Oncological prevention center
The Oncological Prevention Centre (OPC) focuses on the diagnosis and treatment of precancerous conditions affecting the external (vulva) and internal (vagina, cervix, uterine body, ovaries) female reproductive organs.
In cooperation with, and upon referral from, your attending physician, patients with abnormal cervical cytology findings undergo specialised examination at the OPC outpatient clinic for further diagnostic assessment and verification of results.
All examinations are conducted sensitively, in a calm and supportive environment, with an emphasis on clear and comprehensible explanation of each step. Patients are always thoroughly informed about the meaning of the findings, the proposed diagnostic or therapeutic approach, and receive written information as well.
After completion of treatment, the patient is referred back to the care of her attending physician, who continues long-term follow-up.
The guarantor and head physician of the Oncological Prevention Centre at the Sanatorium Helios is MUDr. Jakub Texl, a member of the Czech Society for Cervical Pathology and Colposcopy and a certified expert colposcopist.
Procedures Performed at Our Centre:
Expert Colposcopy and Colposcopic Examination
Colposcopy is a diagnostic procedure that enables magnified visualisation of the cervix, vagina and external genitalia using a binocular colposcope during a gynaecological examination.
We distinguish basic (native) colposcopy in which the examined area is assessed without application of any solution and extended colonoscopy where there is solution applied- most common is acetic acid. The purpose of extended colposcopy is to eliminate factors that impair visual clarity (particularly mucus or blood) and to enhance the visibility of potential abnormalities.
Changes in the surface epithelium and in the morphology and arrangement of blood vessels are assessed. A standardised professional terminology is used to describe the extent and probable severity of observed abnormalities.
Oncological cytology
Oncological cytology is the primary screening method for the detection of precancerous lesions (precancers, dysplasia) and cervical cancer. Cytological sampling is usually performed in conjunction with colposcopic examination. During pregnancy, the sample is taken as a routine part of the initial examination. Cytological samples may also be obtained from suspicious areas in the vagina; however, the usefulness of cytology is limited for lesions of the external genitalia.
Surface cells are collected from the ectocervix using a spatula and from the endocervical canal using a special cytobrush. The examination is painless; occasionally, a dull pressure in the lower abdomen may be felt during endocervical sampling. Mild spotting may occur after the procedure.
Collected cells are smeared onto a glass slide and fixed using an alcohol-based solution. An essential part of the sample is a properly completed request form containing information on the date of the last menstrual period, contraceptive use, or gestational age in pregnancy. The fixed specimen, together with documentation, is sent to a cytology laboratory for evaluation. A trained cytologist examines the sample and provides a detailed report. In the Czech Republic, cytological evaluation currently follows the Bethesda System (2001), with the latest update from 2023.
Based on a comprehensive and unambiguous description, recommendations for further management are provided. The cytologist evaluates the quality of the smear, the hormonal status of the woman and the presence of any infection, and classifies the cervical cells into the appropriate category. In simplified terms, results may be described as normal, equivocal or abnormal. In cases of equivocal or abnormal findings, repeat cytology at a shorter interval, usually within three to six months, or expert colposcopic examination at the specialised outpatient clinic of the Oncological Prevention Centre is recommended.
Biopsy
In cases of abnormal findings, an abnormal cytology result is most often detected first. Subsequent colposcopic examination—frequently performed at the specialised OPC clinic—aims to further assess the severity of the changes. Under colposcopic guidance, a small tissue sample may be taken from the most suspicious area to confirm the presumed diagnosis. Punch biopsy using specialised forceps is well tolerated and is usually performed immediately following colposcopy, typically under local anaesthesia.
Conization
In non-pregnant women with mild precancerous changes (CIN I), a conservative approach with closer follow-up is generally chosen, taking into account lesion severity, patient age and reproductive plans. In cases of high-grade lesions (CIN II or CIN III), a minor surgical procedure(most commonly conization)is recommended to remove the affected portion of the cervix.
During pregnancy, management differs: even high-grade precancerous lesions are usually monitored using punch biopsy, with definitive treatment postponed until after the postpartum period. In very early pregnancy, conization may be performed in selected cases. Confirmed invasive carcinoma, whether during pregnancy or otherwise, requires referral to a specialised oncological centre.
Cervical HPV DNA Testing
The Cobas® 4800 HPV test (Roche) detects DNA of high-risk human papillomavirus (HR HPV) types using PCR technology. Its uniqueness lies in separate detection of the most oncogenic HPV genotypes (HPV 16 and HPV 18) and a pooled detection of 12 other high-risk types (31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 66 and 68).The test is fully automated and demonstrates specificity and sensitivity comparable to the Hybrid Capture II method. Its development is linked to the largest clinical study conducted to date, the ATHENA trial (Addressing the Need for Advanced HPV Diagnostics).
Advantages of this test:
Information about the presence of DNA of HPV 16 and HPV 18 means an increased risk of developing a cervical cancer, because HPV 16 and 18 together are responsible for 70% of diagnosed cervix cancer cases.
Women with a negative PAP test, who have positive cobas® 4800 HPV test for genotypes 16 and 18 have a 35 times higher risk of precancerous lesions than women with HR HPV-negative. It’s the only approved test for primary screening.
Indication
1. Patients aged 30 years or older with abnormal cytological findings
2. Patients aged 21 to 30 with repeated abnormal cytological findings
3. Patients six or more months after conization ( with at least of 12 month gap from the last HPV test)
4. screening of cervical cancer – patients age 35/45/55 years old (+364 days), age 55 is new since 1st january 2024
5. primary screening regardless of the cytology result
Reimbursement:
Covered by public health insurance in cases 1-4 above.
For self-paying patients: – case 5 above.
Limitations of reimbursement by public health insurance:
Reimbursement is limited to once every twelve months and to a maximum of five times during a lifetime for testing following a previous abnormal cytological finding or after conisation. Screening examination without a link to abnormal cytology is reimbursed only when the specified ages of thirty-five, forty-five or fifty-five years are met, including the tolerance of three hundred and sixty-four days.
The examination cannot be performed:
The examination cannot be performed in patients after hysterectomy without a cervix, as the test is not validated for such samples, nor during vaginal bleeding or after previous use of vaginal lubricants.
Interpretation of results:
A positive test result for HPV 16 and or HPV 18 in the presence of a negative Pap smear should lead to colposcopic examination, preferably expert colposcopy, and the proposal of an individual follow-up plan for the specific patient. A positive result for the twelve other high-risk HPV types should lead to careful follow-up and repeat Pap smear testing at an interval of six to twelve months, ideally with repeat Cobas® 4800 HPV testing, though not earlier than twelve months after the initial test. A negative result for all components of the test allows the patient to continue regular annual gynaecological examinations, including Pap testing, and in the case of negative findings, repeat Cobas® 4800 HPV testing is recommended after five years, with reimbursement by public health insurance possible only if the indication criteria are met; otherwise, the test can be performed only with direct payment.
Test of “activity” of the present human papillomavirus (HPV), CINTEC PLUS
This is a next-generation cytological test that provides additional information for HPV-positive women who may have a precancerous finding on the cervix. The test is based on dual immunocytochemical staining and detects the simultaneous presence of the oncoproteins p16 and Ki-67 in cells obtained from a cervical smear. It complements diagnostic options as a so-called triage test.
Reimbursement by public health insurance has not yet been approved.
For self-paying patients:
The test is indicated in cases of a positive high-risk HPV test regardless of detected HPV types, particularly in combination with negative cytology, and in cases of cytological findings classified as ASC-US or LSIL HPV regardless of the results of other examinations.
Interpretation of results:
A CINtec positive result indicates that a transforming HPV infection is developing, and therefore further diagnostic and therapeutic procedures in accordance with current recommendations of the Czech Gynecological and Obstetrical Society are required. A CINtec negative result allows the patient to be monitored at intervals of up to six months, with repeat examination after a minimum interval of two years.
Vaccination against human papillomaviruses (HPV)
Vaccination is performed using the modern vaccines Gardasil® 9 or Cervarix®, exclusively on a self-pay basis according to the currently valid price list. Vaccination is administered in a three-dose schedule, consisting of the first dose, the second dose after one to two months, and the third dose after six to twelve months. Patients should attend vaccination by prior telephone appointment, preferably in the morning hours around 8:30 a.m.
After administration of the vaccine, it is necessary to remain in the waiting area for a further twenty minutes. Vaccination is recommended for all women in indicated cases as well as for their partners as a means of preventing infection with and further transmission of human papillomavirus. It is particularly recommended in situations where an atypical cervical finding or a precancerous lesion has already been identified. If conization of the cervix is planned, it is recommended to initiate vaccination approximately two to four weeks prior to the planned procedure and to continue according to the recommended schedule.
At present, vaccination is fully reimbursed by public health insurance for children, both boys and girls, aged eleven to fifteen years, using a two-dose schedule. Further information is provided by the child’s general practitioner for children and adolescents, who administers this vaccination under public health insurance coverage.