Changing terminology and screening recommendations in cervical cytology screening programs.

In summary, we have presented proposed new diagnostic terminology and screening frequencies for cervical cytology with some of the surrounding debate. As Thailand develops its own cervical screening program for squamous cell carcinoma, an awareness of these new recommendations may help in the design of a local program in the most cost effective manner.

Pap smear examination of patients with leiomyoma.

The Pap smears of 309 patients with leiomyoma were examined at Siriraj Hospital between August 1983 and April 1984. Most of the smears were taken by VCE technique (vaginal scraping, ectocervical scraping and endocervical swabbing); the remainder, by CE or C only. The patients ranged in age from 23 to 66 years, the mean age +/- the standard deviation being 42.1 +/- 7.6 years. The cytological diagnoses were: a) 34.0 per cent abnormal smears, 62.4 per cent infection and 3.6 per cent abnormal cells of the uterine cervix and the endometrium; b) 34.6 per cent normal hormonal evaluation, 8.4 per cent high estrogen; and 5.2 per cent low estrogen with 51.8 per cent having no hormonal evaluation.

X-Chromatin determination in Thai men and women by buccal epithelial cell examination.

X-chromatin determination by Pap smear of buccal epithelial cells of Thais, i.e. 286 normal non-pregnant Thai women, 22 pregnant women and 57 normal Thai men, was made at Siriraj Hospital on cases examined between January 20, 1983 and August 13, 1986. The means and standard deviation of the percentages of X-chromatin were as follows: (a) in the non-pregnant women, 15.0+5.8 (range 2.5-36.5) (of these, 15.0+6.0 were sexually active; 19.2+5.6 were in lactational amenorrhea and 14.3+4.7 were menopausal) and (b) in the pregnant women, 14.0+6.9 (range 5-27). Chromatin-X was not found in the men, but chromocentrum, which is smaller than X-chromatin, was found, the mean chromocentrum being 1.6+1.3 percent (range 0-5).

Results of Pap smear examinations in women with abnormal ovaries.

Using the VCE technique, the Pap smears of 249 women with abnormal ovaries were examined at the Cytological Laboratory, Siriraj Hospital. The cases, ranging in age from 15 to 85 years (the mean age being 42.1 +/- 14.7 years), were diagnosed as follows: 49 cases with cysts, 89 cases with tumours and 111 cases with cancer. The mean ages of the women with cysts, tumours and cancer of the ovaries were 34.0 +/- 8.6, 37.2 +/- 12.8 and 49.5 +/- 14.8 years, respectively. The percentages of women with cysts, tumours and cancer diagnosed cytologically as having a normal smear were 44.9, 28.1 and 23.4; and infection and inflammation of abnormal ovaries 49.0, 49.4 and 41.5, respectively. The percentages of those with abnormal cells at the uterine cervix were 6.1, 21.4, and 31.5; endometrial adenocarcinoma 0, 1.1 and 0; and ovarian adenocarcinoma 0, 0 and 3.6, respectively. Although Pap smear examination using the VCE technique is sensitive in the early detection of cervical cancer, it is not a sensitive method in the detection of ovarian cancer.

Pap smear examinations in women with near-term pregnancy.

Between November 28, 1983 and August 20, 1985 the Pap smears of 263 pregnant women at Siriraj Hospital were examined. They ranged in age from 15 to 40 years, with the mean age being 24.2 +/- 4.9 years. Pre-term pregnancies (24-37 weeks, 127 cases), at-term (38-42 weeks, 115 cases) and post-term (43-44 weeks, 21 cases) had inflammation and/or infection in 26.8, 40.0 and 23.8 per cent of each period, respectively; however, hormonal evaluation could not be carried out no matter what the period of pregnancy. More than half (60.6%) of the women with pre-term pregnancy determined by history showed a pre-term cell pattern, 10.2 per cent at-term and 2.4 per cent post-term. Forty-two point six per cent of the women with at-term pregnancy determined by history showed the at-term cell pattern, 13.0 per cent showed the post-term pattern and 4.4 per cent the pre-term pattern; and 28.6 per cent of the women with post-term pregnancy determined by history showed the cell post-term pattern, 38.1 per cent the at-term pattern and 9.5 per cent the pre-term pattern.

Results of Pap smear examinations in 1989.

Results of Pap smear examinations in 1989 for disease detection in the female reproductive tract were compiled at Siriraj Hospital. The major technique was VCE. A total of 34,884 Pap smears were taken from females ranging in age from one day to 90 years; the mean age was 36.7 +/- 11.5 years. The percentage of the cytological diagnoses were: 51.6 normal smears, 45.3 infection and inflammation, 0.4 few abnormal cells, 1.1 dysplasia, 0.4 carcinoma in situ, 1.0 invasive carcinoma (0.1 keratinizing squamous cell carcinoma of the cervix, 0.4 large cell nonkeratinizing, 0.1 small cell nonkeratinizing and 0.1 adenocarcinoma; 0.1 adenocarcinoma of the corpus; and 0.2 adenocarcinoma of the ovary) and 0.2 unsatisfactory smears. Of the total number of women who underwent Pap smear examination only 5.0 per cent did so more than once a year. Hence, there should be appropriate treatment and/or sufficient investigation in women with infection and with abnormal smears.

Pap smear examinations of infertile women.

Pap smear examinations of 139 infertile women taken between June 19, 1983 and December 26, 1983 were studied at the Cytological Room, Department of Obstetrics & Gynaecology, Faculty of Medicine, Siriraj Hospital, Mahidol University. The range of age was 17 to 44 years, the mean age being 28.2 +/- 4.9 years. The percentage of cytological findings were: 84.9 normal women, 10.1 hormonal abnormality (of those with non-normal hormone, 7.2 of the total had a mild degree of abnormality), 5.0 no hormonal evaluation, 1.4 few abnormal cells and 0.7 folic acid deficiency.

Pap smear examinations in women post-treated for genital organ diseases by operation and radiation.

A total of 846 Pap smears in women post-treated for genital organ diseases by operation and radiation (1.7% of all those made) at the Cytological Unit, Department of Obstetrics & Gynaecology, Faculty of Medicine, Siriraj Hospital between April 4, 1983 and July 4, 1984, were examined. The women were aged 21-75 years (mean age 43.1 +/- 9.7 years). Sixty-seven point two per cent of the women had Wertheim operations and 30.1 per cent total abdominal hysterectomies, due to invasive carcinoma (68.1% of cases) and carcinoma in situ of the uterine cervix (15.2%). Cytological findings revealed 72.8 per cent normal smears, 26.0 per cent infections (17.7% with mixed bacteria), one case of carcinoma in situ and one case of postirradiation dysplasia (both cases were post Wertheim operation). Hormonal conditions were 53.2 per cent in early menopause, 11.7 per cent in crowded menopause, 11.9 per cent in late menopause and 23.2 per cent had no hormonal evaluation. Pap smears of women post-treated for genital organ diseases by operation and radiation were examined for consideration of treatment of choice.

Pap smear examinations of women at the out-patient department of Siriraj Hospital.

Pelvic examinations in 1,906 women at the Gynaecological Room, Out-Patient Department, Siriraj Hospital, in June 1990 were studied. The range of ages was between 14 and 85 years, the mean age being 34.5 +/- 11.5 years. Almost three-quarters (74.7%) of the cases had undergone Pap smear examinations; of these, 36.5 per cent followed up on the results and 6.7 per cent were sent the results by postcard as requested by the patients. The percentage of the clinical diagnoses in women who underwent pelvic and Pap smear examinations (Pap smear data are within the parentheses) were: 36.6 (29.0) no abnormal findings, 14.9 (10.5) vulvovaginitis and leukorrhea, 10.1 (9.7) cervicitis and cervical erosion, 5.6 (1.9) bleeding per os, 3.4 (0.3) abortion, and 3.3 (1.3) adnexitis. The mean age of the women with various diseases were: 27 years in cases of abortion; 30-34 years in women with inflammation of the vulva, vagina, cervix and adnexa, including bleeding per os; 41-45 years in women with cervical polyps, suspected carcinoma, precancer and carcinoma of the cervix, combined with myoma uteri; 48 years in women with relaxation of the genital organ. Every woman who underwent pelvic examination should have a Pap smear and VCE technique performed for the early detection of cervical carcinoma. Health care workers should also ensure that every patient follows up on the results.

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.

A study of patients infested with trichomonas vaginalis uncovered by pap smear examination.

Pap smears examination of 5,995 woman at Cytological Unit, Department of Obstetrics and Gynaecology, Faculty of Medicine Siriraj Hospital, from January 3, 1983 to February 28, 1983, revealed 216 cases (3.6%) harbouring Trichomonas vaginalis. Their ages ranged from 16-67 years with the mean age of 33.9+9.5 years. 63.9% had clinical diagnosis of check-up, 5.5% Trichomoniasis, 5.1% leucorrhea, 4.2% vaginitis and 3.7% myoma uteri. Concurrent cytological findings included mycosis 0.9%, gonorrhea 0.5%, herpes simplex progenitalis 0.9%, nonkeratinizing squamous cell carcinoma of the uterine cervix 0.9% and inflammatory cellular changes 99.5%. It is conceivable that these patients with Trichomonas vaginalis infestation ought to pursue the follow-up examination or surveillance for possible inflammatory cellular changes leading to future occurrence of or association with cervical cancer.

Diagnosis of cervical carcinoma: Report of a case.

Cervical carcinoma is the most common among carcinomas, and numerous cases of late stage of cervical carcinoma are still found. The Ministry of Public Health has realized this problem and is carrying on a mass screening program for early detection of cervical cancer over the entire country. Everybody should participate regularly in order that this program is successful in the near future. The unmarried women were after 20 years of age. Then screening technique should be VCE technique. Married women should be checked after marriage and unmarried after 20 years of age. Then women should be checked every 6 months except during menstruation or in cases of notified. A case of late of cervical cancer was reported. This patient was a good example for many aspects of complications and results of late cancer. After retroperitoneal mass was found the first day attending the O.P.D. at Siriraj Hospital but an appointment in 6 weeks time was made rather than having immediate examined and treatment. The tumor progressed rapidly and the case became more complicated. The patient was investigated and treated completely during this late stage but could not be helped. Many factors such as time and expenses were lost. For these reasons prevention before late of cancer through early detection should be conducted.