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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. [ABSTRACT FROM AUTHOR]

Introduction: Primary HPV screening will be implemented into the English Cervical Screening Programme by 2019. Its impact upon women referred to colposcopy, with negative cytology but persistently positive high‐risk HPV (hrHPV), remains unreported from UK Sentinel sites. HPV primary screening was introduced in Sheffield, UK in April 2013; this paper reports its impact on the service. Methods: A retrospective cohort study was performed from June 2014 to July 2016 at the Jessop Wing Colposcopy Unit, Sheffield. UK. Data were obtained from the pathology and colposcopy databases and cross‐referenced with case‐notes and pathology results for women referred with persistently positive hrHPV, cytology negative samples. Patient demographics, hrHPV genotype, biopsy rates, histological diagnoses, management, and outcomes were collected and baseline statistics performed. Results: During the study 1076 women were seen. Most frequent hrHPV genotypes were: hrHPV other, 41%; and HPV16, 33%. The majority (72%) were found to have normal colposcopy; 28% had an abnormal colposcopic assessment (11% low‐grade; 11% high‐grade; 6% inadequate). The majority were discharged (83%) and only 5% underwent LLETZ. No cancers were detected. High‐grade cervical intraepithelial neoplasia (CIN) was found in 7%; overall risk of CIN2 was 1/29; 1/30 for CIN3. Presence of HPV16 was associated with a significantly higher risk of high‐grade CIN; 1/9. Conclusion: This is the first study to report results for women referred to colposcopy with cytology negative, persistently positive hrHPV. Disease prevalence is low, although women with HPV16 have a significantly higher likelihood of high‐grade disease compared to other HPV subtypes. [ABSTRACT FROM AUTHOR]

Introduction: Abnormal cervical cytology in patients with endometrial cancer (EC) has been associated with poor outcome. The aim of this study was to evaluate whether cervical cytology could contribute to an improved preoperative identification of high‐grade EC (serous, clear cell, carcinosarcoma, high‐grade endometrioid EC) in final histology. Methods: A retrospective cohort study was performed in five hospitals in the Netherlands. A total of 554 patients with EC that underwent primary surgical treatment between 2002 and 2010 were included. Primary outcome was defined as the contribution of abnormal cervical cytology in the preoperative identification of high‐grade EC. As secondary outcome, recurrence‐free survival (RFS) and disease‐specific survival were determined based on preoperative cervical cytology, and compared to the currently established risk factors: myometrial invasion, high‐grade and lymph vascular space invasion. Results: Abnormal cervical cytology was present in 45.1%. For patients with preoperative inconclusive and high‐grade histology, the presence of abnormal cervical cytology contributed to an improved identification of high‐grade EC in final histology (odds ratio [OR] 6.40 [95% confidence interval {CI}: 1.92‐21.26]; OR 2.86 [95% CI: 1.14‐7.14]), respectively. Patients with abnormal cervical cytology had a significant worse 5‐year median RFS. Abnormal cervical cytology was independently related to RFS (hazard ratio 1.67 [95% CI: 1.04‐2.68]) and disease‐specific survival (hazard ratio 3.15 [95% CI: 1.74‐5.71]). Conclusions: Abnormal cytology contributes to the preoperative identification of patients with high‐grade EC, and is associated with compromised outcome. Future studies are warranted to determine whether cervical cytology could be incorporated into preoperative prediction models for lymph node metastasis. [ABSTRACT FROM AUTHOR]

Copyright of Der Pathologe is the property of Springer Nature 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.)

Objective: To determine the frequency and pattern of abnormal cervical smear findings among women attending the University of Science and Technology Hospital (USTH) in Sana'a city. Methods: This study is a retrospective, cross-sectional study. Records of women examined by conventional Pap smears in the Histopathology Laboratory of USTH over a 4-year period (from January 2013 to December 2016) were retrieved and analyzed for abnormalities according to the Bethesda system. Results: Of 688 cases, 599 with satisfactory records were analyzed. The mean age of the cases was 39.18±10.23 years (range: 19-75). Epithelial cell abnormalities (ECAs) were found in 47 cases (7.8%), and these were categorized as follows: ASCUS in 4.5% (27/599) of cases followed by atypical glandular cells (AGC) (2.2%; 13/599) and LSIL (0.5%; 3/599), while ASCH and HSIL abnormalities were equally observed among 0.3% (2/599 each) of cases. Of patients positive Pap smear findings, ASCUS was the most frequent type of ECA (57.4%; 27/47) followed by AGC (27.7%; 13/47) and LSIL (6.4%; 3/47), while ASCH and HSIL were the least frequent ECAs among Yemeni patients. ECAs were significantly more prevalent among women aged >40 years (10.8%) compared with those aged <40 years (5.5%). Conclusions: Cervical cytological abnormalities are not uncommon among women in Yemen, where the AGC is frequent among about a third of women with abnormal Pap smear findings and affects women of different ages. This requires more attention and training of doctors to master good sample taking, preparation and diagnosis with a focus on glandular changes. [ABSTRACT FROM AUTHOR]

The prevalence of obesity is increasing worldwide. The incidence of cervical cancer has decreased after implementation of cervical cancer screening, however, obese women have higher risk of cervical cancer than women of normal weight. This might be caused by a lower participation rate in cervical cancer screening. The aim of this systematic review and meta-analysis was to examine the influence of overweight and obesity on adherence to cervical cancer screening recommendations. We conducted a thorough systematic literature search of electronic databases to identify studies examining screening participation among overweight and obese women compared to women of normal weight. Based on a random effect model, we calculated pooled odds ratios (OR) of screening participation with corresponding 95% confidence intervals (CI). I2 statistic was used to describe heterogeneity. A total of 32 papers were included. The pooled OR of screening participation was 0.94 (95%CI: 0.89–0.99) for overweight women and 0.79 (95%CI: 0.68–0.92) for obese women compared to women of normal weight. The heterogeneity was substantial (overweight: I2 = 89%; obese: I2 = 93%). The OR for screening adherence was 0.91 (95%CI: 0.80–1.05), 0.85 (95%CI: 0.70–1.03) and 0.67 (95%CI: 0.54–0.84) for women in obesity class I, II and III, respectively. The OR varied by geographical region and race. In conclusion, obese women are less likely to participate in cervical cancers screening compared to women of normal weight. In addition, the likelihood of adherence to screening recommendations decreases with increasing obesity class. This stresses the need for targeted intervention to increase screening adherence for overweight and obese women. • Overweight and obese women have a lower adherence to cervical cancer screening • The likelihood of cervical cancer screening participation decreases with increasing obesity class • Studies from Europe reported lower screening uptake than studies from North America • In obesity class I and II, Black women were more likely to participate in screening than White women • There is a need for enhancing equality in cervical cancer screening [ABSTRACT FROM AUTHOR]

Introduction: Pap smear cytology enables the cytopathologist to detect and evaluate the degree of cellular alterations present in uterine cervical lesions. Cytopathological analysis of these smears has stood out amongst other tests because of its simplicity and low cost, which are essential characteristics of methods applicable to mass screening programmes. Aim: Opportunistic screening by using Pap smear examination from the uterine cervix of women attending out reach camps and outpatient department employing the Bethesda System 2014. To detect genital infections and epithelial cell abnormalities in symptomatic and asymptomatic women. Also to correlate the cytology of the lesions with histopathology, wherever available. Materials and Methods: Opportunistic screening programme has the advantage to screen women who attend outpatient department and outreach camps. The study included 3255 Pap smears of women received from the outpatient departments of AJ Institute of Medical Sciences and Research Centre, Mangalore, KMC Hospital, Mangalore and various outreach camps and private consultants of rural Mangalore, Karnataka over a period of three years. The smears were stained by Modified Papanicolaou stain and analyzed using the Bethesda system criteria (2014). Histopathological correlation was done wherever available. Results: Out of a total of 3255 pap smears, 626 (19.23%) were unsatisfactory, 2532 (77.78%) were Negative for Intraepithelial Lesion or Malignancy (NILM) and 97 (2.98%) showed epithelial cell abnormalities of which 23 (23.7%) showed malignancy. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of Pap smear cytology in the study were 80.49%, 92.23% , 67.35%, 95.96% and 90.28% respectively. Conclusion: Cervical smear cytology assists in the early detection of precancerous lesions of the cervix thereby down staging cervical neoplasias and also helps in the diagnosis of specific infections of the female genital tract.

Introduction: Pap smear is a screening procedure to detect precancerous lesions to prevent subsequent invasive cervical cancer. Manual Liquid Based Cytology (MLBC) has been developed as an alternative to Conventional Pap Smear (CPS) as it is said to increase the rate of detection of precancerous lesions as it reduces the screening time, the artifacts, giving a clean background on the smear and providing residual cellular material for molecular testing (HPV DNA). Aim: To compare the diagnostic performance of manual liquid based cytology and conventional Pap smear in cervical cancer screening. Materials and Methods: This is a prospective study, done for a period of 2 months, in 97 women with CPS and MLBC and compared with the gold standard- histopathology. The smears were stained by Rapid Pap stain and reported using Bethesda system of reporting. Results: MLBC showed a higher satisfactory rate of 88.7% and CPS 86.6%. MLBC showed clean background in 34% while CPS only in 8%. The sensitivity and specificity of CPS was 33.33% and 95.65%. The sensitivity and specificity of MLBC was 22.22% and 95.65%. The p-value was not significant (>0.05). Conclusion: MLBC was better than CPS only with respect to specimen adequacy and clean background. Since, LBC is new technique, training in sample collection, processing and analyzing the MLBC slides may improve the efficiency of this method in low resource setting.

The results of HPV detection in 550 cervical samples by cervical cytology were compared with the sequencing analysis and HPV genotyping 9G membrane test. The HPV genotyping 9G membrane test can efficiently identify and discriminate five HR-HPV genotypes. The 100% identical results of HPV genotyping 9G membrane tests with the sequencing results in 550 clinical samples ensure its wide clinical applicability. The simple handling steps and the portable scanning device make the HPV genotyping 9G membrane test applicable in point-of-care settings. Moreover, the HPV genotyping 9G membrane test allows one to obtain final results in 30 min at 25 °C by simply loading the hybridization and washing solution and scanning the membranes without any drying steps or special handling. The clinical sensitivity and specificity of the HPV genotyping 9G membrane test was found to be 100%, which is much higher than cervical cytology.

Background: Papanicolaou (Pap) stain has been used over the years for cervical cytology screening. However; it utilizes a considerable amount of alcohol which is expensive and difficult to procure. In one of the modifications, ethyl alcohol is replaced by 1% acetic acid and is termed as rapid, economical, acetic acid Papanicolaou (REAP) stain. It is cost effective, easily available and provides a suitable and rapid staining alternative. Aim: This study was undertaken to assess the efficacy of REAP stain as an alternative method to conventional Pap stain. Materials and Methods: This study was done over a period of 18 months in a tertiary care hospital. Two sets of cervical smears were prepared of which one was stained with conventional Pap stain, and other was stained with REAP stain. The smears were examined for cytomorphological parameters and were evaluated using a modification of parameters given by Ng et al. Results: A total of 737 smears were examined in duplicate. Most of the conventional Pap smears showed excellent preservation (91.6%) with very few showing optimal (7.6%) and sub-optimal staining (0.8%). In contrast to this excellent preservation was seen in just 33.6% of the REAP stained smears with majority showing optimal and sub-optimal preservation (46.5% and 20% respectively). The P value was statistically significant (

Background: The Norwegian Cervical Cancer Screening Program recommends screening every 3 years for women between 25 and 69 years of age. There is a large difference in the percentage of unsatisfactory samples between laboratories that use different brands of liquid-based cytology. We wished to examine if inadequate ThinPrep samples could be satisfactory by processing them with the SurePath protocol. Materials and Methods: A total of 187 inadequate ThinPrep specimens from the Department of Clinical Pathology at University Hospital of North Norway were sent to Akershus University Hospital for conversion to SurePath medium. Ninety-one (48.7%) were processed through the automated "gynecologic" application for cervix cytology samples, and 96 (51.3%) were processed with the "nongynecological" automatic program. Results: Out of 187 samples that had been unsatisfactory by ThinPrep, 93 (49.7%) were satisfactory after being converted to SurePath. The rate of satisfactory cytology was 36.6% and 62.5% for samples run through the "gynecology" program and "nongynecology" program, respectively. Of the 93 samples that became satisfactory after conversion from ThinPrep to SurePath, 80 (86.0%) were screened as normal while 13 samples (14.0%) were given an abnormal diagnosis, which included 5 atypical squamous cells of undetermined significance, 5 low-grade squamous intraepithelial lesion, 2 atypical glandular cells not otherwise specified, and 1 atypical squamous cells cannot exclude high-grade squamous intraepithelial lesion. A total of 2.1% (4/187) of the women got a diagnosis of cervical intraepithelial neoplasia 2 or higher at a later follow-up. Conclusions: Converting cytology samples from ThinPrep to SurePath processing can reduce the number of unsatisfactory samples. The samples should be run through the "nongynecology" program to ensure an adequate number of cells. [ABSTRACT FROM AUTHOR]

Background: The Norwegian Cervical Cancer Screening Program recommends screening every 3 years for women between 25 and 69 years of age. There is a large difference in the percentage of unsatisfactory samples between laboratories that use different brands of liquid-based cytology. We wished to examine if inadequate ThinPrep samples could be satisfactory by processing them with the SurePath protocol. Materials and Methods: A total of 187 inadequate ThinPrep specimens from the Department of Clinical Pathology at University Hospital of North Norway were sent to Akershus University Hospital for conversion to SurePath medium. Ninety-one (48.7%) were processed through the automated "gynecologic" application for cervix cytology samples, and 96 (51.3%) were processed with the "nongynecological" automatic program. Results: Out of 187 samples that had been unsatisfactory by ThinPrep, 93 (49.7%) were satisfactory after being converted to SurePath. The rate of satisfactory cytology was 36.6% and 62.5% for samples run through the "gynecology" program and "nongynecology" program, respectively. Of the 93 samples that became satisfactory after conversion from ThinPrep to SurePath, 80 (86.0%) were screened as normal while 13 samples (14.0%) were given an abnormal diagnosis, which included 5 atypical squamous cells of undetermined significance, 5 low-grade squamous intraepithelial lesion, 2 atypical glandular cells not otherwise specified, and 1 atypical squamous cells cannot exclude high-grade squamous intraepithelial lesion. A total of 2.1% (4/187) of the women got a diagnosis of cervical intraepithelial neoplasia 2 or higher at a later follow-up. Conclusions: Converting cytology samples from ThinPrep to SurePath processing can reduce the number of unsatisfactory samples. The samples should be run through the "nongynecology" program to ensure an adequate number of cells. [ABSTRACT FROM AUTHOR]

Introduction: Gynecologists have been increasingly frequently switching from vaginal biocoenosis assessment towards cervical cytology results to obtain information on infection type. Exfoliative cervical cytology is a screening test for dysplastic intraepithelial lesions and ectocervical cancers. One should emphasize, however, that one of the four parts of the new Bethesda classification specifies such inflammatory lesions as: Trichomonas vaginalis, Candida, Actinomyces, Chlamydia, cellular changes consistent with HSV infection, and changes in bacterial flora. Gynecologists, however, can perform vaginal biocoenosis assessment individually and diagnose its abnormalities in a relatively short timeframe. Purpose: To analyse associations between lesions revealed during vaginal biocoenosis assessment in correlation to lesions described in studies dedicated to cytological assessments of ectocervical smear. Materials and methods: The study group included 1991 female patients scheduled for follow-up cytological screening in a gynecological office. Patients underwent gynecological examination covering external areas, colposcopy, vaginal pH measurement, sampling for vaginal biocoenosis assessment purposes, and cytological sampling. Results: It was demonstrated that diagnostic conformity for Candida sp accounted for only 17.2%, changes of bacterial flora for only 4%, and in the case of Trichomonas vaginalis for only 3.9%. According to our observations, bacterial infections and candidiases were more frequently diagnosed during vaginal biocoenosis examinations comparing with cytological screening; whereas, Trichomonas vaginalis infections were more frequently diagnosed in cytological screening. Conclusions: Lack of 100% correlation between the vaginal biocoenosis test and cytological results according to the Bethesda system means that assessment of vaginal microflora in phase-contrast microscopy should not be abandoned. [ABSTRACT FROM AUTHOR]

Papanicolaou (PAP) stain is the most common stain used for cytological evaluation. Judicious use of the PAP stain results in a well-stained nuclear chromatin, cytoplasmic transparency, and differential cytoplasmic staining which helps the pathologists in the diagnosis of various lesions. The major disadvantage of the conventional PAP stain is the long duration of the staining process. Since cervical cytology is used as a screening method for diagnosis of cervical cancer, it becomes essential to device a modified stain which gives rapid results. Hence, this study was undertaken to study the utility of a rapid-modified short-duration PAP stain. This is a prospective study conducted on 100 patient samples which were received in the Cytopathology Laboratory of Sree Balaji Medical College and Hospital, Chromepet, Chennai, India. Two PAP smears were collected from the study population and one was stained with the conventional PAP staining technique and the other was stained with the modified rapid-short PAP staining method. The staining characteristics of these smears were evaluated and compared. Smears stained by both the staining techniques were evaluated using a scoring system which assesses the nuclear, cytoplasmic, and the background staining characteristics. It was found that the rapid-short PAP staining technique is found to be more effective compared to the conventional PAP stain with a P value of < 0.0001. Short-duration Papanicolaou staining technique could be a definite better alternative to the conventional PAP stain both by being cost effective and by consuming less time for staining. [ABSTRACT FROM AUTHOR]

Background: Cancer cervix is a leading cause of mortality and morbidity in developing countries like India most probably due to lack of proper screening facilities in the rural and suburban areas or due to the lack of awareness amongst the women of developing countries. Cervical cancer is the fourth most common cancer in the world. Developing countries accounted to about 80% of the global burden. This study was conducted to highlight the importance of Pap smear study in differentiating premalignant and malignant lesions. Materials and methods: This was a prospective study aimed to evaluate all pap smears examined at KGH over a period of 6 months i.e. from December 2016 to May 2017. Detailed clinical data and pap smear cytology reports were obtained and data noted in a structured proforma. All PAP smears reported as per THE BETHESDA System 2014. Women with abnormal smears were followed up by repeat pap smears or acetic acid guided cervical biopsy. Results: Total of 770 pap smears were examined in 6 months duration. Max no. of patients (around 40%) were of 31-40 years age group. Most of the patients (90.77%) were categorized into NILM (negative for intraepithelial lesion or malignancy). Among the five organisms, we found trichomonas were 38 (4.9%), and candida 38 (4.9%) cases of total NILM cases. Epithelial cell abnormalities in cytological examination were found in total 61 cases constituting 7.92%. Among epithelial cell abnormalities, LSIL was the commonest (27 cases, 3.57%). Conclusions: Cervical cytology by Pap smear is an important tool for early detection of premalignant and malignant lesions of cervix. Regular Pap smear screening should be conducted in vulnerable age group. [ABSTRACT FROM AUTHOR]

Introduction Atypical squamous cells, cannot exclude high-grade squamous intraepithelial lesion (ASC-H) represents an interpretative challenge in clinical practice. We aimed to evaluate the histological outcome of ASC-H cytology and to evaluate the accuracy of colposcopy in predicting high-grade histological lesions. Materials and methods Retrospective study of ASC-H cervical cytology results, from January 2010 to December 2016, at a tertiary hospital. Demographic characteristics, colposcopic findings, diagnostic procedures, and histological outcomes were analyzed using SPSS, version 22.0. Results ASC-H prevalence was 0.25%. Patient mean age was 42.02 ± 12.8 years. The overall incidence of cervical dysplasia of any grade was 83.6% (n = 56) and the incidence of high-grade lesions was 50.8% (n = 34) (including 1 case of in situ adenocarcinoma and 2 cases of squamous cell carcinoma). Among patients with type 1 or 2 transformation zone (TZ), 84.9% (n = 45) had abnormal colposcopic findings, with 62.2% (n = 28) corresponding to grade 2 and 37.8% (n = 17) to grade 1. Colpo-histologic concordance was 85.4% (82.1% for grade 2 lesions and 100% for grade 1 lesions). The sensitivity, specificity, positive predicted value (PPV) and negative predictive value (NPV) was 100%, 75%, 82.1%, and 100%, respectively. The histological study of patients with type 3 TZ revealed 45.8% (n = 11) of high-grade lesions. Conclusions ASC-H is strongly associated with high-grade histological lesions. Immediate evaluation of patients with this cytology abnormality is therefore mandatory. Colposcopy, when performed by expert clinicians, has great accuracy in detecting high-grade lesions. Histological evaluation of patients with type 3 TZ is extremely important because almost 50% of patients have this type of lesion. [ABSTRACT FROM AUTHOR]

Background: The prevalence and genotype distribution of Human papillomavirus (HPV) infection vary depending on geographical region and the immunity provided by vaccines. This study aimed to clarify the recent prevalence and genotype distribution of HPV according to age and cervical cytology findings in Korea. Methods: This study included 18,815 health examinees that underwent cervical cytology and HPV genotyping tests at 16 centers of Korean Association of Health Promotion in 13 cities in Korea, between January 2014 and October 2015. HPV was genotyped by using multiplex PCR (Anyplex II HPV 28, Seegene, Korea), which detects 19 high-risk HPVs (HR-HPV) and nine low-risk HPVs (LR-HPV). Results: Overall HPV prevalence was 27.8%, with 22.2% HR-HPV and 11.4% LR-HPV. The five most common carcinogens were HPV 52 (3.2%), 58 (2.7%), 16 (2.0%), 56 (1.9%), and 51 (1.8%). The five most common HR-HPVs in normal cytology samples were HPV 53, 68, 70, 52, and 58, while HPV 16, 52, 58, 33, and 31 were prevalent in high grade squamous intraepithelial lesions (HSIL). In atypical squamous cells of undetermined significance (ASCUS), the prevalence of HR-HPV varied with age; it was highest in those aged <30 yr, declining to a minimum at age 50-59 yr, and then increasing in older women (P <0.05). Conclusions: The prevalence and distribution of HR-HPV varied with age and cervical cytology findings. This information would be helpful in the development of cervical cancer prevention policies. [ABSTRACT FROM AUTHOR]

Copyright of Ginecología y Obstetricia de México is the property of Federacion Mexicana de Ginecologia y Obstetricia 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.)

Copyright of Hungarian Medical Journal / Orvosi Hetilap is the property of Akademiai Kiado 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.)

We propose a framework to detect and segment nuclei and segment overlapping cytoplasm in cervical cytology images. This is a challenging task due to folded cervical cells with spurious edges, poor contrast of cytoplasm and presence of neutrophils and artifacts. The algorithm segments nuclei and cell clumps in extended depth of field (EDF) images and uses volume images to segment overlapping cytoplasm. The boundaries are first approximated by a defined similarity metric and are refined in two steps by reducing concavity, iterative smoothing and outliers removal. We evaluated our framework on two public datasets provided in the first and second overlapping cervical cell segmentation challenges (ISBI 2014 and 2015). The results show that our method outperforms other state-of-the-art algorithms on both datasets. The results on the ISBI 2014 dataset show that our method missed less than 5% of cells when the pairwise cell overlapping degree was not higher than 0.3 and it missed only 7% of cells on average in a dataset of 810 synthetic images with 4860 (overlapping) cells. On the same dataset, it outperforms other state-of-the-art methods in nucleus detection with precision 0.961 and recall 0.933. The results on the ISBI 2015 dataset containing real cervical EDF images show that our method misses around 20% of cells in EDF images where a segmentation is considered a miss if it has dice similarity coefficient not greater than 0.7. The 20% miss rate is around half of the miss rate of two other recent methods. [ABSTRACT FROM AUTHOR]

Objective: Cervical cytology samples were analyzed to determine the prevalence of human papilloma virus infection (HPV) and the most frequently observed types. Methods used to assess the presence of HPV were also evaluated. Methods: A total of 837 female patients who presented at the hospital between June 2016 and March 2017 were retrospectively included in the study. Real-time polymerase chain reaction (RT-PCR) analysis was used to detect the presence and identify the type of HPV, and a liquid-based cytology technique was also used to evaluate cervical cytology in concurrently obtained samples taken during a gynecological examination. Results: Of 837 cervical cytology samples, squamous cell atypia (SCA) was seen in 208 (24.9%) samples, and was not present in the remaining 629 (75.1%). Analysis of the samples with SCA revealed the presence of SCA of undetermined significance in 142 (17.0%), lowgrade squamous intraepithelial lesion in 53 (6.3%), and high-grade squamous intraepithelial lesion in 13 (1.6%) samples. HPV-positivity was detected in 344 of the 837 patients (41.1%). The most frequently seen types were HPV 16, 18, 31, and 51. HPV prevalence was greatest in women younger than 30 years of age and those over 50. HPV 16 and multiple strains were most often seen in women under 30. HPV 16 was the most frequently seen single HPV strain, followed by HPV types 51, 31, and 18, respectively. HPV 16 was also most common among samples with multiple strains, followed by types 31, 51, and 18, respectively. HPV-positivity was detected in 132 (63.5%) patients with SCA. Of the 629 who had an SCA-negative result, HPV positivity was determined in 212 (33.7%) cases. Conclusion: The most frequently detected strain of HPV in this study was type 16. HPV prevalence demonstrated a bimodal age distribution. HPV was correlated with SCA; however, HPV-positivity was also observed using RT-PCR in cases without SCA. This indicates the importance of the combination of RT-PCR and cytological examination in the determination of HPV types and prevalence, and in the treatment and follow-up of HPV-positive patients. [ABSTRACT FROM AUTHOR]

Introduction In concert with the 2014 update to the Bethesda System for Reporting Cervical Cytology, a Web-based image interobserver study was performed to evaluate concordance with the “expert panel” interpretation, as was done during the Bethesda 2001 update. The aim was to identify cytomorphologic features and Bethesda reporting categories that represent sources of poor interobserver agreement and see how the trends compared to the first Bethesda Interobserver Reproducibility Study (BIRST). Materials and methods Participants were recruited online through national and international cytopathology professional societies. Study participants evaluated 84 previously unpublished web images chosen from the third Bethesda Atlas image set, prior to the release of the atlas. These images spanned all reporting categories and included typical and borderline cytomorphology. Demographic information was collected on level of training, practice patterns, and experience of the participants. Participation was restricted to those correctly answering 2 basic cytopathology questions, ensuring minimal knowledge of gynecologic cytopathology. Results A total of 1290 unique individuals attempted access to this Web-based study and 833 correctly answered the two qualifying questions. Of these, 518 respondents completed the survey. Participant origin included: 59% United States, 41% international; 48% cytotechnologists, 41% pathologists, 5% fellows, and 6% other. Practice types were: 39% academic institutions, 29% private hospitals, and 16% commercial laboratories. Overall, the mean participant agreement with the exact Bethesda panel interpretation was 62.8%. The best agreement was found for negative for intraepithelial lesion or malignancy (NILM; 74%) and low-grade squamous intraepithelial lesion (LSIL; 86%) categories. Squamous cell carcinoma (SCC) (63%), high-grade squamous intraepithelial lesion (HSIL; 60%), atypical squamous cells of undetermined significance (ASC-US; 62%) and atypical squamous cells, cannot exclude high-grade squamous intraepithelial lesion (ASC-H; 60%) showed slightly lower concordance with the panel interpretations. Cervical glandular lesions were more problematic (33%). Anal samples performed similarly to their gynecologic counterparts. There was similar diagnostic agreement across participant certifications and practice type (academic versus non-academic). Performance was higher for United States and other North America–based participants ( P = 0.0104). This significance may be attributed to a language bias, as the survey was only offered in English. Conclusions Similar to the BIRST-1 study conducted in 2001, the most important factor for diagnostic agreement by cytotechnologists, pathologists, and trainees was the a priori difficulty of an image rather than participant training, certification, or experience. Participants showed better general diagnostic agreement with the expert panel interpretations of the material in BIRST-2 than in BIRST-1. Agreement was highest for Bethesda categories of NILM, LSIL, HSIL, and SCC. Concordance for even the borderline ASC-US and ASC-H categories exhibited remarkable improvement in the BIRST-2. [ABSTRACT FROM AUTHOR]

Purpose: A repeat Pap smear is sometimes necessary after a short time interval or even immediately, when patients seek for a second opinion or due to study participation. Only limited information is available on the possible impact of a short interval between two Pap smears. Most institutions therefore practice a minimum time span of 6-8 weeks before obtaining a second smear since a short interval is commonly believed to be associated with an increase of false negative results in the second smear.Methods: Two consecutive Pap smears were obtained from 81 women. 41 smears were processed using the conventional technique, whereas liquid-based cytology was used in the remaining 40 women. Smears were independently evaluated by four different cytopathologists. We analyzed the effect of time interval, both processing techniques and inter-observer variance in cytological evaluation.Results: While the result of the second smear shows a tendency towards a more benign outcome (odds ratio (OR) 1.436, 95% CI 0.972-2.121), this difference was not statistically significant (p = 0.07). No significant differences were observed between conservative and liquid-based cytology (OR 1.554, 95% CI 0.659-3.667, p = 0.31). There was considerable inter-observer variability, and the observer was a strong predictor of the cytological result (OR 0.632-5.083, 95% CI 0.355-8.975, p < 0.01).Conclusions: We document a tendency towards a more benign outcome without statistical significance in the second smear. Inter-observer variability of different cytopathologists is high and should be kept in mind when evaluating cytology results. [ABSTRACT FROM AUTHOR]

Cytology-based cervical cancer screening is restricted because of a lack of cytologists. Thus, HPV-based instead of cytology-based screening may be a more suitable strategy in China. Here, we assessed the effectiveness of HPV testing (Cobas® 4800 Test, Roche) and HPV-based programs to detect high-grade cervical intraepithelial neoplasia ( CIN) or cancer compared with cytology (Thinprep, Hologic) and cytology-based programs through a cross-sectional study in 11,064 Chinese women aged 21-65 years who were enrolled from Longyou County in Zhejiang Province, China. The rates of HPV positivity and cytology abnormality were 9.8% and 6.1%, respectively. The HPV positivity rate had two age peaks, 21-24 (15.4%) and 60-65 (14.4%) years. According to adjusted data, HPV testing demonstrated significantly higher sensitivity and negative predictive value ( NPV) than cytology for detecting CIN2 or worse (90.0% vs. 66.7%, 99.9% vs. 99.5%), and there was an acceptable specificity (91.3%) and positive predictive value ( PPV, 12.5%). Furthermore, primary HPV testing with type 16/18 genotyping showed the highest sensitivity (78.6%) and NPV (99.7%) among four screening strategies, and there was similar specificity (96.8%) and PPV (23.9%) compared with co-testing screening to detect CIN2+, while there were fewer colposcopies (4.2) and tests (106.3) performed than with co-testing and primary cytology screening to detect a case of high-grade CIN. The differences in effectiveness were approximately similar when CIN3+ was the identifying target. Our findings suggest that primary HPV testing with type 16/18 genotyping has a higher sensitivity and NPV, possesses optimal cost/effectiveness in the first round of screening and is a feasible strategy of cervical cancer screening for Chinese women. [ABSTRACT FROM AUTHOR]

Zika virus ( ZIKV) infection during pregnancy has been linked to severe birth defects, and the epidemiologic situation of the ZIKV epidemic in Ecuador is poorly understood. Guayaquil, Ecuador, has a tropical climate and experiences frequent outbreaks of dengue and chikungunya virus, and in December 2015, ZIKV was identified. Given the well-documented effects of ZIKV in pregnancy, including microcephaly, we tested for the presence of ZIKV in both plasma and cervical cytology of pregnant women. We report the identification of a population of pregnant women with a high incidence of ZIKV infection detected in the plasma and lower reproductive tract. A case-control study was performed to determine the incidence of ZIKV infection among low-income, pregnant women at risk for preterm delivery compared to matched controls. Plasma and cervical cytology specimens were tested for ZIKV by rRT- PCR. Fifty-nine pregnant women were enrolled. The incidence of ZIKV was 54% (32/59) overall: 18/31 (58.1%) in cases and 14/28 (50.0%) in controls. ZIKV detection in plasma and cervical cytology specimens demonstrated good agreement. Overall, outcomes for neonates born to ZIKV-positive and ZIKV-negative mothers were similar. However, two neonates were born with microcephaly to case mothers who were ZIKV positive. We report a high incidence of ZIKV infection (54%) in a distinctive population in Guayaquil, Ecuador. We identify ZIKV in cervical samples that correlates with ZIKV in the plasma. These data raise concerns regarding the breadth of the ZIKV epidemic in Ecuador and demonstrate the utility of cervical cytology specimens for ZIKV testing. [ABSTRACT FROM AUTHOR]

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Women treated for high-grade cervical intraepithelial neoplasia (CIN) are at risk of recurrent CIN Grade 2 or worse (rCIN2+). Currently, posttreatment monitoring is performed using cytology or cytology/high-risk (hr)HPV cotesting. This study aimed to evaluate the performance of p16/Ki-67 dual-stained cytology (p16/Ki-67) for posttreatment monitoring. Three hundred and twenty-three women treated for high-grade CIN in the SIMONATH study underwent close surveillance by cytology, hrHPV and DNA methylation marker testing up to 12 months posttreatment. Histological endpoints were ascertained by colposcopy with biopsy at 6 and/or 12 months. p16/Ki-67 dual-staining was performed on residual liquid-based cytology samples obtained at, or shortly before biopsy collection. Clinical performance estimates of cytology, hrHPV, p16/Ki-67 testing and combinations thereof for the detection of rCIN2+ were determined and compared to each other. Sensitivity of p16/Ki-67 for rCIN2+ (69.2%) was nonsignificantly lower than that of cytology (82.1%; ratio 0.84, 95% CI: 0.71-1.01), but significantly lower than that of hrHPV testing (84.6%; ratio 0.82, 95% CI: 0.68-0.99). Specificity of p16/Ki-67 for rCIN2+ (90.4%) was significantly higher compared to both cytology (70.8%; ratio 1.28, 95% CI: 1.19-1.37) and hrHPV testing (76.2%; ratio 1.19, 95% CI: 1.12-1.26). Overall, hrHPV testing showed very high sensitivity, along with a good specificity. When considering cotesting, combined p16/Ki-67/hrHPV testing showed rCIN2+ sensitivity comparable to cytology/hrHPV cotesting (87.2% vs. 89.7%; ratio 0.97, 95% CI: 0.92-1.03), but with significantly increased specificity (74.2% vs. 58.1%; ratio 1.28, 95% CI: 1.19-1.38). Thus, when considered in combination with hrHPV, p16/Ki-67 might be an attractive approach for surveillance of women treated for high-grade CIN. [ABSTRACT FROM AUTHOR]

Cervical cancer screening based on the Papanicolaou (Pap) test is a widely applied but not always efficient practice for detecting Human Papillomavirus (HPV) mediated lesions, partially due to a non-systematic and inadequate screening process. Our aim was to introduce an inexpensive easy-to-use direct screening platform for improved detection of abnormal cells indicative of underlying cervical neoplasia as well as persisting HPV infection. By employing a novel, efficient technique of laser-based micromachining, we achieved the fabrication of spatial grids on commercially available coverslips allowing visual segmentation of the slide for efficient screening. Abnormal and formerly diagnosed as negative for intraepithelial lesion or malignancy (NILM) Pap test slides ( n = 200) were analyzed by conventional and grid-based screening. Grid-based microscopy led to a more reliable diagnosis compared to the conventional by identifying an increased number of abnormal cells ( P = 0.001). It decreased borderline ASCUS, AGC diagnosis, increasing LSIL, HSIL and in situ AdenoCa detection rates closely related with biopsy ( P = 0.015; kappa = 0.978). Concerning the set of NILM diagnoses in rapid re-screening, the method upgraded six cases ( n = 6) to LSIL ( P = 0.001). The proposed technical solution offers a calibration and orientation visual aid during the on-site screening process providing significant advantages compared to expensive digital imaging techniques. [ABSTRACT FROM AUTHOR]

Endometritis is a common puerperal disease in livestock. Thus, a practical clinical test for the establishment of diagnosis is needed. We developed a goat model for subclinical endometritis diagnosis by examining cytological, ultrastructural features and molecular expression in cervical discharge collected by cervical cytobrush method. A suspension of E. coli was infused into the uterine horn of goats, and cervical discharge, peripheral blood and endomertrial biopsy samples were collected before inoculation and at 3, 6, 12, 24, 72, 120 and 168 hr post-inoculation (pi). In experimental goats, total leukocytes increased at 6-12 hr pi in hematological examinations, abundant neutrophils were observed in cervical discharge smears, and some micro-villi shortened or were lost from the epithelium at 3 hr pi, with some inflammatory cells infiltrated into the uterine glands and lamina propria. The mRNA expression levels of the Toll-like receptor 4 (TLR4), cytokines and β-defensin-2 increased significantly within 12 hr pi and returned to preinoculation levels at 7 day pi. The results showed that subclinical endometritis was simulated in this bacterial infusion goat model, and the evaluation of cervical cytology was in good agreement with molecular changes of cytokines in cervical discharge, hematology and histology. We thus conclude that the simple cervical cytobrush technique can effectively obtain cervical discharge samples for cytology examination in the early diagnosis of subclinical endometritis in goats. [ABSTRACT FROM AUTHOR]