Adenocarcinomas in the cervicovaginal Papanicolaou smear: analysis of a 12-year experience

We attempted to reassess the significance of cervicovaginal Papanicolaou smear(s) in identifying adenocarcinoma (AC) by comparing Papanicolaou smears with histopathology in a pool of 188 patients. The first part of study dealt with 95 patients, seen over a 12-yr period (1975-1986), who had tissue diagnosis of cervical or endometrial AC, all with prior papanicolaou smears available. Of the 95 patients, Papanicolaou smears were positive and/or inconclusive for uterine AC in 37 (38.9%) and falsely negative in 58 (61.1%) patients. Of the latter, six were either positive and/or inconclusive for squamous carcinoma and moderate to severe dysplasia; thus, the effective detection rate (sensitivity) for malignancy and related condition of Papanicolaou smears was 45.3% (43 of 95). The second part of the study concerned the analysis of 130 patients with 148 Papanicolaou smear in whom cytologic diagnosis positive and/or inconclusive for AC was made during the same study period. Tissue diagnoses were available in 107 of these as follows: AC and glandular hyperplasia in 66 patients (61.7% predictive value), with 11 (10.3%) from extrauterine sources; squamous carcinoma in 12 and moderate to severe dysplasia in 5, totalling 17 patients (15.9%); miscellaneous conditions (polyps, radiation change, and glandular atrophy) in 11 patients (10.3%); and no pathologic change in 13 patients (12.1%). The effective predictive value of positive and/or inconclusive Papanicolaou smears for all malignancy and related states is 77.6%.