Merits and pitfalls of normal saline rehydrated air-dried cervical smears over conventional wet.fixed PAP smears: A comparative study

Background: Cervical Papanicolaou (PAP) smear is the simplest, minimal invasive, and excellent screening method to reduce the female morbidity and mortality due to cervical carcinoma. Immediate alcohol fixation of the cervical smears is required to preserve nuclear details, delay in alcohol fixation leads to air drying artifacts. Rehydrating of the air-dried cervical pap smear with normal saline can help to overcome these artifacts and also have its own advantages. Aims: This study was design to evaluate the effects, merits and pitfalls of normal saline Rehydrated Air-Dried Cervical PAP Smears (RADPS) compared with the Conventional Papanicolaou Smear (C-PAPS). Settings and Design: Comparative study. Methods and Material: Prospectively paired cervical smears of 100 women, who presented to the outpatient department of gynecology of our institute, were prepared. Alcohol fixed smears were labelled as conventional Papanicolaou smear (C-PAPS) and air-dried smears labelled as rehydrated air-dried PAP smears (RADPS). Eight cytomorphological parameters were considered for comparison and analyzed. Statistical analysis used: Chisquare (?2)/Fisher exact test. Results: Clear background with red blood cells (RBC) lysis was noted in 93% of RADPS and 54% of C-PAPS. Cytolysis was observed more in C-PAPS (18%) than in RADPS (08%). Air-drying artifacts observed in 30% of C-PAPS and 08% of RADPS. Cytoplasmic staining (92% of RADPS and 85% of C-PAPS) was superior in RADPS. Cell border, nuclear chromatin, and border were also better appreciated on RADPS as compared to C-PAPS. Statistically significant difference was observed with 3 parameters, i.e., air-drying artifacts, RBC background, and distinct cell borders. Conclusion: Rehydration of air-dried smears can be adopted in regular practice, as an alternative or coupled with conventional wet fixation method to overcome the commonly faced problems of air-drying artifacts, especially in rural screening programs.

Correlation of Cervical Pap Smear with Histopathological Diagnosis in Cervical Lesions: A 2 Years Retrospective Study

Introduction: Cervical cancer is one of the most commonforms of cancer worldwide. In developing countries, cancerof uterine cervix is ranked second with a relative frequency of15% of all cancers in women. Screening women with regularPap smears allows diagnosis of treatable pre-invasive lesions.The objective of the study was to correlate the Pap smeardiagnosis with histopathology and to know the accuracy ofPap smears, so as to assess the efficacy of Pap smears indiagnosing cervical lesions.Material and methods: This two year retrospective study wasdone in the department of Pathology in a tertiary care centre,which includes 250 Pap smears for which histopathologicaldiagnosis was also done. Detailed clinical history of patientswas taken from requisition forms received in cytologydepartment along with Pap smears. The cervical biopsies orhysterectomies received from the same patients were alsostudied and then correlated with the diagnosis of Pap smears.Results: Out of 250 Pap smears, maximum patients (32%)belonged to the age group of 41-50 years and were multipara.Maximum cases were reported as NILM (59%),followedby ASCUS (16%), LSIL (15%), HSIL (7%), squamous cellcarcinoma (1.6%) and 0.8% cases of adenocarcinoma werediagnosed. On histopathology, 41.2% cases were diagnosedas chronic cervicitis, 27.2% cases as chronic cervicitis withsquamous metaplasia, CIN I (22.4%),CIN II (4.0%),CIN III(2.8%), squamous cell carcinoma (1.6%) and (0.8)% casesof adenocarcinoma. Overall sensitivity, specificity, positivepredictive value, negative predictive value and diagnosticaccuracy was 75.24%, 97.98%, 96.20%, 85.38% and 88.8%.Conclusion: As per our study, maximum number of casesdiagnosed on Pap smears correlated on histopathology,thereby concluding that Pap smears have an important role indiagnosis of cervical lesions.

Programa de cáncer de cérvix en el Policlínico Tula Aguilera Céspedes de Camagüey, Cuba (2012-2014) / Cervical Cancer Program at Tula Aguilera Cespedes Policlinic in Camagüey (2012-2014)

Introducción: el programa cubano de diagnóstico precoz del cáncer cervicouterino plantea entre sus objetivos: Disminuir la mortalidad y conocer la morbilidad por cáncer de cuello uterino, mediante su detección en su etapa más temprana posible, lo que permite aplicar una terapéutica precoz y eficaz. Objetivo: caracterizar el comportamiento del programa de cáncer de cérvix durante los últimos tres años. Métodos: se realizó un estudio observacional descriptivo transversal, durante el período desde enero de 2012 hasta diciembre de 2014, en el policlínico Universitario Tula Aguilera Céspedes del municipio Camagüey, Cuba. El universo estuvo constituido por 8 599 tomas de citología que era el plan a realizar. Se trabajó con 8 018 tomas de citologías realizadas en el periodo, incluyendo citologías que se volvieron a realizar y casos nuevos. Los datos se obtuvieron del libro de registro de citologías del área y de las tarjetas de las féminas con resultados positivos en la citología. Se confeccionó una hoja de vaciamiento que se convirtió en el registro definitivo de la investigación. Se determinaron estadísticas descriptivas. Resultados: hubo un cumplimiento del plan por encima de 90 por ciento, la mayoría de las muestras fueron citologías que se volvieron a realizar, una minoría resultó positiva. Predominaron lesiones de alto grado NIC II, hubo calidad en la toma de las muestras y correlación entre el resultado citológico e histológico. Conclusiones: el programa y su ejecución son indispensables para el diagnóstico precoz de la afección(AU)

Introduction: The Cuban program for early diagnosis of cervical cancer poses among its objectives to reduce mortality and know morbidity from cervical cancer by detection at the earliest possible stage, allowing to apply early and effective treatment. Objective: Characterize the behavior of Cervical Cancer Program during the last three years. Methods: Adescriptive cross-sectional observational study was conducted during from January 2012 to December 2014, at Tula Aguilera Cespedes University Polyclinic in Camagüey, Cuba. The universe consisted of 8,599 cytology smears that was our plan. We worked with 8,018 smear tests performed in the period, including repeated cytology and new cases. The data were obtained from the cytology logbook of the area and from the cards with positive results in cytology. A data sheet is constructed and it became the definitive record of this investigation, and descriptive statistics were determined. Results: There was a fulfillment of the plan above 90 percent, most of the samples were cytology that were perform again, a minority was positive. High-grade lesions CIN II predominated, there was quality in making samples and correlation between cytological and histological results. Conclusions: The program and its implementation are essential for early diagnosis of this condition(AU)

Cytological patterns of cervical pap smears with histopathological correlation.

Background: Cervical cancer is the most common, preventable cancer and does not develop suddenly from normal epithelium but is presented by a spectrum of intraepithelial neoplasia. Pap smear is an ideal screening and low cost effective test to detect intraepithelial neoplasia especially in developing countries but has limitations and needs confirmation by histopathology. The study aimed to determine the sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of pap smears as screening test in cervical lesions by comparing with histopathology. Methods: This is a prospective study conducted at a tertiary care centre in Department of pathology from October 2012 to September 2014. A complete clinical history and demographic status of the subjects was recorded. Conventional pap smears were reported adopting Bethesda system and biopsies were taken in cases of epithelial cell abnormality, routinely processed and stained with H&E. Results: Total number of pap smears analysed were 356. NILM (negative for intraepithelial lesions or malignancy) constituted major group 248/356 (69.64%) and epithelial cell abnormality were 98/356 (27.5%). In the present study overall sensitivity was 94.11% specificity 64.28% positive predictive value 82.75%,negative predictive value 85%,diagnostic accuracy 83.33%,concordance rate 78.2% and P value <0.001. Concordance rate for CIN I was 78.9%, for CINII and CINIII 60% and for squamous cell carcinoma 100%. Conclusion: Pap smear is simple, inexpensive and can be performed in the outpatient department. Hence, it should be recommended routinely as a method of improving reproductive health, early detection of premalignant and malignant cervical lesions.

Importância clínica e correlação histológica das células glandulares atípicas detectadas no exame colpocitológico / Clinical implications and histological correlation of atypical glandular cells found in cervicovaginal smears

Introduction: Atypical glandular cells (AGC) are carriers of insufficient nuclear abnormalities for the diagnosis of adenocarcinoma, but exceed the criteria for classification as reactive glandular cells. This is an uncommon diagnosis, which may be associated with neoplastic lesions. Objective: To evaluate the clinical significance of primary cytological diagnosis of AGC through correlation with results of subsequent cyto-histologic examination. Materials and methods: 10 years retrospective study based on cervical cytologic results indicating AGC, classified as "possibly non-neoplastic" or "cannot exclude high-grade intraepithelial lesion". It was performed cyto-histopathological correlation in cases that were submitted to subsequent histopathological examination up to two years after cervical cytology analysis. Results: AGC were reported in 380 (0.06%) exams, providing 160 cases with subsequent biopsy. 85 (53.1%) of these, presented benign changes and 75 (46.9%) neoplastic lesions. From 114 "possibly non-neoplastic" cytological results, 71 (62.3%) had benign histological changes, and 43 (37.7%) neoplastic lesions, corresponding to a negative predictive value (NPV) of 62.3%. In contrast, among the 46 AGC "cannot exclude high-grade intraepithelial lesion" results, 14 (30.4%) presented benign changes and 32 (69.6%) neoplastic lesions (positive predictive value [PPV] = 69.6%). Discussion: The high rate of cancer associated with the diagnosis of AGC reassures the importance of recognizing these atypical cells in pap smears. The classification of "possibly non-neoplastic" and "cannot exclude high-grade intraepithelial lesion" may suggest the origin of cytological changes. Conclusion: Our results reinforce the importance of adequate follow-up of patients with AGC diagnosis on cervical cytology...

Introdução: Células glandulares atípicas (CGA) são portadoras de alterações nucleares insuficientes para o diagnóstico de adenocarcinoma, mas excedem os critérios para classificação como células glandulares reacionais. Trata-se de um diagnóstico incomum, porém pode relacionar-se com lesões neoplásicas. Objetivo: Avaliar o significado clínico do diagnóstico citológico primário indicando CGA por meio da correlação com os resultados de exames histológicos subsequentes. Materiais e métodos: Estudo retrospectivo de 10 anos com base em resultados colpocitológicos indicando CGA, classificados como "possivelmente não neoplásicas" ou "não se pode afastar lesão intraepitelial de alto grau". Realizou-se a correlação cito-histopatológica nos casos que foram submetidos ao exame histopatológico até dois anos após a análise colpocitológica. Resultados: CGA foram relatadas em 380 (0,06%) exames, dispondo-se de 160 casos com biópsia subsequente. Destes, 85 (53,1%) apresentavam alterações benignas e 75 (46,9%), lesões neoplásicas. Dos 114 resultados citológicos "possivelmente não neoplásicas", 71 (62,3%) apresentavam alterações histológicas benignas e 43 (37,7%), neoplásicas, correspondendo a um valor preditivo negativo (VPN) equivalente a 62,3%. Contrariamente, entre os 46 resultados de CGA "não se pode afastar lesão intraepitelial de alto grau", 14 (30,4%) apresentavam alterações benignas e 32 (69,6%), neoplásicas (valor preditivo positivo [VPP] = 69,6%). Discussão: As altas taxas de neoplasias associadas ao diagnóstico de CGA reafirmam a importância do reconhecimento dessas atipias. A classificação em "possivelmente não neoplásicas" e "não se pode afastar lesão intrapitelial de alto grau" pode sugerir a origem das alterações citológicas. Conclusão: nossos resultados reforçam a importância do segmento das pacientes com diagnóstico de CGA no exame colpocitológico...

Factores asociados a las alteraciones del test de papanicolaou Costa Rica, 2009 / Factors associated with changes in PAP smears in a health center Costa Rica, 2009

El cáncer cervicouterino es en el mundo y en Costa Rica una de las 3 primeras causas de cáncer en las mujeres. La detección temprana de lesiones premalignas o malignas mejora el pronóstico de las usuarias. Objetivo: Encontrar si hay factores asociados a las alteraciones de la citología vaginal en un área de salud urbana de Costa Rica durante 2009. Metodología: Estudio de casos y controles en usuarias de una área de salud urbana de Costa Rica durante 2009. Se definió caso como toda mujer residente de esa área que presentara una citología vaginal alterada, displasia leve, moderada, severa o carcinoma durante 2009. Los controles se seleccionaron de forma aleatoria simple, tomando como marco muestral el registro de mujeres que se habían realizado citologías vaginales durante el 2009 en esa área. La recolección de la información se hizo a través de un cuestionario. Se calcularon medidas de frecuencia, de tendencia central y dispersión, OR, IC 95 %. Resultados: Se incluyeron 62 casos y 137 controles. La edad promedio de los casos fue 43 años (DE±17). El ASCUS fue la lesión más frecuente 39 % (IC 95 %=22,43-51,93). Los factores asociados a la aparición de lesiones fueron tabaco (OR=2.35; IC 95 %=1,26-4,31), inicio de actividad sexual antes de 18 años (OR=2;I C 95 %=1,06-3,64) y haber tenido 3 o más compañeros sexuales (OR=2, 10;IC 95 % 1,11-3,97). Discusión: Se encontró similitud entre lo descrito en la literatura y lo hallado en este estudio. Se recomendó dar a conocer este estudio a las mujeres de esa área de salud, ya que los factores encontrados son modificables y además se planteó a la dirección del área realizar campañas de promoción y prevención que fomenten conductas sexuales sanas.

Cervical cancer is among the leading causes of cancer in women globally; in Costa Rica it is among the top three causes. Although the PAP smears is part of the guidelines of care for women, the coverage in some areas of health is low. Objective: Identify demographic and clinical factors associated with abnormal Pap test results Methods: We conducted a health center-based case-control study. A case was defined as any woman seeking care in a health center during 2009, having a Pap test positive for either cells of undetermined significance (Atypical Squamous Cells of Undetermined Significance) mild, moderate or severe dysplasia. Controls were selected by simple random sampling using records of women seen at the same health centers in 2009 and having normal PAP smears. Odds ratios and 95 % confidence intervals (95% CI) were calculated for associations between potential risk factors and abnormal PAP smears. Results: We identified 62 cases and 137 controls. The average age of cases was 43 was not significantly different from that of controls (Student t p = 0,90). ASCUS was the most frequent cause of abnormal cytology (39 %). Factors found to be significantly associated with abnormal cytology were: tobacco use (OR=2,35; 95 % CI=1,26-4,31), onset of sexual activity before age 18 (OR=2,0; 95 % CI=1,06-3,64) and having a history of > 3 sexual partners (OR=2,0; 95 % CI=1,11-3,97). Conclusions: There was similarity between risk factors we identified as described in the literature, like onset of sexual activity before age 18 and have history of 3 or more sexual parthers. These are common risk factors associated with HPV infection. Our study was limited by the failure to follow-up colposcopy results for definitive diagnoses and no HPV test. Considering these risk factors represent modifiable health behaviors, we recommended dissemination of our findings to local health authorities in order to generate intervention strategies to promote responsible, healthy sexual behaviors as how to reduce tobacco consumption and develop healthy sexual habits.

Influencing Factors of Intention of Undergoing Pap Testing among Unmarried Nurses

PURPOSE: This study was to assess the intention of undergoing Pap testing and to identify influencing factors of HPV knowledge and their attitude related to Pap test by sexual activity among unmarried nurses. METHODS: A cross sectional survey design was employed, utilizing a self-administered questionnaire amongst 343 unmarried nurses. Descriptive statistics was utilized to analyze data and inferential statistics used an independent-t test and chi2 test for the differences in measurement variables, and odds ratios for factors on intention of Pap testing by sexual activity. RESULTS: Nurses not sexually active were significantly higher in intention of Pap testing (chi2=40.15, p<.001) and influencing factors of HPV knowledge (t=3.93, p=.048) than did nurses who were sexually active. Factors influencing intention were regularity of the breast self-examination (Adjusted Odds Ratio [AOR]=4.20, 95% Confidence Interval [CI]=1.93~9.17), HPV knowledge (AOR=2.49, 95% CI=1.36~4.56), and attitudes toward the Pap test(AOR=2.33, 95% CI=1.25~4.34) amongst nurses who never had sexual experience. CONCLUSION: It is necessary to minimize negative attitudes of Pap testing and to increase HPV knowledge in order to improve intention of Pap testing for women who were not sexually active. More focus would be given to sexually active women to get Pap tested as a preventive measure for cervical cancer.

Comparación de cuatro métodos de restauración del ADN en muestras de plasma y láminas de citología cérvico-uterina como una herramienta para mejorar la calidad de la muestra / Comparison of four methods of DNA restoration in samples from plasma and pap smears as a tool for better the samples

Objetivos: comparar cuatro métodos de restauración del ADN en plasma y láminas cérvico-uterinas como una herramienta para mejorar la calidad de la muestra. Métodos: a 20 muestras de plasma sanguíneo y 20 muestras de láminas citológicas, se les realizó aislamiento de ADN mediante kit comercial y fenol-cloroformo. A todas las muestras se les realizó un tratamiento pre-PCR con cuatro diferentes tipos de actividad de ADN polimerasa: 1. Exonucleasa y endonucleasa 5'-3'. 2. Exonucleasa 5'-3'. 3. Klenow, y 4. Klenow más ligasa. Los diferentes métodos se evaluaron mediante PCR en tiempo real con el gen ALU. Resultados: todos los métodos de restauración mejoran la calidad del ADN en los dos tipos de muestras. El método 3 mostró mejores resultados en plasma y en lámina, incrementando la concentración del ADN de 0,0022 ng/µL a 0,6474 ng/µL en láminas de citología y de 0,0039 ng/µL a 0,435 ng/µL en plasma sanguíneo. Conclusiones: ADN de las muestras de plasma y lámina al ser tratadas con un proceso de restauración aumenta la calidad del ADN en comparación a las muestras no tratadas.

Objetives: To compare four methods of restoration of DNA in plasma and PAP smears as a tool to improve the quality of the samples. Methods: 20 blood samples and 20 PAP smears samples, we performed DNA isolation by commercial kit and phenol-chloroform respectively. Then all samples underwent a pre-PCR treatment with four different types of activity DNA polymerase: 1. Exonuclease and endonuclease 5'-3'. 2. Exonuclease 5'-3'. 3. Klenow, and 4. Klenow more ligase. Different restoration methods were evaluated quantitatively by real-time PCR with gene ALU. Results: All restoration methods improve the quality of DNA in both types of samples. However, the 3th method showed better results in both plasma and PAP smears, increasing the concentration of DNA from 0.0022 ng/mL to 0.6474 ng/mL in PAP smears and 0.0039 ng/mL to 0.435 ng/mL in blood plasma. Conclusions: DNA from plasma samples and PAP smears to be treated with a restoration process increases the quality of DNA compared to untreated samples.

Citología cervical de trabajadoras sexuales y mujeres del servicio de planificación familiar de la Unidad Sanitaria de Los Teques / Pap smears in sexual workers and women attending the familly planning service of the Unidad Sanitaria de Los Teques

Comparar la prevalencia de lesiones intraepiteliales escamosas y de infecciones en la citología cervical, en dos grupos de mujeres: las trabajadoras sexuales y las usuarias del servicio de planificación familiar. Se evaluaron 1 648 informes de citología, 934 de las usuarias y 714 de trabajadoras sexuales. Unidad Sanitaria de Los Teques. En las trabajadoras sexuales las lesiones intraepiteliales escamosas de bajo grado y de alto grado se presentaron en el 0,98 por ciento y 0,60 por ciento de la población, mientras que en las usuarias fue de 0,1 por ciento de lesiones intraepiteliales escamosas de bajo grado y no se encontraron de alto grado. En las trabajadoras sexuales la prevalencia de Gardnerella vaginalis, Candida, Trichomonas vaginalis y virus de papiloma humano fue de 51,0 por ciento; 5,0 por ciento; 5,6 por ciento; 2,2 por ciento respectivamente, mientras que para las usuarias fue de 35,9 por ciento; 8,6 por ciento; 3,3 por ciento y 0,5 por ciento. Las trabajadoras sexuales presentan una desigualdad relativa mayor de sufrir infecciones de transmisión sexual con respecto las usuarias del servicio de planificación familiar.

To compare the prevalence of squamous intraepithelial lesions and infections in Pap smears, in two groups of women: the sexual workers and the women users of the family planning service. We evaluated 1 648 Pap smear reports: 714 sexual workers and 934 from users of family planning service. Setting: Unidad Sanitaria de Los Teques. In sexual workers the low grade and high grade squamous intraepithelial lesions were present in 0.98 percent and 0.60 percent of the population, while in the users there was 0.1 percent of low grade squamous intraepithelial lesions and no high grade squamous intraepithelial lesions were found. In the sexual workers the prevalence of Gardnerella vaginalis, Candida, Trichomonas vaginalis and human papilloma virus was 51.0 percent; 5.0 percent; 5.6 percent and 2.2 percent respectively, while in the users it was 35.9 percent; 8.6 percent; 3.3 percent and 0.5 percent. The sex workers present a higher odd ratio to suffer infection transmitted diseases than women users the family planning service.

Clinical significance of atypical glandular cells on Pap smear / 부인종양

OBJECTIVE: We determine the rate of an atypical glandular cells (AGC) on cervical cytology and the incidence of clinical significant lesion on subsequent follow up biopsies. In this study, we attempted to assess the clinical significance of a cytologic diagnosis of atypical glandular cells (AGC). METHODS: A total of 60,174 Pap smears were obtained between January 1st 2000 and December 31th 2005 at Ewha Womans University Mokdong Hospital. Among these smears, 26 patients had a diagnosis of AGC. Follow up was available for 23 patients (88.5%) and these patients had histologic follow up including cervical biopsy, endocervical curettage (ECC), and/or endometrial biopsy (EMB). RESULTS: Among 23 patients with AGC, eight (34.8%) were found to have a clinically significant malignant lesions on subsequent histologic follow up, including 2 endometrial adenocarcinoma cases, 1 cervical adenosquamous cell carcinoma case, 1 endocervical adenocarcinoma case, 2 vault adenocarcinoma cases, 1 MMMT case and 1 squamous cell carcinoma case. We found the differences in incidence of malignant lesions between premenopausal (23.5%) and postmenopausal (66.8%) patients with marginal significance (p=0.057). CONCLUSION: The incidence of AGC in Pap smear was 0.04%. The patients with AGC had a substantial risk of having a significant number of squamous or glandular, premalignant or malignant lesions. This study strongly suggests the need for the close follow up of patients with a diagnosis of AGC, especially in postmenopausal women.

Alteraciones en la citología cervical y respuesta inmune contra Chlamydia trachomatis en trabajadoras sexuales

Resumen. Existen controversias en cuanto a la asociación entre infección por Chlamydia trachomatis (C. trachomatis) y el desarrollo de neoplasia cervical. El objetivo del presente estudio fue evaluar la relación entre la presencia de anticuerpos contra la C. trachomatis de tipo IgG en suero e IgA en moco cervical y la prevalencia de modificaciones en citología cervical. Se evaluaron 166 mujeres trabajadoras sexuales, controladas en el servicio de Infecciones de Transmisión Sexual de la Unidad Sanitaria de los Teques, Estado Miranda, Venezuela. Fueron entrevistadas y evaluadas para cervicitis y se tomó muestras de moco cervical y sangre para la determinación de anticuerpos contra C. trachomatis de tipo IgA e IgG (ELISA). Se tomaron muestras cervicales y se estudiaron por coloración de Pap. Los resultados fueron evaluados estadísticamente (Chi cuadrado, Keldal Tau). La prevalencia de IgA contra C. trachomatis en moco cervical fue de 45,2% y la de IgG en suero sanguíneo fue de 69,3%. El 38,0% de las citologías cervicales fue reportada normal o con cambios inflamatorios leves, el 35,5% inflamación moderada, el 25,3% inflamación severa y un 1,2% presentó lesiones intraepiteliales escamosas de bajo grado (LIEBG). No se encontró correlación estadísticamente significativa entre la presencia de anticuerpos contra C. trachomatis (IgA e IgG) y la de cervicitis, ni con los resultados de la citología. En conclusión, no se observó asociación entre respuesta inmune contra C. trachomatis y resultados de la citología cervical ni la presencia de cervicitis. Sin embargo, la existencia de otras infecciones simultáneas pudiera haber interferido en la observación de una posible asociación entre estas variables.

Abstract. There are controversies about the relationship between Chlamydia trachomatis (C. trachomatis) infections and development of cervical carcinoma. The objective of this investigation was to evaluate the relation between the presence of IgG against C. trachomatis in serum and IgA in cervical mucus with the prevalence of abnormalities in the Papanicolaou smears. One hundred sixty-six sexual workers were evaluated. They were checked up for sexual transmitted diseases (STD) at the "Unidad Sanitaria de Los Teques, Edo. Miranda". Sexual workers were interviewed and had a gynecological evaluation. Cervical mucus and peripheral blood samples were obtained to determine antibodies IgA and IgG against C. trachomatis. Cervical samples were taken to be evaluated by Papanicolaou staining. The association among the different variables was statistically evaluated (Chi squared and Kendal Tau). The prevalence of antibodies isotype IgA against C. trachomatis in cervical mucus was 45.2% and IgG in serum was 69.3%. Papanicolaou smear showed that 38% of women had normal or low inflammation grade, 35.5% moderate inflammation, 25.3% severe inflammation and 1.2% presented Low Grade Squamous Intraepithelial Lesion (LGSIL). There was no statistical correlation among presence of antibodies against C. trachomatis, presence of cervicitis and Papanicoloau smears. In conclusion we could not observe any relationships between immune response against C. trachomatis, cervicitis and Papanicolaou smears abnormalities. However, it is important to consider that other infections, that could be present simultaneously, could interfere in the interpretation of the results.

A Study on Nucleus Segmentation of Uterine Cervical Pap-Smears using Multi Stage Segmentation Technique / 대한의료정보학회지

The region segmentation of the pap-smear image is known to be a difficult and important part in the automatic image recognition system. Both the pixel based methods(thresholding) and the region based methods(split and merge, region growing and edge detection) are widely used for segmentation of the nucleus, cytoplasm and background in the pap-smear images. The pixel based methods are relatively fast, but not accurate, while the region based methods are accurate, but slow. This paper proposes a multistage segmentation strategy which uses thresholding and incremental color clustering methods to reduce computation time while not sacrificing accuracy. Proposed method consists of three stages. The first stage uses global thresholding method to search nucleus blob position, and the second stage employs incremental color clustering with color information. The final stage segments unsuitable nuclei using thresholding method after calculating suitability for each extracted nucleus blob. The proposed segmentation method is tested under various error measures. The experimental results showed that each stage of the proposed method reduced specific error measures: The second stage reduced false negative error and the third stage false positive error.