Evaluation of the atypical Pap smear

Two hundred thirty-six consecutively referred patients with "atypical" but not dysplastic Pap smears were evaluated by colposcopy and directed biopsies to assess the significance of this ambiguous result. Additionally the histologic diagnosis was compared with the results obtained by repetition of the Pap smear, interpretation of cervigrams, and the visual impression of the coloposcopist to evaluate the accuracy of these three modalities as intermediate screening procedures. Fifty-eight patients (25%) had biopsy-proved cervical intraepithelial neoplasia. Repeat Pap smears identified only 17% of these patients. Colposcopists noted atypical transformation zones in 97% of the patients with cervical intraepithelial neoplasia. Cervigrams identified 81% of the cervical intraepithelial neoplastic lesions but had a 15% method failure (uninterpretable). The time-honored tradition of repeating atypical smears before definitive diagnostic procedures are performed is to be condemned. Neither colposcopy nor cervicography was judged to be an ideal intermediate screening procedure, but both were superior to Pap smear repetition.