Associations between sexually transmitted infections, high-risk human papillomavirus infection, and abnormal cervical Pap smear results in OB/GYN outpatients / 부인종양

OBJECTIVE: This study aimed to examine the meaning and usefulness of sexually transmitted infection (STI) test when caring for patients who have abnormal cervical cytology and/or positive high-risk human papillomavirus (HPV) DNA test results. METHODS: Among patients who underwent liquid-based cervical cytology and HPV DNA tests at the Obstetrics and Gynecology outpatient clinic, 800 patients who showed abnormal cervical cytology were compared with 200 patients in the control group. Both groups were simultaneously tested via multiplex real-time polymerase chain reaction for seven types of STI-causative microorganisms. RESULTS: The positive rate of high-risk HPV infection in total STIs positive group was 1.47 times higher than that of total STIs negative group. The probability of a cytological diagnosis of a grade equal to or higher than atypical squamous cells-cannot exclude high grade squamous intraepithelial lesion (ASC-H) was significantly higher in patients testing positive for total STIs (1.46 times), Chlamydia trachomatis (3.21 times), or Mycoplasma genitalicum (3.58 times) than in those testing negative. The total STIs positive rate was significantly higher for those having a cytological diagnosis of a grade equal to or higher than atypical squamous cells of undetermined significance (ASC-US) when high-risk HPV test result was negative. CONCLUSION: Correlations were present not only between STIs and high-risk HPV infection but also between abnormal cervical cytology and STIs. Therefore, additional evaluation of STIs will be helpful to appropriately diagnose and treat patients with abnormal cervical cytology, positive results on high-risk HPV DNA test, or a cytological diagnosis of ASC-US despite negative high-risk HPV DNA test result.

The Biopsy Correlates of Abnormal Cervical Cytology Classified According to the Bethesda System / 대한산부인과학회잡지

OBJECTIVE: The goal of this study was to examine the colposcopic findings underlying referred cytologic abnormalities classified according to the Bethesda system. Further determine the strength of correlations between the referral smear performed at colposcopy, and the histologic diagnosis. METHODS: The charts of 462 patients who had referred to our hospital due to abnormal cytology at another hospitals from Jan. 1997 to Dec. 2001 at Soonchunhyang University Chunan Hospital were retrospectively reviewed. According to the necessities, repeat Pap, colposcopy-guided biopsy and conization was done. Results were compared both with referral Pap. One way ANOVA and chi-square test were used for statistical analysis. RESULTS: The results were as follows. 1. Mean age of the patients was 46.3 +/- 3.7 years. 2. Mean interval between referral smear and repeat smear or colposcopy was 3-82 days. 3. The agreement between referral and repeat Pap smears was 48.4%, no AGUS smears were conformed by repeat cytology and abnormal referral smears reverted to negative in 36.7%: 28.6% for the women with ASCUS, 50% with AGUS, 60% with LSIL, 36.4% with HSIL, and 13% with cancer. 4. The likelihood of a negative colposcopy guided biopsy of referral Pap smears was 14.3% for the women with ASCUS, 50% with AGUS, 25% with LSIL, 15.4% with HSIL, and 0% with cancer and more severe lesion than LSIL was found in 71.4% with ASCUS, 100% with AGUS, 68.8% with LSIL, 84.6% with HSIL, 100% with cancer. 5. The likelihood of a negative colposcopy guided biopsy of repeat Pap smears was 9.1% for the women with ASCUS, 50% with LSIL, 9.5% with HSIL, and 0% with cancer and more severe lesion than LSIL was found in 90.9% with ASCUS, 50% with LSIL, 90.5 with HSIL, 100% with cancer. 6. The likelihood of a negative conization of referral Pap smears was 12.5% for the women with ASCUS, 33.3% with AGUS, 0% with LSIL, 16.4% with HSIL, and 0% with cancer and more severe lesion than LSIL was found in 87.5% with ASCUS, 66.6% with AGUS, 100% with LSIL, 83.6% with HSIL, 100% with cancer. CONCLUSION: The agreement of referral smears with colposcopic biopsy and conization was 54.3% and 51.9%, respectively. Since the cytology classified according to the Bethesda system does not accurately predict histologic diagnosis, cytologic findings should not be used to determine treatment. Further we should use other methods as colposcopy, punch biopsy and conization to determine treatment.