European guidelines for quality assurance in cervical cancer screening: recommendations for collecting samples for conventional and liquid‐based cytology*

Arbyn, Marc; Herbert, Amanda; Schenck, U; Nieminen, Pekka; Jordan, J. A.; McGoogan, E; Patnick, Julietta; Bergeron, Christine; Jj, Baldauf; Klinkhamer, Paul J. J. M.; Bulten, Johan; Martin-Hirsch, P

doi:10.1111/j.1365-2303.2007.00464.x

Cited by 98 publications

(89 citation statements)

References 12 publications

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“…The most striking finding was that SBLB ec2 was significantly more often diagnosed in women aged 45 years or older. This may also be an effect of less accessibility of the transformation zone in older women 12 and more frequent presence of cellular atrophy in older women, in which endocervical cells are more difficult to diagnose. The impact of the study site on the unsatisfactory rate was exclusively due to unsatisfactory result based on scant cellularity.…”

Section: Resultsmentioning

confidence: 99%

“…Cell samples for conventional cytology were spread on a glass slide and fixed within seconds, whereas cell samples for LBC were transferred from the brush to a vial containing PreservCyt fixative and transport medium by rotating and pushing the brush vigorously against the vial wall 10 times. 12 The LBC samples were processed at the laboratory with the ThinPrep 3000 processor (Hologic).…”

Section: Methodsmentioning

confidence: 99%

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Causes and Relevance of Unsatisfactory and Satisfactory but Limited Smears of Liquid-Based Compared With Conventional Cervical Cytology

Siebers¹,

Klinkhamer²,

Vedder³

et al. 2012

Archives of Pathology &Amp; Laboratory Medicine

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N Context.-Recent randomized controlled trials have shown a significant decrease in unsatisfactory rates for liquid-based cytology (LBC) compared with conventional Papanicolaou test (CP). The underlying causes and relevance of unsatisfactory results for LBC and CP have never been compared within the setting of a randomized controlled trial.Objective.-To examine differences in causes and relevance of unsatisfactory and satisfactory but limited by (SBLB) results for LBC and CP.Design.-Data from the Netherlands ThinPrep Versus Conventional Cytology (NETHCON) trial were used, involving 89 784 women. Causes and relevance of unsatisfactory and SBLB results were analyzed.Results.-The primary cause for unsatisfactory results for CP and LBC was scant cellularity. Other causes for unsatisfactory CPs were virtually eliminated with LBC. The same was true for SBLB subcategories, with the exception of SBLB absence of transformation zone component and SBLB scant cellularity. The SBLB absence of transformation zone component showed a statistically significant 22% and SBLB scant cellularity a 12% nonsignificant increase with LBC. The detection rates of abnormalities found during 18 months of follow-up of unsatisfactory test results did not differ significantly between the 2 study arms, nor did they differ from the initial test positivity rates from the NETHCON trial.Conclusions.-Liquid-based cytology shows an almost complete elimination of most causes for unsatisfactory CP, with scant cellularity remaining as the sole cause for unsatisfactory LBC. On the other hand, with LBC a significant increase of smears without a transformation zone component was noted. Women with an unsatisfactory test result are not at increased risk for cervical abnormalities either with LBC or with CP.Trial Registration.-Nederlands Trial Register, NTR1032, www.trialregister.nl.(Arch Pathol Lab Med. 2012;136:76-83; doi: 10.5858/ arpa.2011-0113-OA) L iquid-based cytology (LBC) has been largely adopted as an alternative to cervical cancer screening with conventional Papanicolaou tests (CP) in many Western countries. However, recent evidence from 2 randomized controlled trials (RCTs) 1,2 and a meta-analysis comparing the performance of LBC and CP 3 supports the conclusion of equal accuracy for both methods. Yet the RCT has shown a significant decrease in unsatisfactory rates for LBC as compared with CP. 4 Unsatisfactory tests account for a number of screening failures, and are a source of distress to women and a waste of resources.5 It is assumed that LBC decreases the unsatisfactory rate by reducing the number of cases that are inadequate because of obscuring inflammatory cells and blood or because of inhomogeneous distribution or bad fixation of cells. However, to our knowledge differences in the underlying causes and relevance of unsatisfactory smear results for LBC as compared with CP have never been investigated within the setting of an RCT. The aim of the study is to examine the underlying causes for inadequacy in LBC and CP, using the data of the Neth...

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Section: Resultsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Causes and Relevance of Unsatisfactory and Satisfactory but Limited Smears of Liquid-Based Compared With Conventional Cervical Cytology

Siebers¹,

Klinkhamer²,

Vedder³

et al. 2012

Archives of Pathology &Amp; Laboratory Medicine

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“…In the latter case, it is useful for the laboratory to provide advice and sampling devices to the smear taker. 3 Antimicrobial treatment is indicated before re-sampling if there is any suspicion of infection. Similarly, if the first smear was atrophic a second smear is recommended after topical oestrogenic treatment.…”

Section: Repeat Cytologymentioning

confidence: 99%

European guidelines for quality assurance in cervical cancer screening: recommendations for clinical management of abnormal cervical cytology, part 1

et al. 2008

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European guidelines for quality assurance in cervical cancer screening: recommendations for clinical management of abnormal cervical cytology, part 1The current paper presents the first part of Chapter 6 of the second edition of the European Guidelines for Quality Assurance in Cervical Cancer Screening. It provides guidance on how to manage women with abnormal cervical cytology. Throughout this article the Bethesda system is used for cervical cytology terminology, as the European guidelines have recommended that all systems should at least be translated into that terminology while cervical intraepithelial neoplasia (CIN) is used for histological biopsies (Cytopathology 2007; 18:213-9). A woman with a high-grade cytological lesion, a repeated low-grade lesion or with an equivocal cytology result and a positive human papillomavirus (HPV) test should be referred for colposcopy. The role of the colposcopist is to identify the source of the abnormal cells and to make an informed decision as to whether or not any treatment is required. If a patient requires treatment the colposcopist will decide which is the most appropriate method of treatment for each individual woman. The colposcopist should also organize appropriate follow-up for each woman seen. Reflex testing for high-risk HPV types of women with atypical squamous cells (ASC) of undetermined significance with referral for colposcopy of women who test positive is a first option. Repeat cytology is a second possibility. Direct referral to a gynaecologist should be restricted to special circumstances. Follow-up of low-grade squamous intraepithelial lesion is more difficult because currently there is no evidence to support any method of management as being optimal; repeat cytology and colposcopy are options, but HPV testing is not sufficiently selective, unless for older women. Women with high-grade squamous intraepithelial lesion (HSIL) or atypical squamous cells, cannot exclude HSIL (ASC-H) should be referred without triage. Women with glandular lesions require particular attention. In a subsequent issue of Cytopathology, the second part of Chapter 6 will be presented, with recommendations for management and treatment of histologically confirmed intraepithelial neoplasia and guidance for follow-up of special cases such as women who are pregnant, postmenopausal or immunocompromised.

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“…18 A retrospective case-control study was possible because HPV geno-typing was performed systematically in labo RIATOL since the beginning of 2000.…”

Section: Cervical Cytology and Hpv Testingmentioning

confidence: 99%

Type‐specific HPV geno‐typing improves detection of recurrent high‐grade cervical neoplasia after conisation

Heymans

Benoy²,

Poppe

et al. 2011

Intl Journal of Cancer

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The aim of this case-control study was to examine if type-specific human papillomavirus (HPV) DNA geno-typing before and after treatment of high-grade cervical intra-epithelial neoplasia (CIN) improves prediction of recurring or persisting CIN 2 or 3 compared with follow-up cytology or high-risk (hr)HPV testing. Women with biopsy-proven recurrence of CIN 2 or 3 (cases) in a follow-up period of at least 24 months after treatment of high-grade CIN were compared with women without recurrence (controls). These cohorts were identified by a database search of the Riatol Laboratoria (Antwerp, Belgium). In a cohort of 823 women treated with conisation for high-grade CIN between January 2001 and December 2007, 21 patients with a histologically proven recurrence of CIN21 were identified. A group of women (n 5 42) from the same cohort without recurrence was randomly chosen. We found that hrHPV testing at 6 months post-treatment is significantly more sensitive compared with follow-up cytology (ratio: 1.31, 95% confidence interval (CI): 1.10-1.54), but less specific (ratio: 0.85, 95% CI: 0.81-0.90) to predict failure of treatment. When compared with hrHPV testing, HPV geno-typing is more efficient (equal sensitivity, but higher specificity, ratio: 1.43, 95% CI: 1.280-1.62). When compared with follow-up cytology, HPV geno-typing is more sensitive (ratio: 1.31, 95% CI: 1.10-1.54) and more specific (ratio: 1.22, 95% CI: 1.14-1.36). All women who developed a recurrence tested positive for hrHPV. The negative predictive value in the absence of hrHPV DNA was 100%. Six months after treatment HPV genotyping is the most sensitive and specific method to predict recurrent or persistent CIN 2-3 in the next 24 months.There is now overwhelming evidence that a persistent infection with a high-risk human papillomavirus (hrHPV) is the key event in the development of cervical cancer and its precursor lesions, high-grade cervical intra-epithelial neoplasia (CIN 2).1-4 The diagnosis of high-grade CIN 2-3 carries a significant risk of developing invasive carcinoma if it is not detected early and left untreated.5 Conservative treatment with large loop excision of the transformation zone (LLETZ) or conisation is the standard procedure for high-grade CIN and usually results in a complete cure, but residual or recurrent disease still occurs on average in 10% of treated cases. 6 Most treatment failures occur during the first 2 years after surgery. Therefore, according to the current guidelines in most western countries, women who have been treated for CIN2þ, afterward remain under gynaecological surveillance, with cervical smears taken at 6, 12 and 24 months post-treatment.7 Later, they are seen annually until the last two smears read as normal.Various studies have investigated potential predictive factors to identify the women at risk for recurrent disease. These factors include size of the lesion, grade of dysplasia, age, incomplete removal of the lesion and immunosuppressive therapy. 8-11Since persistent cervical infection with hrHPV has been iden...

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European guidelines for quality assurance in cervical cancer screening: recommendations for collecting samples for conventional and liquid‐based cytology*

Cited by 98 publications

References 12 publications

Causes and Relevance of Unsatisfactory and Satisfactory but Limited Smears of Liquid-Based Compared With Conventional Cervical Cytology

Causes and Relevance of Unsatisfactory and Satisfactory but Limited Smears of Liquid-Based Compared With Conventional Cervical Cytology

European guidelines for quality assurance in cervical cancer screening: recommendations for clinical management of abnormal cervical cytology, part 1

Type‐specific HPV geno‐typing improves detection of recurrent high‐grade cervical neoplasia after conisation

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