Aspectos epidemiológicos en citologías con resultados anormales en el hospital boliviano "El Torno" / Epidemiological aspects in cytologies with abnormal results in "El Torno" Bolivian hospital

Se efectuó un estudio observacional, descriptivo, retrospectivo y transversal de 886 mujeres con resultados citológicos positivos, atendidas en la consulta de Ginecología del hospital "El Torno" de Bolivia, desde enero hasta diciembre del 2009, a fin de caracterizar aspectos epidemiológicos en citologías con resultados anormales. La información se obtuvo de la historia clínica individual de cada paciente y una encuesta elaborada al efecto. El procesamiento de los datos se realizó de forma computarizada, a través del sistema Epi Info 6. Se emplearon la prueba estadística Ji al cuadrado y el porcentaje como medida de resumen. En la casuística predominaron el grupo etario de 20-39 años y el diagnóstico de reacciones inflamatorias inespecíficas del cuello uterino. La positividad de los exámenes de papanicolaou mostró una tendencia descendente en relación con años anteriores. Se evidenció que las féminas iniciaron sus relaciones sexuales precozmente y la mayoría tuvo más de una pareja sexual.

An observational, descriptive, retrospective and cross-sectional study of 886 women with positive cytological results, assisted in the Gynecology Department from "El Torno" hospital in Bolivia, was carried out from January to December, 2009, in order to characterize epidemiological aspects in cytologies with abnormal results. The information was obtained from the individual medical record of each patient and a survey elaborated to the effect. The processing of data was carried out in a computerized way, through the system Epi Info 6. Chi square test and the percentage as summary measure were used as statistical tests. The age group 20-39 years and the diagnosis of inespecific inflammatory reactions of the cervix prevailed in the case material. The positivity of the Pap smears showed a descending tendency in relation to previous years. It was evidenced that the patients began their sexual relations in an early stage and most of them had more than one sexual couple.

The Usefulness of Cervicovaginal Cytology as a Primary Screening Test / 대한세포병리학회지

We evaluated the usefulness of cervicovaginal cytology as a primary screening test by analyzing the cytologic and histological diagnoses of 2,254 women. Cervicovaginal cytology had 93.0% sensitivity, 86.1% specificity, 88.2% positive predictive value, and 91.7% of negative predictive value. Cervicovaginal cytology as a primary screening test showed much higher specificity but slightly lower sensitivity than HPV DNA testing. However, the sensitivity of cervicovaginal cytology will be improved continuously due to the development of liquid-based cytology. We regard cervicovaginal cytology as a good primary screening test for cervical intraepithelial neoplasia or carcinoma.

Preoperative Diagnosis and Medical Treatment of Pelvic Actinomycosis

The diagnosis of the pelvic actinomycosis is seldom made preoperatively because of no reliable or specific clinical manifestation which has tendency to mimic advanced gynecological malignancy and the relative infrequency of the disease. To explore the method for improvement of preoperative diagnosis and possibility of avoiding the surgical management of pelvic actinomycosis, we collected and summarized the data of age, parity, state of menopause, history of intrauterine device (IUD) use, symptoms, laboratory findings, radiologic findings, provisional diagnosis and treatment from 14 cases diagnosed pathologically and treated in Hanyang University Hospital from 2000 to 2007. Eleven (78.6%) of 14 cases were IUD users. Most common complaints were lower abdominal pain (71.4%) and vaginal discharge (57.1%) which were followed by fever (28.6%) and back pain (28.6%). Four cases (28.6%) were identified as pelvic actinomycosis before operation and in 3 cases (21.4%) malignancy was provisional preoperative diagnosis. Pelvic actinomycosis was suspected via abdominal computed tomography (CT) or cervicovaginal cytology and confirmed via endometrial biopsy or fine needle aspiration biopsy. Two cases that were diagnosed before operation and received only antibiotics therapy had no recurrence. It was suggested that pelvic actinomycosis could be suspected via abdominal CT and cervicovaginal cytology in IUD users, and endometrial biopsy and fine needle aspiration biopsy may help establish the diagnosis before the operation. Adequate preoperative antibiotics therapy could make extensive exploratory surgery avoided or conservative surgery feasible.

Validez de criterio y reproductividad de la lectura guiada en la citología cérvico-vaginal / Utility of a guided reading technique for cervical cancer screening

Contexto: La lectura de la citología cérvico-vaginal sigue un patrón que puede omitir sectores donde haya nidos de células anormales. Se ha diseñado una estrategia de guía de la lectura de bajo costo. Objetivo: Establecer la validez de criterio y la reproductividad de la lectura guiada sobre la capacidad de discriminar la citología cérvico-vaginal. Metodología: En 300 mujeres sin historia de cáncer de cuello uterino se tomaron dos láminas de citología cérvico-vaginal; ambas se leyeron con el método regular para posterior reevaluación oculta con técnica guiada. Se calcularon los indicadores diagnósticos de las lecturas regular y guiada de cada lámina (patrón de oro: lectura por patólogo). Resultados: Hubo 65 (21.7%) mujeres con citología positiva en la lectura regular, mientras que 64 (21.3%) lo fueron en la lectura guiada. La concordancia de la lectura regular (Kappa 0.354; IC 95% 0.250-0.457) mejoró con la lectura guiada (Kappa 0.395; IC 95% 0.285-0.505). De las placas 24.3% fueron positivas en la lectura por patólogo (2.7% con lesión de alto grado de malignidad). La lectura guiada mejoró los indicadores de validez de criterio. Conclusión: La lectura guiada mejora los indicadores de desempeño, y corrige parcialmente las fallas humanas en la lectura. Sin embargo, esto se debe verificar en estudios poblacionales.

Background: Reading of Papanicolaou test slides follows a pattern that could omit sectors with abnormal cell nests. A low-cost guided reading strategy has been designed. Aim: To establish criteria validity and reproducibility of guided reading strategy in cervical uterine Pap smear. Methodology: To each of 300 women without cervical cancer history in order to apply Papanicolaou test, two slides were taken; both slides were read by regular method, and then reevaluated in blinded conditions with a guided technique. Diagnosis accuracy of regular and guided techniques was determined using pathologist’s reading as a gold standard. Results: When regular readings were used 65 (21.7%) of women had abnormal cytology, and 64 (21.3%) had also abnormal readings with the guided technique. Concordance of the regular reading (Kappa 0.354; 95% CI 0.250-0.457) improved with the guided technique (Kappa 0.395; 95% CI 0.285-0.505), while 24.3% slides were found abnormal in gold standard (2.7% with a high degree of malignancy). The guided reading improves all criteria validity indicators. Conclusion: This study demonstrated that the guided reading improves criteria validity indicators, correcting some technician mistakes; however, a populational study is necessary to confirm these results.

Clinical Experience and Sensitivity of the AutoPap 300 QC System in Cervicovaginal Cytology / 대한세포병리학회지

OBJECTIVE: False negatives of cervical smears due to screening errors pose a significant and persistent problem. AutoPap 300 QC System, an automated screening device, is designed to rescreen conventionally prepared Pap smears initially screened by cytotechnologists as normal. Clinical experience and sensitivity of the AutoPap 300 QC System were assessed and compared with current 10% random quality control technique. MATERIALS AND METHODS: In clinical practice, a total of 18,592 "within normal limits" or "benign cellular changes" cases classified by The Bethesda System were rescreened by the AutoPap System. In study for sensitivity of The AutoPap System to detect false negatives, a total of 1,680 "within normal limits" or "benign cellular changes" cases were rescreened both manually and by the AutoPap System. The sensitivity of the AutoPap System to these false negatives was assessed at 10% review rate to compare 10% random manual rescreen. RESULTS: In clinical practice, 38 false negatives were identified by the AutoPap System and we had achieved 0.2% reduction in the false negative rate of screening error. In study for sensitivity, 37 false negatives were identified by manual rescreening, and 23 cases(62.2%) of the abnormal squamous cytology were detected by the AutoPap System at 10% review rate. CONCLUSONS: The AutoPap 300 QC System is a sensitive automated rescreening device that can detect potential false negatives prior to reporting and can reduce false negative rates in the laboratory. The device is confirmed to be about eight times superior to the 10% random rescreen in detecting false negatives.

Sensitivity and Scoring of AutoPap 300 QC System for Abnormal Cervicovaginal Cytology / 대한세포병리학회지

The AutoPap 300 QC System is an automated device for the analysis and classification of conventional cervical cytology slides for quality control purpose. These studies evaluated the sensitivity of the AutoPap 300 QC System, and estimated morphologic features other than epithelial abnormality to identify a high quality control(QC) score with the AutoPap 300 QC System. The sensitivity of the AutoPap 300 QC System at 10% review rate for 210 cases of cervicovaginal cytology with low grade squamous intraepithelial lesion(LSIL) and higher grade lesion was assessed, and compared with a 10% random rescreening. The morphologic features, such as presence of endocervical component, dirty background, atrophy, abnormal cell size, and cellularity of single atypical cells were estimated in 45 cases of no review and 30 cases of QC review cases. The AutoPap 300 QC System identified 119(56.7%) out of 210 cases with LSIL and higher grade lesion at 10% review rate. It was more sensitive to squamous cell lesions(50-62%) than to glandular lesions(10%). The dirty background and the scanty cellularity of single atypical cells were significantly related to low QC score. Conclusively, AutoPap 300 QC System is superior to human random rescreen for the identification of false negative smears. The upgrading of this device is required to enhance the detection of glandular lesion and certain inadequate conditions of the slides.