A Comparison of Vaginal Biocoenosis Examination with Exfoliative Cervical Cytology

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A Comparison of Vaginal Biocoenosis Examination with Exfoliative Cervical Cytology Prog Health Sci 2017, Vol 7, No 2 Vaginal biocoenosis comparing exfoliative cervical cytology A comparison of vaginal biocoenosis examination with exfoliative cervical cytology Hawryluk M.1A-D, Ustymowicz W.2B,C, Hawryluk I.2B,C, Maciorkowska M.2B,C, Pryczynicz A.*2A,B,C,E,F 1. Gravida, Płock, Poland 2. Department of General Pathomorphology, Medical University of Bialystok, Poland _________________________________________________________________________________________________________________ A- Conception and study design; B - Collection of data; C - Data analysis; D - Writing the paper; E- Review article; F - Approval of the final version of the article; G - Other ___________________________________________________________________________ ABSTRACT _________________________________________________________________________________________________________________ Introduction: Gynecologists have been cytological screening in a gynecological office. increasingly frequently switching from vaginal Patients underwent gynecological examination biocoenosis assessment towards cervical cytology covering external areas, colposcopy, vaginal pH results to obtain information on infection type. measurement, sampling for vaginal biocoenosis Exfoliative cervical cytology is a screening test for assessment purposes, and cytological sampling. dysplastic intraepithelial lesions and ectocervical Results: It was demonstrated that diagnostic cancers. One should emphasize, however, that one conformity for Candida sp accounted for only of the four parts of the new Bethesda classification 17.2%, changes of bacterial flora for only 4%, and specifies such inflammatory lesions as: in the case of Trichomonas vaginalis for only 3.9%. Trichomonas vaginalis, Candida, Actinomyces, According to our observations, bacterial infections Chlamydia, cellular changes consistent with HSV and candidiases were more frequently diagnosed infection, and changes in bacterial flora. during vaginal biocoenosis examinations comparing Gynecologists, however, can perform vaginal with cytological screening; whereas, Trichomonas biocoenosis assessment individually and diagnose vaginalis infections were more frequently its abnormalities in a relatively short timeframe. diagnosed in cytological screening. Purpose: To analyse associations between lesions Conclusions: Lack of 100% correlation between revealed during vaginal biocoenosis assessment in the vaginal biocoenosis test and cytological results correlation to lesions described in studies dedicated according to the Bethesda system means that to cytological assessments of ectocervical smear. assessment of vaginal microflora in phase-contrast Materials and methods: The study group included microscopy should not be abandoned. 1991 female patients scheduled for follow-up Keywords: Bacterial infections, Candida sp, cervical cytology, Trichomonas vaginalis, vaginal biocoenosis _________________________________________________________________________________________________________________ DOI: 10.5604/01.3001.0010.5713 *Corresponding author: Anna Pryczynicz Department of General Pathomorphology Medical University of Bialystok e-mail: [email protected] Received: 01.05.2017 Accepted: 31.07. 2017 Progress in Health Sciences Vol. 7(2) 2017 pp 36-42 © Medical University of Białystok, Poland 36 Prog Health Sci 2017, Vol 7, No 2 Vaginal biocoenosis comparing exfoliative cervical cytology INTRODUCTION MATERIALS AND METHODS The cervix is a site of frequent lesions in The study group included 1991 female females, especially in those of reproductive age. patients, aged 17 – 85 years (average age of 37.4). Inflammations are the most common health The patients underwent gynecological examination problem of the female genital organ. The potential covering external areas, colposcopy, vaginal pH causes of non-infectious cervicitis include local measurement, sampling for vaginal biocoenosis injury, chemical irritation, radiation, systemic assessment purposes, and cytological sampling. inflammation, or neoplasm. Sexually transmitted Upon cervical imaging with a colposcope, infections are a more common etiologic agent of the ectocervical surface and adjoining discharge cervicitis and may be caused by Chlamydia was assessed in detail. The macroscopic trachomatis, Neisseria gonorrhoeae, Trichomonas ectocervical image revealed both normal conditions vaginalis, herpes simplex virus (HSV), or human and the following lesions: inflammation, erosion, papilloma virus (HPV). Non-infectious diseases hyperplasia, polyp, ulceration, condylomas, include Mycoplasma genitalium, Candida spp, and deformation, necrosis, and tumour. bacterial vaginosis [1,2]. Vaginal discharge was sampled from the The standard diagnostic sequence of posterior fornix using a sterile swab (tupfer) and cervical infections includes medical interview, adequately prepared: thin layer of vaginal discharge physical examination, and microscopic was equally distributed on the surface of a dry and examination. Physical examination consists of defatted slide, dripped with 0.9% NaCl solution and abdominal palpation, vaginal examination with covered with a cover slip. The obtained smears vulva abnormality assessment, colposcopy were assessed using the Olympus IX41 phase (assessment of vaginal mucosa and ectocervix), contrast microscope according to the Jirovec – Peter vaginal pH assessment, amine test (with 10% KOH – Malek classification. solution), and sampling for macroscopic For the purposes of cytological sampling, examinations. Vaginal purity degree is assessed the colposcopic cervical image was acquired. from vaginal swabs whereas ectocervical and Ectocervical and cervical canal cells were sampled cervical canal smears are subject to cytological using the Cervex-Brush-type gynecological swab screening according to PAP or Bethesda systems brush. The material sampled on the brush was then (screening test). Detailed infection diagnosis also distributed onto the slide and immediately fixed by covers microbiological examinations or HPV tests treating with Cytofix. The slides were stained using [3-6]. the Papanicolaou method and assessed using the Gynecologists have been increasingly valid cytological slide screening method according frequently switching from vaginal biocoenosis to the Bethesda system with the Olympus CX40 assessment towards cervical cytology results to microscope. obtain information on infection type. Exfoliative In accordance with the GCPs (Guidelines cervical cytology is a screening test for dysplastic for Good Clinical Practice), this research was intraepithelial lesions and ectocervical cancers. One approved by the Bioethical Commission of the should emphasize, however, that one of the four Medical University of Bialystok (Resolution No.: parts of the new Bethesda classification specifies R-I-002/36/2013). such inflammatory lesions as: Trichomonas Statistical research was performed using vaginalis, Candida, Actinomyces, Chlamydia, STATISTICA 10 PL software. Description of the cellular changes consistent with HSV infection, and study group was performed using basic descriptive changes of bacterial flora. Gynecologists, however, statistics. Correlations between the researched can perform vaginal biocoenosis assessment parameters were verified with Spearman’s individually and diagnose its abnormalities in a correlation test. Data is presented in contingency relatively short timeframe. Any identified abnormal tables. The critical level for all tests of significance vaginal discharge should then be assessed to was .05. determine its colour and cohesion. In the first stage, vaginal pH should be assessed using lithmus paper. RESULTS Normal pH ranges between 3.8 and 4.5. A pH<4.5 excludes bacterial vaginitis. In such cases, Vaginal biocoenosis assessment and cytological diagnosis should be switched towards fungal screening results. etiology confirmation. A pH>4.5 result may reveal In vaginal biocoenosis assessment, its pathogenic bacterial flora or trichomoniasis [7-12]. normal condition was demonstrated in 95.1% of Thus, the purpose of this study was to female patients. The presence of Candida sp. fungi analyse the association between lesions revealed was observed in 216 female patients (10.9%), during vaginal biocoenosis assessment in abnormal bacterial flora in 74 female patients correlation to lesions described in studies dedicated (0.3%), and Trichomonas vaginalis in 6 female to cytological assessments of ectocervical smear. patients (Table 1). 37 Prog Health Sci 2017, Vol 7, No 2 Vaginal biocoenosis comparing exfoliative cervical cytology Analysis performed on the basis of to the Bethesda system), with such diagnosed cytological smear results according to the Bethesda lesions as: ASC-US (atypical squamous cells of system revealed normal smears in 24% of female undetermined significance) in 207 female patients, patients. As many as 1544 (76%) female patients ASC-H (atypical squamous cells - cannot exclude screened, out of 1991, were diagnosed with an HSIL) in 8 female patients, LSIL (low-grade abnormal condition associated with non-cancerous squamous intraepithelial lesion) in 37 female lesions and epithelial cell abnormalities. Non- patients, atypical glandular cells of cervical canal cancerous lesions (CI according to the Bethesda (AGC) in 8 female patients and squamous system) were present in 62.9% of the female carcinoma in 1 female patient. HSIL (high-grade patients and included infections (5%) and pH squamous intraepithelial lesion) and other glandular changes in
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