Keratinizing squamous dysplasia pap test: a case for colposcopy

This study characterized women with Pap tests showing keratinizing squamous dysplasia (KSD) and helped develop management strategies in these patients.

This is a retrospective chart review of women presenting to Palmetto Health Women's Center with KSD on a Pap test from 1999 to 2009. Data analysis was performed with standard statistical computer programming; null hypothesis was rejected for p values .05 or less.

A total of 65 Pap tests with KSD were identified. We found that women with KSD were statistically older (35 vs 26.8 y) and were more likely African American and less likely Hispanic than the general clinic population at Palmetto Health Women's Center. There were no statistical differences in body mass index or history of teen pregnancy. Interestingly, 41% of the women with KSD were immunosuppressed (e.g., human immunodeficiency virus infection, end-stage renal disease, long-term steroid use). All women with KSD were referred for colposcopy; 24% of patients failed to follow-up. Pathology distribution on cervical biopsies were similar to what is found after high-grade squamous intraepithelial lesion findings in Pap tests, with 58% cervical intraepithelial neoplasia (CIN) 2/3 or cancer, 32% CIN 1, and 10% negative biopsies. Of the women who had CIN 1 on cervical biopsy, 80% had persistent dysplasia or abnormal Pap test. Also, 60% had CIN 1 and 20% progressed to CIN 2/3 or carcinoma in situ.

Our data suggest that women with KSD on Pap test should be managed aggressively with immediate colposcopy and cervical biopsies and not with expectant management.