Risk of significant gynaecological pathology in women with ?glandular neoplasia on cervical cytology

Talaat, Alaa; Brinkmann, Dirk; Dhundee, J.; Hana, Y.; Bevan, J. R.; Irvine, R.O.H.; Bailey, Stephen P.; Woolas, Robert

doi:10.1111/j.1365-2303.2011.00891.x

Cited by 7 publications

(15 citation statements)

References 33 publications

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“…Normal colposcopic examination and cervical biopsy may not necessarily be reassuring in glandular abnormalities, as the lesion may be small and may be located higher up in the endocervical canal. Many cases of biopsy-confirmed AIS have no observed colposcopic abnormalities and even combination of cytological testing and colposcopy can miss small endocervical adenocarcinoma or AIS localised in the endocervical canal (Luesley et al , 1987; Ullal et al , 2009; Talaat et al , 2012). Accuracy of colposcopy ranges from 9 to 50% in recognising biopsy-confirmed glandular abnormalities (Ullal et al , 2009; Talaat et al , 2012).…”

Section: Discussionmentioning

confidence: 99%

“…Many cases of biopsy-confirmed AIS have no observed colposcopic abnormalities and even combination of cytological testing and colposcopy can miss small endocervical adenocarcinoma or AIS localised in the endocervical canal (Luesley et al , 1987; Ullal et al , 2009; Talaat et al , 2012). Accuracy of colposcopy ranges from 9 to 50% in recognising biopsy-confirmed glandular abnormalities (Ullal et al , 2009; Talaat et al , 2012). Furthermore, the accuracy of colposcopy in predicting high-grade disease, is lower in low-grade cytological abnormality (12%) compared to high-grade cytological abnormality (58% Pretorius et al , 2001).…”

Section: Discussionmentioning

confidence: 99%

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Management of borderline change in endocervical cells: a more dependable approach

et al. 2014

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Background:There are limited data and guidance from the UK on borderline nuclear change in endocervical cells (BNCs). The objective of this study is to determine the clinical outcome of women with BNCs, to determine the accuracy of colposcopy and propose a more robust management algorithm.Methods:This is a retrospective review of all BNC referrals between January 2006 and December 2011 at the Northumbria Healthcare Trust. Histological diagnosis was based on high-grade histology (CIN 2 or worse). Any high-grade histology in the first year of follow-up was included in the final diagnosis.Results:Of the 9001 new referrals, 167 women had BNCs. Thirty-seven (22%) were diagnosed with high-grade histology on initial assessment. Sixty women had satisfactory and negative colposcopy, out of which 7 (12%) were detected with high-grade histology/cytology in the first year of follow-up. Overall, 50 high-grade histology (30%), including two invasive carcinomas were detected.Conclusions:Current follow-up of BNCs relies heavily on colposcopic assessment. A significant proportion of women with negative colposcopy was found to have high-grade histology in the first year of follow-up. We propose a more robust management algorithm to lower the probability of missed high-grade histology in this subgroup of women.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Management of borderline change in endocervical cells: a more dependable approach

et al. 2014

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“…Despite marked variation between regions in the incidence of ADC, there is evidence for an absolute increase in ADC . This fact partly reflects the increase in ADC relative to SCC, the inherently poor identification of adenocarcinoma in situ (AIS) by routine cytology and colposcopy, and the variation in the quality and coverage of cytological screening …”

mentioning

confidence: 99%

Human papillomavirus prevalence and type‐distribution in cervical glandular neoplasias: Results from a European multinational epidemiological study

Holl

Nowakowski

Powell

et al. 2015

Intl Journal of Cancer

134

130

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Cervical glandular neoplasias (CGN) present a challenge for cervical cancer prevention due to their complex histopathology and difficulties in detecting preinvasive stages with current screening practices. Reports of human papillomavirus (HPV) prevalence and type‐distribution in CGN vary, providing uncertain evidence to support prophylactic vaccination and HPV screening. This study [108288/108290] assessed HPV prevalence and type‐distribution in women diagnosed with cervical adenocarcinoma in situ (AIS, N = 49), adenosquamous carcinoma (ASC, N = 104), and various adenocarcinoma subtypes (ADC, N = 461) from 17 European countries, using centralised pathology review and sensitive HPV testing. The highest HPV‐positivity rates were observed in AIS (93.9%), ASC (85.6%), and usual‐type ADC (90.4%), with much lower rates in rarer ADC subtypes (clear‐cell: 27.6%; serous: 30.4%; endometrioid: 12.9%; gastric‐type: 0%). The most common HPV types were restricted to HPV16/18/45, accounting for 98.3% of all HPV‐positive ADC. There were variations in HPV prevalence and ADC type‐distribution by country. Age at diagnosis differed by ADC subtype, with usual‐type diagnosed in younger women (median: 43 years) compared to rarer subtypes (medians between 57 and 66 years). Moreover, HPV‐positive ADC cases were younger than HPV‐negative ADC. The six years difference in median age for women with AIS compared to those with usual‐type ADC suggests that cytological screening for AIS may be suboptimal. Since the great majority of CGN are HPV16/18/45‐positive, the incorporation of prophylactic vaccination and HPV testing in cervical cancer screening are important prevention strategies. Our results suggest that special attention should be given to certain rarer ADC subtypes as most appear to be unrelated to HPV.

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“…Some cancers develop in the background of small foci of cervical intraepithelial neoplasia grade 3 (CIN3) and are inherently more difficult to prevent . Others are adenocarcinomas, which are known to be more difficult to detect as precancerous lesions on cytology and at colposcopy . When women in their 20s and 30s are found to have cancer they are naturally surprised as well as distressed.…”

Section: Interval Cancers In Young Womenmentioning

confidence: 99%

“…15 Others are adenocarcinomas, which are known to be more difficult to detect as precancerous lesions on cytology and at colposcopy. 16,17 When women in their 20s and 30s are found to have cancer they are naturally surprised as well as distressed. However, now that regular screening has controlled invasive cervical cancer in older age groups its peak incidence in England is in women between 25 and 35 years of age.…”

Section: Interval Cancers In Young Womenmentioning

confidence: 99%

Disclosure of cervical cancer audits: how to be honest without making matters worse

Herbert

2013

Cytopathology

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Risk of significant gynaecological pathology in women with ?glandular neoplasia on cervical cytology

Abstract: At least CIN2 was found in 81.5% in women referred with cervical cytology reporting ?glandular neoplasia. A thorough evaluation of the whole genital tract is needed if colposcopy is negative.

Cited by 7 publications

References 33 publications

Management of borderline change in endocervical cells: a more dependable approach

Management of borderline change in endocervical cells: a more dependable approach

Human papillomavirus prevalence and type‐distribution in cervical glandular neoplasias: Results from a European multinational epidemiological study

Disclosure of cervical cancer audits: how to be honest without making matters worse

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