Abstract
The aim of the present study was to evaluate the effect of age and human papillomavirus (HPV) infection associated cellular changes on the predictive value of cervical cytology. In a group of 671 women with Papanicolaou smears suggesting low grade squamous intraepithelial lesion (LSIL), high grade squamous intraepithelial lesion (HSIL) or invasive cervical cancer, cervical cytology was correlated with the histological finding. Predictive values were calculated and related to severity of the lesion, age and HPV associated changes. The predictive values of Papanicolaou (cervical) smears suggesting LSIL, HSIL and invasive carcinoma were 40%, 86%, and 78%, respectively. A poor predictive value of smears suggesting LSIL was found among older women. HPV associated changes were diagnosed in 80% of women ≤25 years of age, 66% in the age group 26 to 35 years, 51% in the age group 36 to 45 years and 38% in women aged ≥46 years (P = 0.03). The presence of HPV associated cellular changes led to a significantly higher number of overdiagnoses (9% with HPV infection compared to 4% without HPV infection) and HPV negative cases were more frequently associated with underdiagnosis (15% without HPV infection compared to 8% with HPV infection,P = 0.0011). This result remained significant after adjustment for age (P = 0.004). Cellular changes associated with HPV infection most frequently occurred in young women. HPV infection should therefore be acknowledged as source of overdiagnosis in the cytological evaluation of SIL especially in woung women.
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References
Anonymous (1989) The 1988 Bethesda System for reporting cervical/vaginal cytological diagnoses. National Cancer Institute Workshop. JAMA 262:931–934
Anonymous (1993) The Bethesda System for reporting cervical/vaginal cytologic diagnoses: revised after the second National Cancer Institute Workshop 1991. Acta Cytol 37:115–124
Crescini C, Pezzica E, Artuso A, Comerio D, Reale D, Bonaldi A (1991) Colposcopic-histologic results in 97 patients with mild dysplasia shown by Pap test. Minerva Ginecol 43:509–512
Gitsch G, Reinthaller A, Tatra G, Breitenecker G (1991) Diagnosis of cervical intraepithelial neoplasia and human papillomavirus infection: punch biopsy versus cervical smear. Arch Gynecol Obstet 249:179–184
Gram IT, Macaluso M, Churchill J, Stalsberg H (1992) Trichomonas vaginalis (TV) and human papillomavirus (HPV) infection and the incidence of cervical intraepithelial neoplasia (CIN) grade III. Cancer Causes Control 3:231–236
Hutchinson M, Fertitta L, Goldbaum B, Hamza M, Vanerian S, Isenstein L (1991) Cervex-Brush and Cytobrush. Comparison of their ability to sample abnormal cells for cervical smears. J Reprod Med 36:581–586
Hutchinson ML, Agarwal P, Denault T, Berger B, Cibas ES (1992) A new look at cervical cytology. ThinPrep multicenter trial results. Acta Cytol 36: 499–504
Kadish AS, Hagan RJ, Ritter DB, et al (1992) Biologic characteristics of specific human papillomavirus types predicted from morphology of cervical lesions. Hum Pathol 23:1262–1269
Kiviat NB, Koutsky LA, Critchlow CW, et al (1992) Prevalence and cytologic manifestations of human papilloma virus (HPV) types 6, 11, 16, 18, 31, 33, 35, 42, 43, 44, 45, 51, 52, and 56 among 500 consecutive women. Int J Gynecol Pathol 11:197–203
Koonings PP, Dickinson K, d'Ablaing G, Schlaerth JB (1992) A randomized clinical trial comparing the Cytobrush and cotton swab for Papanicolaou smears. Obstet Gynecol 80: 241–245
Kurman RJ, Norris HJ, Wilkinson E (1992) Tumors of the cervix, vagina and vulva. In: Atlas of tumor pathology. AFIP, Bethesda, Md
Levine AJ, Harper J, Hilborne L, Rosenthal DL, Weismeier E, Haile RW (1993) HPV DNA and the risk of squamous intraepithelial lesions of the uterine cervix in young women. Am J Clin Pathol 100: 6–11
Melkert PW, Hopman E, Brule AJ van den, et al (1993) Prevalence of HPV in cytomorphologically normal cervical smears, as determined by the polymerase chain reaction, is age-dependent. Int J Cancer 53:919–923
Mesonero CE, Garrett CT, Silverberg SG, Friedman A, Sidawy MK (1991) Human papilloma virus in uterine cervix: a comparison of detection by morphology and by dot-blot hybridization. Int J Gynecol Pathol 10: 333–340
Mincheva A, Shindarov L, Karageosov I, et al (1991) Detection of human papillomavirus DNA in gynaecological swabs by filter in situ hybridization. Acta Virol (Praha) 35:209–217
Mitchell H, Medley G (1991) Reporting of an endocervical component after a previous cervical biopsy. Cytopathology 2:177–180
Parham DM, Wiredu EK, Hussein KA (1991) The cytological prediction of cervical intraepithelial neoplasia in colposcopically directed biopsies. Cytopathology 2:285–290
Soost HJ, Lange HJ, Lehmacher W, Ruffing Kullmann B (1991) The validation of cervical cytology. Sensitivity, specificity and predictive values. Acta Cytol 35:8–14
Sopracordevole F, Cadorin L, Muffato G, De Benetti L, Parin A (1993) Papanicolau smear changes to be diagnostic for cervical squamous intraepithelial lesions (SIL) with or without detectable HPV DNA at in situ hybridization analysis. Eur J Gynaecol Oncol 14:336–338
Tabbara S, Saleh AD, Andersen WA, Barber SR, Taylor PT, Crum CP (1992) The Bethesda classification for squamous intraepithelial lesions: histologic, cytologic, and viral correlates. Obstet Gynecol 79:338–346
Ward BE, Burkett B, Petersen C, et al (1990) Cytologic correlates of cervical papillomavirus infection. Int J Gynecol Pathol 9:297–305
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Supported by the Research Grant of the Mayor of Vienna (no. 1045 [to Dr. Kainz])
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Kainz, C., Tempfer, C., Gitsch, G. et al. Influence of age and human papillomavirus-infection on reliability of cervical cytopathology. Arch Gynecol Obstet 256, 23–28 (1995). https://doi.org/10.1007/BF00634344
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DOI: https://doi.org/10.1007/BF00634344