Evaluation of PAPNET-assisted cervical rescreening.

We have compared the results of targeted manual rescreening of 1211 randomly selected smears with the results of PAPNET-assisted rescreening of 1613 cervical smears, containing at least 6.3% low-grade squamous intraepithelial lesion (SIL). PAPNET diagnosis and the targeted rescreening diagnosis were compared with the initial report, issued on the corresponding smear. Reproducibility scores for inadequacy, presence of endocervical and endometrial cells, specific infections and squamous cell abnormalities were determined. The reproducibility scores for the diagnosis of inadequate smears and specific infections were lower with the PAPNET-assisted rescreening. The detection of squamous cell abnormalities was excellent for both methods (> 0.95), with a higher detection rate for false-negative smears with the PAPNET testing system.

Negative cervical smears before CIN 3/carcinoma. Reevaluation with the PAPNET Testing System.

OBJECTIVE: To test the effectiveness of the PAPNET testing system in identifying false negative smears, using archival cervical cytologic smears from women with histologically proven diagnoses of high grade lesions and carcinoma of the uterine cervix. STUDY DESIGN: Forty-six negative smears from women who developed a high grade cervical intraepithelial lesion (CIN 3) or carcinoma of the uterine cervix within three years were retrieved from the archives, plus 20 consecutive control smears for each case. The smears were analyzed with the PAPNET testing system, and the selected cells were reviewed by a cytotechnologist using a strict protocol. RESULTS: With the PAPNET testing system, 9 of 46 (20%) smears were positive. Seven were reclassified as low grade and two reclassified as high grade squamous intraepithelial lesion (SIL). One of the 31 initially positive smears in the control group of 920 smears was not recognized as such. In the control group of 889 negative smears, 14 newly identified positive cases (1.6%) were detected, all low grade SIL. CONCLUSION: The PAPNET testing system is a good tool for detecting false negative smears and, when used as an adjunct to conventional screening, can reduce the false negative rate.

[The significance of endometrial cells in the cervical smear]. / De betekenis van endometriumcellen in de cervixuitstrijk.

Presence of atypical endometrial cells in a cervical smear is quite unusual; but if they are found the woman needs extra attention because of the risk of adenocarcinoma of the uterus. Postmenopausal women sometimes also have endometrial cells without atypia in the cervical smear, as a sign of endometrial pathology. We conducted a retrospective follow-up study of these women. From 1978 to 1989, 52 smears from a total of about 50,000 postmenopausal women were classified as Pap IIIA, due to the presence of normal endometrial cells. Histological follow-up was performed in 25 cases and 3 times an adenocarcinoma of the endometrium was diagnosed (6%). The smears from 142 women (pre- and postmenopausal) contained atypical endometrial cells and therefore were classified as Pap IIIA or higher. Histological follow-up was performed in 104 cases. In 48% (n = 68) an adenocarcinoma was diagnosed. In 75% of these cases (n = 51) the atypical cells were graded as severe or worse (> or = Pap IIIB). Cervical smears are not taken to detect pathology of the endometrium, but whenever atypical cells are found in the smear there is a strong indication for further (gynaecological) examination.

[Cervix smears with mild atypia classified as Pap-class IIIA: results of a changed policy]. / Cervixuitstrijken met geringe atypie ingedeeld in Pap-klasse IIIA: resultaten van een gewijzigd beleid.

To evaluate the changed policy regarding cervical smears with mild atypia in the Netherlands (before 1988 classified as Pap II, thereafter as Pap IIIA), an descriptive study was carried out in the laboratory of gynaecological cytology Cyt-U-Universitair (University of Utrecht). All women who in 1988 had a first smear with mild atypia were included. After a follow-up period of 2 years the final diagnosis was noted. The results of the follow-up of cervical smears with mild atypia were compared with the follow-up results of moderate atypia. A selection was made of 477 women. In 55% of the cases no dysplasia was found during the 2 years of follow-up. In 12% of the cases severe dysplasia, carcinoma in situ or carcinoma was found. Compared with the smears with moderate atypia the dysplasia in the follow-up of mild atypia led to fewer cases of proven dysplasia. In addition the dysplasia in these cases was of a lower grade. The group of women referred to the gynaecologist after the smear with mild atypia was remarkably large (30%). As the results show, the policy of careful follow-up of women with mild atypia in the cervical smear has been a good one. It implies classifying mild atypia as Pap IIIA. As many women (55%) do not display cervical dysplasia within a 2 year follow-up period, the policy of making a repeat smear before referring appears justified.