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American Journal of Clinical Pathology Sep 2022Specimen adequacy is an important quality assurance component of a cervical Papanicolaou test. Although consensus exists on minimal acceptable cellularity for cervical...
OBJECTIVES
Specimen adequacy is an important quality assurance component of a cervical Papanicolaou test. Although consensus exists on minimal acceptable cellularity for cervical Papanicolaou tests, no such criteria exist for endocervical curettage (ECC) specimens. We sought to identify minimum acceptable cellularity for accurate diagnosis of high-grade dysplasia (HGD) on ECC.
METHODS
All patients with HGD diagnosed in a loop electrosurgical excision procedure (LEEP) from May 8, 2018, to December 18, 2019, and an ECC in the preceding 6 months at our institution were included (n = 51). All ECCs performed before the LEEP were evaluated for cellularity of squamous cells using Aperio eSlide Manager (Leica Biosystems). Biopsy results concurrent with the ECC were noted. We compared the number of squamous cells in positive and negative ECC specimens using a t-test. The proportion of ECC specimens and concurrent biopsies undergoing immunohistochemical (IHC) staining for p16 were compared using the χ2 test. P < .05 was considered significant.
RESULTS
Endocervical curettage specimens positive for HGD have increased cellularity compared with negative ECC specimens (mean cellularity, 10,165 vs 1,055; P < .05). Further, IHC staining for p16 was more likely to be performed on an ECC specimen positive for HGD than on a negative ECC specimen (50% vs 3%; P < .05). Biopsies performed concurrently with a negative ECC finding were more likely to undergo p16 IHC than biopsies performed concurrently with a positive ECC finding (51% vs 7%; P < .05). Finally, we observed no difference in the proportion of biopsies undergoing IHC staining for p16 when comparing biopsies positive for HGD with negative biopsies (37% vs 46%; P = .33).
CONCLUSIONS
We find cellularity of approximately 10,000 cells adequate to diagnose HGD in an ECC specimen and cellularity of approximately 1,000 cells to be inadequate. Further, we find p16 IHC commonly used as a "rule-in" test on ECC specimens at our institution. Biopsies accompanying an ECC specimen negative for HGD are more likely to undergo p16 IHC than those accompanying an ECC specimen positive for HGD, but there is no difference in the proportion of biopsies undergoing p16 IHC when comparing positive and negative results in the biopsies themselves. These findings further support the need for adequate cellularity for diagnosis in ECC, especially when a biopsy is technically difficult. Further areas for exploration include investigating laboratory procedures to maximize the cellularity of ECC specimens.
Topics: Biopsy; Cervix Uteri; Colposcopy; Curettage; Female; Humans; Pregnancy; Uterine Cervical Neoplasms; Vaginal Smears
PubMed: 35568991
DOI: 10.1093/ajcp/aqac058 -
Ernst Schering Research Foundation... 2005
Review
Topics: Cervix Uteri; Female; Glycosylation; Humans; Mucins; Reproduction
PubMed: 15704474
DOI: 10.1007/3-540-27147-3_10 -
Archives of Gynecology and Obstetrics Mar 2024There is a growing body of evidence suggesting that endocervical crypt involvement by high-grade cervical intraepithelial neoplasia (CIN) may represent a risk factor for... (Meta-Analysis)
Meta-Analysis Review
Endocervical crypt involvement by high-grade cervical intraepithelial neoplasia and its association with high-grade histopathological recurrence after cervical excision in women with negative excision margins: a systematic review and meta-analysis.
BACKGROUND
There is a growing body of evidence suggesting that endocervical crypt involvement by high-grade cervical intraepithelial neoplasia (CIN) may represent a risk factor for disease recurrence after cervical treatment.
OBJECTIVES
To provide a systematic review and meta-analysis on whether endocervical crypt involvement by high-grade CIN on the excised cervical specimen is associated with high-grade histopathological recurrence during the follow-up of women after cervical excisional treatment.
SEARCH STRATEGY
We searched the Medline, Scopus, Central, and Clinical Trials.gov databases from inception till May 2023.
SELECTION CRITERIA
Studies that reported on women with a single cervical treatment with any method of excision for CIN2 or CIN3 lesion, negative excision margins, and whose recurrence was defined histopathologically were included.
DATA COLLECTION AND ANALYSIS
Two reviewers independently evaluated study eligibility. We used the fixed effects model for meta-analysis.
MAIN RESULTS
There were 4 eligible studies included in the present systematic review that evaluated 1088 women treated with either large loop excision of the transformation zone (LLETZ) or with cold knife conization (CKC). We found no significant association of endocervical crypt involvement by CIN2-3 with high-grade histopathological recurrence at follow-up after cervical excision (OR 1.93; 95% CI 0.51-3.35). The subgroup analysis of women with LLETZ cervical excision showed again no significant association with high-grade histopathological recurrence at follow-up (OR 2.00; 95% CI 0.26-3.74).
CONCLUSION
Endocervical crypt involvement by high-grade CIN does not seem to be a risk factor for high-grade histopathological recurrence after cervical excision with negative excision margins.
Topics: Female; Humans; Uterine Cervical Neoplasms; Margins of Excision; Neoplasm Recurrence, Local; Uterine Cervical Dysplasia; Cervix Uteri; Conization
PubMed: 37821642
DOI: 10.1007/s00404-023-07242-y -
Clinical Obstetrics and Gynecology Sep 2000The human uterine cervix undergoes extensive changes during pregnancy. Collagen is reorganized and consolidated early in gestation with proliferation and hyperplasia of... (Review)
Review
The human uterine cervix undergoes extensive changes during pregnancy. Collagen is reorganized and consolidated early in gestation with proliferation and hyperplasia of the cellular component. As term approaches, multiple factors work together in complex interactions that cause collagen dispersion and the cervix to ripen (clinically become softer). Increases in decorin levels, hyaluronic acid, and physiologic cell death are in part responsible for this remodeling process. As the collagen bundles disperse and lose strength, cytokines, hyaluronic acid, collagenases, and elastase possibly work together to allow effacement. Then, the mechanical forces of uterine contractions extend the elastin and allow dilatation. During dilation, levels of cytokines and hyaluronic acid begin to decrease, which may serve to decrease collagenolytic activity and allow the cervix to begin the process of repairing itself. Despite this advance knowledge of cervical ripening, the signals responsible for the initiation of these changes remain to be elucidated. If we can understand the exact mechanisms that affect these changes, then we may be better able to address such complex issues as cervical incompetence, preterm delivery, postterm delivery, and proper "ripening" of the cervix to avoid surgical delivery for arrest disorders of the active phase.
Topics: Cervical Ripening; Cervix Uteri; Female; Humans; Pregnancy
PubMed: 10949747
DOI: 10.1097/00003081-200009000-00003 -
Journal of Obstetrics and Gynaecology :... Oct 2021
Topics: Adenocarcinoma; Cervix Uteri; Diagnosis, Differential; Female; Humans; Hyperplasia; Hysterectomy; Laparoscopy; Middle Aged; Precancerous Conditions; Salpingectomy; Uterine Cervical Diseases; Uterine Cervical Neoplasms
PubMed: 33236941
DOI: 10.1080/01443615.2020.1820969 -
International Journal of Surgical... Feb 2023This study aimed to determine whether endocervical glandular involvement by squamous intraepithelial lesion would differ with respect to the depth of the excised...
This study aimed to determine whether endocervical glandular involvement by squamous intraepithelial lesion would differ with respect to the depth of the excised specimen and analyze the related factors that may define endocervical glandular involvement among cases treated with cone biopsy. Between April 2016 and December 2018, women who underwent colposcopy and excisional procedures in the department of gynecologic oncology were retrospectively investigated. Patients with multiple specimens, or whose specimen depths were not measured, and a negative/unknown HPV status were excluded from the study. Also, patients with no dysplasia or microinvasive/invasive cancer in the final pathology report and those who had not undergone endocervical curettage during colposcopy were excluded. HPV genotypes, degree of dysplasia, surgical margin status, and specimen depth were documented from medical records. Further, the association of these factors with endocervical glandular involvement was evaluated. A total of 321 patients who fulfilled the criteria were included in the study, with a mean age of 41.9 years. In total, 101 patients (31.5%) had endocervical glandular involvement. The mean excised specimen depth was 17.04 mm; 17.9 and 16.7 mm for the positive and negative glandular involvement groups, respectively ( = .13). The mean ages were 42.7 and 41.6 years for these groups, respectively ( = .32). There was no association between the HPV genotypes and glandular involvement. Endocervical glandular involvement is not associated with the depth of the excised specimen. A deeper cone biopsy may not necessarily enable a more effective treatment of the disease.
Topics: Female; Humans; Adult; Uterine Cervical Neoplasms; Retrospective Studies; Papillomavirus Infections; Cervix Uteri; Conization; Biopsy
PubMed: 35651307
DOI: 10.1177/10668969221102616 -
The Journal of the American Association... Nov 1996A new method was developed to access the uterine cavity in women in whom cervical stenosis precludes hysteroscopic surgery. Thirty-three women with intractable uterine...
A new method was developed to access the uterine cavity in women in whom cervical stenosis precludes hysteroscopic surgery. Thirty-three women with intractable uterine bleeding were chosen to undergo either hysteroscopic myometrial resection or myomectomy. All of them had cervical stenosis that would, in the authors' opinion, not permit safe dilatation to 9 mm, the minimum diameter necessary to introduce a gynecologic resectoscope. Endocervical resection was performed in all 33 patients, with safe, easy access to the uterine cavity. No cases of fluid overload or excess bleeding occurred. We conclude that hysteroscopic endocervical resection is a safe method to create a portal of entry to the uterine cavity in women with absolute or relative cervical stenosis.
Topics: Cervix Uteri; Constriction, Pathologic; Electrosurgery; Endometrium; Endoscopy; Female; Humans; Hysteroscopy; Myometrium; Uterine Hemorrhage
PubMed: 9050714
DOI: 10.1016/s1074-3804(96)80111-3 -
Biology of Reproduction May 2020Cervical mucus produced by the endocervix plays an essential role as a hormonally induced regulator of female fertility. Cervical mucus fluctuates in both physical...
Cervical mucus produced by the endocervix plays an essential role as a hormonally induced regulator of female fertility. Cervical mucus fluctuates in both physical characteristics and in sperm penetrability in response to estrogens and progestogens. However, the mechanisms by which steroid hormones change mucus remains poorly understood. Current in vitro models have limited capability to study these questions as primary endocervical cells possess limited expansion potential, and immortalized cells lose in vivo characteristics such as steroid sensitivity. Here we overcome these limitations by establishing an in vitro primary endocervical cell culture model using conditionally reprogrammed cells (CRCs). CRC culture utilizes a Rho-kinase inhibitor and a fibroblast feeder layer to expand proliferative potential of epithelial cell types that have normally short in vitro life spans. In our studies, we produce CRC cultures using primary endocervical cells from adult female rhesus macaques (Macaca mulatta). We demonstrate that primary endocervical cells from the nonhuman primate can be robustly expanded using a CRC method, while retaining steroid receptor expression. Moreover, when removed from CRC conditions and switched to differentiation conditions, these cells are able to differentiate and produce mucus including MUC5B, the most prevalent mucin of the endocervix. We conclude that this method provides a promising in vitro platform for conducting mechanistic studies of cervical mucus regulation as well as for screening new therapeutic targets for fertility regulation and diseases of the endocervix.
Topics: Animals; Cellular Reprogramming; Cervix Mucus; Cervix Uteri; Female; Gene Expression Regulation; Macaca mulatta; Receptors, Steroid
PubMed: 32232331
DOI: 10.1093/biolre/ioaa039 -
Journal of the American Society of... 2021Colposcopic endocervical brushing cytology (CEB) is more sensitive than endocervical curettage (ECC) for detecting squamous intraepithelial lesions. There are no data on...
INTRODUCTION
Colposcopic endocervical brushing cytology (CEB) is more sensitive than endocervical curettage (ECC) for detecting squamous intraepithelial lesions. There are no data on performance of CEB for detecting endocervical adenocarcinoma.
MATERIALS AND METHODS
A total of 151 patients were identified in a word search for "endocervical adenocarcinoma" in surgical pathology reports from January 2007 to June 2019. To measure sensitivity, reports of CEB or ECC samples within 1 year preceding the first surgical pathology diagnosis of at least endocervical adenocarcinoma in situ (AIS+) were examined. Specificity was measured in a cohort in which at least atypical glandular cells (AGC+) was reported in CEB or ECC.
RESULTS
Seven CEB preceding diagnosis of AIS were identified: 6 of 7 were positive or suspicious for AIS+. One of 7 was negative and it was negative on re-review. Three of 6 positive CEB cases used cell blocks with immunohistochemistry. Seventy ECC samples preceding diagnosis of AIS were identified: 40 of 70 were diagnosed as AGC+. The sensitivities of CEB and ECC for detecting AIS+ at a threshold of AGC+ are 86% and 57% (too few patients for statistics), respectively. For specificity, 12 of 18 CEB and 9 of 25 ECC reports with AGC+ were false positive by follow-up surgical pathology. The specificities of CEB and ECC are 99.4% and 99.9%, respectively.
CONCLUSION
Sensitivity of CEB for detecting AIS+ (86%) is at least as high as ECC (57%). Specificity of CEB is similar to ECC. Addition of a cell block to CEB may be useful. CEB appears to be an appropriate test for follow-up of atypical glandular cells reported on Papanicolaou tests.
Topics: Adenocarcinoma; Adult; Cervix Uteri; Colposcopy; Curettage; Early Detection of Cancer; Female; Humans; Middle Aged; Sensitivity and Specificity; Uterine Cervical Neoplasms
PubMed: 33097463
DOI: 10.1016/j.jasc.2020.08.008 -
The Journal of Reproductive Medicine Jan 1993Randomized, clinical trial results of a standardized, stable prostaglandin E2 (PGE2) preparation (0.5-mg PGE2 in a 2.5-mL gel base) applied endocervically as a single... (Review)
Review
Randomized, clinical trial results of a standardized, stable prostaglandin E2 (PGE2) preparation (0.5-mg PGE2 in a 2.5-mL gel base) applied endocervically as a single dose 12 hours prior to oxytocin induction were studied. The trials, conducted in the United States and Canada, included 538 women; 277 treated with PGE2 gel and 261 controls, with initial Bishop scores of < or = 4. Compared to controls, PGE2 recipients had significant improvement in cervical Bishop scores (P < .01) and a high rate of labor (47.4% vs. 9.6%, P < .001) during the 12-hour ripening period. In reporting centers, delivery during this same interval occurred without use of oxytocin in PGE2 patients (25.4%) vs. controls (4.9%). PGE2 reduced induction to delivery intervals and the duration of oxytocin administration. Although the composite cesarean section rates were lower in PGE2 recipients than in controls (28.5% vs. 32.9%), this difference did not achieve statistical significance. Maternal and fetal outcome and the incidence of complications were similar in the two groups. These studies confirm the safety and efficacy of this standardized PGE2 preparation as a means of cervical ripening in parturients with highly unfavorable cervixes.
Topics: Administration, Intravaginal; Cervix Uteri; Cesarean Section; Dinoprostone; Drug Therapy, Combination; Female; Humans; Labor, Induced; Oxytocin; Pregnancy; Pregnancy Outcome; Randomized Controlled Trials as Topic
PubMed: 8429531
DOI: No ID Found