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Cervical Cancer Screening And Management In Pregnancy
Published in Vincenzo Berghella, Obstetric Evidence Based Guidelines, 2022
Vaidehi Mujumdar, Scott D. Richard
ASC of either of the following:Undetermined significance (ASC-US) orSuspicious for high-grade squamous intraepithelial lesions (HSIL or ASC-H)
Pneumocystis jirovecii
Published in Rossana de Aguiar Cordeiro, Pocket Guide to Mycological Diagnosis, 2019
Rosely Maria Zancopé-Oliveira, Fernando Almeida-Silva, Rodrigo de Almeida Paes, Mauro de Medeiros Muniz
The gold standard for the diagnosis of PJP remains the histological and microscopic identification of ascus and trophic forms using different stains (White et al., 2017). The microscopic examination of P. jirovecii structures in respiratory samples can be achieved by staining with the methenamine silver stain (Figure 15.1A) or with the Giemsa stain. The former stains only the cell wall of cystic forms, whereas the later stains the nuclei of all Pneumocystis life stages of the fungus. Toluidine blue stains nucleic acids and calcofluor white stains chitin and cellulose. Although frequently applied to the direct examination of Pneumocystis, they are not specific for this fungus. The sensitivity of these methods has a broad range of variation. In comparison of the three staining methods, sensitivities range from 73.8%, 76.9%, and 48.4%, respectively for calcofluor white, Grocott-Gomori (methenamine silver stain), and Diff-Quik (modified Wrights-Giemsa), whereas specificity was higher than 99%. The sensitivity and specificity can be affected by the fungal burden into the lungs and by the observer accuracy and expertise (White et al., 2017).
Probability-Scale Residuals in HIV/AIDS Research: Diagnostics and Inference
Published in Cliburn Chan, Michael G. Hudgens, Shein-Chung Chow, Quantitative Methods for HIV/AIDS Research, 2017
Bryan E. Shepherd, Qi Liu, Valentine Wanga, Chun Li
Figure 9.1a shows a residual-by-predictor plot with the x-axis showing age and the y-axis showing PSRs from a proportional odds model with age and CD4 included as linear predictors; a lowess curve demonstrating the smoothed relationship between the residuals and age is also included. When age is included in the proportional odds model as a linear variable, there appears to be a quadratic relationship between the PSRs and age: the model tends to overpredict severity of lesions at low and high ages. For example, a 23-year-old woman in the data set with a CD4 count of 309 cells/mm3 had predicted probabilities of 0.10, 0.25, 0.27, 0.27, and 0.11 for cytology being normal, ASCUS, low, high, and cancerous, respectively. This suggests that her observed cytology of ASCUS was less severe than predicted by the model—resulting in a residual of 0.10 − (0.27 + 0.27 + 0.11) = −0.55 (left-most residual in Figure 9.1a). If both linear and quadratic terms of age are included in the proportional odds model, the quadratic relationship between the residuals and age is no longer seen (Figure 9.1b), suggesting a better model fit. The observed ASCUS cytology for the 23-year-old woman is now more consistent to what the model predicts (probability of normal, ASCUS, low, high, and cancerous estimated as 0.26, 0.38, 0.21, 0.12, and 0.03, respectively), resulting in a PSR closer to zero: 0.26 − (0.21 + 0.12 + 0.03) = −0.11.
Comparison of conventional and liquid-based Pap smear methods in the diagnosis of precancerous cervical lesions
Published in Journal of Obstetrics and Gynaecology, 2022
Zahra Honarvar, Zahra Zarisfi, Saideh Salari Sedigh, Maryam Masoumi Shahrbabak
In the present study, the unsatisfactory smears were found in a small number of subjects (0.6%) and the ASCUS+ was more frequent among them (41.2%). Also, the results showed that the unsatisfactory smears were more reported by conventional tests (1.4%), while ASCUS+ and LSIL+ were significantly more frequent in LBC cases. Also, in a study by Beerman et al. (2009) in the Netherland, the detection of ASCUS of LBC in detecting cervical cytology lesions was higher. Meanwhile, in a study by Baker (2002) in Hong Kong, the SIL lesions detected by LBC and CN tests were 5.1% and 3.5%, respectively, and the HSIL lesions were 1% and 0.5%, respectively. Also, the detection of ASUS lesions by the LBC method was higher than the CN test. The authors suggested that LBC for detecting the intraepithelial lesions and cervical screening is better than using the CN. In another study by Phaliwong et al. (2018) in Thailand, the results showed that the unsatisfactory smears in CN (52.3%) were higher than LBC (40.5%). These results were similar to the current study that showed the advanced liquid-based method.
Value of colposcopy with dynamic spectral imaging in the detection and evolution of high-grade cervical lesions
Published in Expert Review of Medical Devices, 2022
Pluvio J. Coronado Martín, Virginia González González, María Fasero Láiz
A secondary analysis was performed in 675 patients with ASCUS or LSIL. Among them, CIN2+ was found in 38 (5.6%); 13 (1.9%) in women with ASCUS and 25 (3.7%) in women with LSIL. Table 3 shows the correlation of both methods with histology results (punch biopsy and final histology). The Spearman and kappa correlations with punch biopsy histology was 0.487 and −0.105 respectively for CC (both p < 0.001) and 0.511 and −0.127 respectively for CC-DSI (both p < 0.001). The Spearman and kappa correlations with final histology, was 0.486 and −0.105 respectively for CC (both p < 0.001), and 0.521 and −0.126 respectively for CC-DSI (both p < 0.001). In women with ASCUS or LSIL, the sensitivity for identifying patients with CIN2+ both in punch biopsy and final histology was significantly lower for CC than for CC-DSI (42.9% vs. 62.9% and 39.5% vs. 57.9% respectively, in both p = 0.016). The clinical performance of CC and CC-DSI in identifying women with CIN2+ among those with ASCUS or LSIL is shown in Table 3.
Can Serum Vitamin B12 and Folate Levels Predict HPV Penetration in Patients with ASCUS?
Published in Nutrition and Cancer, 2020
Nefise Nazlı Yenigul, Fatma Yazıcı Yılmaz, Isıl Ayhan
Cervical cancer is the only gynecological cancer that can effectively be screened, diagnosed early or prevented. Therefore, screening tests, follow-up protocols and preventive measures for precancerous lesions have rapidly advanced. 471.000 cases of invasive cervical carcinoma are being diagnosed annually worldwide and it was found to be 10% of all female cancers (1). The cytological results of Papanicolaou (PAP) smears, used as screening tests, are varied. Atypical squamous cells of undetermined significance (ASCUS) is the most commonly seen cervical cytology result (2.8%), aside from normal cytology (2). The risk of CIN 2–3 is 5% and the risk of cervical cancer is around 0.1% after diagnosis (3). Human papillomavirus (HPV) is the main factor responsible for this transition. Most HPV infections are transient, however some infections become persistent and can progress into precancer and invasive cancer (4).