Diagnostic accuracy of Conventional Cervical Cytology (papanicolau smear), Liquid Based Cytology (LBC) and Visual Inspection with Acetic Acid (VIA) in detecting premalignant and malignant cervical lesions among Filipino women in a tertiary hospital / Philippine Journal of Obstetrics and Gynecology

Objective@#Cervical cancer screening can reduce both the incidence and mortality rates of the disease. This study aimed to assess the diagnostic accuracy of conventional cytology, liquid based cytology and visual inspection with acetic acid in detecting pre-malignant and malignant cervical lesions. @*Methods@#There were 249 patients who participated in the study. Of these, 6/249 (2.4%) turned out positive in papsmear, 7/249 (2.8%) turned out positive in liquid based cytology while 23/249 (9.2%) turned out positive in visual inspection with acetic acid. Colposcopic guided cervical biopsy was done on all 249 patients to confirm the results. @*Results@#Fourteen turned out positive for cervical intraepthelial neoplasia, 1 patient had carcinoma in situ and 1 was positive for squamous cell carcinoma. @*Conclusion@#Among the three screening tests, VIA appears to be the most accurate, followed by liquid based cytology as compared to the conventional papsmear.

Lesões cervicais e infecção pelo papilomavirus humano no sistema prisional da cidade de São Paulo, Brasil / Cervical lesions and human papillomavirus infection in women at a prisional system in São Paulo city, Brazil

A relação entre o câncer cervical e a infecção pelo Papilomavírus Humano (HPV) está bem estabelecida. Múltiplos parceiros e múltiplas práticas sexuais são os fatores de risco associados à infecção pelo HPV. Existe uma grande probabilidade em que as mulheres internas em presídios tenham uma maior suscetibilidade de adquirir a infecção genital. A avaliação de alterações celulares, pelo exame de Papanicolaou, e identificação molecular de DNA-HPV de alto risco são utilizadas para a detecção e prevenção do câncer cervical. Quatrocentas e nove amostras cervicais de mulheres internas, nopresídio feminino da cidade de São Paulo, com idade entre 18 e 60 anos, foram analisadas, em 2006. Os achados celulares foram classificados com base no Sistema Bethesda (2001). O DNA-HPV foi identificado pelo PCR convencional, empregando os primersuniversais MY09/11, e os tipos identificados por PCR/RFLP, utilizando enzimas de restrição. Vinte e sete (6,60%) dos 409 esfregaços das internas do sistema penal revelaramLesões Escamosas Intraepiteliais de Baixo Grau (LSIL), 3 (11,11%) mostram alterações compatíveis com Lesões Escamosas Intraepiteliais de Alto Grau (HSIL), 5 (18,53%) exibiram Atipias Escamosas de Significado Indeterminado (ASC-US), 1 (3,70%) mostrou Células Glandulares Atípicas (CGA) e 1 (3,70%) revelou Carcinoma de Células Escamosas. DNA-HPV de alto risco foi identificado em 12 (44,43%) amostras (HPV 16, 18, 31, 33, 34, 39 e 61). Oito (29,62%) amostras revelaram infecção por HPV de baixo risco (HPV 6b). O presente estudo detectou uma alta prevalência de LSIL e HSIL associada à presença de DNA-HPV de alto risco, nas mulheres internas no sistema prisional.

The association between cervical cancer and Human PapillomavirusInfection (HPV) has been determinated. Multiple partners andmultiple sexual practices are risk factors associated with HPVinfection. There is a high probability that women resident in prisionscould be more susceptible to acquire genital HPV infection. Thescreening of cellular changes by pap-smear and the molecularidentification of high risk DNA-HPV is usefull for the detection andprevention of cervical cancer. Four hundred nine samples of cervicalsmear from women resident in a prisional system in São Paulo,between 18 to 60 years old were analyzed in 2006. The cellularresults were reported according to the Bethesda System Terminology,2001. The DNA-HPV detection was made by Conventional PCR usingConsensus Primers MY 09/11 and the HPV types were identify byPCR-RFLP using restriction endonuclease enzymes.Twenty seven(6,60%) out of 409 pap-smears samples showed pre malignant lesion.Seventeen (62,96%) out of these 27 samples revealed Low Squamous Intraepitheal Lesion (LSIL), 3 (11,11%) showed changessuggestive of High Squamous Intraepithelial Lesion (HSIL), 5(18,53%) samples presented Atypical Squamous Cells ofUndetermined Significance (ASC-US), 1 (3,70%) sample had AtypicalGlandular Cells (AGC), and 1 (3,70%) sample showed CervicalSquamous Carcinoma. High Risk DNA-HPV was identified in 12(44,43%) (HPV 16, 18, 31, 33, 34, 39 and 61). Eight (29,62%) samplesrevealed the low risk for neoplasic lesion subtype HPV-6b. Thepresent study reveal a high prevalence of LSIL and HSIL associatedwith the presence of High-risk DNA-HPV in women resident in aprisional system.

PAP Smear-screening in Primary Care Women Physicians and Its Influence on Patients

BACKGROUND: PAP smear has been highly appraised for screening cervical cancer. Generally regarded is that women physicians regularly screen for PAP would promote patients' early detection and treatment rate by their strong recommendation. Hereby we investigated PAP-screening in primary care women physicians, recommending proportion and associated factors. METHODS: Questionnaires were sent to 981 members of the Korean Academy of Family Medicine, Korean Association of Family Practitioners, Korean Medical Women's Association, and Songpa-gu and Kangdong-gu family practitioners. a total of 193 respondents was analyzed. RESULTS: Among the total 55.4% of the respondents screened for PAP smear regularly, either annually (23.9%), or from their treating gynecologists (61.6%) or through routine check-up (81.1%). Common reasons for not screening were lack of time (40.7%) and forgetfulness (38.4%). Recommending proportion for PAP to patients was 49.2%. Reasons for not recommending were lack of equipment, forgetfulness (18.8% each). Confidence of PAP as a screening test was very high (71.5%); significantly related to PAP-screening and to recommending proportion (P=0.033, P=0.005, respectively). Many of the respondents thought physician's own PAP-screening affected its recommendation (45.3%), whereas significant relation to their actual PAP-screening was not found (P=0.845). PAP-screening in physicians showed no significant relationship with recommending proportion (P=0.053). Internal disease history had meaningful relation only with recommending proportion (P=0.001). CONCLUSION: Though physicians show strong confidence in PAP and undergo more than the general public, most do not screen for it regularly and the recommending proportion was low. To improve physician's PAP-screening and recommending proportion, re-education of physicians and provision of proper clinical equipment are required.

Adaptive Thresholding for Pap-Smear / 대한의료정보학회지

We can assume a histogram of uterus neck cytoplasm image has three peaks which is consisted of nucleus, cytoplasm and background. We proposed a method for extraction of adaptive thresholding value that is suitable to each various intensity distribution. First, the adaptive thresholding is divided into thresholding of cytoplasm area and nucleus area. The thresholding of cytoplasm area, utilizing whole histogram, extracts thresholding value by using histogram standard deviation which of recognized as a background for each histogram distribution. The classification of nucleus is various in size and has difficulty in precise image extraction because of great difference in intensity in a cell image when using whole histogram distribution. So we suggests 'local thresholding' . In the first place, by using optimal thresholding, we can find nucleus seed area as a mask, and get adaptive thresholding value correct to each histogram distribution by obtaining histogram for each mask. Comparing to other methods that use the same thresholding value for one image, this can effectively extract nucleus and cyotoplasm. Because 'local thresholding' decides most suitable thresholding value for each distribution and characteristics.

A Study on an Automatic Detection of Uterine Cervical Pap-smears by Image Processing / 대한세포병리학회지

Cancer of the cervix is the most common malignancy in women in developing countries and the second most common cancer in women throughout the world with approximately 500,000 new cases each year. Prevention of this large number of premature deaths among women is, therefore, a goal worthy of urgent and serious consideration. In this thesis, an automatic cancerous nucleus detection method essential to a screening system with Papanicolaou stained specimens called Pap-smear is proposed which employs image processing techniques. It uses edge information to segment objects and morphologic as well as densitometric information to distinguish cancerous nuclei from dirts or normal nuclei. It has produced useful results in our study.

Post-cervical conization pap-smear examination.

Out of 68,240 slide of total Pap smears at Cytological Unit, Department of Obstetrics and Gynaecology, Faculty of Medicine Siriraj Hospital, fron January 18, 1988 to October 31, 1989, 288 (0.4%) slides of Pap smears from post-cervical conization patients were examined. The median age was 32 years, the mean age was 35.5+10.5 years and the range of ages was between 19-73 years. They were carcinoma in situ (44.4%), severe dysplasia (6.3%), morderate dysplasia (4.5%) and normal (3.5%). Cytological diagnosis were normal (39.6%), infection and inflammation (39.6%), moderate dysplasia (4.2%), severe dysplasia (4.5%), carcinoma in situ (3.8%), non-keratinized squamous cell carcinoma (1.0%) and inadequate specimen (37.8%). Histological examination in abnormal Pap smears was 4.2% that had 1.7% of abnormal results (1 case of carcinoma in situ, 1 case of adenocarcinoma in situ, 1 case of atypical hyperplasia of endocervix and 2 case of severe dysplasia.