ABSTRACT
OBJECTIVE: To report the prevalence of Gardnerella, Trichomonas and Candida in the cervical smears of 9 immigrant groups participating in the Dutch national cervical screening program. STUDY DESIGN: Cervical smears were taken from 58,904 immigrant participants and 498,405 Dutch participants. As part of the routine screening process, all smears were screened for the overgrowth of Gardnerella (i.e. smears with an abundance of clue cells) and for the presence of Trichomonas and Candida. The smears were screened by 6 laboratories, all of which use the Dutch KOPAC coding system. The odds ratio and confidence interval were calculated for the 9 immigrant groups and compared to Dutch participants. RESULTS: Immigrants from Suriname, Turkey and the Dutch Antilles have a 2-5 times higher prevalence of Gardnerella and Trichomonas when compared to native Dutch women. Interestingly, the prevalence of Trichomonas in cervical smears of Moroccan immigrants is twice as high, yet the prevalence of Gardnerella is 3 times lower than in native Dutch women. CONCLUSIONS: Immigrants with a high prevalence of Gardnerella also have a high prevalence of Trichomonas. In the context of the increased risk of squamous abnormalities in smears with Gardnerella, such slides should be screened with extra care.
Subject(s)
Candidiasis, Vulvovaginal/pathology , Emigrants and Immigrants , Trichomonas Infections/pathology , Trichomonas Vaginitis/pathology , Uterine Cervical Diseases/pathology , Vaginal Smears , Vaginosis, Bacterial/pathology , Adult , Animals , Candida albicans/isolation & purification , Candidiasis, Vulvovaginal/epidemiology , Candidiasis, Vulvovaginal/ethnology , Female , Gardnerella vaginalis/isolation & purification , Humans , Middle Aged , National Health Programs , Netherlands/epidemiology , Netherlands/ethnology , Trichomonas Infections/epidemiology , Trichomonas Infections/ethnology , Trichomonas Vaginitis/epidemiology , Trichomonas Vaginitis/ethnology , Trichomonas vaginalis/isolation & purification , Uterine Cervical Diseases/epidemiology , Uterine Cervical Diseases/ethnology , Vaginal Smears/trends , Vaginosis, Bacterial/epidemiology , Vaginosis, Bacterial/ethnologyABSTRACT
OBJECTIVE: The large set of ThinPrep slides prepared in the Leiden Cytology and Pathology Laboratory is exploited for calculating the impact of the transition from PAPNET neural network scanning to the Imager technology. STUDY DESIGN: All cervical samples were suspended and fixed in the coagulant fixative BoonFix. We compared 57,541 ThinPrep slides which were scanned by PAPNET and 64,273 ThinPrep slides processed with the Imager: 99,157 cases originated from the Dutch population screening program of asymptomatic women (screenees) and the remaining 22,657 samples were of symptomatic women. In the PAPNET series, 23% were diagnosed by additional light microscopy; in the Imager method, all slides were studied light microscopically. The cytoscores (positive cytology per 1,000 samples) were calculated for normal, atypical squamous cells of undetermined significance (ASC-US), cervical intraepithelial neoplasia (CIN) grades I-II, and for CIN III+. The odds ratios (ORs) for the positive cytoscores were assessed for both the screenees and the symptomatic women. RESULTS: The cytoscores, per 1,000 cases, for ASC-US varied from 17.77 to 40.59, for CIN I-II from 7.17 to 33.35, and for CIN III+ from 2.81 to 8.8. These 6 cytoscores were higher for symptomatic women than for screenees. We observe significantly elevated ORs for the Imager for ASC-US (1.26 and 1.23), CIN I-II (1.45) and for CIN III+ (1.58 and 1.45). These 3 ORs are higher for screenees than for symptomatic women. CONCLUSION: The Imager technology is more efficacious, particularly for handling screenee slides.
