A retrospective review of cervical cytology in women developing invasive squamous cell carcinoma

Abstract

The records of 93 women who presented with invasive squamous cell carcinoma were searched for evidence of cervical cytology during the years preceding this diagnosis; a search was also made through the files of local laboratories and contact was made with general practitioners and relevant hospital departments. Only 26 (28%) of these 93 women had had a cervical smear at any time before the diagnosis of invasive cancer, and only 11 (12%) had had regular cytological survcillance. Fifteen (60%) had had a smear taken and reported as negative within the previous 5 years, six (6%) within the previous year. Eleven of these 15 slides were obtained for review: three were regarded as positive and three more were re-classed as too scanty for conclusive assessment. In nine of the 67 women who had never had a smear, a gynaecological or obstetric examination was known to have been performed or indicated within the previous 5 years, thereby representing a missed opportunity for screening. In three patients cytological abnormalities had been reported within the previous 3 years but no action had been taken.

Smear misclassification in a cervical cancer screening programme

“…There was less variation between the smears from cases and from controls in the percentages of unsatisfactory, which varied between 13-25% among smears from cases and 15-29% among smears from controls. (Mitchell et al, 1988) to 64% (Attwood et al, 1985) previously reported in the predominantly small series of patients with invasive cervical cancer for whom the previous negative smears have been reviewed (Rylander, 1977;Gad & Koch, 1978;Berkowitz et al, 1979;Berkeley et al, 1980;Holman et al, 1981;Morell et al, 1982;Walker et al, 1983: Paterson et al, 1984Gay et al, 1985;Attwood et al, 1985;Graff et al, 1987;Mitchell et al, 1988;Mitchell et al, 1990).…”

Controle da qualidade em colpocitologia: visão rápida com campo marcado

“…Muitos autores (6,18,21,27,28,32,35,36) salientam que podem ocorrer erros no diagnóstico do teste de Papanicolaou.…”

Review of invasive cervical cancers and uptake of disclosure of results: an audit of procedures and response

“…Since the early days of screening, there has been considerable interest in exploring the cytological history of women enrolled in the programme who subsequently developed cervical cancer. Several studies during the 1980–90s 1–3 reviewed previously negative smears and proposed misclassification of smears as a potential contributing factor in the development of invasive disease. These findings were also seen in the Leicestershire audit of invasive cervical cancers, 4 which resulted in the issue of errors in cytological interpretation as part of the screening programme, being brought to the media’s attention.…”