Prevalence of abnormal Papanicolaou smears in female sex workers in Hong Kong.

OBJECTIVE. To investigate the prevalence of pre-cancerous uterine cervix lesions as detected in Papanicolaou (Pap) smears from female sex workers in Hong Kong. DESIGN. Retrospective analysis of laboratory records. SETTING. Private anatomical pathology laboratory, Hong Kong. PATIENTS. Female sex workers undergoing Pap smear examinations at two non-governmental organisations between 2006 and 2012. MAIN OUTCOME MEASURES. Detection of pre-cancerous uterine cervical conditions and their management. RESULTS. A total of 2697 satisfactory Pap smears from female sex workers were performed during the study period from 2006 to 2012. In these subjects, the point prevalence of low-grade squamous intraepithelial lesion and atypical squamous cells of unknown significance was 10.12% (compared with 3.92% for the general population during the same period), whereas that of high-grade squamous intraepithelial lesions and atypical squamous cells of unknown significance with or without high-grade intraepithelial lesions was 2.22% (compared with 0.54% in the general population). For both categories of lesions, the higher prevalence among female sex workers than in the general population was statistically significant. Most patients who had abnormal Pap smears received proper referrals and follow-up management according to recommended guidelines. CONCLUSIONS. Female sex workers in Hong Kong as a group had a significantly higher prevalence of abnormal Pap smears than the general population. Non-governmental organisations providing free-of-charge screening services to these women helped early detection and proper follow-up for those who had abnormal Pap smears, whilst also increasing their awareness of women's health issues.

The significance of endocervical cells and metaplastic squamous cells in liquid-based cervical cytology.

We conducted a retrospective study to investigate whether the presence or absence of endocervical cells (EC) and metaplastic squamous cells (MSC) was associated with the detection of squamous intraepithelial lesions in liquid-based cervical cytology. 90,376 cases of liquid-based cervical cytology smears received in 2006 were included in the study. Low-grade (LSIL) and high-grade squamous intraepithelial lesions (HSIL) were classified according to the Bethesda system (2001). The rates of detecting LSIL and HSIL in smears with and without EC and/or MSC were determined. There were 1,540 LSIL and 396 HSIL. The ratio of HSIL/NILM (no intraepithelial lesion or malignancy) was 0.0022 in smears without EC or MSC, 0.0040 in smears with EC only, 0.0044 in smears with MSC only, and 0.0056 in smears with both EC and MSC present. Compared with smears without EC or MSC, this ratio was significantly higher (P < 0.05) when either EC or MSC was present. Compared with smears with EC only, the ratio was also significantly higher when both EC and MSC were present (P < 0.05). On the other hand, the presence or absence of EC had no effect on the detection rate of LSIL (0.0191 for both groups), while the presence of MSC was actually associated with lower detection rate of LSIL (0.0153, P < 0.05). The presence of endocervical and metaplastic cells was associated with higher detection rates of HSIL. MSC was associated with lower detection or LSIL.

Characteristics of false-negative ThinPrep cervical smears in women with high-grade squamous intraepithelial lesions.

OBJECTIVE: To examine the cellular characteristics and other possible factors affecting the correct prediction of ThinPrep cervical smears from patients with high-grade squamous intraepithelial lesions. DESIGN: Retrospective study. SETTING: Private anatomical pathology service, Hong Kong. PATIENTS: Patients (n=98) with biopsy-confirmed high-grade squamous intraepithelial lesion of the uterine cervix encountered between 2004 and 2006. MAIN OUTCOME MEASURES: Correct prediction of the cervical ThinPrep Papanicolaou tests. RESULTS: There were no significant differences in age, hormonal status, degree of inflammation, and the presence or absence of endocervical/metaplastic cells between the true-positive and false-negative groups. There was a significant difference in the number of abnormal cells present and the screening time between the two groups. Approximately 79% (34/43) false-negative smears had 100 or less abnormal cells, while only 11% (5/45) true-positive smears had 100 or less abnormal cells (P<0.001). The true-positive smears were also more likely to contain koilocytic cells and abnormal cells with hyperchromatic nuclei. CONCLUSIONS: The number of abnormal cells present, the presence or absence of koilocytic cells, and the presence or absence of abnormal cells with nuclear hyperchromasia appeared to be independent factors affecting the correct prediction of smears from patients with high-grade squamous intraepithelial lesions.

Breast pathology in complications associated with polyacrylamide hydrogel (PAAG) mammoplasty.

OBJECTIVE: To study the tissue pathology of breast lesions associated with hydrophilic polyacrylamide gel injection augmentation mammoplasty. DESIGN: Retrospective study. SETTING: Private anatomical pathology practice, Hong Kong. PATIENTS: Eight patients who underwent lumpectomy of the breast due to complications of hydrophilic polyacrylamide gel injection for augmentation mammoplasty. MAIN OUTCOME MEASURES: Identification of hydrophilic polyacrylamide gel in breast tissue and associated pathological changes. RESULTS: We reviewed the pathological changes in breast tissue associated with hydrophilic polyacrylamide gel injection in eight cases retrieved from our archive. Microscopically, the hydrophilic polyacrylamide gel appeared as pools of pale violet gelatinous material of variable size, between the interstices of connective tissue and fat cells. The larger pools were often surrounded by cellular reactions consisting of histiocytic cells and foreign body-type multinucleated giant cells. Inflammatory reaction featuring infiltration by lymphocytes and plasma cells in the adjacent breast tissue was observed in samples from four patients, and a sample from another patient showed acute inflammation with abscess formation. There was no evidence of abnormal cellular proliferation, atypia or malignant change in the stromal connective tissue or ductal-acinic epithelial components of the breast tissue. CONCLUSIONS: Hydrophilic polyacrylamide gel injection for augmentation mammoplasty can give rise to a breast lump and inflammation. Pathologically, this complication is associated with fibrosis, foreign body reaction, and inflammation.

Clinical relevance of intra-operative sentinel lymph node examination in breast cancer management.

OBJECTIVES: To determine the sensitivity, accuracy, and clinical relevance of intra-operative examination of sentinel lymph nodes in breast cancer management. DESIGN: Retrospective study. SETTING: Private anatomical pathology practice. PARTICIPANTS: Three hundred breast cancer patients who underwent axillary sentinel lymph node biopsies for intra-operative assessment between January 2004 and March 2006. MAIN OUTCOME MEASURES: Correct identification of metastatic carcinoma in sentinel lymph nodes during intra-operative examination, sparing patient a second surgery. RESULTS: The intra-operative diagnosis of sentinel lymph node biopsies from 300 consecutive patients were compared with the final pathological diagnoses. The final pathology results showed metastatic carcinoma in 74 patients, of whom 63 (85%) were correctly diagnosed during frozen section examination. There was no false-positive case (positive predictive value 100%). The sensitivity for detecting macro- and micro-metastases were 95% and 50%, respectively (P<0.01). The sensitivity for detecting metastases in T1 and T2/above tumours were 72% and 90%, respectively (P<0.05). CONCLUSIONS: Intra-operative examination is a reliable and sensitive method for the detection of sentinel lymph node metastasis. Eighty-five percent of the patients with metastatic disease were correctly diagnosed and spared a second operation for axillary dissection. The disadvantage of missing a positive lymph node is by far outweighed by the advantage of a single stage operation in case of a positive diagnosis. The benefit of intra-operative examination was slightly less in patients with smaller tumours.

Human papillomavirus DNA and liquid-based cervical cytology cotesting in screening and follow-up patient groups.

OBJECTIVE: To compare the use of human papillomavirus (HPV) DNA and cervical cytology cotesting in screening and follow-up of patients with previous cervical abnormalities and to assess the significance of a positive HPV DNA test result in re-screening of cytologically normal cases. STUDY DESIGN: Cellular samples collected in liquid-based fixative were used for both cervical cytology and HPV DNA testing. The cervical cytology slides were manually screened by cytotechnologists followed by rapid re-screening by pathologists. The HPV DNA tests were performed using hybrid capture test kits. Statistical analyses of cervical cytology results and HPV DNA tests for high- and low-risk HPV from both patient groups were carried out. RESULTS: The prevalence of HPV DNA-positive cases was higher in younger patients. There was a poor correlation between cervical cytology results and HPV DNA tests for the screening group (kappa = 0.23), but a fair to good correlation was obtained for the follow-up group (kappa = 0.51). The false negative fraction of cytology negative/HPV DNA positive cases (0.1317), as compared with cytology negative/HPV DNA negative cases (0.0056), was statistically significant (p = 0.000001). CONCLUSION: The prevalence of HPV DNA decreased with increasing age in both the screening and follow-up patient groups. Virus clearance was delayed in the follow-up group as compared with the screening group. There was a poor correlation between cervical cytology and HPV DNA tests in the screening group but a fair to good correlation in the follow-up patient group. Cotesting of HPV DNA and cervical cytology increases the sensitivity and decreases the false negative fraction, suggesting that cotesting could be used to increase the interval of screening.