleus, cytoplasm, or background. A modified DeepLab V2 model is applied to perform cytoplasm segmentation. To provide more training samples, a synthesis method is utilized to generate cell masses containing touching or overlapping cells. The presented method was tested on three independent data cohorts, including two public datasets. We achieved improved performance in terms of dice coefficient (DSC), false negative and false positive rates, with up to 15% improvement in DSC, compared with the state-of-the-art approaches. The results indicated that the DCNN based segmentation method could be useful in an image-based computerized analysis system for early detection of cervical cancer. [ABSTRACT FROM AUTHOR]

George Papanicolaou, a Greek immigrant and cytopathologist, was responsible for what is now colloquially known as the "Pap smear"—undoubtedly one of the greatest advances in medicine and public health of the last century. However, his landmark research on the development of cervical cytology for the detection of precancerous lesions of the cervix ("New Cancer Diagnosis," 1928) made a rather inauspicious debut in an unlikely venue: John Harvey Kellogg's Third Race Betterment Conference—a meeting devoted to the furtherance of the concept and implementation of eugenics. Herein, we discuss the stark juxtaposition of Papanicolaou's landmark discovery amid the pseudoscience of the third Race Betterment Conference. We discuss the latency of Papnicolaou's discovery–its potential implications unrealized–until co-publication with Herbert Traut, which catapulted Papanicolaou's research to the scientific foreground. This gave rise to public health initiatives aimed at establishing the Pap smear as a screening tool. We further delineate the progress made in recent decades with the identification of HPV as the etiological agent for cervical cancer, and the subsequent development of the HPV vaccine, and discuss ongoing research in the present day. In this way, we hope to provide a background and historical context for the development of the Pap smear. • Papanicolaou first described the Pap smear in 1928. His findings were not recognized by the medical community until 1941. • The 1941 re-publication of the Pap method spurred epidemiologic studies and screening protocols for cervical cancer. • In 1983, human papillomavirus was identified as the causal agent for cervical dysplasia by Harald zur Hausen. • Recent developments in cervical cytology include use of liquid-based cytology and HPV genotyping. [ABSTRACT FROM AUTHOR]