Cervical cancer screening


Glossary - List of common terms download icon Download

Term Definition
Adenomyosis A condition of the uterus where the endometrium (cells that line the inside of the uterine body) also grow into the myometrium (wall of the uterus).
Adequate colposcopy The cervix is clearly seen and not obscured by blood, inflammation or scarring.
ASC-H Atypical squamous cells, possible high-grade lesion
In the standard US Bethesda System, a category of atypical squamous cells, possible high-grade lesion. Equivalent to possible high-grade squamous intraepithelial lesion (pHSIL) in the Australian Modified Bethesda System.
ASC-US Atypical squamous cells, undetermined significance
In the standard US Bethesda System, a category of atypical squamous cells of undetermined significance: The nature of the abnormality is uncertain or unequivocal. Equivalent to possible low-grade squamous intraepithelial lesion (pLSIL) in the Australian Modified Bethesda System.
ASCUS Atypical squamous cells, undetermined significance

In the previous versions of the US Bethesda System, a category of atypical squamous cells of undetermined significance: The nature of the abnormality is uncertain or unequivocal. Included lesions equivalent to both possible low-grade squamous intraepithelial lesion (pLSIL) and possible high-grade squamous intraepithelial lesion (pHSIL) in the Australian Modified Bethesda System. Later versions (including the current version) of the Bethesda System split this category into ASC-H and ASC-US.

Biopsy Removal of tissue for medical examination.
BNA Borderline nuclear abnormalities (British Society for Clinical Cytology)
Post 2008: considered equivalent to atypical squamous cell, undetermined significance (ASC-US) in the Bethesda 2001 reporting system considered equivalent to possible LSIL (pLSIL) in the Australian modified Bethesda reporting system
Pre 2009: included atypical squamous cells cannot exclude HSIL (ASC-H) and border line changes in endocervical cells. (Denton KJ et al., (2008) The revised BSCC terminology for abnormal cervical cytology. Cytopathology 19: 137-157)
BMD Borderline or mild dyskaryosis considered equivalent to atypical squamous cell, undetermined significance (ASCUS) and low-grade squamous intraepithelial lesion (LSIL) in the Bethesda reporting system and possible LSIL (pLSIL) in the Australian modified Bethesda reporting system
CD4 count The number of CD4 T lymphocytes (CD4 cells) per cubic millimetre of blood, a measure of immune system function.
CIN Cervical Intraepithelial Neoplasia
Refers to abnormal changes in the cells on the surface of the cervix that are seen using a microscope (i.e. histologically-confirmed).
CIN1 – mild dysplasia
CIN2 – moderate dysplasia
CIN 3 – severe dysplasia to carcinoma in situ

(The term CIN2+ refers to CIN2,3, or invasive cervical cancer; CIN3+ refers to CIN3 or invasive cervical cancer)
CIN2/3 refers to CIN2 or CIN3.

Cumulative incidence rate The cumulative incidence rate is a cumulative hazard for a specific disease and should be distinguished from crude (or absolute) risk.
CKC Cold-knife conisation (cold-knife cone biopsy) is the removal of cone shaped piece of tissue from the cervix using a scalpel.
Coagulopathy Coagulopathy is a condition in which the blood’s ability to coagulate (clot) is impaired.
Cohorts offered vaccination Women who were part of a cohort who were offered vaccination as pre-adolescents (12-13 years), in the context of the National HPV Vaccination Program as implemented in Australia. Specifically, we modelled a cohort of women born in 1997 who were offered vaccination as 12 year olds in 2009. This is the same cohort that was analysed in the Economic Evaluation of the Renewal report.
Colposcopy The examination of the cervix and vagina with a magnifying instrument called a colposcope, to check for abnormalities.
Colposcopists Health professionals, usually gynaecologists, trained to perform colposcopy.
Columnar epithelium Epithelium which has cells of much greater height than width i.e. endocervical epithelium.
Congenital anomaly Congenital anomaly is a structural or functional abnormality (anomaly) that occur during intrauterine life and can be identified prenatally, at birth or later in life.
Congenital TZ Congenital transformation zone
During early embryonic life, the cuboidal epithelium of the vaginal tube is replaced by the squamous epithelium, which begins at the caudal end of the dorsal urogenital sinus. This process is completed well before birth and the entire length of vagina and the ectocervix is meant to be covered by squamous epithelium. This process proceeds very rapidly along the lateral walls, and later in the anterior and posterior vaginal walls. If the epithelialization proceeds normally, the original squamocolumnar junction will be located at the external os at birth. On the other hand, if this process is arrested for some reason or incomplete, the original squamocolumnar junction will be located distal to the external os or may rarely be located on the vaginal walls, particularly involving the anterior and posterior fornices. The cuboidal epithelium remaining here will undergo squamous metaplasia. This late conversion to squamous epithelium in the anterior and posterior vaginal walls, as well as the ectocervix, results in the formation of the congenital transformation zone. Thus, it is a variant of intrauterine squamous metaplasia, in which differentiation of the squamous epithelium is not fully completed due to an interference with normal maturation. Excessive maturation is seen on the surface (as evidenced by keratinization) with delayed, incomplete maturation in deeper layers. Clinically, it may be seen as an extensive whitish-grey, hyperkeratotic area extending from the anterior and posterior lips of the cervix to the vaginal fornices. Gradual maturation of the epithelium may occur over several years. This type of transformation zone is seen in less than 5 % of women and is a variant of the normal transformation zone.
Condyloma A ‘knob like’ or warty growth on the genitals caused by an infection with the human papillomavirus.
Cost-effectiveness A cost-effectiveness evaluation is a form of economic analysis that compares the relative gain in effectiveness and relative gain in costs of two or more possible scenarios
CO2 Laser Carbon Dioxide Laser
A gas laser (based on a gas medium containing carbon dioxide, helium, nitrogen, some hydrogen, water vapour and/or xenon) that is used in cervical ablation, cervical conisation and ablation of genital condyloma (warts).
Co-test HPV test and LBC both requested and performed on a cervical sample.
Co-testing HPV test and LBC both requested and performed on a cervical sample.
Cryotherapy The use of extreme cold in surgery. Used in treatment of cervix with specially designed cryoprobe, but its use is limited to low resource countries.
Cyanosis A bluish discolouration of the skin due to poor circulation or inadequate oxygenation of the blood.
Cytobroom A plastic broom-shaped device used to sample cells from the cervix.
Deciduosis A visual change on the cervix that is seen commonly in pregnancy, characterised by multiple small, yellow/red elevations of cervical mucosa.
Diathermy point Straight wire excision of the transformation zone (SWETZ) or needle excision of the transformation zone (NETZ).
Discounted costs Discounted costs represent the total predicted cost associated with cervical cancer screening for the lifetime of a woman, which is discounted by 5% per year after the age of 12 years (the age at which the earlier intervention, vaccination, occurs).
Discounted life–years Discounted life–years represent the predicted probability of remaining alive each year after birth, which is discounted by 5% per year after the age of 12 years (the age at which the earlier intervention, vaccination, occurs).
Dysplasia Dysplasia is an abnormality of epithelial growth and differentiation. Categorised as mild, moderate and severe and correlates with CIN1, CIN2 and CIN3.
Dynamic model A dynamic model captures time-dependent changes in the state of the system, which is in contrast to a static model, which is time-independent. For instance, the change in the number of infected women over time due to vaccination may influence the rate of new infections due to herd immunity, and cannot be captured through a static model.
Ectopy Cervical ectopy or ectropion is a condition in which the endocervical columnar epithelium protrudes through the external cervical os and onto the vaginal portion of the cervix.
ECC Endocervical curettage: The removal of tissue from the endocervical canal of the cervix.
Endometriosis A condition when the endometrium is found in abnormal sites around the body, most commonly in extrauterine sites in the pelvis.
Exophytic lesion A lesion that grows outwards from an epithelial surface.
Experienced colposcopist An experienced colposcopist is usually considered to be one who is, or has been, associated with a tertiary referral centre and has experience in the management of patients with complex problems.
Fischer cone The Fischer cone is a conisation specimen obtained by using a Fischer cone biopsy excisor, and uses similar electrosurgical technology as used in loop excision procedures.
Gynaecological oncologist A gynaecological oncologist is a gynaecologist who has received special training in the management of genital tract cancer in women and has been certified by the RANZCOG: Certified Gynaecological Oncologist (CGO).
HPV 16/18 Only HPV types 16 and or 18 detected using routine HPV screening tests in laboratory
HPV not 16/18 Oncogenic HPV types other than 16 and/or 18 detected using routine HPV screening tests in laboratory.
HPV any type Oncogenic HPV types detected using routine HPV screening tests in laboratory.
HPV positive Women with a positive HPV test result of any oncogenic HPV types detected using HPV testing platforms in a pathology laboratory.
HPV detected Women with a positive HPV test result of any oncogenic HPV types detected using HPV testing platforms in a pathology laboratory.
HPV negative Women in whom oncogenic HPV types are not detected by the HPV testing platform.
HPV not detected Oncogenic HPV types not detected by the HPV testing platform.
Hr-HPV type HPV types associated with high risk of cervical high grade precancerous lesions and cancer.
HSIL High-grade squamous intraepithelial lesion. In the Australian context, HSIL is used to refer to a cytology predictive of a high grade precancerous lesion (AMBS 2004), or histologically confirmed high grade precancerous lesion (HSIL-CIN2 or HSIL-CIN3 as per LAST terminology).
Hysterectomy (total) Complete surgical removal of the uterus including the cervix.
LBC Liquid based cytology (LBC) is a way of preparing cervical samples for examination in the laboratory.
Intermenstrual bleeding Vaginal bleeding at any time other than during normal menstruation or following sexual intercourse.
Leiomyoma Leiomyoma is a benign tumour arising from the smooth muscle of the uterus, commonly known as a fibroid.
Loop diathermy Loop electrosurgical excision procedure (LEEP) or large loop excision of the transformation zone (LLETZ).
LSIL Low-grade squamous intraepithelial lesion. In the Australian context, LSIL is used to refer to a cytology predictive of a low grade precancerous lesion (AMBS 2004), or histologically confirmed low grade precancerous lesion (LSILHPV, LSIL –condyloma and LSILCIN1 as per LAST terminology).
Lympho-vascular space invasion The spread of malignant cells from a cancer, to the blood vessels or lymphatics. In the cervix it is described most commonly in early invasive disease and is important in determining the need for further treatment in superficially invasive squamous cell carcinoma.
Metaplastic squamous epithelium Metaplasia is a non-neoplastic transformation of one mature cell type to another type that is not normally present at that location. In the cervix this refers to the transformation of endocervical columnar epithelium to squamous epithelium, described as metaplastic squamous epithelium.
Mild dyskaryosis Mild dyskaryosis (British Society for Clinical Cytology) considered equivalent to low-grade squamous intraepithelial lesion (LSIL) in the Bethesda 2001 reporting system considered equivalent to definite LSIL in the Australian modified Bethesda reporting system; renamed Low-grade dyskaryosis in 2008. (Denton KJ et al., (2008) The revised BSCC terminology for abnormal cervical cytology. Cytopathology 19: 137-157)
Multi-HPV-type model A model which takes into account different rates of progression and regression of infection/CIN caused by different HPV types (for instance, CIN caused by HPV 16 is less likely to regress, and more likely to progress, than CIN caused by other HPV types)
Multiple-cohort model A multiple-cohort model can simulate outcomes for cohorts born at different ages
Nabothian cysts A mucus filled cyst on the surface of the cervix (this is a normal finding)
NCSP National Cervical Screening Program
A joint program of the Australian, state and territory governments. It aims to reduce morbidity and mortality from cervical cancer, in a cost-effective manner through an organised approach to cervical screening. The program encourages women in the target population to have regular cervical screening.
Needle excision Straight wire excision of the transformation zone (SWETZ) or needle excision of the transformation zone (NETZ).
Necrosis The death of living cells and tissues.
Negative colposcopy A colposcopy in which no abnormalities are seen: it does not include the subsequent reports on any biopsy taken. Also called a ‘normal’ colposcopy and implies that the entire transformation zone of the cervix is visible.
Negative co-test Oncogenic HPV types not detected and LBC negative.
Normal cervical screening history Women who have participated in the NCSP with no detected abnormalities.
NPV Negative predictive value: the probability that a negative test result is a true negative.
Oedema A condition characterised by an excess of watery fluid collecting in the tissues or cavities of the body.
Oncogenic HPV Potentially cancer-causing HPV DNA types, pathogenically linked to intraepithelial neoplasia – e.g. of the uterine cervix (termed CIN)
Oncogenic HPV types Oncogenic HPV are HPV types considered capable of causing cancer. Types 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59 and 68 are included in tests suitable for cervical screening. Some tests also detect type 66.
Partial HPV genotyping Testing for subgroups of high risk HPV types e.g. types 16 or 18
PCB Postcoital bleeding
Vaginal bleeding after intercourse.
pHSIL Possible HSIL in the Australian Modified Bethesda System is broadly equivalent to ASC-H in US Bethesda system.
pLSIL Possible LSIL in the Australian Modified Bethesda System is broadly equivalent to ASCUS in US Bethesda system.
Polyp (ectocervical/endocervical) inflammation A polyp is a small protrusion of tissue that looks like a ball on the end of a slim stalk, and can be visible on the cervix, usually arising from the endocervical or endometrial tissue of uterus. Polyps are usually not neoplastic but can unusually be neoplastic or cancerous.
Positive oncogenic HPV (16/18) Women with a positive HPV test result of HPV types 16 and/or 18 detected using routine HPV testing in a pathology laboratory.
Positive oncogenic HPV (not 16/18) Women with a positive HPV test result of other oncogenic HPV types other than types 16 and 18 detected using routine HPV testing in a pathology laboratory.
Positive oncogenic HPV (any type) Women with a positive HPV test result of any oncogenic HPV types detected using routine HPV testing in a pathology laboratory.
Profiled electrosurgical excision This type of excision uses a specific type of ‘loop’ that can be inserted into the cervical canal and allows for a rotational excision of a ‘cone’ shaped piece of tissue.
Reflex cytology Reflex cytology refers to the automatic performance of a cytological examination of a liquid based cervical sample that has tested positive for oncogenic HPV types, determined by the pathologist.
Reflex LBC Reflex liquid-based cytology LBC (cytology)
A test performed on a liquid-based cytology sample when there is a positive oncogenic HPV test result. Reflex LBC may allow for the triage of women along different pathways, negative, LSIL and HSIL, glandular. For women who have HPV16 and/or 18, and who are being referred directly to colposcopy, the reflex LBC result would inform the colposcopic assessment.
Registry A database of identifiable persons containing defined demographic and health information, established for a specific purpose. In the case of cervical screening or other cancer screening registers, the purpose includes inviting eligible persons for screening, sending reminders when they are overdue for screening, follow up of abnormalities, statistical reporting and research.
Register A database of identifiable persons containing defined demographic and health information, established for a specific purpose. In the case of cervical screening or other cancer screening registers, the purpose includes inviting eligible persons for screening, sending reminders when they are overdue for screening, follow up of abnormalities, statistical reporting and research.
Sexual activity Sexual intercourse, oral sexual contact or genital skin-to-skin contact.
SIL A squamous intraepithelial lesion (SIL) is an abnormal growth of epithelial cells on the surface of the cervix, commonly called squamous cells.
SISCCA Superficially invasive squamous cell carcinoma (previously termed micro-invasive carcinoma).
Squamous epithelium In the cervix and the vagina this is a stratified squamous epithelium that consists of layers of cells arranged in layers on a basement membrane.
Squamocolumnar junction The junction where the ectocervical squamous epithelium and the endocervical columnar epithelium meet, and may be located on the visible ectocervix or may be within the endocervical canal.
Squamous metaplasia In the cervix this refers to the transformation of endocervical columnar epithelium to squamous epithelium, described as metaplastic squamous epithelium.
Stenosis A narrowing of a cylindrical canal.
Subclinical Not clinically apparent.
Thermal coagulation Also known as 'Semm' or ‘Cold’ coagulation.
Triage cytology The results of liquid based cytology are used to determine the optimum management.
TZ Transformation zone
This region of the cervix where the columnar epithelium has been replaced and/or is being replaced by the new metaplastic squamous epithelium is referred to as the transformation zone. It corresponds to the area of cervix bound by the original squamocolumnar junction at the distal end and proximally by the furthest extent that squamous metaplasia has occurred as defined by the new squamocolumnar junction. In premenopausal women, the transformation zone is fully located on the ectocervix. After menopause through old age, the cervix shrinks with the decreasing levels of estrogen. Consequently, the transformation zone may move partially, and later fully, into the cervical canal.

The transformation zone may be described as normal when it is composed of immature and/or mature squamous metaplasia along with intervening areas or islands of columnar epithelium, with no signs of cervical carcinogenesis. It is termed an abnormal or atypical transformation zone (ATZ) when evidence of cervical carcinogenesis such as dysplastic change is observed in the transformation zone. Identifying the transformation zone is of great importance in colposcopy, as almost all manifestations of cervical carcinogenesis occur in this zone.


Type 1 TZ: the whole TZ including all the upper limit is ectocervical
Type 2 TZ: the upper limit of the TZ is partly or wholly visible in the canal and is completely visible around 360 degrees
Type 3 TZ: part or the entire upper limit of the TZ cannot be seen in the canal.

Type 1 excision (for Type 1 TZ): usually to 8mm and not more than 10mm length of cervical tissue excised
Type 2 excision (for Type 2 TZ): not more than 15mm length of tissue excised
Type 3 excision (for Type 3 TZ): equivalent to ‘cone biopsy’ and >15mm length.

Type 1 TZ The whole TZ including all the upper limit is ectocervical.
Type 1 excision Type 1 excision (for Type 1 TZ): usually to 8mm and not more than 10mm length of cervical tissue excised.
Type 2 TZ The upper limit of the TZ is partly or wholly visible in the canal and is completely visible around 360 degrees.
Type 2 excision Type 2 excision (for Type 2 TZ): Not more than 15mm length of tissue excised.
Type 3 excision Type 3 excision (for Type 3 TZ): Equivalent to 'cone biopsy' and > 15mm length.
Ulceration The loss of a small or large portion of a surface epithelium, leading to a ‘raw’ area. Can be caused by local trauma, inflammation and cancer.
Under-screened Women who are over 30 years of age and are 2 or more years overdue for their routine 5-yearly cervical screening test.
Unvaccinated cohorts Women who were not offered HPV vaccination, and who experience no herd immunity effects from the National HPV Vaccination Program.
Vaginal stenosis Narrowing of the vagina.
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Glossary - List of common abbreviations and acronyms[edit source]

Glossary - List of common abbreviations and acronyms download icon Download

Term/Abbreviation Association
AGC Atypical glandular cells
AGUS Atypical glandular cells of undetermined significance
AIHW Australian Institute of Health and Welfare
AIN Anal intra-epithelial neoplasia
AIS Adenocarcinoma in situ
AMBS Australian Modified Bethesda System
ASCCP Australian Society for Colposcopy and Cervical Pathology
ASC-H Atypical squamous cells, possible high-grade lesion
ASCUS Atypical squamous cells, undetermined significance
ASR Age-standardised to the Australian population
ASRW Age-standardised to the world standard population
BNA Borderline nuclear abnormalities (British Society for Clinical Cytology)
BMD Borderline or mild dyskaryosis
CCC Clear cell carcinoma
CGIN Cervical glandular intraepithelial neoplasia
CIN Cervical intraepithelial neoplasia
CIN1 Cervical intraepithelial neoplasia 1
CIN2 Cervical intraepithelial neoplasia 2
CIN3 Cervical intraepithelial neoplasia 3
CIN2/3 Cervical intraepithelial neoplasia 2 or 3
CIR Cumulative incidence rates
CKC Cold-knife conisation
DCV Direct colposcopic vision
DES Diethylstilboestrol
ECC Endocervical curettage
FIGO The International Federation of Gynaecology and Obstetrics
FU Follow-up
HGGA High-grade glandular atypia
HGGL High-grade glandular lesion
HPV Human papillomavirus
HPV 16/18 HPV types 16 and/or 18
HPV +ve (any type) HPV positive (any oncogenic type)
HPV –ve HPV negative
Hr-HPV High-risk human papillomavirus
HSIL High-grade squamous intraepithelial lesion
IARC International Agency for Research on Cancer
IFCPC The International Federation of Cervical Pathology and Colposcopy
IMB Intermenstrual bleeding
LAST Lower anogenital squamous terminology
LBC Liquid-based cytology
LEEP Loop electrosurgical excision procedure
LC Carbon dioxide laser cone biopsy
LLETZ Large loop excision of the transformation zone
LSIL Low-grade squamous intraepithelial lesion
MSAC The Australian Medical Services Advisory Committee
MST Multi-disciplinary team
NCI National Cancer Institute
NCSP National Cervical Screening Program
NCSR National cancer screening register
NETZ Needle excision of the transformation zone
NHMRC National Health and Medical Research Council
Not HPV 16/18 All other oncogenic HPV types other than 16 and 18
NPV Negative predictive value
PBAC Pharmaceuticals Benefits Advisory Committee
PCB Post-coital bleeding
PCR Polymerase chain reaction
PPV Positive predictive value
PTL Preterm labour
RANZCOG The Royal Australian and New Zealand College of Obstetricians and Gynaecologists
RCPA Royal College of Pathologists of Australasia
SCC Squamous cell carcinoma
SIL Squamous intraepithelial lesion
SIR Standardised incidence rate
SISCCA Superficially invasive squamous cell carcinoma (previously termed micro-invasive carcinoma)
SWETZ Straight wire excision of the transformation zone
TBS The Bethesda System
TZ Transformation zone
VAIN Vaginal intra-epithelial neoplasia
Less than or equal to
Greater than or equal to