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The "Inconclusive--possible high grade epithelial abnormality" category in Papanicolaou smear reporting
M Schoolland1, G F Sterrett, S A Knowles
1Western Diagnostic Pathology, Myaree, Western Australia.
Insights
The "Inconclusive" cervical cytology reporting category is valuable, identifying high-grade lesions in over half of cases. This category accurately captures diagnostic uncertainty, preventing misclassification and missed diagnoses.
Area of Science:
- Cytopathology
- Gynecologic Oncology
- Histopathology
Background:
- The Australian Terminology for Cervical Cytology Reporting includes an "Inconclusive-Possible high grade epithelial abnormality" category.
- This category addresses diagnostic uncertainty in cervical smear analysis.
Purpose of the Study:
- To evaluate the frequency of use of the "Inconclusive" category in cervical cytology.
- To analyze associated cellular patterns and the diagnostic yield of high-grade lesions upon biopsy.
Main Methods:
- Retrospective analysis of 102 "Inconclusive" cervical cytology cases reported between January and June 1995.
- Review of cellular morphology, preservation quality, and follow-up biopsy results.
Main Results:
- The "Inconclusive" category was used in 0.24% of Papanicolaou (Pap) smears.
- High-grade abnormalities (CIN 2/3, squamous cell carcinoma, adenocarcinoma in situ) were confirmed in 55.9% of total cases.
- Suboptimal cell preservation was noted in 25.3% of cases.
Conclusions:
- The "Inconclusive" category is not overused and demonstrates a high yield for detecting significant cervical abnormalities.
- Accepting diagnostic uncertainty in this category helps prevent misclassification of high-grade lesions and avoids missed diagnoses due to poor sample quality.
Background:
The Australian Terminology for Cervical Cytology Reporting includes the category "Inconclusive-Possible high grade epithelial abnormality."
Methods:
The frequency of use of this category, the types of associated cell patterns, and the yield of high grade lesions at biopsy were studied.
Results:
One hundred and two cases categorized as "Inconclusive" were reported between January and June 1995, representing 0.24% of 41,712 Papanicolaou (Pap) smears screened. The abnormal cells were reported as squamous in 74.5% of cases, endocervical in 4.9% of cases, endometrial in 3.9% of cases, and indeterminate in 16.7% of cases. The main cellular patterns included disorganized groups of hyperchromatic squamous, glandular, or indeterminate cells (64.2% of cases) and atypical metaplastic squamous cells (28.4% of cases). Cell preservation was suboptimal. In 25.3% of cases the cells were highly degenerate or air-dried. Follow-up included biopsy (84.3% of cases), colposcopy alone (7.8% of cases), and repeat Pap smears without any detected abnormality (3.9% of cases). No follow-up was available in 3.9% of cases. High grade abnormalities were found in 66.3% of the biopsied cases and 55.9% of the total cases (48 cervical intraepithelial neoplasia [CIN] of Grade 2 or 3; 2 squamous cell carcinomas; 3 endocervical adenocarcinoma in situ [ACIS]; 3 adenocarcinomas of endocervical, ovarian, and endometrial origin; and 1 endometrial stromal sarcoma). In 16.2% of cases a low grade squamous lesion was present on biopsy (CIN, Grade 1 or human papillomavirus effect); and no lesion was found in 17.4% of cases.
Conclusions:
The "Inconclusive" category was not overused, and gave a high yield of biopsy abnormalities. Accepting uncertainty in the diagnosis of some high grade lesions reduces their likelihood of being classified incorrectly as reactive changes, ignored because of poor cell preservation, or lost in the larger group of classifications such as atypical cells of undetermined significance, borderline nuclear abnormality, or non-specific minor changes.