Is it clinically useful to repeat a pap smear at colposcopy?

To assess the role of repeating a Pap smear at the time of colposcopy performed within 6 months of a referent Pap smear.

A clinical database was queried to identify colposcopies performed within 6 months of a referent abnormal squamous Pap smear at which time a repeat Pap smear was obtained. All Pap smears and cervical biopsy specimens were interpreted at an affiliated hospital laboratory. Referent Pap smears, repeat Pap smears, colposcopic cervical biopsy results, patient age and ethnicity, and the interval since the referent Pap smear were tabulated. A hierarchy of Pap smear results was defined a priori to characterize the relative differences between the referent and repeat Pap smears. Results of repeat smears and cervical biopsies were contrasted with the referent Pap smears. An assessment was made of the clinical usefulness of the repeat Pap smear.

Four hundred ninety-eight patients contributed 536 colposcopies with repeat Pap smears within 6 months of the referent smear. Pap smears obtained at colposcopy predominantly were either of lower severity (52.2%) or unchanged (42%). Management of 8 of 498 patients (1.6%) was influenced by the results of the repeat Pap smear. The outcomes for six recommendations for a loop electrosurgical excision procedure included three cases of diagnoses of potentially reversible conditions.

The evidence for the clinical usefulness of repeating a Pap smear at colposcopy for a squamous cytologic abnormality under the defined study parameters is noncompelling. Continued surveillance is a critical component of management.