Pushpa Sodhani

Low-cost technology for screening uterine cervical cancer

We report on an illuminated, low-cost (Rs 1500 (US

Solitary Nodular Goiter

36)) magnifying device (Magnivisualizer) for detecting precancerous lesions of the uterine cervix. A total of 403 women attending a maternal and child health care clinic who had abnormal vaginal discharge and related symptoms were referred for detailed pelvic examination and visual inspection by means of the device after the application of 5% (v/v) acetic acid. Pap smears were obtained at the same time. The results were compared with those obtained using colposcopy and/or histology. The Magnivisualizer improved the detection rate of early cancerous lesions from 60%, for unaided visual inspection, to 95%. It also permitted detection of 58% of cases of low-grade dysplasia and 83% of cases of high-grade dysplasia; none of these cases were detectable by unaided visual inspection. For low-grade dysplasia the sensitivity of detection by means of the Magnivisualizer was 57.5%, in contrast with 75.3% for cytological examination. However, the two methodologies had similar sensitivities for higher grades of lesions. The specificity of screening with the Magnivisualizer was 94.3%, while that of cytology was 99%. The cost per screening was approximately US

Association between reproductive tract infections and cervical inflammatory epithelial changes.

0.55 for the Magnivisualizer and US

Morphologic spectrum of papillary carcinoma of the thyroid: role of cytology in identifying the variants.

1.10 for cytology.

Prevalence of high‐risk human papillomavirus type 16/18 infection among women with normal cytology: risk factor analysis and implications for screening and prophylaxis

OBJECTIVE To study the cytomorphologic features of solitary nodular goiters (SNG). STUDY DESIGN May-Grunwald-Giemsa-stained smears in 441 SNG diagnosed by ultrasonography and fine needle aspiration (FNA) and found to have optimum cellular material at review were subjected to detailed cytologic assessment. The age of the patients ranged from 11 to 75 years, with a median of 35. Male: female ratio was 69:372. The parameters for cytologic assessment included cellularity, colloid content, acinar formation, papillary formation, intranuclear cytoplasmic inclusions, nuclear grooves, marginal vacuoles, Hurthle cells and various inflammatory cells. Histopathology reports on thyroidectomy specimens were available in 27 cases from two Delhi hospitals. RESULTS Hyperplastic nodules (68 cases) differed significantly from colloid goiters (269 cases) by having more cases with excessive cellularity, acinar formation and marginal vacuoles (P < .001). There was also a significant difference with respect to papillary formation and moderate-to-excessive colloid content (P < .001). As compared to hyperplastic nodules, neoplasms (60 cases) had a significantly higher number of cases with papillary formation, intranuclear inclusions and nuclear grooves but lower number of cases with marginal vacuoles (P < .01-.001). Among neoplasms, usual papillary carcinoma (19 cases) differed from follicular neoplasms (20 cases) with respect to acinar formation, papillary formation and nuclear grooves (P < .001). A significant difference was also observed with respect to colloid content and nuclear inclusions. Follicular variant of papillary carcinomas (FVPC) (10 cases) emerged as a distinct cytologic entity following review and differed from usual papillary carcinomas in having a higher number of cases with acinar formation, tubular formation and marginal vacuoles (P < .01-.001) and lower number of cases with nuclear grooves (P = .05). FVPC also differed from follicular neoplasms with respect to papillary formation, tubular formation, intranuclear inclusions and nuclear grooves (P < .01-.001). Overall cytohistologic agreement was achieved in 24 of 27 (88.9%) cases. CONCLUSION Detailed cytologic assessment of FNA smears-in SNG was helpful in highlighting parameters that differentiate between various types of goiters.

Microfilariae in association with neoplastic lesions: report of five cases.

Objective To determine the association, if any, between different reproductive tract infections and cervical inflammatory epithelial changes. Study Design Clinical, colposcopic, cytologic, and microbiologic screening for reproductive tract infections was conducted. Subjects were screened for Chlamydia trachomatis, Neisseria. gonorrhoeae, Trichomonas vaginalis, bacterial vaginosis, yeast vaginitis, human papillomavirus, and serology for herpes simplex viruses, syphilis, and human immunodeficiency virus-1 and −2. The subjects were 257 women who visited a maternal and child health center between January 1992 and December 1993. Results Cervical cytology revealed inflammatory epithelial changes in 207 women (80.5%), the highest proportion in the published series. Inflammatory epithelial changes were significantly associated with the number of reproductive tract infections. Risk increased up to 72.6 fold when women were infected with two or more agents. The positive predictive value of inflammatory epithelial changes for any infection was 88.4%, whereas the negative predictive value for any infection was 63.4%. In univariate analysis, the cervical inflammatory epithelial changes were significantly associated with infections such as chlamydia (28.0%), human papillomavirus (56.5%), Trichomonas vaginalis (18.3%), bacterial vaginosis (38.2%), and herpes simplex virus as evidenced by the presence of immunoglobulin M antibodies (28%). Multivariate analysis, however, revealed an independent association of inflammatory epithelial changes with chlamydia (odds ratio, 21.3; 95% confidence interval, 2.6, 181.3), human papillomavirus (odds ratio, 13.5; 95% confidence interval, 4.5, 39.6), and bacterial vaginosis (odds ratio, 22.6; 95% confidence interval, 2.9, 181) only. Conclusion Cervical inflammatory epithelial changes are significantly associated with reproductive tract infection. Cervical inflammatory epithelial changes predict correctly to an extent of 81% infections with chlamydia, bacterial vaginosis, and human papillomavirus infection. A negative smear, on the other hand, rules out these infections to an extent of 83%.

Prevalence of Bacterial Vaginosis in a Community Setting and Role of the Pap Smear in Its Detection

OBJECTIVEnTo evaluate the efficacy of fine needle aspiration cytology (FNAC) in the diagnosis of morphologic variants of papillary carcinoma of the thyroid (PCT) and to determine the reasons for misdiagnosis in discrepant cases on cytology.nnnSTUDY DESIGNnFine needle aspiration smears from 158 histologically proven cases of PCT were blindly reviewed and an attempt made to subclassify them into different variants on the basis of various architectural and morphologic features. Cytohistologic correlation was performed to assess the efficacy of cytology in correctly identifying these variants.nnnRESULTSnIn cases with satisfactory aspirates, the diagnosis of papillary carcinoma was correctly made in 112 of 139 (80.5%) histologically proven cases of PCT. Subclassification was correct in 87 of 96 (90.6%) cases of classic papillary carcinoma and in 25 of 43 (58.1%) of the other variants of PCT with adequate aspirates. Cytohistologic agreement was 100% in columnar cell variant (CCV) and high grade variant (HGV). Although there was overlap in the morphologic features of tall cell variant (TCV) and Hürthle cell variant, cytology correctly identified 60% and 76.4% of these cases, respectively. The accuracy of cytology was limited in diagnosing follicular variant as only 50% of these cases could be correctly typed on cytology. Nodular fascitis-like stroma and diffuse sclerosis variants could not be diagnosed on cytology.nnnCONCLUSIONnThough FNAC is of limited value in typing the variants of PCT due to overlapping morphologic features, it can provide clues to the diagnosis in certain aggressive variants such as TCV, CCV and HGV. Early diagnosis in these cases can assist clinicians with management.

Acantholytic cells exfoliated from pemphigus vulgaris of the uterine cervix. A case report.

Objective:u2002 To determine the prevalence of high‐risk human papillomavirus (HR‐HPV) 16/18 infection of uterine cervix among women in the reproductive age group, with cytologically normal cervical (Pap) smears; to analyse the risk factors for HR‐HPV acquisition and to address their implications for cervical cancer screening and prophylaxis in a low resource setting.

Age trends in pre-cancerous and cancerous lesions of the uterine cervix in a cytology screening programme: what should be the target age group for a major thrust of screening in resource-limited settings?

Microfilariae in association with neoplastic lesions: Report of five cases

Test characteristics of various screening modalities for cervical cancer: a feasibility study to develop an alternative strategy for resource‐limited settings

OBJECTIVEnTo study the revalence of bacterial vaginosis (BV) in symptomatic and asymptomatic women in a community setting, to assess the validiy of the Pap smear in the detection of BV and to determine the sensitivity and specificity of clinical criteria for the diagnosis of BV.nnnSTUDY DESIGNnGram staining was performed on vaginal secretions collected from 301 women to determine the prevalence of BV. Each smear was assigned a score on the basis of the bacterial morphotypes identified. The bacterial pattern was also studied on 270 adequate, Pap-stained cervical smears and compared with the gold standard, the morphotypes on gram stain, to derive the validity of the Pap smear in diagnosing BV. Also each clinical criterion defined for diagnosis of BV was independently evaluated to determine their sensitivity and specificity.nnnRESULTSnThe overall prevalence of BV was 41.5% in the study subjects using Amsels and Nugents criteria. The Pap smear was 78.3% sensitive and 86.9% specific in detection of BV. Among the clinical criteria, the presence of clue cells on wet mounts was both highly sensitive (76.7%) and specific (92.4%) for diagnosing BV, while a positive whiff test had a specificity of 86.9% with sensitivity of 33.9%. Vaginal pH > 4.5 was sensitive (88.3%) but less specific (58.6%). The presence of a thin, homogeneous discharge clinging to vaginal mucosa had low sensitivity (56.3%) and specificity (48.9%). In this study, BV was prevalent in both symptomatic and asymptomatic women. The routine Pap smear was able to detect BV in the majority of women. Its utility can be greater in asymptomatic women, in whom this infection may go undetected otherwise, resulting in future complications related to reproductive health. Among Amsels clinical criteria, the most sensitive and specific was the presence of clue cells in wet mounts. They can be detected easily by laboratory staff with little training in primary health care seting