Usefulness of repeat cytology at the time of first colposcopy

Abstract

The value of repeat cytology in the detection of high-grade preinvasive or invasive disease was analyzed at the time of colposcopy in cases of patients with abnormal referral cytology. A series of 136 patients with squamous abnormalities in their referral cytology, who had undergone repeat cytology and for whom outcome had been established, were included in the study. Final diagnosis consisted of 27 negative results (20%), 37 cases of CIN1 (27%), 31 CIN2 (23%), 39 CIN3 (29%), and 2 (1%) cases of squamous cell carcinoma (SCC). Referral and repeat cytology suggestive of atypical squamous cells cannot exclude high-grade squamous intraepithelial lesion (ASC-H), high-grade squamous intraepithelial lesion (HSIL) were findings significantly associated with a final diagnosis of CIN2 or worse. Sensitivity and positive predictive value of repeat cytology for the histological diagnosis of significant histological neoplasia (CIN2 or worse) were 81.9% and 77.6%, respectively. In women with referral cytology findings of atypical squamous cells of undetermined significance or low-grade squamous intraepithelial lesion (ASC-US/ LSIL), repeat cytology was suggestive of HSIL in 20% of cases (11/ 54), and in 4% (2/54) biopsy was negative or CIN1, and the final diagnosis established by LLETZ was CIN3. Eight cases (10%) of HSIL in referral and repeat cytology in which biopsies were negative or insufficient were diagnosed as CIN3 or worse in the final diagnosis. Repeat cytology would have changed therapeutic management in 4 and 10%, respectively, of patients included as ASC-US/ LSIL and ASC-H/HSIL in referral cytology. Diagn. Cytopathol. 2009;37:68-73. ' 2008 Wiley-Liss, Inc.Key Words: cytology; colposcopy; CIN; outcome Conventional cervical cytology is the worldwide screening test for cervical cancer and its accuracy has been discussed recently. The levels of sensitivity and specificity of cervical cytology vary greatly. A meta-analysis on the accuracy of cervical cytology estimates sensitivity and specificity ranging from 11 to 99% and 14 to 97%, respectively. 1,2 New technologies such as liquid-based cytology (LBC) and human papilloma virus (HPV) testing have been introduced into cervical cancer screening. However, there is continuous debate about whether society's limited resources are better spent on reaching the underserved rather than on these technologies. 3 Davey et al. 4 in a meta-analysis did not show evidence that LBC reduced the proportion of unsatisfactory slides or detected more high-grade lesions in high-quality studies than in conventional cytology. This review does not lend support to claims of better performance by liquidbased cytology. In addition, although HPV-DNA testing had higher sensitivity for detecting high-grade squamous intraepithelial lesions, its specificity is lower than that of cytology, particularly in younger women, and this represents an important restriction to the adoption of this technique as a single screening tool. 2,5 Performing a repeat cervical smear just prior to colposcopy is a common pr...

Internal Quality Control for Cervical Cytopathology: Comparison of Potential False-Negatives Detected at Rapid Prescreening and at 100% Rapid Review

“…These results are in agreement with findings from studies that evaluated the performance of cytopathology using histopathology as the gold standard. In these studies, the frequency of results confirmed by histopathology ranged from 62.8 to 86.6% [24,25,31,32,33]. Sensitivity ranged from 51.0 to 91.6% [33,34,35,36,37,38,39,40,41,42,43].…”

“…Michelow et al [30] reported that 16/19 (84.0%) cases identified at RR-100% were confirmed at repeat cytopathology and, even though our rates of agreement are lower, the result of repeat cytopathology confirmed 44.5% of cases identified at RPS and only 22.2% of cases identified at RR-100%. The studies by Lapin et al [24] and Alves et al [31] reported that 62.4 and 80.9% of cytopathology examinations, respectively, were abnormal on repeat cytopathology.…”

A retrospective study comparing the efficiency of recurrent LSIL cytology to high-grade cytology as predictors of high-grade cervical intraepithelial neoplasia or worse (CIN2+)

“…Women with negative HPV results are referred for a followup cytology after one year. 16,17 Screening for hrHPV could provide 60-70% higher protection from CC than cytology screening. 18 However, HPV DNA or mRNA testing is not yet readily available in the South African public sector setting.…”