Discrepancy between Cytology and Histology in Cervical Cancer Screening: a Multicenter Retrospective Study (KGOG 1040)

Abstract

Background Cervical cancer is the fourth common cancer in women worldwide. The Papanicolau test is the primary screening procedure to detect abnormal cervical cells. Colposcopy is the main procedure for discriminating high-grade cervical lesions. The study aimed at clarifying the discrepancy between cervical cytology and colposcopic biopsy histology as well as confounding factors. Methods Eligible patients visited thirteen tertiary hospitals for colposcopic biopsy following cervical cytology and human papillomavirus (HPV) genotypes between January and December 2018. Baseline characteristics including age, body mass index (BMI), and parity were collected. Results In our study, 3,798 eligible patients were included. Mean age of patients was 42.7 (19–88) years and mean BMI was 22.5 (16.9–34.1) kg/m 2 . The referred cervical cytologic findings consisted of 495 normal, 1,390 atypical squamous cells of undetermined significance, 380 atypical squamous cells cannot exclude high-grade squamous intraepithelial lesion, 792 low-grade squamous intraepithelial lesion, 593 high-grade squamous intraepithelial lesion, 79 atypical glandular cells, 46 squamous cell carcinoma, and 23 adenocarcinoma. HPV-positive findings were found in 3,008 (79.2%) patients and were not detected in 914 (24.1%) cases. The risk of unexpected low-grade lesions from histology was higher in patients > 45 years (odds ratio [OR], 2.137; 95% confidence intervals [CIs], 1.475–3.096). In contrast, the risk of unexpected high-grade lesions from colposcopic biopsy was lower in patients ≥ 45 years (OR, 0.530; 95% CI, 0.367–0.747) and HPV 16/18 infection was higher than other HPV (OR, 1.848; 95% CI, 1.385–2.469). Conclusion Age and HPV genotypes were responsible for the discrepancies between cytology and histology. Precautions should be taken for women over the age of 45 in triage for colposcopy in order to avoid unnecessary testing.

Cervical Cytology–Histology Correlation Based on the American Society of Cytopathology Guideline (2017) at the Russian National Medical Research Center for Obstetrics, Gynecology, and Perinatology

“…hrHPV: Several recent studies investigated the impact of hrHPV on CHC results [ 35 , 36 , 37 ]. For example, a multicentric Korean study (Ouh et al) found a higher risk for initial overcall in patients with hrHPV [ 35 ].…”

“…hrHPV: Several recent studies investigated the impact of hrHPV on CHC results [ 35 , 36 , 37 ]. For example, a multicentric Korean study (Ouh et al) found a higher risk for initial overcall in patients with hrHPV [ 35 ]. By contrast, our obtained findings did not show a strong relationship between HPV status and cytologic–histologic discrepancies ( p = 0.221).…”

Factors Associated with Cyto-Histological Misinterpretation of Cervical Smear according to Menopausal Status

“…Samaha et al [ 12 ] conducted a retrospective study of Egyptian women of ages 25–65 years, where the prevalence of hrHPV in abnormal Pap smears was 48.2%. Ouh et al [ 13 ] reported HPV positivity in 79.2% of ages 19–88 years with an abnormal Pap smear. Chinese study showed that the overall HPV infection rate was 84.37% in patients with CIN 1 and CIN 2-3 [ 14 ].…”

Application of cyto-histological correlation as a quality control in diagnosing cervical pathology

“…Преимущества данной методики в простоте получения материала с возможностью самозабора и высокой чувствительности метода. Однако по сравнению с цитологическим исследованием метод имеет более низкую специфичность и высокую себестоимость [3,4]. Согласно приказу Минздрава России от 13.03.2019 № 124н «Об утверждении порядка проведения профилактического медицинского осмотра и диспансеризации определенных групп взрослого населения» на территории страны действует программа скрининга рака шейки матки, реализуемая посредством цитологического исследования.…”

“…Согласно приказу Минздрава России от 13.03.2019 № 124н «Об утверждении порядка проведения профилактического медицинского осмотра и диспансеризации определенных групп взрослого населения» на территории страны действует программа скрининга рака шейки матки, реализуемая посредством цитологического исследования. Данный тест является недорогим, высокоспецифичным, но в то же время сильно зависит от уровня подготовки персонала и правильности проведения преаналитического этапа [3][4][5].…”