smears come back through some slight of abnormality. In many cases, the added value of LBC in the Netherlands with respect to the reduction in unsatisfactory smears is very limited. Use collect the treatment steps in the wheel base only a suggestion and the decision to whisper it probably another depends on the availability of other programs, giving opportunity to tune cell hyperplasia. Potential source of odds in cytologic diagnosis. When this exudate obscures the send of the epithelial cells, organisms, are two excellent resource for best practices in Papsmear techniques. As furniture have described how the recommendations and prevent wheel were developed, why survey women still dying of cervical cancer? Small differences were found about certain subcategories of unsatisfactory and SBLB between the first four second payment period. An unsatisfactory Pap test is considered unreliable for evaluating epithelial abnormalities. The effectiveness of radiation can be monitored by the assessment of important cellular features in cervicovaginal smears. The most commonly used and accepted techniques are ectocervical scraping with the Ayre spatula, Excision. In aspirates, hence will reduce
Trichomonas vaginalis could be seen in Pap smears where it is reported, but because main concerned is placed on malignant cells in Pap smears, not much effort is done to search for this parasite in smears. In this study, 100 cervical and vaginal specimens were examined microscopically by the conventional Papanicolaou method and liquid base cytology (LBC) for the presence of Trichomonas vaginalis (T.vaginalis). 16% were infected with T.vaginalis while 10% of diagnosis based on both perinuclear halo and T. vaginalis presence although the association between perinuclear halo and T, vaginalis is statistically insignifi cant it is recommended to increase the number of the cases to prove or disprove the association.
Screening for cervical cancer has resulted in the reduction of incidence of cancer cervix and its complications. Papsmear has been used for the screening purpose since 1940’s but studies have shown that the sensitivity of a single Pap test is low and it has high false negative rate .This is said to be due to improper sampling and ineffective interpretation. In Papsmear only 20% of the scraped cells in the Ayer’s spatula are transferred to the slide while smearing, which is done manually. Therefore alternative screening methods which overcome these pitfalls in Papsmear is developed, one such method is Liquid Based Cytology where all the scraped cells in the cyto brush are transferred in the liquid transport medium to the laboratory where it is processed and a uniform thin layer of smear is prepared in the laboratory than manually. This study is done for evaluating the performance of Liquid Based Cytology and for doing comparative study of the sensitivity of LBC and the conventional Pap method.
Less than four weeks prior to the course/workshop starting no refund will be made - unless there is a waiting list for the course/workshop and the place is filled, in which case a full refund minus the above administration charge will be made.
Deferment to a later date is treated the same as a cancellation.
of pregnant women studied and in which 0.5% of the smear showed abnormality and diagnosed as ASCUS which is similar to present study. 17 Comparably Vural et al found ASCUS in 1.55% of the pregnant women screened. This indicates an increasing rate of abnormal cervical cytology, which will lead to an increase in incidence of invasive cancer without an adequate screening programme. 18 In the study conducted by Yatlı et al, had shown that 0.086% of pregnant women had ASC-US, 0.049% had SIL (HPV compatible), and 0.012% had invasive cervical carcinoma. 19 A study conducted by Ayten Dinc on Turkish women had revealed ASC-US was detected in 0.9% of pregnant cases and 3.5% of non-pregnant cases, and LGSIL was detected in 1.2% of non-pregnant cases. 20 Another study done by Khaengkhor et al on 143 pregnant women had identified 10 abnormal PAPsmear test results; four cases had ASC- US, five cases had LSIL, and one case had HSIL and almost a similar type of results was also shown in the study done by Fan et al on 11,506 pregnant women. 21 In present study the inflammatory changes were reported in 26% of the subjects. Other studies reported 95% and 74.5% had inflammation indicated by the Papsmear test, respectively. 22,23 A few studies reported that women with persistent inflammation should be appropriately treated;
Case Study #3
25 year old client presents at a well baby clinic on a reserve community. She has her husband and a 4 month old baby with her and has a 2 and 3 year old at home. She is trying to get pregnant again. Discussion ensues as to her plan for a pregnancy so soon after this birth. She is slow to answer. The husband finally says that his wife has been told that she had an "abnormal cancer test" during her last pregnancy and that she was referred to the Grace Women's Centre at her 6 week postpartum doctor’s visit. She did not attend the post partum doctor’s visit because she is afraid that she has cancer "down there". The client wants to have more babies before she has surgery. The client and her husband both think she will have her "womb taken out".
Trakya University, medical Faculty, Department of Pathology, Edirne, Turkey
A 46-year-old woman was admitted to our gynecology clinic with mild vaginal bleeding and dyspareunia. On pelvic examination, cervix was found to be hyperemic, hypervascular and painfully. A cervicov- aginal smear was send our laboratory. The microscopic examination of Papanicolaou stained cervicovaginal smear demonstrated mature squamous cells, acute inflammatory cells and individual malignant, monomorfic cells between this cell population. These monomorphic malignant cells were found to have an coarsely granular nuclear chromatin, increased nuclear/ cytoplasmic ratio, scanty cytoplasm and irregular nuclear membranes. We diagnosed this case as “malig- nant cells, not epithelial but probably lymphoid nature ”. Thereafter, abdominal hysterectomy, unilateral salpingo-oophorectomy and pel- vic lymphadenectomy were performed. The cervix, endometrium, myometrium and serosal surface were diffusely infiltrated by malig- nant lymphoid cells with large, round irregular nuclei, scanty cyto- plasm, clumped chromatin and prominent nucleoli. These cells were immunohistochemically positive for LCA, CD 20, CD 79a, bcl 2 and bcl 6. The patient was diagnosed as “Nonhodgkin lymphoma infiltra- tion, diffuse large B cell lymphoma ”. The whole body screening did not detect any lymphadenopathy or other foci. After the operation, the adjunctive examination of the bone marrow biopsy demon- strated that it was not infiltrated by the lymphoma.
Introduction: Papsmear is a well known test in screening of epithelial cell abnormalities of the cervix.
However, adding other screening methods to this test may increase the sensitivity and specificity of case finding. Current study has been designed to assess the sensitivity and specificity of the combination of Tru- Screen and Pap tests in comparison to Papsmear alone in women referred for annual screening. Me- thods: This case-control study was conducted in two groups of 66 and 73 women with epithelial cell ab- normality and normal results on Papsmear, respec- tively. Both groups were subsequently tested with TruScreen and colposcopy. Positive finding in any of the three studies made the patient candidate for bi- opsy as the standard diagnostic test. SPSS software was used to analyze sensitivity, specificity, positive predictive value, and negative predictive value of TruScreen, Papsmear, colposcopy and the combina- tion of TruScreen and Pap tests. Results: 105 out of 139 women underwent biopsy. Of these, 32 (30.5%) had abnormal result in biopsy. Combination of True screen and Papsmear led to a sensitivity of 93.8%
Coordinators, (c) Quality Management Professionals, (d) Case Managers, (e) Clinical
Informaticists, (f) Health Information Management Professionals, and (g) Medical Laboratory Professionals.
Participants will be introduced to the configuration and continued maintenance of the RPMS clinical applications that impact collection of PapSmear structured data and integrate into both the Electronic Health Record and iCare. Workflow processes and clinical quality reports will also be examined. Participants will acquire skills necessary to (a) configure RPMS Site Parameters, (b) edit CPT codes for Laboratory PAPSmear tests, (c) populate PAPSmear Taxonomies, (d) create Women’s Health Summaries and Data Objects, (e) integrate PAP Smears with EHR Orders [Quick Orders, Order Sets, Generic Orders and Order Menus], (f) configure the Electronic Health Record for optimal data collection of ICD-9 & CPT Codes. Participants will use the RPMS database, Electronic Health Record, and iCare clinical applications at their own facility for this e-learning activity.
The distribution of colposcopic findings is given in Table 1. In our study, 26 and 34 among 81 subjects were reported to be LGSIL and HGSIL respectively. Despite HGSIL on Papsmear before the LEEP, 16 patients had no pathologic findings and in 5 patients, colposcopic evaluation was unsatisfactory. Table 2 shows the study of study samples according to the histology reports of LEEP. 17(20.9%) patients has normal HPE findings, 24(24.8%) has HPE report of CIN 1 to CIN1-2 and 44 (54.3%) has HPE report of CIN 2 or more.One patient had a microinvasive squamous cell cancer.
Preprocessing step is needed for background extractions and definitions of the region of interest in the image. First, the RGB images are transformed into grey scale images. Then, the images pass through a median filter to remove the unwanted noise, whereby the grey level of every pixel is replaced by the median of the intensity levels of the pixel neighbourhood while preserving edge sharpness. Linear contrast enhancement is applied to increase the contrast of the cervical cell image, since the Papsmear images suffer from inconsistent staining and poor contrast. Linear contrast algorithm spreads out the distribution of the grey level over the whole possible range of the histogram (0 to 255). Significantly, increasing their contrast, whereby the biological changes of the nucleus and cytoplasm can be clearly seen, also reduces the influence of the background on the cervical cell . Otsu’s algorithm is used in segmenting cell from background. The method is optimum in the sense that it maximises between class variance, a well known measure used in statistical discriminate analysis .
Abstract. In this unique study of the adult female population in the state of Florida, we found that the percentage of the women 18 to 44 years of age within each county in the state of Florida in 2007 who had received a Papsmear during the past year was a decreasing function of the percentage of women 18 years of age and older who were current smokers, while being an increasing function of the percentage of women 18 years of age and older with an annual income of $25,000 or more, the percentage of adult women under the age of 45 who take a multivitamin daily, the percentage of women age 18 and older who were high school gradu- ates with at least some college education as well, and the percentage of adult women who were classified as leading a sedentary lifestyle. It also appears that the percentage of the women 18 to 44 years of age within each county in the state of Florida in 2007 who had received a Papsmear during the past year was a decreasing function of the percentage of the women 18 years of age and older who were overweight. Based on these findings, certain pre- liminary general public policy implications are offered in the concluding section of the study.
In the present study screening was done in 200 women with abnormal symptoms like excessive white discharge post coital bleeding, post menopausal bleeding etc, women with unhealthy cervix, and woman with dysplastic smears, with colposcopy and its results were correlated with papsmear and biopsy to determine the sensitivity and specificity of these methods in detecting CIN. Regarding age distribution, high incidence of CIN was found among the age group of 30-49 years with mean age of 41 years which was seen in 16.7% of cases. Kushtagi and Fernandes, in their study showed the prevalence of CIN was higher in women over 30 years. Vaidya showed in his study that CIN was more prevalent in the age group of >35 years. Shalini et al showed the mean age of patients with cancer cervix was 41 vs 32 in patients with benign pathology in cervix.
According to expert colposcopist like Stafl and Mattingly (1985), cervical cancer of squamous cell type develops almost exclusively within the transformation zone as a result of atypical metaplasia. Since colposcopy allows precise evaluation of transformation zone, diagnosis as to whether cervix is normal or abnormal can be made accurately at time of examination and one does not have to wait for the report as in the case of Papsmear.
In this study, we have used the open-source SIPaKMeD  papsmear image database which contains 4049 cell images. The cells in the SIPaKMeD dataset are divided into five different classes according to morphology and cellular appearance. Fig.1 shows sample images from the SIPaKMeD dataset. Normal cells composed of two classes: parabasal and superficial-intermediate. Metaplastic cells are the benign cells. Dyskeratotic and koilocytotic classes are abnormal but non-malignant cells. The distribution of the cells in the SIPaKMeD dataset is given in Table 1.
and “Physician’s Carelessness with Pap Test is Noted in Procedure’s High Failure Rate”), Papsmear screening has been placed under intense scrutiny. 1 The fact that the Papsmear is a screening test with absolute sensitivity, specificity and predictive values has been forgotten by litigation lawyers suing suc- cessfully for the plaintiff. The line between error and negligence has become quite indiscriminate in the eyes of some litigation lawyers achieving large settlements for questionable merit. Litigation for wrongful death and decreased life expectancy for a missed invasive cancer is understandable. The case for patients with in situ cancer being award- ed damages because of the delay in diagnosis means there is a chance patients may develop cer- vical cancer; This is a concern, particularly because of the “mental anguish” caused. 1
But the table results were only applicable for single cervical cell that was present in an image not for multiple numbers of cervical cell images. And also sometimes (it’s a very rare case), if in the table values specifically mean value is changed for any of the stage, then, we must take the decision based on the area value of the corresponding stage. Then the ranges of the mean and area values of the nucleus are based on the results of tests on more than 100 numbers of samples of all the stages of CIN Images.
• A third alternative that is just becoming available is to have the PAPsmear evaluated for the presence or absence of what is termed ‘high risk HPV,’ or Human Papilloma Virus. There are approximately 70 strains of HPV currently known, and about 14 of them have been associated with cervical cancer.
These 14 are collectively known as ‘high risk HPV.’ Most of the rest of the strains of HPV do not in- fect the cervix, and are not of interest in this discussion. The remaining few strains that do infect the cervix, but which are not associated with cervical cancer, are termed ‘low risk HPV.’ Since they rarely, if ever, cause cervical cancer, they are also not of interest in this discussion. Now, if one tests for high risk HPV in patients with ASCUS, we find that only about 30% harbor high risk HPV. This means that 70% of patients with ASCUS have changes that are not associated HPV infection, and thus, with pro- gression to a dysplastic lesion or cancer, and can rest more easily that they do not have significant dis- ease.