Follow-up of abnormal cervical cytology: a Jamaican experience - abstract

ABSTRACT

Prevalence rates for preclinical cancer in different countries depend upon efficiency of screening programmes, the quality of cytological services and the level of gynaecological expertise in colposcopy, cyrosurgery and cone biopsy of the cervix. The Jamaica Cancer Society, which screens over 6,000 patients annually, provides ample clinical material for the study of the effectiveness of these services in Jamaica. Of 202 patients, with Class III pap smear reports, referred for colposcopic evaluation, the repeat smears taken at colposcopy were reported as follows 18 - Class I; 32 - Class II; 134 - Class III; and 18 - Class IV. That is, there was consistency in about 66 percent. In 46 cases of Class IV smears, the repeat smear was confirmatory in 26 cases (56 percent). These data argue strongly for early follow-up of all cases of Class III reports. Colposcopy revealed 8 cases of carcinoma-in-situ from 120 Class II smears; there were 15 cases of invasive cancer from 46 Class IV smears. Of 14 Class V smears, 10 were confirmed as invasive and four downgraded to carcinoma-in-situ. In 252 patients, cone biopsies were performed on those who had already had colposcopic biopsies done. In roughly 83 percent of these cases, the colposcopic and cone biopsy reports were in agreement. In our series, the relationship between cytology, colposcopy and cone biopsy gives a false-negative cytology rate of 16 percent and a false-positive rate of 4 percent. A review of the literature shows that the false-negative rate varies between 6 percent and 28 percent in some large series. Prevalence for carcinoma-in-situ in this study was 18/1000, compared with 3.7/1000 reported from the United States and 7.0/1000 from Scotland (AU)