Cervical smears: new terminology and new demands.

Fox, Harold

doi:10.1136/bmj.294.6583.1307

Cited by 18 publications

(4 citation statements)

References 9 publications

(5 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Almost 86% of CINIII was detected following a moderately or severely dyskaryotic smear. The ratio of other grades of abnormality to severe dyskaryosis was unaltered and similar to other studies at 3.6:1 1,17,18 . There was poor agreement over low grade CIN and HPVI between cytology, colposcopy and histology, consistent with other evidence that these diagnoses are not reproducible 15,[19][20][21] .…”

Section: Discussionsupporting

confidence: 91%

“…Improving the discriminatory power of cytology is important in achieving the best use of resources for managing women with abnormal smears 16,17 . Invasive cancer and CINIII are usually accepted as reproducible end-points for significant disease in assessing cervical screening or diagnosis 15,18,19 . Following the introduction of quality assurance for cytology by review of smears showing discrepancies between cytology, colposcopy and histology no patient with a single mild dyskaryotic or borderline smear had invasive cancer, and the risk of CINIII was much less than that reported in previous studies, including our own [7][8][9][10] .…”

Section: Discussionmentioning

confidence: 99%

“…The policy of prompt referral for colposcopy has been criticised as causing many patients the embarrassment and discomfort of an examination which infrequently discloses serious disease, and often finds only a small, low grade lesion which may regress spontaneously 16,18,[22][23][24] . With appropriate quality assurance to improve cytological discrimination, a rigorous programme of cytological follow up is an attractive and effective alternative to immediate colposcopy for managing low grade smear abnormalities in women who can comply.…”

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Regular audit of colposcopic biopsies from women with a mildly dyskaryotic or borderline cervical smear results in fewer cases of CINIII

1996

View full text Add to dashboard Cite

Two years after introducing mandatory review of cases in which the cervical smear was discrepant with subsequent colposcopic or histological finding, the predictive accuracy of a first abnormal smear and the need for treatment were analysed. The results were compared with performance figures prior to this form of audit policy. Over 12 months 415 women referred for colposcopy were studied. Three per cent of patients with a single borderline smear and 6% with mild dyskaryosis had cervical intraepithelial neoplasia grade III (CINIII) revealed in histopathological examinations after colposcopy. Only 25% with a borderline smear and 33% with mild dyskaryosis required treatment. Of women with moderate dyskaryosis, 18% had a biopsy showing CINIII and 46% were treated. Of women with severe dyskaryosis in their cervical smear, 61% were shown to have CINIII or invasive cancer on biopsy and 90% were treated. Regular audit improved cytological prediction of grade of epithelial abnormality found on biopsy, allowing accurate, safe surveillance for minor smear abnormalities.

show abstract

Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Regular audit of colposcopic biopsies from women with a mildly dyskaryotic or borderline cervical smear results in fewer cases of CINIII

1996

View full text Add to dashboard Cite

show abstract

“…'6 Continued follow up remains necessary after treatment. 9 Monitoring low grade cytological abnormalities by repeat cytology reduces unnecessary treatment, but with some cost in delayed diagnosis of high grade precancer, although the implications for invasive cancer are less clear.7-9 It is not practical to test every possible combination of screening and management of cytological abnormality in a formal controlled trial. '7 This paper presents a mathematical technique for estimating the interrelated effects of different policies for cervical screening and for the management of cytological abnormalities.…”

mentioning

confidence: 99%

Cytological screening and management of abnormalities in prevention of cervical cancer: an overview with stochastic modelling.

Sherlaw-Johnson

Gallivan

Jenkins

et al. 1994

Journal of Clinical Pathology

View full text Add to dashboard Cite

Aims-To develop a mathematical model of the histological changes of precancer and the development of invasive cancer and how these are related to cytological findings. To use this to investigate the effects on incidence of cervical cancer, number of smear tests and colposcopies, of different schedules for cervical screening, and the clinical management policies for dyskaryosis. Methods-A stochastic model was developed relating the available data on tissue progression to the cytological findings. Two strategies, A and B, were compared: under A, women with any abnormal smear receive immediate colposcopy and treatment; under B, women with mild or borderline dyskaryosis have repeated smears at six monthly intervals with colposcopy only for persistent abnormalities. Results-The model predicted an incidence of invasive cervical cancer in an unscreened population of women aged over 18 years of 5 9 per 10 000 per year. With 70% coverage and three yearly screening under strategy A, the incidence fell to 2-00 and under B to 2*10. The number of smears required was similar but A required two to three times as many colposcopies as B. Raising the coverage to 90% reduced the incidence to around 1 per 10 000 per year but changing the screening interval, the specificity or sensitivity of cytology had much less effect. Conclusion-The model has been tested under a wide range of possible variations in natural history, specificity and sensitivity of cytology. For low grade smear abnormalities, open colposcopic referral is predicted to reduce invasive cancer only slightly more than repeat cytology, at the expense of much additional colposcopy. Improving cytological coverage is suggested as more effective in reducing invasive cancer than increased use of colposcopy or more frequent screening. ( Clin Pathol 1994;47:430-435) Cervical screening is important and costly. Evaluating the overall effectiveness of cervical screening in relation to the contribution of different components is difficult. Determining overall policy requires the evaluation of many possible alternative combinations of cytology, colposcopy, and treatment for their effectiveness in preventing the progression of precancer to invasion and death.There has been debate, reflected by wide variations of practice,34 concerning the relative merits of screening at intervals of less than five years, of achieving more complete coverage of women at risk, and of colposcopy or repeat cytology for low grade smear abnormalities.5-9 This has arisen mainly from concern about the limited accuracy of cytology for the detection and grading of tissue changes of precancer and invasive cancer, and uncertainty about the natural history of precancer.There is detailed information about the effectiveness of colposcopy and the sensitivity and specificity of cervical cytology for detecting cervical abnormality and for predicting its histological grade.'1"2 There are also areas of uncertainty. High grade precancer (CIN 3) has a high risk of progressing to invasion'3 but much borderline or...

show abstract

HPV typing of cervical squamous lesions by in situ HPV DNA hybridization: Influence of HPV type and therapy on the follow‐up of low‐grade squamous cervical disease

Ghirardini

Aloisi

et al. 1994

Diagnostic Cytopathology

View full text Add to dashboard Cite

Papanicolaou (Pap)-stained cervical specimens from 160 squamous lesions were processed for the detection of human papillomavirus (HPV) DNA by an in situ hybridization (ISH) assay. Three biotinylated HPV DNA probes were employed, each containing HPV genotypes 6/11, HPV genotypes 16/18, or HPV genotypes 31/35/51. The HPV etiology of 86 lesions was ascertained (53.8%). In 74 out of 135 (58.8%) HPV-typed low-grade squamous intraepithelial lesions (SILs), HPV 6/11 was found in nine (6.6%), HPV 16/18 in 46 (34.2%), and HPV 31/35/51 in 19 lesions (14.1%); in 11 out of 18 HPV-typed high-grade SILs (61.1%), seven lesions (38.9%) were typed for HPV 16/18 and four (22.2%) for HPV 31/35/51. Of seven invasive carcinomas, only one (14.3%) reacted with the HPV 16/18 DNA probe. A cohort of 124 low-grade SILs were followed cytologically for a year. The results of this study are discussed in light of HPV type association and therapy.

show abstract

Cervical smears: new terminology and new demands.

Cited by 18 publications

References 9 publications

Regular audit of colposcopic biopsies from women with a mildly dyskaryotic or borderline cervical smear results in fewer cases of CINIII

Regular audit of colposcopic biopsies from women with a mildly dyskaryotic or borderline cervical smear results in fewer cases of CINIII

Cytological screening and management of abnormalities in prevention of cervical cancer: an overview with stochastic modelling.

HPV typing of cervical squamous lesions by in situ HPV DNA hybridization: Influence of HPV type and therapy on the follow‐up of low‐grade squamous cervical disease

Contact Info

Product

Resources

About