Human Papilloma Virus Pictures - Research

Duncan LD, Jacob SV. Department of Pathology, University of Tennessee Medical Center Hospital, Knoxville, Tennessee.

The 2001 Bethesda System diagnostic category of atypical squamous cells cannot exclude a high grade squamous intraepithelial lesion (ASC-H) was developed and implemented after many studies that proved its clinical relevance. In this study, we describe the practice experience of a hospital-based reference laboratory with this new diagnostic category. The anatomic pathology computer database was searched, and 414 Papanicolaou (Pap) smears signed out as ASC-H were discovered among 60,390 Pap smear accessions over a 17-month period of time. One hundred four cases had corresponding tissue specimens. Slides from all Pap smears and tissue specimens were reviewed, and five Pap smears were reclassified, leaving 99 study cases. In our laboratory, 88.9% of the study cases had either low or high grade dysplasia diagnosed on subsequent tissue specimens. The positive predictive value of ASC-H for histologically proven high-grade squamous intraepithelial lesions (HSIL's) was 40.4%. Of those having human papillomavirus (HPV) hybrid capture II testing, high-risk HPV types were detected in 73.9% of cases. The majority of study cases had less than 25 atypical cells. In two hysterectomy cases and three loop electrosurgical excession procedure (LEEP) conization cases, high-grade dysplasia was present as a single microscopic focus, suggesting that the paucity of atypical cells in ASC-H Pap smears may be secondary to small lesion sampling. Thirteen study patients were postmenopausal and 30.8% had low-grade dysplasia, and of these, 46.2% had high-grade dysplasia on subsequent tissue specimens. In conclusion, our practice experience with ASC-H is similar to that reported in the literature before the 2001 Bethesda System. Diagn. Cytopathol. 2005;32:243-246. (c) 2005 Wiley-Liss, Inc.

Am J Obstet Gynecol. 2005 Feb;192(2):414-21.

Current cervical neoplasia screening practices of obstetrician/gynecologists in the US.

Saint M, Gildengorin G, Sawaya GF. Department of Obstetrics and Gynecology, Kaiser Permanente Northern California, USA.

OBJECTIVE: The purpose of this study was to determine cervical cancer screening practices of obstetrician/gynecologists in the US after recent revised guidelines. STUDY DESIGN: Questionnaires were mailed to 355 randomly selected US obstetrician/gynecologists. Questions were structured as clinical vignettes. RESULTS: Questionnaires were returned by 60% (213/355) of recipients; 185 were eligible. Seventy-four percent would begin screening virginal girls at age 18. Sixty percent would continue annual screening in a 35-year-old woman with 3 or more normal tests. Frequent screening is common in women after total hysterectomy for symptomatic fibroids and no history of dysplasia, and in 70-year-old women with a 30-year history of previous normal tests. Most (82%) use liquid-based cytology; 78% of female respondents would prefer it for themselves. Most (64%) would not adopt triennial Pap/HPV DNA screening, although 58% of women would choose it for themselves. CONCLUSION: Most US obstetrician/gynecologists screen low-risk women often and indefinitely, despite national guidelines designed to minimize screening harms resulting from overtesting.

Eur J Gynaecol Oncol. 2004;25(4):475-7.

A second Pap smear during colposcopy: is it really worth it?

Kourounis GS, Michail GD, Ravazoula P. Patras University, Greece.

The aim of this study was to determine whether the clinical value of a second Pap smear during colposcopy outweighed its cost-effectiveness and reliability parameters. We studied retrospectively 569 cases focusing on A) The initial Pap smear, B) The smear performed during colposcopy, C) The colposcopic findings, and D) The histopathological reports of the cases where biopsy sampling was performed. In 380 patients (67%), the second Pap smear corresponded to the first one. In 13% of the patients, the cytological lesions were worse (particularly in 2% of the patients staging increased from HPV-associated reactive cellular changes to CIN II, or from CIN I to CIN III), and in 20% slighter than the initial. In 79% of the cases revealing more serious lesions in the second smear, the histological result of the biopsy corresponded to that of the initial smear. Conclusively, only 2% seem to benefit from a second repeat Pap smear during referral colposcopy.

Diagn Cytopathol. 2004 Dec;31(6):376-9.

Assessing the feasibility of single lifetime PAP smear evaluation between 41-50 years of age as strategy for cervical cancer control in developing countries from our 32 years of experience of hospital-based routine cytological screening.

Misra JS, Gupta HP, Das V. Department of Obstetrics and Gynecology, K.G. Medical University, Lucknow, India. jata_misra@yahoo.com

In view of the huge expenditure involved in mass cytological screening as well as lack of cytology manpower in the developing countries, single lifetime screening at 45 yr of age has been suggested as feasible strategy for control of cervical cancer. The present study is aimed at testing this hypothesis in a broader prospective, accommodating women between 41 and 50 yr of age from the data derived from the ongoing long-term hospital-based routine cervicovaginal cytology at Queen Mary's Hospital, Lucknow, India. The cervical smears of 31,032 women have been evaluated cytologically during a span of 32 yr (April 1971-March 2003) for early detection of carcinoma cervix and sexually transmitted diseases (STDs). The incidence of squamous intraepithelial lesions (SIL) was found to be 6.1% while frank malignancy was seen in 0.5% of cases. The following observations were made from the accumulated cytological data: (a) approximately 30% of the total cancer cases was in the age group of 41-50 yr; (b) the maximum number of SIL cases was detected in women between 41 and 50 yr of age (35% of the total SIL cases), and adequate management of these SIL cases would prevent cancer cases from occurring in later years, thus minimizing the maximum incidence of 1.3% observed in women beyond 50 yr of age; (c) the incidence of human papillomavirus (HPV) infection also was found quite high in women between 41 and 50 yr old, the adequate management of which would prevent onset/progression of any premalignant changes in the cervix. Our experience of 32 yr of cytological screening substantiates the hypothesis of single lifetime screening between 41 and 50 yr of age as an effective strategy for control of carcinoma cervix in developing countries like ours. copyright (c) 2004 Wiley-Liss, Inc.

Eur J Gynaecol Oncol. 2004;25(5):577-84.

Human papillomavirus (HPV) testing in the management of women with abnormal Pap smears. Experience of a colposcopy referral clinic.

Ciotti M, Sesti F, Paba P, Benedetto A, Patrizi L, Criscuolo A, Piccione E, Branca M, Syrjanen K, Favalli C. Laboratory of Clinical Microbiology and Virology, University Hospital Policlinico Tor Vergata (Italy).

BACKGROUND AND OBJECTIVES: Several detailed algorithms for the appropriate use of human papillomavirus (HPV) testing in the management of women with abnormal Pap (Papanicolaou) smears have been launched, but their direct country-to-country adoption is difficult. This necessitates their testing in individual settings, which is ongoing in our colposcopy referral clinic. METHODS: A series of 224 consecutive women attending the clinic with the usual referral indications (ASC-US or higher in Pap) were examined by the conventional diagnostic tools (PAP smear, colposcopy, punch biopsy) and subjected to HPV testing and viral typing for both low-risk (L-R) and high-risk (H-R) types by nested PCR-based techniques. Predictors of the high-grade diagnostic categories were analysed using both univariate- and multivariate modelling, and the performance characteristics (sensitivity, specificity, NPV, PPV) of all tests in detecting high-grade CIN were calculated. RESULTS: In the PAP test, ASC-US smears were most common (37.9%), followed by low-grade squamous intraepithelial lesions (LSIL) (26.3%) and high-grade SIL (HSIL) (4.9%). Colposcopy was performed for 180 women, of whom 48.3% had a normal transformation zone (TZ), 40.6% had ATZ1 (abnormal TZ grade 1), and 5.6% had ATZ2. In biopsy (n = 71), 49.3% had CIN1, 5.6% CIN2, and 16.9% CIN3. The HPV test was positive in 64 (28.8%) women, more often in those aged < 35 years (p = 0.025). High-grade colposcopy (ATZ2) was significantly associated with HSIL in the Pap test (OR 20.5; 95% CI: 4.34-96.47), and with HPV test positivity (OR 6.37; 95% CI: 1.58-25.73). The most significant predictors of CIN3 were HSIL in the PAP, HPV test positivity, and high-grade colposcopy. HSIL and HPV test (for H-R types), but not colposcopy, retained their significance as independent predictors of CIN3 also in adjusted multivariate models: OR 88.27; 95% CI 4.17-1867.04, and OR 19.46; 95% CI 2.01-187.75, for the HSIL and H-R HPV test, respectively. Changing the cut-off level of the Pap test from ASC-US to HSIL increased the specificity of the test up to 96.4%, with the loss in sensitivity from 87.5% to 43.8%. Colposcopy (ATZ2) had 92% specificity, and NPV competing with that of the Pap test. The sensitivity of HPV test exceeds that of the Pap test at HSIL cut-off level, but the specificity of the PAP test is clearly superior. CONCLUSIONS: Accurate predictors of significant cervical pathology (CIN3) are well defined, but the problem is the different performance of the diagnostic tools in clinical practice. A proficient combination of the tests is likely to result in the most satisfactory clinical practice in the management of women with abnormal Pap tests (MAPS).

Publication Types:
• Evaluation Studies

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