Papanicolaou smear에서 자궁내막암의 세포학적 진단의 의의 : 조직유형, 분화도 및 병기와의 관련성

홍성란,김희숙,박종숙,Hong, Sung-Ran,Kim, Hy-Sook,Park, Jong-Sook 대한세포병리학회 1993 대한세포병리학회지 Vol.4 No.2

The cytologic detection of endometrial carcinoma in Papanicolaou(Pap) smear according to histologic type, grade and stage was studied in 49 patients. The smears of patients who had histologically confirmed were retrospectively evaluated by the Bethesda System. The cytologic diagnosis of endometrial carcinoma was made in 61% (39/49) of patients, atypical glandular cells of undetermined significance (AGCUS) in 16% (8/49) and within normal limits in 23% (11/49). The positive rate for AGCUS and carcinoma was correlated to the histologic type, grade and stage. The cytologic grade revealed a good correlation with histologic grade, too. In conclusion, the presence of cancer cells in Pap smear suggests the tumor in high grade and high stage. Additionally, cytologic detection of AGCUS or carcinoma needs a further diagnostic evaluation. The Pap smear is a valuable method to screen for endometrial carcinoma.

Papanicolaou smear 진단에 있어 원격 영상처리 장치 ( Patho _ Net system ) 의 유용성 : 슬라이드 진단과 영상진단의 비교연구

윤은혜(Eun Hye Yoon),이경순(Kyung Soon Lee),김승철(Sung Chul Kim),우복희(Bok Hee Woo),이민진(Min Jin Lee),성순희(Sun Hee Sung),한운섭(Woon Sup Han) 대한산부인과학회 2001 Obstetrics & Gynecology Science Vol.44 No.12

N/A objective : To validate the efficacy of Patho_Net system for cervical cytology screening Methods : The results of imaging diagnosis by Patho_Net system were compared to those of 102 cervical smears diagnosed by conventional light microscopy. Results : There was 52.9% concordant results. The image result for the slide were 41 (80.4%) WNL or atrophy, 19 (61.3%) inflammation or benign atypia, 1 (20%) LSIL, 2 (20%) HSIL and 1 (100%) invasive squamous cell carcinoma. Conclusion : Patho_Net system has potential for diagnostic value as a valid alternative to the traditional glass slide screening of Pap smear.

Health Interventions and Misuse of Cervical Cancer Screening among Young Women

김남훈,Travis P. Mountain 사단법인 한국융합기술연구학회 2023 아시아태평양융합연구교류논문지 Vol.9 No.6

Despite the guidelines for the proper usage of cervical cancer screening, majority of young women misuse the screening methods, which can harm their health. To avoid the misuse, there is a need for empirical evidence to explore effective interventions. Hence, this study investigated the effect of the three health-related intervention and cognitive constructs: a doctor’s recommendation, knowledge of human papillomavirus (HPV), and HPV vaccination, on the misuse of three cervical cancer screenings: too-early screening, unnecessary HPV tests, and unnecessary annual Papanicolaou (Pap) tests among young women. This study examined the 2015 National Health Interview Survey (NHIS) collected by the Centers for Disease Control and Prevention (CDC) in the United States (N=1,776). Three types of dependent variables were considered relating to the misuse of cervical cancer screenings based on the U.S. Preventive Services Task Force (USPSTF) guideline. Multinomial logistic regression models were employed to estimate the coefficients, odds ratio, and relative risk ratios. The recommendation of health professionals played a significant role in not only receiving Pap smears at the proper usage, but when improper advice was given, can also induce unnecessary HPV testing and too-early and too-frequent Pap smear screening. HPV vaccination encouraged compliance with the recommendations, including Pap smears alone (without simultaneous HPV testing) and at a proper frequency, while it also induced screening misuse, including unnecessary HPV testing simultaneous with Pap smears. In addition, having heard of HPV increased the likelihood that women underwent Pap smears at a proper frequency while also inducing unnecessary HPV testing and screening overuse. To prevent young women from the misuse of cervical cancer screening, health professionals need to follow the recommendations proposed by experts. Also, public health authorities need to provide precise and correct information about appropriate cancer screening to young women.

한국인 일반 여성의 HPV 감염 유병율 -부산지역 일반 여성에서의 HPV DNA 및 항 VLPs 항체 양성 빈도 -

홍숙희,이덕희,신해림,Hong, Sook-Hee,Lee, Duk-Hee,Shin, Hai-Rim 대한세포병리학회 2004 대한세포병리학회지 Vol.15 No.1

To investigate a population-based survey of the prevalence of human papillomavirus (HPV) infection in South Korea, we performed Papanicolaou smears and tests for HPV DNA and anti-HPV antibody detection in 909 sexually active general women (age range; 20-74 years, median 44 years) who were randomly selected residents from S district of Busan City. The presence of DNA of 36 different HPV types was detected by means of a GP 5+/6+ primer-mediated PCR enzyme immunoassay in cervical exfoliated cells, and IgG antibodies against L1 virus-like particles (anti-VLPs) of 5 HPV types 16, 18, 31, 33, and 58 were tested by means of enzyme linked immunoassay. The incidence of cytologic abnormality was 5.2% in Pap smear. The positive rate of HPV DNA was 10.4%, high in young women younger than 35 years old and proportionally increased according to the cytologic grades. The most often found HPV type was HPV 70, followed by HPV 16 and 33, and high-risk HPV types were more frequent in women younger than 35 years old. The most common HPV type in abnormal cytologic smears was HPV 16, followed by HPV 58 and 66. Anti-VLPs was positive in 19.7% and the frequent anti-VLPs type was against HPV 18, followed by HPV 31 and 16. The concordance between the markers for each specific HPV type was noted in 10 women and HPV 16 was the most frequent one. The incidence of multiple HPV infection was 18.9% and that of multiple anti-VLPs antibodies was 31%. Among 103 self-reported virgins, 4.9% had anti-VLP antibodies.

Population-Based Cervical Screening Outcomes in Turkey over a Period of Approximately Nine and a Half Years with Emphasis on Results for Women Aged 30-34

Sengul, Demet,Altinay, Serdar,Oksuz, Hulya,Demirturk, Hanife,Korkmazer, Engin Asian Pacific Journal of Cancer Prevention 2014 Asian Pacific journal of cancer prevention Vol.15 No.5

Purpose: To appraise the frequency of cervical cytological abnormalities in a population at normal risk via analysing the archive records of cytology for the period of approximately 9,5 years, comparing them with patient demographic charecteristics, and discuss the results for women under age of 35. Materials and Methods: A total of 32,578 cases of Pap smears were retrieved and analysed from our archive included the Pap tests performed between January 2001 and April 2010 at the Early Cancer Screening, Diagnosing and Education Center by the consent of three pathologists via utilizing the Bethesda System Criteria 2001 and the results were compared with some demographical characteristics. Results: Our rate of the cervical cytological abnormality was 1.83%, with ASCUS in 1.18%, LSIL in 0.39, HSIL in 0.16%, AGUS in 0.07%, squamous cell carcinoma in 0.02%, and adenoarcinoma in 0.006%. Cytological abnormalities were detected mostly in those with higher age, lower parity, and premenopausal period whereas the smoking status was without influence. Bacterial vaginosis (5.6%) was the most frequent infectious finding (Candida albicans 2.7%; Actinomyces sp. 1.3%; and Trichomonas vaginalis 0.2%) detected on the smears. The rate of abnormal cervical cytology was 9.5% among the women aged between 30-34. Conclusions: Early detection of the cervical abnormalities by means of the regular cervical cancer screening programmes is useful to attenuate the incidence, mortality, and morbidity of cervical cancer. Our prevalence of the cytological abnormalities was much lower than the one in Western populations in general but very similar to those reported from other Islamic countries that may be explained by the conservative lifestyle and the lower prevalence of HPV in Turkey. A remarkable rate of abnormal cervical cytology of women aged 30-34 was pointed out in the present study.

Accuracy of Visual Inspection with Acetic acid in Detecting High-Grade Cervical Intraepithelial Neoplasia in Pre- and Post-Menopausal Thai Women with Minor Cervical Cytological Abnormalities

Poomtavorn, Yenrudee,Suwannarurk, Komsun Asian Pacific Journal of Cancer Prevention 2015 Asian Pacific journal of cancer prevention Vol.16 No.6

Purpose: To determine the accuracy of visual inspection with acetic acid (VIA) in detecting high-grade cervical intraepithelial neoplasia (CIN) in pre- and post-menopausal women with atypical squamous cells of undetermined significance (ASC-US) and low grade squamous intraepithelial lesion (LSIL) Papanicolaou (Pap) smears. Materials and Methods: Two hundred women (150 pre-menopausal and 50 post-menopausal) with ASC-US and LSIL cytology who attended the colposcopy clinic, Thammasat University Hospital, between March 2013 and August 2014 were included. All women underwent VIA testing and colposcopy by gynecologic oncologists. Diagnostic values of VIA testing including sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) for detecting high-grade CIN were determined using the histopathology obtained from colposcopic-directed biopsy as a gold standard. Results: VIA testing was positive in 54/150 (36%) pre-menopausal women and 5/50 (10%) post-menopausal women. Out of 54 pre-menopausal women with positive VIA testing, 15 (27.8%) had high-grade CIN and 39 (72.2%) had either CIN 1 or insignificant pathology. Ten (10.4%), 43 (44.8%) and 43 (44.8%) out of the remaining 96 pre-menopausal women with negative VIA testing had high-grade CIN, CIN 1 and insignificant pathology, respectively. Out of 5 post-menopausal women with positive VIA testing, there were 4 (80%) women with high-grade CIN, and 1 (20%) women with insignificant pathology. Out of 45 VIA-negative post-menopausal women, 42 (93.3%) women had CIN 1 and insignificant pathology, and 3 (6.7%) had high-grade CIN. Sensitivity, specificity, PPV and NPV of the VIA testing were 59.4%, 76.2%, 32.2% and 90.8%, respectively (60%, 68.8%, 27.8% and 89.6% in pre-menopausal women and 57.1%, 97.7%, 80% and 93.3% in post-menopausal women). Conclusions: VIA testing may be used as a screening tool for detecting high-grade CIN in women with minor cervical cytological abnormalities in a low-resource setting in order to lower the rate of colposcopy referral.

Prevalence and Risk Assessment of Cervical Cancer Screening by Papanicolaou Smear and Visual Inspection with Acetic Acid for Pregnant Women at a Thai Provincial Hospital

Lertcharernrit, Jiraporn,Sananpanichkul, Panya,Suknikhom, Wineeya,Bhamarapravatana, Kornkarn,Suwannarurk, Komsun,Leaungsomnapa, Yosapon Asian Pacific Journal of Cancer Prevention 2016 Asian Pacific journal of cancer prevention Vol.17 No.8

Background: Cervical cancer is the second most common in Thailand, but the mortality rate may be rising yearly. It is a cancer that can be prevented by early screening for precancerous lesions, several methods being available. Objective: To identify the prevalence of abnormal Papanicolaou (Pap) smears and lesions with visual inspection with acetic acid (VIA) in pregnant women and assess risk factors for this group. Materials and Methods: This prospective study was performed at Prapokklao Hospital, Thailand during April-July 2016. All pregnant women of gestational age between 12-36 weeks who attended an antenatal clinic were recruited. All participants were screened for cervical cancer by Pap smear and VIA. If results of one or both were abnormal, colposcopic examination was evaluated by gynecologic oncologist. Results: A total of 414 pregnant women were recruited. Prevalence of abnormal Pap smear and VIA were 6.0 and 6.7 percent, respectively. The most common abnormal Pap smear was low grade intraepithelial lesion (LSIL, 44%). Factors associated with abnormal Pap smear in pregnant women were low BMI, multiple partners and being a government officer. In pregnancy, Pap smear had higher sensitivity and specificity than VIA for detection of precancerous cervical lesion. Patients with young coitarche or more than 25 years of active sexual activity were high risk groups. Conclusions: Prevalence of abnormal Pap smear and VIA in pregnant women was 6.0 and 6.7 percent, respectively. Factors associated with abnormal Pap smear were coitarche, years of sexual activity, low BMI, multiple partners and being a government officer.

False-Negative Results of Conventional Papanicolaou Cervical Cytology in Women with Cervical Conization

박충학 대한부인종양학회 2008 Journal of Gynecologic Oncology Vol.19 No.1

Objective:The conventional Papanicolaou smear seems to be more accurate for detecting a high-grade squamous intraepithelial lesion (HSIL) than a low-grade squamous intraepithelial lesion (LSIL). The purpose of this study was to investigate false-negative results of conventional Pap smear cytology in women with cervical conization. Methods:This study was performed in Gynecologic Oncology Clinic of the Department of Obstetrics and Gynecology at Dankook University Medical Center from July 1, 1994 to December 31, 2004. 260 women from age 22 to 75 years had undergone conventional Papanicolaou cervical cytologic test and cervical conization. Conization was performed using ‘cold-knife cone' method or ‘large electrosurgical excision procedure (LEEP) cone' method. The cervical cytology were studied in comparison with histology of conization specimens. Results:Of the 260 histologic diagnoses, there were 41 (15.8%) diagnoses of chronic cervicitis, 8 (3.1%) of CIN 1, 18 (6.9%) of CIN 2, 150 (57.7%) of CIN 3, 38 (14.6%) of SCC, 2 (0.8%) of AIS, 1 (0.4%) of ACC, and 2 (0.8%) of ASC. Pap cytology showed sensitivity of 97.9-98.2%, specificity of 4.9-6.7%, and false-negative rate of 1.8-2.2% according to the variables. Conclusion:Significantly false-negative rate of Pap cytology in women with conization was very low. And so, conventional Pap cytology is still clinically efficient for screening high-grade cervical lesions with adequate sampling technique. Objective:The conventional Papanicolaou smear seems to be more accurate for detecting a high-grade squamous intraepithelial lesion (HSIL) than a low-grade squamous intraepithelial lesion (LSIL). The purpose of this study was to investigate false-negative results of conventional Pap smear cytology in women with cervical conization. Methods:This study was performed in Gynecologic Oncology Clinic of the Department of Obstetrics and Gynecology at Dankook University Medical Center from July 1, 1994 to December 31, 2004. 260 women from age 22 to 75 years had undergone conventional Papanicolaou cervical cytologic test and cervical conization. Conization was performed using ‘cold-knife cone' method or ‘large electrosurgical excision procedure (LEEP) cone' method. The cervical cytology were studied in comparison with histology of conization specimens. Results:Of the 260 histologic diagnoses, there were 41 (15.8%) diagnoses of chronic cervicitis, 8 (3.1%) of CIN 1, 18 (6.9%) of CIN 2, 150 (57.7%) of CIN 3, 38 (14.6%) of SCC, 2 (0.8%) of AIS, 1 (0.4%) of ACC, and 2 (0.8%) of ASC. Pap cytology showed sensitivity of 97.9-98.2%, specificity of 4.9-6.7%, and false-negative rate of 1.8-2.2% according to the variables. Conclusion:Significantly false-negative rate of Pap cytology in women with conization was very low. And so, conventional Pap cytology is still clinically efficient for screening high-grade cervical lesions with adequate sampling technique.

자궁경부암 선별진단에 있어서 자궁경부확대촬영술의 유용성

최원석(Won Suk Choi),김수녕(Soo Nyung Kim),손인숙(In Sook Sohn),이지영(Ji Young Lee) 대한산부인과학회 2001 Obstetrics & Gynecology Science Vol.44 No.7

N/A Objective :Although incidence of the cervical cancer has been very high, it is possible to detect the early cervical cancer with screening methods. Among the screening methods of cervical cancer, Papanicolaou smear has lower sensitivity and higher false negative rate. The goal of this study is to evaluate the usefulness of cervicography in cervical cancer screening. Methods :The data of Papanicolaou smear and cervigram has been obtained from 292 patients. The age range varied between 20 and 78 years with the average age of 42. Histologic specimens were obtained from patients whose abnormalities were detected by either Papanicolaou smear or cervigram. A total of 101 patients received a biopsy. We calculated sensitivity, specificity, positive predictive values, negative predictive values, false negative rates and false positive rates. Results . Results for Papanicolaou smear are as follows; sensitivity, 60.8%, specificity, 93.4%, positive predictive values, 66.0%, negative predictive values, 91.8%, false negative rates, 39.2% and false positive rates, 6.6%. In cervicography, sensitivity, 70.1%, specificity, 85.5%, positive predictive values, 56.3%, negative predictive values, 94.5%, false negative rates, 23.5% and false positive rates, 11.6%. Results for the combined methods are sensitivity with 82.4%, specificity with 92.5%, positive predictive values with 51.9%, negative pedictive values with 97.0%, false negative rates with 11.8% and false positive rates with 16.2%. Conclusion Cervicography is an effective method to screen cervical cancer. When cervicography is used with Papanicolaou smear, the detection rate of cervical cancer will be increased.

Colposcopy Requirement of Papanicolaou Smear after Atypical Squamous Cells of Undetermined Significance (ASC-US) by Follow-up Protocol in an Urban Gynaecology Clinic, a Retrospective Study in Thailand

Perksanusak, Thitichaya,Sananpanichkul, Panya,Chirdchim, Watcharin,Bhamarapravatana, Kornkarn,Suwannarurk, Komsun Asian Pacific Journal of Cancer Prevention 2015 Asian Pacific journal of cancer prevention Vol.16 No.12

Background: ASC-US cases are managed according to the current American Society for Colposcopy and Cervical Pathology (ASCCP) guideline in which a human papillomavirus (HPV) test and repeat Pap smear are performed in the next 1 year. Colposcopy in cases of positive high risk HPV and persistent ASC-US or more in subsequent Pap smear is recommended. The HPV test is more expensive and still not currently a routine practice in Thailand. Objective: To identify the risk factors of persisted abnormal Pap smear and the colposcopic requirement rate in women with ASC-US. Materials and Methods: During 2008-2013, this study was conducted in Prapokklao Hospital, Chanthaburi, Thailand. Participants were women who attended gynaecology clinic for cervical cancer screening. Women who had cytological reports with ASC-US were recruited. During the study period, 503 cases were enrolled. Colposcopic requirement was defined as those who were detected with an ASC-US or more in subsequent Pap smears up to 1 year follow-up. Results: The colposcopic referral rate was 23.2 (85/365) percent at 12 months. Prevalence of cervical intraepithelial neoplasia (CIN) 2/3 was 3.3 (12/365) percent. Loss follow-up rate of subsequent Pap smear and colposcopic appointment were 27.4 (138/503) and 48.2 (41/85) percent, respectively. There was no invasive cancer. High risk factors for persisted abnormal Pap smears in subsequent test were premenopausal status, HIV infected patients and non-oral contraceptive pills (COC) users. Conclusions: Referral rate for colposcopy in women with ASC-US reports was rather high. Loss to follow-up rate was the major limitation. Immediate colposcopy should be offered for women who had high risk for silent CIN.