A second Pap smear during colposcopy: is it really worth it?

The aim of this study was to determine whether the clinical value of a second Pap smear during colposcopy outweighed its cost-effectiveness and reliability parameters. We studied retrospectively 569 cases focusing on A) The initial Pap smear, B) The smear performed during colposcopy, C) The colposcopic findings, and D) The histopathological reports of the cases where biopsy sampling was performed. In 380 patients (67%), the second Pap smear corresponded to the first one. In 13% of the patients, the cytological lesions were worse (particularly in 2% of the patients staging increased from HPV-associated reactive cellular changes to CIN II, or from CIN I to CIN III), and in 20% slighter than the initial. In 79% of the cases revealing more serious lesions in the second smear, the histological result of the biopsy corresponded to that of the initial smear. Conclusively, only 2% seem to benefit from a second repeat Pap smear during referral colposcopy.

HPV; SIL; Pap smear; Colposcopy; Smoking; Condom use

[1] Wright T.C. Jr, Cox J.T., Massad L.S., Twiggs L.B., Wilkmson E.J.: "ASCCP-Sponsored Consensus Conference, 2001 Consensus Guidelines for the management of women with cervical cytologic abnormalities". JAMA, 2002, 287 (16), 2120

[2] Tuon F.F., Bittencourt M.S., Panichi M.A., Pinto A.P.: "Sensibility and specificity of cytology and colposcopy exams with the histological evaluation of cervical intraepithelial lesions". Rev. Assoc. Med. Bras., 2002, 48 (2), 140.

[3] Hollingworth J., Kotecha K., Dobbs S.P., Shaw P.A., Ireland D.: "Cervical disease in women referred to colposcopy following inadequate smears". Cytopathology, 2000, 11 (1), 45

[4] Paraskevaidis E., Davidson E.J., Malamou-Mitsi V., Hirsch P.M., Pappa L., Koliopoulos G. et al.: "An observational study of women with positive HPV-DNA tests and normal cytology and colposcopy". Eur. J. Gynaecol. Oneal., 2002, 23 (4), 320.

[5] Tanaka H., Karube A., Tanaka T., Nakagomi 0.: "Much higher risk of premalignant and malignant cervical diseases in younger women positive for HPV 16 than in older women positive for HPV 16". Microbial. Immunol., 2001, 45 (4), 323.

[6] Guido R., Schiffman M., Solomon D., Burke L.: "ASCUS LSIL Triage Study (ALTS) Group; Postcolposcopy management strategies for women referred with low-grade squamous intraepithelial lesions or human papillomavirus DNA-positive atypical squamous cells of undetermined significance: a two-year prospective study" Am. J. Obstet. Gynecol., 2003, 188 (6), 1401.

[7] Paraskevaidis E., Malamou-Mitsi V., Koliopoulos G., Pappa L., Lolis E.,G eorgiou I., Agnantis NJ.: "Expanded cytological referral criteria for colposcopy in cervical screening: comparison with human papillomavirus testing". Gynecol. Oncol., 2001, 82 (2), 355.

[8] Henry J., Wadehra V.: "Influence of smear quality on the rate of detecting significant cervical cytologic abnormalities". Acta Cytol., 1996, 40, 529.

[9] Anderson M., Jordan J., Morse A., Sharp F.: "The normal cervix". In: 2nd edidion. Integrated Colposcopy. London, Chapman & Hall Medical, 1996.

[10] Panos J.C., Jones B.A., Mazzara P.F.: "Usefulness of concurrent Papanicolaou smear at the time of cervical biopsy". Diag. Cytopathol., 2002, 26 (6), 405 (author reply 406).

[11] Spitzer M., Ryskin M., Chernys A.E., Shifrin A.: "The value of repeat Pap smear at the time of initial colposcopy". Gynecol Oneal., 1997, 67 (1), 3.

[12] Zardawi J.M., Rode J.W.: "Clinical value of repeat Pap smear at the time of colposcopy". Acta Cytol., 2002, 46 (3), 495.

[13] Simsir A., Ioffe O.B., Bourquin P., Brooks S.E., Henry M.: "Repeat cervical cytology at the time of colposcopy. Is there an added benefit?". Acta Cytol., 2001, 45 (1), 23

[14] Korman J.: "Repeat Pap smear at the time of initial colposcopyanother view". Gynecol. Oneal., 1998, 69 (3), 269.

[15] Massad L.S., Cejtin H.E.:'The value of repeat cervical cytology at the time of colposcopy". Gynecol. Oncol., 1998, 68 (2), 216.

[16] Smith R.C., Nguyen G.K.: "Cytohistologic discrepancies in cervical intraepithelial neoplasia and value of repeat cervical smears taken during colposcopy". Diagn. Cytopathol., 1998, 18 (4), 317.

[17] Gerber S., De Grandi P., Petignat P., Mihaescu A., Delaloye J.F.: "Colposcopic evaluation after a repeat atypical squamous cells of undetermined significance (ASCUS) smear". Int. J. Gynaecol. Obstet., 2001, 75 (3), 251.

[18] Castellsague X., Munoz N.: "Cofactors in human papillomavirus carcinogenesis-role of parity, oral contraceptives, and tobacco smoking". J. Natl. Cancer Inst. Monogr., 2003, (31), 20.

[19] Castellsague X., Bosch F.X., Munoz N.: "Environmental cofactors in HPV carcinogenesis". Virus Res., 2002, 89 (2), 191.

[20] Boardman L.A., Adams A.E., Peipert J.F.: "Clinical predictors of cervical intraepithelial neoplasia 2 in women with mildly abnormal Pap smears". J. Reprod. Med., 2002, 47 (11), 891.

[21] Nunez J.T., Delgado M., Pino G., Giron H., Bolet B.: "Smoking as a risk factor for preinvasive and invasive cervical lesions in female sex workers in Venezuela". Int. J. Gynaecol. Obstet., 2002, 79 (1), 57.

[22] Moscicki A.B., Hils N., Shiboski S., Powell K., Jay N., Hanson E. et al.: "Risks for incident human papillomavirus infection and low-grade squamous intraepithelial lesion development in young females" JAMA, 2001, 285 (23), 2995.

[23] Thomas D.B., Qin Q., Kuypers J., Kiviat N., Ashley R.L., Koetsawang A. et al.: "Human papillomaviruses and cervical cancer in Bangkok. II. Risk factors for in situ and invasive squamous cell invasive carcinomas". Am. J. Epidemiol., 2001, 153 (8), 732.

[24] Frega A., Stentella P., De loris A., Piazze J.J., Fambrini M., Marchionni M., Cosmi E.V.: "Young women, cervical intraepithelial neoplasia and human papillomavirus, risk factors for persistence and recurrence". Cancer Lett., 2003, 196 (2), 127.

[25] Opoix E., Berthet J., Guillemin B.: "Condyloma and contraception: the influence of contraception on the evolution of cervical lesions caused by papillomavirus". Conracept. Fertil. Sex (Paris), 1988, 16 (12), 1007.

[26] Schiff M., Becker T.M., Masuk M., van Asselt-King L., Wheeler C.M., Altobelli K.K. et al.: "Risk factors for cervical intraepithelial neoplasia in southwestern American Indian women". Am. J. Epidemiol., 2000, 152 (8), 716.