Introduction/Background Cytological classification and management of abnormal smears remains a controversial issue, as various classification systems have been proposed over the years. Management of most abnormal smears is by colposcopic guided biopsies, while management of cervical intraepithelial lesions varies according to the degree. Correlation between cytology and colposcopy is very important for assessment of sampling technique, sensitivity and specificity of methods used for screening and diagnosis.
Methodology 431 abnormal smears were included that were managed at the cervical pathology department between 2013–2017. The Bethesda and the CIN classification systems were used to classify the results.
Results ASC-US with positive HPV DNA testing was 37.04%, LSIL 32.44%, ASC-H 17.67% and HSIL 12.83%. The ASC-US smears were 27.45% normal, 29.41% HPV infected, 27.45% CIN 1, 13.07% CIN 2, 01.96% CIN 3 and 0.65% cancer, while the LSIL smears were 20.14% normal, 08.95% HPV infected, 45.52% CIN 1, 20.89% CIN 2, 04.47% CIN 3. The ASC-H smears were normal in 15.06%, HPV infected 10.95%, CIN 1 26.02%, CIN 2 17.80%, CIN 3 28.76% and cancer 01.36%, while the HSIL smears were normal 09.43%, HPV infected 01.88%, CIN 1 15.09%, CIN 2 16.98%, CIN 3 50.94% and cancer 05.66%.
Conclusion ASC-US and LSIL have a low risk of moderate-severe intraepithelial neoplasia or cancer (15.68% vs 25.39% respectively), therefore monitoring with repeat smear or using surrogate markers (HPV DNA methylation) may be of use in clinical management. ASC-H and HSIL have a high risk of moderate-severe intraepithelial neoplasia or cancer (47.97% vs 73.60% respectively), which indicates that excisional procedures (cone biopsy) are usually required.
Disclosure Nothing to disclose
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