The compliance of cytology and cytology combined with HPV HR test with a histological biopsy result, indicating cervical pathology

Aim: The compliance of cytology and cytology combined with HPV HR test with cervical biopsy result, indicating the presence of cervical pathology was studied. Materials and Methods: The study enrolled 1,300 patients of Laboratory of Cervical Pathophysiology of University of Medical Sciences, who have had an abnormal Pap test and / or suspected cervical pathology following the clinical picture. The largest group consisted of 496 patients with cytological diagnosis of low-grade intraepithelial lesions (LSIL) and 388 patients diagnosed with atypical squamous cells of undetermined significance (ASC-US). Women age ranged from 16 to 79. In each of the women, cytological smear was performed, together with the DNA HPV HR (high-risk oncogenic) test and colposcopy with biopsy of suspected cervical changes. Results: After histopathological verification, 461 (35.4%) of abnormal results were obtained. Compliance of cytological diagnosis of ASC-US with abnormal cervical biopsy reached 15.2%, for atypical squamous cells - cannot exclude HSIL (ASC-H) - 40.4%, for LSIL - 42.1%, for high grade intraepithelial lesions (HSIL) - 63.8%, for atypical glandular cells (AGC) - 25.0%, and for suspected cancer – 77.8%, respectively. Considering HPV test result, the results of cytology with abnormal histopathology was by 5.8–25% higher, depending on the diagnosis, then the compliance of the single Pap smear. Conclusions: Cytology combined with molecular test, results in a significant increase in compliance of the cytological diagnosis with histopathological result. This compliance is the lowest for the cytological diagnosis of ASC-US and gradually increases with advancing cytological diagnosis, reaching the highest values when the cancer is suspected. Both cytological smear and HPV DNA HR test, applied separately, have false negative rates.

Cytological smear; HPV test; Screening; Cervical cancer; ASC-US atypical squamous cells of undetermined significance.

[1] International Agency for Research on Cancer, World Health Organization: “Latest world cancer statistics, 2013”. Available at: https://www.iarc.fr/en/media-centre/pr/2013/pdfs/pr223_E.pdf

[2] Wojciechowska U., Didkowska J.: “Zachorowania i zgony na nowotwory złośliwe w Polsce. Krajowy Rejestr Nowotworów, Centrum Onkologii - Instytut im. Marii Skłodowskiej - Curie. Dostępne na stronie”. Available at: http://onkologia.org.pl/wp-content/uploads/Biul2012net.pdf

[3] Waxman A.G., Chelmow D.: “Revised Terminology for Cervical Histopathology and Its Implications for Management of High-Grade Squamous Intraepithelial Lesions of the Cervix” Obstet. Gynecol., 2012, 120, 1465.

[4] Spaczyński M., Karowicz-Bilinska A., Kedzia W., Molińska-Glura M., Seroczyński P., Januszek-Michalecka L., et al.: “Costs of population cervical cancer screening program in Poland between 2007- 2009”. Ginekol. Pol., 2010, 10, 750. [In Polish]

[5] Spaczyński M., Nowak-Markwitz E., Kędzia W.: “Skrining raka szyjki macicy w kraju i na świecie”. Ginekol. Pol., 2007, 5, 354. [In Polish]

[6] Nieh S., Chen S.F., Chu T.Y., Lai H.C., Fu E.: “Expression of p16 INK4a in Papanicolaou smears containing atypical squamous cells of undetermined significance from the uterine cervix”. Gynecol. Oncol., 2003, 91, 201.

[7] Saslow D., Runowicz C.D., Solomon D., Moscicki A.B., Smith R.A., Eyre H.J., et al.: “American Cancer Society guideline for the early detection of cervical neoplasia and cancer”. CA Cancer J. Clin., 2002, 52, 342.

[8] Subramaniam A., Fauci J.M., Schneider K.E., Whitworth J.M., Er ickson B.K., Kim K., Huh W.K.: “Invasive cervical cancer and screening: what are the rates of unscreened and underscreened women in the modern era?” J. Low. Genit. Tract Dis., 2011, 15, 110.

[9] Leyden W.A., Manos M.M., Geiger A.M., Weinmann S., Mouchawar J., Bischoff K., et al.: “Cervical cancer in women with comprehensive health care access: attributable factors in the screening process”. J. Nat. Cancer Inst., 2005, 95, 675.

[10] Islam S., West A.M., Saboorian M.H., Ashfaq R.: “Reprocessing unsatisfactory ThinPrep Papanicolaou test specimens increases sample adequacy and detection of significant cervicovaginal lesions”. Cancer, 2004, 102, 67.

[11] Boone J., Erickson B.K., Huh W.K.: “New insights into cervical cancer screening”. J. Gynecol. Oncol., 2012, 23, 282.

[12] The American Society for Colposcopy and Cervical Pathology (ASCCP): Cervical Cancer Screening Recommendations, 2012”. Available at: ASCCP_Cervical_Cancer_Screening_Recommendations.pdf

[13] Będziński M.: “i wsp., Korelacja pozytywnego wyniku testu na DNA HPV HR oraz genotypowania wirusów brodawczaka ludzkiego z obecnością CIN u kobiet z rozpoznaniem cytologicznym ASC-US i LSIL”. Ginekol. Pol., 2008, 79, 490. [Article in Polish]