Abnormal Pap-smear frequency and comparison of repeat cytological follow-up with colposcopy during patient management; The importance of pathologist's guidance in the management

Abstract

OBJECTIVE: Cervical cancer contributes to a significant global health burden with room for improvement of primary prevention methods. This study aimed to determine the prevalence of Turkish women with abnormal cytology and their management by comparing results from repeat cytological analysis with close follow-up and colposcopy. METHODS: A retrospective evaluation of 8738 women who underwent Pap smears at a single institution during 2011 was performed. Either repeat cytological analysis or colposcopic biopsy was used for follow-up evaluation of women who had abnormal index cytology. RESULTS: From the 8670 women, 8259 of had normal cytology results (95.3%) and 411 women had abnormal cytology (4.7%) in the index Pap smear. The frequency of initial abnormal cytology was 65% (n=267), 27% (n=111), 3.4% (n=14), 2.4% (n=10), 1.9% (n=8), and 0.3% (n=1) for atypical squamous cell of undetermined significance (ASCUS), low-grade squamous intraepithelial lesion (LSIL), ASC cannot exclude high-grade intraepithelial lesion (ASC-H), high-grade SIL (HSIL), atypical glandular cells (AGC), and invasive cancer, respectively. Of the 267 women with initial ASCUS, 108 (40.4%) underwent repeat cytology analysis, 84 (31.5%) underwent colposcopic biopsy, and 75 (28.1%) were lost to follow-up. On histopathology, 8.3% (n=7) of patients had cervical intraepithelial neoplasm 2 (CIN2) on colposcopy. Of 60 women with LSIL that underwent colposcopic biopsy, 13.3% (n=8) had CIN2/3. CONCLUSION: The results of the study suggest that routine cytological follow-up may be an appropriate method in the management of ASCUS instead of immediate colposcopy while immediate colposcopy cannot place repeat cytology for LSIL in developing countries.

Cervical polyp: evaluating the need of routine surgical intervention and its correlation with cervical smear cytology and endometrial pathology: a retrospective study

“…It is well known that genetic (e.g., BRCA1, BRCA2 and Lynch syndrome) and hormonal (e.g., estrogen) factors play a role in the etiology of endometrial hyperplasia and malignancy [ 27 ]. Therefore, similar genetic and hormonal factors may also play a role in the etiology of cervical polyps [ 11 , 28 ]. Furthermore, endometrial pathologies may exist in the presence of a cervical polyp, irrespective of the presence or absence of symptoms.…”

Progression Low Squamous Intraepithelial Lesion and Human Papillomavirus Infections

“…Human Papillomavirus infection is the main cause of cervical carcinoma. There are at least 15 high-risk HPV types that are significantly connected with progression of squamous intraepithelial lesion (SIL) into cervical carcinoma ( 2 ).…”

Cytological, Colposcopic and Pathohistological Correlation of HSIL and ASC H Findings

“…Cervical carcinoma is the third most common carcinoma in women and second most common cause of death, including 300,000 deaths annually ( 1 ). In Bosnia and Herzegovina 556 cases of cervical carcinoma are diagnosed annually, and 141 women die of it according to the ICO/IARC report from 2019 ( 2 , 3 ).…”