Cytohistological discrepancies of cervico-vaginal smears and HPV status

Abstract

Objectives: Discrepancies between abnormal cervical cytology or high-risk human papillomavirus (HR-HPV) status (cytology negative/HPV positive) and subsequent histological findings are a common occurrence. After using co-testing, the discrepancies between the HR-HPV status and cervical cytology have become an issue. In this study, we aimed to determine the characteristics of women with a discrepancy between histology and cytology/HR-HPV status, in terms of diagnosis, review and identification. Material and methods:A total of 52 women, patients of the University Hospital between 2013-2015, with cytohistological or HR-HPV status discrepancy were recruited for the study and retrospectively analyzed. The cytological samples were liquid-based Pap smears, classified according to the 2001 Bethesda system. The HR-HPV status was identified using the Hybrid Capture 2 HR-HPV DNA assay. The histological samples were obtained by cervical biopsy as well as large loop excision of the transformation zone (LLETZ). Results:A cytohistological discrepancy was demonstrated in patients with (-)cytology/HR-HPV(+), ASCUS, LSIL, ASC-H, HSIL, AGC-NOS: 17.3%, 23.07%, 26.9%, 9.5%, 17.3% and 5.7%, respectively. When the degree of atypia in cytology increases, the concurrency of cervical cytology with biopsy also increases. A positive HR-HPV co-test result (19/24, 79.1%) was observed in nearly all CIN2 ≥ (+) cases. Our study emphasizes the significance of HR-HPV testing to determine CIN2 ≥ (+) cases, even in the presence of a normal cytological result. Conclusions:In case of cytohistological or HR-HPV discrepancies, a careful review of the HR-HPV status and the degree of cytological atypia should be performed before further intervention.

Evaluation of the consistency ratios of cervical smear, cervical biopsy and conization results

“…Poomtavorn et al [20], report the rate of colposcopic cervical biopsy discrepancy as 45.7% with the Pap smear test and the rate of colposcopic directed biopsy histology discrepancy as 29.5% with the Pap smear test. Alanbay et al [21], report that when the level of atypia increases in cervical cytology, cytology-histology consistency rate increases. In our study, while the exact diagnosis of cervical cytology with LEEP was 27.3% for LSIL, this rate increased to 81.8% for HSIL.…”

Diagnostic Test Accuracy Review of Cytology for Squamous Intraepithelial Lesion and Squamous Cell Carcinoma of Uterine Cervix

“…Previous studies show that the ranges of sensitivities and specificities of cytology and HPV test varied widely 39. In the eligible studies, sensitivities and specificities of cytology ranged from 22.4% to 99.4% and 0.0% to 99.0%, respectively 1234567891011121314151617181920212223242526272829303132333435363738. Therefore, it is useful to assess the diagnostic accuracy of a screening test to predict the presence of SIL and SqCC in the uterine cervix by performing a meta-analysis, including a DTA review.…”

“…These tests have contributed to a decrease in the incidence of cervical cancer, especially in geographic areas supported by well-organized screening programs 1. Although several studies have reported on the diagnostic accuracy of the cervico-vaginal smear, results showed a wide range of estimated sensitivity compared to the specificity 1234567891011121314151617181920212223242526272829303132333435363738. Because the diagnostic accuracy can be affected by variable factors, including study time, geographic area, and population,1234567891011121314151617181920212223242526272829303132333435363738 it should be fully elucidated based on these standardized parameters, including the diagnostic grades of cytology.…”

Human Papilloma Virus Genotype Distribution in Women with Cervical Intraepithelial Neoplasia

“…The discrepancy between the abnormal cervical cytology and histological findings of the specimen obtained by biopsy is reported by other investigators. 24 The sensitivity of cervical cytology versus HPV testing as a triage testing has been investigated for different cervical lesions in order to avoid false negative results and unnecessary invasive procedures due to false positive results. 25,26 There is an ongoing dilemma about the most reliable method that can be used for cervical cancer screening; cervical cytology versus HPV testing.…”