Cervical cancer screening module 2
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Cervical Cancer Screening Module 2 - from Massachusetts Medical Society. Copyright © 2013. Massachusetts Medical Society, 860 Winter Street, Waltham Woods Corporate Center, Waltham, MA 02451-1411

Cervical Cancer Screening Module 2 - from Massachusetts Medical Society. Copyright © 2013. Massachusetts Medical Society, 860 Winter Street, Waltham Woods Corporate Center, Waltham, MA 02451-1411

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  • 1. Cervical Cancer Screening Module II Terminology Cytology Pathology Module II
  • 2. Cervical Cancer Screening Terminology Equivalent 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
  • 3. 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 histopathological CIN I and cytological HSIL is not equivalent to histopathological CIN 2 or 3 Module II
  • 4. 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
  • 5. 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
  • 6. Terminology - Bethesda System: Interpretation: Other Endometrial cells In a woman over 40 years Specify whether negative for squamous intraepithelial lesion Module II
  • 7. 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
  • 8. 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
  • 9. Terminology - Bethesda System: Epithelial Cell Abnormalities: Glandular Atypical Endocervical cells Endometrial cells Not otherwise specified Atypical, favor neoplastic Endocervical cells Not otherwise specified Endocervical Adenocarcinoma-in-situ (AIS) Adenocarcinoma Module II
  • 10. Terminology - Bethesda System: Epithelial Cell Abnormalities Other malignant neoplasms (specify) Module II
  • 11. Terminology - PATHOLOGY Lower Anogenital Squamous Terminology LAST Project Designed to comprehensively evaluate the terminology of HPV associated lesions Module II
  • 12. Terminology - PATHOLOGY LAST Project Recommendations Squamous Intraepithelial lesions Superficially invasive squamous cell carcinoma Biomarkers in HPV-associated lower anogenital squamous lesions Module II
  • 13. 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 HPVassociated 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
  • 14. 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
  • 15. 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
  • 16. Cervical Cancer Screening Cytology Module II
  • 17. Cytology The Atypical Pap Smear Definition Abnormality in squamous or columnar cells in which the cells show mild to moderate alterations in nuclear size and morphology Causes Trauma Infection Intraepithelial neoplaisia Cancer Radiation Chemotherapy
  • 18. Cytology Atypical 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
  • 19. Atypical Squamous Cells Pap Smear Diagnosis ASC-US 50% will be positive for high risk HPV 5-7% presence of CIN 2-3 ASC-H 24-94% presence of CIN 2-3
  • 20. Cytology: ASCUS Single cell shows increased nuclear to cytoplasmic ratio but otherwise bland features
  • 21. Cytology : ASCUS Atypical cells with surrounding inflammatory cells
  • 22. Cytology : Atypical Glandular Cells Clumps of Glandular cells with surrounding inflammatory and atypical squamous cells
  • 23. Cytology: Atypical Glandular Cells Clumps of atypical glandular cells concerning for malignancy
  • 24. Cytology: Atypical Glandular Cells Adenocarcinoma
  • 25. 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)
  • 26. Cervical Cancer Screening Pathology Module II
  • 27. Cervical Biopsy Overlying benign stratified squamous epithelium. Underlying normal endocervical glands
  • 28. Cervical Biopsy Squamous metaplasia and benign squamous metaplasia in endocervical gland crypts
  • 29. Cervical Biopsy condyloma
  • 30. Cervical Biopsy CIN 2 with keratinization
  • 31. Cervical Biopsy Carcinoma in situ with gland crypt involvement
  • 32. Cervical Biopsy Microinvasive squamous cell carcinoma : disruption of the basement membrane (arrow)
  • 33. Cervical Biopsy Invasive squamous cell carcinoma
  • 34. Cervical Biopsy Benign endocervical glands
  • 35. Cervical Biopsy Adenocarcinoma-in-situ: note full thickness atypical change within endocervical gland
  • 36. Cervical biopsy Invasive endocervical adenocarcinoma
  • 37. 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.