Library

Notes: Aims 〈list xml:id="l1-14" style="custom"〉1 To identify the outcome status of women with borderline and mild dyskaryosis smears.2To determine whether the presence or absence of koilocytosis influences the outcome status.3To identify the proportion of women with borderline smears showing koilocytosis.Materials and methods  Borderline and mild dyskaryosis cervical smears diagnosed during January to March 1997 were identified from the laboratory database. Each slide was reviewed by two researchers independently, who then agreed a final consensus diagnosis. All slides were classified according to the presence or absence of koilocytosis. Slides were excluded from the study if the review diagnosis was negative, inadequate or high-grade dyskaryosis. The outcome status was classified according to the worst lesion identified histologically and/or cytologically during the 5-year follow-up period.Results  1974 women were identified with borderline or mild dyskaryosis cervical smears of which 1597 were included in the study. 〈link href="#t1-14"/〉〈link href="#t1-14"〉Table 1 shows the outcome status of these women.〈tabular xml:id="t1-14"〉1. 〈title type="main"〉 The outcome status of these women 〈table frame="topbot"〉〈tgroup cols="4" align="left"〉〈colspec colnum="1" colname="col1"/〉〈colspec colnum="2" colname="col2"/〉〈colspec colnum="3" colname="col3"/〉〈colspec colnum="4" colname="col4"/〉〈thead valign="bottom"〉〈row rowsep="0"〉〈entry valign="bottom" morerows="1"〉Cytology〈entry rowsep="1" namest="col2" nameend="col4"〉Outcome status〈row rowsep="1"〉Negative (%)Low-grade (%)High-grade (%)〈tbody valign="top"〉Borderline681913Mild dyskaryosis462628 〈link href="#t2-14"/〉 〈link href="#t2-14"〉Table 2 shows the outcome of women with borderline and mild dyskaryosis smears with or without koilocytosis.〈tabular xml:id="t2-14"〉2〈title type="main"〉 The outcome of women with borderline and mild dyskaryosis smears with or without koilocytosis 〈table frame="topbot"〉〈tgroup cols="4" align="left"〉〈colspec colnum="1" colname="col1"/〉〈colspec colnum="2" colname="col2"/〉〈colspec colnum="3" colname="col3"/〉〈colspec colnum="4" colname="col4"/〉〈thead valign="bottom"〉〈row rowsep="0"〉〈entry valign="bottom" morerows="1"〉Koilocytosis〈entry rowsep="1" namest="col2" nameend="col4"〉Outcome status〈row rowsep="1"〉Negative (%)Low-grade (%)High-grade (%)〈tbody valign="top"〉Present582220Absent612118 〈link href="#t3-14"/〉 〈link href="#t3-14"〉Table 3 shows the proportion of borderline and mild dyskaryosis cervical smears with or without koilocytosis.〈tabular xml:id="t3-14"〉3〈title type="main"〉 The proportion of borderline and mild dyskaryosis cervical smears with or without koilocytosis 〈table frame="topbot"〉〈tgroup cols="3" align="left"〉〈colspec colnum="1" colname="col1"/〉〈colspec colnum="2" colname="col2"/〉〈colspec colnum="3" colname="col3"/〉〈thead valign="bottom"〉〈row rowsep="1"〉CytologyKoilocytosis present (%)Koilocytosis absent (%)〈tbody valign="top"〉Borderline2476Mild dyskaryosis3466Conclusions 〈list xml:id="l2-14" style="custom"〉1Sixty-eight per cent of women with a borderline cervical smear had a normal outcome.2Thirteen per cent of women with a borderline cervical smear developed a high-grade lesion.3The presence or absence of koilocytosis in borderline and mild dyskaryosis cervical smears does not appear to affect the outcome status of these women.4Twenty-four per cent of smears showing borderline nuclear changes were found to have koilocytosis.

Notes: Objective  This study was conducted to compare the performance of liquid-based cytology (LBC) and conventional cytology (CS) in the high prevalence setting of colposcopy clinic.Design  A split sample of matched ThinPrep (TP) and conventional smear from 563 patients were evaluated blindly. The performance of both techniques was compared with the gold standard of biopsy results or normal colposcopy examination in 441 cases.Setting  Colposcopy clinic of an inner city hospital for women and children.Sample  Five hundred and sixty-three women referred to colposcopy clinic over 14-month period.Methods  Cervical smears were taken from 563 women referred for colposcopy. Using the split-sample technique, the material was spread on a conventional (CS) slide and the remaining material rinsed in a PreservCyt solution. A T2000 processor was used to prepare LBC preparations. All women underwent colposcopy/biopsy according to local protocol. Four hundred and forty-one women met the diagnostic standard criteria of the study, which was either a normal colposcopy or histopathology result. Sensitivity, specificity and positive and negative predictive values were calculated for both methods of cytology preparations.Main outcome measures  Matched TP and conventional smears, detection of abnormality, matched biopsies, sensitivity, specificity, and positive and negative predictive values.Results  Inadequate rates for CS and LBC (TP) were 4.3% and 0.68%, respectively. In 73% of cases, the CS and the LBC preparations showed exact agreement, whereas 77% agreement was seen when comparison was made for amalgamated low grade and high grade abnormalities. Low grade cytological abnormalities accounted for 44% of LBC slides versus 37% in CS slides. High grade cytological abnormalities accounted for 22% of LBC versus 17% seen in CS cases (P 〈 0.001). LBC showed increased sensitivity in the detection of CIN2 or worse than CS (92% and 83%, respectively) and CS showed greater specificity than LBC (82% and 76%, respectively).Conclusions  In high prevalence setting, LBC performed at least as well as CS. The inadequate rate was significantly lower with LBC. The numbers are too small, however, to make confident comments about increased sensitivity and negative predictive value with LBC. Larger studies are required to verify these findings.

Notes: Introduction  A randomized controlled trial comparing the adequacy of cytological sampling using the Cervex brush and the Aylesbury spatula, published in 1996, revealed that the Cervex brush did not reduce the inadequate smear rate but smears were more likely to contain cytological abnormalities (odds ratio 1.19; P = 0.05). We report the long-term follow-up of women who had a normal smear during the trial.Methods  The trial has been described elsewhere.1 Matching of trial and laboratory databases identified follow-up smears taken before 31/12/2000 from women with a normal smear during the trial. The analysis was restricted to 66 centres using the laboratory during the follow-up period when all were supplied with the Aylesbury spatula. The Kaplan–Meier method was used to estimate the cumulative risk of cytological abnormality following a normal smear. The difference between study arms was estimated using the hazards ratio (HR) derived from a Cox proportional hazards model adjusted for the cluster-randomized design and controlling for centre type.Results  A total of 7129 women had at least one follow-up smear: 3716 were first sampled with the Cervex brush and 3413 with the Aylesbury spatula. There was no difference between study groups in the incidence of any cytological abnormality (HR 1.11; 95% CI 0.92–1.34) or of moderate dyskaryosis or worse (HR 1.02; 95% CI 0.70–1.49).Conclusion  The excess of abnormal smears observed during the trial in women sampled with the Cervex brush is unlikely to be due to earlier detection, because the incidence of cytological abnormality following a normal smear was similar in the two study arms.

Notes: This study investigated the 5-year follow-up status of women with cervical smears showing borderline nuclear changes (BNC) or mild dyskaryosis and the effect of koilocytosis on the outcome. Thirteen per cent of women with cervical smears showing BNC had high-grade cervical intraepithelial neoplasia (CIN). In contrast, 28% of women with cervical smears showing mild dyskaryosis had high-grade CIN. The presence of koilocytosis (24% for borderline smears and 34% for mild dyskaryotic smears) did not appear to influence the risk of developing high-grade CIN. Our results suggest that the simultaneous implementation of the British Society for Clinical Cytology proposed terminology and the colposcopy guidelines from the British Society for Colposcopy and Cervical Pathology could have an impact on colposcopy services.

Notes: The European panel agreed that reproducibility and translatability of terminology in cervical cytology were essential, auguring well for harmonization of reporting systems. The majority at this meeting use a modification of the Bethesda system (BS). Local modifications involved reporting subcategories within high grade and low grade lesions, which would not alter the overall translatability of their systems both with each other and BS. The majority agree that low grade lesions with and without koilocytosis should be managed similarly as should high grade lesions (moderate dysplasia/CIN2 or worse). Those systems linking moderate dysplasia with mild rather than severe dysplasia would need to define moderate dysplasia as such, if their results were to be translatable, which would be preferable to their using a different definition of low grade and high grade lesions. Translation between systems might anyway be facilitated by reporting moderate dysplasia as a subcategory within high grade, which was favoured by most of those present. Therefore, there is no need for exact agreement of terminology if broad principles are agreed. This useful discussion adds weight to the British Society for Clinical Cytology recommendation that the new classification should be adopted by the UK National Health Service Cervical Screening Programme. If the new classification is adopted, the UK would join the European consensus opinion on terminology.