Interpreting epithelial cell abnormalities detected during cervical smear screening - a cytohistologic approach

Purpose: To determine the underlying pathology and clinical significance of epithelial cell abnormalities (ECA) identified during cervical Papanicolaou (Pap) smear screening.

Material and methods: A total of 19,215 Pap smears stained by Papanicolaou stain were screened during a 36-month period. They were classified according to The Bethesda System (TBS) for cervical cytology screening and the results of ECA were compared with histology. The chi square test was applied to determine the significance and validity of high-grade lesions on cytology diagnosis.

Result: 360 cases of ECA were identified. Mean age at presentation was 50.58 years. Cytohistologic correlation of ECA was possible in n = 249 (69.17%) of cases. Out of these, 18 cases were negative, six were inflammatory, three were benign, and 222 cases showed pathology ranging from mild dysplasia to invasive carcinoma. The chi square test showed a highly significant predictive value (p < 0.001) for high-grade lesions detected on Pap smears.

Conclusion: Pap smear results of high-grade squamous intraepithelial lesions (HSIL) or invasive malignancy are highly reliable and the patient may be considered directly for therapeutic intervention. Of cytologically detected ASCUS cases 38.89% were diagnosed as CIN (1-3) on histology. Thus the management of these patients needs to be re-evaluated. Atypical glandular cells of undetermined significance (AGUS) detected in postmenopausal women signify an underlying pathology. These patients should be further investigated and followed to biopsy if necessary.

Epithelial cell abnormalities (ECA); Histology; Pap smear; TBS

[1] Papanicolaou G.N., Traut H.F.: "The diagnostic value of vaginal smears in carcinoma of the uterus". Am. J. Obstet. Gyncol., 1941, 42, 193.

[2] Koss L.G., The Papanicolaou: "Test for cervical cancer detection: a triumph and a tragedy". JAMA, 1989, 261, 737.

[3] National Cancer Institute Workshop: "The 1988 Bethesda system for reporting cervical/vaginal cytologic diagnoses". JAMA, 1989, 262, 931.

[4] The 1991 Bethesda System for reporting cervical/vaginal cytologic diagnoses: report of the 1991 Bethesda Workshop. JAMA, 1992, 267, 1892.

[5] Solomon D., Davey D., Kurman R., Moriarty A., O'Connor D., Prey M. et al.: "The 2001 Bethesda system. Terminology for reporting results of cervical cytology". JAMA, 2002, 287, 2114.

[6] Davey D.D., Tritz D.M.: "Communication and cytopathology: Part IV. Cytohistologic correlation and patient care". Diagn. Cytopathol., 1995, 13, 1.

[7] Kurman R.J., Solomon D.: "The Bethesda System for Reporting CervicalNaginal Diagnoses: Definitions, Criteria and Explanatory Notes for Terminology and Specimen Adequacy". New York, Springer-Verlag, 1994, 30.

[8] Patel D.D., Shah P.M., Patel N.L., Bala D.V.: Asia, India, ln: Parkin D.M., Whelan S.L., Ferlay J., Teppo L., Thomas D.B (eds.). Cancer Incidence in Five Continents Vol. V III. Lyon, France: International Agency for Research on Cancer, 2002, 232.

[9] Lousuebsakul V., Knutsen S.M.F., Gram LT., Akin M.R.M.: "Clinical impact of atypical squamous cells of undetermined significance. A cytohistologic comparison". Acta. Cytol., 2000, 44, 23.

[10] Denis G.L., Hernandez E., Davis J.L., Miyazawa K.: "Atypical squamous cells in Papanicolaou smears". Obstet. Gynecol., 1987, 69, 43.

[11] Robb J.A.: "The'ASCUS'swamp". Diagn. Cytopathol., 1994, 11, 319.

[12] Obenson K., Abreo F., Grafton W.D.: "Cytohistologic correlation between AGUS and biopsy - detected lesions in postrnenopausal women". Acta. Cytol., 2000, 44, 41.

[13] Ferraz M.D.G., Focchi J., Stavale J.N., Nicolau S.M., Lima G.R., Baracat E.C.: "Atypical glandular cells of undetermined significance. Cytologic predictive values for glandular involvement in high grade squamous intraepithelial lesions". Acta. Cytol., 2003, 47, 154.