[Verification of doubtful PAP smear results of women included in the screening program in the Podlaskie province]. / Weryfikacja watpliwych wyników cytologicznego testu diagnostycznego u kobiet objetych badaniami przesiewowymi w województwie podlaskim.

OBJECTIVES: Verification of uncertain PAP-smear results in a group of women covered by the cervical screening program in the Podlaski province. The main aim of the study was to identify CIN (Cervical Intraepithelial Neoplasia) lesions present, with varying degrees of severity in women with cytological diagnosis of ASCUS (atypical squamous cells of undetermined significance), LSIL (low grade squamous intraepithelial lesion), and ASC-H (atypical squamous cells - cannot exclude high grade squamous intraepithelial lesion). MATERIALS AND METHODS: The study evaluated 101 cervical smears taken from the vaginal part of the cervix in a group of screened women in the Podlaski province. Cytological evaluation was performed according the Bethesda System. We analyzed abnormal smears selected from a total of 7296 cytological examinations performed during 2012 at the University Center for Pathomorphological and Genetic - Molecular Diagnosis, Medical University in Bialystok. The cytological results which were of interest to us included 19 cases with ASCUS, 59 with LSIL, and 23 with ASC-H, as well as with morphological features of the presence of Human Papilloma Virus (HPV). Staining was performed using CINtecPLUS test according to the manufacturer's instructions. CINtecPLUS is a immunocytochemical test based on specially designed monoclonal antibodies (E6H4TM) that let us identify protein p16ink4a within the cervical smear Additionally the diagnostic kit was provided with antibodies for diagnosing the presence of Ki-67 protein, a known marker of cell proliferation. The result was considered positive when staining of the nucleus and the cytoplasm appeared in red and brown, respectively. All abnormal results were eventually verified by histological examination of the tissue taken from cervical lesions by diagnostic-therapeutic procedure following colposcopic evaluation of cervical lesion topography RESULTS: In the group of cytological smears with ASCUS, the diagnosis was positive in 5 cases (26.3%), negative in 14 (73.7%). In the group with the diagnosis of LSIL, the cytology results were positive in 32 cases (54.2%), negative in 27 (45.8%). In the cytological diagnosis of ASC-H there were 20 positive (87%) and 3 negative (13%) results. CONCLUSIONS: Test CINtecPLUS could be a helpful tool in the final diagnosis of cervical abnormality in patients with the cytological diagnosis of ASCUS, LSIL and ASC-H. The combination of conventional cytological test and CINtecPLUS can help create a new procedure algorithm for cases with abnormal or ambiguous cytological screening results. It could be especially useful in a group of young women of childbearing age, when it is common to avoid a more radical treatment of cervical lesions.

[Implementation of cytology images classification--the Bethesda 2001 System--in a group of screened women from Podlaskie region--effect evaluation]. / Ocena efektów wdrozenia klasyfikacji obrazów cytologicznych wg systemu Bethesda 2001, w populacji kobiet województwa podlaskiego poddanych badaniom profilaktycznym.

UNLABELLED: Increasing knowledge concerning carcinogenesis within cervical epithelium has forced us to make continues modifications of cytology classification of the cervical smears. Eventually, new descriptions of the submicroscopic cytomorphological abnormalities have enabled the implementation of Bethesda System which was meant to take place of the former Papanicolaou classification although temporarily both are sometimes used simultaneously. AIM: The aim of this study was to compare results of these two classification systems in the aspect of diagnostic accuracy verified by further tests of the diagnostic algorithm for the cervical lesion evaluation. MATERIALS AND METHODS: The study was conducted in the group of women selected from general population, the criteria being the place of living and cervical cancer age risk group, in the consecutive periods of mass screening in Podlaski region. The performed diagnostic tests have been based on the commonly used algorithm, as well as identical laboratory and methodological conditions. RESULTS: Performed assessment revealed comparable diagnostic accuracy of both analyzing classifications, verified by histological examination, although with marked higher specificity for dysplastic lesions with decreased number of HSIL results and increased diagnosis of LSILs. Higher number of performed colposcopies and biopsies were an additional consequence of TBS classification. Results based on Bethesda System made it possible to find the sources and reasons of abnormalities with much greater precision, which enabled causing agent treatment. CONCLUSION: Two evaluated cytology classification systems, although not much different, depicted higher potential of TBS and better, more effective communication between cytology laboratory and gynecologist, making reasonable implementation of The Bethesda System in the daily cytology screening work.