Abnormal Papanicolaou (PAP) smears at UWI, 1997-1999 [abstract]

ABSTRACT

OBJECTIVE: Our aim was to document the distribution of epithelial abnormalities diagnosed on Pap smears in the Department of Pathology, the University of the West Indies (UWI), Mona, Jamaica, and to determine the likelihood of the prescence of clinically significant disease on biopsy for a given cytological diagnosis. METHODS: We reviewed the results of all Pap smears accessioned in the Cytology Unit of the Department of Pathology, over the 3-year period 1997-1999 and collated the epithelial abnormalities using a hybrid cervical intraepithelial neoplasia (CIN)/Bethesda system. We calculated the atypical squamous cells of undetermined significance (ASCUS) rate, the CIN rate and the ASCUS/CIN ratio. Follow-up histology results were obtained from the departmental files. The likelihood ratios (LRs for clinically significant disease on histology for each cytological category were calculated. RESULTS: During the study period a total of 21,144 Pap smears were accessioned, 1,324 (6.3 percent) of which showed epithelial abnormalities. These abnormal Pap smears were most prevalent in the 21-30 year age group (37.5 percent of patients). The distribution of epithelial abnormalities was ASCUS 34.7 percent, atypical glandular cells of undetermined significance (ASCUS) 1.1 percent, ASCUS/AGUS 0.2 percent, CIN 141.4 percent, CIN II 12.5 percent, CIN III 8.3 percent, sqaumous cell carcinoma (SCC) 1.3 percent, adenocarcinoma (AC) 0.3 percent and vaginal intraepithelial neoplasia (VAIN) II/III 0.2 percent. The CIN rate, ASCUS rate and ASUCS/CIN ratio were 3.9 percent, 2.2 percent and 0.6 respectively. Histological follow-up was available for 477 (36 percent) cases. The LRs for clinically significant disease for the following cytological diagnoses were AGUS 0.08, ASCUS 0.31, CIN I 1.12, CIN II 2.01 and CIN III 3.38. All cases of SCC, AC and VAIN with histological follow-up were shown to be clinically significant. CONCLUSIONS: There was a relatively low incidence of epithelial abnormalities in Pap smears seen at the UWI during the study period with ASCUS and CIN 1 compromising the majority of cases. Biopsy follow-up showed an increasing likelihood for the presence of clinically significnat disease with increasing degrees of epithelial atypia on Pap smear. (AU)