What is new in cervical precanceroses cytodiagnostics?
Authors:
J. Dušková
Authors‘ workplace:
Autorka je členkou Komise pro screening karcinomu děložního hrdla Ministerstva zdravotnictví ČR.
; Ústav patologie 1. LF UK a VFN a Katedra patologie IPVZ, Vysoká škola zdravotní, CGOP, s. r. o., Praha, Česká republika.
Published in:
Čes.-slov. Patol., 48, 2012, No. 1, p. 22-29
Category:
Reviews Article
Overview
Cytopathology investigation of the uterine cervix transformation zone smear (Pap test) has been accepted during the last 80 years worldwide as a potent tool in lowering the incidence of squamous cell cervical cancer; it can reveal a proportion of adenocarcinomas as well and contributes to the diagnostics of cervicovaginal infections.
The technique itself and diagnostic criteria have been internationally unified in the systems Bethesda I (1988) and Bethesda II (2002). Nevertheless, the cytodiagnostics of cervical precanceroses continues to develop vividly in the following fields of interest.
In processing the cervical sample:
- Unified polychrome staining has been accepted as compulsory
- Processing of the sample acquired has split into two branches - conventional preparation - CP and liquid based preparation – LBP.
- In both types of processing (mainly in LBP) additional tests are employed.
- Differences of the petrified diagnostic features formulated formerly for CP in the LBP have been described.
- Differentially-diagnostic pitfalls (look-alikes) are studied.
- Sensitivity of precanceroses detection in a screening routine with the prevalence of negative findings has been improved with compulsory rescreening of 10-20% random selected negative cases as well as rapid pre- or postscreening of the whole material or involvement of automated pre- or postscreening using image analysis systems.
- Some cytomorphology findings are followed with additional tests – especially HR HPV detection.
- Cyto-bioptic correlations are constantly studied.
- Opportune screening is substituted with nationwide programs aimed at:
- Involvement of as many women of the target group as possible.
- Standardized investigation (CP or LBP) in an accredited laboratory with functioning systems of external and internal quality control.
- Selective additional investigation with non-morphological tests.
- Appropriate treatment of women with pathology findings.
- Some newly designed nationwide screening models start with a non-morphological test (HPV) followed by a pap test and colposcopy.
Keywords:
cervical cytology – Pap test – precanceroses – National programme of cervical cancer screening
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Anatomical pathology Forensic medical examiner ToxicologyArticle was published in
Czecho-Slovak Pathology
2012 Issue 1
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