Vol 92, No 11 (2021)
Research paper
Published online: 2021-04-22

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

Nadi Keskin1, Ismail Biyik1, Onur Ince1, Hazal Gokten1, Sercan Simsek2, Cenk Soysal1, Ozlem Erten1
Pubmed: 33914320
Ginekol Pol 2021;92(11):778-783.


Objectives: Possible discrepancies between the cervical smear, biopsy histology and loop electrosurgical excision procedure (LEEP) results of the same patient is a matter of debate in the literature. In this study, we investigate the degree to which these results differ, and the clinical reasons for these differences.
Material and methods: With a retrospective design, cervical smear, cervical biopsy and LEEP results of patients were
compared in terms of consistency. One hundred sixty-four patients who underwent till LEEP procedure due to pathologic initial smear and biopsy results between January 2015 and March 2020 were included in the study.
Results: Exact diagnosis discrepancy and high grade squamous intraepithelial lesion (HSIL) discrepancy were 78.9% and 50.0% between smear and cervical biopsy, 64.6% and 31.7% between cervical smear and LEEP and 43.8% and 28.1% between cervical biopsy and LEEP results, respectively. Age did not affect the consistency rates of pathologic results between smear-biopsy (p = 0.408) and biopsy-LEEP (p = 0.590). However, the probability of the consistency of smear and LEEP results exhibited a statistically significant linear relation with age (OR = 1.043, p = 0.015). HPV infections did not affect the discrepancy between smear-biopsy (p = 0.533), smear-LEEP (p = 1.000) and biopsy-LEEP (p = 0.529).
Conclusions: Smear technique has a serious discrepancy and under-diagnosis problem when its results are compared with biopsy and LEEP. The consistency between smear and LEEP results appears to improve with age. When HSIL is evaluated in terms of detection, this discrepancy decreases. A smear test can detect HSIL and carcinoma with a higher accuracy than low-grade lesions.

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  1. Bruni L, Albero G, Serrano B, et al. ICO/IARC information centre on HPV and cancer (HPV information centre). Human papillomavirus and related diseases in the world. Summary report. https://www. hpvcentre.net/statistics/reports/XWX.pdf (19.07.2019).
  2. Papanicolaou GN, Traut HF. The diagnostic value of vaginal smears in carcinoma of the uterus. Am J Obstet Gynecol. 1941; 42: 193.
  3. Bhattacharyya AK, Nath JD, Deka H. Comparative study between pap smear and visual inspection with acetic acid (via) in screening of CIN and early cervical cancer. J Midlife Health. 2015; 6(2): 53–58.
  4. Bobdey S, Balasubramanium G, Kumar A, et al. Cancer Screening: Should Cancer Screening be Essential Component of Primary Health Care in Developing Countries? Int J Prev Med. 2015; 6: 56.
  5. Karimi-Zarchi M, Zanbagh L, Shafii A, et al. Comparison of Pap Smear and Colposcopy in Screening for Cervical Cancer in Patients with Secondary Immunodeficiency. Electron Physician. 2015; 7(7): 1542–1548.
  6. Nkwabong E, Laure Bessi Badjan I, Sando Z. Pap smear accuracy for the diagnosis of cervical precancerous lesions. Trop Doct. 2019; 49(1): 34–39.
  7. Ibrahim SN, Krigman HR, Coogan AC, et al. Prospective correlation of cervicovaginal cytologic and histologic specimens. Am J Clin Pathol. 1996; 106(3): 319–324.
  8. Tritz DM, Weeks JA, Spires SE, et al. Etiologies for non-correlating cervical cytologies and biopsies. Am J Clin Pathol. 1995; 103(5): 594–597.
  9. Bewtra C, Pathan M, Hashish H. Abnormal Pap smears with negative follow-up biopsies: improving cytohistologic correlations. Diagn Cytopathol. 2003; 29(4): 200–202.
  10. Chappatte OA, Byrne DL, Raju KS, et al. Histological differences between colposcopic-directed biopsy and loop excision of the transformation zone (LETZ): a cause for concern. Gynecol Oncol. 1991; 43(1): 46–50.
  11. Duesing N, Schwarz J, Choschzick M, et al. Assessment of cervical intraepithelial neoplasia (CIN) with colposcopic biopsy and efficacy of loop electrosurgical excision procedure (LEEP). Arch Gynecol Obstet. 2012; 286(6): 1549–1554.
  12. Witt BL, Factor RE, Jarboe EA, et al. Negative loop electrosurgical cone biopsy finding following a biopsy diagnosis of high-grade squamous intraepithelial lesion: frequency and clinical significance. Arch Pathol Lab Med. 2012; 136(10): 1259–1261.
  13. Kabaca C, Koleli I, Sariibrahim B, et al. Is cervical punch biopsy enough for the management of low-grade cervical intraepithelial neoplasia? J Low Genit Tract Dis. 2014; 18(3): 240–245.
  14. Jung Y, Lee AhRa, Lee SJ, et al. Clinical factors that affect diagnostic discrepancy between colposcopically directed biopsies and loop electrosurgical excision procedure conization of the uterine cervix. Obstet Gynecol Sci. 2018; 61(4): 477–488.
  15. Massad LS, Einstein MH, Huh WK, et al. 2012 ASCCP Consensus Guidelines Conference, 2012 ASCCP Consensus Guidelines Conference. 2012 updated consensus guidelines for the management of abnormal cervical cancer screening tests and cancer precursors. J Low Genit Tract Dis. 2013; 17(5 Suppl 1): S1–S27.
  16. Khan MJ, Werner CL, Darragh TM, et al. ASCCP Colposcopy Standards: Role of Colposcopy, Benefits, Potential Harms, and Terminology for Colposcopic Practice. J Low Genit Tract Dis. 2017; 21(4): 223–229.
  17. Kim TH, Han JH, Shin E, et al. Clinical Implication of p16, Ki-67, and Proliferating Cell Nuclear Antigen Expression in Cervical Neoplasia: Improvement of Diagnostic Accuracy for High-grade Squamous Intraepithelial Lesion and Prediction of Resection Margin Involvement on Conization Specimen. J Cancer Prev. 2015; 20(1): 70–77.
  18. Anschau F, Guimarães Gonçalves MA. Discordance between cytology and biopsy histology of the cervix: what to consider and what to do. Acta Cytol. 2011; 55(2): 158–162.
  19. Goodman S, Mody RR, Coffey D, et al. Negative Pap tests in women with high-grade cervical lesions on follow-up biopsies: Contributing factors and role of human papillomavirus genotyping. Diagn Cytopathol. 2018; 46(3): 239–243.
  20. Poomtavorn Y, Himakhun W, Suwannarurk K, et al. Cytohistologic discrepancy of high-grade squamous intraepithelial lesions in Papanicolaou smears. Asian Pac J Cancer Prev. 2013; 14(1): 599–602.
  21. Alanbay İ, Öztürk M, Fıratlıgil FB, et al. Cytohistological discrepancies of cervico-vaginal smears and HPV status. Ginekol Pol. 2017; 88(5): 235–238.
  22. Aydogmus H, Sen S, Aydogmus S. Pathological discrepancy between colposcopic directed cervical biopsy and conisation results: A five years experience of a single center in Turkey. Pak J Med Sci. 2019; 35(6): 1627–1630.
  23. Petousis S, Christidis P, Margioula-Siarkou C, et al. Discrepancy between colposcopy, punch biopsy and final histology of cone specimen: a prospective study. Arch Gynecol Obstet. 2018; 297(5): 1271–1275.
  24. Kim SeIk, Kim SeJ, Suh DH, et al. Pathologic discrepancies between colposcopy-directed biopsy and loop electrosurgical excision procedure of the uterine cervix in women with cytologic high-grade squamous intraepithelial lesions. J Gynecol Oncol. 2020; 31(2): e13.
  25. Dalla Palma P, Giorgi Rossi P, Collina G, et al. NTCC Pathology Group. The reproducibility of CIN diagnoses among different pathologists: data from histology reviews from a multicenter randomized study. Am J Clin Pathol. 2009; 132(1): 125–132.
  26. Martin CM, O'Leary JJ. Histology of cervical intraepithelial neoplasia and the role of biomarkers. Best Pract Res Clin Obstet Gynaecol. 2011; 25(5): 605–615.
  27. Byrom J, Douce G, Jones PW, et al. Should punch biopsies be used when high-grade disease is suspected at initial colposcopic assessment? A prospective study. Int J Gynecol Cancer. 2006; 16(1): 253–256.
  28. Vooijs GP, Elias A, van der Graaf Y, et al. The influence of sample takers on the cellular composition of cervical smears. Acta Cytol. 1986; 30(3): 251–257.