Absence or Presence of High-Grade Squamous Intraepithelial Lesion in Cervical Conization Specimens: A Clinicopathologic Study of 540 Cases
To explore the implications of cervical conization specimens lacking the targeted high-grade squamous intraepithelial lesions (negative cone). We studied 540 conization procedures: 400 positive cones and 140 negative cones. Clinicopathologic features and 2-year follow-up results were reported. Negat...
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| Veröffentlicht in: | American journal of clinical pathology 2016-01, Vol.145 (1), p.96-100 |
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| creator | Walavalkar, Vighnesh Stockl, Thomas Owens, Christopher L Manning, Mark Papa, Debra Li, Anjie Khan, Ashraf Liu, Yuxin |
| description | To explore the implications of cervical conization specimens lacking the targeted high-grade squamous intraepithelial lesions (negative cone).
We studied 540 conization procedures: 400 positive cones and 140 negative cones. Clinicopathologic features and 2-year follow-up results were reported.
Negative cones comprised 22% of procedures triggered by CIN2 or higher biopsies. Procedures triggered by cytology produced much higher percentages of negative cones (37% high-grade squamous intraepithelial lesion [HSIL], 46% atypical squamous cells-cannot exclude high-grade squamous intraepithelial lesion [ASC-H], and 76% low-grade squamous intraepithelial lesion-cannot exclude high-grade squamous intraepithelial lesion [LSIL-H]). Upon reviewing negative excision-triggering biopsy and cytology, we downgraded 24 (24%) CIN2 biopsies, three (14%) HSIL, five (83%) ASC-H, and 12 (92%) LSIL-H. One-third of our negative cones can be attributed to overdiagnosis either on biopsy or cytology. Patients with negative cones were older and had smaller excisions, negative colposcopic findings, and negative/equivocal high-risk human papillomavirus (HR-HPV). Within 2 years, 35 (25%) women with negative cones experienced ASCUS or LSIL. Only one (0.7%) recurred as CIN3, a significantly lower percentage than women with positive cones (13%).
We advocate careful review of all excision-triggering biopsy and cytology, especially in cases of LSIL-H. Patients with negative cones should be surveyed with cytology and HR-HPV testing. |
| doi_str_mv | 10.1093/ajcp/aqv007 |
| format | Article |
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We studied 540 conization procedures: 400 positive cones and 140 negative cones. Clinicopathologic features and 2-year follow-up results were reported.
Negative cones comprised 22% of procedures triggered by CIN2 or higher biopsies. Procedures triggered by cytology produced much higher percentages of negative cones (37% high-grade squamous intraepithelial lesion [HSIL], 46% atypical squamous cells-cannot exclude high-grade squamous intraepithelial lesion [ASC-H], and 76% low-grade squamous intraepithelial lesion-cannot exclude high-grade squamous intraepithelial lesion [LSIL-H]). Upon reviewing negative excision-triggering biopsy and cytology, we downgraded 24 (24%) CIN2 biopsies, three (14%) HSIL, five (83%) ASC-H, and 12 (92%) LSIL-H. One-third of our negative cones can be attributed to overdiagnosis either on biopsy or cytology. Patients with negative cones were older and had smaller excisions, negative colposcopic findings, and negative/equivocal high-risk human papillomavirus (HR-HPV). Within 2 years, 35 (25%) women with negative cones experienced ASCUS or LSIL. Only one (0.7%) recurred as CIN3, a significantly lower percentage than women with positive cones (13%).
We advocate careful review of all excision-triggering biopsy and cytology, especially in cases of LSIL-H. Patients with negative cones should be surveyed with cytology and HR-HPV testing.</description><identifier>ISSN: 0002-9173</identifier><identifier>EISSN: 1943-7722</identifier><identifier>DOI: 10.1093/ajcp/aqv007</identifier><identifier>PMID: 26712876</identifier><language>eng</language><publisher>England: Oxford University Press</publisher><subject>Adolescent ; Adult ; Aged ; Carcinoma, Squamous Cell - pathology ; Cervical Intraepithelial Neoplasia - pathology ; Conization ; Female ; Humans ; Middle Aged ; Papanicolaou Test ; Squamous Intraepithelial Lesions of the Cervix - pathology ; Young Adult</subject><ispartof>American journal of clinical pathology, 2016-01, Vol.145 (1), p.96-100</ispartof><rights>American Society for Clinical Pathology, 2016. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.</rights><rights>Copyright Oxford University Press Jan 2016</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c275t-81f9cb3f158e73a21bea2f0c459433fde93157b496db1d96fe67a3ffaa17ba493</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,777,781,27905,27906</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/26712876$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Walavalkar, Vighnesh</creatorcontrib><creatorcontrib>Stockl, Thomas</creatorcontrib><creatorcontrib>Owens, Christopher L</creatorcontrib><creatorcontrib>Manning, Mark</creatorcontrib><creatorcontrib>Papa, Debra</creatorcontrib><creatorcontrib>Li, Anjie</creatorcontrib><creatorcontrib>Khan, Ashraf</creatorcontrib><creatorcontrib>Liu, Yuxin</creatorcontrib><title>Absence or Presence of High-Grade Squamous Intraepithelial Lesion in Cervical Conization Specimens: A Clinicopathologic Study of 540 Cases</title><title>American journal of clinical pathology</title><addtitle>Am J Clin Pathol</addtitle><description>To explore the implications of cervical conization specimens lacking the targeted high-grade squamous intraepithelial lesions (negative cone).
We studied 540 conization procedures: 400 positive cones and 140 negative cones. Clinicopathologic features and 2-year follow-up results were reported.
Negative cones comprised 22% of procedures triggered by CIN2 or higher biopsies. Procedures triggered by cytology produced much higher percentages of negative cones (37% high-grade squamous intraepithelial lesion [HSIL], 46% atypical squamous cells-cannot exclude high-grade squamous intraepithelial lesion [ASC-H], and 76% low-grade squamous intraepithelial lesion-cannot exclude high-grade squamous intraepithelial lesion [LSIL-H]). Upon reviewing negative excision-triggering biopsy and cytology, we downgraded 24 (24%) CIN2 biopsies, three (14%) HSIL, five (83%) ASC-H, and 12 (92%) LSIL-H. One-third of our negative cones can be attributed to overdiagnosis either on biopsy or cytology. Patients with negative cones were older and had smaller excisions, negative colposcopic findings, and negative/equivocal high-risk human papillomavirus (HR-HPV). Within 2 years, 35 (25%) women with negative cones experienced ASCUS or LSIL. Only one (0.7%) recurred as CIN3, a significantly lower percentage than women with positive cones (13%).
We advocate careful review of all excision-triggering biopsy and cytology, especially in cases of LSIL-H. Patients with negative cones should be surveyed with cytology and HR-HPV testing.</description><subject>Adolescent</subject><subject>Adult</subject><subject>Aged</subject><subject>Carcinoma, Squamous Cell - pathology</subject><subject>Cervical Intraepithelial Neoplasia - pathology</subject><subject>Conization</subject><subject>Female</subject><subject>Humans</subject><subject>Middle Aged</subject><subject>Papanicolaou Test</subject><subject>Squamous Intraepithelial Lesions of the Cervix - pathology</subject><subject>Young Adult</subject><issn>0002-9173</issn><issn>1943-7722</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2016</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><sourceid>GNUQQ</sourceid><recordid>eNpdkUtr3DAUhUVpaKZpV90XQTeF4EYPy7K6G0zzgIEUpl0bWb7KaLAlj2QH0p_QX10NM-2iq3u4fJx7DwehD5R8oUTxG703040-PBMiX6EVVSUvpGTsNVoRQlihqOSX6G1Ke0Ioq0n5Bl2ySmYpqxX6ve4SeAM4RPw9wllbfO-edsVd1D3g7WHRY1gSfvBz1DC5eQeD0wPeQHLBY-dxA_HZmbxqgne_9HxcbycwbgSfvuI1bgbnnQmTnndhCE_O4O289C_HS6IkuNEJ0jt0YfWQ4P15XqGft99-NPfF5vHuoVlvCsOkmIuaWmU6bqmoQXLNaAeaWWJKkZNz24PiVMiuVFXf0V5VFiqpubVaU9npUvEr9PnkO8VwWCDN7eiSgWHQHnLMlkrBRC1IRTL66T90H5bo83eZUlyoWgieqesTZWJIKYJtp-hGHV9aStpjRe2xovZUUaY_nj2XboT-H_u3E_4HT_COYQ</recordid><startdate>201601</startdate><enddate>201601</enddate><creator>Walavalkar, Vighnesh</creator><creator>Stockl, Thomas</creator><creator>Owens, Christopher L</creator><creator>Manning, Mark</creator><creator>Papa, Debra</creator><creator>Li, Anjie</creator><creator>Khan, Ashraf</creator><creator>Liu, Yuxin</creator><general>Oxford University Press</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8FE</scope><scope>8FH</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BBNVY</scope><scope>BENPR</scope><scope>BHPHI</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>HCIFZ</scope><scope>K9.</scope><scope>KB0</scope><scope>LK8</scope><scope>M0S</scope><scope>M1P</scope><scope>M7P</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope></search><sort><creationdate>201601</creationdate><title>Absence or Presence of High-Grade Squamous Intraepithelial Lesion in Cervical Conization Specimens: A Clinicopathologic Study of 540 Cases</title><author>Walavalkar, Vighnesh ; Stockl, Thomas ; Owens, Christopher L ; Manning, Mark ; Papa, Debra ; Li, Anjie ; Khan, Ashraf ; Liu, Yuxin</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c275t-81f9cb3f158e73a21bea2f0c459433fde93157b496db1d96fe67a3ffaa17ba493</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2016</creationdate><topic>Adolescent</topic><topic>Adult</topic><topic>Aged</topic><topic>Carcinoma, Squamous Cell - pathology</topic><topic>Cervical Intraepithelial Neoplasia - pathology</topic><topic>Conization</topic><topic>Female</topic><topic>Humans</topic><topic>Middle Aged</topic><topic>Papanicolaou Test</topic><topic>Squamous Intraepithelial Lesions of the Cervix - pathology</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Walavalkar, Vighnesh</creatorcontrib><creatorcontrib>Stockl, Thomas</creatorcontrib><creatorcontrib>Owens, Christopher L</creatorcontrib><creatorcontrib>Manning, Mark</creatorcontrib><creatorcontrib>Papa, Debra</creatorcontrib><creatorcontrib>Li, Anjie</creatorcontrib><creatorcontrib>Khan, Ashraf</creatorcontrib><creatorcontrib>Liu, Yuxin</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Nursing & Allied Health Database</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest SciTech Collection</collection><collection>ProQuest Natural Science Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>Biological Science Collection</collection><collection>ProQuest Central</collection><collection>Natural Science Collection</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>SciTech Premium Collection</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>ProQuest Biological Science Collection</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Biological Science Database</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><jtitle>American journal of clinical pathology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Walavalkar, Vighnesh</au><au>Stockl, Thomas</au><au>Owens, Christopher L</au><au>Manning, Mark</au><au>Papa, Debra</au><au>Li, Anjie</au><au>Khan, Ashraf</au><au>Liu, Yuxin</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Absence or Presence of High-Grade Squamous Intraepithelial Lesion in Cervical Conization Specimens: A Clinicopathologic Study of 540 Cases</atitle><jtitle>American journal of clinical pathology</jtitle><addtitle>Am J Clin Pathol</addtitle><date>2016-01</date><risdate>2016</risdate><volume>145</volume><issue>1</issue><spage>96</spage><epage>100</epage><pages>96-100</pages><issn>0002-9173</issn><eissn>1943-7722</eissn><abstract>To explore the implications of cervical conization specimens lacking the targeted high-grade squamous intraepithelial lesions (negative cone).
We studied 540 conization procedures: 400 positive cones and 140 negative cones. Clinicopathologic features and 2-year follow-up results were reported.
Negative cones comprised 22% of procedures triggered by CIN2 or higher biopsies. Procedures triggered by cytology produced much higher percentages of negative cones (37% high-grade squamous intraepithelial lesion [HSIL], 46% atypical squamous cells-cannot exclude high-grade squamous intraepithelial lesion [ASC-H], and 76% low-grade squamous intraepithelial lesion-cannot exclude high-grade squamous intraepithelial lesion [LSIL-H]). Upon reviewing negative excision-triggering biopsy and cytology, we downgraded 24 (24%) CIN2 biopsies, three (14%) HSIL, five (83%) ASC-H, and 12 (92%) LSIL-H. One-third of our negative cones can be attributed to overdiagnosis either on biopsy or cytology. Patients with negative cones were older and had smaller excisions, negative colposcopic findings, and negative/equivocal high-risk human papillomavirus (HR-HPV). Within 2 years, 35 (25%) women with negative cones experienced ASCUS or LSIL. Only one (0.7%) recurred as CIN3, a significantly lower percentage than women with positive cones (13%).
We advocate careful review of all excision-triggering biopsy and cytology, especially in cases of LSIL-H. Patients with negative cones should be surveyed with cytology and HR-HPV testing.</abstract><cop>England</cop><pub>Oxford University Press</pub><pmid>26712876</pmid><doi>10.1093/ajcp/aqv007</doi><tpages>5</tpages></addata></record> |
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| source | MEDLINE; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; Oxford University Press Journals All Titles (1996-Current); Alma/SFX Local Collection |
| subjects | Adolescent Adult Aged Carcinoma, Squamous Cell - pathology Cervical Intraepithelial Neoplasia - pathology Conization Female Humans Middle Aged Papanicolaou Test Squamous Intraepithelial Lesions of the Cervix - pathology Young Adult |
| title | Absence or Presence of High-Grade Squamous Intraepithelial Lesion in Cervical Conization Specimens: A Clinicopathologic Study of 540 Cases |
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