The ecologization of the Papanicolaou stain in the diagnosis of cervical cancer

Authors

  • Víctor Rojas-Zumaran <p>Hospital Nacional Docente Madre-Ni&ntilde;o San Bartolom&eacute;, Servicio de Anatom&iacute;a Patol&oacute;gica, &Aacute;rea de Citolog&iacute;a. Lima</p>
  • Jeel Moya-Salazar <p>Universidad Continental, Facultad de Ciencias de la Salud. Huancayo</p>

Keywords:

Uterine Cervical Neoplasms, Cytological Techniques, Papanicolaou Test, Polycyclic Aromatic Hydrocarbons, Hydrochloric Acid, Ammonia

Abstract

Background: Cervical cancer is the fourth most common cancer worldwide among women.

Objective: To evaluate the implementation and efficiency of the Ecological Papanicolaou staining (Eco-Pap) in exfoliative cytology for the diagnosis of cervical cancer.

Methods: A prospective, experimental, cross-sectional research was performed at the Hospital Nacional Docente Madre-Niño “San Bartolomé” during 2015. Three strategies for controlling toxic reagents were used: the use of progressive Harris haematoxylin, polychromatic cytoplasmic solution and direct mounting. Cellular details were analyzed by using the Quality Index Staining, the Bethesda system and the Quality Program for External Evaluation of Cytology.

Results: We evaluated 72 901 cervical smears stained with Eco-Pap. The validation of Eco-Pap against the standard Papanicolaou staining had very good agreement (kappa = 0.89), showing a sensitivity and specificity of 88.3 and 98.7%, respectively (p < 0.05). The Eco-Pap had a high diagnostic yield and reduced environmental pollution caused by xylene (72 liters), hydrochloric acid and ammonia (each one with six liters), as well as mercury oxide.

Conclusions: The Eco-Pap is a new, efficient and innovative method which eliminates the use of toxic-carcinogenic reagents, generating ecological performance in the diagnosis of cervical cancer.

Downloads

Download data is not yet available.

References

International Agency for Research on Cancer (IARC). GLOBOCAN 2012: Estimated Cancer Incidence, Mortality and Prevalence Worldwide in 2012 v1.0. IARC, Cancer Base No.11. Lyon: International Agency for Research on Cancer; 2013. 2

 

Basen-Engquist K, Paskett ED, Buzaglo J, Miller SM, Schover L, Wenzel LB et al. Cervical Cancer Behavioral Factors Related to Screening, Diagnosis, and Survivors’ Quality of Life. Cancer. 2003;S98(9):2009-14.

 

Huh WK, Williams E, Huang J, Bramley T, Poulios N. Cost effectiveness of human papillomavirus-16/18 genotyping in cervical cancer screening. Appl Health Econ Health Policy. 2015;13(1):95-107.

 

World Health Organization. Boletín de la Organización Mundial de la Salud. Recopilación de artículos. Geneva; 2011;89(9):621-700.

 

Cramer DW. The role of cervical cytology in declining morbidity and mortality of cervical cancer. Cancer. 1974;34:2018-27.

 

Mayrand MH, Duarte-Franco E, Rodrigues I, Walter SD, Hanley J, Ferenczy A, et al. Human papillomavirus DNA versus Papanicolaou screening tests for cervical cancer. N Engl J Med. 2007;357(16):1579-88.

 

Stoler MH, Schiffman M. Interobserver reproducibility of cervical cytologic and histologic interpretations: realistic estimates from the ASCUS-LSIL Triage Study. JAMA. 2001;285(11):1500-5.

 

Instituto Nacional de Salud (INS). Manual de procedimientos para el diagnóstico en citología cérvico-uterina. Serie de normas técnicas. Vol. 43. Lima: MINSA; 2005.

 

Moya-Salazar J, Rojas-Zumaran V, Torres-Martínez R, Rosas-Vargas L. [Quality of Cervical-uterine smears within Pap staining for cervical cancer screening in Lima, Peru]. Rev Esp Patol. 2016;49(1):7-18.

 

Moya-Salazar J, Rojas-Zumaran V. Validation of the modification of the prolonged Papanicolaou stain for the diagnosis of cervical cancer. Acta Cytol. 2016; 60(1):79-84.

 

Culling CFA. Handbook of Histopathological and Histochemical Techniques. 3th edition. London: Butterworth; 1974. pp. 489-90.

 

Tamburini E, Fernández A, Sánchez G, Odorico C, Rojas V. Evaluación del screening colpocitológico en un periodo de dos años. (Unidad Móvil Genito-Mamaria y Hospital Penna) nueva estrategia de Atención Primaria. Poster. 25 Noviembre, 2001 Foyer. Congreso Internacional de Patología del Tracto Genital Inferior y Colposcopía. Buenos Aires, Argentina: Sociedad Argentina de Patología del Tracto Genital Inferior y Colposcopía; 2001.

 

Moya-Salazar J, Rojas-Zumaran V. Environmental Performance of xylene, hydrochloric acid and ammonia solution during Pap stain for diagnosing cervical cancer. J Health Pollution. 2016;6(11):58-65.

 

Solomon D, Nayar R. The Bethesda System for Reporting Cervical Cytology: Definitions, Criteria, and Explanatory Notes. 2nd Ed. New York: Springer Science & Business Media; 2004.

 

Moya-Salazar J, Rojas-Zumaran V. Control de calidad postanalítico en citología exfoliativa cervical en Lima, Perú. Rev Esp Patol. 2017;50(4):207-17 - DOI: 10.1016/j.patol.2017.05.002

 

Acuña CR, Falla PA, Romaní RM. Evaluación de la técnica de tinción rápida Cytocolor versus la tinción Papanicolaou en citología cérvico-vaginal. [Tesis]. Lima: Universidad Nacional Federico Villareal. Facultad de Tecnología Médica; 2006.

 

Izhar S, Kaur, Masih K. Efficacy of rapid, economical, acetic acid, Papanicolaou stain in cervical smears as an alternative to conventional Papanicolaou stain. J Cytol. 2014;31(3):154-7.

 

Gupta S, Chachra KL, Bhadola P, Sodhani P. Modified Papanicolaou staining protocol with minimum alcohol use: a cost-cutting measure for resource-limited settings. Cytopathology. 2010;21(4):229-33.

 

Gachie RN, Muchiri LW, Ndungu LR. A comparison of modified and standard Papanicolaou staining methods in the assessment of cervical smears at Kenyatta National Hospital. East Afr Med J. 2011;88(7):244-50.

 

Choudhary P, Sudhamani S, Pandit A, Kiri VM. Comparison of modified ultrafast Papanicolaou stain with the standard rapid Papanicolaou stain in cytology of various organs. J Cytol. 2012;29(4):241-5.

 

Walter J, Klein C, Wehrend A. Comparison of eosin-thiazin and Papanicolaou-Shorr staining for endometrial cytologies of broodmares. Tierarztl Prax Ausg G Grosstiere Nutztiere. 2011;39:358-62.

 

Takahashi M. Color Atlas of Cancer Cytology. 3th Ed. Alphen aan den Rijin: Kluwer; 2000.

 

Nauth HF. Gynecological Cytology. Stuttgart: Thieme Publishers Series; 2007.

 

Koss LG. Diagnostic Cytology and Its Histopathologic Bases. 3th edition. Philadelphia: JB Lippincott; 1979.

 

Papanicolaou G, Traut H. The diagnostic value of vaginal smear in carcinoma of the uterus. Am J Obstet Gynecol. 1941;42:16.

 

Occupational Safety and Health Administration (OSHA). Ocupational Health Guideline for Xylene. U.S. Department of Health and Human Services, Public Health Services, Centers for Disease Control; 1978.

 

Cibas SE. Laboratory Management. In: Cibas SE, Ducatman SB (eds). Cytology: Diagnostic principles and clinical correlates. Philadelphia: Saunders Elsevier; 2009. pp. 495-522.

 

Riihimäki V, Savolainen K, Pfäffli P, Pekari K, Sippel W, Laine A. Metabolic interaction between m-xylene and ethanol. Arch Toxicol. 1982;49(4):253-63.

 

Dergovics F, Moura P, Shirata N, Pereira S. Valuation of performance of solution varnish/xylene in the diaphanization of citopatology slides stained with Papanicolaou's technique. RBAC. 2012;44(1):35-8.

 

Araya JC, Fuente A, Gallegos G. Hipoacusia por solventes orgánicos: enfermedad profesional inducida por la acción ototoxica de xilol & toluol: reporte de caso en Chile. Rev Chil Tecnol Medica. 2007;27(1):1331-8.

 

Kuling K. General approach to the poisoned patient. In: Marx J, (ed.). Rosen's Emergency Medicine: Concepts and Clinical Practice. 8th Edition. Philadelphia: Elsevier Mosby; 2013.

 

Agency for Toxic Substances & Disease Registry (ATSDR). Medical Management Guidelines for Hydrogen Chloride. Atlanta, GA: ATSDR; 2014.

 

Levine M, Zane R. Chemical injuries. In: Marx J (ed). Rosen's Emergency Medicine: Concepts and Clinical Practice. 8th edition. Philadelphia: Elsevier Mosby; 2013.

 

Viccellio P. Handbook of Medical Toxicology. Philadelphia: Lippincott Williams and Wilkins; 1992.

 

World Health Organization (WHO). International Programme on Chemical Safety: WHO Environmental Health Criteria. Geneva: WHO; 1997.

 

Rojas-Zumaran VA, Moya-Salazar JJ. From the Cytocolor towards ecological Pap test: Origins. Patología Rev Latinoam. 2016;54(3):66-75.

 

De Bekker-Grob EW, de Kok IM, Bulten J, van Rosmalen J, Vedder JE, Arbyn M, et al. Liquidbased cervical cytology using ThinPrep technology: weighing the pros and cons in a cost-effectiveness analysis. Cancer Causes Control. 2012;23:1323-31.

 

Klug SJ, Neis KJ, Harlfinger W, Malter A, König J, Spieth S, et al. A randomized trial comparing conventional cytology to liquid-based cytology and computer assistance. Int J Cancer. 2013;132:2849-57.

Published

2018-10-25

Issue

Section

Original Articles