ABSTRACT
In our study, we investigated the factors that may participate to false-negative colposcopic biopsy results. It was a descriptive study. Damanhour National Medical Institute Hospital [DNMI] during the period from January 2004 to August 2006. A computerized search identified patients with ASC Pap test results and positive results of reflexive high-risk HPV DNA testing during the period of study. Patients who underwent subsequent colposcopic-directed biopsy and/or endocervical curettage with no histologic evidence of HPV infection or dysplasia were selected for the study. Three levels were obtained from each block and stained with H and E. The original H and E-stained glass slides were reviewed. For cases that still were diagnosed as negative for dysplasia or HPV cytopathic effect on review, 3 additional H and E-stained levels were obtained. For the few cases in which there was disagreement with regard to the original and reviewed diagnoses, the discrepancy was recorded, and no other tissue sections were ordered. Patients with atypical squamous cells of undetermined significance [ASC] in Papanicolaou smears, with positive HPV DNA results, but negative cervical histopathologic findings accounted for 4.5% of all ASC smears submitted for HPV DNA testing. We found 4% of the cases had focal HPV infection or mild dysplasia. When serial sectioning of the biopsy material were examined, we found that 31% had clinically significant lesions: HPV infection or cervical intraepithelial neoplasia [CIN] 1, 19%; CIN 2/3, 8%; and dysplasia, not otherwise specified, 3%. Of the remaining patients, follow-up revealed squamous abnormalities in 25%. About 5% of patients with positive HPV DNA results had a negative follow-up biopsy result. [False-negative] biopsies.We recommend that additional levels have to be obtained when initial histologic sections do not demonstrate evidence of dysplasia or HPV cytopathic changes after a cytologic diagnosis of ASC and a positive HPV DNA test result