A Cervical smear review in women developing cervical carcinoma with particular reference to age, false negative cytology, and the histologic type of the carcinoma - abstract

ABSTRACT

A review of all available cervical smears from 96 consecutive women diagnosed as having invasive cervical carcinoma during 1985 - 1991 was undertaken. The purpose of the study was to determine the incidence of confirmed negative smears prior to the histologic diagnosis of carcinoma and to investigate the relationship between the duration and grade of smear abnormality, the patient's age and the histological types of cervical carcinoma. The slides of the smears were mixed and examined "blind" by at least two pathologists separately. The degree of concordance was 95 percent. Thirty-four patients had microinvasive disease and 62 had invasive carcinoma. Review of 54 smears initially reported as "negative" revealed that 44 (81 percent) were assessed as abnormal; 42 ( 44 percent) of the 96 patients in this study had abnormal cytology reported correctly at varying time intervals prior to diagnosis of carcinoma and there was inadequate clinical follow-up of 16/42 (38 percent) of these women with knowm abnormality. The review revealed that 43 (70 percent) of the 61 younger (< 40 years) women had significant or high grade abnormality in smears (or histology) taken > 1 year before diagnosis of carcinoma. This study revealed that 81 percent of the reviewed smears were falsely reported as negative. There is evidence to suggest that the preinvasive phase of cervical cancer may be shorter in younger women and the less common types of cervical cancer occur more frequently in this group. The combination of inadequate clinical follow-up and false negative cytology may have allowed a significant proportion of these women to develop invasive cervical carcinoma (AU)