Article Data

  • Views 349
  • Dowloads 118

Original Research

Open Access

Koilocytosis and squamous (pre)neoplasia as detected in population-based cervical screening: practice and theory

  • M.E. Boon1,*,
  • L.M. Boon1
  • M.J.A. de Bosschere2
  • B.-S.M. Verbruggen1
  • L.P. Kok3

1Leiden Cytology and Pathology Laboratory, Leiden, The Netherlands

2SBBW (Stichting Bevolkingsonderzoek Baarmoederhalskanker regio West, Organization for Cervical Screening West Netherlands), Leiden, The Netherlands

3NeuroImaging Center, Biomedical Engineering, Groningen University, Groningen, The Netherlands

DOI: 10.12892/ejgo200505533 Vol.26,Issue 5,September 2005 pp.533-536

Published: 10 September 2005

*Corresponding Author(s): M.E. Boon E-mail:

Abstract

Introduction: Koilocytosis (cavitation of the cytoplasm due to active HPV infection) can be detected in the screening process for cervical carcinoma.

Objective: To report the practice of detection of koilocytosis and (pre)neoplasia in population screening and to exploit the collected data to propose an explanation for the relationship between HPV infection and nuclear precancerous changes.

Study design: Centrally collected and stored (SBBW, Leiden, the Netherlands) data from all smears of six regional pathology laboratories (1995-2002), coded according to KOPAC (the national cervical smear coding system; S1: normal thru S9: invasive carcinoma) were accessed. Prevalences per 100,000 smears were calculated for koilocytosis and for squamous abnormalities after stratification for country of origin of screenees. The relative risk (RR) for the ethnic (age) groups was computed by dividing the prevalence of the relevant ethnic (age) group by the prevalence of all women.

Results: Surinamese women featured the highest prevalence of koilocytosis and of all squamous abnormalities. Moroccan women the lowest. The RR for koilocytosis was highest at 30 years (1.84) and lowest at 60 (0.26). RR dependence on age of S5-S9 lesions was similar. Compared to nonkoilocytotic smears, koilocytosis was 104 times more frequent in the 1,500 S4 smears, 36x more frequent in the 6,700 S2-S3 smears, and 24x more frequent in the 1,740 S5-S9 smears. In all three categories this difference is statistically significant.

Conclusion: High prevalences for both koilocytosis and for preneoplasia were detected in Surinamese immigrants, however, it still does not exclude HPV infection as a confounder linked to sexual lifestyle. The presence of koilocytosis in cervical smears may serve to identify patients with an increased risk for cervical cancer and perhaps warrant more intensive surveillance than what is provided through five-yearly screening.

Keywords

Koilocytosis; Cervical screening; Immigrants

Cite and Share

M.E. Boon,L.M. Boon,M.J.A. de Bosschere,B.-S.M. Verbruggen,L.P. Kok. Koilocytosis and squamous (pre)neoplasia as detected in population-based cervical screening: practice and theory. European Journal of Gynaecological Oncology. 2005. 26(5);533-536.

References

[1] Koss LG.: "Diagnostic cytology and its histopathologic bases" 2nd. edn. Philadelphia, J.B. Lippincott Company, 1968.

[2] Koss L.G., Durfee G.R.: "Unusual pattern、of squamous epithelium of the uterine cervix: cytologic and pathologic study of koilocytotic atypia". Ann. N. Y. Acad. Sci., 1956, 63, 1245.

[3] Papanicolaou G.N.: "Atlas of exfoliative cytology". Suppl. 2. Cambridge, 􀆞as_sachuse􀆟s, Harvard University Pres:s, 1960.

[41 Meisels A., Fortin R.: "Condylomatous lesions of the cervix and vagina. I. Cytologic patterns". Acta Cytol., 1976, 20, 505.

[5] Purola E., Savia E.: "Cytology of gynecologic condyloma acum1- natum". Acta Cytol., 1977, 21, 26.

[6] Laverty C.R., Russell P., Hills E., Booth N.: "The significance of noncondylomatous wart virus infection of the cervical transformation zone. A review with discussion of two illustrative cases". Acta Cytol., 1978, 22, 195.

[7] Sato S., Okagaki T., Clark B.A., Twiggs L.B., Fukushima M., Ostrow R.S., Faras A.J.: "Sensitivity of koilocytosis, immunocytochemistry, and electron microscopy as compared to DNA hybridization in detecting human papillomavirus in cervical and vaginal condyloma and intraepithelial neoplasia". Int. J. Gynecol Pathol., 1986, 5, 297.

[8] Luzzatto R., Poli M., Recktenvald M., Luzzatto L.: "Human papillomavirus infection in atrophic smears. A case report". Acta Cytol., 2000, 44, 420.

[9] Adam E., Berkova Z., Daxnerova Z., Icenogle J., Reeves W.C., Kaufman R.H.: "Papillomavirus detection: demographic and behavioral characteristics influencing the identification of cervical disease". Am. J. Obstet. Gynecol., 2000, 182, 257.

[10] Abadi M.A., Ho G.Y., Burk R.D., Romney S.L., Kadish A.S.: "Stringent criteria for histological diagnosis of koilocytosis fail to eliminate overdiagnosis of human papillomavirus infection and cervical intraepithelial neoplasia grade l ". Hum. Pathol., 1998, 29, 54.

[11] Cortes-Gutierrez E.I., Cerda-Flores R.M., Leal-Klevezas D.S., Hernandez-Garza F., Leal-Garza C.H.: "Validating polymerase chain reaction for detecting HPV in cervical intraepithelial neoplasia". Anal. Quant. Cytol. Histol., 2003, 25, 115.

[12] Dudding N., Sutton J., Lane S.: "Koilocytosis; an indication for conservative management". Cytopathology, 1996, 7, 32.

[13] Lee K.R., Minter L.J., Crum C.P.: "Koilocytotic atypia in Papamcolaou smears. Reproducibility and biopsy correlations". Cancer, 1997, 81, 10.

[14] Cramer H.M., Skinner-Wannemuehler S.E., Brown D.R., Katz B.P., Fife K.H.: "Cytomorphologic correlates of human papillomavirus infection in the'normal'cervicovaginal smear". Acta Cytol., 1997, 41, 261.

[15] Boon M.E., Deng Z., Baowen G., Ryd W.: "Koilocyte frequency in positive cervical smears as indicator of sexual promiscuity" Lancet, 1986, 8474, 205.

[16] Boon M.E., Susanti I., Tasche M.J.A., Kok LP.: "Human papillomavirus (HPV)-associated male and female genital carcinomas in a Hindu population: The male as vector and victim". Cancer, 1989, 64, 559.

[17] Hinchliffe S.A., van Velzen D., Korporaal H., Kok P.G., Boon M.E.: "Transience of cervical HPV infection in sexually active, young women with normal cervicovaginal cytology". Br. J Cancer, 1995, 72, 943.

[18] Boon M.E., Fox C.H.: "Simultaneous condyloma acuminatum and dysplasia of the uterine cervix". Acta Cytol., 1981, 25, 393.

[191 Winkler B., Crum C.P., Fujii T., Ferenczy A., Boon M., Braun L et al.: "Koilocytotic lesions of the cervix. The relationship of mitotic abnormalities to the presence of papillomavirus antigens and nuclear DNA content". Cancer, 1984, 53, 1081.

[20] Mittal K.R., Miller H.K., Lowell D.M.: "Koilocytosis preceding squamous cell carcinoma in situ of uterine cervix". Am. J. Clin Pathol., 1987, 87, 243.

[21] Tewari K.S., Taylor J.A., Liao S.Y., DiSaia P.J., Burger R.A., Monk B.J. et al.: "Development and assessment of a general theory of cervical carcinogenesis utilizing a severe combined immunodeficiency mnrine-hnman xenograft model". Gynecol Oncol., 2000, 77, 137.

[22] Boon M.E., van Ravenswaay Claasen H.H., Kok LP.: "Urbamzation and baseline prevalence of genital infections including Candida, Trichomonas, and human papillomavirus and of a distnrbed vaginal ecology as established in the Dutch cervical screening program". Am. J. Obstet. Gynecol., 2002, 187, 365.

[23] Boon M.E., van Ravenswaay Claasen H.H., van Westering R.P., Kok L.P.: "Urbanization and the incidence of abnormalities of squamous and glandular epithelium of the cervix". Cancer (Cancer Cytopathol.), 2003, 99, 4.

[24] Siemens F.C., Boon M.E., Kuypers J.C., Kok LP.: "Populationbased cervical screening with a 5-year interval in the Netherlands; Stabilization of the incidence of squamous cell carcinoma and its precursor lesions in the screened population". Acta Cytol., 2004, 48, 348.

[25] Boon M.E., Sunrmeijer A.J.H.: "The Pap Smear". 3rd edn. Amsterdam- Tokyo, Harwood Academic Publishers, 1996.

[26] Orth G.,Breitburd F., Favre M., Croisant O.: "Papilloma viruses: possible role in human". In: Origins of human cancer. Hiatt H.H., Watson J.D., Wisten J.D. (eds.). New York: Cold Spring Harbor, 1977, 1043.

[27] Rozendaal L., Westerga J., Van der Linden J.C., Walboumers J.M., Voorhorst F.J., Risse E.K., Boon M.E., Meijer C.J.: "PCR based high risk HPV testing is superior to neural network based screening for predicting incident CIN III in women with normal cytology and borderline changes". J. Clin. Pathol., 2000, 53, 606.

[28] Syrjanen K.J.: "Spontaneous evolution of intraepithelial lesions according to the grade and type of the implicated human papillomavirus (HPV)". Eur. J. Obstet. Gynecol. Reprod. B叫,1996,65, 45.

Abstracted / indexed in

Science Citation Index Expanded (SciSearch) Created as SCI in 1964, Science Citation Index Expanded now indexes over 9,500 of the world’s most impactful journals across 178 scientific disciplines. More than 53 million records and 1.18 billion cited references date back from 1900 to present.

Biological Abstracts Easily discover critical journal coverage of the life sciences with Biological Abstracts, produced by the Web of Science Group, with topics ranging from botany to microbiology to pharmacology. Including BIOSIS indexing and MeSH terms, specialized indexing in Biological Abstracts helps you to discover more accurate, context-sensitive results.

Google Scholar Google Scholar is a freely accessible web search engine that indexes the full text or metadata of scholarly literature across an array of publishing formats and disciplines.

JournalSeek Genamics JournalSeek is the largest completely categorized database of freely available journal information available on the internet. The database presently contains 39226 titles. Journal information includes the description (aims and scope), journal abbreviation, journal homepage link, subject category and ISSN.

Current Contents - Clinical Medicine Current Contents - Clinical Medicine provides easy access to complete tables of contents, abstracts, bibliographic information and all other significant items in recently published issues from over 1,000 leading journals in clinical medicine.

BIOSIS Previews BIOSIS Previews is an English-language, bibliographic database service, with abstracts and citation indexing. It is part of Clarivate Analytics Web of Science suite. BIOSIS Previews indexes data from 1926 to the present.

Journal Citation Reports/Science Edition Journal Citation Reports/Science Edition aims to evaluate a journal’s value from multiple perspectives including the journal impact factor, descriptive data about a journal’s open access content as well as contributing authors, and provide readers a transparent and publisher-neutral data & statistics information about the journal.

Submission Turnaround Time

Conferences

Top