Simon M. Scheck

Cytopathological review of cervical pathology: Impact for women and follow‐up results

BackgroundCervical screening programs have had an important effect on the reduction of cervical cancer rates. Comprehensive programs require access to pathological review to improve the sensitivity of screening cytology and the specificity of diagnostic histology.AimsTo determine the number of cases where cervical cytology or histology was amended at cytopathological review; whether amendments were ‘upgrades’ or ‘downgrades’, and how amendments aligned with follow‐up results for these patients.Materials and MethodsA retrospective cohort study was performed of all patients reviewed from January 2016 to December 2017 (n = 287 cases, from 254 patients) at colposcopy multidisciplinary meetings at Wellington Hospital, a tertiary referral hospital. Where amendments to cytology or histology were made, follow‐up results were retrieved where available (85.7% and 84.2% respectively).ResultsCytology or histology was amended in 24.7% of cases. Smear cytology was amended in 16.7%. Where cytology was upgraded (n = 9), 44% had subsequent results of equal or higher grade including one case of adenocarcinoma. Where cytology was downgraded (n = 19), 93.8% (81.9–100%) had follow‐up studies showing equal or lower results. Cervical biopsy histology was amended in 12.2% of cases (upgraded n = 19, downgraded n = 6). Large loop excision of the transformation zone or cone biopsy histology was amended in three cases (7.9%).ConclusionsCytopathological review appears to improve the specificity of the comprehensive cervical screening program, leading to a reduction in unnecessary treatment. Additionally, a small number of cases of malignant or premalignant disease were detected.

Five‐year follow‐up after cervical cytology and histology discordance: A retrospective cohort study

BackgroundCervical smear cytology and colposcopic biopsy histology are prone to error at both collection and interpretation stages, leading to a large number of discordant cases.AimsInvestigation of five‐year outcomes for women who have cervical cytology that is discordant and higher grade than histology results.Materials and MethodsA retrospective cohort study was carried out for 111 women with cervical cytology discordant and higher grade than histology, after cytopathological review, over a three‐year period. Five‐year follow‐up data were reviewed to identify the highest level of pathology seen within five years from the discordance.ResultsWomen with atypical squamous cells with possible high‐grade change (ASC‐H) cytology and negative biopsy (n = 28) had a 46% chance of high‐grade histological disease within 5 years; with cervical intraepithelial neoplasia grade 1 (CIN1) histology (n = 20), this was reduced to 30%. With high‐grade cytology and negative histology (n = 23), 48% had high‐grade disease within five years, including one case of invasive disease; with CIN1 histology 50% had high‐grade disease within five years.ConclusionsThis study demonstrates a 30–50% chance of high‐grade disease within five years, in the setting of ASC‐H or high‐grade cytology with a negative or low‐grade colposcopic biopsy. This highlights that in the setting of cytology and histology discordance, at least one of the tests indicating high‐grade pathology warrants the need for treatment or close ongoing surveillance.