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Regular follow-up with cervical cytology is of questionable value following surgical treatment of microinvasive cervical cancer.OBJECTIVES: To assess the follow-up smears and their outcomes of patients with conservatively managed early-stage cervical cancer as per UK guidelines within our service. To evaluate whether intensive follow-up can detect pre-cancer early compared to the standard 3 yearly follow-up. STUDY DESIGN: Retrospective review. METHODS: All patients treated for early stage (stage 1A1 and 1A2) with cervical cancer from 01/2002 to 01/2020 at University Hospitals of Derby and Burton were included. Patients who had initial hysterectomy were excluded from our analysis. Review conducted using electronic patient records for treatment, histology, and follow-up smears. Number of abnormal follow-up smears and number of recurrent cervical cancers were considered the main outcome measures. RESULTS: 98 cases were identified. 81 (82.65 %) were stage 1A1 and 17 (17.35 %) were stage 1A2. 74 (75.51 %) patients had squamous histology and 24 (24.49 %) had adenocarcinomas. Median follow-up was 11.08 years (4043 days). 510 follow-up smears were performed, of which 33 (6.47 %) were abnormal. 5 of these abnormal smears showed low grade dyskaryosis (0.98 %) and 2 smears showed high grade dyskaryosis (0.39 %). The positive predictive value of follow-up smears to detect pre-cancerous changes was 5.71 %. There were no recurrent cancers detected. CONCLUSIONS: Microinvasive cervical cancer is effectively managed with conservative surgery. There were no recurrent cancers detected in our cohort during follow-up and there were only 2 high grade dyskaryoses detected (n = 2/510, 0.39 %). We therefore believe that reducing the intensity of follow up of these patients should be considered.
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A randomised controlled trial on the effectiveness of a lateral glide cervical spine mobilisation on cervicobrachial (neck and arm) painCervicobrachial (neck and arm) pain is a painful condition which, when chronic, leads to high levels of disability. Small-scale, short-term (<2 months follow-up) studies have identified that lateral glide mobilisation reduces cervicobrachial pain. However, long-term (>6 months) effectiveness of this intervention on cervicobrachial pain is unknown. Purpose: The main objective was to identify whether the lateral glide cervical mobilisation was effective in reducing pain levels in the long-term for patients with chronic cervicobrachial pain. Secondary objectives included evaluating effects of the lateral glide mobilisation on; patient perceived recovery, function and disability, cost, and harm. Methods: Ninety-nine participants with chronic cervicobrachial pain were recruited to the trial from an acute Hospital Trust in the United Kingdom. A randomised controlled trial was undertaken. Participants were randomised to receive lateral glide with selfmanagement (n = 49); or self-management alone (n = 50). Assessments were made on four occasions (at weeks 0 (baseline), 6, 26 and 52 post intervention). The primary outcome measure was the Visual Analogue Scale (VAS) for pain. Secondary outcomes measures included; the Global Rating of Change score (GROC), the Neck and Upper Limb Index score (NULI), the Short-from 36 (SF36) and cervical active range of motion (AROM). In addition to these outcomes the costs (quantity of physiotherapy appointments) and reported number of harmful effects in response to intervention were evaluated. An intention to treat approach was used. Analysis of Covariance evaluated between-group differences on VAS (pain) at the primary end point (52 weeks). Multi-level modelling was the main method used for longitudinal analysis of other continuous outcomes. Mann-Whitney tests were used to evaluate ordinal data. Results: Primary outcome: No statistically significant between-group differences were identified for pain (using VAS) at six weeks (p = 0.52; CI -14.72 to 7.44) and one year (p = 0.37; CI -17.76 to 6.61) post-intervention. The VAS outcomes correlated well with GROC scores (p < 0.001). Secondary outcomes: There was a statistically significant difference in NULI scores favouring self-management alone (p = 0.03), but no between-group differences for SF36 (p = 0.07). Cervical AROM indicated no statistically significant findings for most movements measured (p < 0.05). The cost of providing the lateral glide and self-management were twice that of providing self-management alone. Minor harm was reported in both groups, with 11% more harm being associated with the lateral glide. Conclusion(s): According to the Grading of Recommendations, Assessment, Development and Evaluations (GRADE), there is low strength of evidence to support recommendation for the use of the lateral glide for chronic cervicobrachial pain in clinical practice. Future research in the form of a well-designed longitudinal observational study might identify clinically important differences among therapeutic options for specific sub-groups of patients with cervicobrachial pain. Implications: The results of this study indicate that in the long-term 'less is more' with a minimal intervention approach based on self-management strategies being a more cost-effective way to manage chronic cervicobrachial pain than hands-on manual therapy in the form of the lateral glide mobilisation.
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The BAC recommended code of practice for cytology laboratories participating in the United Kingdom cervical screening programmes (2022) - a new edition for a new decade.The last update of the British Association for Cytopathology (BAC) code of practice (CoP) was published in 2017, since when there have been such significant changes to the UK cervical screening programmes (CSPs) in, most notably the implementation of primary screening for high-risk Human Papilloma Virus (hrHPV), that a major revision is required. Previous versions of the CoP have provided a valuable resource for cytology laboratories and other key stakeholders, and it is hoped that this latest edition will continue to do so.