Standardized timing of specimen collections may minimize the natural variability of test outcomes for specific individuals also, facilitating interpretation of serial outcomes thereby

Standardized timing of specimen collections may minimize the natural variability of test outcomes for specific individuals also, facilitating interpretation of serial outcomes thereby. infected women, 3rd party of eventual diagnosis and the number of viral genotypes present, mid-cycle specimens yielded the highest frequency of LSIL cytologic interpretations and the highest HPV load; however, the magnitude of these effects were small. Intraindividual correlations of cytology or HPV by LMP were generally weak. We conclude that mid-cycle specimens yield slightly higher HPV DNA loads and slightly increased LSIL interpretations, but the clinical impact is marginal. Standardizing collection times would slightly improve interpretation of trends in HPV load. Finally, these data are consistent with the view that the biological properties of the HPV-infected cervix vary with the date of the LMP. strong class=”kwd-title” Keywords: cervix, screening, cytology, human papillomavirus, menstrual cycle, epidemiology Important goals of cervical cancer research include improving detection of precancerous lesions and reducing equivocal results by Echinocystic acid employing better collection, preparation, and testing methods (Baldwin em et al /em , 2003). Previous analyses of cytology results obtained with conventional smears have documented that suboptimal specimens result in increased reporting of false negative and equivocal results (Gay em et al Echinocystic acid /em , 1985; Mitchell em et al /em , 1990; Pairwuti, 1991; Henry and Wadehra, 1996; Ransdell em et al /em , 1997; Mintzer em et al /em , 1999; Boon em et al /em , 2003; Nygard em et al /em , 2004). Although many factors affect the quality of cervical cellular specimens, the time of sampling with respect to a woman’s last menstrual period (LMP) has demonstrated importance. Historically, clinicians have recognized that cytologic samples collected on days of active menstruation are typically bloody and often yield smears that are hypocellular, obscured, and lack endocervical cells (Vooijs em et al /em , 1987). Furthermore, data demonstrating that unsatisfactory cytology specimens are associated with a higher than expected frequency of cervical intraepithelial neoplasia (CIN) and carcinoma (Ransdell em et al /em , 1997; Nygard em et al /em , 2004) in later follow-up, suggest that that these specimens may be linked to false negative results. However, efforts to coordinate return visits to re-screen women with unsatisfactory cytology often fail (McGarahan and Smith-McCune, 2005), and presumably, deferring screening for women who present near the time of menses would present similar problems. Given this dilemma, it is important to determine whether the advantages of liquid-based cytology methods, such as increased cellular recovery and reduction of obscuring by blood (Bernstein em et al /em , 2001), eliminate the association between the performance of cytology and LMP that has Echinocystic acid been demonstrated for smears. Similarly, the implementation of concurrent human papillomavirus (HPV) DNA and cytologic testing in some settings highlights the need to clarify inconsistencies in reported analyses assessing the performance Echinocystic acid of HPV testing CD79B in relation to LMP (Schneider em et al /em , 1992; Fairley em et al /em , 1994; Wheeler em et al /em , 1996; Van Ham em et al /em , 2002; Harper em et al /em , 2003). Accordingly, we analyzed data for cytology and HPV DNA testing by LMP collected in the National Cancer Institute sponsored ASCUS LSIL Triage Study (ALTS). MATERIALS AND METHODS Subject selection ASCUS LSIL Triage Study was a randomized clinical trial that enrolled subjects with community cytologic interpretations of ASCUS ( em n /em =3488) or LSIL ( em n /em =1572) at four clinical centres in the US (Schiffman and Adrianza, 2000). The study was approved by responsible review boards at the National Cancer Institute and participating institutions. Clinical procedures and pathology review At enrollment, eligible subjects were interviewed regarding risk factors for cervical cancer and then underwent a pelvic examination, followed by collection of two cervical samples. The first specimen, collected with a Papette? broom (Wallach Surgical, Orange, CT, USA), was placed in PreservCyt (Cytyc Corp., Boxborough, MA, USA) and used to prepare a ThinPrep (Cytyc) cytology slide and to perform the Hybrid Capture 2 (HC2, Digene Corp., Gaithersburg, MD, USA) test, which targets 13 oncogenic HPV types..