{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,2,21]],"date-time":"2025-02-21T11:20:00Z","timestamp":1740136800043,"version":"3.37.3"},"reference-count":29,"publisher":"Oxford University Press (OUP)","issue":"3","license":[{"start":{"date-parts":[[2022,5,15]],"date-time":"2022-05-15T00:00:00Z","timestamp":1652572800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2022,9,2]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Objectives<\/jats:title>\n                  <jats:p>Specimen adequacy is an important quality assurance component of a cervical Papanicolaou test. Although consensus exists on minimal acceptable cellularity for cervical Papanicolaou tests, no such criteria exist for endocervical curettage (ECC) specimens. We sought to identify minimum acceptable cellularity for accurate diagnosis of high-grade dysplasia (HGD) on ECC.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>All patients with HGD diagnosed in a loop electrosurgical excision procedure (LEEP) from May 8, 2018, to December 18, 2019, and an ECC in the preceding 6 months at our institution were included (n = 51). All ECCs performed before the LEEP were evaluated for cellularity of squamous cells using Aperio eSlide Manager (Leica Biosystems). Biopsy results concurrent with the ECC were noted. We compared the number of squamous cells in positive and negative ECC specimens using a t-test. The proportion of ECC specimens and concurrent biopsies undergoing immunohistochemical (IHC) staining for p16 were compared using the \u03c72 test. P &amp;lt; .05 was considered significant.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Endocervical curettage specimens positive for HGD have increased cellularity compared with negative ECC specimens (mean cellularity, 10,165 vs 1,055; P &amp;lt; .05). Further, IHC staining for p16 was more likely to be performed on an ECC specimen positive for HGD than on a negative ECC specimen (50% vs 3%; P &amp;lt; .05). Biopsies performed concurrently with a negative ECC finding were more likely to undergo p16 IHC than biopsies performed concurrently with a positive ECC finding (51% vs 7%; P &amp;lt; .05). Finally, we observed no difference in the proportion of biopsies undergoing IHC staining for p16 when comparing biopsies positive for HGD with negative biopsies (37% vs 46%; P = .33).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>We find cellularity of approximately 10,000 cells adequate to diagnose HGD in an ECC specimen and cellularity of approximately 1,000 cells to be inadequate. Further, we find p16 IHC commonly used as a \u201crule-in\u201d test on ECC specimens at our institution. Biopsies accompanying an ECC specimen negative for HGD are more likely to undergo p16 IHC than those accompanying an ECC specimen positive for HGD, but there is no difference in the proportion of biopsies undergoing p16 IHC when comparing positive and negative results in the biopsies themselves. These findings further support the need for adequate cellularity for diagnosis in ECC, especially when a biopsy is technically difficult. Further areas for exploration include investigating laboratory procedures to maximize the cellularity of ECC specimens.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/ajcp\/aqac058","type":"journal-article","created":{"date-parts":[[2022,4,15]],"date-time":"2022-04-15T03:58:40Z","timestamp":1649995120000},"page":"378-382","source":"Crossref","is-referenced-by-count":2,"title":["Adequacy in Endocervical Curettage"],"prefix":"10.1093","volume":"158","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5207-1965","authenticated-orcid":false,"given":"Roa","family":"Alqabbani","sequence":"first","affiliation":[{"name":"Department of Pathology, Thomas Jefferson University Hospital , Philadelphia, PA , USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Joanna","family":"Chan","sequence":"additional","affiliation":[{"name":"Department of Pathology, Thomas Jefferson University Hospital , Philadelphia, PA , USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Allison","family":"Goldberg","sequence":"additional","affiliation":[{"name":"Department of Pathology, Thomas Jefferson University Hospital , Philadelphia, PA , USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2022,5,15]]},"reference":[{"key":"2022090208584699500_CIT0001","doi-asserted-by":"crossref","first-page":"e191","DOI":"10.1016\/S2214-109X(19)30482-6","article-title":"Estimates of incidence and mortality of cervical cancer in 2018: a worldwide analysis","volume":"8","author":"Arbyn","year":"2020","journal-title":"Lancet Glob Health."},{"key":"2022090208584699500_CIT0002"},{"key":"2022090208584699500_CIT0003","doi-asserted-by":"crossref","first-page":"576","DOI":"10.1002\/dc.2840070606","article-title":"The determination of Papanicolaou smear adequacy using a semiquantitative method to evaluate cellularity","volume":"7","author":"Valente","year":"1991","journal-title":"Diagn Cytopathol."},{"key":"2022090208584699500_CIT0004","doi-asserted-by":"crossref","first-page":"289","DOI":"10.1097\/COC.0000000000000264","article-title":"Impact of widespread cervical cancer screening: number of cancers prevented and changes in race-specific incidence","volume":"41","author":"Yang","year":"2018","journal-title":"Am J Clin Oncol."},{"key":"2022090208584699500_CIT0005","doi-asserted-by":"crossref","first-page":"132","DOI":"10.1097\/LGT.0000000000000529","article-title":"Risk estimates supporting the 2019 ASCCP risk-based management consensus guidelines","volume":"24","author":"Egemen","year":"2020","journal-title":"J Low Genit Tract Dis."},{"key":"2022090208584699500_CIT0006","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/S0140-6736(79)90172-7","article-title":"Does screening by \u201cPap\u201d smears help prevent cervical cancer?","volume":"314","author":"Clarke","year":"1979","journal-title":"Lancet."},{"key":"2022090208584699500_CIT0007","first-page":"727","article-title":"Natural history of cervical squamous intraepithelial lesions: a meta-analysis","volume":"92","author":"Melnikow","year":"1998","journal-title":"Obstet Gynecol."},{"key":"2022090208584699500_CIT0008","doi-asserted-by":"crossref","first-page":"176","DOI":"10.1016\/j.pvr.2019.04.005","article-title":"Refining our understanding of cervical neoplasia and its cellular origins","volume":"7","author":"Doorbar","year":"2019","journal-title":"Papillomavirus Res."},{"key":"2022090208584699500_CIT0009","doi-asserted-by":"crossref","first-page":"368","DOI":"10.1111\/j.1365-2303.1995.tb00484.x","article-title":"Differences between Papanicolaou smears with correct and incorrect diagnoses","volume":"6","author":"Mitchell","year":"1995","journal-title":"Cytopathology."},{"key":"2022090208584699500_CIT0010","doi-asserted-by":"crossref","first-page":"155","DOI":"10.1046\/j.1365-2303.1998.00155.x","article-title":"A case- control study of true-positive versus false-negative cervical smears in women with cervical intraepithelial neoplasia (CIN) III","volume":"9","author":"O\u2019Sullivan","year":"1998","journal-title":"Cytopathology."},{"key":"2022090208584699500_CIT0011","first-page":"1053","article-title":"Liquid-based Papanicolaou smears without a transformation zone component: should clinicians worry?","volume":"99","author":"Baer","year":"2002","journal-title":"Obstet Gynecol."},{"key":"2022090208584699500_CIT0012","doi-asserted-by":"crossref","first-page":"3812","DOI":"10.1073\/pnas.80.12.3812","article-title":"A papillomavirus DNA from a cervical carcinoma and its prevalence in cancer biopsy samples from different geographic regions","volume":"80","author":"D\u00fcrst","year":"1983","journal-title":"Proc Natl Acad Sci U S A."},{"key":"2022090208584699500_CIT0013","doi-asserted-by":"crossref","first-page":"321","DOI":"10.3322\/caac.21628","article-title":"Cervical cancer screening for individuals at average risk: 2020 guideline update from the American Cancer Society","volume":"70","author":"Fontham","year":"2020","journal-title":"CA Cancer J Clin."},{"key":"2022090208584699500_CIT0014","doi-asserted-by":"crossref","first-page":"5523","DOI":"10.1073\/pnas.88.13.5523","article-title":"The state of the p53 and retinoblastoma genes in human cervical carcinoma cell lines","volume":"88","author":"Scheffner","year":"1991","journal-title":"Proc Natl Acad Sci U S A."},{"key":"2022090208584699500_CIT0015","doi-asserted-by":"crossref","first-page":"1741","DOI":"10.1016\/S0002-9440(10)65689-1","article-title":"Expression status of p16 protein is associated with human papillomavirus oncogenic potential in cervical and genital lesions","volume":"153","author":"Sano","year":"1998","journal-title":"Am J Pathol"},{"key":"2022090208584699500_CIT0016","doi-asserted-by":"crossref","first-page":"102","DOI":"10.1097\/LGT.0000000000000525","article-title":"2019 ASCCP risk-based management consensus guidelines for abnormal cervical cancer screening tests and cancer precursors [published correction appears in J Low Genit Tract Dis. 2020;24:102-131]","volume":"24","author":"Perkins","year":"2020","journal-title":"J Low Genit Tract Dis."},{"key":"2022090208584699500_CIT0017","first-page":"441","article-title":"Cervical cancer screening","volume":"97","author":"Rerucha","year":"2018","journal-title":"Am Fam Physician."},{"key":"2022090208584699500_CIT0018","doi-asserted-by":"crossref","first-page":"141","DOI":"10.1093\/ajcp\/aqaa125","article-title":"Impact of a modified HistoGel method for processing endocervical curettage specimens on diagnostic yield","volume":"155","author":"Ramia de Cap","year":"2021","journal-title":"Am J Clin Pathol."},{"key":"2022090208584699500_CIT0019","doi-asserted-by":"crossref","first-page":"583","DOI":"10.1016\/j.ogc.2008.09.007","article-title":"To ECC or not to ECC: the question remains","volume":"35","author":"Driggers","year":"2008","journal-title":"Obstet Gynecol Clin North Am."},{"key":"2022090208584699500_CIT0020","doi-asserted-by":"crossref","first-page":"1218","DOI":"10.1097\/AOG.0000000000002330","article-title":"Diagnosis of cervical precancers by endocervical curettage at colposcopy of women with abnormal cervical cytology","volume":"130","author":"Liu","year":"2017","journal-title":"Obstet Gynecol."},{"key":"2022090208584699500_CIT0021","doi-asserted-by":"crossref","first-page":"481.e1","DOI":"10.1016\/j.ajog.2010.06.048","article-title":"Detection of cervical cancer and its precursors by endocervical curettage in 13,115 colposcopically guided biopsy examinations","volume":"203","author":"Gage","year":"2010","journal-title":"Am J Obstet Gynecol."},{"key":"2022090208584699500_CIT0022","doi-asserted-by":"crossref","first-page":"278","DOI":"10.1097\/LGT.0000000000000119","article-title":"Which colposcopies should include endocervical curettage?","volume":"19","author":"Pretorius","year":"2015","journal-title":"J Low Genit Tract Dis."},{"key":"2022090208584699500_CIT0023","doi-asserted-by":"crossref","first-page":"38","DOI":"10.1093\/ajcp\/111.1.38","article-title":"Accuracy and reproducibility of estimating the adequacy of the squamous component of cervicovaginal smears","volume":"111","author":"Renshaw","year":"1999","journal-title":"Am J Clin Pathol."},{"key":"2022090208584699500_CIT0024","doi-asserted-by":"crossref","DOI":"10.1007\/978-3-319-11074-5","volume-title":"The Bethesda System for Reporting Cervical Cytology: Definitions, Criteria, and Explanatory Notes","author":"Nayar","year":"2015"},{"key":"2022090208584699500_CIT0025","doi-asserted-by":"crossref","first-page":"2114","DOI":"10.1001\/jama.287.16.2114","article-title":"The 2001 Bethesda System: terminology for reporting results of cervical cytology","volume":"287","author":"Solomon","year":"2002","journal-title":"JAMA."},{"key":"2022090208584699500_CIT0026","doi-asserted-by":"crossref","first-page":"633","DOI":"10.1159\/000326967","article-title":"Cellularity of liquid-based, thin-layer cervical cytology slides","volume":"46","author":"Bishop","year":"2002","journal-title":"Acta Cytol."},{"key":"2022090208584699500_CIT0027","doi-asserted-by":"crossref","first-page":"168","DOI":"10.1111\/j.1365-2303.2006.00344.x","article-title":"Using a quality control approach to define an \u201cadequately cellular\u201d liquid-based cervical cytology specimen","volume":"17","author":"McQueen","year":"2006","journal-title":"Cytopathology."},{"key":"2022090208584699500_CIT0028","doi-asserted-by":"crossref","first-page":"605","DOI":"10.1159\/000326576","article-title":"Effect of cellularity on the sensitivity of detecting squamous lesions in liquid-based cervical cytology","volume":"47","author":"Studeman","year":"2003","journal-title":"Acta Cytol."},{"key":"2022090208584699500_CIT0029","doi-asserted-by":"crossref","first-page":"474","DOI":"10.1002\/cncy.20110","article-title":"Should adequacy criteria in cervicovaginal cytology be modified after radiotherapy, chemotherapy, or hysterectomy?","volume":"118","author":"Lu","year":"2010","journal-title":"Cancer Cytopathol."}],"container-title":["American Journal of Clinical Pathology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/ajcp\/article-pdf\/158\/3\/378\/45608595\/aqac058.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ajcp\/article-pdf\/158\/3\/378\/45608595\/aqac058.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,9,2]],"date-time":"2022-09-02T08:59:16Z","timestamp":1662109156000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/ajcp\/article\/158\/3\/378\/6586005"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,5,15]]},"references-count":29,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2022,5,15]]},"published-print":{"date-parts":[[2022,9,2]]}},"URL":"https:\/\/doi.org\/10.1093\/ajcp\/aqac058","relation":{},"ISSN":["0002-9173","1943-7722"],"issn-type":[{"type":"print","value":"0002-9173"},{"type":"electronic","value":"1943-7722"}],"subject":[],"published-other":{"date-parts":[[2022,9,1]]},"published":{"date-parts":[[2022,5,15]]}}}