Papanicolaou Smear Sensitivity for Adenocarcinoma In Situ of the Cervix:A Study of 34 Cases

Abstract

The sensitivity of cervical smears for adenocarcinoma in situ (AIS) is not known, nor is it known whether false-negative smears are due to sampling or to screening or interpretive errors. In 16 of 34 patients with AIS, 38 negative smears were reported 2 weeks to 7 years before biopsy. Thirty-one of these negative smears were rescreened, and 17 (55%) were retrospectively diagnosed as abnormal. The purpose of this study was to obtain an estimate of Pap smear sensitivity for AIS and to uncover difficulties in interpretation of smears that may have led to false-negative diagnoses. MATERIALS AND METHODS The surgical p a t h o l o g y files of Brigham andWomen's Hospital, Boston, were searched for case reports of AIS or AIS combined with squamous cervical intraepithelial neoplasia (CIN) with a complete cone biopsy, hysterectomy, or both for the years 1986 to 1995. All available smears diagnosed as negative before an initial biopsy confirming AIS were confirmed sampling errors. The sensitivity of cervical smears for AIS was 55% to 72%. Improved sampling of the endocervical canal offers cytologists the opportunity to diagnose AIS. This study demonstrates that this opportunity may not be fully exploited. Small "endometrioid" AIS cells and AIS cells resembling reactive endocervical cells may be mistaken for benign cells, thus decreasing sensitivity.

Comparative sensitivities of ThinPrep and Papanicolaou smear for adenocarcinoma in situ (AIS) and combined AIS/high-grade squamous intraepithelial lesion (HSIL): Comparison with HSIL

“…However, those studies varied in their definition of a positive outcome and in the time interval between cytology and positive histology. 5,15,16 Schoolland et al, 5 using methods similar to our own, reported that 'high-grade' sensitivities at 2 different centers were 48% and 54% using conventional PS only.…”

Cervical Cytology Screening History of Women Diagnosed with Adenocarcinoma in Situ of the Cervix

“…This finding is at least as good as in other recent series. 17,18 We conclude that AIS is predominantly a screen-detected disease and are encouraged by the earlier mean age at diagnosis as compared with earlier studies. A decline in the incidence of invasive adenocarcinoma may be expected in the near future.…”

Papanicolaou smear sensitivity for the detection of adenocarcinoma of the cervix

“…21 To determine the sensitivity of the Papanicolaou smear for diagnosing CVCA and to characterize sources of false-negative diagnoses, we conducted a retrospective review of the Papanicolaou smear findings from 49 patients with CVCA.…”