Effect of Lower Anogenital Squamous Terminology Recommendations on the Use of p16 Immunohistochemistry and the Proportion of High-Grade Diagnoses in Cervical Biopsy Specimens

ABSTRACT Objectives Cervical carcinoma, the commonest carcinoma affecting Indian females, is caused by human papilloma virus (HPV) infection. Primordial prevention and primary prevention with HPV vaccine and cancer screening respectively, can go a long way in preventing this carcinoma. The health system project in Tamil Nadu has done a commendable job in reducing the disease burden by introducing screening programs for cervical carcinoma at the grassroots level, way back in 2005. This study was done to evaluate the cervical biopsy specimens received as a part of this program to compute its incidence, compare the incidence among various districts, and suggest future directions based on our observations. Materials and methods From visual inspection with acetic acid/visual inspection with Lugol’s iodine positive cervical biopsy specimens, 506 were chosen randomly from various districts. Based on histopathological examination, incidence of individual lesions and district-wise incidence were calculated. Predictive factors that determine the progression of these lesions were analyzed based on the literature. Results Out of the 506 cervical biopsy specimens, 34 were unsatisfactory. The incidence of high-grade dysplasia peaked around 31 to 40 years, and squamous cell carcinoma peaked among 51 to 60 years. Madurai ranked high in the incidence of both high-grade dysplasia and carcinoma. Conclusion Incidence of dysplasia and carcinoma in our study was comparable to those seen in the literature. Integration of HPV deoxyribonucleic acid studies into the program can increase the detection rate, detect the progressors, help to identify the HPV species prevalent in an area, and aid in formulating cost-effective HPV vaccine cocktail. How to cite this article Ibrahim SS, Kesavaraj K, Arun M, Ameen SAM, Sankar R. Review of Cervical Carcinoma Screening Program in Tamil Nadu – Current Trend and Recommendations from a Histopathologist’s Viewpoint. J South Asian Feder Menopause Soc 2017;5(1):1-7.

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Do Deeper Levels of Cervical Biopsies Preceded by a Pap Smear Diagnosis of LSIL, ASCUS, or NILM/HPV+ Increase the Yield of Identifying Clinically Significant Lesions?

American Journal of Clinical Pathology ◽

10.1093/ajcp/aqaa161.356 ◽

2020 ◽

Vol 154 (Supplement_1) ◽

pp. S163-S164

Author(s):

K G Manjee ◽

W G Watkin

Keyword(s):

Pap Smear ◽

Past History ◽

Prior History ◽

Cervical Biopsy ◽

P16 Immunohistochemistry ◽

Hpv Status ◽

Significant Difference ◽

History Of ◽

Clinically Significant ◽

Almost All

Abstract Introduction/Objective Cervical biopsy is performed following an abnormal pap smear or positive HPV testing in an attempt to uncover clinically significant lesions [HSIL/invasive carcinoma (HSIL+)]. An excisional procedure is considered if biopsy confirms HSIL+. When preceded by pap smear of LSIL, ASCUS, NILM/HPV+ or persistent HPV, continued surveillance is recommended for biopsies showing no SIL or LSIL. In our laboratory, cervical biopsies are routinely sectioned at 3 levels. Deeper levels are often ordered when initial sections are non-diagnostic. p16 immunohistochemistry, with or without deeper levels, is often ordered to confirm HSIL, or to differentiate HSIL from mimics. In this study, we examine whether and in what clinical situations does obtaining additional levels uncover clinically significant lesions. Methods 430 cervical biopsies between January-May 2018, with recent cytology of LSIL, ASCUS or NILM/HPV+ were identified in the pathology database. HPV status (if known), final biopsy diagnosis and past history of LSIL/HSIL were recorded. For each biopsy, orders for additional levels and/or p16 immunohistochemistry were recorded resulting in 4 categories: C1-no additional levels or p16, C2-deeper only, C3-deeper+p16 and C4-p16 only. Final diagnoses were divided into HSIL+, LSIL and no SIL. Results There was no significant difference in prior history of LSIL/HSIL and HPV status between all categories. Biopsy results were as follows: HSIL+: 11/222 (5%) C1; 1/78 (1%) C2; 7/43 (16%) C3; 15/87 (17%) C4 LSIL: 91/222 (41%) C1; 7/78 (9%) C2; 16/43 (37%) C3; 35/87 (40%) C4 No SIL: 120/222 (54%) C1; 70/78 (90%) C2; 20/43 (46%) C3; 37/87 (42%) C4 The average number of additional levels in C2 and C3 was 3.8 and 1.8, respectively. Conclusion Deeper levels alone did not enhance the detection of HSIL+. Almost all LSIL/HSIL were detected when initial levels were diagnostic or suspicious and supported by p16 immunohistochemistry. 3 levels are adequate to detect clinically significant lesions.

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Controversies in the Diagnosis of Barrett Esophagus and Barrett-Related Dysplasia: One Pathologist's Perspective

Archives of Pathology & Laboratory Medicine ◽

10.5858/2010-0249-ra.1 ◽

2010 ◽

Vol 134 (10) ◽

pp. 1479-1484 ◽

Cited By ~ 4

Author(s):

John R. Goldblum

Keyword(s):

English Literature ◽

Goblet Cells ◽

High Grade Dysplasia ◽

Barrett Esophagus ◽

Low Grade ◽

High Grade ◽

Biopsy Specimens ◽

Columnar Lined Esophagus ◽

Intramucosal Adenocarcinoma ◽

Rule Out

Abstract Context.—Pathologists frequently assess esophageal biopsy specimens to “rule out Barrett esophagus,” as well as to assess for the presence or absence of dysplasia. Objective.—To review some of the recent controversies in the diagnosis of Barrett esophagus and Barrett-related dysplasia. Data Sources.—Sources were the author's experience and review of the English literature from 1978 to 2009. Conclusions.—Although goblet cells are required by the American College of Gastroenterology to confirm a diagnosis of Barrett esophagus, this definition might expand to include columnar-lined esophagus without goblet cells. The recognition of dysplasia in Barrett esophagus remains a difficult task for the surgical pathologist, with difficulties in distinguishing reactive epithelium from dysplasia, low-grade dysplasia from high-grade dysplasia, and even high-grade dysplasia from intramucosal adenocarcinoma.

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Variability of Pathologists' Utilization of p16 and Ki-67 Immunostaining in the Diagnosis of Cervical Biopsies in Routine Pathology Practice and Its Impact on the Frequencies of Cervical Intraepithelial Neoplasia Diagnoses and Cytohistologic Correlations

Archives of Pathology & Laboratory Medicine ◽

10.5858/arpa.2012-0472-oa ◽

2014 ◽

Vol 138 (1) ◽

pp. 76-87 ◽

Cited By ~ 12

Author(s):

Charanjeet Singh ◽

J. Carlos Manivel ◽

Alexander M. Truskinovsky ◽

Kay Savik ◽

Samy Amirouche ◽

...

Keyword(s):

Cervical Intraepithelial Neoplasia ◽

Intraepithelial Neoplasia ◽

Lower Range ◽

Ki 67 ◽

Detection Rates ◽

Cervical Biopsy ◽

Biopsy Specimens ◽

Frequency Of Use ◽

Lower Variability ◽

The Impact

Context.—The use of p16 in cervical biopsies improves the accuracy of cervical intraepithelial neoplasia (CIN) diagnosis and grading and decreases its interpathologist variability. Objective.—To determine the impact of the frequency of use of p16 immunostains in cervical biopsies on pathologists' diagnoses of CIN grade 1 and grade 2 or above (CIN1 and CIN2+) and on cytohistologic correlations. Design.—We identified all cervical biopsy specimens with cytologic correlations subjected or not to p16 staining from January 1, 2005, to September 30, 2010; calculated each pathologist's percentage of p16 use; and correlated it with their major cytohistologic discrepancy rates, CIN2+ diagnoses, and CIN1/CIN2+ ratios. Results.—During the study period, each of the 23 pathologists interpreted 59 to 1811 (mean, 518) of 11 850 cervical biopsy specimens, used p16 for 0% to 21.31% (mean, 10.14%) of these, had CIN2+ detection rates of 9.5% to 24.1% (mean, 18.9%), and CIN1/CIN2+ ratios of 0.7 to 4.5 (mean, 1.5). Compared to the 12 “low users” of p16, who used p16 fewer times than the institution's mean for p16 use, the 11 “high users” of p16 diagnosed more biopsies (8391 versus 3459), had a lower rate of major cytohistologic discrepancies (12.62% versus 14.92%, P < .001), a higher rate of CIN2+ diagnoses (19.9% versus 16.4%, P < .001), a lower range of CIN2+ rates (15.0%–23.1% versus 9.5%–24.1%), and lower CIN1/CIN2+ ratios (1.2 versus 2.3). Conclusions.—We found a high intrainstitutional variability of p16 use in cervical biopsies, CIN2+ rates, and CIN1/CIN2+ ratios. Use of p16 for greater than 10% of cervical biopsies was associated with improved cytohistologic correlation rates and with lower variability in the frequencies of histologic diagnoses.

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