Cytology at the time of cervical colposcopy

The efforts of the authors are to evaluate the role of performing a Papanicolaou (Pap) smear at the time of colposcopy. Materials and Methods: This retrospective chart review included patients from 2004 to 2009 who underwent cold knife cone (CKC) biopsy or loop electrosurgical excision procedure (LEEP) for cervical intraepithelial neoplasia types 2 and 3 (CIN 2 and 3) or patients with discrepancy between Pap and colposcopic results. All patients presented to the gynecology clinics in a tertiary care hospital. Results were compared which included: the abnormal Pap smear which led to referral for colposcopy, the Pap smear performed at the time of colposcopy, the colposcopic biopsy, and the excisional biopsy. Interpretation of results was calculated with Cohen’s κ Statistics. Results: One hundred forty-seven patients qualified for the study. One hundred five patients had excisional biopsy proven high-grade squamous intraepithelial lesion (HSIL). Eighty-two of these high-grade excisional pathology results were preceded by high-grade Pap cytology at the time of colposcopy; however 23 Pap cytology results indicated either low-grade squamous intraepithelial lesion (LSIL) or negative (20 and 3 respectively), but were followed by an excisional procedure revealing high-grade pathology. Eighty-one colposcopic biopsies confirmed high-grade excisional biopsy pathology. However, 24 colposcopic biopsies were low-grade or negative (13 and 11 respectively), but followed by a high-grade excisional biopsy. Conclusion: The addition of a Pap smear at the time of colposcopy has the potential role of recognizing high-grade cervical dysplasia.

Colposcopy; Papanicolaou (Pap) smear; High-grade squamous; Intraepithelial lesion (HSIL).

[1] Cancer Facts & Figures 2011. Available at the American Cancer Society Website: http://www.cancer.org/Research/CancerFactsFigures/CancerFactsFigures/cancerfacts-figures-2011. Accessed August 22, 2011.

[2] Waxman A.G., Zsemkye M.M.: “Preventing cervical cancer: the Pap test and the HPV vaccine”. Med. Clin. North. Am., 2008, 92, 1059.

[3] Joste N.: “Overview of the cytology laboratory: specimen processing through diagnosis”. Obstet. Gynecol. Clin. North Am., 2008, 35, 549.

[4] Sawaya G.: “Cervical cancer screening - new guidelines and the balance between benefits and harms”. N. Engl. J. Med., 2009, 361, 2503.

[5] Zsemlye M.: “High-grade cervical dysplasia: pathophysiology, diagnosis, and treatment”. Obstet. Gynecol. Clin. North Am., 2008, 35, 615.

[6] Moscicki A.B., Shiboski S., Hills N.K., Powell K.J., Jay N., Hanson E.N. et al.: “Regression of low-grade squamous intraepithelial lesions in young women”. Lancet, 2004, 364, 1678.

[7] Melnikow J., Nuovo J., Willan A.R., Chan B.K., Howell L.P.: “Natural history of cervical squamous intra-epithelial lesions: a meta-analysis”. Obstet. Gynecol., 1998, 92, 727.

[8] Wright T.C. Jr., Massad L.S., Dunton C.J., Spitzer M., Wilkinson E.J., Solomon D.; 2006 American Society for Colposcopy and Cervical Pathology-sponsored Consensus Conference: “2006 consensus guidelines for the management of women with abnormal cervical cancer screening tests”. Am. J. Obstet. Gynecol., 2007, 197, 346.

[9] Katz V.L., Lentz G.M., Lobo R.A., Gershenson D.M. (eds.). Comprehensive Gynecology, 5th ed., Chap 28; Intraepithelial Neoplasia of the Lower Genital Tract - Excisional Methods, Philadelphia, Pa: Mosby Elsevier, 2007.

[10] Arbyn M., Kyrgiou M., Simoens C., Raifu A.O., Koliopoulos G., Martin-Hisch P. et al.: “Perinatal mortality and other severe adverse pregnancy outcomes associated with treatment of cervical intraepithelial neoplasia: meta-analysis”. BMJ, 2008, 337, 1284.

[11] Kyrgiou M., Koliopoulos G., Martin-Hirsch P., Arbyn M., Prendiville W., Paraskevaidis E.: “Obstetric outcomes after conservative treatment for intraepithelial or early invasive cervical lesions: systematic review and meta-analysis”. Lancet, 2006, 367, 489.

[12] Jakobsson M., Gissler M., Sainio S., Paavonen J., Tapper A.M.: “Preterm delivery after surgical treatment for cervical intraepithelial neoplasia”. Obstet. Gynecol., 2007, 109, 309.

[13] Jakobsson M., Bruinsma F.: “Adverse pregnancy outcomes after treatment for cervical intraepithelial neoplasia”. BMJ, 2008, 337, 1350.

[14] Jakobsson M., Gissler M., Paavonen J., Tapper A.M.: “Loop electrosurgical excision procedure and the risk for preterm birth”. Obstet. Gynecol., 2009, 114, 504.

[15] Fleiss J.L.: “Statistical methods for rates and proportions”. Second ed., New York, John Wiley, ISBN 0471263702, 1981.

[16] ASCUS-LSIL Traige Study (ALTS) Group: “Results of a randomized study on the management of cytology interpretation of atypical squamous cells of undetermined significance”. Am. J. Obstet. Gynecol., 2003, 188, 1383.

[17] Trivers K.F., Benard V.B., Eheman C.R., Royalty J.E, Ekwueme D.U., Lawson H.W.: “Repeat pap testing and colposcopic biopsies in the underserved”. Obstet. Gynecol., 2009, 114, 1049.

[18] Massad L.S., Collins Y.C.: “Strength of correlations between colposcopic impression and biopsy histology”. Gynecol. Oncol., 2003, 89, 424.