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Cervical cancer screening in the 21st century, is it time to retire PAP Smear?

Ginecología de Novak

The cervix in most women is coated with mucus or secretions of varying appearances, ranging from very scant to abundant. The results are expressed in percentages and frequencies for all parameters. Cervicovaginal cytology based on the Papanicolaou technique: Accordingly, the authors concluded that the cervix should be wiped at the discretion of the clinician. Author information Article notes Copyright and License information Disclaimer. The false negative rate was lower in the SS Figure 4.

All biopsy samples were stained with hematoxylin and eosin as per standard protocol and analyzed by immunohistochemical staining for cyclin-dependent kinase inhibitor 2A p16 clone J6; Cell Marke, CA, USAusing the CIN classification [ 16 ].

The samples should be obtained by trained personnel, including gynecologists, and ideally, the sample should be taken from the transformation zone TZ [ 23 ]. On the other hand, another study by Hans et al. Materials and methods Subjects Out of consecutive patients who attended our laboratory for cytology and colposcopy between June and March The age of the study cohort ranged from years, with an average age of 33 years.

Conversely, the CS was in contact with the vaginal wall and contained diagnostic cells in this case, and the biopsy found a typical condyloma with koilocytes. National Center for Biotechnology InformationU. A Resource Pack for Trainers. Moreover, a higher rate of inflammatory reaction was found to be present in the CS compared to the SS, whereas more epithelial cells with clear nuclear details were present in the SS compared with the CS Figure 2likely owing to the fact that these are living cells that are attached to the cervical surface, and if these are actively removed, their cytological characteristics will be more well-preserved at the time of fixation Figure 3.


The inflammatory reaction was moderate-to-severe in In these text books and manuals, how to use the relevant instruments, how to best prepare the sample in the slide or in the preservative fluid for liquid-based cytology LBCand how to obtain the sample from the cervical orifice and the TZ, receive the most attention [ 2 – 10 ].

A biopsy was performed in cases, in which acetowhite imaging was seen; of these, 24 cases had a previous positive biopsy. If the CS is removed with an oversized or normal-sized cotton swab, it is likely that the swab touches the cervical surface and may result in some CIN cells being removed; and these would hence not be present in the clean, second sample SS.

Table 1 Sample characteristic and kind of inflammation detected in the histophatologycal analyze in CS and SS respectively. Thieme Medical Publishers; In this study, we analyzed samples obtained with or without cleaning the cervix, and compared their contents in order to determine the sensitivity and specificity of these two methods. However, when the cervix is cleaned using a cytobrush, the abundance of the mucus becomes apparent, and these CS samples were found to have less epithelial cells and more inflammatory reactions than the samples obtained from the cleaned cervix.

The following parameters were recorded in all samples according to TBS: Cervical cleaning improves Pap smear quality. In cases of atrophy or if the SQCJ was not visible in endocervical canal with a very small orifice, ginecologai devices were used: To date, no analysis on what the mucus contains giinecologia the cervix has been performed.

Sample characteristic and kind of inflammation detected in the histophatologycal analyze in CS and SS respectively. Thus, gently removing the CS without touching the cervical surface should be recommended in any procedure for obtaining a cervical cytology sample.


La crétinisation par la culture

P16 INK4a Immunohhistochemestry impreoves interobserver agreement in the diagnosis of cervical intraepithelial neoplasia. In cases where the previous colposcopy was clearly overdiagnosed, in cases with the same image of metaplasia or ectopia in the actual colposcopy, or in cases with a simultaneous previous normal cytology or biopsy report, no additional biopsies were performed.

The SS was obtained from the transformation zone using a cervical cytobrush or broom depending of the nature of the TZ.

View of the mucus on the cervical surface. The types of diagnosed CIN were divided as shown in Table 2. All patients provided informed consent, and an external ethical committee approved the study protocol.

Dysplastic cells of the same patient, in A from the Cs, with more inflammatory cells, and the nucleus of the atypical cells are note clearly seen.

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Am J Surg Path. Examples of different cervix, both with large ectopia, abundant mucus, with the brush, showing how to clean it getting the mucus to the top in A and left in B.

CS was removed and compared with the clean, second sample SS using in both liquid-based cytology. The laboratory nvoak a private practice, serving a low-risk population in Mexico City, Mexico. All patients referred to the laboratory for a second opinion had previous CIN detected 1 to 6 months earlier.

Disclosure of conflict of interest None. All CIN-positive cases detected in the CS samples and SS were confirmed by biopsy and p16 immunohistochemical staining, and were considered true positive cases.

False positive frequency in CS samples.

Of patients who underwent cytology and colposcopy,