ABSTRACT
The Bethesda System [TBS] for reporting the results of cervical cytology was developed as a uniform system of terminology that would provide clear guidance for clinical management. According to TBS, the diagnostic report should include a recommendation for further evaluation when appropriate. The aim of this wok was to use TBS terminology in classification of abnormal cervical Pap smears or with persistent significant inflammatory changes, and correlate the results with the final histopathological findings for optimum evaluation and clinical use. This prospective study was conducted in the Cytocolposcopic Unit of Teaching Laboratories and Outpatient Department of Medical City Teaching Hospital over a period of one year [Sep. 2001- Sep. 2002]. Eighty-three married females were included in the study. A cervical smear was taken followed by a punch biopsy, taken under colposcopic guidness, from the suspicious lesions for histopathological study. All cytological interpretations were reported and categorized according to The Bethesda System [TBS]. The rate of different cytological and histopathological findings and a comparison between the results were estimated by a special statistical analysis. Minimal cytological abnormalities were significantly more common than high-grade squamous intraepithelial lesion/HGSIL [95.5% compared to 4.5% respectively]. Atypical squamous cells of undetermined significance/ASCUS, as a single entity, was the most common cytological abnormality [44.8%], followed by low-grade squamous intraepithelial lesion/LGSIL [41.8%], atypical glandular cells of undetermined significance/AGUS [9%], and then HGSIL [4.5%]. [24.1%] of ASCUS in cytology was associated with underlying CIN [SIL] lesions in: histopathology, out of those, [20.7%] had CIN1/LGSIL and [3.4%] had CINII-III/HGSIL [14.3%] of cases with LGSIL.in cytology had CIN II-III [HGSIL] in histopathology, while HGSILs in cytology were associated with 100% high-grade lesions in histopathology. The most common cytologic diagnoses immediately preceding the discovery of histologic HGSIL were LGSIL [57.1%], ASCUS [14.3%], and then HGSIL [28.6%]. Minimal cytological abnormalities in cervical smears were significantly more common than HGSIL. ASCUS, as a single entity, was the most common cytological abnormality. All cases of HGSIL, in cytology, were found to have the same diagnosis by histopathology. So all cases with HGSIL in cytology should be immediately referred for colposcopy for final diagnosis. On the other hand, cases with minor cytological abnormalities were found to have high-grade lesions in histopathology in only 3.3% of women referred with ASCUS smears, and 14.3% of those with LGSIL smears. The latter finding demonstrates that an adjunctive method like colposcopy or close follow-up [particularly with three-smear follow up] is recommended to rule out high-grade lesions
ABSTRACT
An optimal cancer detection system for preclinical cervical lesions should combine a cytological examination with a colposcopic follow-up examination. Detection at early pre-invasive stage provides an opportunity for treatment to prevent progression to invasive cancer. The present study aimed at evaluation of cytology, colposcopy, and combined cytology and colposcopy in predicting histopathological diagnosis of cervical intraepithelial neoplasia/squamous intraepithelial lesion [CIN/SIL] or other neoplastic changes in patients with abnormal cervical cytological findings. This prospective study was conducted in the Cyto-colposcopy Unit of Teaching Laboratories and Outpatient Department of Medical City Teaching Hospital over a period of one year [Sep. 2001- Sep. 2002]. Eighty-one married females were included in the study. A cervical smear was taken followed by a colposcopic examination of the cervix and then a punch biopsy was taken from the suspected lesions for histopathological study. Estimation and evaluation of the validity parameters of cytology, colposcopy, and combined cytology and colposcopy were performed using different cutoff points by special statistical analysis. Sensitivity, specificity and accuracy of cytology in the diagnosis of CIN/SIL were 73%, 93.2% and 84.0% respectively. The False- negative rate was 27%. Sensitivity, specificity and accuracy of colposcopy in the diagnosis of CIN were 83.3%, 58.5% and 70.1% respectively choosing doubtful findings as a cut-off point. The combination of cytology and colposcopy gave the following results: sensitivity, specificity and accuracy were 94.6%, 61.4% and 76.5% respectively; the negative predictive value [NPV] was 93.1%. When suspicious colposcopic findings were chosen as the cut-off point, the specificity and the positive predictive value [PPV] were higher at the expense of sensitivity and NPV. The conventional Pap smear, a valuable tool in the evaluation of patients with abnormal cervical cytology, was found to be of relatively low sensitivity in predicting CIN/SIL. Colposcopy is a valuable tool too. However, the validity parameters showed variable figures depending on the different cut-off points applied for the diagnosis of CIN/SIL. The ideal cut-off point was when doubtful and higher-grade colposcopic lesions are considered positive. The combination of cytology and colposcopy resulted in an increased sensitivity and NPV. The specificity could be further increased or improved when the threshold was set to distinguish higher-grade lesions [suspicious lesions] from lesser abnormalities