An audit of liquid‐based cytology samples reported as high‐risk human papillomavirus and borderline nuclear change in endocervical cells

Abstract

Introduction Primary human papillomavirus (HPV) screening, testing for the virus responsible for 99% of cervical cancers, was introduced in 2018‐2020 in the UK. This was preceded by HPV triage of low‐grade cytology from 2012. Much of the evidence incorporated into current National Health Service (NHS) colposcopy guidance assessed outcomes prior to this change in screening. The aim of this paper is to assess adherence to NHS cervical screening programme standards, determine the incidence of cases reported as high‐risk HPV plus borderline nuclear change in endocervical cells, to calculate colposcopic accuracy and assess histological outcomes in this cohort. Method A retrospective audit of women referred to a colposcopy clinic in one NHS trust from 2016 to 2018. Data relating to histological outcomes, cytological follow‐up and demographics were collected. Results Of 2001 referrals, 22 data sets identifying HPV‐positive borderline endocervical change were eligible for analysis (1.2% incidence). Median age was 29.5. Two‐thirds (68.2%, n = 15) had high‐grade dysplasia at diagnostic biopsy. Those women with reassuring histology had normal cytological follow‐up. Colposcopic accuracy was moderate (positive predictive value 43.8%, negative predictive value 100%). Conclusions Borderline nuclear change in endocervical cells is an uncommon condition but should be treated as a high‐grade referral. All women should be offered a diagnostic biopsy at the initial colposcopy; if no histopathological abnormality is identified, alternative sources of pathology should be considered. Excisional treatment should be recommended to unreliable attenders, those with a complete family and inadequate colposcopy (TZ3) and considered in younger women with a TZ3.

Cervical glandular neoplasia referrals and the diagnosis of adenocarcinoma in situ: Correlating cytology, colposcopy findings, and clinical outcomes

“…Specifically, a metaanalysis regarding borderline cytology on cervical samples by Schnatz et al 17 19 One audit of 22 women referred with borderline changes in endocervical cells and positive high-risk HPV revealed AIS in seven patients and high-grade CIN in eight. 20 One recent study of referrals with borderline changes in liquid-based cytology without assessment of high-risk HPV described outcomes of 4.3% and 7.2% for AIS and malignancy, respectively, with the percentage of invasive adenocarcinoma being 4.3%. 21 A similar study 22 revealed the presence of borderline referral cytology in 18% of the patients with pre-invasive or invasive cervical adenocarcinoma, with 52% of the total number of patients having low-grade or negative cytology.…”

“…The first study in the UK that documented outcomes of referrals with borderline changes of squamous cells on cytology in combination with a high‐risk HPV positive test was the Sentinel Sites study, which showed 15.7% having high‐grade CIN, including three cases of invasive cancers, in 3161 patients 19 . One audit of 22 women referred with borderline changes in endocervical cells and positive high‐risk HPV revealed AIS in seven patients and high‐grade CIN in eight 20 . One recent study of referrals with borderline changes in liquid‐based cytology without assessment of high‐risk HPV described outcomes of 4.3% and 7.2% for AIS and malignancy, respectively, with the percentage of invasive adenocarcinoma being 4.3% 21 .…”