Chapter 14: Role of Triage Testing in Cervical Cancer Screening
|
|
- Anne Lester
- 6 years ago
- Views:
Transcription
1 Chapter 14: Role of Triage Testing in Cervical Cancer Screening Diane Solomon The classic model of cervical cancer prevention primary screening with cytology, followed by diagnostic colposcopically directed biopsy, and finally treatment of cancer precursors is undergoing dynamic change. The introduction of human papillomavirus (HPV) DNA testing and other new modalities provides more options but increases complexity in the sequence of screening, triage, diagnosis, and patient management. This chapter will focus on the role of triage and risk stratification in management. The utility of HPV testing has been established for triage of cytologic findings of atypical squamous cells of undetermined significance but not for low-grade squamous intraepithelial lesions or worse. Countries without established cytology services may consider alternative screening, triage, and treatment programs that may be more readily implemented than a resource-rich cytology followed by colposcopy paradigm requiring an infrastructure of highly trained personnel. The diagnostic step of colposcopy and directed biopsy is not completely sensitive in the detection of cervical intraepithelial neoplasia (CIN) 2 or 3 as is sometimes assumed. The partial insensitivity of this diagnostic step results in a population of women with negative colposcopically directed biopsy findings but at increased risk for missed prevalent disease: these women may require additional triage rather than resumption of routine screening. As more efficient screening, triage, and diagnosis increase the sensitivity of detection of even very small CIN2 or CIN3, overtreatment of lesions that might otherwise regress becomes a concern and highlights the need to identify accurate markers of risk of progression to cancer. Markers of molecular events further along the pathway from HPV infection to development of cancer may ultimately provide more specificity in triage and diagnosis. [J Natl Cancer Inst Monogr 2003;31:97 101] CLASSIC MODEL The classic construct of cancer prevention consists of three steps: 1) screening asymptomatic individuals to identify those at risk of disease, 2) diagnosis of the disease state, and 3) treatment of those with cancer or a cancer precursor (Fig. 1). Screening A screening test must be safe, easily performed on large populations of asymptomatic individuals, acceptable to the patient, and relatively inexpensive. Ideally, a screening test should have both high sensitivity and high specificity; however, sensitivity is the more important consideration in the context of screening. Cervical cytology, also known as the Pap test after its originator Dr. George Papanicolaou, is an example of a successful screening test that has dramatically reduced the incidence of and mortality from cervical cancer where screening has been implemented. Diagnosis Diagnosis establishes the severity of disease and forms the basis for treatment. Colposcopy combined with directed biopsy is the standard diagnostic procedure for evaluating the cervix and has been presumed to be highly sensitive and accurate. Treatment Treatment of cancer precursor lesions consists of removal or ablation of involved tissue by one of several methods: loop electrosurgical excision procedure (LEEP), cryotherapy, or coldknife conization. Triage Triage is an additional step (Fig. 1) interposed between screening and diagnosis to further stratify individuals with positive primary screening results according to risk for the disease state. Certain procedures may overlap several of the categories diagrammed in Fig. 1. Under certain circumstances, LEEP or conization may be both a diagnostic and a therapeutic procedure. As another example, colposcopy combined with cervical biopsy is viewed as diagnostic, but colposcopy is used in some settings, particularly in Europe, as an adjunctive screening test to improve cytology sampling. Alternatively, colposcopy after an abnormal screening test result may function as a form of triage that determines whether or not a diagnostic biopsy is obtained. In addition to the varying functional role of colposcopy, there is a broad range of examiner expertise that affects the accuracy of colposcopy. Guidelines and classification schemes for reporting colposcopic interpretations have been proposed; however, validation and reproducibility assessments are generally not available. Since colposcopy has not been shown to be adequate for primary screening and is not by itself considered to be diagnostic, it is categorized as a triage modality in Fig. 1. This chapter focuses on the role of triage and risk stratification in cervical cancer prevention. UTILITY OF TRIAGE The utility of a triage test in the context of a screening program will depend not only on the performance characteristics of the test itself but also on the target screening population, the prevalence of disease, the screening test employed, the costs of Affiliation of author: Breast and Gynecologic Cancer Research Group, Division of Cancer Prevention, National Cancer Institute, Bethesda, MD. Correspondence to: Diane Solomon, M.D., National Institutes of Health, Executive Plaza North, Rm. 2130, 6130 Executive Blvd., Rockville, MD ( ds87v@nih.gov). Journal of the National Cancer Institute Monographs, No. 31, Oxford University Press 2003, all rights reserved. Journal of the National Cancer Institute Monographs No. 31,
2 Fig. 1. Classic steps of cancer screening and prevention are screening, diagnosis, and treatment. Triage is interposed between screening and diagnosis to identify subpopulations at increased risk and thereby to optimize the overall management process. Test modality options are listed in italics. Note that the same tests may be used at multiple points in the algorithm, serving different functions. HPV human papillomavirus; LEEP loop electrosurgical excision procedure. follow-up, the available resources (logistical and monetary), and patient compliance. Triage is of most value when the screening test lacks specificity and/or the diagnostic procedure is expensive or a limited resource. An efficient triage test should reduce overtreatment, patient anxiety and inconvenience, and overall management costs, usually by reducing the number of diagnostic procedures performed all without sacrificing sensitivity for detection of disease. However, if the initial screening test is highly specific and/or the triage test is positive in the vast majority of cases and/or the triage test results in a decrement of sensitivity, then the triage test has questionable utility. Cost-effectiveness analyses are critical to evaluating the interplay of population prevalence, sensitivity for disease detection, specificity, and overall management costs with various screening and triage strategies. TRIAGE AFTER CERVICAL CYTOLOGY SCREENING Cytology results are not dichotomous positive or negative but are based on the degree of the morphologic abnormality observed (atypical squamous cells, low-grade squamous intraepithelial lesions [LSILs], high-grade squamous intraepithelial lesions [HSILs], and cancer) (1). These diagnostic gradations have different performance characteristics. A cytologic interpretation of HSIL or cancer, for example, has extremely high specificity (high positive predictive value), obviating the need for a triage test. However, in an effort to maximize sensitivity and negative predictive value, atypical squamous cells of undetermined significance (ASCUS) is used as the threshold for referral for additional follow-up in the United States. This lower threshold greatly increases sensitivity for identifying histologic cervical intraepithelial neoplasia (CIN) 2 or 3 (2) but at the cost of referring millions of women for colposcopy and biopsy, the majority of whom do not have prevalent CIN2 or CIN3 and who are not destined to develop it in the immediate future. In this setting of lower specificity, a triage test that could further stratify women according to cancer risk would be useful. One concern, however, is that the costs associated with developing novel triage tests may make them unaffordable to most countries. Triage of ASCUS and LSILs A multicenter, randomized clinical trial was conducted by the National Cancer Institute (NCI), Bethesda, MD, to compare different strategies for managing the 2 3 million women with ASCUS and the 1.25 million women with LSIL cytology results in the United States each year (3). The Atypical Squamous Cells of Undetermined Significance/Low-Grade Squamous Intraepithelial Lesions Triage Study (ALTS) and other studies (4 6) have shown that cytologic interpretations of LSIL are so highly associated with human papillomavirus (HPV) that an HPV triage test is not useful. In the setting of an ASCUS interpretation, however, approximately 40% 50% of the women are HPV positive (7,8). The proportion of ASCUS that is HPV positive depends on the patient population and the cytomorphologic threshold used by the cytologist. Importantly, virtually all of the occult CIN2 or CIN3 associated with ASCUS is found in the HPVpositive fraction. Therefore, in the context of an ASCUS cytology, HPV triage saves approximately 50% of the women from unnecessary colposcopy without compromising sensitivity. Follow-up by repeat cytology with a low threshold of ASCUS as a trigger for colposcopy is also a safe triage strategy; however, the trade-off of sensitivity and referral percentage is not as favorable for cytology as with HPV triage (9). A recently published modeling analysis (10) comparing four management strategies for ASCUS immediate colposcopy, HPV testing, repeat cytology, and no action confirms that HPV triage is more cost-effective than repeat cytology, colposcopy, or no action. Even so, only about one quarter of the women who are ASCUS and HPV positive (HPV+ ASCUS) who are referred to colposcopy will have CIN2 or CIN3 over the course of 2 years. How can we further improve specificity? Sherman et al. (11) evaluated using viral load and age parameters as potential ways to improve specificity of HPV testing in the context of an ASCUS or LSIL cytology. Compared with a 1-pg HPV-DNA/mL cut point for referral to colposcopy, a higher 10-pg/mL threshold decreased referral percentages from 59.0% to 41.7% but also decreased HPV testing sensitivity for CIN3 from 96.1% to 91.5%. The overall sensitivity of HPV testing at 1.0 pg/ml varied minimally with age (range, 93.9% 97.8%), but strikingly, only 31.2% of women aged 29 years or older would be referred compared with more than 65% of younger women. Thus, the positive predictive value of HPV testing for triage of ASCUS improved in older women. However, using an age-restricted strategy of HPV triage would not address the majority of ASCUS cases, which occur in younger women. In addition, in contrast with ASCUS, for women with LSIL the percentage referred on the basis of a positive HPV test did not decline dramatically with age. We clearly need to inves- 98 Journal of the National Cancer Institute Monographs No. 31, 2003
3 tigate other innovative strategies to triage ASCUS in younger women and all women with LSIL to reduce referrals to colposcopy while maintaining sensitivity for CIN3. In addition, studies focusing on older, perimenopausal and postmenopausal women may be helpful in refining triage strategies specific for this age group. International variation in cytology terminology, compounded by the use of different morphologic criteria for similarly termed diagnoses, might suggest that ALTS results cannot be generalized to settings outside the United States (12). However, using an atlas of cytology images, with known HPV status and disease outcome, the performance of HPV triage could be predicted for any classification system or screening program. A web-based collection of cytology images and cervigrams (high-resolution photographs), derived from ALTS and other NCI-funded studies, is currently in development. This could reduce the need for additional randomized clinical trials for different terminologies and/or different locales. Consensus management guidelines for follow-up of an ASCUS cytology result developed under the sponsorship of the American Society for Colposcopy and Cervical Pathology (ASCCP) include repeat cytology, immediate colposcopy, or HPV testing as options (13). However, if liquid-based collection was used for the initial cytologic sample, then reflex HPV testing is considered to be the preferred approach because it obviates the need for a repeat office visit. With conventional cytology smears, there is no residual sample available for HPV testing. Dual collection of a cytology and an HPV sample at the initial visit, or a selfcollected HPV sample done later, may be ways to perform triage HPV testing without the need for an additional office visit if using conventional smears. Studies evaluating self-collected cervicovaginal samples for HPV testing have found good agreement with clinician-collected specimens (14); however, the sensitivity of HPV testing for CIN2 or CIN3 is slightly lower (15). Self-collection may be more acceptable to certain groups of women who may be reluctant to undergo pelvic examination (16). Additional studies are needed that compare clinician-directed sampling and selfcollected specimens with regard to sensitivity and specificity performance characteristics for both cytologic assessment and HPV testing. Triage of Atypical Glandular Cells Atypical glandular cells (AGC), the glandular counterpart of atypical squamous cells, is a much less common cytologic interpretation with a higher positive predictive value for CIN2 or CIN3 compared with ASCUS. Current ASCCP guidelines recommend colposcopic evaluation with endocervical sampling for all women with AGC (13). One study (17) suggests the possible utility of HPV triage in the setting of an AGC result. If these findings could be confirmed in a larger study, HPV triage may have a role in AGC. However, considering the overall small number and the apparently elevated risk of women with AGC, reducing colposcopic referral for these women is not the most critical research priority. OTHER MOLECULAR MARKERS IN TRIAGE HPV infection is a necessary but early step in the pathogenesis of CIN2 or CIN3 and cancer. Markers of molecular events further along the path toward development of a cancer precursor may provide greater specificity for triage. For example, women with LSIL or HPV+ ASCUS screening results have an approximately 25% risk of CIN2 or CIN3 over 2 years (18). According to ASCCP guidelines, all such women are referred to colposcopy (13). An assay that could distinguish the quarter of women with high-grade disease would allow the majority of women with LSIL and HPV+ ASCUS screening results to avoid the worry and costs associated with colposcopy and further follow-up. At this writing, no such markers have been validated, but research efforts should focus on this critical question. PRIMARY SCREENING USING HPV-DNA TESTING AFFECTS THE ROLE OF TRIAGE For women aged 30 years and over, the use of HPV as a primary screening test in conjunction with cytology was approved by the U.S. Food and Drug Administration in March 2003 and included in the American Cancer Society guidelines (19). Women who are dual negative (HPV negative and cytology negative) are at very low risk of CIN3 or cancer and can safely be screened every 3 years (20). However, strategies to manage women who are HPV positive and cytology negative need to be defined. Do these women need more intensive follow-up? At what interval? By what test? In the United States, given the current medicolegal climate and societal expectations that emphasize sensitivity at the expense of specificity, it will require intensive patient and clinician education to accept a 6- to 12-month follow-up (rather than colposcopy) of women with HPV-positive and cytologynegative findings. If management includes repeat HPV testing, a type-specific HPV assay might be of value in this context to distinguish persistence of a specific viral type as opposed to sequential infection with different HPV types. The time interval between HPV testing events will be determined by balancing the woman s desire for action and the need to allow time for regression of the virus. It is also imperative to restrict HPV screening to women aged 30 years and older to avoid excessive referral and unnecessary procedures and treatment. The high prevalence of HPV in younger women and the low risk of invasive cancer argue against using HPV as a primary screening technique in the younger age group. The combination of HPV and cytology may be an interim strategy in an evolution that ultimately leads to primary screening by HPV with triage by cytology. In fact, many suggest that HPV followed by cytology is the more rational approach for older women, given the higher sensitivity of HPV testing and the greater specificity of cytology. The performance of cytology as a triage test may be very different compared with its characteristics as a screening test. Currently, the vast majority (>90%) of the 55 million screening Pap tests performed each year in the United States are negative. With a 10 : 1 ratio of negative-toabnormal specimens, cytotechnologists face problems of visual boredom. Microscopic review of Pap specimens is the pathology equivalent of looking for the needle in the haystack and requires exceptional vigilance. In some cases, false-negative cytology results are due to the limitations inherent in this subjective process. If cytology shifted from functioning as a primary screening test to a triage test, there would be a dramatic reduction in the number of tests overall and a marked increase in the yield of positive results, altering the negative-to-abnormal ratio of specimens. It is unclear how this would impact the sensitivity and specificity of Pap testing. Would the higher proportion of Journal of the National Cancer Institute Monographs No. 31,
4 abnormal specimens improve the cytotechnologist s performance by reducing visual boredom? Or would knowledge of the HPV-positive screening result bias the interpretation of the subsequent cytologic sample, leading to more false-positive results? Even so, the slightly increased false-positive fraction might be acceptable if sensitivity is maintained. In many developing countries without established cytology services for comprehensive screening or for triage, other approaches that do not rely on an extensive infrastructure of highly trained personnel must be considered. It may be more feasible to combine an inexpensive HPV test for primary screening with triage modalities other than cytology, e.g., direct visual assessment by nonphysician providers (Jeronimo J, Castle PE, Herrero R, Burk RD, Hildesheim A, Bratti MC, et al.: unpublished data). Visual-assessment thresholds could be calibrated to maximize sensitivity if screening was done only once or twice in a woman s lifetime. Screening, triage, and even treatment services could be combined in the same visit and thereby reduce loss to follow-up in areas remote from health clinics. MANAGEMENT AFTER COLPOSCOPY: RETURN TO TRIAGE Colposcopically directed biopsy has been used as the gold standard for diagnosis. However, findings from ALTS indicate that colposcopy and biopsy misses about one quarter of prevalent CIN2 or CIN3 (5,9). Women with less than CIN2 after colposcopy are at approximately 10% risk of CIN2 or CIN3 within 2 years. This risk is similar, regardless of whether the colposcopy and directed biopsy result was negative or CIN1 (18). Incomplete sensitivity of colposcopy and directed biopsy results in a group of women with negative results but at increased risk of CIN3 relative to the general screening population. These women may require additional triage rather than returning to routine screening (Fig. 1). Using ALTS data for women who were less than CIN2 after initial colposcopy, various retriage strategies combining follow-up cytology and HPV testing were compared (21). A single HPV test at 12 months demonstrated the best trade-off of sensitivity and referral percentage. Alternatively, semiannual cytology sampling could be considered if HPV testing is not available. Further studies are needed to find assays or strategies that more efficiently identify women with occult CIN2 or CIN3 and allow the majority of women to safely return to routine screening. DIAGNOSIS AND RISK CLARIFICATION FUTURE DIRECTIONS Diagnosis and risk clarification is conceptually a step between diagnosis and treatment (Fig. 1) that includes efforts to refine the histologic diagnosis and/or to further stratify individuals according to risk of invasive cancer. Diagnosis Clarification Histologic diagnosis is generally the basis for determining patient management and treatment, and in research settings, it is often used to establish definitive determinations of disease. However, histologic interpretation is associated with significant interobserver variability (22). To improve disease determination and risk assessment, we need to identify molecular markers of neoplasia to augment light microscopy and morphologic diagnosis. As an example, p16 ink4a, a cyclin-dependent kinase inhibitor, is highly expressed in CIN2 and CIN3 tissues and in CIN1 associated with high-risk HPV, but not in normal cervical tissues. The use of ancillary immunohistochemistry with a monoclonal antibody directed to p16 ink4a improved interobserver diagnostic reproducibility for CIN among a group of experts by highlighting small CIN lesions (often a source of false-negative results) and reduced false-positive interpretations associated with equivocal CIN1 (23). However, the prognostic value of p16 INK4a remains to be determined. Risk Clarification The essence of cervical cancer prevention is detection and ablation of true precursor lesions (CIN3) that would otherwise progress to cancer. However, because screening and management strategies are acknowledged to be less than completely sensitive and effective for detecting and treating CIN3, screening and treatment thresholds are set lower to increase sensitivity and safety. Lower screening thresholds increase costs of referral for additional follow-up, and lower treatment thresholds result in unnecessary procedures. Current standards in the United States generally require treatment of histologically confirmed CIN2 or CIN3. More sensitive screening and triage strategies that translate into increased detection of early and often very small CIN2 or CIN3 lesions may lead to earlier treatment of high-grade lesions; however, the impact on cancer outcomes is probably minimal. The vast majority of small high-grade lesions would probably not progress to invasive cancer if detected later, when larger but still intraepithelial (24). In addition, there is a greater likelihood of overtreatment of lesions, particularly CIN2, that might otherwise regress. Identifying markers of risk of progression to cancer is a priority to reduce unnecessary treatment and attendant complications and costs associated with treating all CIN2 or CIN3. MONITORING AFTER TREATMENT Ablative and excisional procedures are very effective (>90%) in treating CIN2 or CIN3. However, in the United States, in approximately 5% 10% of the cases, there is residual or recurrent disease after initial treatment that necessitates additional therapeutic procedures (25). In addition, women treated for CIN2 or CIN3 remain at increased risk of cervical cancer for at least 8 years compared with the general population (26). Generally, cytology and/or colposcopy have been used for posttreatment surveillance (27). HPV testing merits investigation as another possible strategy to monitor the efficacy of treatment. Several small studies (28,29) have shown that HPV DNA clearance is associated with low risk of subsequent CIN after treatment, and persistent HPV positivity predicts increased risk of treatment failure. However, the possibility of vaginal recolonization with HPV or a new HPV infection with another HPV type must be considered. Type-specific HPV testing may be more informative in this context than a cocktail probe such as the Hybrid Capture 2 assay to distinguish the persistence and recurrence of the same lesion as opposed to newly acquired infection. REFERENCES (1) Solomon D, Davey D, Kurman R, Moriarty A, O Connor D, Prey M, et al. The Bethesda System 2001: terminology for reporting the results of cervical cytology. JAMA 2002;287: Journal of the National Cancer Institute Monographs No. 31, 2003
5 (2) Kinney WK, Manos MM, Hurley LB, Ransley JE. Where s the high-grade cervical neoplasia? The importance of minimally abnormal Papanicolaou diagnoses. Obstet Gynecol 1998;91: (3) Schiffman M, Adrianza ME. ASCUS LSIL Triage Study. Design, methods and characteristics of trial participants. Acta Cytol 2000;44: (4) The Atypical Squamous Cells of Undetermined Significance/Low-Grade Squamous Intraepithelial Lesions Triage Study (ALTS) Group. Human papillomavirus testing for triage of women with cytologic evidence of low-grade squamous intraepithelial lesions: baseline data from a randomized trial. J Natl Cancer Inst 2000;92: (5) The ASCUS LSIL Triage Study (ALTS) Group. A randomized trial on the management of LSIL cytologic interpretations. Am J Obstet Gynecol. In press (6) Clavel C, Masure M, Bory JP, Putaud I, Mangeonjean C, Lorenzato M, et al. Hybrid Capture II-based human papillomavirus detection, a sensitive test to detect in routine high-grade cervical lesions: a preliminary study on 1518 women. Br J Cancer 1999;80: (7) Manos M, Kinney WK, Hurley LB Sherman ME, Sheih-Ngai J, Kurman RJ, et al. Identifying women with cervical neoplasia: using human papillomavirus DNA testing for equivocal Papanicolaou results. JAMA 1999; 281: (8) Solomon D, Schiffman M, Tarone R. Comparison of three management strategies for patients with atypical squamous cells of undetermined significance: baseline results from a randomized trial. J Natl Cancer Inst 2001; 93: (9) The ASCUS LSIL Triage Study (ALTS) Group. Results of a randomized trial on the management of cytology interpretations of atypical squamous cells of undetermined significance. Am J Obstet Gynecol. In press (10) Kim JJ, Wright TC, Goldie SJ. Cost-effectiveness of alternative triage strategies for atypical squamous cells of undetermined significance. JAMA 2002;287: (11) Sherman ME, Schiffman M, Cox JT. Effects of age and human papilloma viral load on colposcopy triage: data from the randomized Atypical Squamous Cells of Undetermined Significance/Low-Grade Squamous Intraepithelial Lesion Triage Study (ALTS). J Natl Cancer Inst 2002;94: (12) Scott DR, Hagmar B, Maddox P, Hjerpe A, Dillner J, Cuzick J, et al. Comparison of equivocal cervical cytologic interpretations in the United States, Scandinavia, and the United Kingdom: implications for international comparisons of HPV testing. Cancer Cytopathol 2002;96: (13) Wright TC Jr, Cox JT, Massad LS, Twiggs LB, Wilkinson EJ Consensus guidelines for the management of women with cervical cytological abnormalities. JAMA 2002;287: (14) Gravitt PE, Lacey JV Jr, Brinton LA, Barnes WA, Kornegay JR, Greenberg MD, et al. Evaluation of self-collected cervicovaginal cell samples for human papillomavirus testing by polymerase chain reaction. Cancer Epidemiol Biomarkers Prev 2001;10: (15) Wright TC Jr, Denny L, Kuhn L, Pollack A, Lorincz A. HPV DNA testing of self-collected vaginal samples compared with cytologic screening to detect cervical cancer. JAMA 2000;283: (16) Dzuba IG, Diaz EY, Allen B, Leonard YF, Lazcano Ponce EC, Shah KV, et al. The acceptability of self-collected samples for HPV testing vs. the Pap test as alternatives in cervical cancer screening. J Womens Health Gend Based Med 2002;11: (17) Ronnett BM, Manos MM, Ransley JE, Fetterman JB, Kinney WK, Hurley LB, et al. Atypical glandular cells of undetermined significance (AGUS): cytopathologic features, histopathologic results, and human papillomavirus DNA detection. Hum Pathol 1999;30: (18) Cox JT, Schiffman M, Solomon D. Prospective follow-up suggest similar risk of subsequent high-grade CIN among women with CIN 1 or negative colposcopically directed biopsy. Am J Obstet Gynecol. In press (19) Saslow D, Runowicz CD, Solomon D, Moscicki AB, Smith RA, Eyer HJ, et al. American Cancer Society guideline for the early detection of cervical neoplasia and cancer. CA Cancer J Clin 2002;52: (20) Sherman ME, Lorincz A, Scott DR, Wacholder S, Castle PE, Glass AG, et al. Baseline cytology, human papillomavirus testing, and risk for cervical neoplasia: a 10-year cohort analysis. J Natl Cancer Inst 2003;95: (21) Guido R, Schiffman M, Solomon D, Burke L. Post-colposcopy management strategies for patients with minor cytologic abnormalities: a two-year prospective study. Am J Obstet Gynecol. In press (22) Stoler MH, Schiffman M. Interobserver reproducibility of cervical cytologic and histologic interpretations: realistic estimates from the ASCUS LSIL Triage Study. JAMA 2001;285: (23) Klaes R, Benner A, Friedrich T, Ridder R, Herrington S, Jenkins D, et al. P16 INK4a immunohistochemistry improves interobserver agreement in the diagnosis of cervical intraepithelial neoplasia. Am J Surg Pathol 2002;26: (24) Sherman ME, Wang SS, Tarone R, Rich L, Schiffman M. Histopathologic extent of CIN3 lesions in the ASCUS LSIL Triage Study (ALTS): implications for subject safety and lead-time bias. Cancer Epidemiol Biomarkers Prev. 2003;12: (25) Mitchell MF, Tortolero-Luna G, Cook E, Whittaker L, Rhodes-Morris H, Silva E. A randomized clinical trial of cryotherapy, laser vaporization, and loop electrosurgical excision for treatment of squamous intraepithelial lesions of the cervix. Obstet Gynecol 1998;92: (26) Soutter WP, de Barros Lopes A, Fletcher A, Monaghan JM, Duncan ID, Paraskevaidis E, et al. Invasive cervical cancer after conservative therapy for cervical intraepithelial neoplasia. Lancet 1997;349: (27) Gardeil F, Barry-Walsh C, Prendiville W, Clinch J, Turner MJ. Persistent intraepithelial neoplasia after excision for cervical intraepithelial neoplasia grade III. Obstet Gynecol 1997;89: (28) Cox JT. Management of women with cervical cancer precursor lesions. Obstet Gynecol Clin North Am 2002;29: (29) Paraskevaidis E, Koliopoulos G, Alamanos Y, Malamou-Mitsi V, Lolis ED, Kitchener HC. Human papillomavirus testing and the outcome of treatment for cervical intraepithelial neoplasia. Obstet Gynecol 2001;98: Journal of the National Cancer Institute Monographs No. 31,
Atypical squamous cells. The case for HPV testing
OBG MANAGEMENT FOCUS ON CERVICAL DISEASE BY J. THOMAS COX, MD ASC-US is most often due to transient changes or HPV. HPV-positive ASC-US is 12.5 to 23 times more likely to be associated with CIN 2,3 on
More informationHPV Testing & Cervical Cancer Screening:
HPV Testing & Cervical Cancer Screening: Are they linked? By William Chapman, MD, FRCPC Screening for precursor lesions of cervical cancer by the Papanicolaou (Pap) smear has been one of the greatest success
More informationVasile Goldiş Western University of Arad, Faculty of Medicine, Obstetrics- Gynecology Department, Romania b
Mædica - a Journal of Clinical Medicine ORIGINAL PAPERS Cervical Intraepithelial Neoplasia in the Dr. Salvator Vuia Clinical Obstetrics and Gynecology Hospital - Arad During the 2000-2009 Period Voicu
More informationCan HPV-16 Genotyping Provide a Benchmark for Cervical Biopsy Specimen Interpretation?
Anatomic Pathology / Monitoring HPV-16 Fractions in CIN Can HPV-16 Genotyping Provide a Benchmark for Cervical Biopsy Specimen Interpretation? Mary T. Galgano, MD, 1 Philip E. Castle, PhD, MPH, 2 Mark
More informationPAP SMEAR WITH ATYPICAL SQUAMOUS CELLS OF UNDETERMINED SIGNIFICANCE
Arch Iranian Med 2005; 8 (3): 192 196 Original Article PAP SMEAR WITH ATYPICAL SQUAMOUS CELLS OF UNDETERMINED SIGNIFICANCE Fatemeh Ghaemmaghami MD *, Fereshteh Ensani MD**, Nadereh Behtash MD* Ebrahim
More informationOriginal Policy Date
MP 2.04.03 Cervicography Medical Policy Section Medicine Issue 12:2013 Original Policy Date 12:2013 Last Review Status/Date Reviewed with literature search/12:2013 Return to Medical Policy Index Disclaimer
More informationAtypical Glandular Cells of Undetermined Significance Outcome Predictions Based on Human Papillomavirus Testing
Anatomic Pathology / ATYPICAL GLANDULAR CELLS AND HUMAN PAPILLOMAVIRUS Atypical Glandular Cells of Undetermined Significance Outcome Predictions Based on Human Papillomavirus Testing Jeffrey F. Krane,
More informationOutcome of Atypical Squamous Cells in Cervical Cytology: Follow-up Assessment by Loop Electrical Excision Procedure
The Korean Journal of Pathology 2012; 46: 359-364 ORIGINAL ARTICLE Outcome of Atypical Squamous Cells in Cervical Cytology: Follow-up Assessment by Loop Electrical Excision Procedure Joon Seon Song Ilseon
More informationAppropriate Use of Cytology and HPV Testing in the New Cervical Cancer Screening Guidelines
Appropriate Use of Cytology and HPV Testing in the New Cervical Cancer Screening Guidelines Tim Kremer, MD Ralph Anderson, MD 1 Objectives Describe the natural history of HPV particularly as it relates
More informationFaculty Pap Smear Guidelines: Family Planning Update 2008 Part Two
Faculty Pap Smear Guidelines: Family Planning Update 2008 Part Two Seshu P. Sarma, MD, FAAP Emory University Regional Training Center Atlanta, Georgia Produced by the Alabama Department of Public Health
More informationPhilip E. Castle, Diane Solomon, Mark Schiffman, Cosette M. Wheeler for the ALTS Group
ARTICLEARTICLESHuman Papillomavirus Type 16 Infections and 2-Year Absolute Risk of Cervical Precancer in Women With Equivocal or Mild Cytologic Abnormalities Philip E. Castle, Diane Solomon, Mark Schiffman,
More information!"#$%&'(#)*$+&,$-&.#,$/#0()1-$ ),1')$2(%&,2#,%$%(0'#$34567$
!"#$%&'(#)*$+&,$-&.#,$/#0()1-$ ),1')$2(%&,2#,%$%(0'#$34567$ Updated Consensus Guidelines for Managing Abnormal Cervical Cancer Screening Tests and Cancer Precursors American Society for and Cervical Pathology
More informationMaking Sense of Cervical Cancer Screening
Making Sense of Cervical Cancer Screening New Guidelines published November 2012 Tammie Koehler DO, FACOG The incidence of cervical cancer in the US has decreased more than 50% in the past 30 years because
More informationThe society for lower genital tract disorders since 1964.
The society for lower genital tract disorders since 1964. Updated Consensus Guidelines for Managing Abnormal Cervical Cancer Screening Tests and Cancer Precursors American Society for and Cervical Pathology
More informationThe devil is in the details
The cobas KNOW THE RISK For cervical cancer prevention The devil is in the details Leading with the cobas as your primary screening method uncovers disease missed by cytology, and can protect women from
More informationHPV TESTING AND UNDERSTANDING VALIDITY: A tough row to hoe. Mark H. Stoler, MD ASC Companion Meeting USCAP 2008
OBJECTIVES: HPV TESTING AND UNDERSTANDING VALIDITY: A tough row to hoe Mark H. Stoler, MD ASC Companion Meeting USCAP 2008 1. Describe the concept of marker validation in the context of HPV tests. 2. Present
More informationThe Korean Journal of Cytopathology 13(1): 14-20, 2002
13 1 The Korean Journal of Cytopathology 13(1): 14-20, 2002 : ASCUS 1941 Papanicolaou. The Bethesda System(TBS) 1) 1988, atypical squamous cells of undetermined significance(ascus), low-grade squamous
More informationASCCP 2013 Guidelines for Managing Abnormal Cervical Cancer Screening Tests
ASCCP 2013 Guidelines for Managing Abnormal Cervical Cancer Screening Tests www.treatmentok.com Barbara S. Apgar, MD, MS Professor of Family Medicine University of Michigan Ann Arbor, Michigan Disclosures
More informationClinical Guidance: Recommended Best Practices for Delivery of Colposcopy Services in Ontario Best Practice Pathway Summary
Clinical Guidance: Recommended Best Practices for Delivery of Colposcopy Services in Ontario Best Practice Pathway Summary Glossary of Terms Colposcopy is the examination of the cervix, vagina and, in
More informationHKCOG GUIDELINES NUMBER 3 (revised November 2002) published by The Hong Kong College of Obstetricians and Gynaecologists
HKCOG Guidelines Guidelines on the Management of An Abnormal Cervical Smear Number 3 revised November 2002 published by The Hong Kong College of Obstetricians and Gynaecologists A Foundation College of
More informationFor the Atypical Squamous Cells of Undetermined Significance/Low-Grade Squamous Intraepithelial Lesion Triage Study Group
Effects of Age and Human Papilloma Viral Load on Colposcopy Triage: Data From the Randomized Atypical Squamous Cells of Undetermined Significance/ Low-Grade Squamous Intraepithelial Lesion Triage Study
More informationOver-diagnoses in Cytopathology: Is histology the gold standard?
Over-diagnoses in Cytopathology: Is histology the gold standard? Teresa M. Darragh, MD UCSF Departments of Pathology and Obstetrics, Gynecology & Reproductive Sciences Faculty Disclosures: Teresa M. Darragh,
More informationRESEARCH ARTICLE. Abstract. Introduction
DOI:http://dx.doi.org/10.7314/APJCP.2015.16.16.6857 Cost-Effectiveness of Strategies for Detection CIN2+ in Women with ASC-US Pap Smears in Thailand RESEARCH ARTICLE Cost-Effectiveness Analysis of Different
More informationCervical Cancer Screening for the Primary Care Physician for Average Risk Individuals Clinical Practice Guidelines. June 2013
Cervical Cancer Screening for the Primary Care Physician for Average Risk Individuals Clinical Practice Guidelines General Principles: Since its introduction in 1943, Papanicolaou (Pap) smear is widely
More informationUpdated ASCCP Consensus Guidelines For Managing Diagnosed Cervical Cancer Precursors Michael A. Gold, M.D.
Updated ASCCP Consensus Guidelines For Managing Diagnosed Cervical Cancer Precursors Michael A. Gold, M.D. 27 May, 2014 London, England Faculty Disclosure X No, nothing to disclose Yes, please specify
More informationCytology/Biopsy/Leep Gynecologic Correlation: Practical Considerations and Approaches.
Cytology/Biopsy/Leep Gynecologic Correlation: Practical Considerations and Approaches. Fadi W. Abdul-Karim MD MEd. Professor of Pathology. Vice chair for education. Robert Tomsich Pathology and Lab Med
More informationLessons From Cases of Screened Women Who Developed Cervical Carcinoma
Lessons From Cases of Screened Women Who Developed Cervical Carcinoma R. Marshall Austin MD,PhD Magee-Womens Hospital of University of Pittsburgh Medical Center raustin@magee.edu Why Focus Study On Cases
More informationHuman Papillomavirus Testing Using Hybrid Capture II With SurePath Collection
468 Human Papillomavirus Testing Using Hybrid Capture II With SurePath Collection Initial Evaluation and Longitudinal Data Provide Clinical Validation for This Method Vincent Ko, MD Rosemary H. Tambouret,
More informationA Cytologic/Histologic Review of 367 Cases. Original Article. Cancer Cytopathology August 25,
Correlation Between Hybrid Capture II High-Risk Human Papillomavirus DNA Test Chemiluminescence Intensity From Cervical Samples With Follow-Up Histologic Results A Cytologic/Histologic Review of 367 Cases
More informationAbnormal Cervicovaginal Cytology With Negative Human Papillomavirus Testing
280 Abnormal Cervicovaginal Cytology With Negative Human Papillomavirus Testing Giovanni Negri, MD Bettina Rigo, BS Fabio Vittadello, ScD Christine Mian, ScD Eduard Egarter-Vigl, MD Department of Pathology,
More informationManagement of Abnormal Cervical Cytology and Histology
Management of Abnormal Cervical Cytology and Histology Assoc. Prof. Gökhan Tulunay Etlik Zübeyde Hanım Women s Diseases Teaching & Research Hospital Gynecologic Oncology Clinic Universally accepted guideline
More informationAbsolute Risk of a Subsequent Abnormal Pap among Oncogenic Human Papillomavirus DNA-Positive, Cytologically Negative Women
Absolute Risk of a Subsequent Abnormal Pap among Oncogenic Human Papillomavirus DNA-Positive, Cytologically Negative Women 2145 Philip E. Castle, Ph.D., M.P.H. 1 Sholom Wacholder, Ph.D. 1 Mark E. Sherman,
More informationUnderstanding Your Pap Test Results
Understanding Your Pap Test Results Most laboratories in the United States use a standard set of terms called the Bethesda System to report pap test results. Normal: Pap samples that have no cell abnormalities
More informationThe Korean Journal of Cytopathology 15 (1) : 17-27, 2004
5 The Korean Journal of Cytopathology 5 () : 7-7, / 5 / / (human papillomavirus, HPV), 6%, 5% HPV. HPV HPV. HPV HPV,,5 HPV HPV. HPV, 6 HPV. HPV HPV International Agency for Research on Cancer (IARC) HPV
More informationEradicating Mortality from Cervical Cancer
Eradicating Mortality from Cervical Cancer Michelle Berlin, MD, MPH Vice Chair, Obstetrics & Gynecology Associate Director, Center for Women s Health June 2, 2009 Overview Prevention Human Papilloma Virus
More informationColposcopy at a crossroads
American Journal of Obstetrics and Gynecology (2006) 195, 349 53 www.ajog.org CLINICAL OPINION Colposcopy at a crossroads Jose Jeronimo, MD, Mark Schiffman, MD, MPH Hormonal and Reproductive Epidemiology
More informationNews. Laboratory NEW GUIDELINES DEMONSTRATE GREATER ROLE FOR HPV TESTING IN CERVICAL CANCER SCREENING TIMOTHY UPHOFF, PHD, DABMG, MLS (ASCP) CM
Laboratory News Inside This Issue NEW GUIDELINES DEMONSTRATE GREATER ROLE FOR HPV TESTING IN CERVICAL CANCER SCREENING...1 NEW HPV TEST METHODOLOGY PROVIDES BETTER SPECIFICITY FOR CERVICAL CANCER...4 BEYOND
More informationNegative Colposcopic Biopsy After Positive Human Papilloma Virus (HPV) DNA Testing False-Positive HPV Results or False-Negative Histologic Findings?
Anatomic Pathology / FALSE-NEGATIVE HISTOLOGIC FINDINGS Negative Colposcopic Biopsy After Positive Human Papilloma Virus (HPV) DNA Testing False-Positive HPV Results or False-Negative Histologic Findings?
More informationP16 et Ki67 Biomarkers: new tool for risk management and low grade intraepithelial lesions (LGSIL): be ready for the future.
P16 et Ki67 Biomarkers: new tool for risk management and low grade intraepithelial lesions (LGSIL): be ready for the future. Mark H Stoler, MD University of Virginia Health System, Charlottesville, VA,
More informationHPV Genotyping: A New Dimension in Cervical Cancer Screening Tests
HPV Genotyping: A New Dimension in Cervical Cancer Screening Tests Lee P. Shulman MD The Anna Ross Lapham Professor in Obstetrics and Gynecology and Chief, Division of Clinical Genetics Feinberg School
More informationCervical Cancer Screening. David Quinlan December 2013
Cervical Cancer Screening David Quinlan December 2013 Cervix Cervical Cancer Screening Modest variation provincially WHO and UK begin at 25 stop at 60 Finland begin at 30 stop at 60 Rationale for
More informationWoo Dae Kang, Ho Sun Choi, Seok Mo Kim
Is vaccination with quadrivalent HPV vaccine after Loop Electrosurgical Excision Procedure effective in preventing recurrence in patients with High-grade Cervical Intraepithelial Neoplasia (CIN2-3)? Chonnam
More informationCase Based Problems. Recommended Guidelines. Workshop: Case Management of Abnormal Pap Smears and Colposcopies. Disclosure
Disclosure Workshop: Case Management of Abnormal Pap Smears and Colposcopies Rebecca Jackson, MD Associate Professor Obstetrics, Gynecology & Reproductive Sciences and Epidemiology & Biostatistics This
More informationObjectives. I have no financial interests in any product I will discuss today. Cervical Cancer Screening Guidelines: Updates and Controversies
Cervical Cancer Screening Guidelines: Updates and Controversies I have no financial interests in any product I will discuss today. Jody Steinauer, MD, MAS University of California, San Francisco Objectives
More informationHPV test results and histological follow-up results of patients with LSIL Cervical Cytology from the Largest CAP-certified laboratory in China
2436 Ivyspring International Publisher Research Paper Journal of Cancer 2017; 8(13): 2436-2441. doi: 10.7150/jca.19421 HPV test results and histological follow-up results of patients with LSIL Cervical
More informationCervical Cancer 4/27/2016
Guidelines for Cervical Cancer Screening and Prevention Management of Abnormal Results Kathy A. King, MD Assistant Professor of OB/GYN Medical College of Wisconsin May 6, 2016 Cervical Cancer In US about
More informationCervical Cancer Prevention in the 21 st Century Changing Paradigms
Cervical Cancer Prevention in the 21 st Century Changing Paradigms Teresa M. Darragh, MD UCSF Departments of Pathology and Obstetrics, Gynecology & Reproductive Sciences Faculty Disclosures: Teresa M.
More informationI have no financial interests in any product I will discuss today.
Cervical Cancer Prevention: 2012 and Beyond George F. Sawaya, MD Professor Department of Obstetrics, Gynecology and Reproductive Sciences Department of Epidemiology and Biostatistics University of California,
More informationThe LAST Guidelines in Clinical Practice. Implementing Recommendations for p16 Use
AJCP / Original Article The LAST Guidelines in Clinical Practice Implementing Recommendations for p16 Use Lani K. Clinton, MD, PhD, 1,2 Kyle Miyazaki, 1 Asia Ayabe, 1 James Davis, PhD, 2 Pamela Tauchi-Nishi,
More informationRunning head: EVIDENCE-BASED MEDICINE TWO-STEP DISCREPANCY
Evidence-Based Medicine Two-Step Discrepancy 1 Running head: EVIDENCE-BASED MEDICINE TWO-STEP DISCREPANCY Evidence-Based Medicine Two-Step Discrepancy Julie Nelson Texas Woman s University Philosophy of
More information9/18/2008. Cervical Cancer Prevention for Adolescent Populations Garcia. Faculty disclosure. Objectives. HPV Positivity by Age (UK)
Faculty disclosure Cervical Cancer Prevention for Francisco, MD, MPH Associate Professor Obstetrics & Gynecology Mexican American Studies Public Health Francisco, MD, MPH has no financial affiliations
More informationNo Disclosures. Updated Guidelines for Cervical Cancer Screening and Prevention Management of Abnormal Results. Objectives 5/9/2016
Updated Guidelines for Cervical Cancer Screening and Prevention Management of Abnormal Results Kathy A. King, MD Assistant Professor of OB/GYN Medical Director, PPWI Medical College of Wisconsin May 6,
More informationComparative study of human papilloma virus DNA detection and results of histopathological examination of cervical colposcopic biopsy
Iranian Journal of Reproductive Medicine Vol.5. No.3. pp:121-126, Summer 2007 Comparative study of human papilloma virus DNA detection and results of histopathological examination of cervical colposcopic
More informationDysplasia: layer of the cervical CIN. Intraepithelial Neoplasia. p16 immunostaining. 1, Cervical. Higher-risk, requires CIN.
CLINICAL PRACTICE GUIDELINE Guideline Number: DHMP_DHMC_PG1015 Guideline Subject: Routine Cervical Cancer Screening Effective Date: 9/2018 Revision Date: 9/2019 Pages: 2 of 2 Quality Management Committee
More informationMolecular Analysis in the Diagnosis and Management of Lesions of Uterine Cervix: The 95% solution. Mark H. Stoler, MD PSC Symposium USCAP 2008
Molecular Analysis in the Diagnosis and Management of Lesions of Uterine Cervix: The 95% solution Mark H. Stoler, MD PSC Symposium USCAP 2008 Objectives: This presentation will briefly review the currently
More informationSamuel B. Wolf, D.O., F.A.C.O.G. Emerald Coast Obstetrics and Gynecology Panama City Florida
Making sense of the new Pap smear screening guidelines. Samuel B. Wolf, D.O., F.A.C.O.G. Emerald Coast Obstetrics and Gynecology Panama City Florida Case 17 year old G1P0010 with first sexual encounter
More informationCME/SAM. Follow-up Outcomes in a Large Cohort of Patients With Human Papillomavirus Negative ASC-H Cervical Screening Test Results
Anatomic Pathology / HPV-Negative ASC-H Follow-up Outcomes in a Large Cohort of Patients With Human Papillomavirus Negative ASC-H Cervical Screening Test Results David Cohen, MD, R. Marshall Austin, MD,
More informationHuman papiloma virus testing in the cervix of high-risk women: A hospital-based clinicopathological, colposcopic, and cytogenetic study
Research Article Human papiloma virus testing in the cervix of high-risk women: A hospital-based clinicopathological, colposcopic, and cytogenetic study Subhash Bhardwaj 1, Farooq Ahmed Wani 2, Altaf Bandy
More informationA systematic review of the role of human papilloma virus (HPV) testing within a cervical screening programme: summary and conclusions
British Journal of Cancer (2000) 83(5), 561 565 doi: 10.1054/ bjoc.2000.1375, available online at http://www.idealibrary.com on A systematic review of the role of human papilloma virus (HPV) testing within
More informationMolecular markers for diagnosis and prognosis in cervical neoplasia Eijsink, Jasper Johannes Hendrikus
University of Groningen Molecular markers for diagnosis and prognosis in cervical neoplasia Eijsink, Jasper Johannes Hendrikus IMPORTANT NOTE: You are advised to consult the publisher's version (publisher's
More informationINTRODUCTION HSIL AND CERVICAL CARCINOMA IN ASCUS CERVICAL CYTOLOGY
HSIL AND CERVICAL CARCINOMA IN ASCUS CERVICAL CYTOLOGY PREVALENCE OF HIGH GRADE SQUAMOUS INTRAEPITHELIAL LESIONS (HSIL) AND INVASIVE CERVICAL CANCER IN PATIENTS WITH ATYPICAL SQUAMOUS CELLS OF UNDETERMINED
More informationCervical Screening Results Leading to Detection of Adenocarcinoma in Situ of the Uterine Cervix
DOI:10.31557/APJCP.2019.20.2.377 Cervical Screening Results Leading to Detecting Cervical AIS RESEARCH ARTICLE Editorial Process: Submission:09/27/2018 Acceptance:01/18/2019 Cervical Screening Results
More informationCervical FISH Testing for Triage and Support of Challenging Diagnoses: A Case Study of 2 Patients
Cervical FISH Testing for Triage and Support of Challenging Diagnoses: A Case Study of 2 Patients Richard Hopley, MD, Alexandra Gillespie, MD* Laboratory Medicine 47:1:52-56 CLINICAL HISTORY Patients:
More informationSouthern California CSU DNP Consortium
Southern California CSU DNP Consortium California State University, Fullerton California State University, Long Beach California State University, Los Angeles ESSENTIAL CHANGES TO THE MANAGEMENT OF ABNORMAL
More informationThe Bethesda System for Reporting Cervical Cytology: A Historical Perspective
Commentary Received: May 17, 2017 Accepted after revision: May 18, 2017 Published online: July 11, 2017 The Bethesda System for Reporting Cervical Cytology: A Historical Perspective Ritu Nayar a David
More informationLong-Term Outcome and Relative Risk in Women With Atypical Squamous Cells of Undetermined Significance
Anatomic Pathology / LONG-TERM OUTCOME WITH ATYPICAL SQUAMOUS CELLS OF UNDETERMINED SIGNIFICANCE Long-Term Outcome and Relative Risk in Women With Atypical Squamous Cells of Undetermined Significance Stephen
More informationPap plus HPV every 3 years with screening stopped at 65, 75 and 100 years; Pap plus HPV every 2 years with screening stopped at 65, 75 and 100 years.
Benefits and costs of using HPV testing to screen for cervical cancer Mandelblatt J S, Lawrence W F, Womack S M, Jacobsen D, Yo B, Hwang Y, Gold K, Barter J, Shah K Record Status This is a critical abstract
More informationGynecologic Cytology-Histology Correlation Guideline
Gynecologic Cytology- Correlation Guideline George G. Birdsong, MD and Joe W. Walker, Jr., MS, SCT(ASCP) CM Clinical Practice Committee Dr. Birdsong and Mr. Walker are grateful for extensive input from
More informationCervical Precancer: Evaluation and Management
TAJ June 2002; Volume 15 Number 1 ISSN 1019-8555 The Journal of Teachers Association RMC, Rajshahi Review fam Cervical Precancer: Evaluation and Management SM Khodeza Nahar Begum 1 Abstract Carcinoma of
More informationManagement Algorithms for Abnormal Cervical Cytology and Colposcopy
Management Algorithms for Abnormal Cervical Cytology and Colposcopy Table of Contents Standard Colposcopic Definitions... 1 Guidelines for the Assessment of Abnormal Cervical Cytology... 2 Ia: Persistent
More informationAbstract. Human papillomavirus (HPV) DNA testing is cost-effective 1-3 (S. Kulasingam, PhD, et al, unpublished Atypical
Anatomic Pathology / HPV DNA DETECTION IN ALTS A Comparison of a Prototype PCR Assay and Hybrid Capture 2 for Detection of Carcinogenic Human Papillomavirus DNA in Women With Equivocal or Mildly Abnormal
More informationDisclosures & images
Cervical Cancer Screening: New Approaches Levi S. Downs, Jr., MD Disclosures & images During the previous 12 months, I have been a consultant for and received honoraria from Merck. Images are attributed
More informationI have no financial interests in any product I will discuss today.
Cervical Cancer Screening Update and Implications for Annual Exams George F. Sawaya, MD Professor Department of Obstetrics, Gynecology and Reproductive Sciences Department of Epidemiology and Biostatistics
More informationName of Policy: Speculoscopy
Name of Policy: Speculoscopy Policy #: 095 Latest Review Date: September 2011 Category: Medicine/OB Gyn Policy Grade: C Background/Definitions: As a general rule, benefits are payable under Blue Cross
More informationAn Update on Cervical Cancer Screening Recommendations and on the DOH BCC Program
An Update on Cervical Cancer Screening Recommendations and on the DOH BCC Program Susan Baum, MD, MPH NM Nurse Practitioner Council Annual Conference April 20, 2012 I have no commercial relationships related
More informationI have no financial interests in any product I will discuss today.
Cervical Cancer Screening Update and Implications for Annual Exams George F. Sawaya, MD Professor Department of Obstetrics, Gynecology and Reproductive Sciences Department of Epidemiology and Biostatistics
More informationHuman Papillomavirus
Human Papillomavirus Dawn Palaszewski, MD Assistant Professor of Obstetrics and Gynecology University of February 18, 2018 9:40 am Dawn Palaszewski, MD Assistant Professor Department of Obstetrics and
More informationCervical Testing and Results Management. An Evidenced-Based Approach April 22nd, Debora Bear, MSN, MPH
Cervical Testing and Results Management An Evidenced-Based Approach April 22nd, 2010 Debora Bear, MSN, MPH Assistant Medical Director for Planned Parenthood of New Mexico, Inc. Burden of cervical cancer
More informationCytologic screening programs to detect cervical intraepithelial
Combining Human Papillomavirus Testing or Cervicography With Cytology to Detect Cervical Neoplasia Michelle Howard, MSc; John W. Sellors, MD, MSc; Alice Lytwyn, MD, MSc; Paula Roth, MD; James B. Mahony,
More informationClinical outcomes after conservative management of CIN1/2, CIN2, and CIN2/3 in women ages years
Clinical outcomes after conservative management of CIN1/2, CIN2, and CIN2/3 in women ages 21-39 years Michelle I. Silver, PhD, ScM Cancer Prevention Fellow National Cancer Institute Division of Cancer
More informationSESSION J4. What's Next? Managing Abnormal PAPs in 2014
37th Annual Advanced Practice in Primary and Acute Care Conference: October 9-11, 2014 2:45 SESSION J4 What's Next? Managing Abnormal PAPs in 2014 Session Description: Linda Eckert, MD Review current guidelines
More informationHuman papillomavirus testing as a cytology gold standard: comparing Surinam with the Netherlands
& 2005 USCAP, Inc All rights reserved 0893-3952/05 $30.00 www.modernpathology.org Human papillomavirus testing as a cytology gold standard: comparing Surinam with the Netherlands Mitchell S Wachtel 1,
More informationHigh-risk Human Papillomavirus Infection in Low Risk Women: Incidence, Patient Characteristics, and Clinical Meaning for Cervical Cancer
103 Ivyspring International Publisher Research Paper International Journal of Medical Sciences 2012; 9(1):103-107 High-risk Human Papillomavirus Infection in Low Risk Women: Incidence, Patient Characteristics,
More informationFactors associated with HPV persistence after conization in patients with negative margins
J Gynecol Oncol Vol. 20, No. 2:91-95, June 2009 DOI:10.3802/jgo.2009.20.2.91 Original Article Factors associated with HPV persistence after conization in patients with negative margins Kyehyun Nam, Sooho
More informationTreatment of Cervical Intraepithelial Neoplasia. Case. How would you manage this woman?
Treatment of Cervical Intraepithelial Neoplasia Karen Smith-McCune Professor, Department of Obstetrics, Gynecology and Reproductive Sciences I have no conflicts of interest Case How would you manage this
More informationHPV and Cervical Cancer, Screening and Prevention. John Ragsdale, MD July 12, 2018 CME Lecture Series
HPV and Cervical Cancer, Screening and Prevention John Ragsdale, MD July 12, 2018 CME Lecture Series We have come a long Way Prevalence HPV in Young Adults in U.S HPV genotypes 55-60% of All cancers 20%
More informationCervical Cancer Screening Rates in the United States and the Potential Impact of Implementation of Screening Guidelines
Cervical Cancer Screening Rates in the United States and the Potential Impact of Implementation of Screening Guidelines Diane Solomon, MD; Nancy Breen, PhD; Timothy McNeel, BA Dr. Solomon is Senior Investigator,
More informationchapter 4. The effect of oncogenic HPV on transformation zone epithelium
chapter 4. The effect of oncogenic HPV on transformation zone epithelium CHAPTER 1 All squamous cervical cancer (and probably all cervical adenocarcinoma) is associated with oncogenic HPV, and the absence
More informationComparison of HPV test versus conventional and automation-assisted Pap screening as potential screening tools for preventing cervical cancer
BJOG: an International Journal of Obstetrics and Gynaecology August 2004, Vol. 111, pp. 842 848 DOI: 1 0. 1111/j.1471-0528.2004.00210.x Comparison of HPV test versus conventional and automation-assisted
More informationBiomed Environ Sci, 2015; 28(1): 80-84
80 Biomed Environ Sci, 2015; 28(1): 80-84 Letter to the Editor Assessing the Effectiveness of a Cervical Cancer Screening Program in a Hospital-based Study* YANG Yi1, LANG Jing He1, WANG You Fang1, CHENG
More informationPerformance of the Aptima High-Risk Human Papillomavirus mrna Assay in a Referral Population in Comparison with Hybrid Capture 2 and Cytology
JOURNAL OF CLINICAL MICROBIOLOGY, Mar. 2011, p. 1071 1076 Vol. 49, No. 3 0095-1137/11/$12.00 doi:10.1128/jcm.01674-10 Copyright 2011, American Society for Microbiology. All Rights Reserved. Performance
More informationHPV Testing ASC-US. Jodie Zeke, a nurse practitioner, received initial CE2. 5. By Kim K. Choma, MSN, APN,C
CE2. 5 HOURS Continuing Education By Kim K. Choma, MSN, APN,C & ASC-US HPV Testing When the Pap result is atypical squamous cells of undetermined significance, testing for the human papillomavirus may
More informationUpdate on Cervical Cancer Screening. Rahmouna Farez M.D. Assistant Professor, Medical College of Wisconsin 5/2/2014
Update on Cervical Cancer Screening Rahmouna Farez M.D. Assistant Professor, Medical College of Wisconsin 5/2/2014 Objectives Review the natural history of HPV as it relates to cervical cancer screening
More informationUpdate on Cervical Cancer Screening
Update on Cervical Cancer Screening Rahmouna Farez M.D. Assistant Professor, Medical College of Wisconsin 5/2/2014 Objectives Review the natural history of HPV as it relates to cervical cancer screening
More informationCryotherapy has No Place in Colposcopy Practice
Cryotherapy has No Place in Colposcopy Practice No financial disclosures No conflicts of interest ? Precision? Personalized Medicine? Best Evidence Based Practice Prinicipals of Surgical Management CIN1
More informationDetecting High-Grade Cervical Disease on ASC-H Cytology. Role of BD ProEx C and Digene Hybrid Capture II HPV DNA Testing
Anatomic Pathology / BD ProEx C Use in ASC-H Cy t o l o g y Detecting High-Grade Cervical Disease on ASC-H Cytology Role of BD ProEx C and Digene Hybrid Capture II HPV DNA Testing Momin T. Siddiqui, MD,
More informationSydney Gynaecology Oncology Group, Sydney Cancer Centre, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
bs_bs_banner doi:10.1111/jog.12545 J. Obstet. Gynaecol. Res. Vol. 41, No. 3: 440 444, March 2015 Abnormal cervicovaginal cytology, unsatisfactory colposcopy and the use of vaginal estrogen cream: An observational
More informationComparative evaluation of smear cytology & hybrid capture II for the diagnosis of cervical cancer
Indian J Med Res 126, July 2007, pp 39-44 Comparative evaluation of smear cytology & hybrid capture II for the diagnosis of cervical cancer Kamlesh Kumar, Venkateswaran K. Iyer, Neerja Bhatla*, Alka Kriplani*
More informationRisk : How does it define cervical cancer screening?
Risk : How does it define cervical cancer screening? Alan G. Waxman, MD, MPH Dept. of Obstetrics and Gynecology University of New Mexico The University of New Mexico Disclosures I have no commercial interests
More information