Etiologies for Non-Correlating Cervical Cytologies and Biopsies

Abstract

To investigate the etiologies for discrepancies between cervicovaginal smear and corresponding cervical biopsy results, 615 patients with cytologic diagnoses of dysplasia or malignancy during 1 year were reviewed. Sixty-nine patients (11%) were identified in which the cytologic and histologic diagnoses differed. Utilizing an algorithm developed for the study, these cases were assigned an etiologic category for discrepancy: colposcopic biopsy or cytologic sampling, cytologic screening, histotechnical processing, histologic or cytologic interpretation. The most common cause for a discrepancy was colposcopic biopsy sampling (36 cases, 51%). There were nine errors (13%) in biopsy interpretation, with seven underdiagnoses and two overdiagnoses. Eight errors (11%) in cytologic interpretation occurred with half of these representing underdiagnoses. The other causes for discrepancy were less common--cytologic sampling (6 cases), histotechnical processing (3 cases), cytologic screening (2 cases), and a combination of factors (5 cases). Use of this algorithm allows laboratories to identify problem areas and design specific corrective protocols to improve diagnostic accuracy and patient care.

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

“…We did not encounter any cases in which a high-grade SIL (CIN II/III) was under-diagnosed. Although it could be argued that this 4% error rate merely represents inter-observer variability, our rate is similar to that reported in the literature, where errors in interpretation account for 3.4% to 33% of all cases with false-positive cytologic-histologic discrepancie (8,17).…”

“…In our study, we found HPV cytopathic changes and/or dysplasia in approximately one third of the cervical biopsy specimens when additional levels were obtained. Many workers agree with these observations (8,17).…”

“…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).…”

“…The reported rate of false-positive cases ranged from 5.5% to 7.0% (7,18). Tritz et al (1995), reported that factors related to colposcopic biopsy, including sampling and interpretation errors, were the most common causes of a discrepancy between cytologic and corresponding histologic findings (8,31). Also, Anderson and Jones (1997) demonstrated that as many as 45% of the cases subsequently developed SIL, indicating an initial "false-negative" biopsy result rather than a "false-positive" cytologic result in a review of negative cervical biopsy specimens with corresponding cytologic specimens positive for a squamous intraepithelial lesion (SIL) during the preceding 3 months (7).…”

Correlación Citohistológica De Lesiones Escamosas Intraepiteliales De Cuello Uterino, en La Unidad De Patología Cervical Del Hospital Naval De Talcahuano

“…De acuerdo a los resultados obtenidos en este trabajo como en otros trabajos previos (12,13), la correlación citohistológica demostró que sigue siendo un buen método para el control de calidad interno en los servicios de anatomía patológica.…”