Objective: This study was conducted to compare the correlation between Pap smear and colposcopic biopsy findings in premenopausal and postmenopausal women. Study design: A total of 68,738 ThinPrep Pap smears were done in 2011 in our institution, and of these, 865 of the women (787 premenopausal and 78 postmenopausal) had subsequent colposcopic directed biopsies performed within 3 months of obtaining the results. Results: We discovered that 52.5% of the Pap smears in postmenopausal women versus 33.6% in premenopausal women were classified as false positive (FP), with respect to the biopsy, and of these, 47.6 vs. 17% cases had no transformation zone (TZ) on the subsequent biopsies, respectively. Interestingly, with respect to high-risk human papilloma virus (hrHPV) testing in patients having both Pap smear and biopsies performed, we found the Pap smear diagnoses were a better predictor of positive hrHPV than the respective colposcopic biopsies. Conclusion: As many of the FP postmenopausal women had an absent TZ (47.6%) on biopsy, and because the majority (83.3%) of those which had hrHPV testing were positive, we suggest that this indicates a potential sampling error on biopsy, perhaps due to an inability to visualize the involved area in older women due to an upward migration of the TZ.

Liaw KL, Glass AG, Manos MM, Greer CE, Scott DR, Sherman M, Burk RD, Kurman RJ, Wacholder S, Rush BB, Cadell DM, Lawler P, Tabor D, Schiffman M: Detection of human papillomavirus DNA in cytologically normal women and subsequent cervical squamous intraepithelial lesions. J Natl Cancer Inst 1999;91:954-960.
Karlsson R, Jonsson M, Edlund K, Evander M, Gustavsson A, Bodén E, Rylander E, Wadell G: Lifetime number of partners as the only independent risk factor for human papillomavirus infection: a population-based study. Sex Transm Dis 1995;22:119-127.
Bauer HM, Ting Y, Greer CE, Chambers JC, Tashiro CJ, Chimera J, Reingold A, Manos MM: Genital human papillomavirus infection in female university students as determined by a PCR-based method. JAMA 1991;265:472-477.
Ho GY, Bierman R, Beardsley L, Chang CJ, Burk RD: Natural history of cervicovaginal papillomavirus infection in young women. N Engl J Med 1998;338:423-428.
Ferenczy A, Gelfand MM, Franco E, Mansour N: Human papillomavirus infection in postmenopausal women with and without hormone therapy. Obstet Gynecol 1997;90:7-11.
Saslow D, Solomon D, Lawson HW, Killackey M, Kulasingam SL, Cain J, Garcia FA, Moriarty AT, Waxman AG, Wilbur DC, Wentzensen N, Downs LS Jr, Spitzer M, Moscicki AB, Franco EL, Stoler MH, Schiffman M, Castle PE, Myers ER: American Cancer Society, American Society for Colposcopy and Cervical Pathology, and American Society for Clinical Pathology screening guidelines for the prevention and early detection of cervical cancer. Am J Clin Pathol 2012;137:516-542.
Halford J, Walker KA, Duhig J: A review of histological outcomes from peri-menopausal and post-menopausal women with a cytological report of possible high grade abnormality: an alternative management strategy for these women. Pathology 2010;42:23-27.
Gupta S, Kumar N, Singhal N, Manektala U, Jain S, Sodhani P: Cytohormonal and morphological alterations in cervicovaginal smears of postmenopausal women on hormone replacement therapy. Diagn Cytopathol 2006;34:676-681.
Waddell CA: The influence of the cervix on smear quality. I. Atrophy. An audit of cervical smears taken post-colposcopic management of intraepithelial neoplasia. Cytopathology 1997;8:274-281.
Ejersbo D, Jensen HA, Hølund B: Efficacy of Ki-67 antigen staining in Papanicolaou (Pap) smears in post-menopausal women with atypia - an audit. Cytopathology 1999;10:369-374.
Moore KN, Bannon RJ, Lanneau GS, Zuna RE, Walker JL, Gold MA: Cervical dysplasia among women over 35 years of age. Am J Obstet Gynecol 2008;199:471.e1-e5.
Abali R, Bacanakgıl BH, Celık S, Aras O, Koca P, Boran B, Dursun N: Histopathological correlation of squamous cell abnormalities detected on cervical cytology. Turk Patoloji Derg 2011;27:144-148.
Tranbaloc P: Natural history of precursor lesions of cervical cancer. Gynecol Obstet Fertil 2008;36:650-655.
Virtej P, Matei M, Badea M, Badea I, Popa O: Cervical intraepithelial neoplasia and HPV infection. Eur J Gynaecol Oncol 1998;19:179-181.
Aschkenazi-Steinberg SO, Spitzer BJ, Spitzer M: The role treatment for cervical intraepithelial neoplasia plays in the disappearance of human papilloma virus. J Low Genit Tract Dis 2005;9:19-22.
Gyllensten U, Gustavsson I, Lindell M, Wilander E: Primary high-risk HPV screening for cervical cancer in post-menopausal women. Gynecol Oncol 2012;125:343-345.
Dunne EF, Unger ER, Sternberg M, McQuillan G, Swan DC, Patel SS, Markowitz LE: Prevalence of HPV infection among females in the United States. JAMA 2007;297:813-819.
Peyton CL, Gravitt PE, Hunt WC, et al: Determinants of genital human papillomavirus detection in a US population. J Infect Dis 2001;183:1554-1564.
Jackson JA, Kapur U, Erşahin Ç: Utility of p16, Ki-67, and HPV test in diagnosis of cervical intraepithelial neoplasia and atrophy in women older than 50 years with 3- to 7-year follow-up. Int J Surg Pathol 2012;20:146-153.
Matthews-Greer J, Rivette D, Reyes R, Vanderloos CF, Turbat-Herrera EA: Human papillomavirus detection: verification with cervical cytology. Clin Lab Sci 2004;17:8-11.
Venturoli S, Cricca M, Bonvicini F, Giosa F, Pulvirenti FR, Galli C, Musiani M, Zerbini M: Human papillomavirus DNA testing by PCR-ELISA and hybrid capture II from a single cytological specimen: concordance and correlation with cytological results. J Clin Virol 2002;25:177-185.
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