cervical cancer screening module 2
DESCRIPTION
Cervical Cancer Screening Module 2 - from Massachusetts Medical Society. Copyright © 2013. Massachusetts Medical Society, 860 Winter Street, Waltham Woods Corporate Center, Waltham, MA 02451-1411TRANSCRIPT
Cervical Cancer Screening
Module II
Terminology
Cytology
Pathology
Module II
Cervical Cancer Screening
TerminologyEquivalent terminologies
Squamous intraepithelial lesion (SIL)
Dysplasia
Intraepithelial lesion, specify location
Cervix : CIN
Vagina : VAIN
Vulva : VIN
Anus : AIN
Penis : PIN
Carcinoma–in–situ (CIS)Module II
Cervical Cancer Screening
Terminology
Bethesda System (2001) has been used to describe Pap Smear Findings
Terminology for Pap smear interpretation is discrete from terminology for biopsies (histology) of the lower genital tract
Cytology: LSIL, HSIL
Histology: CIN 1, CIN 2, CIN 3, CIS
Cytological LSIL is not equivalent to histopathologicalCIN I and cytological HSIL is not equivalent to histopathological CIN 2 or 3
Module II
Terminology (CYTOLOGY)
Bethesda System
Specimen Type
Conventional, ThinPrep, Other
Specimen Adequacy
Satisfactory for evaluation
Unsatisfactory due to (specify reason)
General Category
Negative for malignancy
Epithelial cell abnormality (squamous or glandular)
Other (see interpretation)
Module II
Terminology - Bethesda System:
Interpretation: Negative
Absence of malignancy needs to be stated
Describe infection if present
Trichomonas, Candida, Actinomyces
Other Nonneoplastic findings
Reactive cellular changes
Glandular cells post hysterectomy
Atrophy
Module II
Terminology - Bethesda System:
Interpretation: Other
Endometrial cells
In a woman over 40 years
Specify whether negative for squamous intraepithelial
lesion
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Terminology - Bethesda System: Epithelial Cell Abnormalities: Squamous
Atypical Squamous Cells (ASC)
Of undetermined significance (ASC -US)
Cannot exclude High Grade Squamous
Intraepithelial Lesion (ASC -H)
Module II
Terminology - Bethesda System: Epithelial Cell Abnormalities: Squamous
Low Grade Squamous Intraepithelial Lesion (LSIL)
Cellular changes consistent with HPV, CIN 1, mild
dysplasia
High Grade Squamous Intraepithelial Lesion (HSIL)
Moderate to severe dysplasia, CIN 2, CIN 3, CIS
Indicate if features suspicious for invasion
Squamous Cell Carcinoma
Module II
Terminology - Bethesda System: Epithelial Cell Abnormalities: Glandular
AtypicalEndocervical cells
Endometrial cells
Not otherwise specified
Atypical, favor neoplasticEndocervical cells
Not otherwise specified
Endocervical Adenocarcinoma-in-situ (AIS)
AdenocarcinomaModule II
Terminology - Bethesda System: Epithelial Cell Abnormalities
Other malignant neoplasms (specify)
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Terminology - PATHOLOGY
Lower Anogenital Squamous Terminology LAST
Project
Designed to comprehensively evaluate the terminology
of HPV associated lesions
Module II
Terminology - PATHOLOGY
LAST Project Recommendations
Squamous Intraepithelial lesions
Superficially invasive squamous cell carcinoma
Biomarkers in HPV-associated lower anogenital
squamous lesions
Module II
Terminology - PATHOLOGY
LAST Project Recommendations
Squamous Intraepithelial lesions
A unified histopathological nomenclature with a single
set of diagnostic terms for all HPV associated
preinvasive lesions
A two tiered nomenclature for noninvasive HPV-
associated squamous proliferations
The terminology for HPV associated squamous lesions
of the lower anogenital tract is LSIL and HSIL (just as it
is for cytology)
Module II
Terminology - PATHOLOGY
LAST Project Recommendations
Superficially invasive squamous cell carcinoma
(SISCCA)
SISCCA should be used for minimally invasive cancer is
defined as an invasive cancer that is
1) not visible
2) depth of invasion of <3 mm
3) horizontal spread < 7 mm
4) has been completely excised
Module II
Terminology - PATHOLOGY
LAST Project Recommendations
Biomarkers in HPV-associated lower anogenital
squamous lesions
P16 immunohistochemistry staining is recommended
when unclear if CIN 2 or 3 versus nonmalignant
process such as reparative, squamous metaplasia
Module II
Cervical Cancer Screening
Cytology
Module II
Cytology
The Atypical Pap Smear
DefinitionAbnormality in squamous or columnar cells in which the cells show mild to moderate alterations in nuclear size and morphology
CausesTrauma
Infection
Intraepithelial neoplaisia
Cancer
Radiation
Chemotherapy
CytologyAtypical Squamous Cells Uncertain Significance
3 to 10% of all screening Pap smears
10 to 40% risk of underlying intraepithelial lesion
Decreased estrogen results in increase ASCUS in
menopause
Atypical Squamous CellsPap Smear Diagnosis
ASC-US 50% will be positive for high risk HPV5-7% presence of CIN 2-3
ASC-H24-94% presence of CIN 2-3
Cytology: ASCUSSingle cell shows increased nuclear to cytoplasmic ratio but otherwise
bland features
Cytology : ASCUSAtypical cells with surrounding inflammatory cells
Cytology : Atypical Glandular CellsClumps of Glandular cells with surrounding inflammatory and
atypical squamous cells
Cytology: Atypical Glandular CellsClumps of atypical glandular cells concerning for malignancy
Cytology: Atypical Glandular CellsAdenocarcinoma
Cytology
Glandular Lesions
LESIONS NUMBER (% of 268 AGUS Pap Smears )
Premalignant squamous cervix 28 (10.4%)
Premalignant glandular cervix 13 (4.9%)
Adenocarcinoma of the cervix 7 (2%)
Endometrial hyperplasia 6 (2.2%)
Uterine cancer 12 (4.5%)
Metastatic adenocarcinoma 1 (0.4%)
TOTAL 67 (25%)
Kim et al; Gyn Oncol vol 73 p 292 (1999)
Cervical Cancer Screening
Pathology
Module II
Cervical BiopsyOverlying benign stratified squamous epithelium. Underlying normal
endocervical glands
Cervical BiopsySquamous metaplasia and benign squamous metaplasia in
endocervical gland crypts
Cervical Biopsycondyloma
Cervical BiopsyCIN 2 with keratinization
Cervical BiopsyCarcinoma in situ with gland crypt involvement
Cervical BiopsyMicroinvasive squamous cell carcinoma : disruption of the basement
membrane (arrow)
Cervical BiopsyInvasive squamous cell carcinoma
Cervical BiopsyBenign endocervical glands
Cervical BiopsyAdenocarcinoma-in-situ: note full thickness atypical change within
endocervical gland
Cervical biopsyInvasive endocervical adenocarcinoma
CERVICAL CANCER
SCREENING MODULE II
CONCLUSIONS-The Bethesda system for pap smear reporting is reviewed.
-Lower Anogenital Squamous Terminology LAST Project is
discussed.
-Terminology for cytology and pathology are reviewed.