Repeat Cervical Cytology at the Time of Colposcopy

Simsir, Aylin; Ioffe, Olga B.; Bourquin, Patricia M.; Brooks, Sandra E.; Henry, Michael

doi:10.1159/000327183

Cited by 14 publications

(12 citation statements)

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“…Simsir et al 7 stated that colposcopic biopsy and repeat cytology should be considered as complementary procedures and that the role of repeat cytology is not to avoid biopsy but to enhance sensitivity in the detection of highgrade lesions. Zardawi and Rode 10 established that a second cevical smear at the time of colposcopy is justifiable in the group with low-grade changes on the first smear.…”

Section: Discussionmentioning

confidence: 99%

“…7,10 This would be the higher economic and social impact of this procedure. New technologies such as LBC and HPV testing have not been extensively used in Brazil considering that they added cost.…”

Section: Discussionmentioning

confidence: 99%

“…2,5 Performing a repeat cervical smear just prior to colposcopy is a common procedure in the management of women referred because of an abnormal initial smear. 6,7 The rationale for recommending this procedure is that it facilitates the direct comparison of biopsy, smear, and colposcopy findings, particularly when patients are referred from other institutions. 1 Lesions may progress or regress, even over relatively short periods of time.…”

mentioning

confidence: 99%

“…Therefore it is logical to expect that a cervical smear taken at the time of colposcopy would reflect the actual state of the lesion more accurately than one taken weeks or months earlier. [6][7][8][9] In fact, when colposcopy findings fail to agree with the abnormal referral smear, patients may be submitted to invasive procedures based on a single abnormal result when the lesion may have resolved itself or the initial diagnosis may have been erroneous. 7,10 On the other hand, recent studies suggest that the value of repeating a cervical smear at the time of colposcopy may be low, with sensitivity ranging from 25 to 57%.…”

mentioning

confidence: 99%

“…[6][7][8][9] In fact, when colposcopy findings fail to agree with the abnormal referral smear, patients may be submitted to invasive procedures based on a single abnormal result when the lesion may have resolved itself or the initial diagnosis may have been erroneous. 7,10 On the other hand, recent studies suggest that the value of repeating a cervical smear at the time of colposcopy may be low, with sensitivity ranging from 25 to 57%. [11][12][13][14][15] Possible mechanisms that justify this low sensitivity include recent removal of the neoplastic cells and the fact that, after the initial scraping, the abnormal cells are not so easily exfoliated.…”

mentioning

confidence: 99%

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Usefulness of repeat cytology at the time of first colposcopy

Alves

Rabelo-Santos

Ribeiro

et al. 2008

Diagnostic Cytopathology

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The value of repeat cytology in the detection of high-grade preinvasive or invasive disease was analyzed at the time of colposcopy in cases of patients with abnormal referral cytology. A series of 136 patients with squamous abnormalities in their referral cytology, who had undergone repeat cytology and for whom outcome had been established, were included in the study. Final diagnosis consisted of 27 negative results (20%), 37 cases of CIN1 (27%), 31 CIN2 (23%), 39 CIN3 (29%), and 2 (1%) cases of squamous cell carcinoma (SCC). Referral and repeat cytology suggestive of atypical squamous cells cannot exclude high-grade squamous intraepithelial lesion (ASC-H), high-grade squamous intraepithelial lesion (HSIL) were findings significantly associated with a final diagnosis of CIN2 or worse. Sensitivity and positive predictive value of repeat cytology for the histological diagnosis of significant histological neoplasia (CIN2 or worse) were 81.9% and 77.6%, respectively. In women with referral cytology findings of atypical squamous cells of undetermined significance or low-grade squamous intraepithelial lesion (ASC-US/ LSIL), repeat cytology was suggestive of HSIL in 20% of cases (11/ 54), and in 4% (2/54) biopsy was negative or CIN1, and the final diagnosis established by LLETZ was CIN3. Eight cases (10%) of HSIL in referral and repeat cytology in which biopsies were negative or insufficient were diagnosed as CIN3 or worse in the final diagnosis. Repeat cytology would have changed therapeutic management in 4 and 10%, respectively, of patients included as ASC-US/ LSIL and ASC-H/HSIL in referral cytology. Diagn. Cytopathol. 2009;37:68-73. ' 2008 Wiley-Liss, Inc.Key Words: cytology; colposcopy; CIN; outcome Conventional cervical cytology is the worldwide screening test for cervical cancer and its accuracy has been discussed recently. The levels of sensitivity and specificity of cervical cytology vary greatly. A meta-analysis on the accuracy of cervical cytology estimates sensitivity and specificity ranging from 11 to 99% and 14 to 97%, respectively. 1,2 New technologies such as liquid-based cytology (LBC) and human papilloma virus (HPV) testing have been introduced into cervical cancer screening. However, there is continuous debate about whether society's limited resources are better spent on reaching the underserved rather than on these technologies. 3 Davey et al. 4 in a meta-analysis did not show evidence that LBC reduced the proportion of unsatisfactory slides or detected more high-grade lesions in high-quality studies than in conventional cytology. This review does not lend support to claims of better performance by liquidbased cytology. In addition, although HPV-DNA testing had higher sensitivity for detecting high-grade squamous intraepithelial lesions, its specificity is lower than that of cytology, particularly in younger women, and this represents an important restriction to the adoption of this technique as a single screening tool. 2,5 Performing a repeat cervical smear just prior to colposcopy is a common pr...

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%