Clinical Significance of Unsatisfactory Conventional Pap Smears Owing to Inadequate Squamous Cellularity Defined by the Bethesda 2001 Criterion

Adams, Amy L.; Gidley, Jonathan; Roberson, Janie; Wang, Wenquan; Eltoum, Isam; Chhieng, David C.

doi:10.1309/ga19kpy3ylmkvwyu

Cited by 25 publications

(12 citation statements)

References 13 publications

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“…7 These results were similar to those mentioned by Elumir-Tanner in their review. 8 These findings challenge the notion that the Pap cytological test needs to be repeated after a period of 2-4 months, i.e.…”

Section: Introductionsupporting

confidence: 89%

Follow-up of women with inadequate Pap smears: a prospective cohort study

López-Alegría

Lorenzi

O³

2015

Sao Paulo Med. J.

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CONTEXT AND OBJECTIVE: Inadequate Pap smears do not provide satisfactory cell samples for evaluation, thus making it more difficult to detect cervical cytological abnormalities. The objective of this study was to determine the cytological and histological follow-up results from women with inadequate smear reports in primary healthcare centers in Santiago, Chile 2010-2011. DESIGN AND SETTING: Prospective cohort study at primary healthcare clinics in Santiago, Chile. METHODS:The population was taken from the "Cito-Expert" database of 2010. The data were then organized according to the cytological and histological follow-up results of 2,547 women with inadequate cervical cytological reports over the 12-month period. The samples were assigned to groups based on the cause of inadequacy (smears with endocervical cells alone; insufficient, hemorrhagic, inflammatory or poorly fixed samples; insufficient and hemorrhagic samples; or insufficient and inflammatory specimens). The data were analyzed using the "conditional probability tree diagram" and descriptive statistics. RESULT: Half of the women (n = 1,285) met the requirements of the Ministry of Health for repeating these inadequate smears, and 1,104 of these women had normal cytological results (85.9%). The detection rate for cervical lesions according to group ranged from 0% (smears with endocervical cells alone or insufficient and hemorrhagic specimens) to 4.1% (poor fixation). CONCLUSION:The large proportion of normal results justifies revision of the current clinical guidelines. The results showed that it is not necessary to repeat the Pap test early on, with the exception of inadequate hemorrhagic and inflammatory cytological results.RESUMO CONTEXTO E OBJETIVO: Esfregaços inadequados de Papanicolaou não fornecem amostra satisfatória de células para avaliação, ficando assim mais difícil detectar anomalias citológicas cervicais. O objetivo deste estudo foi determinar os resultados de seguimento citológico e histológico de mulheres com relatórios de esfregaços inadequados nas unidades básicas de saúde em Santiago, Chile, 2010. DESENHO E LOCAL: Estudo prospectivo de coorte em unidades básicas de saúde em Santiago, Chile. MÉTODOS: A população foi selecionada do banco de dados Cito-Expert em 2010. Na sequência, os dados foram organizados pelos resultados de seguimento citológico e histológico de 2.547 mulheres com relatórios inadequados de citologia cervical pelo período de 12 meses. As amostras foram atribuídas a grupos com base na causa de inadequação (esfregaços com células endocervicais; amostras insuficientes, inflamatórias, ou com má fixação, amostras insuficientes e hemorrágicas, ou espéci-mes insuficientes e inflamatórios). Os dados foram analisados com base no "conditional probability tree diagram" e estatísticas descritivas. RESULTADOS: Metade das mulheres (n = 1.285) preencheram os requisitos do Ministério da Saúde para repetir esses esfregaços; dessas mulheres, 1.104 tiveram resultados normais para citologia (85,9%). A detecção de lesões cervicais p...

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Section: Introductionsupporting

confidence: 89%

Follow-up of women with inadequate Pap smears: a prospective cohort study

López-Alegría

Lorenzi

O³

2015

Sao Paulo Med. J.

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“…Inappropriate reporting of unsatisfactory samples as negative has been shown to be a factor in false-negative cytology preceding cancer and provides clinicians and patients with false reassurance. 21,22 A high threshold results in unacceptable unsatisfactory rates with coinciding anxiety and unnecessary costs. In this RCT criteria for cellularity were based on Bethesda 2001.…”

Section: Resultsmentioning

confidence: 99%

“…The Bethesda 2001 criteria with a minimum of 8000 to 12 000 squamous cells for CP and 5000 cells for LBC were set arbitrarily and are controversial. 21,22 Some authors favor setting the threshold for LBC at 10 000 or even more squamous cells as a minimum.…”

Section: Resultsmentioning

confidence: 99%

Causes and Relevance of Unsatisfactory and Satisfactory but Limited Smears of Liquid-Based Compared With Conventional Cervical Cytology

Siebers¹,

Klinkhamer²,

Vedder³

et al. 2012

Archives of Pathology &Amp; Laboratory Medicine

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N Context.-Recent randomized controlled trials have shown a significant decrease in unsatisfactory rates for liquid-based cytology (LBC) compared with conventional Papanicolaou test (CP). The underlying causes and relevance of unsatisfactory results for LBC and CP have never been compared within the setting of a randomized controlled trial.Objective.-To examine differences in causes and relevance of unsatisfactory and satisfactory but limited by (SBLB) results for LBC and CP.Design.-Data from the Netherlands ThinPrep Versus Conventional Cytology (NETHCON) trial were used, involving 89 784 women. Causes and relevance of unsatisfactory and SBLB results were analyzed.Results.-The primary cause for unsatisfactory results for CP and LBC was scant cellularity. Other causes for unsatisfactory CPs were virtually eliminated with LBC. The same was true for SBLB subcategories, with the exception of SBLB absence of transformation zone component and SBLB scant cellularity. The SBLB absence of transformation zone component showed a statistically significant 22% and SBLB scant cellularity a 12% nonsignificant increase with LBC. The detection rates of abnormalities found during 18 months of follow-up of unsatisfactory test results did not differ significantly between the 2 study arms, nor did they differ from the initial test positivity rates from the NETHCON trial.Conclusions.-Liquid-based cytology shows an almost complete elimination of most causes for unsatisfactory CP, with scant cellularity remaining as the sole cause for unsatisfactory LBC. On the other hand, with LBC a significant increase of smears without a transformation zone component was noted. Women with an unsatisfactory test result are not at increased risk for cervical abnormalities either with LBC or with CP.Trial Registration.-Nederlands Trial Register, NTR1032, www.trialregister.nl.(Arch Pathol Lab Med. 2012;136:76-83; doi: 10.5858/ arpa.2011-0113-OA) L iquid-based cytology (LBC) has been largely adopted as an alternative to cervical cancer screening with conventional Papanicolaou tests (CP) in many Western countries. However, recent evidence from 2 randomized controlled trials (RCTs) 1,2 and a meta-analysis comparing the performance of LBC and CP 3 supports the conclusion of equal accuracy for both methods. Yet the RCT has shown a significant decrease in unsatisfactory rates for LBC as compared with CP. 4 Unsatisfactory tests account for a number of screening failures, and are a source of distress to women and a waste of resources.5 It is assumed that LBC decreases the unsatisfactory rate by reducing the number of cases that are inadequate because of obscuring inflammatory cells and blood or because of inhomogeneous distribution or bad fixation of cells. However, to our knowledge differences in the underlying causes and relevance of unsatisfactory smear results for LBC as compared with CP have never been investigated within the setting of an RCT. The aim of the study is to examine the underlying causes for inadequacy in LBC and CP, using the data of the Neth...

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“…A similar conclusion was reached in a recent study in which women who had an unsatisfactory index Pap smear had a higher hazard rate for histologic CIN-2/CIN-3 or invasive squamous cell carcinoma, especially during the first 2 years of follow-up. 50 However, Adams et al 15 observed no differences in the incidence of squamous abnormalities detected on follow-up between patients who had unsatisfactory Pap smears because of inadequate squamous cellularity, as defined by the 2001 Bethesda System, and patients who had satisfactory and negative smears.…”

Section: Unsatisfactory Lb Pap Tests/alsharif Et Almentioning

confidence: 99%

“…Furthermore, the evidence that there is an increase in abnormalities in the follow-up of women with unsatisfactory conventional Pap smears also is controversial, because the 2 studies that have attempted to address that issue using traditional and 2001 Bethesda adequacy criteria, respectively, reached different conclusions. 14,15 The objective of the current study was to asses the frequency, causes, and significance of unsatisfactory SurePath PTs, as defined by the 2001 Bethesda System, in a population that was screened predominantly by LBPTs. In addition, we compared the incidence of squamous abnormalities that occurred within a 2-year follow-up period in patients who had unsatisfactory SurePath PTs with the incidence of a matched group of patients who had negative SurePath PTs that were accessioned during the same period.…”

mentioning

confidence: 99%

Unsatisfactory SurePath liquid‐based Papanicolaou tests

Alsharif

McKeon

Gulbahce

et al. 2009

Cancer Cytopathology

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BACKGROUND:The introduction of liquid‐based Papanicolaou (Pap) tests (LBPTs) has reduced the incidence of unsatisfactory Pap tests (UPTs), but little is known about their causes and significance, especially in the case of SurePath LBPTs.METHODS:All unsatisfactory LBPTs from January 1, 2003 to December 31, 2006 were retrieved. The characteristics of patients, providers, and LBPTs; the reason for UPTs; and any cytologic or histologic follow‐up within 24 months were recorded. Negative Pap tests that were evaluated immediately after a UPT served as a control group.RESULTS:Of 243,006 Pap tests (95.5% SurePath LBPTs), 0.23% were unsatisfactory. Scant cellularity was the primary cause of SurePath UPT. Women in this UPT group were older, had more diagnostic Pap tests taken, less frequently were taking contraceptives or were pregnant, and were more likely to be menopausal or posthysterectomy. The 278 women who had UPTs had significantly higher rates of follow‐up Pap tests (65.1% vs 22.2%), abnormal Pap tests (5.4% vs 1.4%), biopsies (10% vs 1%), and abnormal biopsies (5% vs 1%) than the 284 women in the control group, including 7 women with cervical intraepithelial neoplasia 1 (CIN‐1), 1 woman with CIN‐2, 4 women with CIN‐3, and 2 women with endometrial hyperplasia. The UPT rates varied little between provider groups (physicians vs nonphysicians and gynecologists vs nongynecologists).CONCLUSIONS:The frequency of UPTs in a predominantly SurePath LBPT‐screened population was very low and was caused mainly by low cellularity. Similar to conventional Pap smears, unsatisfactory SurePath LBPTs had a higher risk of significant histologic abnormalities on follow‐up than negative satisfactory Pap tests and could have benefited from a repeat Pap test or other evaluation, according to current management guidelines. Cancer (Cancer Cytopathol) 2009. © 2009 American Cancer Society.

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Clinical Significance of Unsatisfactory Conventional Pap Smears Owing to Inadequate Squamous Cellularity Defined by the Bethesda 2001 Criterion

Cited by 25 publications

References 13 publications

Follow-up of women with inadequate Pap smears: a prospective cohort study

Follow-up of women with inadequate Pap smears: a prospective cohort study

Causes and Relevance of Unsatisfactory and Satisfactory but Limited Smears of Liquid-Based Compared With Conventional Cervical Cytology

Unsatisfactory SurePath liquid‐based Papanicolaou tests

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