Risk of CIN2 in Women With a Pap Test Without Endocervical Cells vs. Those With a Negative Pap Test With Endocervical Cells

Rossi, Paolo; Baiocchi, Diego; Ciatto, Stefano

doi:10.1159/000325033

Cited by 5 publications

(9 citation statements)

References 23 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Our results are consistent with most other cohort studies, that is, no excess HGA or cancer following negative smears without ECC when compared to women with negative smears with ECC . The results were similar whether studies used histological or cytological endpoints .…”

Section: Discussionsupporting

confidence: 92%

“…These studies concluded that the presence of ECC in the smear is associated with increased detection of squamous abnormalities suggesting a higher sensitivity of smears with ECC . However, cross‐sectional studies are limited primarily because it is not possible to determine if the increased detection of abnormalities in smears with ECC is due to the higher sensitivity of these smears or the presence of the lesions in the cervix that allows convenient sampling of the TZ (or ECC) . The case–control studies and case‐series studies of review of smears prior to histological diagnosis of CIN showed that endocervical columnar cells (that defines the ECC) were less likely to be present in false‐negative smears compared to true positive smears; but the difference was not statistically significant.…”

Section: Discussionmentioning

confidence: 99%

“…Although cohort studies provide the strongest evidence, they have some limitations . Most prior cohort studies were conducted during the time when ECC‐ smears required early repeat smears.…”

Section: Discussionmentioning

confidence: 99%

“…Six previous cohort studies have followed women who had an initial normal (index) smear to determine whether their risk of a histologically‐confirmed HGA or invasive cervical cancer was higher when the smear had no ECC . All but one study showed that women whose index smear had no ECC were at either lower or equal likelihood of having a subsequently detected cervical intraepithelial neoplasia grade 2 lesion or higher (CIN2+) than women whose index smear contained an ECC.…”

mentioning

confidence: 99%

“…Six previous cohort studies have followed women who had an initial normal (index) smear to determine whether their risk of a histologically-confirmed HGA or invasive cervical cancer was higher when the smear had no ECC. [10][11][12][13][14][15] All but one study 10 showed that women whose index smear had no ECC were at either lower or equal likelihood of having a subsequently detected cervical intraepithelial neoplasia grade 2 lesion or higher (CIN21) than women whose index smear contained an ECC. Only one cohort study had sufficient cases (n 5 243) to analyse incidence of invasive cervical cancer; and in that study the incidence rate did not vary by ECC status of the index smear after eight years of follow-up (OR: 1.01 95% CI: 0.68-1.49).…”

mentioning

confidence: 99%

See 4 more Smart Citations

High‐grade cervical abnormalities and cervical cancer in women following a negative Pap smear with and without an endocervical component: A cohort study with 10 years of follow‐up

Sultana

English

Simpson

et al. 2014

Intl Journal of Cancer

View full text Add to dashboard Cite

The proportion of Pap smears containing an endocervical component (ECC) has been declining in Australia. Given that ECC negative (ECC2) smears may be associated with reduced sensitivity, we undertook a retrospective cohort study to estimate rates of histologically confirmed high-grade cervical abnormality (HGA) and cancer in women with negative Pap smears with and without an ECC. Women 18-69 years with at least two Pap smears between 1 January 2001 and 31 December 2010 with the first smear in that period (index smear) showing no abnormality were eligible. Follow-up ended at date of the first abnormal smear, date of histological diagnosis, date of hysterectomy, date of death, or 31 December 2010, whichever came first. ECC status was treated as a time varying exposure. Follow-up was split at each smear after the index smear. Poisson regression was used to estimate adjusted incidence rates and incidence rate ratios (IRR) by ECC status. The incidence rate of histologically confirmed HGA was significantly lower following ECC2 smears than after ECC1 smears (adjusted IRR: 0.69, 95%Confidence Interval (CI) 0.62-0.77), particularly at older ages (interaction between ECC status and age, p 5 0.001). In contrast, the overall rate of invasive cancer was not significantly different after ECC2 than after ECC1 smears (IRR: 1.27, 95%CI 0.90-1.77). In conclusion, women had a lower rate of confirmed HGA and no significant increase in the rate of invasive cervical cancer following ECC2 smears. This study does not support differential (accelerated) follow-up in women with a negative smear without an endocervical component.Substantial reductions in cervical cancer incidence and mortality have been achieved in most developed countries, including Australia, through organized screening programs based on Papanicolaou (Pap) smears. 1 The objective of taking a Pap smear is to sample the transformation zone (TZ) and detect precancerous lesions, if present, and treat them before they develop into cancer. The TZ is the area of the cervix where the transformation from the columnar epithelium to squamous epithelium takes place and is the site where most cervical cancers and intraepithelial lesions develop.1 The presence of columnar cells (also known as endocervical cells or an endocervical component (ECC)) in the smear, although not required for a smear to be "satisfactory for evaluation," is an indication that the TZ has been sampled 2 and traditionally considered an indicator of specimen adequacy. 3Most cross-sectional studies show that the prevalence of cervical intraepithelial neoplasia (CIN) is lower in smears without an ECC (ECC-) than in smears that have an ECC (ECC1). [4][5][6][7] Case-control studies of smears that preceded a histologic diagnosis of CIN and that correctly predicted CIN were more likely to include the ECC than smears that failed to predict the CIN lesion, suggesting that false-negative results may be an issue. 8,9 These findings have raised concerns as to whether Pap smears without ECC are less sensitive in detecting pr...

show abstract

Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

See 3 more Smart Citations

High‐grade cervical abnormalities and cervical cancer in women following a negative Pap smear with and without an endocervical component: A cohort study with 10 years of follow‐up

Sultana

English

Simpson

et al. 2014

Intl Journal of Cancer

View full text Add to dashboard Cite

show abstract

Worldwide incidence of cervical lesions: a systematic review

et al. 2014

View full text Add to dashboard Cite

We conducted a systematic review summarizing data on incidence of high- and low-grade lesions in women with normal baseline cervical cytology, stratified by age (<30 and ⩾30 years), and baseline human papillomavirus (HPV) infection. Incidence of high- and low-grade lesions in women aged ⩾30 years with a baseline HPV infection increased over follow-up time (5-127 months), although incidence generally remained <10%. Without baseline HPV infection, incidence of high-grade lesions remained low over follow-up time (<5% over 5-122 months). Incidence of high-grade lesions in women aged ⩾30 years with baseline HPV infection appeared similar to that in women aged <30 years. In some women aged <30 years, high-grade lesions can develop relatively shortly after initial HPV infection. We observed an increase in low-grade lesions over time in women aged ⩾30 years with baseline HPV infection, potentially indicative of an HPV infection that is potentially progressing to higher grade lesions.

show abstract

HPV Testing Is an Efficient Management Choice for Women With Inadequate Liquid-Based Cytology in Cervical Cancer Screening

et al. 2012

View full text Add to dashboard Cite

This study compares colposcopy referrals of 2 management strategies: oncogenic human papillomavirus (HPV)-DNA testing (Hybrid Capture 2 assay, Qiagen, Germantown, MD) and repeat cytology. In the New Technology in Cervical Cancer Trial, 22,708 subjects were randomly assigned to undergo both HPV and liquid-based cytologic testing. Women aged 35 to 60 years old with unsatisfactory cytologic findings were directly referred for colposcopy if the HPV test result was positive, and were referred for repeat cytologic examination if the HPV test result was negative; women aged 25 to 35 years old were referred for repeat cytologic examination independent of HPV test results. A positive or a second unsatisfactory cytologic examination referred women for colposcopy. Five hundred sixty women had unsatisfactory cytologic findings. Colposcopy referral was not significant and slightly higher with HPV testing than repeat cytologic test (9.8% vs 6.8%, P = .11). When cytologic testing was repeated 36.8% were unavailable for follow-up and most of the colposcopies were performed in HPV-negative women. For unsatisfactory cytologic findings, HPV triage is a more logical and efficient management strategy than a repeat cytologic test.

show abstract

Risk of CIN2 in Women With a Pap Test Without Endocervical Cells vs. Those With a Negative Pap Test With Endocervical Cells

Cited by 5 publications

References 23 publications

High‐grade cervical abnormalities and cervical cancer in women following a negative Pap smear with and without an endocervical component: A cohort study with 10 years of follow‐up

High‐grade cervical abnormalities and cervical cancer in women following a negative Pap smear with and without an endocervical component: A cohort study with 10 years of follow‐up

Worldwide incidence of cervical lesions: a systematic review

HPV Testing Is an Efficient Management Choice for Women With Inadequate Liquid-Based Cytology in Cervical Cancer Screening

Contact Info

Product

Resources

About