Cervical cytopathology: An evaluation of its accuracy based on cytohistologic comparison

Abstract

Background. Although Papanicolaou cytology represents the most effective technique to prevent and detect precancerous conditions of the uterine cervix, its false‐negative yield is still a reason of concern among pathologists and gynecologists. Methods. Because histologic control is one of the best ways to assess the accuracy of cytology diagnosis, the authors have investigated 1000 women who had cervical smears and tissue sampling obtained during the same colposcopic evaluation between 1987 and 1990. Results. Out of 1000 cases (average age, 34.6 years; range, 14–80 years), 918 had adequate, 62 had less than optimal, and 10 had unsatisfactory samples. Cytology unsatisfactory and less than optimal cases as well as inadequate histology cases have been disregarded from all calculations. After histologic comparison, confirmed negatives were 622 of 918 (67.8%). Cytologic diagnoses of cervical intra‐epithelial neoplasia (CIN) I were 96, of CIN II were 44, of CIN III, inclusive of carcinoma in situ, were 39, and of invasive carcinoma were 2. Atypical cases were 56. The overall sensitivity was 76.3%, with group sensitivity rates increasing directly with CIN grade. Positive predictive value was 80.2%. Specificity was 93.0%, and negative predictive value was 91.3%. False‐negatives were 59 of 681 (8.7%), basically due to sampling errors. Among true‐positives, there was 1 category discrepancy in 30 cases (mostly undercalled or overcalled CIN II) and 2 category discrepancies in 4 cases. Conclusions. Cervical cytology has an overall accuracy close to that reported in studies employing indirect control methods, such as patient follow‐up. Higher sensitivity rates emerged for CIN II, CIN III, and cervical carcinoma. Our figures of sensitivity and specificity may represent a useful reference source for future studies dealing with quality control in cervical cytopathology.

Fourier transform infrared (FTIR) spectral mapping of the cervical transformation zone, and dysplastic squamous epithelium

“…Despite its success, cytological screening has limitations, the most important being falsenegative results. Reported false-negative rates for the PAP smear vary widely; from as low as 1% to as high as 93% [12][13][14]. The Consensus Development Conference of Cancer of the Cervix, convened by the National Institutes of Health (NIH), concluded that about half of the false-negative PAP tests are due to inadequate specimen collection, with the other half due to failure of identifying or interpreting the specimens correctly.…”

Role of visual inspection of cervix with acetic acid and high risk human papilloma virus DNA testing in screening for cervical cancer

“…However it has been shown to have a low sensitivity varying from 51 to 84% 8,9,10,11 resulting in a high false negative rate varying from 25-48 %.The sensitivity of Pap smear has been found to be even lower in developing countries, specially with regards to lower grade of abnormality. The possible reason for this may be the large percentage of cervicitis and inflammatory smears which mask mild dysplasia.…”

“…Our study showed 95.12% specificity which compares well with other studies which have shown the specificity to range from 95 to 99.8% with a low false positive rate of only 0.2 to 1%. [8][9][10]13 There are many limitations of Pap smear besides its low sensitivity. Large scale screening requires infrastructure and technical staff which may not be available in developing countries.…”

Comparative Study of Human Papilloma Virus DNA Detection and Results of Histopathological Examination of Cervical Colposcopic Biopsy

“…The reported rates of cytologic-histologic differences range from 11% to 47 % ( 8,(14)(15)(16)(17)(18). According to the College of American Pathologists' Q-Probes study of 22,439 correlations in 348 laboratories, the mean rate of cytologichistologic discrepancies was 16.5% (11,32).…”