Related Experiment Videos
Proliferation in "atypical" atrophic pap smears
J Bulten1, P C de Wilde, H Boonstra
1Department of Pathology, University Hospital Nijmegen, Nijmegen, 6500 HB, The Netherlands.
Gynecologic Oncology
|November 7, 2000
Summary
Measuring proliferative activity index (PAI) in cervical smears accurately differentiates between cervical atrophy and high-grade cervical intraepithelial neoplasia (CIN) in postmenopausal women. This PAI test significantly reduces the need for repeat Pap smears and estrogen treatment.
Area of Science:
- Gynecologic pathology
- Cervical cytology
- Immunohistochemistry
Background:
- Postmenopausal cervical epithelium can mimic high-grade cervical intraepithelial neoplasia (CIN2-3) on Papanicolaou (Pap) smears.
- Atypical Pap smears in postmenopausal women often require repeat Pap smears after estrogen therapy for definitive diagnosis.
Purpose of the Study:
- To evaluate the reliability of measuring proliferative activity index (PAI) in differentiating cervical atrophy from high-grade CIN in postmenopausal women.
- To assess the feasibility of a PAI-based diagnostic decision tree to minimize estrogen courses and follow-up Pap smears.
Main Methods:
- Pap smears from 30 postmenopausal women with atypical results were restained using the MIB1 antibody to detect proliferating cells.
- Proliferative Activity Index (PAI) was measured before and after estrogen treatment.
Main Results:
- The PAI-based test achieved 100% accuracy for high-grade CIN and 96% for cervical atrophy.
- Implementing the PAI test would have reduced the number of women requiring repeat Pap smears after estrogen treatment from 30 to 2.
Conclusions:
- Measurement of PAI in MIB1-restained Pap smears is a reliable, simple, and safe method for differentiating cervical atrophy and high-grade CIN.
- This PAI measurement can significantly decrease the number of diagnostic estrogen courses and subsequent Pap smears in postmenopausal women with atypical Pap smears, potentially offering cost-effectiveness.