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Chen YC, Liang CN, Wang XF, Wang MF, Huang XN, Hu JD. Follow-up study on ThinPrep cytology test-positive patients in tropical regions. World J Clin Cases 2022; 10:12543-12550. [PMID: 36579088 PMCID: PMC9791535 DOI: 10.12998/wjcc.v10.i34.12543] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Revised: 10/16/2022] [Accepted: 11/17/2022] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND As shown in the statistics from the World Health Organization, it is estimated that approximately 75000 new cases of cervical cancer occur every year in China. In 2008, 33000 people died of cervical cancer in China. It is proven that most women are at risk of cervical cancer. The progression from human papillomavirus (HPV) infection to cervical cancer can be several years or decades, which offers a unique opportunity to prevent cancer.
AIM To observe the changes in ThinPrep cytology tests (TCT) and HPV infection in patients who were detected to be positive via TCT screening of cervical cancer and further explore the biopsy results.
METHODS This paper performed a follow-up study on 206 cervical cancer screening-positive patients of 12231 total cases from our previous research. We conducted an observational study on the TCT results based on the interpretation of The Bethesda System.
RESULTS Over a 5-year period, 10 cases received consistent follow-up. The proportions of cases in which glandular epithelial lesions were detected increased over the follow-up period. The differences between the years were statistically significant (P < 0.01). Over the 5 years, the proportion of patients whose squamous epithelial lesions transformed into glandular epithelial lesions increased yearly. Annual positive rates of HPV infection were: year 1, 73% (24/33); year 2, 43% (6/14); year 3, 36% (9/25); year 4, 50% (9/18); and year 5, 25% (6/24). The positive detection rate after biopsy over a 9-year period was 29%.
CONCLUSION The follow-up study for 5 years to 9 years revealed a tendency to change from squamous epithelial lesions to glandular epithelial lesions and an improvement of the disease (which had not been reported previously). The HPV test indicated a high negative conversion ratio of the viral infection. However, the follow-up cases were not found to have persistent infection of high-risk HPV. Therefore, early intervention of cervical cancer screening is necessary. Low re-examination compliance, patient education, and preventive measures should be enhanced.
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Affiliation(s)
- Yun-Chun Chen
- Department of Laboratory Medicine, Haikou Branch of Yueyang Integrative Medicine Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Haikou 570216, Hainan Province, China
| | - Chong-Nan Liang
- Department of Laboratory Medicine, Haikou Hospital of Traditional Chinese Medicine, Haikou 570216, Hainan Province, China
| | - Xiang-Feng Wang
- Department of Ultrasound Medicine, Second Affiliated Hospital of Hainan Medical University, Haikou 570311, Hainan Province, China
| | - Min-Fa Wang
- Department of Ultrasound Medicine, Second Affiliated Hospital of Hainan Medical University, Haikou 570311, Hainan Province, China
| | - Xu-Ning Huang
- Department of Ultrasound Medicine, Second Affiliated Hospital of Hainan Medical University, Haikou 570311, Hainan Province, China
| | - Jian-Dong Hu
- Department of Internal Medicine, Haikou branch of Yueyang Hospital of Integrated Traditional Chinese and Western Medicine Shanghai University of Traditional Chinese Medicine (Haikou Hospital of Traditional Chinese Medicine), Haikou 570216, Hainan Province, China
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El Mazghi A, Bouhafa T, Loukili K, El Kacemi H, Lalya I, Hassouni K. [Management of cervical cancer during pregnancy: report of 05 cases]. Pan Afr Med J 2014; 19:245. [PMID: 25852788 PMCID: PMC4382065 DOI: 10.11604/pamj.2014.19.245.5094] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2014] [Accepted: 09/27/2014] [Indexed: 11/24/2022] Open
Abstract
L'association d'un cancer du col utérin avec une grossesse est une éventualité rare. Son incidence est assez mal évaluée, elle se situe selon les études entre 1 et 2/10 000. Lorsque la découverte en est faite, il faut conjuguer deux impératifs parfois totalement divergents: le traitement de la mère et la prise en charge du foetus. Cette association pose schématiquement quatre grands problèmes, qui sont: Celui du diagnostic, qui est loin d’être évident, compte tenu des remaniements cervicaux observés en début de gestation, le pronostic de l'affection, la date du traitement chirurgical et du délai entre le diagnostic et la prise en charge thérapeutique, enfin et de manière plus accessoire, le devenir de la grossesse et le mode d'accouchement. Nous rapportons une série de 5 cas de cancer du col utérin découverts au cours de la grossesse colligés dans notre service entre 2010 et 2013. La prise en charge thérapeutique est identique à celle des patientes en dehors de la grossesse même si quelques adaptations sont nécessaires du fait de l’état gravide, le pronostic du cancer ne semble pas être modifié par la grossesse.
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Affiliation(s)
- Abderrahman El Mazghi
- Faculté de Médecine, Université Sidi Mohamed Ben Abdallah, Service de Radiothérapie, CHU Hassan II, Fès, Maroc
| | - Touria Bouhafa
- Faculté de Médecine, Université Sidi Mohamed Ben Abdallah, Service de Radiothérapie, CHU Hassan II, Fès, Maroc
| | - Kaoutar Loukili
- Faculté de Médecine, Université Sidi Mohamed Ben Abdallah, Service de Radiothérapie, CHU Hassan II, Fès, Maroc
| | - Hanan El Kacemi
- Service de Radiothérapie, Institut National d'Oncologie, Rabat, Maroc
| | - Issam Lalya
- Service de Radiothérapie, HIM Mohamed V, Rabat, Maroc
| | - Khalid Hassouni
- Faculté de Médecine, Université Sidi Mohamed Ben Abdallah, Service de Radiothérapie, CHU Hassan II, Fès, Maroc
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Uzan C, Gouy S, Balleyguier C, Haie-Meder C, Morice P. Cancer du col durant la grossesse. IMAGERIE DE LA FEMME 2011. [DOI: 10.1016/j.femme.2010.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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The management of women with abnormal cervical cytology in pregnancy. Best Pract Res Clin Obstet Gynaecol 2009; 24:51-60. [PMID: 19805007 DOI: 10.1016/j.bpobgyn.2009.07.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2009] [Accepted: 07/29/2009] [Indexed: 11/29/2022]
Abstract
The management of women with abnormal cytology in pregnancy represents both a diagnostic and a therapeutic challenge for colposcopists. The emphasis should be on diagnosis and confirmation of cervical precancer (Cervical intraepithelial neoplasia (CIN) or Adenocarcinoma in situ (AIS), thus excluding invasive cancer). Following an initial assessment, careful follow-up is essential. This must include colposcopy and take into account the physiological changes of the cervix during pregnancy and the puerperium. The management of women with invasive cancer diagnosed during pregnancy depends on the gestation at diagnosis and requires careful assessment and multidisciplinary planning.
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Bond S. Caring for women with abnormal papanicolaou tests during pregnancy. J Midwifery Womens Health 2009; 54:201-10. [PMID: 19410212 DOI: 10.1016/j.jmwh.2009.01.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2008] [Revised: 01/22/2009] [Accepted: 01/22/2009] [Indexed: 10/20/2022]
Abstract
The Papanicolaou (Pap) test is one of the best screening tests available for cancer detection and has achieved widespread acceptance among women. Pregnancy provides a valuable opportunity to educate and screen women for cervical cancer when receiving prenatal care. However, evolving knowledge about the course of human papillomavirus infection (HPV) in women, new technologies, and the advent of vaccines are driving radical changes in practice and new ways to consider cervical cancer screening. Modifications in the 2006 Consensus Guidelines for the Management of Women with Abnormal Cervical Cancer Screening Tests are most evident among adolescents. Because of high rates of HPV regression, pregnant adolescents with minor Pap abnormalities may now be followed rather than referred for immediate colposcopy. Postponing colposcopy in pregnant, reproductive-age women with minor Pap changes until after delivery is now acceptable. Pregnant immunocompromised women with abnormal Pap tests are followed similarly to pregnant women in the general population. While a strong evidence base is gradually emerging to support guideline revisions, the highest quality evidence may not yet be available for all recommendations. Midwives can keep abreast of the science while using clinical judgment to provide safe and expert cancer screening care to women.
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Affiliation(s)
- Sharon Bond
- Medical University of South Carolina, College of Nursing, 99 Jonathan Lucas St., MSC 160, Charleston, SC 29425, USA.
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Selleret L, Mathevet P. Diagnostic et prise en charge des lésions précancéreuses du col utérin pendant la grossesse. ACTA ACUST UNITED AC 2008; 37 Suppl 1:S131-8. [DOI: 10.1016/j.jgyn.2007.11.018] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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Fambrini M, Penna C, Fallani MG, Pieralli A, Mattei A, Scarselli G, Taddei GL, Marchionni M. Feasibility and outcome of laser CO2 conization performed within the 18th week of gestation. Int J Gynecol Cancer 2007; 17:127-31. [PMID: 17291242 DOI: 10.1111/j.1525-1438.2007.00802.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
The purpose of this study is to evaluate the feasibility, safety, and potential therapeutic benefit of laser CO(2) conization of the cervix for in situ and minimally invasive carcinoma diagnosed during pregnancy. Twenty-six pregnant patients with biopsy-proven carcinoma in situ/cervical intraepithelial neoplasia III but colposcopically suspicious for invasion underwent laser CO(2) conization during the 18th week of gestation in an outpatient setting under local anesthesia. No major intraoperative or postoperative complications occurred, and cervical cerclage was not required in any case. Two cases (7.7%) of occult FIGO stage IA1 minimally invasive cervical cancers with free surgical margins were diagnosed. Both patients delivered vaginally at term and were free of disease at postpartum follow-up. Median length of gestation was 39.1 weeks with a median birth weight of 3450 g. All 1-min Apgar scores were 8 or greater. Twenty patients (76.9%) delivered vaginally, while six patients underwent cesarean section for indications not related to the prior conization. After a mean postpartum follow-up of 18 months (range 3-42), 92.3% of patients continued to have both cytologic and colposcopic evaluations negative for persistent or recurrent disease. Two cases of persistent intraepithelial disease were successfully managed by reconization. In summary, our data suggest that laser CO(2) conization performed within the 18th week of gestation is safe for both the patient and the fetus, provides reliable histologic diagnosis, and can be curative. Further studies are required to confirm the favorable risk-benefit ratio of laser CO(2) conization in the management of non-reassuring cervical lesions observed in the first half of pregnancy.
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Affiliation(s)
- M Fambrini
- Department of Gynecology, Perinatology and Human Reproduction, School of Medicine, University of Florence, Via Morgagni 85, 50134 Florence, Italy.
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Dunn TS, Bajaj JE, Stamm CA, Beaty B. Management of the minimally abnormal papanicolaou smear in pregnancy. J Low Genit Tract Dis 2006; 5:133-7. [PMID: 17050957 DOI: 10.1046/j.1526-0976.2001.53004.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To evaluate the effectiveness of colposcopy of the uterine cervix in pregnant patients with minimally abnormal Papanicolaou smears. METHODS Two hundred, indigent, pregnant patients with atypical cells of undetermined significance (ASCUS) or low-grade squamous intraepithelial lesions (LGSIL) on Papanicolaou smear underwent colposcopy and endocervical evaluation. Directed biopsies were performed on 64 patients. One hundred thirty-five patients were compliant with postpartum Papanicolaou smears or colposcopy with endocervical evaluation. RESULTS One hundred eighty-seven pregnant patients had satisfactory prenatal Papanicolaou smears, colposcopy and endocervical brushings. High-grade intraepithelial lesions were found in 2.1% of prenatal endocervical brushings, 4.7% of prenatal biopsies, 0.8% of postpartum Papanicolaou smears, 2.2% of postpartum endocervical brushings, and 7.9% of postpartum biopsies. No invasive cervical cancer was detected. CONCLUSION Antepartum colposcopic evaluation did not add in the management of minimally abnormal Papnicolaou smears in this population of pregnant women.
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Affiliation(s)
- T S Dunn
- Department of Obstetrics and Gynecology, University of Colorado Health Sciences Center, Denver Health Medical Center, Denver, CO 80204, USA.
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Onuma K, Saad RS, Kanbour-Shakir A, Kanbour AI, Dabbs DJ. Clinical implications of the diagnosis “atypical squamous cells, cannot exclude high-grade squamous intraepithelial lesion” in pregnant women. Cancer 2006; 108:282-7. [PMID: 16991139 DOI: 10.1002/cncr.22170] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Atypical squamous cells, cannot exclude high-grade squamous intraepithelial lesion (ASC-H) has a high predictive value for high-grade intraepithelial lesion (HSIL) in the general population. However, the significance of ASC-H in pregnant women remains to be elucidated. The objective of this study was to investigate the clinical implications and pathologic significance of ASC-H in pregnant women, so that these patients will be managed appropriately. METHODS All Papanicolaou tests that were diagnosed as ASC-H in pregnant women over 1.5 years (total, 60 women) were reviewed and correlated with histologic and/or cytologic follow-up. High-risk type of human papillomavirus (HPV) status was also correlated with follow-up findings. The following cytomorphologic parameters were evaluated for each woman and were compared between the squamous intraepithelial lesion (SIL) follow-up group and the benign follow-up group: inflammatory background, the number of atypical cells, cell arrangement pattern, nuclear irregularity/grooves, hyperchromasia, and cell shape. RESULTS Among 30 women who had histologic follow-up, 3 women (10%) had HSIL, and 13 women (43%) had low-grade intraepithelial lesion (LSIL). Among 32 women who had cytologic follow-up, 2 women (6%) had HSIL, 3 women (9%) had LSIL, 1 woman (3%) had ASC-H, and 3 women (9%) had atypical squamous cells of undetermined significance (ASCUS). HPV was detected in 24 of 43 women (56%). The cytomorphologic features were similar in the SIL follow-up group and the benign follow-up group. No specific cytomorphologic features that predicted underlying SIL were identified. CONCLUSIONS ASC-H in pregnant women had a lower predictive value for an underlying HSIL compared with the general population. A positive HPV test result was not a good indicator for an underlying SIL, but a negative result appeared to be useful for ruling out an underlying HSIL. Because of low positive predictive value for HSIL and the difficult colposcopic examination, a more conservative follow-up may be reasonable for pregnant women who have a diagnosis of ASC-H. HPV testing may be used as an adjunctive test.
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Affiliation(s)
- Kazuya Onuma
- Department of Pathology, Magee-Womens Hospital of the University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
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Van Calsteren K, Vergote I, Amant F. Cervical neoplasia during pregnancy: Diagnosis, management and prognosis. Best Pract Res Clin Obstet Gynaecol 2005; 19:611-30. [PMID: 15886059 DOI: 10.1016/j.bpobgyn.2005.03.002] [Citation(s) in RCA: 58] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Pregnancy represents an exceptional opportunity for the early diagnosis of cervical cancer since visual inspection, cytological examination and bimanual palpation are considered to be part of routine antenatal care. An abnormal cervical smear should generally be managed as in the non-pregnant state. However, colposcopy and biopsies are mainly intended to exclude invasive disease because a conservative approach is preferred in cases of pre-invasive disease. The only absolute indication for conization in pregnancy is to rule out (micro-)invasive disease or make the diagnosis of invasive carcinoma when such a diagnosis will alter the timing or mode of delivery. Overall, earlier stages of cervical cancer are encountered during pregnancy compared with the general population. Although stage of disease and gestational age will largely influence the timing of the interventions, treatment of invasive cervical cancer is similar to the non-pregnant state. In strongly desired pregnancies, the use of neo-adjuvant chemotherapy in order to obtain fetal maturity should be considered and discussed with the patient. Although good evidence supports short-term safety, long-term data regarding the in-utero exposure of cytotoxic drugs need to be consolidated. After stratifying for stage, the outcome is similar to the non-pregnant state.
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Affiliation(s)
- K Van Calsteren
- Division of Gynaecological Oncology, Department of Obstetrics and Gynaecology, University Hospitals Leuven, Katholieke Universiteit Leuren, Herestraat 49, 3000 Leuven, Belgium
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Douvier S, Filipuzzi L, Sagot P. Prise en charge d’une néoplasie intra-épithéliale du col de l’utérus en cours de grossesse. ACTA ACUST UNITED AC 2003; 31:851-5. [PMID: 14642944 DOI: 10.1016/j.gyobfe.2002.12.001] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Approximately 30% of women diagnosed with cervical cancer are in their childbearing years. Prenatal care provides an excellent opportunity for cervical cancer screening. The incidence of abnormal Pap smear has been reported in 5-8% of pregnant women. But we must know that Pap smears have cytologic modifications because of pregnancy. All abnormal smears have to be referred to colposcopic examination. The squamocolumnar junction is visualized in almost 100% of cases. The sensitivity of colposcopy is nearly 87% with complete concordance in 72.6%. Colposcopically directed biopsies have a good correlation with the final diagnosis with very minimal risks for both mother and fetus. The high rate of complications (hemorrhage, abortion, premature labor) and residual lesions in half of cases do not encourage conization during pregnancy. The final treatment is carried out after delivery. The only absolute indication for conization in pregnancy is to rule out microinvasive disease or make the diagnosis of invasive carcinoma when such a diagnosis will alter the timing of delivery but also when there is a no satisfactory colposcopy and a high-grade Pap smear. In these cases conization is performed for diagnostic and not therapeutic purpose. We must be aware of the high rate of loss of follow-up (6-33%).
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Affiliation(s)
- S Douvier
- Clinique gynécologique, CHU de Dijon, 10, boulevard du Maréchal-de-Lattre-de-Tassigny, BP 77908, 21079 Dijon, France.
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Broderick D, Matityahu D, Dudhbhai M, Alter S. Histologic and Colposcopic Correlates of ASCUS Pap Smears in Pregnancy. J Low Genit Tract Dis 2002; 6:116-9. [PMID: 17051010 DOI: 10.1097/00128360-200204000-00008] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE A historic cohort analysis was performed to assess the colposcopic and histologic correlates of atypical squamous cells of undetermined significance (ASCUS) Pap smears in pregnant and nonpregnant women. MATERIALS AND METHODS A chart review of all gynecologic and obstetric patients seen in the outpatient clinic at the Maimonides Medical Center between January 1996 and December 1999 was undertaken. All of the charts of patients with ASCUS Pap smears were reviewed to confirm the diagnosis and to obtain medical and demographic information. To be eligible for inclusion, patients needed to have a documented colposcopic exam within 6 months of the ASCUS Pap smear and be between the ages of 14 and 45 years old. The records from the colposcopic examination including histologic data were subsequently reviewed. The generalized Fisher exact test was utilized to determine the exact probability. RESULTS Over a 4-year period from January of 1996 to December of 1999, 198 women were diagnosed with ASCUS on their Pap smears. A total of 122 patients met the inclusion criteria. Of those included in the study, 58 were pregnant at the time of diagnosis and 64 were nonpregnant. The mean age of the obstetric and gynecologic patients was 26.9 (range = 18-37) and 31.0 (range = 18-44) years, respectively (p = NS). Thirty-two (50%) nonpregnant patients had histologic findings of cervical intraepithelial neoplasia (CIN) compared with 15 of the 45 (33.3%) (p = .019) obstetric patients who had biopsies within the first 6 months postpartum. CIN 1 was detected in 12 of the 45 (26.7%) biopsies of the postpartum patients and 26 of the 64 (40.6%) (p = .16) gynecologic patients. CIN 2,3 was found in 2 of the 45 (4.4%) postpartum patients versus 6 of the 64 (9.4%) (p = .12) gynecologic patients. One pregnant woman with ASCUS was found to have cervical cancer (2.2%). Overall, a biopsy proven neoplastic lesion was found in 15 of 45 (33.3%) postpartum women compared with 32 of the 64 (50%) (p = .019) nonpregnant women. CONCLUSION A cytologic diagnosis of ASCUS in pregnancy is associated with a significantly lower rate of neoplasia than the rate of neoplasia found among nonpregnant women with an ASCUS smear. A risk of cervical cancer following an ASCUS Pap smear was 2.2% in our pregnant population. Therefore, ASCUS diagnosed on the Pap smear in both pregnant and nonpregnant women warrants colposcopy and close follow-up.
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Affiliation(s)
- Douglas Broderick
- Department of Obstetrics and Gynecology, Maimonides Medical Center, Brooklyn, NY 11219, USA
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Management of the Minimally Abnormal Papanicolaou Smear in Pregnancy. J Low Genit Tract Dis 2001. [DOI: 10.1097/00128360-200107000-00003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Affiliation(s)
- C W Michael
- Department of Pathology, University of Michigan, Ann Arbor 48109, USA
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15
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Bedrossian UK, Fairfax MR, Ayers M. Pap smear follow-up of possible role of mucopurulent exudate as a prognosticator of a negative pregnancy outcome. Diagn Cytopathol 1999; 21:4-6. [PMID: 10405798 DOI: 10.1002/(sici)1097-0339(199907)21:1<4::aid-dc2>3.0.co;2-v] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Our objective was to study a cohort of women by various means to detect sexually transmitted diseases (STD) and to correlate the presence of mucopurulent exudate (PEX) on Papanicolaou (Pap) smears with pregnancy outcome. Bacteriologic cultures taken from swabs for chlamydia and gonorrhea were correlated with Gen-Probe results. Smears were examined for trichomonas, yeast, HPV, obscuring mucopurulent exudate, and squamous intraepithelial abnormalities. There was no positive correlation between STD and negative pregnancy outcome. Mucopurulent exudate on Pap smears was very high in this population. Continuing study of this population of women is needed to see if larger cohorts will demonstrate any positive correlations between PEX and pregnancy outcome. Placing women with obscuring mucopurulent exudate in a "high-risk" category for complications may prevent adverse side effects to the birth product. The Pap smear works as well as the Gram stain for detection of bacterial vaginosis and cervicitis. Eliminating the Gram stain from routine pelvic exam results in cost savings.
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Affiliation(s)
- U K Bedrossian
- Department of Pathology, Wayne State University, Detroit, Michigan, USA
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Coppola A, Sorosky J, Casper R, Anderson B, Buller RE. The clinical course of cervical carcinoma in situ diagnosed during pregnancy. Gynecol Oncol 1997; 67:162-5. [PMID: 9367700 DOI: 10.1006/gyno.1997.4856] [Citation(s) in RCA: 48] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE The objective was to determine the frequency with which regression or progression of disease without treatment occurred in women diagnosed with squamous cell cervical carcinoma in situ (CIS) during pregnancy. METHODS . A retrospective chart review of all women evaluated at the University of Iowa Colposcopy Clinic diagnosed with CIS during pregnancy from 1987 through 1992 was used. Thirty-four women were evaluated during pregnancy, of which 26 also had postpartum evaluation. All pathology reports of initial cytology and biopsies, as well as colposcopic impressions, were reviewed and compared to the same evaluations postpartum. RESULTS Of the 26 women evaluated both antepartum and postpartum, only 1 was treated (cone biopsy) during pregnancy. She had disease suspicious for microinvasion. She was disease free postpartum. Of the remaining 25, 20 (80%) had persistent disease, 2 (8%) had either missed disease or progressive disease postpartum, and 3 (12%) resolved without treatment at postpartum evaluation. No statistical significance was found between route of delivery and persistence (P = 0.34). No statistical significance was found between smoking and persistence of disease (P = 1.0). In 46% of women the initial cytology was CIN I or II, and the initial colposcopic impression was found to underestimate the severity of the disease in 35% of cases. Two women were found to have invasive disease postpartum. CONCLUSIONS There is a high persistence rate of CIS complicating pregnancy. Given the relatively high rate of underestimation of disease severity by both cytology and colposcopic impression, the use of routine biopsy at the time of colposcopy is recommended. Invasive disease may be encountered on postpartum evaluation.
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Affiliation(s)
- A Coppola
- Department of Obstetrics and Gynecology, The University of Iowa Hospitals and Clinics, Iowa City, Iowa 52242, USA
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Shivvers SA, Miller DS. Preinvasive and Invasive Breast and Cervical Cancer Prior to or During Pregnancy. Clin Perinatol 1997. [DOI: 10.1016/s0095-5108(18)30171-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Benoit JL, Kini SR. "Arias-Stella reaction"-like changes in endocervical glandular epithelium in cervical smears during pregnancy and postpartum states--a potential diagnostic pitfall. Diagn Cytopathol 1996; 14:349-55. [PMID: 8725137 DOI: 10.1002/(sici)1097-0339(199605)14:4<349::aid-dc13>3.0.co;2-k] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
A wide spectrum of histologic changes has been described throughout the female genital tract during pregnancy and in the postpartum period. Of these, the endometrial glandular changes referred to as the Arias-Stella reaction have classically been a diagnostic pitfall in histologic sections. Pregnancy-related changes are also reflected in cytologic material obtained from the cervix and vagina. Both glandular and stromal alterations may be seen. The changes involving endocervical glandular epithelium are often alarming enough to cause diagnostic difficulties, especially when the history of pregnancy is not provided. We report 13 cases where marked glandular changes led to diagnostic misinterpretations. These were characterized by cyto- and karyomegaly, a high nuclear to cytoplasmic ratio, round to oval nuclei with smudgy chromatin imparting a ground glass appearance, frequent intranuclear inclusions, and vacuolated to dense variable cytoplasm. The cytologic diagnoses ranged from "glandular atypia" to "suspicious for adenocarcinoma." Follow-up was available in 11/13 cases. In 9/11 cases, subsequent cervical smears on multiple occasions were negative. Cervical biopsies and/or dilatation and curettage in 4/11 cases did not show significant glandular abnormalities. The glandular changes encountered in cytologic material were similar to those described histologically in the Arias-Stella reaction involving the cervix. This similarity and the fact that these changes disappeared upon termination of the pregnancy favors the presumption that they represent the Arias-Stella reaction. Awareness of these changes during pregnancy and postpartum may prevent interpretive errors and unnecessary surgical procedures.
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Affiliation(s)
- J L Benoit
- Division of Cytopathology, Henry Ford Hospital, Detroit, MI 48202, USA
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Abstract
Between January, 1991 and February, 1993 inclusive, 396 Papanicolaou smears were reported to show Mild Squamous Atypia with or without Human Papilloma Virus (MSA +/- HPV). All women with MSA +/- HPV smears were routinely recalled for colposcopy. To determine the significance of MSA +/- HPV on routine smear screening, the records of all patients were reviewed. Three hundred and thirty-seven women (85.1%) attended the colposcopy clinic and are the subjects analyzed for this report. The remaining 59 (14.9%) failed to attend. Intraepithelial neoplasia was found in 61 patients (18.1%), of whom 27 (8.0%) had a high grade lesion (CIN 2 or 3 or GIN 2). No patient had invasive cancer of the cervix. Only 1 of the 45 pregnant women had a significant lesion. It is concluded that all asymptomatic women with MSA +/- HPV on cervical smear may be managed in accordance with the current NH and MRC recommendations (1) and have a repeat smear in 6 months and colposcopy if the abnormality persists at 12 months.
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Affiliation(s)
- J E Dew
- Royal Hospital for Women, Paddington, New South Wales
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Baldauf JJ, Dreyfus M, Ritter J, Philippe E. Colposcopy and directed biopsy reliability during pregnancy: a cohort study. Eur J Obstet Gynecol Reprod Biol 1995; 62:31-6. [PMID: 7493705 DOI: 10.1016/0301-2115(95)02178-a] [Citation(s) in RCA: 54] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
The reliability of cytology, colposcopy, and directed biopsy were assessed in pregnancy and compared with that observed in a matched non-pregnant control group in order to evaluate the influence of pregnancy. One hundred and seventeen gravidas in which the final pathology could be ascertained and 234 control patients were examined by the same colposcopist. Concordance between cytology and final diagnosis was complete or within one degree of severity in 55.6% and 77.8% of patients, respectively. Unsatisfactory colposcopy was significantly less frequent in pregnant patients than in controls (12.8% vs. 23.1%, P = 0.023). In pregnant patients, colposcopy provided concordance, overestimation and underestimation of the final diagnosis in 72.6%, 17.6% and 9.8%, respectively. In the same group, the concordance between the histologic findings of directed biopsy and final diagnosis was complete or within one degree of severity in 83.7% and 95.9%, respectively. The reliability of cytology, colposcopy and directed biopsy was not related to pregnancy. These data show that the physiological changes which occur in pregnancy do not significantly alter the reliability of colposcopy and directed biopsy, if the colposcopist is aware of the peculiar difficulties and does not overreact to the accentuated patterns that may occur during pregnancy.
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Affiliation(s)
- J J Baldauf
- Department of Obstetrics and Gynaecology 1, Hôpitaux Universitaires de Strasbourg, Hôpital de Hautepierre, France
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