Long term follow up of women with borderline cervical smear test results: Effects of age and viral infection on progression to high grade dyskaryosis

Abstract

Objective-To follow up and assess the significance of borderline change in cervical smears. Design-Retrospective study of women undergoing routine cervical cytological screening in 1981. Setting-Avon Cervical Screening Programme, covering 250 000 women in Bristol and Weston super Mare. Subjects-437 women showing borderline cervical changes in 1981 and 437 age matched controls with normal results in 1981. Main outcome measures-Cytological progression to high grade dyskaryosis (cervical intraepithelial neoplasia grade III or invasive carcinoma). Results-During follow up ranging from 13 to 106 months 98 of the 437 women (22.4%) with borderline cytological changes on routine cervical cytology screening had a subsequent smear test showing high grade dyskaryosis compared with three of the 437 women (0.9%) in the control group. The risk of progression was greater in women aged 20 to 39 than in those aged 40 and over. Human papillomavirus infection had initially been diagnosed cytologically in 101 of the 437 (23%) women with borderline results. Significantly fewer of these women developed high grade dyskaryosis (13/98 (13%) v 88/339 (26%), p<005). Conclusions-Women with borderline smear test results are at increased risk of developing high grade dyskaryosis, particularly if the borderline changes occur without cytological features of human papil-lomavirus infection. Progression occurs within three years in 50% of cases, although a linearly increasing risk was sustained over the nine years of foliow up and was greatest in women aged 20 to 39. Careful follow up of these women is indicated.

Women with low‐grade abnormalities on Pap smear should be referred for colposcopy

“…In the current study, the few cases referred with ASCUS means that conclusions on the management of these patients cannot be drawn; there has been significant debate within the literature on this subject with up to 16% of patients progressing to CIN within 2 years 29,30 and 6–7% of cases already have high‐grade change 25,26 . The ASCUS LSIL Triage Study (ALTS) study has found that reflex HPV‐DNA testing is a useful option under these circumstances 31…”

Follow up of women with borderline cervical smears as defined by national guidelines

“…Hirschowitz et al found that 22.4% of women with borderline cytological changes had a smear test showing high grade dyskaryosis which developed between 13 and 106 months after the index smear. 1 Fifty per cent of these women, or 11.2% of their total study group, developed their high grade lesion within 34 months. The frequency with which a high grade lesion was identified after a borderline smear was therefore similar in the two studies.…”

“…1 More recently the British Society for Clinical Cytology and the Royal College of Pathologists cooperated to produce a series of guidelines defining borderline nuclear changes in cervical smears and provided illustrations to assist in their identification. 2 The appropriateness of these guidelines has been discussed publicly.…”

Invasive cancer of the cervix in women with mild dyskaryosis followed up cytologically

“…9,12,15 One study included only women with borderline results,11 one study included both mild and moderate dyskaryosis but did not indicate the proportion of subjects with mild disease,10 and the last study included borderline results (30%), mild dyskaryosis (64%), and moderate dyskaryosis (6%). There seems to be no correlation between the scope of the inclusion criteria and the incidence of invasive disease.…”