Gynecologic Cytopathology
Log in to MyKarger to check if you already have access to this content.
Buy FullText & PDF Unlimited re-access via MyKarger Unrestricted printing, no saving restrictions for personal use read more
CHF 38.00 *
EUR 35.00 *
USD 39.00 *
Buy a Karger Article Bundle (KAB) and profit from a discount!
If you would like to redeem your KAB credit, please log in.
Save over 20% compared to the individual article price. Rent via DeepDyve Unlimited fulltext viewing of this article Organize, annotate and mark up articles Printing and downloading restrictions apply Subscribe Access to all articles of the subscribed year(s) guaranteed for 5 years Unlimited re-access via Subscriber Login or MyKarger Unrestricted printing, no saving restrictions for personal use read more Select* The final prices may differ from the prices shown due to specifics of VAT rules.
Article / Publication DetailsFirst-Page Preview
Received: September 01, 2022
Accepted: November 08, 2022
Published online: January 26, 2023
Number of Print Pages: 14
Number of Figures: 5
Number of Tables: 0
ISSN: 0001-5547 (Print)
eISSN: 1938-2650 (Online)
For additional information: https://www.karger.com/ACY
AbstractBackground: Squamous intraepithelial lesions observed in Papanicolaou (Pap) test gynecologic cytology arise as a result of infection of the cervicovaginal tract by human papillomavirus (HPV). The viral cytopathic effect of HPV manifests as koilocytosis, also known as low-grade squamous intraepithelial lesion (LSIL) in The Bethesda System (TBS). Integration of HPV genetic material into the genome of squamous cells can, in some women, result in progressive accumulation of mutations and abnormalities of growth and maturation leading to high-grade squamous intraepithelial lesion (HSIL) and possibly invasive squamous cell carcinoma. Due to morphologic overlap between reactive processes and these changes related to HPV, TBS includes equivocal categories that may be applied to Pap tests with uncertain morphology: atypical squamous cells of undetermined significance (ASC-US) and atypical squamous cells cannot exclude HSIL (ASC-H). Quality assurance (QA) measures in gynecologic cytology laboratories aim to maximize the sensitivity for LSIL and HSIL lesions while simultaneously keeping the use of ASC-US at reasonable levels. Summary: TBS provides a comprehensive nomenclature for squamous abnormalities encountered in screening, but subjectivity in interpretation remains. QA practices attempt to identify problematic patterns of misinterpretation for correction. Key Message: This review aimed to provide practical recommendations for cytology practitioners seeking to alter their interpretive thresholds for ASC-US, LSIL, and HSIL in response to feedback from QA procedures indicating deviation from desired norms.
© 2023 S. Karger AG, Basel
References Crosbie EJ, Einstein MH, Franceschi S, Kitchener HC. Human papillomavirus and cervical cancer. Lancet. 2013;382(9895):889–99. Mittal S, Banks L. Molecular mechanisms underlying human papillomavirus E6 and E7 oncoprotein-induced cell transformation. Mutat Res Rev Mutat Res. 2017;772:23–35. Muñoz N, Bosch FX, de Sanjosé S, Herrero R, Castellsagué X, Shah KV, et al. Epidemiologic classification of human papillomavirus types associated with cervical cancer. N Engl J Med. 2003;348(6):518–27. Nayar R, Wilbur DC. The Bethesda system for reporting cervical cytology: definitions, criteria, and explanatory notes. 3rd ed. Cham, Switzerland: Springer; 2015. Darragh TM, Colgan TJ, Cox JT, Heller DS, Henry MR, Luff RD, et al.; Members of LAST Project Work Groups. The lower anogenital squamous terminology standardization project for HPV-associated lesions: background and consensus recommendations from the College of American Pathologists and the American society for colposcopy and cervical Pathology. Arch Pathol Lab Med. 2012;136(10):1266–97. Plummer M, Schiffman M, Castle PE, Maucort-Boulch D, Wheeler CM; ALTS Group. A 2-year prospective study of human papillomavirus persistence among women with a cytological diagnosis of atypical squamous cells of undetermined significance or low-grade squamous intraepithelial lesion. J Infect Dis. 2007;195(11):1582–9. Rosalik K, Tarney C, Han J. Human papillomavirus vaccination. Viruses. 2021;13(6):1091. Solomon D, Schiffman M, Tarone R, ALTS Study group. Comparison of three management strategies for patients with atypical squamous cells of undetermined significance: baseline results from a randomized trial. J Natl Cancer Inst. 2001;93(4):293–9. Alrajjal A, Pansare V, Choudhury MSR, Khan MYA, Shidham VB. Squamous intraepithelial lesions (SIL: LSIL, HSIL, ASCUS, ASC-H, LSIL-H) of uterine cervix and Bethesda system. Cytojournal. 2021;18:16. Schmidt JL, Henriksen JC, McKeon DM, Savik K, Gulbahce HE, Pambuccian SE. Visual estimates of nucleus-to-nucleus ratios: can we trust our eyes to use the Bethesda ASCUS and LSIL size criteria? Cancer. 2008;114(5):287–93. Hoda RS, Loukeris K, Abdul-Karim FW. Gynecologic cytology on conventional and liquid-based preparations: a comprehensive review of similarities and differences. Diagn Cytopathol. 2013;41(3):257–78. Crothers BA, Jones BA, Cahill LA, Moriarty AT, Mody DR, Tench WD, et al. Quality improvement opportunities in gynecologic cytologic-histologic correlations: findings from the College of American Pathologists Gynecologic Cytopathology Quality Consensus Conference working group 4. Arch Pathol Lab Med. 2013;137(2):199–213. Renshaw AA. Rescreening in cervical cytology for quality control. When bad data is worse than no data or what works, what doesn’t, and why. Clin Lab Med. 2003;23(3):695–708. Brooke D, Dudding N, Sutton J. Rapid (partial) prescreening of cervical smears: the quality control method of choice? Cytopathology. 2002;13(4):191–9. Djemli A, Khetani K, Auger M. Rapid prescreening of Papanicolaou smears: a practical and efficient quality control strategy. Cancer. 2006;108(1):21–6. Clary KM, Davey DD, Naryshkin S, Austin RM, Thomas N, Chmara BA, et al. The role of monitoring interpretive rates, concordance between cytotechnologist and pathologist interpretations before sign-out, and turnaround time in gynecologic cytology quality assurance. Findings from the College of American Pathologists Gynecologic Cytopathology Quality Consensus Conference Working Group 1. Arch Pathol Lab Med. 2013;137(2):164–74. Quinn AM, Minhajuddin AT, Hynan LS, Reisch JS, Cibas ES. Agreement between cytotechnologists and cytopathologists as a new measure of cytopathologist performance in gynecologic cytology. Cancer Cytopathol. 2017;125(7):576–80. Stelow EB, Skeate R, Wahi MM, Kjeldahl K, McKeon D, Larkin S, et al. Pap test discrepancies and follow-up histology: who’s right and does it help to know? Diagn Cytopathol. 2003;29(2):111–5. Eversole GM, Moriarty AT, Schwartz MR, Clayton AC, Souers R, Fatheree LA, et al. Practices of participants in the College of American Pathologists interlaboratory comparison program in cervicovaginal cytology. Arch Pathol Lab Med. 2010;134(3):331–5. Kitchener HC, Almonte M, Thomson C, Wheeler P, Sargent A, Stoykova B, et al. HPV testing in combination with liquid-based cytology in primary cervical screening (ARTISTIC): a randomised controlled trial. Lancet Oncol. 2009;10(7):672–82. Wright TC, Stoler MH, Behrens CM, Sharma A, Zhang G, Wright TL. Primary cervical cancer screening with human papillomavirus: end of study results from the ATHENA study using HPV as the first-line screening test. Gynecol Oncol. 2015;136(2):189–97. Zhao C, Moriarty AT, Ghofrani M, Husain M, Tambouret RH, Laucirica R, et al. Human papillomavirus testing and reporting rates in 2012: results of a College of American Pathologists national survey. Arch Pathol Lab Med. 2015;139(6):757–61. Cibas ES, Zou KH, Crum CP, Kuo F. Using the rate of positive high-risk HPV test results for ASC-US together with the ASC-US/SIL ratio in evaluating the performance of cytopathologists. Am J Clin Pathol. 2008;129(1):97–101. Horback K, Sundling KE, Schmidt RJ, Cibas ES. Developing dashboards for performance improvement in cytopathology. J Am Soc Cytopathol. 2021;10(6):535–42. Kubba LA, Patel K, Du H, Hahn EA, Sturgis CD. Atypical parakeratotic spires and HCII HPV results: correlation in liquid-based cervicovaginal cytology specimens interpreted as ASC-US. Diagn Cytopathol. 2007;35(8):476–81. Johnston EI, Logani S. Cytologic diagnosis of atypical squamous cells of undetermined significance in perimenopausal and postmenopausal women: lessons learned from human papillomavirus DNA testing. Cancer. 2007;111(3):160–5. McHugh KE, Reynolds JP, Suarez AA. Postmenopausal squamous atypia: cytologic features, Hybrid Capture 2 tests and contribution to the ASCUS Pool. Acta Cytol. 2018;62(5–6):418–22. Doxtader EE, Brainard JA, Underwood D, Chute DJ. Knowledge of the HPV status biases cytotechnologists' interpretation of Pap tests originally diagnosed as negative for intraepithelial lesion or malignancy. Cancer Cytopathol. 2017;125(1):60–9. Moriarty AT, Nayar R, Arnold T, Gearries L, Renshaw A, Thomas N, et al. The Tahoe Study: bias in the interpretation of Papanicolaou test results when human papillomavirus status is known. Arch Pathol Lab Med. 2014;138(9):1182–5. Salazar KL, Duhon DJ, Olsen R, Thrall M. A review of the FDA-approved molecular testing platforms for human papillomavirus. J Am Soc Cytopathol. 2019;8(5):284–92. Zhao C, Li Z, Nayar R, Levi AW, Winkler BA, Moriarty AT, et al. Prior high-risk humanpapillomavirus testing and Papanicolaou test results of 70 invasive cervical carcinomas diagnosed in 2012: results of a retrospective multicenter study. Arch Pathol Lab Med. 2015;139(2):184–8. Cheung LC, Egemen D, Chen X, Katki HA, Demarco M, Wiser AL, et al. 2019 ASCCP risk-based management consensus guidelines: methods for risk estimation, recommended management, and validation. J Low Genit Tract Dis. 2020;24(2):90–101. Stoler MH, Austin RM, Zhao C. Point-counterpoint: cervical cancer screening should be done by primary human papillomavirus testing with genotyping and reflex cytology for women over the age of 25 years. J Clin Microbiol. 2015;53(9):2798–804. Bonde J, Floore A, Ejegod D, Vink FJ, Hesselink A, van de Ven PM, et al. Methylation markers FAM19A4 and miR124-2 as triage strategy for primary human papillomavirus screen positive women: a large European multicenter study. Int J Cancer. 2021;148(2):396–405. Zhang L, Tan W, Yang H, Zhang S, Dai Y. Detection of host cell gene/HPV DNA methylation markers: a promising triage approach for cervical cancer. Front Oncol. 2022;12:831949. Chivukula M, Austin RM, Shidham VB. Evaluation and significance of hyperchromatic crowded groups (HCG) in liquid-based paps. Cytojournal. 2007;4:2. Goyal A, Heymann JJ, Alperstein SA, Siddiqui MT. Underrecognized patterns of high-grade squamous intraepithelial lesion on ThinPrep preparations. Am J Clin Pathol. 2021;156(2):300–12. Article / Publication DetailsFirst-Page Preview
Received: September 01, 2022
Accepted: November 08, 2022
Published online: January 26, 2023
Number of Print Pages: 14
Number of Figures: 5
Number of Tables: 0
ISSN: 0001-5547 (Print)
eISSN: 1938-2650 (Online)
For additional information: https://www.karger.com/ACY
Copyright / Drug Dosage / Disclaimer Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Comments (0)