ABSTRACT
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.
ABSTRACT
OBJECTIVE: This study was aimed to identify the diagnostic role of HPV DNA chip test that may predict high grade lesions in gladular cell abnormalities on cervical cytology. METHODS: This study was performed in 88 patients, who were reported for atypical glandular cells on liquid-based cytologic test and was done subsequent cervical biopsies in Chonnam National University Hospital, between January 2003 and June 2007. HPV DNA chip test was performed on residual material of previous liquid-based cytologic test. And it was compared with pathologic results. RESULTS: Of the 88 patients with atypical glandular cells, the distribution was as follows: 60 patients were reported as atypical glandular cells, not otherwise specified (AGC, NOS), 28 patients were reported as atypical glandular cells, favor neoplastics (AGC, favor neoplastics). Of the 88 patients with an AGC result, pathologic results were as follows: 47 patients (53.4%) had a clinically significant high grade lesions. Of this high grade lesions, 5 cases of high grade squamous intraepithelial lesion, CIN 2 & CIN 3 (83.4%, 5/6), 2 cases of SCC (66.7%, 2/3), 4 cases of AIS (80.0%, 4/5), and 11 cases of endocervical adenocarcinoma (69%, 11/16) were positive on HPV DNA chip test. The sensitivity of human papilloma virus positivity to predict the presence of high grade lesion in cervix was 73.3%, specificity 85.3%, positive predictive value 78.5%, and negative predictive value 81.3%. There were 16 patients with endometrial cancer. Only 3 patients were HPV DNA chip positive. CONCLUSION: HPV DNA detection was strongly associated with high grade lesions in women with atypical glandular cells on cervical pap smear. These results suggest that although there is no high grade lesion in patients with HPV positive AGC-NOS at initial work-up, meticulous search like cone biopsy should be done to find high grade lesion. If the women with a diagnosis of AGC on pap smear are over 35 years of age and has abnormal utero-vaginal bleeding, this patients needed to be evaluated with endometrial biopsy.