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Papanicolaou smear discrepancy: resolution by review
M K Cline1, E G Baxley, R P Montgomery
1Anderson Area Medical Center Family Practice Center, SC.
The Journal of the American Board of Family Practice
|January 1, 1994
Summary
Discrepancies between Pap smears and biopsies can be resolved. Reviewing slides using the Bethesda System helped a pathologist correctly identify cervical lesions in 79.2% of cases.
Area of Science:
- Gynecologic pathology
- Cervical cancer screening
Background:
- Discrepancies between Papanicolaou (Pap) smears and colposcopically directed biopsies present a clinical challenge.
- This is particularly true when cytology suggests a higher-grade lesion than histology.
Purpose of the Study:
- To evaluate a side-by-side review method using the Bethesda System to resolve discrepancies between cytologic and histologic specimens.
- To determine the efficacy of pathologist-led review in managing discordant cervical lesion findings.
Main Methods:
- Retrospective chart review of 150 patients with abnormal Pap smear results undergoing colposcopy.
- Focused analysis on 38 patients with higher-grade lesions on cytology than histology.
- Blinded review of available cytologic and histologic slides by a single pathologist using the Bethesda System for 24 of these patients.
Main Results:
- The Bethesda System review resolved the discrepancy in 19 out of 24 cases reviewed.
- Achieved a 79.2% resolution rate for discrepancies where cytology indicated a higher-grade cervical lesion than histology.
Conclusions:
- Pathologist review of cytologic and histologic specimens using the Bethesda System effectively resolves many discrepancies.
- This method aids in managing cases where Pap smears suggest a higher-grade cervical lesion than subsequent biopsies.