High-grade squamous intraepithelial lesion in women aged <30 years has a prevalence pattern resembling low-grade squamous intraepithelial lesion.

BACKGROUND: Cervical cytology is the cervical cancer screening test for women aged <30 years because of the low specificity of human papillomavirus tests in this age group. The Bethesda System classifies cervical intraepithelial neoplasia grade 2 (CIN 2) and grade 3 (CIN 3) as high-grade intraepithelial lesions (HSIL). In this study, the authors subclassified cytologic HSIL as suggestive of CIN 2 (HSIL-CIN 2) or CIN 3 (HSIL-CIN 3) and evaluated whether there was a correlation between these findings and age for screened and unscreened women. METHODS: The study included 2,002,472 cervical smears collected from women who had at least 1 previous test (screened) and 217,826 previously untested women (unscreened). The laboratory has been using the Bethesda System since 1998 with the subcategorization of HSIL-CIN 2 and HSIL-CIN 3. RESULTS: For unscreened women, the prevalence of low-grade intraepithelial lesion (LSIL) and HSIL-CIN 2 decreased with age, whereas the prevalence of HSIL-CIN 3 increased. The prevalence of HSIL-CIN 2 was greater than that of HSIL-CIN 3 for women up to age 29 years (prevalence ratio [PR], 4.73; 95% confidence interval [CI], 3.90-5.75) and lower for the groups ages 30 to 49 years (PR, 0.66; 95% CI, 0.50-0.87) and ≥ 50 years (PR, 0.21; 95% CI, 0.12-0.36). For screened women, the prevalence of HSIL-CIN 2 also was greater in the group aged ≤ 29 years (PR, 2.72; 95% CI, 2.49-2.97). CONCLUSIONS: The prevalence pattern of HSIL suggestive of CIN 2 resembled the pattern observed in LSIL and was more prevalent than HSIL suggestive of CIN 3 in younger women. The impact of screening was less evident when HSIL was suggestive of CIN 2. A conservative approach for younger women who have HSIL is important for management guidance.

Atypical glandular cells and adenocarcinoma in situ according to the Bethesda 2001 classification: cytohistological correlation and clinical implications.

BACKGROUND: The objective of this study was to evaluate the correlation between the 2001 Bethesda classification of endocervical glandular abnormalities and histological diagnosis. STUDY DESIGN: A series of 155 women with endocervical glandular abnormalities on cervical smears were included: 91 with atypical glandular cells (AGC) not otherwise specified (NOS), 15 with AGC-favor neoplastic (FN); 35 with AGC associated with high-grade squamous intraepithelial lesion (HSIL) as combined diagnosis and 14 with adenocarcinoma in situ (AIS). RESULTS: Histological outcome of squamous neoplasias (CIN 2 or worse) and adenocarcinoma were significantly associated with AGC-FN and AIS, taking as reference AGC-NOS, and more associated with AIS than AGC-FN. Similar associations were observed for histological outcome of adenocarcinoma, but no association was observed for only squamous neoplasia. Histological outcome of CIN2 or worse was strongly associated with AGC when HSIL was also present, but no association was observed with only for adenocarcinoma histological outcome. CONCLUSIONS: AGC-NOS, AGC-FN and AIS cytological diagnosis represent a progressively increasing association with neoplastic diagnosis, due to progressively increasing association with adenocarcinoma. Histological outcome of squamous neoplasia is frequent but does not differ with these cytological interpretations. The presence of HSIL associated with AGC represents greater probability of squamous neoplasia but not adenocarcinoma.

Is bacterial vaginosis associated with squamous intraepithelial lesion of the uterine cervix?

The objective of this study was to analyze the association between bacterial vaginosis (BV) and squamous intraepithelial lesion (SIL). Pap smears were analyzed to verify the presence of BV and SIL. One hundred and ten women with SIL comprised the study group, while 110 women with no cytological abnormalities served as controls. BV was similarly present in women of both groups: 18% of women with SIL and 12% of women without SIL. Results were also similar when the grade of SIL was taken into consideration. BV was detected in 16% of women with low-grade SIL and in 12% of women in the control group, while a higher rate of BV (33%) was found among women with high-grade SIL in comparison to the controls (12%). This difference, however, was not statistically significant. BV tended to be more common among women with high-grade SIL than in women with no cytological abnormalities.

Presence of 20% or more clue cells: an accurate criterion for the diagnosis of bacterial vaginosis in Papanicolaou cervical smears.

A study was carried out in 135 women of reproductive age to evaluate the role of the Papanicolaou smear performed in cervical and vaginal samples for the diagnosis of bacterial vaginosis (BV), to validate the method for this diagnosis and to evaluate the reproducibility of the criterion used. The cervical and vaginal smears were stained using the Papanicolaou method and evaluated by two separate observers. The finding of 20% or more clue cells was considered positive for the presence of BV. This diagnostic criterion presented a sensitivity of 87%, specificity of 94%, a positive predictive value of 81%, and a negative predictive value of 96%, both in cervical and vaginal samples. There was excellent agreement in the diagnosis of BV between the two observers (kappa, 0.87) and between cervical and vaginal samples (kappa, 0.92). Therefore, the presence of 20% or more clue cells in the Papanicolaou smear is an accurate and reproducible criterion for the diagnosis of BV and may be used in screening for this infection, eliminating the need for further vaginal sample collection.