Cytologic–histologic correlation of screening and diagnostic Papanicolaou tests

Abstract

The Pap test (PT) is most commonly used as a screening test; however, it is often also used as a "diagnostic test," usually in patients of known or suspected lesions. As we have recently shown that the yield of atypical interpretations in diagnostic Pap tests (DPTs) is nearly five times greater than the yield for screening Pap tests (SPTs), we speculated that the PT might function differently when used in each population. The University of Virginia's cytologic-histologic correlation results for PTs, accessioned between 4 January 2003 and 11 December 2003, were reviewed. PTs were considered as SPTs or DPTs, depending on the billing codes used by referring physicians. Using the original diagnosis, results were compared for SPTs and DPTs using chi-square testing. There were 1,311 PTs (776 DPTs and 535 SPTs), which had histologic follow-up within a 7-mo period. Of SPTs interpreted as negative (242), 11 (4.5%) showed SIL or worse and 3 (1.2%) showed HSIL or worse on follow-up biopsy. Of SPTs interpreted as ASC (133), 59 (44.3%) showed SIL or worse and 16 (12.0%) showed HSIL or worse on follow-up biopsy. Of SPTs interpreted as LSIL (117), 65 (55.5%) showed SIL or worse and 17 (14.5%) showed HSIL or worse on follow-up biopsy. Of SPTs interpreted as HSIL (38), 31 (81.6%) showed SIL or worse and 23 (60.5%) showed HSIL or worse on follow-up biopsy. Of SPTs interpreted as glandular lesions (AGC, adenocarcinoma, etc.) (4), 3 (75%) showed HSIL or malignancy. Of DPTs interpreted as negative (261), 69 (26.4%) showed SIL or worse and 10 (3.8%) showed HSIL or worse on follow-up biopsy. Of DPTs interpreted as ASC (166), 75 (45.2%) showed SIL or worse and 22 (13.3%) showed HSIL or worse on follow-up biopsy. Of DPTs interpreted as LSIL (227), 146 (64.4%) showed SIL or worse and 31 (13.7%) showed HSIL or worse on follow-up biopsy. Of DPTs interpreted as HSIL (119), 105 (87.4%) showed SIL or worse and 84 (70.6%) showed HSIL or worse on follow-up biopsy. Of DPTs interpreted as glandular lesions (AGC, adenocarcinoma, etc.) (3), 3 (100%) showed HSIL or malignancy. Overall, DPTs were more likely than SPTs to show SIL or HSIL on follow-up biopsy (P < 0.01), and negative DPTs were more likely than negative SPTs to show SIL or HSIL on follow-up biopsy (P < 0.01, P = 0.01, respectively). Some of this may be a reflection of the increased percentage of LSIL and HSIL results for DPTs. Despite the difference in disease prevalence between women having SPTs and those having DPTs, the PT seems to function relatively the same in both scenarios, except in high risk women with negative DPTs.

High‐grade histologic lesions in women with low‐grade squamous intraepithelial lesion cytology from a region of Thailand with a high incidence of cervical cancer

“…In regions with a low incidence of cervical cancer, positive smear results for LSIL are associated with CIN 2-3 in approximately 12%-18% of women on initial colposcopy and are rarely associated with invasive cancer (less than 1%) [6][7][8][9]. The unique finding from the present study was an extremely high prevalence of CIN 2-3 (30.3%) and invasive cervical cancer (1.9%) on initial evaluation of women with LSIL.…”

Accuracy of Visual Inspection with Acetic acid in Detecting High-Grade Cervical Intraepithelial Neoplasia in Pre- and Post-Menopausal Thai Women with Minor Cervical Cytological Abnormalities

“…By using colposcopic-directed biopsy, the incidences of CIN 2-3 in patients with atypical squamous cells of undetermined significance (ASC-US) and LSIL ranged from 7-15% and 15-30%, respectively and the incidences of cervical cancer in patients with ASC-US and LSIL were reported at 0.1-2% and 1-5%, respectively (Chute et al, 2006;Evans et al, 2006;Kantathavorn et al, 2008;Khuakoonratt et al, 2008).…”

Histopathological Outcomes of Women with Abnormal Cervical Cytology: a Review of Literature in Thailand

“…The nuclei are usually hyperchromatic, and multinucleation is common However, in LSIL with marked HPV cytopathic changes, the nucleus are often only 2-3 times the size of a normal intermediate cell nucleus (Solomon and Nayar, 2004). In a region with a low incidence of cervical cancer, positive smear results for LSIL were associated with CIN2-3/AIS in approximately 12%-18% of women on initial colposcopy and with less than 1% of underlying invasive cancer (Massad et al, 2001;ALTS Group, 2003;Fairman et al, 2004;Chute et al, 2006). In Thailand, reported incidence of significant cervical pathology ranges from 11.2% to 32.2% (Table 2) (Khuakoonratt et al, 2008;Boonlikit, 2008;Kiatiyosnusorn et al, 2010;Ekalaksananan et al, 2011;Pothisuwan et al, 2011;Kingnate et al, 2014).…”

“…Diagnostic cervical excision is advised if the colposcopic examination is inadequate, microinvasive carcinoma or low-grade lesion is identified on colposcopically-directed biopsy. Previous reported incidence of precancerous lesion and invasive cancer among population resided in low cervical cancer incidence areas ranges 60%-80% and 1-3%, respectively (Jones and Davey, 2000;Massad et al, 2001;Szurkus and Harrison, 2003;Berdichevsky et al, 2004;Boman et al, 2004;Numnum et al, 2005;Chute et al, 2006;Sadan et al, 2007). In Thailand, although incidence of CIN2-3 and AIS in women with HSIL smears (62% to 74%) paralleled those reports of other populations, the incidences of underlying invasive disease were remarkably higher ranging from 7.9% to 25.8% (Kantathavorn et al, 2006;Boonlikit, 2008;Aue-Aungkul et al, 2011;Sripipattanakul, 2011;Ingkapairoj et al, 2012;Kingnate, et al, 2014) (Table 2).…”