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Related Experiment Videos

The inadequate smear: does it matter?

J Bhaumik1, P G Morris, H R Beer

  • 1Department of Obstetrics and Gynaecology, Princess of Wales Hospital, Bridgend CF31 1RQ, UK. rik2004@aol.com

Cytopathology : Official Journal of the British Society for Clinical Cytology
|October 1, 2004
PubMed
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Three consecutive inadequate cervical screening smears led to colposcopy for 433 women. This study questions if three inadequate smears should mandate colposcopy, suggesting a further smear may be more appropriate for detecting cervical intraepithelial neoplasia (CIN).

Area of Science:

  • Gynecology
  • Cervical Cancer Screening
  • Pathology

Background:

  • Inadequate cervical smears pose a challenge in routine screening.
  • Three consecutive inadequate smears prompt referral for colposcopy in some healthcare systems.
  • The diagnostic yield of colposcopy following multiple inadequate smears requires evaluation.

Purpose of the Study:

  • To quantify the incidence of underlying cervical intraepithelial neoplasia (CIN) in women referred for colposcopy after three consecutive inadequate smears.
  • To assess the accuracy of colposcopy and repeat cytology in this patient group.

Main Methods:

  • Retrospective cohort study utilizing data from Cervical Screening Wales.
  • Analysis of women referred with three consecutive inadequate smears between April 2001 and March 2002.

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  • Examination of fourth smear results, biopsy data, and colposcopic accuracy.

    • Main Results:

    • Of 302 women with linked data, 85% had an adequate smear at colposcopy (77% negative, 8% abnormal).
    • High-grade CIN was found in 3% and low-grade CIN in 8% of 347 women undergoing colposcopy.
    • The fourth smear's sensitivity for CIN was 15% (specificity 84%), and colposcopy's sensitivity was 70% (specificity 49%).

    Conclusions:

    • The diagnostic value of colposcopy following three consecutive inadequate smears is limited.
    • The study questions the current indication for colposcopy after three inadequate smears.
    • Further investigation into alternative strategies, such as repeat cytology with improved collection conditions, is warranted.