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How predictive is a cervical smear suggesting invasive squamous cell carcinoma?
1Department of Cytology, Royal Victoria Infirmary, Newcastle upon Tyne NE1 4LP, England.
Summary
Cervical cytology can suggest invasive squamous cell carcinoma, but its predictive value varies. Smears indicating frank invasion showed a 55.7% positive predictive value for invasive disease.
Area of Science:
- Gynecologic pathology
- Cervical cancer screening
- Cytopathology
Background:
- Severely dyskaryotic cervical smears can exhibit features suggestive of invasive or microinvasive squamous cell carcinoma.
- These findings are currently categorized into three distinct groups within our department.
Purpose of the Study:
- To evaluate the positive predictive value of these specific cervical smear categories for detecting invasive squamous cell carcinoma on subsequent histology.
- To determine the accuracy of cytological findings in predicting invasive cervical cancer.
Main Methods:
- A retrospective analysis correlating cervical smear results with histological diagnoses over a five-year period.
- Assessment of 527 cases where smears were reported in categories suggestive of invasion or microinvasion.
Main Results:
- The positive predictive value for any invasive squamous cell carcinoma was 55.7% for smears suggesting frank invasion.
- For stage IB or higher invasive squamous cell carcinoma, the positive predictive value was 40%.
- Smears suspicious of microinvasion or invasion had positive predictive values of 17.2% and 22.3%, respectively, with most being stage IA.
Conclusions:
- Cervical cytology offers a limited but valuable prediction of invasive squamous cell carcinoma.
- The predictive accuracy is highest when smears strongly suggest frank invasion, correlating with more advanced disease stages.