The significance of the Papanicolaou smear diagnosis of low-grade squamous intraepithelial lesion cannot exclude high-grade squamous intraepithelial lesion

Abstract

In this article, we consider the risk management for mid‐term planning of a global multi‐product chemical supply chain under demand and freight rate uncertainty. A two‐stage stochastic linear programming approach is proposed within a multi‐period planning model that takes into account the production and inventory levels, transportation modes, times of shipments, and customer service levels. To investigate the potential improvement by using stochastic programming, we describe a simulation framework that relies on a rolling horizon approach. The studies suggest that at least 5% savings in the total real cost can be achieved compared with the deterministic case. In addition, an algorithm based on the multi‐cut L‐shaped method is proposed to effectively solve the resulting large scale industrial size problems. We also introduce risk management models by incorporating risk measures into the stochastic programming model, and multi‐objective optimization schemes are implemented to establish the tradeoffs between cost and risk. To demonstrate the effectiveness of the proposed stochastic models and decomposition algorithms, a case study of a realistic global chemical supply chain problem is presented. © 2009 American Institute of Chemical Engineers AIChE J, 2009

Is the Low-Grade Squamous Intraepithelial Lesion/Atypical Squamous Cells Cannot Exclude High-Grade Squamous Intraepithelial Lesion Category Associated with Cervical Intraepithelial Neoplasia 2?

“…Some of these terminologies are: (1) LSIL with rare atypical cells suggestive of but not diagnostic for HSIL, (2) LSIL with ASC-H, (3) LSIL cannot exclude HSIL, (4) LASC-H, (5) LSIL-H, and (6) LSIL/ASC-H [1,2,4,5,6,7,12]. In the Zeynep Kamil Hospital Pathology Laboratory, in which the current study was conducted, these lesions are defined as LSIL/ASC-H. …”

The Utility of ‘Low-Grade Intraepithelial Lesion, Cannot Exclude High Grade’ Diagnosis: A Single Institution’s Experience

“…Hong et al [10] also reported a moderate degree of nuclear atypia, such as an increased N/C ratio, hyperchromasia and coarse chromatin, and a mild degree of nuclear membrane irregularity, among the most frequently encountered morphologic findings of these borderline cells. Nasser et al [5] described atypical squamous metaplastic cells (62%), atypical keratinized cells (20%) and dysplastic cells with a borderline N/C ratio (18%) as the cytological criteria of the cells that are suggestive but not diagnostic of HGSIL. Elsheikh et al [7] included rare dysplastic cells (usually <5 cells), atypical metaplastic squamous cells and cells with an intermediate N/C ratio between LGSIL and HGSIL as the criteria, and excluded atypical keratinized cells or keratinizing dysplasia.…”

“…The cytological diagnosis of LGSIL-H is typically entertained when a Pap smear demonstrates cells with definitive changes of LGSIL and a number of atypical cells that are suggestive but not diagnostic of HGSIL, and/or the Pap smear has borderline dysplastic cells that are between LGSIL and HGSIL [4,5,7,9]. The morphologic characteristics of these cells are not uniformly defined.…”

“…TBS 2001 indicated that in occasional cases where it is not possible to grade an SIL as clearly low or high, an interpretation of ‘SIL, grade cannot be determined’ may be appropriate, though no particular criteria or data on the utility of this category and clinical follow-up were provided [2]. However, there is an increasing body of evidence that these lesions are commonly encountered by cytopathologists and need to be reported to the gynecologist in way that would transmit the pathologist’s concerns appropriately [4,5,6]. During a 3-year period reviewed in this study, we encountered 311 cases of PAP smears with changes exceeding the TBS criteria for LSIL, 144 of which had tissue follow-up.…”

Trends in Cervical Cytology Screening and Reporting Practices: Results From the College of American Pathologists 2011 PAP Education Supplemental Questionnaire

“…This finding supports the need for terminology that identifies this situation, so that women with LSIL who may have a higher-grade lesion receive colposcopies and possibly biopsies to exclude HSIL. Several studies [7][8][9][10][11] indicate that an LSIL-H interpretation has a higher likelihood of a cervical intraepithelial neoplasm 2 or 3 biopsy on follow-up than does LSIL alone.…”