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Inflammatory events as detected in cervical smears and squamous intraepithelial lesions

Anne M E Roeters1, Mathilde E Boon, Maarten van Haaften

  • 1Leiden Cytology and Pathology Laboratory, Leiden 2301 GB, The Netherlands.

Diagnostic Cytopathology
|October 2, 2009
PubMed

Insights

The KOPAC system analyzes cervical smears for eight inflammatory conditions. Dysbacteriosis and non-specific inflammation were most common in screening smears, while Chlamydia and Gardnerella correlated with high-grade cervical lesions.

Area of Science:

  • Gynecologic Cytopathology
  • Cervical Cancer Screening
  • Infectious Disease Epidemiology

Background:

  • The Dutch KOPAC cytological coding system identifies eight inflammatory events in cervical smears.
  • These include human papillomavirus (HPV)-related koilocytosis, Trichomonas, bacterial vaginosis (BV)-related dysbacteriosis, Candida, Gardnerella, Actinomyces, Chlamydia, and non-specific inflammation (leucocytosis).

Purpose of the Study:

  • To analyze a large dataset of cervical smears using the KOPAC system.
  • To determine the prevalence of various inflammatory conditions and their association with high-grade squamous intraepithelial lesions (HSIL) and indications for smear taking.

Main Methods:

  • Analysis of 1,008,879 cervical smears, recording patient age and reason for smear (screening or indication).
  • Calculation of cytoscores (per mille) for each KOPAC code.
  • Calculation of Odds Ratios (OR) with normal smears as reference to assess associations with HSIL and indication smears.

Main Results:

  • For screening smears, the highest cytoscores were for non-specific inflammation (66.4) and dysbacteriosis (31.4).
  • Chlamydia (OR=7) and Gardnerella vaginalis (OR=12) covaried with HSIL.
  • Trichomonas vaginalis, dysbacteriosis, and leucocytosis showed significantly higher ORs in indication smears.

Conclusions:

  • The KOPAC system effectively identifies a wide range of cervical infections and inflammatory changes.
  • Cytological detection of these conditions, particularly Chlamydia and Gardnerella, is valuable for identifying women at higher risk for HSIL.
  • Cervical cytology screening provides valuable insights into the prevalence of various cervical infections.

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