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Cervical cancer is frequent neoplasia. Currently, the diagnostic approach includes cervical cytology, colposcopy, and histopathology studies; combining detection techniques increases the sensitivity and specificity of the tests. Raman spectroscopy is a high-resolution technique that supports the diagnosis of malignancies. This study aimed to evaluate the Raman spectroscopy technique discriminating between healthy and premalignant/malignant cervical cells. We included 81 exfoliative cytology samples, 29 in the "healthy group" (negative cytology), and 52 in the "CIN group" (premalignant/malignant lesions). We obtained the nucleus and cytoplasm Raman spectra of individual cells. We tested the spectral differences between groups using Permutational Multivariate Analysis of Variance (PERMANOVA) and Canonical Analysis of Principal Coordinates (CAP). We found that Raman spectra have increased intensity in premalignant/malignant cells compared with healthy cells. The characteristic Raman bands corresponded to proteins and nucleic acids, in concordance with the increased replication and translation processes in premalignant/malignant states. We found a classification efficiency of 76.5% and 82.7% for cytoplasmic and nuclear Raman spectra, respectively; cell nucleus Raman spectra showed a sensitivity of 84.6% in identifying cervical anomalies. The classification efficiency and sensitivity obtained for nuclear spectra suggest that Raman spectroscopy could be helpful in the screening and diagnosis of premalignant lesions and cervical cancer. [ABSTRACT FROM AUTHOR]

There is a paucity of trained cytopathologists in low-resource settings for effective cervical cancer screening. There has been no documented report of the impact of a dedicated training program in cervical cytology on pathologists' knowledge and skill in this field. The present study aimed to evaluate the efficacy of the regularly conducted training workshops on the attending pathologists' knowledge, practice, and skills in cervicovaginal smear reporting. Our institute, a premier cancer research institute, has conducted 10 cytology-based cervical cancer screening workshops for pathologists with pre- and post-training evaluation using sets of digital images and a questionnaire (knowledge score). Additionally, feedback on diagnostic skills was taken at a 1-month and 6-month interval post-workshop using a separate set of digital images of cervical lesions. A Google form-based questionnaire was designed to seek the participants' feedback on the perceived improvement in knowledge and skills. All the data thus collected were analyzed to assess the efficacy of these workshops in imparting the desired knowledge and skills. A total of 350 participants were enrolled in these workshops. The average knowledge score improved from 10.56 (± 3.23) in the pre-training questionnaire to 21.17 (± 2.41) in the post-training evaluation, making a 100.5% increase (P < 0.001). Similarly, the diagnostic accuracy on digital images was enhanced from 8.6 (± 2.12) to 19.5 (± 4.28) immediately post-training and was maintained at 17.6 (± 3.87) at 1-month and 16.4 (± 4.26) at a 6-month interval (P < 0.001). The majority of the participants reported fair to a marked improvement in their knowledge, practice, and confidence in reporting cervical cytology in the response to form-based questionnaire. One-fifth of the responders also acknowledged the assistance of the knowledge gained during the workshop in refinement or initiation of cervical cytology at their set-up. Our experience of conducting these regular workshops demonstrates the utility of such training programs in human resource development in the field of cervical cytology for enhancement of cervical cancer screening in resource-constrained settings. [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]

Abstract Background In 2013, Jinan KingMed Diagnostics (JKD) first established a systematic cervical cytology training and quality control (QC) program in Shandong Province, China. We compared the efficacy of high-risk human papillomavirus (HR-HPV) detection, cytology, and their combination in routine clinical practice after the implementation of the training and QC program to identify the optimal first-line screening method in this region. Methods The data of patients histologically diagnosed with cervical intraepithelial neoplasia (CIN) 1, CIN2/3, and invasive cervical cancer (ICC) between January 2014 and December 2017 were retrieved from the JKD database. Cytology and/or HR-HPV testing results within 3 months preceding the CIN1 diagnoses and 6 months preceding the CIN2/3 and ICC diagnoses were analyzed. Results Prior screening data were available for 1829 CIN1 patients, 2309 CIN2/3 patients, and 680 ICC patients. Cytology alone and HR-HPV testing alone had similar rates of positive results for CIN2/3 (97.2% [854/879] vs. 95.4% [864/906], P = 0.105) and ICC detection (89.1% [205/230] vs. 92.7% [204/220], P = 0.185). Compared with either method alone, co-testing slightly increased the screening sensitivity for CIN2/3 (99.8% [523/524], all P

Objectives: The objectives of this study were (1) to estimate the frequency of preoperative abnormal cervical cytology (CC), (2) to explore correlations between preoperative CC and specific clinicopathological prognostic factors (tumor stage, endometrioid grade, myometrial invasion, lymphovascular space involvement, cervical involvement, and recurrence), and (3) to examine the impact of preoperative CC on disease-free survival (DFS) and overall survival (OS) in Saudi patients with endometrioid-type endometrial cancer (EC). Materials and Methods: A retrospective cross-sectional study was conducted at a tertiary hospital in Saudi Arabia. The study’s inclusion criteria included: (1) patients who underwent staging operation for EC from 2010–2014, (2) patients who had preoperative CC results within 3 months before staging operation, and (3) patients with final histopathological diagnosis of endometrioid-type EC. Results: Hundred and sixteen patients (n = 116) met the study’s inclusion criteria. CC results were abnormal in 46 patients (39.7%). Patients with abnormal CC had statistically significant higher rates of unfavorable Grades II–III tumor and cervical involvement than patients with normal CC (P = 0.004, chi-square test). There were no statistically significant differences (log-rank test) between patients with normal and abnormal CC with regard to DFS (P = 0.525) and OS (P = 0.166). Multivariate analyses of DFS and OS (Cox proportional hazards model) failed to show preoperative CC as a significant independent prognostic factor of DFS and OS (P > 0.05). Conclusion: The frequency of abnormal preoperative CC in patients with endometrioid-type EC is not uncommon. Abnormal CC correlates with poor prognostic factors, namely high tumor grade and cervical involvement. Preoperative CC is not a significant independent prognostic factor of survival.

Objectives: This study aimed to evaluate the correlation between uterine cervical squamous cell abnormalities by conventional cytology and corresponding histopathology, and to assess the accuracy between them. Methods: A total of 192 cytological smears of patients with squamous cell abnormalities who underwent colposcopy examination from April – December 2015 were included in this study. The final agreement between cytology and histopathology was defined by the evaluation of histology as a golden standard. Results: The agreement between cytology and histopathology evaluation was 65.6%, and the discrepancy was 33.6% (k=0.512). When the classes of cytology were evaluated for accuracy, it was discovered that NILM* had a higher sensitivity of 77.0%, a specificity of 87.0%, a false positive of 23% and a false negative of 13.0% (k=0.711). Among the LSIL cases a sensitivity was discovered of 39.0%, a specificity of 82.7%, a false positive of 61.0% and a false negative of 17.3% (k=0.392. However, in HSIL sensitivity dropped to 37.8%, specificity increased to 91.6%, false positive were 62.0% and false negative were 8.4% (k=0.501). Conclusion: The agreement for diagnosis of uterine cervical cytology and histopathology was 65.6% (n = 126) and the discrepancy was 33.6% (n = 64) (p = 0.001). The correlation between cervical cytology and histopathology remained moderate (kappa=0.512). Thus, it is proposed that an appropriate quality control system for the cytopathological confirmation may contribute to the further detection and treatment for uterine cervical cancer in Mongolia.

Abstract 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.

Background: Cervical cancer is a major public health concern, especially among women in developing countries like India. The human papillomavirus (HPV) is a widely recognized etiological factor for cervical carcinogenesis. There is an increased risk of the development of cervical cancer among certain groups of women, particularly the sex workers due to high HPV exposure. Objectives: This study was conducted to analyze the spectrum of epithelial cell abnormalities and the cytomorphology in the cervical smears of the high-risk groups of women in the North Malabar region of Kerala, India. Materials and Methods: This retrospective study was conducted at the Malabar Cancer Center, in Thalassery, India, between December 2011 and December 2015. Women who attended the Early Cancer Detection Camps organized for high-risk groups were included in the study. Pap smears were collected from all the women to study the spectrum of changes in their cervical smears to determine a possible correlation between high-risk behaviors and the occurrence of precancerous lesions. Descriptive statistics were used to describe the qualitative variables and Chi-square test was used to determine the association between the abnormalities and demographic variables. A P < 0.05 was considered statistically significant. Results: Out of 289 women enrolled in the study, 277 had satisfactory smears. The median age of the women was 40 years (range, 20–69 years), with majority (44%) in the age group of 30–39 years. Epithelial abnormalities were reported in 53 (19.1%) women. Nonspecific inflammation was observed in 56.6% of the women who were negative for intraepithelial lesion/malignancy (NILM), Candidiasis was seen in 13 (4.7%) women and bacterial vaginosis in 8 (2.9%). Younger women had a significantly higher number of epithelial abnormalities than older (P = 0.01). The highest prevalence of intraepithelial lesions was observed in women in the childbearing age group. Conclusions: The high frequency of epithelial abnormalities emphasizes the need for cervical cancer awareness and prevention campaigns. Periodic cervical smear examination for these vulnerable groups could be a feasible option for the early detection of cervical cancer. The Pap smear test is a rapid, noninvasive, simple, low-cost, and effective diagnostic method for the early detection of cervical cancer in high-risk groups.

Background: Precancerous lesions, conditions associated with exposure to human papillomavirus (HPV), threaten women's health at different stages of life, from adolescence to old age. It has been observed that a low-cost strategy, such as visual inspection with acetic acid (VIA), reveals cervical lesions, while establishing interventions that allow modifying the course of the disease, thus improving women's quality of life., Objective: To determine the validity of VIA in comparison with cervical cytology for the detection of precancerous lesions., Material and Methods: Descriptive, observational, cross-sectional, prospective, analytical study. The type of sampling was non-probabilistic. The sample consisted of 638 participants. Data were collected with a data collection form and analyzed quantitatively with the SPSS software. The study complied with the provisions of the General Health Law on Research in Mexico and was approved by the local research committee of the Mexican Institute for Social Security (IMSS, according to its initials in Spanish)., Results: VIA compared with cervical cytology showed a sensitivity of 75%, a specificity of 98%, a positive predictive value of 47%, a negative predictive value of 99%, a positive post-test probability of 97%, and a concordance of 61%., Conclusion: VIA showed an acceptable sensitivity and can be used as a screening test in conjunction with cytology., (Licencia CC 4.0 (BY-NC-ND) © 2024 Revista Médica del Instituto Mexicano del Seguro Social.)

Background: Persistent human papillomavirus (HPV) infection remains a key risk factor for cervical cancer. HPV-based primary screening is widely recommended in clinical guidelines, and further longitudinal studies are needed to optimize strategies for detecting high-grade cervical lesions compared to cytology., Methods: From November 2015 to December 2023, 31,942 participants were included in the real-world observational study. Among those, 4,219 participants underwent at least two rounds of HPV tests, and 397 completed three rounds of HPV tests. All participants were tested for high-risk types of HPV 16/18/31/33/35/39/45/51/52/56/58/59/66/68 (hrHPV) and low-risk types of HPV6/11 genotyping. Some participants also received cytology or colposcopy with pathology., Results: In the cross-sectional cohort, the prevalence of hrHPV and all HPV subtypes was 6.6% (2,108/31,942) and 6.8% (2,177/31,942), respectively. The three top hrHPV genotypes were HPV52 (1.9%), HPV58 (0.9%), and HPV16 (0.9%). Age distributions showed two peaks at 45-49 and 60-65 years. For the primary screening cohort, the hrHPV prevalence rate increased from 4.8% in 2015-2017 to 7.0% in 2020-2020 and finally reached 7.2% in 2023. For the longitudinal cohort study, the hrHPV prevalence rates in the repeated population (3.9, 5.3, and 6.0%) were lower than the primary hrHPV screening rates (6.6%), which indicated that repeated screening might decrease the prevalence rate. Methodologically, the hrHPV (89.5%) and the screening group of 16 subtypes (92.3%) demonstrated superior sensitivity than the cytology group (54.4%). Moreover, the longitudinal study indicated that the persistent hrHPV subgroup had a significantly higher ( p  = 0.04) incidence of high-grade squamous intraepithelial lesions and more histology progression events (7/17 vs. 0/5) than the reinfection group., Conclusion: The study indicates a rising high-risk HPV prevalence in Dongguan, with repeated screening reducing this trend. The findings support HPV-based primary screening and might guide HPV vaccination and cervical cancer prevention in South China., Competing Interests: Author BC was employed by company BGI Genomics. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Zhong, Pan, Chen, Gu, Liang, Sun, Huang, Yuan, Guo, Zhong, Li, Zhou, Zeng and Tang.)

Human papillomavirus (HPV) is the most common sexually transmitted pathogen that causes anogenital disease. Cervical screening by cytology and HPV testing (co-testing) are important in prevention of cervical cancer. The Bethesda System category of atypical squamous cells (ASC) is used when a neoplastic process cannot be confidently identified. In such cases, the differential diagnosis is broad and includes benign conditions. Monitoring of ASC/SIL ratio is a commonly used laboratory quality assurance measure to prevent over- or under-use of this category. High risk human papillomavirus (hr-HPV) has been used in conjunction with the ASC/SIL ratio in determining whether a particular pathologist is over/under-using the indefinite category. However, the laboratory overall sample population prevalence rate of hr-HPV subtypes has not been previously examined for association with the ASC rate. In this study, the relationships between ASC/SIL ratio and hr-HPV prevalence rate and hr-HPV subtypes (16/18 and non-16/18) to the laboratory ASC prevalence were studied. The results demonstrate that HPV non-16/18 is the main subtype which is associated with ASC-US category. A large proportion of non-16/18 HPV-related cases are seen in young patients, which largely abates by the by fourth decade. In addition, there are differences in the ASC/SIL ratio for HPV 16/18 and non-16/18 types. The overall ASC/SIL ratio is an average of the ASC/SIL rate for the non-16/18 population and the HPV 16/18 population. Instead of basing the laboratory and practitioners' quality indicator solely on ASC/SIL ratio, the overall prevalence of HPV and its subtype ratio should also be reported as they are more reflective of laboratory performance., (© 2024 Wiley Periodicals LLC.)

Objectives: To compare the effect of oral estradiol (E2) plus vaginal progesterone (P4) against placebo on endometrial thickness, endometrial biopsy pathology, cervical cytology and total cancer incidence among healthy postmenopausal women.Study Design: This study is a sub-analysis of the Early versus Late Intervention Trial with Estradiol (ELITE), a randomized, double-blinded, placebo-controlled trial that previously demonstrated that hormone therapy (HT) was associated with less progression of subclinical atherosclerosis than placebo when therapy was initiated within 6 years after menopause but not when it was initiated 10 or more years after menopause. This sub-analysis included only ELITE participants with an intact uterus, who were randomized to either daily oral micronized 17-beta-E2 1 mg/day with 4% vaginal micronized P4 gel 45 mg/day for 10 days each month or placebo.Main Outcome Measures: Participants were evaluated at baseline and annually during a median follow-up of 4.8 years for endometrial thickness as determined by pelvic transvaginal ultrasound followed by an endometrial biopsy when indicated, and cervical cytology and cancer incidence.Results: Over up to 80 months of follow-up, participants randomized to oral E2 plus vaginal P4 had progressive and statistically significant increases in endometrial thickness (p<0.001), underwent more endometrial biopsies and had a higher rate of endometrial hyperplasia on endometrial biopsy compared with the placebo group. Due to the close follow-up of participants in the trial protocol, these abnormal findings were effectively treated.Conclusion: Our results suggest that 10 days of vaginal P4 45 mg/day is insufficient to completely oppose the effect of oral E2 1 mg/day on the endometrium. Further studies are needed to test alternative doses or frequencies of administration of vaginal P4 for adequate endometrial protection from E2 therapy among postmenopausal women. ClinicalTrials.gov registration NCT00114517. [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]

Purpose: This study aims to validate the value of microRNA (miRNA) detection for triaging human papillomavirus (HPV)-positive women in the general population. Patients and Methods: miR-375 detection in cervical exfoliated cells has been demonstrated to have the superior value to cytology in triaging primary HPV-positive women in the hospital population. In this study, residual samples of cervical exfoliated cells from 10,951 women in a general population were used to detect miRNA. The performance efficiency of miRNA detection in identifying high-grade cervical intraepithelial neoplasia (CIN) was evaluated. Pearson chi-square test and McNemar pairing test were used to compare miRNA detection and cytology. Results: In valid 9,972 women aged 25–65, miR-375 expression showed a downward trend along with an increase in cervical lesion severity. The expression level of miR-375 ≤1.0 × 10-3 was identified as positive. In the HPV-positive and 12 HPV genotypes other than 16/18 (HR12)-positive women, miR-375 detection showed equivalent sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) to that of cytology (≥ASC-US) and higher or similar sensitivity and NPV but lower specificity and PPV than that of cytology (≥ASC-H) in identifying CIN3+ and CIN2+. In HPV 16-positive women, miR-375 positivity had higher sensitivity and NPV but lower specificity and PPV than that of cytology (≥ASC-H and HSIL) in identifying CIN3+ and CIN2+. The immediate CIN3+ risk of miR-375 positivity was 19.8% (61/308) in HPV-positive, 10.8% (22/204) in HR12-positive, and 43.5% (37/85) in HPV16-positive women, respectively. Conclusion: The detection of miR-375 in cervical exfoliated cells may be an optional method for triaging primary HPV-positive women in population-based cervical cancer screening. [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]

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The present study attempted to analyse human papillomavirus (HPV) genotype distribution and its association with cervical cytology results in women in western China. The present retrospective analysis was performed in 1089 female outpatients with a positive HPV test result who had undergone a cervical cytology test at the gynaecological clinic, West China Second Hospital, Sichuan University, China, between January 2014 and December 2016. Of the 1089 patients with HPV infection, multiple HPV genotypes were detected in 220 patients (20.20%). Among the 1368 HPV genotypes detected, 1145 (83.70%) were high-risk subtypes. The most common genotypes were HPV-52 (18.64%), HPV-16 (16.59%), HPV-58 (13.23%), HPV-18 (6.80%), HPV-56 (5.56%) and HPV-59 (5.56%). Cervical cytology revealed abnormal cells in 430 (39.49%) patients. The most common diagnoses were atypical squamous cells of undetermined significance (ASC-US; 236 cases, 54.88%), low-grade squamous intraepithelial lesions (LSIL; 151 cases, 35.12%), high-grade squamous intraepithelial lesions (HSIL; 63 cases, 14.65%) and atypical glandular cells (AGC; 21 cases, 4.88%). HPV-66 was significantly associated (P = 0.037) with ASC; HPV-52 and HPV-56 were significantly associated with LSIL (P = 0.009 and 0.026, respectively); HPV-16 (P < 0.001), HPV-33 (P = 0.014) and HPV-58 (P = 0.003) were significantly associated with HSIL; and HPV-16 (P = 0.005) was significantly associated with AGC. HPV-16, HPV-52 and HPV-58 are associated with different diagnoses in patients with positive cervical cytological findings. [ABSTRACT FROM AUTHOR]

PurposeThis study aims to validate the value of microRNA (miRNA) detection for triaging human papillomavirus (HPV)-positive women in the general population.Patients and MethodsmiR-375 detection in cervical exfoliated cells has been demonstrated to have the superior value to cytology in triaging primary HPV-positive women in the hospital population. In this study, residual samples of cervical exfoliated cells from 10,951 women in a general population were used to detect miRNA. The performance efficiency of miRNA detection in identifying high-grade cervical intraepithelial neoplasia (CIN) was evaluated. Pearson chi-square test and McNemar pairing test were used to compare miRNA detection and cytology.ResultsIn valid 9,972 women aged 25–65, miR-375 expression showed a downward trend along with an increase in cervical lesion severity. The expression level of miR-375 ≤1.0 × 10-3 was identified as positive. In the HPV-positive and 12 HPV genotypes other than 16/18 (HR12)-positive women, miR-375 detection showed equivalent sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) to that of cytology (≥ASC-US) and higher or similar sensitivity and NPV but lower specificity and PPV than that of cytology (≥ASC-H) in identifying CIN3+ and CIN2+. In HPV 16-positive women, miR-375 positivity had higher sensitivity and NPV but lower specificity and PPV than that of cytology (≥ASC-H and HSIL) in identifying CIN3+ and CIN2+. The immediate CIN3+ risk of miR-375 positivity was 19.8% (61/308) in HPV-positive, 10.8% (22/204) in HR12-positive, and 43.5% (37/85) in HPV16-positive women, respectively.ConclusionThe detection of miR-375 in cervical exfoliated cells may be an optional method for triaging primary HPV-positive women in population-based cervical cancer screening.

Cervical cancer is one of the most common cancers that threaten women’s lives, and its early screening is of great significance for the prevention and treatment of cervical diseases. Pathologically, the accurate segmentation of cervical cells plays a crucial role in the diagnosis of cervical cancer. However, the frequent presence of adherent or overlapping cervical cells in Pap smear images makes separating them individually a difficult task. Currently, there are few studies on the segmentation of adherent cervical cells, and the existing methods commonly suffer from low segmentation accuracy and complex design processes. To address the above problems, we propose a novel star-convex polygon-based convolutional neural network with an encoder-decoder structure, called SPCNet. The model accomplishes the segmentation of adherent cells relying on three steps: automatic feature extraction, star-convex polygon detection, and non-maximal suppression (NMS). Concretely, a new residual-based attentional embedding (RAE) block is suggested for image feature extraction. It fuses the deep features from the attention-based convolutional layers with the shallow features from the original image through the residual connection, enhancing the network’s ability to extract the abundant image features. And then, a polygon-based adaptive NMS (PA-NMS) algorithm is adopted to screen the generated polygon proposals and further achieve the accurate detection of adherent cells, thus allowing the network to completely segment the cell instances in Pap smear images. Finally, the effectiveness of our method is evaluated on three independent datasets. Extensive experimental results demonstrate that the method obtains superior segmentation performance compared to other well-established algorithms.

Objective: Cervical cancer screening by primary human papilloma virus detection and cytology is fraught with low specificity and variable sensitivity, respectively. Cytology‐histology correlation remains modest. Biomarkers associated with early genetic events in cervical squamous carcinogenesis and detectable in cytology material are likely to be relevant. Human telomerase RNA component (hTERC) gene overexpression and aneuploidy are promising candidates in view of their reported early and consistent association with cervical squamous oncogenesis. Methods: We analysed hTERC gene expression and chromosome 7 ploidy by fluorescent in‐situ hybridisation (FISH) in 50 women with cytological precursor squamous intraepithelial lesions and available histology outcomes. Results were expressed as percentages of cells showing ≥3 signals, mean signals/nucleus, and maximum amplitude across various cytology and histology categories. Proportions of positive cases were calculated from threshold values derived from 6 controls. Distribution of above indices with respect to ≥cervical intraepithelial neoplasia 2 (CIN2) was explored. Results: For both genetic aberrations, there was significant positive correlation (for all indices) between the proportion of positive cases and worsening cytological and histological outcomes (P <.05), with significant intergroup differences (P <.05). High‐grade lesions (≥CIN2) had significantly higher results compared to

BACKGROUND: Cervical cytology screening is usually laborious with a heavy workload and poor diagnostic consistency. The authors have developed an artificial intelligence (AI) microscope that can provide onsite diagnostic assistance for cervical cytology screening in real time. METHODS: A total of 2167 cervical cytology slides were selected from a cohort of 10,601 cases from Shenzhen Maternity and Child Healthcare Hospital, and the training data set consisted of 42,073 abnormal cervical epithelial cells. The recognition results of an AI technique were presented in a microscope eyepiece by an augmented reality technique. Potentially abnormal cells were highlighted with binary classification results in a 10× field of view (FOV) and with multiclassification results according to the Bethesda system in 20× and 40× FOVs. In addition, 486 slides were selected for the reader study to evaluate the performance of the AI microscope. RESULTS: In the reader study, which compared manual reading with AI assistance, the sensitivities for the detection of low‐grade squamous intraepithelial lesions and high‐grade squamous intraepithelial lesions were significantly improved from 0.837 to 0.923 (P <.001) and from 0.830 to 0.917 (P <.01), respectively; the κ score for atypical squamous cells of undetermined significance (ASCUS) was improved from 0.581 to 0.637; the averaged pairwise κ of consistency for multiclassification was improved from 0.649 to 0.706; the averaged pairwise κ of consistency for binary classification was improved from 0.720 to 0.798; and the averaged pairwise κ of ASCUS was improved from 0.557 to 0.639. CONCLUSIONS: The results of this study show that an AI microscope can provide real‐time assistance for cervical cytology screening and improve the efficiency and accuracy of cervical cytology diagnosis. In this study, an artificial intelligence microscope has been developed that can provide real‐time assistance for cervical cytology screening. This artificial intelligence microscope can improve the efficiency and accuracy of cervical cytology diagnosis. [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]

Objectives: To identify less readily identifiable patterns of high-grade squamous intraepithelial lesions (HSIL) in negative human papillomavirus (HPV)-positive Papanicolaou (Pap) tests on ThinPrep preparations.Methods: Of all HPV-positive Pap tests that were negative for intraepithelial lesion or malignancy (NILM) from July 2013 to June 2018, those with HSIL on subsequent histology within 6 months were identified. ThinPrep slides from the latter group (group 1) and from NILM HPV-negative Pap tests with negative follow-up (group 2) were reviewed independently by 4 participants. Group 1 cases were then reviewed together for consensus and with the ThinPrep Imaging System (TIS). Any discrepancies from the original interpretation were recorded.Results: The study cohort included 57 cases each in groups 1 and 2. On final review of group 1 cases, 17 (29.8%) were classified as NILM or unsatisfactory. Of the remaining, 4 cases revealed rare abnormal cells not flagged by the TIS in the fields of view. In the 36 cases (63.1%) with screening or interpretative errors, the key cytologic findings accounting for major discrepancies included atypical metaplastic cells, atypical repair, rare syncytial groups, and atypical immature metaplastic cells.Conclusions: There are 3 main underrecognized patterns of HSIL in cervical cytology: atypical metaplastic cells, atypical repair, and rare syncytial groups. [ABSTRACT FROM AUTHOR]

Cervical cancer is the fourth most common cancer in women in the world. To eliminate cervical cancer by 2030, the World Health Organization has given the target of 70 per cent coverage of twice lifetime screening. A multitude of screening methods are available, including cytology, human papillomavirus (HPV) DNA testing and visual inspection tests. Precision tests, including molecular and protein biomarkers such as DNA methylation, p16 immunostaining, and HPV mRNA testing help to enhance specificity of the screening. Worldwide HPV DNA testing with or without cytology is used as a screening method of choice, while in resource-poor settings, visual inspection tests are recommended. The major hurdle is a uniform and systematic implementation with a recall method in the population. Besides, controversies still exist regarding strategies to manage HPV-positive women and developing guidelines to screen the vaccinated population. [ABSTRACT FROM AUTHOR]

For every 100,000 women in the United States, eight new cervical cancer cases and two deaths are reported as per the most recent (2017) Center of Disease Control and Prevention statistics. Of all the gynecologic cancers (ovary, uterus, cervix, vagina, and vulva), only cervical cancer has a screening test. Cervical Pap test (or Pap smear) is the best screening method for cervical precancerous lesions and is best reported using a unified and a well-established reporting system like Bethesda System. In this system, "Epithelial cell abnormality: Squamous" includes squamous intraepithelial lesion (SIL) category which encompasses a spectrum of squamous cell lesions starting from the precancerous lesions of low-grade SIL (LSIL) to high-grade SIL (HSIL), and ultimately invasive squamous cell carcinoma. However, depending on the qualitative and quantitative limitations with the specimen, some equivocal morphological features suggestive of squamous cell abnormality may fall under equivocal category: "Atypical Squamous Cells" (ASCs), which are subdivided into two categories; "Atypical Squamous Cells of Undetermined Significance" (ASC-US) or "Atypical Squamous Cells, HSIL cannot be excluded" (ASC-H), based on the suspected underlying lesion LSIL versus HSIL, respectively. This review provides the key cytologic features that distinguish Bethesda squamous categories from other important entities, using algorithmic approach and illustrations of common cytomorphologic patterns for clear identification of those entities in practice. The important mimickers which may be considered during the differential interpretation of SIL are discussed and presented here in a brief cytomorphologic review. [ABSTRACT FROM AUTHOR]

Background: Cervical cancer is the leading cause of death among women in developing countries. It is preventable through effective cervical cancer screening program. However, in Nigeria, screening programs are opportunistic and coverage is insufficient to make an impact. Aim: This study assessed the cervical cytopathological changes among pregnant women at booking using liquid-based cytology (LBC) in Aminu Kano Teaching Hospital (AKTH). Methodology: This was a cross-sectional study that was carried out at the antenatal Clinic of AKTH, Kano, Nigeria. A total of 161 pregnant women who fulfilled the criteria and gave their consent were recruited into the study using systematic sampling technique at booking for antenatal care. LBC was employed using standard procedure and samples sent to histopathology department for analysis. Pro forma developed for the study was used to obtain the socio-demographic and reproductive characteristics of the women and the risk factors for abnormal cervical cytology. Results: Out of the 161 pregnant women that had cervical cytology screening using LBC on their first prenatal visit during the study, 22 had abnormal cervical cytology, giving a prevalence rate of 13.7%. Out of this, six (27.3%) were atypical squamous cells of undetermined significance, 3 (13.6%) were Atypical Squamous Cells, Cannot Rule Out HSIL (ASC-H), 11 (50.0%) were low-grade Squamous Intraepithelial Lesions while 2 (9.1%) were high grade squamous intraepithelial lesions. Negative smears were seen in 104 women (64.6%). Inflammatory and other conditions of the cervix which are technically negative smears made up the remaining 21.7%. There was a statistically significant association between cervical cytology results and advanced age (P < 0.01), increasing number of lifetime sexual partners since coitarche (P < 0.01), high parity (P < 0.01), absent previous Pap test (P < 0.027), previous history of sexually transmitted infections (P < 0.040), and positive HIV status (P < 0.001). Following binary logistic regression, advanced maternal age, increasing number of sexual partners, high parity, and positive HIV status stood out to be independent predictors of premalignant lesions of the cervix in pregnancy in this study. Conclusion: Advanced maternal age, increasing number of sexual partners, high parity, and positive HIV status stood out to be independent predictors of premalignant lesions of the cervix in the study. Routine cervical cytology screening using LBC should be offered to all antenatal clients in our setting to increase coverage and detection rate of preinvasive lesions of the cervix, and/or pregnant women with increased risk of abnormal cervical cytology from this study. [ABSTRACT FROM AUTHOR]

We investigated the prevalence and carcinogenic risks of individual high-risk human papillomavirus (HR-HPV) in all types of cervical cytology specimens in the Shanghai population. A total of 124,251 cases with cotesting of cytology and HPV genotyping between October 2017 and February 2020 were included. The overall HPV positive rate was 24.3%, with 22.9% for HR-HPV and 6.1% for low-risk HPV. The top five most common HR-HPV subtypes were HPV 52/16/58/53/39 in the entire studied population, and HPV 16/53/56/51/39 in women with abnormal cytology. The most prevalent subtypes in negative/LSIL, HSIL, and glandular lesions were HPV 52, 16, and 18, respectively. HPV 16, 33, 26, 18, 58, and 82 were the most common subtypes significantly associated with an increased risk for HSIL + cytology. HPV 16/18 were present in 53.6% and 66.7%, and HPV 16/18/31/33/45/52/58 were identified in 90.3% and 80.1% of HSIL and squamous cell carcinoma cytology, respectively. HPV 16/18 and HPV 16/18/31/33/45/52/58 were detected in 37.0% and 44.4% of women with cytologic interpretation of in situ and invasive adenocarcinoma. This large-scale study identified the most common HPV subtypes in each cytology category, and the carcinogenic risks of individual HR-HPV in the studied Shanghai population. The results would provide valuable information for the development of next-generation HPV vaccines and cervical cancer screening programs for the Chinese population, and, more specifically, the Shanghai metropolitan population. • This is largest data about all categories of Papanicolaou cytology with HPV genotyping. • HPV positive rate is 24.3% (HR-HPV: 22.9%, LR-HPV: 6.1%). • Top five most common HR-HPVs were HPV 52/16/58/53/39. • HR-HPV types varied with different Papanicolaou cytology. [ABSTRACT FROM AUTHOR]

Hui-xia Yang, Yu Zhong, Wei-hua Lv, Hong YuLabor Model Health Management Center, Beijing Rehabilitation Hospital, Capital Medical University, Beijing, People’s Republic of ChinaCorrespondence: Hong YuLabor Model Health Management Center, Beijing Rehabilitation Hospital, Capital Medical University, Xixiazhuang, Badachu, Shijingshan District, Beijing 100144, People’s Republic of ChinaTel +86 105 698 1131Fax +86 105 698 1131Email y_hong@aliyun.comBackground: In 2018, the Beijing Federation of Trade Unions organized a cervical cancer screening program for female employees for the first time. This study aimed to investigate the screening results of this program and determine the factors associated with human papillomavirus (HPV) infection.Methods: A total of 8297 female employees participating in the screening program between January 1, 2018, and December 31, 2018, were enrolled in this study. The methods for screening cervical cancer included ThinPrep cytology test (TCT) and HPV genotyping test. Single-factor analysis and multiple binary logistic regression analysis were used to identify the factors associated with HPV infection.Results: Of the 8297 women (median age: 43.00 years), TCT was found to be abnormal in 116 patients (1.40%) and 1169 (14.09%) were positive for HPV genotyping test. Notably, HPV-52 was the most prevalent subtype (3.05%), followed by HPV-16 (2.82%), HPV-58 (2.01%), HPV-51 (1.58%) and HPV-56 (1.49%). Multivariate logistic regression analysis revealed that taxi drivers (OR =1.98; 95% CI =1.31–2.99) and single women with a history of sexual activity (OR =2.32; 95% CI =1.41–3.82) were significantly associated with an increased risk of HPV infection (P

Abstract Background Human papillomavirus is recognized as a major cause of cervical cancer. It is estimated that annually, 7,095 women are diagnosed with cervical cancer and 4,732 die from the disease in Ethiopia. Understanding that the screening practice is very poor and the coverage is very limited, this disease burden is one of the major public health agendas in Ethiopia. This study aimed to assess the burden and genotype distribution of high-risk human papillomavirus (HR HPV) infection and cervical cytology abnormalities at selected obstetrics and gynecology clinics of Addis Ababa, Ethiopia. Methods An institutional-based cross-sectional study design was employed from June to October 2015. Cervical samples were collected from 366 participants based on inclusion criteria. HR HPV DNA was analyzed using an Abbott Real-Time PCR system, and cervical cytology screening was performed using the conventional Pap-smear technique. Data were entered in to Epi-data version 13 and analyzed using STATA version 11. Results The overall HR HPV burden and abnormal cytology were 13.7 and 13.1%, respectively. The majority of HR HPV types were other than types 16 and 18. Of the total abnormal cytology results, 81.3% were low-grade squamous intraepithelial lesions (LSILs), and 12.5 and 6.3% were atypical squamous cells of undetermined significance (ASCUS) and high-grade squamous intraepithelial lesions (HSILs), respectively. Residence, occupation, and HIV serostatus were significantly associated with HR HPV infection. Among the variables, age, age at first marriage, and education were the only ones associated with cervical cytology abnormalities. The overall agreement between the real-time PCR and Pap cytology screening methods was 78.96% (Kappa value of 0.12, 95% CI (0.00–0.243), P = 0.01). Conclusions Non-16/18 HR HPV genotypes represented the largest proportion of HR HPV infections in this study. Women without cervical cytology abnormalities had the highest frequency of HR HPV infection. A large-scale community-based cohort study shall be designed and implemented to further identifying the persistent genotype and assessing the changes in cervical epithelial cell lines.

All types of cytological procedures bear a burden of unequivocal reports and confusion with setting a proper clinical procedure. In 1989, The Bethesda System (TBS) was introduced to resolve many concerns in the matter of unclear classification of changes in cervical cytology. The guidelines of TBS were based on the clinical data provided, the quality of the smear assessment, unification of terminology, and updated knowledge about changes underlying cell abnormalities. It is believed that both TBS and thyroid TBS inspired the members of the Papanicolaou Society of Cytology to design and publish a modern approach to pancreatic lesion description. The presented proposal created a strong foundation for clinical management and revealed a serious risk of underdiagnosis. In light of the short time since the launch of this guide, more time is needed to estimate its impact, especially since only a few clinical centres have implemented it to this day.

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.

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.

Cervical cancer is the fourth leading cause of cancer-related deaths in women, especially in low to middle-income countries. Despite the outburst of recent scientific advances, there is no totally effective treatment, especially when diagnosed in an advanced stage. Screening tests, such as cytology or colposcopy, have been responsible for a substantial decrease in cervical cancer deaths. Cervical cancer automatic screening via Pap smear is a highly valuable cell imaging-based detection tool, where cells must be classified as being within one of a multitude of ordinal classes, ranging from abnormal to normal. Current approaches to ordinal inference for neural networks are found to not sufficiently take advantage of the ordinal problem or to be too uncompromising. A non-parametric ordinal loss for neuronal networks is proposed that promotes the output probabilities to follow a unimodal distribution. This is done by imposing a set of different constraints over all pairs of consecutive labels which allows for a more flexible decision boundary relative to approaches from the literature. Our proposed loss is contrasted against other methods from the literature by using a plethora of deep architectures. A first conclusion is the benefit of using non-parametric ordinal losses against parametric losses in cervical cancer risk prediction. Additionally, the proposed loss is found to be the top-performer in several cases. The best performing model scores an accuracy of 75.6% for seven classes and 81.3% for four classes.

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]

Cervical intraepithelial neoplasia (CIN) and cervical cancer are major health problems faced by women worldwide. The conventional Papanicolaou (Pap) smear analysis is an effective method to diagnose cervical pre-malignant and malignant conditions by analyzing swab images. Various computer vision techniques can be explored to identify potential precancerous and cancerous lesions by analyzing the Pap smear image. The majority of existing work cover binary classification approaches using various classifiers and Convolution Neural Networks. However, they suffer from inherent challenges for minute feature extraction and precise classification. We propose a novel methodology to carry out the multiclass classification of cervical cells from Whole Slide Images (WSI) with optimum feature extraction. The actualization of Conv Net with Transfer Learning technique substantiates meaningful Metamorphic Diagnosis of neoplastic and pre-neoplastic lesions. As the Progressive Resizing technique (an advanced method for training ConvNet) incorporates prior knowledge of the feature hierarchy and can reuse old computations while learning new ones, the model can carry forward the extracted morphological cell features to subsequent Neural Network layers iteratively for elusive learning. The Progressive Resizing technique superimposition in consultation with the Transfer Learning technique while training the Conv Net models has shown a substantial performance increase. The proposed binary and multiclass classification methodology succored in achieving benchmark scores on the Herlev Dataset. We achieved singular multiclass classification scores for WSI images of the SIPaKMed dataset, that is, accuracy (99.70%), precision (99.70%), recall (99.72%), F-Beta (99.63%), and Kappa scores (99.31%), which supersede the scores obtained through principal methodologies. GradCam based feature interpretation extends enhanced assimilation of the generated results, highlighting the pre-malignant and malignant lesions by visual localization in the images.

Background: Human papillomavirus (HPV) genotype testing has limited utility to identify human immunodeficiency virus‐infected (HIV+) women's risk for developing cervical cancer (CC) due to high positivity rate of high‐risk (HR) HPVs. We investigated the accuracy of HPV testing in isolation/in combination with CD4 and HIV viral load (VL) to identify HIV+ women at risk for developing CC. Methods: Study consisted of 344 HIV+ women on combination antiretroviral therapy (cART), tested for cervical cytology/HPV using the Cobas test and had data on absolute CD4 count and VL measurements. We calculated the positive predictive value (PPV) and negative predictive value (NPV) of HPV testing, pre‐, post‐cART, and current CD4 and VL in isolation and in combinations to identify those with or free of higher than atypical squamous cells of unknown significance (ASCUS+) or low‐grade intraepithelial lesions (LSIL+). Results: HPV test in combination with pre‐/post‐cART or current CD4 counts and VL had higher PPVs compared to HPV test alone for identifying ASCUS+ or LSIL+. PPV of HPV‐CD4 combinations yielded higher PPVs compared to HPV‐VL combinations. The NPVs with pre‐, post‐cART, or current CD4 count and VL in isolation or in combinations were comparable to that of HPV test alone. Conclusions: Our results provide a more accurate tool for managing HIV+ women by combining Cobas HPV with CD4 and VL, especially those who had an undesirable pre‐cART CD4 and VL status. Our results also indicate the usefulness of CD4 and VL measurements to identify those at lower risk in the absence of HPV testing. [ABSTRACT FROM AUTHOR]

Cervical cytology has remained a diagnostically challenging area despite its long and widespread use. At least part of this challenge has stemmed from the cytomorphologic overlap between benign and neoplastic processes. The present review has highlighted select benign processes that present diagnostic pitfalls. For each of these, we have discussed the pertinent cytologic features and emphasized the morphologic clues that will aid in distinguishing the benign entities from the neoplastic processes they mimic. • Cervical cytology is a particularly challenging area of cytology given the overlap between benign and neoplastic processes. • Select benign/reactive processes are herein described with their corresponding mimics. • Emphasized are the cytomorphologic features, diagnostic pitfalls, and approaches to handling these challenging cases with illustrative examples of each. [ABSTRACT FROM AUTHOR]

The Polish Society of Colposcopy and Cervical Pathophysiology (PTKiPSM) together with the Polish Society of Gynecologists and Obstetricians (PTGiP) issued a final summary of interim guidelines for secondary cervical cancer prevention during the SARS-CoV-2 pandemic based on the analysis of the latest directional publications and the authors' own experiences. The aim of the summary is to facilitate the implementation of the most effective possible screening of cervical precancerous lesions and cervical cancer due to temporary significant limitation of screening as a consequence of the ongoing epidemiological threat. These final guidelines are taking into account the 2020 call of the World Health Organization (WHO) for global epidemiological elimination of cervical cancer. The guidelines supplement the interim guidelines of PTKiPSM and PTGiP announced in March 2020 on the possible deferral of diagnostic and therapeutic procedures in patients with abnormal screening tests results in secondary prevention of cervical cancer in current pandemic. [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]

Objective: Cervical cytology and Human papillomavirus (HPV) testing are effective screening techniques but both have limitations. A few recent studies in the literature have highlighted the role of co-expression of p16INK4a and Ki-67 for cervical cancer screening. The present study was undertaken to evaluate the diagnostic performance of the CINtec® PLUS kit (dual immunostaining for p16 and Ki-67) in SurePathTM liquid-based (LBC) cervico-vaginal samples. Materials and Methods: This was a prospective study performed on 52 cervico-vaginal SurePath? LBC samples reported as having squamous epithelial cell abnormality (ECA). All the samples were stained using CINtec® PLUS kits. Additionally, HPV-DNA testing was also done and the results were compared. Results: The age range was 34-74 years. ECA included 18 (34.6%) cases of ASC-US, 9 (17.3%) cases of low-grade squamous intraepithelial lesion (LSIL), 11 (21.2%) cases of high-grade squamous intraepithelial lesion (HSIL), and 14 (26.9%) cases of squamous cell carcinoma (SCC). Cervical biopsies were available in 19 (36.5%) cases. A total of 34/52 (65.4%) cases were positive for HPV-DNA (5/18-ASC-US; 6/9-LSIL; 10/11-HSIL; 13/14-SCC). The CINtec® PLUS test was positive in 41/52 (78.8%) cases (11/18-ASC-US; 6/9-LSIL; 11/11-HSIL; 13/14-SCC). On comparing CINtec® PLUS positivity (78.8%) with HPV positivity (65.4%), dual positivity was seen in 3/18 cases of ASC-US, 6/9 cases of LSIL, 10/11 cases of HSIL, and 12/14 cases of SCC. One case each of HSIL and SCC was negative on the HPV test and was positive on CINtec® PLUS. Conclusions: CINtec® PLUS test helps to improve the detection of pre-cancerous cervical lesions as compared to cervical cytology or HPV testing alone and hence can serve as a potentially useful diagnostic and triage tool, especially for indeterminate cases. [ABSTRACT FROM AUTHOR]

An unusual case is described of a 64‐year‐old woman with a remote history of breast cancer whose first non‐nodal metastasis was discovered on a routine Pap test. The Pap test was supported by the results of cervical and endometrial biopsies. [ABSTRACT FROM AUTHOR]