Evaluation of inflammatory atypia. A literature review

The accepted procedure for evaluating women with inflammatory atypia on a Papanicolaou smear has changed over the years. Early studies reflected a general consensus that inflammatory atypia was normal and required no further evaluation. In the early 1970s several authors noted a higher-than-expected incidence of cervical intraepithelial neoplasia (CIN) and even cervical cancer in these patients. Further work in the late 70s and early 80s demonstrated that up to 79% of patients who had both initial and repeat atypical Papanicolaou smears had CIN or worse on biopsy. Those studies were flawed in their methodology. However, recent studies have been more sound methodologically. They clearly showed that 18.79%-56.00% of initially atypical smears are associated with CIN, human papillomavirus or cervical cancer. Furthermore, they demonstrated an alarmingly high number of false-negative repeat smears. Those studies pointed to a need for a more aggressive approach to the evaluation of inflammatory atypia seen on the initial smear.