The impact of the introduction of liquid based cytology on the variation in the proportion of inadequate samples between GP practices

<p>Abstract</p> <p>Background</p> <p>Historically there has been a wide variation in the proportion of inadequate smears between general practices. Cervical screening in the UK is undergoing a fundamental change by moving from conventional to liquid based cytology (LBC). The main driver for this change has been a predicted reduction in the proportions of inadequate samples. This study investigates the effect of LBC on the variation in the proportion of inadequate samples between general practices using Shewhart's theory of variation and control charts.</p> <p>Methods</p> <p>Routinely collected cervical cytology data was obtained for all general practices in two localities in South Staffordshire for periods before and after the introduction of liquid based cytology. Control charts of the proportion of inadequate smears were plotted for the practices stratified by laboratory. A standardised measure of variation for all of the practices in each laboratory and each time period was also calculated.</p> <p>Results</p> <p>Following the introduction of liquid based cytology the overall proportion of inadequate samples in the two localities fell from 11.8 to 1.3% (p < 0.05). This fall was associated with a reduction in the average variation between the GP practices in the two localities from 1.6 to 1.0 standard deviations. There has also been a reduction in the number of practices showing special cause variation from eight to one following the introduction of liquid based cytology.</p> <p>Conclusion</p> <p>A reduction in the proportion of inadequate samples has been realised in these localities. The reduction in the overall proportion of inadequate samples has also been accompanied by a reduction in variation between GP practices.</p

Significance of atypia in conventional Papanicolaou smears and liquid-based cytology: a follow-up study

Udgivelsesdato: 2004-JunThe diagnosis of atypical squamous epithelial cells, borderline nuclear changes, is associated with some controversy, as it encompasses benign, reactive, as well as possible neoplastic conditions. The aim of this study was to evaluate the follow-up diagnoses of cytological atypia in conventional Papanicolaou smears (CP) and liquid-based samples by the ThinPrep Pap Test (TP). A total of 1607 CP smears from 1 January 2000 to 31 December 2000 and 798 TP samples from 1 January 2002 to 31 December 2002 diagnosed as atypia were included. The results show that the detection rate of atypia in cervical cytological samples was reduced by 41.3% (P &lt; 0.001) in TP compared with CP. Cytological and histological follow-up data showed the presence of neoplastic lesions in 34.7% of patients screened by TP versus 22.3% of patients screened by CP, corresponding to a 55.6% increase in TP (P &lt; 0.001). Follow-up diagnosis of mild dysplasia was seen more than twice as often in TP than in CP (12.8% versus 5.0%, P &lt; 0.001). The prevalence of moderate and severe dysplasia was significantly increased with 26.7% in TP compared with CP (21.9% versus 17.2%, P &lt; 0.01). In conclusion, the ThinPrep Pap Test yielded a significant decrease in atypia rates compared with the conventional Papanicolaou test. In subsequent follow-up the percentage of neoplastic lesions was significantly increased in the ThinPrep Pap Test samples

Is there a need for surgical staging of uterine endometrioid adenocarcinomas grade 1 and 2?

Background and aims: Our institution has followed the Danish Guidelines for treatment of uterine carcinomas including staging lymphadenectomy in the pelvis for endometrioid adenocarcinomas (EA) grade 1 and 2 with deep myometrial invasion (&gt;50%) or cervical involvement. We wanted to find out how often staging lymphadenectomy resulted in upstaging and further therapy. Methods: Retrospective analysis of records for all patients with endometrial cancer at Odense University Hospital, Odense, Denmark from Jan. 1st 2004 to Dec. 31st 2013. The focus was on EA grade 1 and 2. Patients with this histology and FIGO stage IB, II and IIIC were evaluated. Results: 467 patients had EA grade 1 in their hysterectomy specimen. 85 were stage IB, 54 stage II and 8 stage IIIC. 58 (68%) of stage IB and 33 (61%) of stage II had staging lymphadenectomy with negative nodes. If positive they were included in stage IIIC. In 32/39% lymphadenectomy was omitted due to old age and/or comorbidity. In grade 1, stage IIIC, 6 of the 8 patients had cervical involvement (+/- deep myometrial invasion) and only 2 had deep invasion without cervical involvement. For grade 2 the numbers are: total 246, 53 stage IB, 33 stage II and 9 stage IIIC. 39 (74%) stage IB and 19 (58%) stage II were staged. Of the 9 stage IIIC 5 had cervical involvement and deep myometrial invasion. 4 had only deep invasion. Conclusion: Staging of stage II, grade 1 and 2 EA seems reasonable, while it could be omitted in stage IB

Are adjunctive markers useful in routine cervical cancer screening? Application of p16(INK4a) and HPV-PCR on ThinPrep samples with histological follow-up

Udgivelsesdato: 2008-JulThe objectives of the study were to evaluate 1) the diagnostic sensitivity and specificity of p16(INK4a) as a marker for high-grade cervical lesions, 2) the results of a real-time polymerase chain reaction detecting high-risk human papillomavirus, and 3) the interobserver variability of the p16(INK4a) interpretation.A total of 232 ThinPrep samples were stained for p16(INK4a), and HPV-DNA PCR was performed on 107 specimens with inclusion of both benign and abnormal cytology. Histological follow-up information was collected.The diagnostic sensitivity of ASC+ with CIN2+ in histology as endpoint was 96% for p16(INK4a) and 100% for HR-HPV DNA PCR, and the diagnostic specificity was 41% and 27%, respectively. If p16(INK4a) had been used for triage of the ASC samples, then 18 patients (42%) could have been spared unnecessary follow-up procedures compared to six patients (21%) with the HR-HPV DNA test

Impact of technology on cytology outcome in cervical cancer screening of young and older women

Little is known about age‐dependent variation in outcomes of cervical cytology with modern technologies. This population‐based study evaluated age‐dependent changes after routine implementation of ThinPrep and SurePath technology in two independent laboratories, and controlled for time trends in a third laboratory using manually read conventional cytology continually. Data were collected from the Danish National Health Care Registers. For each laboratory, we compared proportions of abnormal cytology defined as atypical squamous cells of undetermined significance or worse (ASCUS+) by age and technology phase. The study included 489,960 cytological samples with no recent abnormality from women aged 23–59 years, routinely screened between 1998 and 2007. Implementation of SurePath liquid‐based cytology (LBC) was followed by an increase in abnormal cytology in women aged 23–29 years from 4.6 to 6.1%, relative proportion (RP): 1.31 [95% confidence interval (CI): 1.08–1.61], and a decrease in women aged 45–59 years from 2.9 to 2.0%, RP: 0.71 (95% CI: 0.60–0.83). Implementation of ThinPrep LBC was followed by a decrease in abnormal cytology both in women aged 23–29 years from 7.7 to 6.8%, RP: 0.89 (95% CI: 0.78–1.02) and in women aged 45–59 years from 3.4 to 1.0%, RP: 0.30 (95% CI: 0.24–0.37). With implementation of imaging‐assisted reading, regardless of the brand of technology, the proportion of abnormality increased by around 30% in all age groups (range from 19 to 41%). In the laboratory with unchanged technology no trends in abnormality proportions were observed. The impact of LBC implementation on cytological abnormality proportions varied considerably across age groups