Cervical Cytology Screening History of Women Diagnosed with Adenocarcinoma in Situ of the Cervix

Comparative sensitivities of ThinPrep and Papanicolaou smear for adenocarcinoma in situ (AIS) and combined AIS/high-grade squamous intraepithelial lesion (HSIL): Comparison with HSIL

“…1,[5][6][7][8][9] The current results indicate that, for histologic AIS alone, PS and TP have similar sensitivities, whether we define sensitivity as the detection of any abnormality, or as the detection of a high-grade abnormality, or as the detection of a high-grade glandular abnormality.…”

“…Despite a rising incidence of CAC in many countries, [1][2][3][4] there is emerging evidence that cytologic detection of the precursor lesion, adenocarcinoma in situ (AIS), may reduce the incidence of and mortality from CAC. 1,[5][6][7][8][9][10] Although many countries have replaced conventional cervical cytology with liquid-based cytology (LBC), currently in Australia, LBC, mostly ThinPrep (TP), is used as an optional adjunctive test to the conventional Papanicolaou (Pap) smear (PS). Although this may appear cumbersome, one advantage is that it gives us the opportunity to compare paired samples and, consequently, to learn how to recognize the corresponding morphologic appearances on TP slides.…”

Incidence Trends of Adenocarcinoma of the Cervix in 13 European Countries

“…Mitchell et al (29) observed decreases among Australian women who had a pap smear with endocervical material within 1 year, or with an increasing number of pap smears with an endocervical component. One explanation for an increasing ability to detect endocervical lesions in cervical screening involves the improved diagnostic yield via use of the extended tip spatula or the Cervex (endocervical) brush, or a combination of both (65), as well as an understanding and recognition of adenocarcinoma in situ (30). Nevertheless, in the province of Florence, Italy, the extended tip spatula has been in common use since the 1980s (66), and has had little impact on the increasing adenocarcinoma rates in women ages <55 (67), whereas in a case-control study within the same region, the use of the cytobrush did not seem to offer any significant protection from adenocarcinoma (28).…”

“…Cytologic screening has been shown to effectively detect squamous cell carcinoma in early stages, whereas adenocarcinomas have been reported to be less detectable by screening (26)(27)(28). However, recent work by Mitchell and colleagues in Australia, investigating the efficacy of cytologic examinations in the 1990s, reported that screening has offered an increasing level of protection against adenocarcinoma (29), citing improved endocervical sampling and the recognition that adenocarcinoma in situ is the precursor to invasive adenocarcinoma as responsible (30).…”

Is Improved Detection of Adenocarcinoma in Situ by Screening a Key to Reducing the Incidence of Cervical Adenocarcinoma?

“…1,2,4,8,25 An important step forward in validating the concept of AIS as a predominantly screening-detected disease is made in a paper by Mitchell et al, published in this issue of Acta Cytologica. 27 The authors reason that if the increased incidence of AIS 6 were due to improved detection by Pap smear screening, then the screening history of women with diagnosed AIS should be equivalent to that of healthy controls, including the sampling efficiency of endocervical cells in the smears. The authors designed a case-control (1:4) study analyzing the screening history of women with biopsy-confirmed AIS as an outcome measure.…”