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ABSTRACT Objective Methods Results Conclusions This study aimed to investigate the supporting role of artificial intelligence (AI) in digital cervical cytology training.A total of 104 trainees completed both manual reading and AI‐assisted reading tests following the AI‐assisted digital training regimen. The interpretation scores and the testing time in different groups were compared. Also, the consistency, sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of diagnoses were further analysed through the confusion matrix and inconsistency evaluation.The mean interpretation scores were significantly higher in the AI‐assisted group compared with the manual reading group (81.97 ± 16.670 vs. 67.98 ± 21.469, p < 0.001), accompanied by a reduction in mean interpretation time (32.13 ± 11.740 min vs. 11.36 ± 4.782 min, p < 0.001). The proportion of trainees' results with complete consistence (Category O) were improved from 0.645 to 0.803 and the averaged pairwise κ scores were improved from 0.535 (moderate) to 0.731 (good) with AI assistance. The number of correct answers, accuracies, sensitivities, specificities, PPV, NPV and κ scores of most class‐specific diagnoses (NILM, Fungi, HSV, LSIL, HSIL, AIS, AC) also improved with AI assistance. Moreover, 97.8% (89/91) of trainees reported substantial improvement in cervical cytology interpretation ability, and all participants (100%, 91/91) expressed a strong willingness to integrate AI‐assisted diagnosis into their future practice.The utilisation of an AI‐assisted digital cervical cytology training platform positively impacted trainee performance and received high satisfaction and acceptance among clinicians, suggesting its potential as a valuable adjunct to medical education. [ABSTRACT FROM AUTHOR]

Cervical cytology remains a critical screening tool for cervical cancer. While various factors can influence cytology quality, the effect of lubricant type used during specimen collection has been previously studied with inconclusive results. This study aimed to evaluate the impact of surgical lubricant on cervical cytology results and elucidate risk factors associated with unsatisfactory results. We hypothesized that switching from a carbomer-containing lubricant to a noncarbomer, water-soluble lubricant would improve specimen adequacy in cervical cytology. A retrospective chart review was performed examining patient cytologic results from January to December 2017 at a single academic institution. After historical rates of unsatisfactory cytology were higher than acceptable standards, the practice changed lubricant formulation from a carbomer containing lubricant to a noncarbomer, water soluble lubricant. Demographic data and treatment characteristics were collected for eligible patients. Matched analysis was performed to examine factors associated with an unsatisfactory cytology result. After the change in lubricant, there was a significant decline in the rates of unsatisfactory cytology from 9.6% to 5.7%, P = 0.01. This decline was also observed when patients were matched based on menopausal status, personal history of gynecologic malignancy, pregnancy status, and cytology specimen type (10.0% to 4.8%, P = 0.001). Change in lubricant from a carbomer containing to noncarbomer, water soluble product was associated with a statistically significant decline in the rates of unsatisfactory cytology. Although prior data have had mixed results as to the etiology of unsatisfactory cytology, we feel that this directly contributed to the high rates observed at our institution. [ABSTRACT FROM AUTHOR]

Timely detection of endometrial carcinoma in Lynch syndrome patients ensures prompt treatment and appropriate cancer screening for the patient and impacted family members. While cervical cytology is utilized primarily in cervical cancer screening, endometrial glandular abnormalities can be identified as part of routine cervical cancer screening or during work-up for abnormal uterine bleeding. We retrospectively evaluated cervical cytology samples from Lynch syndrome patients with endometrial carcinoma to determine how often atypical/malignant glandular cells were identified on prior/concurrent cytology. We identified 14 Lynch syndrome patients with cervical cytology available within a year of endometrial carcinoma diagnosis. The average patient age was 55 years (36-73). Cervical cytology preceded diagnostic biopsy in 57% and was concurrent in 43%. A glandular abnormality was identified on original diagnosis in 43% and ranged from atypical glandular cells (AGC), not otherwise specified to adenocarcinoma consistent with endometrial primary. In 4 cases, abnormal cervical cytology triggered the subsequent biopsy. Evaluation of 8 cases with accessible cytology slides revealed 2 previously unrecognized glandular abnormalities, leading to an abnormal rate of 63% among cases reviewed retrospectively and a final glandular abnormality detection rate of 57% based on either original or review diagnosis. In summary, abnormal glandular cells were commonly identified in endometrial cancer patients with Lynch syndrome and led to endometrial cancer work-up and diagnosis in a subset. These results suggest that cervical cytology may have utility in endometrial cancer screening in this population and indicate that awareness of the patient's familial cancer risk is important for maximizing sensitivity of this test. They also caution against primary human papillomavirus screening in the Lynch syndrome population, as this may result in missed opportunities for early endometrial carcinoma detection among these high-risk individuals. • A total of 50% of Lynch syndrome patients with endometrial carcinoma had glandular abnormalities on cytology. • In some cases abnormal cytology prompted further work-up and led to endometrial carcinoma diagnosis. • Atypical cells were often identified only on retrospective review. • Pathologist review of all cervical cytology samples from Lynch patients may be prudent. • As primary HPV testing gains traction it is worth considering supplemental cytology in Lynch patients. [ABSTRACT FROM AUTHOR]

Trichomonas vaginalis infection is one of the most prevalent curable STIs. Although treatments are available, T. vaginalis infections pose a significant challenge, especially in resource-limited regions, as the prevalence of this STI is often unknown. We aimed to determine the prevalence of Trichomonas vaginalis infection in women screened for cervical cancer precursor lesions in Botucatu in São Paulo, Brazil. We conducted a descriptive and retrospective study that included 23,735 women who attended the cervical cancer screening program at health units in 2019 and 2022. Clinical and sociodemographic data were collected from the cancer information system (SISCAN) and test requisition forms. Descriptive analysis was conducted, and comparisons were performed using the X2 Test and Student's t-test (SigmaPlot version 13.0). The prevalence of T. vaginalis infection was 0.84% in 2019 and 0.57% in 2022. The mean age of patients with trichomoniasis was 42 (±11.2) years; 75% self-reported as white, 43% were married or in a stable relationship, and 40% had not completed primary education. Regarding the vaginal microbiota, only 15.3% of the cytology exams with infection by T. vaginalis showed a predominance of lactobacilli species, while inflammation was present in 82% of the smears. Cytological analysis revealed precursor lesions of cervical cancer in 0.05% of patients with trichomoniasis, including ASC, LSIL, and HSIL. The study showed a low prevalence of infection with T. vaginalis in low-risk women screened for precursor lesions of cervical cancer in Botucatu in São Paulo, Brazil. [ABSTRACT FROM AUTHOR]

Objective: To compare the performance of cytology, HPV16/18 genotyping and PAX1/SOX1 methylation for the triage of high‐risk HPV‐positive cervical samples. Design: Retrospective analyses of archival samples collected from a large‐scale prospective randomised controlled trial. Setting/Sample: HPV‐positive women recruited from the general cervical screening population. Methods: 403 HPV‐positive samples including 113 normal, 173 low‐grade cervical intraepithelial neoplasia (LG‐CIN), 114 HG‐CIN and three cervical cancers. All samples were assessed by liquid‐based cytology, HPV genotyping and PAX1/SOX1 methylation. Main Outcome Measures: AUC (area under the curve), sensitivity and specificity for cytology, HPV16/18 genotyping and PAX1/SOX1 methylation for high‐grade (HG) premalignant cervical lesions. Results: PAX1 was more sensitive than cytology and HPV16/18 genotyping in detecting a HG lesion (CIN2+). The sensitivity for PAX1, SOX1, cytology and HPV16/18 were 73.5% (95% CI: 65.5–81.5), 41.9% (95% CI: 32.9–50.8), 48.7% (95% CI: 39.7–57.8) and 36.8% (95% CI: 28.0–45.5), respectively, and their respective specificities were 70.3% (95% CI: 65.0–75.6), 83.6% (95% CI: 79.3–87.9), 77.6% (95% CI: 72.8–82.5) and 67.1% (95% CI: 61.7–72.6), respectively. Overall, PAX1 gave the best AUC at 0.72. Adding SOX1 to PAX1 did not improve the AUC (0.68). Three hundred and twenty‐two women who did not have a HG lesion at baseline were followed up for two rounds of screening. Fewer women developed a HG lesion with a normal baseline PAX1 compared to women with a normal baseline cytology or negative HPV16/18 (8.4% vs. 14.5% and 17.5%, respectively). Conclusion: PAX1 triage for referral to colposcopy in HPV‐positive women may be superior to cytology and HPV16/18 genotyping. [ABSTRACT FROM AUTHOR]

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, crosssectional, 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. [ABSTRACT FROM AUTHOR]

Cervical precancerous lesions signify cellular changes in the cervix linked to an escalated risk of cancer. These lesions often evolve towards malignancy influenced by various factors, including sexually transmitted infections (STIs), irrespective of human papillomavirus (HPV) presence. STIs represent a substantial global public health concern, affecting both sexes, with over 30 pathogens, comprising bacteria, viruses, and parasites, capable of causing STIs. The clinical presentation of these pathogens varies significantly. This study aimed to delineate the microbial profile within HPV-containing precancerous lesions. A prospective cross-sectional descriptive study was conducted in Cameroon's central region, particularly in the Endom district. Among 343 patients screened, 225 women were enrolled based on positive HPV cervical smear results. Cervical cell lesions were analyzed using the Papanicolaou technique, while parasitological and microbiological methods were utilized to identify other microbes. HPV genotypes were determined via multiplex PCR. The study revealed 65 HIV-positive and HPV-positive individuals (18.96%); 40 HIV-negative and HPV-positive individuals (11.65%); 25 HIV-positive and HPV-negative individuals (7.29%); and 213 HIV-negative and HPVnegative individuals (62.10%). Various cervical lesions were identified, including Low-grade Lesions (LSILs) (21%) and High-grade lesions (HSILs) (16%). Trichomonas vaginalis (TV) (51%), Candida albicans (CA) (28%), Herpes simplex (HS) (2%), Gardnerella vaginalis (GV) (17%), Aspergillus (A) (2%), and HIV were the primary infectious agents identified in these precancerous lesions, with significant distribution (P<0.005), suggesting their role as risk factors for precancerous lesions (OR=13.89, 95% CI 6.87-21.60). Multiple HPV genotypes were characterized in the same precancerous lesions, with approximately 25% (85) of women harboring either Low_Risk (LR) (6, 11) or High_Risk (HR) (16, 18, 45, 58) HPV genotypes (P<0.001). Coinfections such as HPV/TV/CA and HPV/HIV/TV were prevalent, indicating their potential as associated risk factors for precancerous lesions. Coinfections with other microbes, typically associated with cervicitis, appear to facilitate HPV infection. These findings contribute to understanding the microbial landscape of cervical samples and underscore the importance of integrated care approaches for HIV-positive individuals with HPV-related lesions. [ABSTRACT FROM AUTHOR]

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

Introduction: Cervical cancer still ranks highest causing cancer-related morbidity and mortality in women in India. It is prudent to emphasise and implement cervical cancer screening strategies in the population efficiently and with regular intervals. Conventionally, PAP smear cytology is obtained by wooden spatula-Ayre's spatula. To improve sensitivity and specificity of the procedure and detection rate, better techniques of cells retrieval are available mainly liquid-based cytology (LBC), with help of cyto-brush. Literature has consistently proven efficiency of the technique and also reduced the proportion of inadequate sampling. We conduct this study to compare both the techniques and efficiency in a community hospital from data over 6 years, to asses its role and benefits among Indian women. Aims and Objectives: To compare conventional PAP smear and liquid-based cytology techniques analysing detection rates of positive lesions (CIN and also includes ASCUS and malignant), incidence of inadequate sampling, efficiency and cost-effectiveness. Methods: This is retrospective study at tertiary care obstetric hospital affiliated to government-run medical college in a metropolitan city of Mumbai. Data are retrieved from the Pathology Department, Medical Records Department, laboratory books and OPD registers. Pap's smear sampling was done mainly from OPD with all indications including routine tests as a part of gynaecological evaluation and screening, as well as for suspicious lesions on inspection. Group A consists women who had conventional PAP smear test for 3 years (Dec 2015–Nov 2018) and Group B had women who benefited by LBC method for 3 years (Dec 2018–Nov 2021). COVID-19 pandemic majorly affected the routine gynaecological OPD practice during 2021 as hospital was COVID facility hospital. Results: Demographic parameters and presentations were comparable and similar. LBC methods have higher detection rate for positive reports, including ASCUS. But results were comparable in both groups and not statistically different. Importantly, incidences of inadequate sampling are reduced significantly with the LBC method. Unsatisfactory smears war high in Group A (7.752%) compared to Group B (3.712%) p-value 0.005, stating the increased rate of requirement of sending repeat smears, which involves higher engagement of time, resources and active participation from healthcare personnel. Conclusion: Good detection rates and significantly low rates of unsatisfactory smears make LBC rational and cost-effective. These are the times to switch to liquid-based cytology techniques, especially at the community level hospitals; in order to detect more women with cervical premalignant as well as malignant neoplastic lesions and to save lives. This can be made possible by emphasising the policy makers to incorporate these services through quality resources. [ABSTRACT FROM AUTHOR]

Background Abnormal cervical cytology is commonly observed in women with human immunodeficiency virus (WWH). Methods A cross-sectional study was conducted with 130 WWH and 147 age-matched healthy controls, who underwent gynecological examinations at Beijing Ditan Hospital. The presence of abnormal cervical cytology in WWH was predicted after performing a logistic regression analysis. Results Multivariate logistic regression revealed 3 independent factors, among which CD4 cell count ≥350 cells/μL was the protective factor, while human papillomavirus infection and abnormal vaginal pH were the risk factors. Conclusions Vaginal microecological disorders can increase the risk of abnormal cervical cytology in WWH. [ABSTRACT FROM AUTHOR]

Cervical cancer ranks among the leading causes of mortality in women worldwide, underscoring the critical need for early detection to ensure patient survival. While the Pap smear test is widely used, its effectiveness is hampered by the inherent subjectivity of cytological analysis, impacting its sensitivity and specificity. This study introduces an innovative methodology for detecting and tracking precursor cervical cancer cells using SIFT descriptors in video sequences captured with mobile devices. More than one hundred digital images were analyzed from Papanicolaou smears provided by the State Public Health Laboratory of Michoacán, Mexico, along with over 1800 unique examples of cervical cancer precursor cells. SIFT descriptors enabled real-time correspondence of precursor cells, yielding results demonstrating 98.34% accuracy, 98.3% precision, 98.2% recovery rate, and an F-measure of 98.05%. These methods were meticulously optimized for real-time analysis, showcasing significant potential to enhance the accuracy and efficiency of the Pap smear test in early cervical cancer detection. [ABSTRACT FROM AUTHOR]

Background/Aims: There are currently few reports describing the liquid-based cytological characteristics of small cell neuroendocrine carcinoma of the cervix. This study aimed to retrospectively analyze these features to reduce missed or misdiagnosis. Methods: A total of 11 patients with histologically diagnosed small cell carcinoma of the cervix from three hospitals between 2017 and 2023 were included in this study. The cytological morphology of small cell carcinoma of the cervix and causes of missed or misdiagnosis were analyzed and summarized through a review of clinical data, liquid-based cytology, histology, immunohistochemistry, and human papillomaviruses (HPV) test results. Results: In this study, the positivity rate of preliminary cytological screening was 63.6% (7/11); however, no cases were accurately diagnosed as small cell carcinoma of the cervix. A total of 36.4% (4/11) of small cell carcinoma of the cervix cases were cytologically negative; retrospective cytology found that two of these were false negatives. The main cytological features of small cell carcinoma of the cervix were summarized. Most of the liquid-based cytology smear cells were dense, and almost all cases showed clustered and scattered cytoplasm-scanty tumor cells. The tumor cells were all deeply stained and relatively consistent small cells. Most cases showed typical nuclear molding, chromatin stippling, and no obvious nucleoli. Mild nuclear smears, nuclear fragments, and mitotic figures were seen in most cases. Conclusion: Liquid-based cytology has a high rate of missed diagnosis and misdiagnosis in small cell carcinoma of the cervix. This study confirms that reviewing cytology results can effectively reduce this proportion and that increasing understanding of small cell carcinoma of the cervix morphology is conducive to improving the cytology-based diagnosis rate. [ABSTRACT FROM AUTHOR]

Background: Human papillomavirus (HPV) is a well-established causal agent of cervical cancer, and the first group of viruses to have been acknowledged to prompt carcinogenesis. They are linked with cancers of the uterine cervix, anogenital tumours, and head and neck malignancies. Cervical cancer is by far the most common HPV-related disease, with about 99% of cervical cancer cases caused by persistent genital high-risk (HR) HPVs, especially types 16 and 18. Methodology: A hospital-based descriptive analytical study of 300 consenting HIV-infected women on antiretroviral therapy (ART), selected from the three senatorial districts of Plateau State, Nigeria, was conducted over a period of 24 months (November 2018 to November 2020). Blood and cervical specimens were collected from each participant. HIV status was confirmed by standard rapid test on serum sample, CD4+ cell count was determined by flow cytometry and HIV viral load estimation was done by GeneXpert nucleic acid amplification technique. Cervical cytology was performed by Papanicolaou (Pap smear) on the cervical specimen and reported according to the 2004 Bethesda system classification. HPV antigen was first detected on the cervical specimen using ELISA, and samples positive for HPV antigen were then subjected to multiplex PCR amplification of E6 and E7 genes to detect HR-HPV (16 and 18) and other HPV types. Standard questionnaires were administered to obtain information on biodata, risk factors and clinical presentations. Data were analyzed using the Statistical Package for the Social Sciences (SPSS) version 26.0, and significance level was determined at p<0.05. Results: Of the 300 participants, 84 were positive for HPV of any type, giving an overall prevalence of HPV infection of 28.0%. The prevalence of HPV-16 and HPV-18 types were 5.0% (15/300) and 5.3% (16/300) respectively. Cytological analysis showed that 36.3% (109/300) of the participants had cervical abnormalities ranging from low-grade to high grade squamous intraepithelial lesions and cervical intraepithelial neoplasia. HPV prevalence of 46.8% (51/109) in women with cervical abnormalities was significantly higher than 17.3% (33/191) in women with normal cervical cytology (OR 4.2, p<0.0001). HPV prevalence was higher in women with AG-US (100.0%), ASC-US (78.8%), AC-US (66.7%), ASC-H (33.3%), HSIL (33.3%), HSIL (23.8%), and LSIL (41.2%) compared with women with normal cervical cytology (p<0.001). Aside educational level (p=0.03), none of the analyzed sociodemographic characteristics or risk factors for cervical cancer was significantly associated with HPV infection in the study (p>0.05). Conclusion: This study showed high prevalence of HPV infections among HIV-infected patients on ART in Plateau State, north-central Nigeria including detection of high-risk HPV types 16 and 18, which are major risk factors for progression of cervical intraepithelial neoplasia to cervical cancer. [ABSTRACT FROM AUTHOR]

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

Introduction: Screening programs has conventional cytology such as Conventional Pap Smear (CPS) have successfully reduced cervical cancer, but newer tests like Manual Liquid-based cytology (MLBC) and Human Papillomavirus testing might enhance screening. Materials and Methods: This was a cross sectional study conducted on 175 samples was processed for CPS and MLBC. Cytobrush was used for LBC which was suspended and detached in the preservative fluid and processed by manual method. Histopathological correlation and HPV DNA testing was also done. Results: MLBC showed higher specimen adequately, cellularity, clean background and uniform distribution of cells than CPS. Conclusion: MLBC showed improved specimen adequately, better cytomorphological features and higher detection of epithelial cell abnormality. [ABSTRACT FROM AUTHOR]

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

BackgroundPersistent 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.MethodsFrom 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.ResultsIn 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.ConclusionThe 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.

Abstract Background For women diagnosed with HR-HPV DNA positivity in community hospitals, the necessity of investigating the potential presence of multiple HR-HPV infections upon referral to tertiary medical institutions remains unclear. Methods In our cohort, women tested positive for HR-HPV DNA during examinations in community hospitals, were subsequently referred to tertiary medical facilities, reevaluated HR-HPV genotype and categorized based on cytological and histopathological results. The risk of cytologic/histopathology abnormalities and ≧ high grade squamous intraepithelial lesion(HSIL) or Cervical Intraepithelial Neoplasia (CIN) 2 associated with individual genotypes and related multiple HPV infections are calculated. Results A total of 1677 women aged between 21 and 77 were finally included in the present study. The cytology group included 1202 women and the histopathological group included 475 women with at least one HR-HPV infection of any genotype. We only observed a higher risk of low grade cytological abnormalities in women with multiple infections than those in corresponding single infections (for all population with an OR of 1.85[1.39–2.46]; p

Introduction: Screening programs has conventional cytology such as Conventional Pap Smear (CPS) have successfully reduced cervical cancer, but newer tests like Manual Liquid-based cytology (MLBC) and Human Papillomavirus testing might enhance screening. Materials and Methods: This was a cross sectional study conducted on 175 samples was processed for CPS and MLBC. Cytobrush was used for LBC which was suspended and detached in the preservative fluid and processed by manual method. Histopathological correlation and HPV DNA testing was also done. Results: MLBC showed higher specimen adequately, cellularity, clean background and uniform distribution of cells than CPS. Conclusion: MLBC showed improved specimen adequately, better cytomorphological features and higher detection of epithelial cell abnormality.

Trichomonas vaginalis infection is one of the most prevalent curable STIs. Although treatments are available, T. vaginalis infections pose a significant challenge, especially in resource-limited regions, as the prevalence of this STI is often unknown. We aimed to determine the prevalence of Trichomonas vaginalis infection in women screened for cervical cancer precursor lesions in Botucatu in São Paulo, Brazil. We conducted a descriptive and retrospective study that included 23,735 women who attended the cervical cancer screening program at health units in 2019 and 2022. Clinical and sociodemographic data were collected from the cancer information system (SISCAN) and test requisition forms. Descriptive analysis was conducted, and comparisons were performed using the X2 Test and Student’s t-test (SigmaPlot version 13.0). The prevalence of T. vaginalis infection was 0.84% in 2019 and 0.57% in 2022. The mean age of patients with trichomoniasis was 42 (±11.2) years; 75% self-reported as white, 43% were married or in a stable relationship, and 40% had not completed primary education. Regarding the vaginal microbiota, only 15.3% of the cytology exams with infection by T. vaginalis showed a predominance of lactobacilli species, while inflammation was present in 82% of the smears. Cytological analysis revealed precursor lesions of cervical cancer in 0.05% of patients with trichomoniasis, including ASC, LSIL, and HSIL. The study showed a low prevalence of infection with T. vaginalis in low-risk women screened for precursor lesions of cervical cancer in Botucatu in São Paulo, Brazil.

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

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

Cervical cancer is a worldwide major health burden. It is a disease that is both common and preventable. Early diagnosis can play a critical role in successful therapy. Thus effective screening techniques, such as Liquid-Based Cytology (LBC) and Visual Inspection with Acetic Acid (VIA) can play an important role. In this study, the efficacy of LBC and VIA are compared against the histopathology findings. A statistically significant sample of women were enrolled in the study and were examined by both LBC and VIA. Tissue samples were also taken from both VIA-positive and abnormally LBC-positive people. Histopathological investigation of these samples was performed to ascertain the presence and grade of cervical cancer and precancerous lesions (CIN). The findings suggested that LBC is preferable compared to a routine Pap smear for examination of cervical cytology. [ABSTRACT FROM AUTHOR]

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

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

Cervical cancer ranks as the third most common female cancer in Cape Verde and is the leading cause of cancer-related deaths among women in the country. While Human Papillomavirus (HPV) vaccination, which started in 2021, is anticipated to significantly reduce disease incidence, cervical screening remains crucial for non-vaccinated women. We retrospectively reviewed gynecologic cytology exams and HPV tests performed in Cape Verde between 2017 and April 2023 and processed at IMP Diagnostics. For this study, we considered 13035 women with cytology examinations performed and, 2013 of these, also with an HPV molecular test. Cytology diagnostics comprised 83 % NILM cases; 12 % ASC-US; 2.7 % LSIL; 1.2 % ASC-H; 0.5 % HSIL and 0.1 % SCC. In 505 (25.1 %) high-risk HPV infection was detected. Prevalence of HPV infection varied with age, peaking at young ages - ≤24 years old (55.5 %) and 25-35-year-old women (31.5 %) - and the lowest after 66 years old (9.7 %). Herein we present a comprehensive study regarding Cape Verde's cervical cytology and HPV distribution, aiming to provide a snapshot of the country's cervical cytology results and HPV distribution in recent years. Moreover, these data may contribute to establish a baseline to assess, in the future, the vaccination impact in the country.

In response to the incidence of cervical intraepithelial neoplasia and cervical cancer in China and global screening strategies, a collaborative effort was undertaken by seven Chinese medical associations to develop this guideline for cervical cancer screening. The guideline recommends high-risk human papillomavirus (hr-HPV) testing as the preferred method for primary screening, which should have been approved by authoritative institutions and clinically validated for primary screening. In areas without access to HPV testing, cytology can be used as an alternative. However, it is recommended to replace cytology with HPV-based screening as conditions permit. Cotesting (HPV testing in combination with cytology) is recommended for areas with sufficient medical resources, opportunistic screening populations, and partial special populations. The guideline recommends that individuals with a cervix initiate cervical cancer screening at the age 25 years and undergo HPV testing alone or cotesting every five years, or cytology alone every three years. Women over the age of 65 who have had documented adequate negative prior screening in the past may terminate screening. Corresponding screening programs are proposed for different special populations. The development of these guidelines is an important step in the effort to eliminate cervical cancer in China.

Since government-provided annual cervical cytology testing for all Taiwanese women aged 30 years or older became available in 1995, both cervical cancer incidence and death have decreased significantly. However, with the 2018 introduction of the national immunization program for human papillomavirus (HPV) vaccination in all schoolgirls aged 13–15 years old, the positive predictive value of cytology testing is expected to decrease with rising vaccination rates, and therefore a transition to more sensitive HPV-based testing may be needed. This position paper, derived from discussions by a panel of experts in cervical cancer screening, provides short-, medium-, and long-term policy recommendations to manage the transition between cervical screening methods for Taiwan. The recommendations include concrete suggestions regarding testing procedures, standards, accreditation, monitoring, promotion, and implementation. It is hoped that comprehensive preparation and management of this transition will enable Taiwan to repeat the previous successes of the cervical cytology testing program.

Cervical cancer ranks among the leading causes of mortality in women worldwide, underscoring the critical need for early detection to ensure patient survival. While the Pap smear test is widely used, its effectiveness is hampered by the inherent subjectivity of cytological analysis, impacting its sensitivity and specificity. This study introduces an innovative methodology for detecting and tracking precursor cervical cancer cells using SIFT descriptors in video sequences captured with mobile devices. More than one hundred digital images were analyzed from Papanicolaou smears provided by the State Public Health Laboratory of Michoacán, Mexico, along with over 1800 unique examples of cervical cancer precursor cells. SIFT descriptors enabled real-time correspondence of precursor cells, yielding results demonstrating 98.34% accuracy, 98.3% precision, 98.2% recovery rate, and an F-measure of 98.05%. These methods were meticulously optimized for real-time analysis, showcasing significant potential to enhance the accuracy and efficiency of the Pap smear test in early cervical cancer detection.

Human papillomavirus (HPV) can be transmitted sexually and causes cervical malignancies in women. Among the risk factors, sexually transmitted infections (STIs) caused by bacteria have raised concerns because they are asymptomatic and persistent and can increase the risk of HPV infection. This study assessed the correlation among Ureaplasma urealyticum, Ureaplasma parvum, Chlamydia trachomatis, and Mycoplasma hominis infections towards abnormal cervical cells positive for HPV. Seventy outpatients at the Colposcopy Outpatient Clinic, Dr. Cipto Mangunkusumo Hospital in Jakarta, Indonesia, were enrolled in this cross-sectional study. Viruses and bacteria were detected using polymerase chain reaction and compared with liquid-based cytology results for cervical cytology. Of the 70 patients, 24 (34.28%) showed abnormal cervical cytology. Among those with abnormal cervical cytology, C.trachomatis was reported in 1 patient (4.2%), M.hominis in 6 patients (25%), U.urealyticum in 13 patients (54.2%), and U.parvum in 10 patients (41.7%). Statistical analysis demonstrated an association between U.urealyticum and U.parvum infections and HPV infection (U.urealyticum p = 0.012; U.parvum p = 0.022). U.urealyticum and U.parvum were more prevalent than C.trachomatis and M.hominis in HPV-positive women, suggesting their role in HPV infection.

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

Within the Bethesda System, the recommendation of describing benign-appearing endometrial cells (BECs) has changed over recent years. Since the 2014 revision, their presence in cervical cytology reports has been deemed essential, beginning with age 45. Recent studies have suggested rising the reporting age to 50 years. Does the presence of these cells necessitate further assessment? This retrospective cohort study included patients aged between 45 and 65 years in whom BECs were present on cervical cytology between January 2001 and December 2010, with a follow-up at 5 and 10 years. Women who had abnormal cervical cells or atypical endometrial cells on cervical cytology were excluded, as well as women with a history of cervical or endometrial cancer, or a history of hysterectomy and incomplete follow-up data. One hundred seventy-six women were included. Of these, 31% were postmenopausal of which 65% used hormonal substitution therapy. Twenty-eight percent presented with abnormal uterine bleeding at inclusion. During the follow-up period of 10 years, 87.5% had a normal gynecological follow-up and 11.4% underwent a hysterectomy for benign pathology. One percent (2 patients) had been diagnosed with endometrial malignancy, both presenting with postmenopausal bleeding and aged over 60 years. Our study confirmed that the presence of BECs is not a reason for concern when no additional clinical indicator is recognized, especially with normal ultrasonographic examination. Further invasive exploration may be controversial. If reporting BECs in cervical cytology continues, we strongly agree on rising the reporting age to 50 years or postmenopausal state. • Within the Bethesda System, the recommendation of describing benign-appearing endometrial cells (BECs) has changed over recent years. • The presence of BECs is not a reason for concern when no additional clinical indicator is recognized, especially with normal ultrasonographic examination. • If reporting BECs in cervical cytology continues, we strongly agree on rising the reporting age to 50 years or postmenopausal state. [ABSTRACT FROM AUTHOR]

Since government-provided annual cervical cytology testing for all Taiwanese women aged 30 years or older became available in 1995, both cervical cancer incidence and death have decreased significantly. However, with the 2018 introduction of the national immunization program for human papillomavirus (HPV) vaccination in all schoolgirls aged 13–15 years old, the positive predictive value of cytology testing is expected to decrease with rising vaccination rates, and therefore a transition to more sensitive HPV-based testing may be needed. This position paper, derived from discussions by a panel of experts in cervical cancer screening, provides short-, medium-, and long-term policy recommendations to manage the transition between cervical screening methods for Taiwan. The recommendations include concrete suggestions regarding testing procedures, standards, accreditation, monitoring, promotion, and implementation. It is hoped that comprehensive preparation and management of this transition will enable Taiwan to repeat the previous successes of the cervical cytology testing program. [ABSTRACT FROM AUTHOR]

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

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

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

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

Summary: Background: Cervical cytology remains widely used as the initial tool in cervical cancer screening worldwide. WHO guidelines recommend replacing cytology with primary HPV testing to reach cervical cancer elimination goals. We assessed the performance of cytology and high-risk HPV testing to detect cervical precancer, cervical intraepithelial neoplasia (CIN) grade 3 or worse (CIN3+) among women aged 30–64 years participating in the ESTAMPA study. Methods: Women were screened with cytology and HPV across ESTAMPA study centres in Latin America. Screen-positives were referred to colposcopy with biopsy collection and treatment as needed. Those with no evident precancer were recalled at 18-months for a second HPV test to complete disease ascertainment. Performance indicators for cytology and HPV to detect CIN3+ were estimated. Findings: 30,606 participants with available cytology and HPV results were included in the analysis. A total of 440 histologically confirmed CIN3s and 30 cancers were diagnosed. Cytology sensitivity for CIN3+ was 48.5% (95% CI: 44.0–53.0), whereas HPV testing had a sensitivity of 98.1% (95% CI: 96.3–96.7). Specificity was 96.5% (95% CI: 96.3–96.7) using cytology and 88.7% (95% CI: 88.3–89.0) with HPV. Performance estimates varied substantially by study centre for cytology (ranging from 32.1% to 87.5% for sensitivity and from 89.2% to 99.5% for specificity) while for HPV results were more consistent across sites (96.7%–100% and 83.6–90.8%, respectively). Interpretation: The limited and highly variable sensitivity of cytology strongly supports transition to the more robust and reproducible HPV-based cervical screening to ensure progress towards global cervical cancer elimination targets in Latin America. Funding: IARC/WHO, UNDP, HRP/WHO, NCI and local funders.

Objectives: The Papanicolaou's (Pap's) stain is used for cervical cancer screening. It employs toxic-carcinogenic expensive reagents, which may not be easily accessible to many communities worldwide. The objective of this study was to validate the grape-based alcohol-extracted dye (Vinatela) on normal cervical samples for the Pap test. Material and Methods: Samples of the two grape species were collected from two vineyards through the Agroindustrial Research Institute of Universidad Privada San Juan Bautista. The dye extraction from the grape species and the dye performance to stain cells were conducted in three phases: (a) direct staining with prefermentation wine products, (b) direct fragmentation of grapes and direct staining with shells of the grapes, and (c) alcoholic extraction of the dye. Vinatela obtained from two species (Vitis vinifera "Tempranillo" and "Malbec") and posterior staining of cervical samples. We conducted a double-blind validation on 30 cervical samples. Results: The basophilic components of the cervical cells were stained. Alcoholic extraction staining protocol had a low yield. The nuclear and cytoplasmic borders, the nuclear details, and the polymorphonuclear nuclei were stained with Vinatela and could be differentiated during nuclear coloration. The initial staining protocol was 10-20 min x (mean ~12 min) staining time. We noted a slightly better staining with V. v. Tempranillo as compared to V. v. Malbec (P = 0.045). Conclusion: Cervical cells stained with Vinatela stain from two grape species cultivated in the Southern of Peru, showed basophilic nuclear details. [ABSTRACT FROM AUTHOR]

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

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

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

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

The 2019 ASCCP Risk Based Management Consensus Guidelines for prevention of cervical cancer promote clinical management recommendations aligned with our increased understanding of HPV biology and cervical carcinogenesis. They employ HPV-based testing as the basis for risk estimation, allow for personalized risk-based management by incorporating knowledge of current results with prior results, and streamline incorporation of new test methods as they are validated. They continue to support the principles of "equal management for equal risk" and "balancing harms and benefits" adopted in the 2012 version of the guidelines. These updated guidelines will be able to adjust for decreasing CIN3+ risks as more patients who received HPV vaccination reach screening age. Pathology organizations were closely involved in the development of these guidelines. Herein the pathologists who served as representatives to the 2019 ASCCP guidelines steering committee and workgroups, summarize the changes that are relevant to laboratories, pathologists, and cytotechnologists. Prior relevant screening and reporting recommendations that have not been widely and/or inconsistently adopted by laboratories are also discussed and considerations for modification of laboratory practices offered.

Objective: Because the specific prevalence and carcinogenesis of non-16/18 high-risk (hr) Human Papillomavirus (HPV) is not fully understood, we designed a study with aim of evaluating the risk of high-grade cervical intraepithelial neoplasia (CIN) in non-16/18 hr-HPV positive/cytology negative cases and assessing the distribution of non-16/18 hr-HPV subtypes. Materials and methods: This cross-sectional study was conducted on 138 non-16/18 hr-HPV positive/cytology negative women, who were referred to the gynecologic oncology clinic of Yas hospital, affiliated with Tehran University of Medical Sciences, January 2021 to 2022. Results: Among the detected types, HPV 31 was the most frequent type. 63 cases underwent biopsy as indicated based on colposcopic examination with acetic acid 3% application among which 34 had normal results. In the remaining 29 cases, 25 had insignificant findings. CIN2 was reported in 2 cases, one with HPV 31, 45, 58, and the other with HPV 58. CIN3 was also detected in 2 cases, one with HPV 31 and the other with HPV 35, 45.The overall incidence of high-grade CIN was 2.8%. A statistically significant (P-value = 0.046) difference was detected between patients with high-grade CIN compared with the others regarding the Hookah usage. Conclusion: The risk of CIN among non-16/18 hr-HPV positive/cytology negative cases is noticeably low. Based on ASCCP guidelines return testing at 1 year without immediate colposcopy seems sufficient; however, because of many reasons doing immediate colposcopy rather than 1-year follow-up may be a more accessible approach in resource poor, low-income countries such as ours.

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

Abstract Background Few studies have investigated the vaginal microbiota (VM) in women living with HIV (WLWH) in the context of high-risk human papillomavirus (HR-HPV) infection, even though WLWH are at an increased risk of HPV-related malignancies, including cervical cancer. To explore the impact of HIV and HPV infection on the VM in WLWH, we determined the prevalence of HR-HPV infection and cervical cytologic abnormalities in a cohort of 44 WLWH and 39 seronegative-women (SNW), characterized the vaginal microbiota by 16S sequencing, assessed genital inflammation and systemic immune activation by multiplex bead assay and flow cytometry, respectively. Finally, we explored relationships between bacterial richness and diversity, the top 20 bacterial genera, genital inflammation and systemic immune activation. Results We found that HR-HPV prevalence was similar between WLWH and SNW. High-grade squamous intraepithelial lesions (HSIL) were only detected in WLWH negative for HR-HPV infection. In regression analyses, no risk factors were identified. Women co-infected with HIV and HR-HPV had the highest level of systemic immune activation, and these levels were significantly different compared with SNW without HR-HPV infection. Lactobacillus iners was the dominant Lactobacillus species in WLWH and SNW alike. Conclusion We found no evidence of differences in vaginal microbial richness and diversity, microbial community structure, and genital inflammation by HIV, HPV, or HIV and HPV status.

Screening of Pap smear images continues to depend upon cytopathologists’ manual scrutiny, and the results are highly influenced by professional experience, leading to varying degrees of cell classification inaccuracies. In order to improve the quality of the Pap smear results, several efforts have been made to create software to automate and standardize the processing of medical images. In this work, we developed the CEA (Cytopathologist Eye Assistant), an easy-to-use tool to aid cytopathologists in performing their daily activities. In addition, the tool was tested by a group of cytopathologists, whose feedback indicates that CEA could be a valuable tool to be integrated into Pap smear image analysis routines. For the construction of the tool, we evaluate different YOLO configurations and classification approaches. The best combination of algorithms uses YOLOv5s as a detection algorithm and an ensemble of EfficientNets as a classification algorithm. This configuration achieved 0.726 precision, 0.906 recall, and 0.805 F1-score when considering individual cells. We also made an analysis to classify the image as a whole, in which case, the best configuration was the YOLOv5s to perform the detection and classification tasks, and it achieved 0.975 precision, 0.992 recall, 0.970 accuracy, and 0.983 F1-score.