Analysis of Cervico-vaginal (Papanicolaou) smears, in girls 18 years and under

The study was conducted retrospectively at the Queen Elizabeth Hospital and a private laboratory in Barbados to determine the types of epithelial abnormalities in cervico-vaginal Papanicolaou (Pap)-stained smears, and their clinical implications in Barbadian girls, 18 years and under, during the five-year period January 1995 to December 1999. Two hundred and sixty-five Pap smears from 236 patients were examined and the gynaecological history, initial and repeat Pap smear diagnoses, and histology reports of these patients were analyzed. Of the 236 first-visit smears, 94 (39.8 percent) were abnormal with 36 (15.3 percent) displaying cytological features of squamous intra-epithelial lesions (SIL), (33 low grade and 3 high grade). A diagnosis of atypical squamous cells of undetermined significance (ASCUS) was reported in the remaining 58 (24.5 percent) abnormal smears, of which 35 (60.3 percent) were suspected to be related to human papillomavirus (HPV) infection. Twenty-two (23.4 percent) of these 94 patients, who had abnormal smears of either ASCUS or low grade squamous intra-epithelial lesions (LSIL) were re-evaluated within six to twelve months of the initial abnormal Pap smear diagnosis. Eight of these 22 patients (36.4 percent) had histological diagnosis of LSIL inclusive of cervical intra-epithelial neoplasia grade 1 (CIN 1) and condylomata. High-risk HPV DNA types were detected in two of these eight patients (25 percent). The study confirms that sexually active teenage girls are at risk of developing SIL and high-risk HPV infection. Screening of sexually active teenage girls by Pap smears followed by other appropriate investigative procedures is recommended. (AU)

Cervical cytology quality control cytological and histological correlation at a private laboratory in Barbados - abstract

In this study, the cytological and histological diagnoses made during a six and a half-year period were compared with the aim of assessing the diagnostic accuracy of cervical cytology in a small private laboratory. There were 3486 cases biopsied, 40 (1.2 percent) cases with previous inadequate cervical smears, 195 (5.6 percent) cases with normal cytology and the remaining 3251 (93.2 percent) with abnormal cytological diagnoses. The overall concordance between the cytological and histological diagnoses was 63.9 percent. The greatest concordance was in cases with cytodiagnosis of CIN grade 3 (CIS) and invasive carcinoma combined 100/112 (89.3 percent), and the lowest with normal cytodiagnosis 75/195 (38.5 percent) cases. The significant histological diagnoses of the discordant cases were CIN 22.6 percent, condyloma 15.3 percent and carcinoma 1.1 percent. Fifty percent of the carcinomas diagnosed by cytology were of endometrial origin. Significant discordance occurred in cases with cytodiagnosis of HPV infection and CIN, in that 113 cases with cytodiagnosis of HPV infection/codyloma had histological diagnosis of CIN, and 156 cases with the cytodiagnosis of CIN had histological diagnosis of condyloma. The sensitivity rate for the diagnosis of HPV infection or condyloma by cytology was 632/1214 (52 percent). Most of the cases with inadequate smears had histodiagnosis of cervicitis with inflammatory atypia. This study has shown that the cytological evaluation of the severity of significant cervical abnormalities was a reliable guide for the clinician to the proper management of the patient (AU)

What is the significance of the class II Papanicolaou-stained cervical smear in Barbados? - abstract

At the Barbados Reference Laboratory (BRL), Papanicolaou-stained cervical smears are reported by a modified Papanicolaou system of Classes I to V, accompanied by a description of the significant findings. Concerns and criticisms of too many Class II reports, quality assurance rate and management of such patients were addressed in this study. From 1986 to 1989, of 27,327 smears screened at the BRL, 8,581 (31.4 percent) were given a Class II report and 984 (11.5 percent) of these patients were biopsied; 60.1 percent (591) of the biopsies showed evidence of cervicitis with and without inflammatory epithelial atypia, 24.2 percent (238) had no diagnostic abnormality, 15.2 percent (150) had evidence of cervical intraepithelial neoplasia (CIN) and 0.4 percent (4) had frank malignancy. There were 3 cases of endometrial adenocarcinoma and one of invasive squamous cell carcinoma. The false negative rate for CIN was 15 percent. On reviewing 74 (48 percent) of the smears with corresponding histologic diagnosis of CIN/carcinoma, 22 (29.7 percent), including the case of invasive carcinoma, were missed. All these smears had a marked acute inflammatory exudate making assessment difficult. In conclusion, this study showed that a Class II smear indicated a reasonable chance (75.7 percent) of an abnormality in the cervix, ranging from cervicitis (high risk) to invasive cancer (low risk), and that the quality assurance for cytologic diagnosis of CIN was low (AU)

An analysis of cervico-vaginal (Papanicolaou) smears in girls 18 years and under

During the two year period, January 1995 to December 1996 124 cervico-vaginal smears from 109 girls 18 years old and younger were examined. The gynaecological history, cytology reports, histological and cytological follow-up reports were analyzed to determine the demographics, common infections, epithelial abnormalities and follow-up management in this age group. The mean age was 17.4 with a range of 15-18 years. Twenty-five percent were gravid and 4.5 percent multigravida. The teen delivery/termination ratio was 0.73:1. The most common specific infection was yeast and, suspected infection, HPV .39 percent had normal smears, 14.7 percent inflammatory epithelial changes, 36 percent atypical squamous cells of undetermined significance (ASCUS), 8.3 percent low grade squamous intra-epithelial lesions (LGSIL) and 1.0 percent high grade intra-epithelial lesions (HGSIL). The ASCUS/SIL ratio was 3.9. Only 40 percent of patients with cytologic diagnosis of SIL and 28 percent with ASCUS had follow-up by repeat smear and/or colposcopy, endocervical curettage and guided cervicals biopsy. Five (45 percent) of the followed up patients had LGSIL inclusive of CIN 1 and condyloma. These results indicate that sexually active girls are risk of developing SIL and those with a diagnosis of ASCUS should be adequately followed up.(AU)