DOCSLIB.ORG

Family Practice

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Family Practice THE JOURNAL OF FAMILY PRACTICE Michael E. Pichichero, MD Who should get Department of Microbiology and Immunology, Pediatrics, the HPV vaccine? and Medicine, University of Rochester Medical Center, Elmwood Pediatric Group, Latest recommendations from ACIP and others Rochester, NY Practice recommendations have not started sexual activity—are the • Consider recommending HPV vaccine for primary targets of immunization. How- 11- and 12-year-old girls in your practice, ever, the US Food and Drug Administra- before sexual activity puts them at risk tion also approved the use of Gardasil of viral infection (A). The FDA has also for girls as young as 9. Girls this age may approved the HPV vaccine for women require other vaccines, such as meningo- up to 26 years of age. ® Dowdencoccal conjugate Health and tetanus-diphtheria- Media acellular pertussis, and experience thus • If women older than 26 years ask to be far indicates no negative immune effects vaccinated, make sureCopyright they understandFor personalwith co-administration use only of vaccines.1,2 it is an off-label use for them (A). According to one study, vaccination Strength of recommendation (SOR) of the entire US population of 12-year-old A Good-quality patient-oriented evidence girls would prevent more than 200,000 B Inconsistent or limited-quality patient-oriented evidence C Consensus, usual practice, opinion, disease-oriented HPV infections, 100,000 abnormal Pap IN THiS ARTiCLE evidence, case series tests, and 3300 cases of cervical cancer.3 z How vaccination Parental as well as health care provider resexual adolescent girls and acceptance of HPV vaccines for adoles- prevents cervical sexually active women can now cents will be critical to the success of the cancer Plower their lifetime risk of cervical vaccination effort (see “What makes FPs Page 199 cancer, thanks to a newly available quad- recommend the HPV vaccine” on page rivalent vaccine (Gardasil) directed at hu- 201).4 z How HPV infection man papillomavirus (HPV). This gives us Practical issues. As with any new vac- progresses the opportunity to educate parents and cine added to the childhood/adolescent to cervical cancer adolescents (the primary target group for vaccination schedule, a host of issues will Page 200 the vaccine), many of whom remain un- need to be resolved to ensure adequate informed about the direct link between coverage. Factors likely to influence use of HPV infection and cervical cancer. HPV vaccine among adolescents are cost Ethical, cultural, social, and religious and reimbursement, and adherence to the issues that will require attention1 are be- 3-dose regimen that spans 6 months. yond the scope of this article. The American Academy of Pediatrics’ Committee on Infectious Diseases and the CORR e S p ON de NC e Advisory Committee on Immunization Michael E. Pichichero, MD, Elmwood Pediatric Group, 601 z Who should receive Practices (ACIP) recommends universal Elmwood Avenue, Box 672, the HPV vaccine? use of the HPV vaccine for girls, with a Rochester, NY 14642 Pre-adolescent and adolescent girls focus on 11- to 12-year-olds. The vaccine Michael_pichichero@ Girls ages 11 to 12 years—most of whom is also recommended for 13- to 26-year- urmc.rochester.edu www.jfponline.com VOL 56, NO 3 / MARCH 2007 197 For mass reproduction, content licensing and permissions contact Dowden Health Media. THE JOURNAL OF FAMILY PRACTICE TABLe z The rationale behind Factors that put women the recommendations at risk for HPV infection HPV transmission occurs easily with skin- to-skin contact.8–11 HPV can infect the Young age (peak age group: 20–24 years) external genitalia during non-intercourse Lifetime number of sexual partners sexual activities, including manual and First sexual intercourse at early age oral genital contact. Sexual intercourse is the most frequent mode of infection of Male partner sexual behavior the cervix. Condoms may help protect Smoking against transmission of HPV but are not 8,12 Oral contraceptive use fully effective. Adolescents are particularly vulnerable to Uncircumcised male partners HPV, but respond best to vaccine. The cervix Sources: Winer et al 2003;8 Schiffman and Castle is especially susceptible to HPV infection 2003;14 Insinga et al 2003.15 in adolescence because the squamous columnar cell junction transformation old girls and women who have received zone is more exposed. The adult cervix or completed the 3-dose vaccine series. is less susceptible to HPV than the ado- Why not vaccinate boys? HPV infec- lescent cervix because of the smaller area tion is highly prevalent in sexually ac- of cervical ectopy comprised of columnar tive men.5 The efficacy of vaccinating epithelial cells.13 However, in adolescents, boys against HPV infection is currently the immune response to HPV exposure is being explored.6 However, one model greater than in than adults. has suggested that vaccinating adoles- Risk for acquiring HPV infection. Risk cent males with a bivalent HPV vac- factors for acquiring HPV infection are cine would only slightly reduce the in- listed in the TaBLE.8,14,15 According to the cidence of cervical cancer cases beyond Centers for Disease Control and Preven- that achieved by vaccination of adoles- tion, sexually active men and women FAST TRACK cent girls, and with an extremely high have a 50% lifetime risk of acquiring Any sexually active cost-effectiveness ratio compared with HPV infection.16 An estimated 6.2 mil- female-only vaccination.5 lion people in the US become infected patient may benefit with HPV each year,16 and approximate- from vaccination Women ≤26 years ly 20 million currently harbor HPV infec- and should have Indications under FDA approval also in- tions.17 This estimate includes more than the opportunity clude women up to 26 years. Even adults 9 million sexually active adolescents and who have been sexually active for years young adults 15 to 24 years of age, the to receive it may not have been exposed to all high- group in which nearly 75% of new HPV risk HPV covered by the vaccine. infections occur.18 Among women <25 years of age, between 28% and 46% are Are women older infected with HPV.19,20 than 26 years eligible? Infection cannot always be cleared. Though FDA approval of the vaccine is Most HPV infections (whether high-risk for females aged 9 to 26 years, a recent or low-risk type) are asymptomatic and working group on HPV prevention con- are efficiently cleared (ie, no detection of cluded that any sexually active person DNA for a specific HPV type) by the im- may benefit from vaccination and should mune system.21,22 However, if the infec- have the opportunity to receive the vac- tion cannot be cleared or controlled by cine.1 Importantly, women older than 26 the immune system, it may become a per- years who request the vaccine should be sistent infection. made fully aware of its off-label applica- Persistent infection with HPV in- tion in their case. creases the probability of progression 198 VOL 56, NO 3 / MARCH 2007 THe JOURNaL OF FamILY PRactIce Who should get the HPV vaccine? How vaccination prevents cervical cancer Antibody Human papillomavirus Cervical cells Virus-like particle TOdd BuCK © 2006 After HPV vaccination, neutralizing antibodies are secreted from memory B cells, and bind to their target HPV type, preventing infection before it occurs, thereby blocking the For more about the initial step toward development of cervical cancer. 15 high-risk oncogenic types. Papillomaviruses such as HPV are nonenveloped, development of double-stranded, DNA viruses. They infect cutaneous and mucosal epithelial tissues. More HPV vaccines than 100 HPV types have been identified,3 about 30 to 40 of which are spread by sexual Go to our website at contact.4 Of the many known HPVs, only 15 are high-risk oncogenic types (16, 18, 31, 33, www.jfponline.com 35, 39, 45, 51, 52, 56, 58, 59, 66, 68, and 73) that can cause cervical cancer.5.6 Of these high-risk oncogenic types, HPV 16 and 18 account for about 70% of all cervical cancers.7 The new HPV vaccines (Gardasil and Cervarix) both contain virosomal antigens to vaccinate against HPV types 16 and 18. Persistent infection with these high-risk HPV types is necessary for the development of cervical cancer. Chronic infection with low-risk HPV types (eg, HPV 6 or 11) may lead to the development of anogenital warts and other low- grade genital abnormalities, as well as laryngeal cancer or recurrent respiratory papilloma- tosis. Gardasil also contains virosome antigens for these 2 HPV types. Warts on the hands are usually attributable to HPV 7.8 to high-grade cervical intraepithelial Viral integration is a necessary step neoplasia (CIN) and invasive carcino- in the malignant transformation of HPV ma (FIGURE).18–19 Evidence also increas- infection; infection may progress from ingly shows that high-risk HPV types residential to episomal, and, finally, to likely cause anal, penile, scrotal, vul- an integrated form. Residential infection var, vaginal, and some head and neck typically occurs a minimum of 6 weeks cancers.25 from exposure, can persist without de- www.jfponline.com VOL 56, NO 3 / MARCH 2007 199 THE JOURNAL OF FAMILY PRACTICE FIGURe How HPV infection progresses to cervical cancer 0–1 Year 0–5 Years 0–20 Years Continuing infection CIN 2/3 Invasive cervical cancer Initial HPV infection CIN 1 Cleared HPV infection Adapted with permission from Pinto and Crum 2000 23 and Schlecht et al 2001.24 tection for decades, and can be low risk z The case for vaccination or high risk. In the episomal state, virally plus screening active HPV is located in the cell nucleus, It will likely take at least a decade to as- separate from the human DNA.
Load more

Recommended publications
  • Human Papillomavirus (HPV) and Cervical Cancer: an Update on Prevention Strategies Script August 9, 2005
    Human Papillomavirus (HPV) and Cervical Cancer: An Update on Prevention Strategies Script August 9, 2005 [1]DANIELS Hello and welcome to “Human Papillomavirus (HPV) and Cervical Cancer: An Update on Prevention Strategies.” I’m Kysa Daniels, your moderator for this program, which is originating from the Centers for Disease Control and Prevention in Atlanta, Georgia. In this Webcast, we’ll be discussing genital human papillomavirus (HPV) infection, a sexually transmitted disease. This is an extremely common infection of growing concern to both the public and to health care providers. Our focus today is - an update on the natural history of HPV infection, - the association of different HPV types with various clinical manifestations, - HPV transmission, and... - methods for HPV and cervical cancer prevention. Before we introduce our panelists, let’s hear from CDC Director, Dr. Julie Gerberding. DR. JULIE GERBERDING: Hello! I am Dr. Julie Gerberding, Director of the Centers for Disease Control and Prevention. Thanks for joining us for this very important webcast on Human Papilloma Virus. Genital infection with HPV is the most common sexually transmitted infection in the United States. About 20 million Americans are currently infected with the virus, and about 6.2 million people become newly infected each year. Most infections cause no clinical problems and go away on their own without treatment. But some infections lead to genital warts in men and women, and cervical cancer in women. Although a vaccine against HPV is in development, there is no curative treatment for genital HPV infection. Treatments are available for the abnormalities caused by HPV infection.
    [Show full text]
  • HPV and Cervical Cancer, Screening and Prevention
    HPV and Cervical Cancer, Screening and Prevention John Ragsdale, MD July 12, 2018 CME Lecture Series We have come a long Way… Prevalence HPV in Young Adults in U.S HPV genotypes • 20% of all • 55-60% of adeno- All cancers carcinomas 16 18 The 6,11 rest • 90-95% of • 25% all warts cervical cancers HPV Vaccines • Gardisil 9: – 6, 11, 16, 18, 31, 33, 45, 52, and 58 • Gardisil: – 6, 11, 16, and 18 • Cervarix: – 16 & 18 – For girls only How Effective is the HPV vaccine? • Answer – very!!! • Large RCT of 2392 women ages 16-23 split into two groups. All women were tested for HPV virus at enrollment – One group was placebo • Rate of persistent HPV infection 3.8% – One group got series of 3 HPV 16 vaccines at 0,2,and 6 months • Rate of persistent infection 0% A controlled trial of a human papillomavirus type 16 vaccine. Koutsky LA1, Ault KA, Wheeler CM, Brown DR, Barr E, Alvarez FB, Chiacchierini LM, Jansen KU; Department of Epidemiology, University of Washington, Seattle, USA. [email protected] HPV vaccine: efficacy • HPV Cancers U.S. HPV Cancers 2008-12: 38,793 – 38,793 HPV-associated cancers (11.7 per 100,000 persons) • 23,000 (13.5) among females 15,793 • 15,793 (9.7) among males. 23,000 – 30,700/38,793 = HPV attributed – 28,500/38793 = Preventable Women Men Human Papillomavirus–Associated Cancers — United States, 2008–2012 MMRW Weekly / July 8, 2016 / 65(26);661–666 74% Preventable Risk Factors Cervical Cancer Screening Being rarely or never screened is THE major contributing factor to the MOST cervical cancer deaths today.
    [Show full text]
  • Cytological Changes Preceding Cervical Cancer
    27828 Clin Pathol 1994;47:278-279 Cytological changes preceding cervical cancer J H Robertson, B Woodend, H Elliott J Clin Pathol: first published as 10.1136/jcp.47.3.278 on 1 March 1994. Downloaded from Abstract invasive disease. However, recent studies of Cervical smears were reviewed from 62 cervical intraepithelial neoplasia (CIN), the women who developed squamous carci- histological counterpart of dyskaryosis, cast noma of the cervix up to 18 years later. doubt on this concept of the evolution of The findings indicate that the prevention cancer. 1 of cervical cancer by screening depends To investigate the relation between carci- very largely on the detection of severe noma and dyskaryosis we report a study dyskaryosis. In this series there was no based on 62 women with cervical cancer, evidence that mild dyskaryosis was a describing the cytology of positive smears forerunner of invasive disease. Cytology taken up to 18 years before diagnosis of the during the evolution of squamous disease. carcinoma is not characterised by a dyskaryosis which progressively in- creases in severity. Instead the findings Methods support new concepts that cervical can- Most of these 62 patients had been given cer generally arises from an aggressive false negative smear reports by a number of CIN 3 lesion widely present in the cervix, laboratories at varying intervals before the and in our series, established years development of carcinoma. The method of before invasion occurs. It would be more tracing the patients and their smears has been useful to report cytology as showing described before.3 The present study also either a low or high grade abnormality includes patients who had positive smear rather than distinguishing between dif- reports but who were lost to follow up and ferent degrees of dyskaryosis.
    [Show full text]
  • Recommendations for Cervical Cytology Terminology
    DOI:10.1111/j.1365-2303.2007.00469.x European guidelines for quality assurance in cervical cancer screening: recommendations for cervical cytology terminology A. Herbert*, C. Bergeron , H. Wienerà, U. Schenck§, P. Klinkhamer–, J. Bulten** and M. Arbyn *GuyÕs & St ThomasÕ Hospital NHS Foundation Trust, London, UK, Laboratoire Pasteur Cerba, Cergy Pontoise, France, àInstitute of Clinical Pathology, University Vienna, Vienna, Austria, §Institute of Pathology, Technical University Munich, Munich, Germany, –PAMM, Eindhoven, The Netherlands, **Institute of Pathology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands and Unit of Cancer Epidemiology, Scientific Institute of Public Health, Brussels, Belgium Accepted for publication 20 April 2007 A. Herbert, C. Bergeron, H. Wiener, U. Schenck, P. Klinkhamer, J. Bulten and M. Arbyn European guidelines for quality assurance in cervical cancer screening: recommendations for cervical cytology terminology There are many different systems of cytology classification used in the member states of the European Union (EU) and many different languages. The following short annexe to Chapter 3 of the European Guidelines for Quality Assurance in Cervical Cancer Screening provides a framework that will allow different terminologies and languages to be translated into standard terminology based on the Bethesda system (TBS) for cytology while retaining the cervical intraepithelial neoplasia (CIN) classification for histology. This approach has followed extensive consultation with representatives of many countries and professional groups as well as a discussion forum published in Cytopathology (2005;16:113). This article will describe the reporting of specimen adequacy, which is dealt with in more detail elsewhere in Chapter 3 of the guidelines, the optional general categorization recommended in TBS, the interpretation ⁄ cytology result and other comments that may be made on reports such as concurrent human papillomavirus testing and the use of automation review and recommendations for management.
    [Show full text]
  • Abnormal Pap Smears: Management and Counseling
    Abnormal Pap Smears: Faculty Management and Seshu P. Sarma, M.D. Counseling Emory Regional Training Center Satellite Conference and Live Webcast Atlanta, Georgia Wednesday, February 14, 2007 2:00 - 4:00 p.m. (Central Time) Produced by the Alabama Department of Public Health Video Communications and Distance Learning Division Program Objectives Program Objectives • Discuss the epidemiology and • Describe Bethesda 2001 Pap etiology of cervical precancerous terminology. and cancerous disease. • Describe the natural course of HPV • Discuss management guidelines for infection and its role in the development of cervical cancer. various abnormal Pap smear findings. • Discuss new Pap smear recommendations and the rationale behind the new changes. Cervical Cancer Etiology of Cervical Cancer • Incidence of Cervical Cancer: • Infection with high risk HPV – 9.2 per 100,000 (age-adjusted for the US population) in 2000 – 16,18,31,33,35,39,45,51,52,56,58,59 and 68 • Cervical cancer incidence has decreased by 77.7% from 1950 to – Mostly 16,18,45 and 31 2001 • Mortality reduced by as much as 70% – Due to pap smear screening 1 HPV Infection HPV and Cervical Cancer • The prevalence of genital HPV • HPV infections resolve infection spontaneously within 1-2 years. • Persistent infection with High Risk – Highest among sexually active HPV infection is a prerequisite for teens and women in their 20s the development of cervical cancer. • Although HPV infection is necessary – Decreases after age 30 for the development of cervical cancer, majority of women who
    [Show full text]
  • SECTIO~5.Qxd:Layout 1
    SECTION 5 Management of smear results Page Issue date 5.1 Management recommendations 1 Oct 08 5.2 Classification systems for reporting cytology 1 Oct 08 5.3 Formats in which smeartakers may receive reports 3 Oct 08 5.4 Smear result management in primary care 6 Oct 08 Appendix 5 10 Oct 08 Colposcopy Referral Form 11 Oct 08 Data Protection guidelines 12 Oct 08 References & further reading 13 Oct 08 Notes 14 CS/PUB/ST-15 Rev 2 Guide for smeartakers Management of smear results Aim of section The aim of this section is to provide an overview of the key issues relating to the management of smear results including the classification systems for reporting cytology, the management of laboratory recommendations and considerations for primary care when interpreting, communicating and recording results. 5.1 Management recommendations CervicalCheck, in consultation with laboratory specialists, has agreed recommendations for the management of the range of possible smear test results. In the national programme every eligible screening smear will carry a management recommendation. The EU recommended guidelines for best practice is a turnaround time of ten days in laboratories. 5.2 Classification systems for reporting cytology 5.2.1 Bethesda and BSCC Terminologies Smear reporting uses either the Bethesda System of Classification (TBS) or the British Society for Clinical Cytology (BSCC) CIN terminology. Bethesda terminology is used in most other countries outside of the UK and Ireland. Although the BSCC or CIN terminology has been most commonly used to date in Irish laboratories, smeartakers registered with CervicalCheck need to be familiar with both terminologies.
    [Show full text]
  • Effectiveness of the Quadrivalent HPV Vaccine in Preventing Anal Hsils
    viruses Article Effectiveness of the Quadrivalent HPV Vaccine in Preventing Anal ≥ HSILs in a Spanish Population of HIV+ MSM Aged > 26 Years Carmen Hidalgo-Tenorio 1,* , Juan Pasquau 1, Mohamed Omar-Mohamed 2, Antonio Sampedro 3, Miguel A. López-Ruz 1, Javier López Hidalgo 4 and Jessica Ramírez-Taboada 1 1 Infectious Disease Department, Hospital Universitario Virgen de las Nieves Granada, 18014 Granada, Spain; [email protected] (J.P.); [email protected] (M.A.L.-R.); [email protected] (J.R.-T.) 2 Infectious Disease Unit, Complejo Hospitalario Jaén, 23007 Jaén, Spain; [email protected] 3 Microbiology Department, Hospital Universitario Virgen de las Nieves, 18014 Granada, Spain; [email protected] 4 Pathology Department, Hospital Universitario Virgen de las Nieves, 18014 Granada, Spain; [email protected] * Correspondence: [email protected] or [email protected]; Tel.: +34-627010441 Abstract: Anal squamous cell carcinoma is the most frequent virus-related non-AIDS-defining neoplasia among HIV-infected individuals, especially MSM. The objectives of this study were to analyze the effectiveness of the quadrivalent HPV (qHPV) vaccine to prevent anal ≥ high-grade squamous intraepithelial lesions (≥HSILs), external ano-genital lesions (EAGLs), and infection by Citation: Hidalgo-Tenorio, C.; qHPV vaccine genotypes in HIV+ MSM, and to study the immunogenicity of the vaccine and risk Pasquau, J.; Omar-Mohamed, M.; factors for ≥ HSILs. This study is nested within a randomized, double-blind, placebo-controlled Sampedro, A.; López-Ruz, M.A.; trial of the qHPV vaccine, which enrolled participants between May 2012 and May 2014, with a López Hidalgo, J.; Ramírez-Taboada, J.
    [Show full text]
  • A Comparison of Uterine Cervical Cytology and Biopsy Results: Indications and Outcomes for Colposcopy Marian Swinker, MD, MPH; Anne C
    A Comparison of Uterine Cervical Cytology and Biopsy Results: Indications and Outcomes for Colposcopy Marian Swinker, MD, MPH; Anne C. Cutlip, MD; and Daniel Ogle, MD Morgantown, West Virginia Background. There is some debate in the literature over moderate or severe dysplasia. Of eight patients with the proper approach to the patient with a mildly ab­ atypia, 63% had dysplasia on biopsy. Of 41 patients normal cervical cytologic finding. One current ap­ with mild dysplasia on Pap smear, 37% had moderate proach for handling low-grade cytologic abnormalities dysplasia or higher grade disease on biopsy. Of nine is to perform colposcopy and biopsy if atypia, human patients with persistent inflammation on cytologic ex­ papillomavirus (HPV) changes, or mild dysplasia is amination, biopsy showed 56% with inflammation. noted on cytologic examination. If a Papanicolaou 33% with mild dysplasia, and 11% normal. (Pap) smear shows inflammation without atypia, the Conclusions. Patients who presented with minimal Pap test is repeated after 3 months, and if inflammation smear abnormalities such as HPV changes or atypia are ' does not clear, colposcopy is performed. This study likely to have a worse histologic diagnosis, with ap­ was undertaken to determine whether the above rec­ proximately two thirds showing dysplasia. Patients ommendations are appropriate. with persistent inflammation are less likely to have dys­ Methods. In a 1-year period, 125 patients underwent plasia. The results support our aggressive approach to colposcopy and biopsy. Results were reviewed and ward minimally abnormal smears and our consideration compared. of inflammation without atypia as a separate and lower1 risk category. Results. Of 47 patients with smears showing human papillomavirus (HPV) changes, 68% had a higher Key words.
    [Show full text]
  • HPV: Here, There, Everywhere Denise Rizzolo, Phd, PA-C HPV Overview
    HPV: Here, There, Everywhere Denise Rizzolo, PhD, PA-C HPV Overview • Human papillomavirus (HPV) is the most common sexually transmitted infection (STI). • According to the CDC the prevalence of genital infection with any HPV type was 42.5% among United States adults aged 18–59 years during 2013–2014. • The CDC states that HPV is so common that nearly all men and women who have sex will get it at some point in their lives. • However, many infections remain asymptomatic and resolve spontaneously. HPV Virology • Papillomavirus • Infection limited to basal cells of stratified epithelium. • Infects epithelial tissues through micro-abrasions that expose portions of the basement membrane. • HPV lesions are thought to arise from the proliferation of infected basal keratinocytes. Oncogenic Strains of HPV • 16, 18, 26, 31, 33, 35, 39, 45, 51, 52, 53, 56, 58, 59, 66, 68, 73, 82 • Probable oncogenic strains: 26, 53, 66, 73, 822 HPV as Causative Agent in… • Anal Cancer • Cervical Cancer • Penile Cancer • Vaginal/Vulvar Cancer • Recurrent Respiratory Papillomatosis* • *Caused most commonly by HPV types 6 + 11 (non-oncogenic) and rarely by HPV types 16/18 The History of HPV Viruses as Emerging Cause of Cancer • As early as 1842 an association was found between sexual activity and cervical cancer • By the 1990 a definitive link between HPV and cancer was determined • What about HPV and Head and Neck Cancer? • 1983 researchers found HPV structural proteins via immunohistochemistry in 6 out of 8 oral squamous cell carcinoma HPV and Oral Cancer—The stats • HPV has been detected in 45% to 90% of head and neck squamous cell carcinomas (HNSCC), most commonly in the lingual and palatine tonsils or base of the tongue.
    [Show full text]
  • Results of Cervical Cytology the 2001 Bethesda System: Terminology For
    The 2001 Bethesda System: Terminology for Reporting Results of Cervical Cytology Diane Solomon; Diane Davey; Robert Kurman; et al. Online article and related content current as of February 17, 2009. JAMA. 2002;287(16):2114-2119 (doi:10.1001/jama.287.16.2114) http://jama.ama-assn.org/cgi/content/full/287/16/2114 Correction Contact me if this article is corrected. Citations This article has been cited 529 times. Contact me when this article is cited. Related Articles published in 2001 Consensus Guidelines for the Management of Women With Cervical the same issue Cytological Abnormalities Thomas C. Wright, Jr et al. JAMA. 2002;287(16):2120. New Bethesda Terminology and Evidence-Based Management Guidelines for Cervical Cytology Findings Mark H. Stoler. JAMA. 2002;287(16):2140. April 24, 2002 JAMA. 2002;287(16):2153. Subscribe Email Alerts http://jama.com/subscribe http://jamaarchives.com/alerts Permissions Reprints/E-prints [email protected] [email protected] http://pubs.ama-assn.org/misc/permissions.dtl Downloaded from www.jama.com at HSE: Health Service Executive (Ireland) on February 17, 2009 CONSENSUS STATEMENT The 2001 Bethesda System Terminology for Reporting Results of Cervical Cytology Diane Solomon, MD Objectives The Bethesda 2001 Workshop was convened to evaluate and update Diane Davey, MD the 1991 Bethesda System terminology for reporting the results of cervical cytology. A primary objective was to develop a new approach to broaden participation in the Robert Kurman, MD consensus process. Ann Moriarty, MD Participants Forum groups composed of 6 to 10 individuals were responsible for Dennis O’Connor, MD developing recommendations for discussion at the workshop.
    [Show full text]
  • The 2014 Bethesda System and Pap-Smear Soheila Aminimoghaddam1,* 1Department of Obstetrics and Gynecology, Iran University of Medical Sciences, Tehran, IR Iran
    J Obstet Gynecol Cancer Res. 2016 August; 1(2):e7946. doi: 10.17795/ojcr-7946. Published online 2016 August 21. Letter The 2014 Bethesda System and Pap-Smear Soheila Aminimoghaddam1,* 1Department of Obstetrics and Gynecology, Iran University of Medical Sciences, Tehran, IR Iran *Corresponding author: Soheila Aminimoghaddam, Department of Obstetrics and Gynecology, Iran University of Medical Sciences, Tehran, IR Iran. E-mail: [email protected] Received 2016 July 19; Revised 2016 August 05; Accepted 2016 August 15. Keywords: Bethesda System, Pap Smear, Human Papilloma Virus Dear Editor, logic process. Bethesda style reporting system, such as the system c. Pregnancy-associated changes: True stromal decid- used in the cervix, is employed to report thyroid cy- ual nature of the cells in pregnancy, such as smudgy chro- topathology and pancreaticobiliary tract cytology and matin with nucleolus, can be mistaken with a high-grade urine cytology. Therefore, it is beneficial for gynecologists, squamous intraepithelial lesion. Therefore, changes asso- endocrinologists, thyroid surgeons, gastroenterologists, ciated with pregnancy should be reported as a normal pro- general surgeons, and urologists (1). cess (5). The Bethesda system (TBS) was modified in 2014, which 4. In the inflammation section, the lymphocytic (follic- altered compared to the 2001 version. According to the ular) cervicitis was added. Due to the high-prevalence of new evidence in 2014, the TBS is enhanced. The evidence in- sexually transmitted diseases, cellular changes consistent cludes an additional understanding of human papilloma with herpes simplex and cytomegalovirus were added in virus (HPV) biology, HPV vaccination in at least hundred the organism section. countries, and the high utilization of liquid base cytology 5.
    [Show full text]
  • Orres )Onc Ence Cited by Us Only As an Example
    J Clin Pathol 1994;47:569-571 569 ........................................... ............... ... ... -,,e,,. In advocating a low and high grade method of reporting, the Bethesda system is orres )onc ence cited by us only as an example. We accept ... ;.-,. ........... % ea that it is rather too elaborate. However, unlike Dr Slater, we hesitate to include J Clin Pathol: first published as 10.1136/jcp.47.6.569-a on 1 June 1994. Downloaded from Cytological changes preceding cervical nostic gold standard of CIN has partially "borderline changes", with wart virus and cancer collapsed, it is hard to believe that gynaeco- mild dyskaryosis as a low grade abnor- logical cytology can emerge unscathed. mality. Among cytopathologists "border- Dr Robertson and colleagues must be con- Which cytopathologist, with their hands on line" seems almost to have achieved the gratulated for holding up the "red flag of their hearts, can deny that accurate distinc- status of a diagnostic entity. Our experience classification" to the "bulls of gynaecologi- tion between borderline changes, wart virus, is that in practice it merely reflects uncer- cal cytology".' Their timing is excellent, and mild dyskaryosis is a difficult, often tainty in interpretation of a smear. particularly as the frailty of the current impossible, time consuming, and a largely Reparative changes in the cervix, papillo- reporting system becomes increasingly evi- pointless pursuit? These changes are all far mavirus infection, or atypical cells due to dent. more realistically grouped together as low inflammation can all present difficulties. A basic premise in the currently recom- grade abnormalities, requiring the same The latter may occasionally be confused mended terminology and management of clinical management.
    [Show full text]