Baseline human papillomavirus status of women with abnormal smears in cervical screening: a 5-year follow-up study in The Netherlands.

OBJECTIVE: To determine in a screening population the human papillomavirus (HPV) status in those with cytological abnormalities and to evaluate the presence of high-risk (HR) HPV with a minimum of 5-year follow up. DESIGN: Retrospective examination of HPV status on prospectively collected and cytologically screened cervical smears. SETTING: Canisius-Wilhelmina Hospital in Nijmegen, The Netherlands. POPULATION: Three hundred and fifty-seven women aged 30-60 years, from the population screened. METHODS: Three hundred and fifty-seven women with borderline or higher cytological abnormalities were retrospectively examined for HPV with DNA microarray typing. Follow up was through the nationwide Dutch Pathology database (PALGA). MAIN OUTCOME MEASURES: For the cytological abnormalities, the CISOE-A classification was used. HPV was scored as negative or positive. In case of positive HPV polymerase chain reaction, the HPV genotype was determined. The occurrence of cervical intraepithelial neoplasia lesions of grade 3 or higher was considered as endpoint for follow up. RESULTS: The majority of the women with borderline cytology in this study were HPV negative (87%). Among the HPV-positive women in borderline cytology group, 74% had HR-HPV or probable high-risk types. The overall percentage of HR-HPV types increased with progressive cytological abnormalities. The cytological classifications of borderline dyskaryosis and moderate dyskaryosis contain all types of HPVs, e.g. low risk, HR and unknown risk. The samples with severe dyskaryosis or higher contain only HR types. The negative predictive value for HR-HPV typing in the group with borderline cytological abnormalities is more than 99%. CONCLUSIONS: In cervical screening with an interval of 5 years, HPV can be reliably used as triage point in cases of borderline cytological abnormalities.

Histologic processing of microbiopsies from cervical smears is diagnostically useful in selected cases.

We analyzed the value in cervical cytology of a recently developed technique by which it is possible to remove thick tissue specimens, called microbiopsies, from cervical smears and to process them for histologic examination. In 12 (48%) of 25 cervical smears in which microbiopsies were found, the histologic sections from them confirmed the cytologic diagnosis. Most cases involved classification of lesions diagnosed as cervical intraepithelial neoplasia. In 13 (52%) of 25 smears, processing the microbiopsy allowed considerable modification of the cytologic diagnosis. In six of these cases, microbiopsies consisted of groups of columnar cells that were incorrectly classified as atypical on the basis of cytologic criteria. After histologic processing, the microbiopsies revealed nonatypical columnar cells in four cases and only mildly atypical columnar cells in two cases. In 3 of 13 smears, there were insufficient dispersed atypical cells for a conclusive diagnosis. Processing the microbiopsies in these cases allowed classification into one of the cervical intraepithelial neoplasia categories.

Histologic processing of thick tissue specimens from cytology slides. A novel technique.

OBJECTIVE: To describe a novel method by which small tissue fragments found in routine cytology specimens can be processed for histologic slides without destroying or damaging the cytologic specimen. STUDY DESIGN: To develop a method by which small tissue fragments (microbiopsies) are removed from cytologic slides and processed through paraffin or plastic, after which histologic slides can be prepared. RESULTS: In all cases described, the histologic sections from the microbiopsies were of excellent quality. Microscopic examination gave additional important information. Furthermore, immunochemistry could be performed on paraffin-processed microbiopsies. CONCLUSION: This method can be of great value in cytologic specimens in which microbiopsies are present, not only in those cases in which cytologic information is insufficient for diagnosis, but also in cases with conclusive diagnostic information. Routinely applied, this method could make biopsies unnecessary in some cases.