If the problems of the subjective nature of colposcopy could be avoided, colposcopy could be a non-invasive method of allowing women to remain under safe surveillance whilst avoiding having tissue biopsies taken. This thesis presents an evaluation of different methods to identify a high risk group from women with mild dyskaryosis in the context of a prospective randomised trial. Chapter 1 describes the historical background to the management of low grade cytological abnormalities and the changes brought about by the introduction of colposcopy. This is used to put into context the current dilemma regarding the management of mild dyskaryosis. The role of human papillomavirus in the development of cervical neoplasia will be discussed with a literature review of current evidence to support its use as a secondary screening tool for cervical disease. Chapter 2 describes the design of this prospective randomised controlled trial including patient recruitment and randomisation and the trial protocol. Chapter 3 presents the histopathological outcome for each trial arm and evaluates the use of semi-quantitative HPV 16 detection with the current use of cytological surveillance as a method of secondary screening. Chapter 4 presents the results of a pilot study to compare the efficiency of a commercial HPV detection kit, hybrid capture, with semi-quantitative HPV 16 detection by polymerase chain reaction for women with mild dyskaryosis. Chapter 5 compares the value of objective measurement of colposcopic features of cervical intraepithelial neoplasia on digitised colposcopic images with subjective colposcopic assessment and comments on image digitising in the surveillance of women with mild dyskaryosis. Chapter 6 presents the socio-demographic data on the trial women and evaluates the ability of high risk behaviour to identify a high risk group from those women with mild dyskaryosis. Chapter 7 summarises the results of this trial and presents the main conclusions.

Cartas al Editor

Liquid-based cytology (LBC) has replaced conventional smears in the UK. The National Institute for Health and Clinical Excellence (NICE) recommended the use of LBC in 2003. ThinPrepTM (TP) and SurePathTM (SP) LBC systems were adopted for use in the National Health Service Cervical Screening Programme (NHSCSP) in the UK. NICE recommended further review of any other technologies or other liquid-based cytology systems in the future. For any second-generation LBC systems to be considered for cervical screening in the NHSCSP, there must be an evaluation of technical requirements and clinical data relating to their sensitivity, specificity and the percentage of inadequate samples.The objective of the work undertaken for this thesis was to provide evidence to enable an informed decision on the use of second-generation liquid-based cytology systems for cervical screening in the UK. The decision to accept the second-generation LBC system in the NHSCSP is based on its reliability, clinical effectiveness and cost implications. This work will determine the reliability, microscopic quality and reproducibility of slides of the second-generation LBC system, and the results of this work will form the platform for progression to the clinical evaluation of the system.Initially, four second-generation LBC systems were considered suitable for evaluation. They were Seroa CYTO-screen, Shandon Papspin, LGM Liqui-PREP and CellSolution 120. However, the specifications of only one system (CellSolution 120TM) met NHSCSP technical requirements to start the evaluation. One hundred random, electronically generated colposcopy patient samples were used to assess the technical reliability of the CellSolution 120TM system. The technical evaluation consisted of pre-phase I and phase I. The results of these phases will decide whether the CS 120TM liquid-based cytology system could be carried further for clinical evaluation (phase II) or not.This study was sponsored by the NHS Purchasing and Supply Agency (PASA), the Centre for Evidence based Purchasing (CEP) on behalf of the NHSCSP. The Manchester Cytology Centre (MCC) was selected as the site for evaluation of CellSolution 120™ and the project was managed by Guildford Medical Device Evaluation Centre (GMEC) on behalf of CEP.

Made available in DSpace on 2016-08-10T10:38:30Z (GMT). No. of bitstreams: 1 ROSANGELA NAZARETH PEREIRA.pdf: 1275029 bytes, checksum: ea1109256027101f482837583dc3baa8 (MD5) Previous issue date: 2011-04-27 / Human papillomavirus (HPV) infections are highly prevalent among young women and they are considered the most prevalent sexually transmitted infection worldwide. The relationship between cervical carcinogenesis and HPV is well established. Objectives: to study the prevalence of HPV infection and possible risk factors associated with HPV infection and cytopathological abnormalities in a group of university students, aged from 18 to 25 years old, from a Central area in Brazil. Methods: a cross-sectional study was developed in São Luis de Montes Belos, Goiás, Brazil, and it comprised 107 university students. Socio-demographic, behavioural, sexual related and obstetrical data were obtained from all the students by responding a questionnaire. The students were subjected to gynecological examination and to collection of cervical specimens for cytological and molecular analysis. The Bethesda Cytology Classification was used for the evaluation of cytological abnormalities. Results: the prevalence of HPV infection was 39.3% (95%CI: 30, 0-49.2). HPV infection was significantly associated with the age under 15 years old at the first intercourse (OR: 2.7; 95%CI: 1.1-6.7), and with three or more sexual partners during sexual life (OR: 2.4; 95%CI: 0.9-6.3). The prevalence of cytological abnormalities was 3.7% and none of the examined factors were significantly associated with the presence of such abnormalities. Conclusions: The results of our study demonstrated a high prevalence of HPV infection in young Brazilian women. First intercourse before the age of 15 years old, and the history of more than three sexual partners during lifetime were significantly associated to HPV infection. / A infecção pelo papilomavírus humano (HPV), com maior prevalência entre as mulheres jovens, é considerada a infecção de transmissão sexual mais freqüente em todo o mundo. O papel fundamental desta infecção na carcinogênese cervical foi estabelecido. Objetivos: Estimar a prevalência e identificar os fatores associados à infecção pelo HPV e às anormalidades citológicas em estudantes universitárias na faixa etária de 18 a 25 anos de idade, na região de São Luís de Montes Belos, no estado de Goiás. Método: Estudo de corte transversal conduzido na região de São Luís de Montes Belos, no estado de Goiás, incluindo 107 estudantes universitárias. Os dados sócio-demográficos, comportamentais, história sexual e obstétrica foram obtidos por meio de um questionário. Em seguida as estudantes foram submetidas a exame ginecológico com coleta de espécime biológico cervical para análise citológica e molecular. A classificação citológica foi baseada no sistema de Bethesda. A detecção do genoma do HPV foi realizada pela reação em cadeia da polimerase (PCR) utilizando os oligonucleotídeos iniciadores PGMY09/11. Para análise de dados foi utilizado o programa de análise estatística Epi Info versão 3.5.1. Os dados sócio-demográficos, comportamentais, história sexual e obstétrica foram analisados por estatística descritiva. Foi realizada análise univariada com cálculo do Odds Ratio (OR), com intervalo de confiança de 95% (IC 95%) e nível de significância estatística de 5%. Resultados: A prevalência da infecção pelo HPV foi de 39,3% (IC 95%: 30,0-49,2). Os fatores associados à infecção pelo HPV, na amostra estudada, foram o início da atividade sexual até os 15 anos de idade (OR: 2,7, IC95%: 1,1-6,7) e o número de parceiros sexuais acima de três (OR: 2,4, IC95%: 0,9-6,3). A prevalência de anormalidades citológicas foi de 3,7% (IC95%: 1,0-9,3) e nenhum dos fatores avaliados mostrou associação estatisticamente significativa com a ocorrência destas anormalidades. Conclusões: Os resultados deste estudo mostraram uma elevada prevalência da infecção pelo HPV. Os fatores significativamente associados à infecção pelo HPV foram o início da atividade sexual até os 15 anos de idade e o número de parceiros sexuais acima de três.

Cervical cancer, a completely curable disease with early detection and management, is an international concern. Early identification allows for treatment of the disease, which prevents or slows progression, ultimately reducing morbidity and mortality. Due to the regressive nature of most cervical lesions, the duration between cervical cytology has been lengthened to prevent over diagnosis and treatment. This was reflected in the 2012 United States Preventative Services Task Force (USPSTF) clinical practice guideline for cervical cancer screening. The purpose of this project was to determine the effectiveness of a quality improvement initiative to increase adherence to the 2012 USPSTF guideline at a volunteer medical clinic for the working uninsured. In this retrospective, time series observational evaluation, data were collected via chart review regarding adherence to the guideline. The intervention consisted of the placement of a visual algorithm educational tool for clinical decision-making for cervical cytology screening in each exam room. Data were collected during three time periods: (1) the 3 months prior to initial education of clinic staff regarding the guideline; (2) the 3months between initial education and introduction of the algorithm; and (3) the 3 months post introduction of the algorithm. A total of 335 charts were reviewed. There was a significant difference in the proportion of appropriate screening among the three groups (Χ2= 6.83 p=.03). There was also a significant difference in appropriate screening rates between the new and established patients’ group, controlling for group (p<.0001). The use of the interventional algorithm is recommended to improve adherence to evidence-based practice guideline related to cervical screening as it decreases harm(s) to the patient by reduction of fear, cost to the patient, and overtreatment of benign regressive lesions.