Objective: Previous studies have demonstrated diagnostic discrepancies for the detection of high-grade cervical intraepithelial neoplasia (CIN 2/3) from previously confirmed cytological high-grade squamous intraepithelial lesions (HSILs). The goal of this study is to investigate the possible factors which may be responsible for this diagnostic discrepancy. Study Design: The study included all the cytological specimens diagnosed with a HSIL by the Papanicolaou (Pap) test at Temple University Hospital (2000-2010) as well as timely follow-up cervical biopsies. The biopsy tissue types and diagnoses were subsequently categorized and analyzed. Results: Of the total 842 Pap tests with HSIL diagnosis, 96 cases (11.4%) showed non-CIN 2/3 in follow-up cervical biopsies. Among those cases, the most common biopsy diagnoses were cervicitis (27.9%) and CIN 1 (25%). Endocervical curettage (ECC) samples showed a high percentage of inadequacy for diagnosis (43.7%). Thirty-seven cases had subsequent follow-up biopsy, and CIN 2/3 was found in 15 cases. However, none of the CIN 2/3 cases was detected by ECC sampling. Conclusions: Our study indicated that the discrepant correlation between HSIL and CIN 2/3 was most likely due to tissue sampling issues during colposcopic examination. The diagnostic value of ECC remains poor for the detection and grading of cervical intraepithelial dysplasia.

Keywords:
Cervical high-grade squamous intraepithelial lesions, Diagnostic discrepancy, Endocervical curettage
1.
Solomon D, Davey D, Kurman R, Moriarty A, O'Connor D, Prey M, Raab S, Sherman M, Wilbur D, Wright T Jr, Young N: The 2001 Bethesda System: terminology for reporting results of cervical cytology. JAMA 2002;287:2114-2119.
2.
Bansal M, Li Z, Zhao C: Correlation of histopathologic/cytologic follow-up findings with vaginal ASC-US and ASC-H Papanicolaou test and HPV test results. Am J Clin Pathol 2012;137:437-443.
3.
Bansal M, Austin RM, Zhao C: Correlation of histopathologic follow-up findings with vaginal human papillomavirus and low-grade squamous intraepithelial lesion Papanicolaou test results. Arch Pathol Lab Med 2011;135:1545-1549.
4.
Katki HA, Schiffman M, Castle PE, Fetterman B, Poitras NE, Lorey T, Cheung LC, Raine-Bennett T, Gage JC, Kinney WK: Benchmarking CIN 3+ risk as the basis for incorporating HPV and Pap cotesting into cervical screening and management guidelines. J Low Genit Tract Dis 2013;17:S28-S35.
5.
Zhao C, Kalposi-Novak P, Austin RM: Follow-up findings in young females with high-grade squamous intraepithelial lesion Papanicolaou test results. Arch Pathol Lab Med 2011;135:361-364.
6.
Castle PE, Cox JT, Schiffman M, Wheeler CM, Solomon D: Factors influencing histologic confirmation of high-grade squamous intraepithelial lesion cytology. Obstet Gynecol 2008;112:637-645.
7.
Driggers RW, Zahn CM: To ECC or not to ECC: the question remains. Obstet Gynecol Clin North Am 2008;35:583-597, viii.
8.
Alvarez RD, Wright TC: Effective cervical neoplasia detection with a novel optical detection system: a randomized trial. Gynecol Oncol 2007;104:281-289.
9.
Massad LS, Einstein MH, Huh WK, Katki HA, Kinney WK, Schiffman M, Solomon D, Wentzensen N, Lawson HW: 2012 updated consensus guidelines for the management of abnormal cervical cancer screening tests and cancer precursors. Obstet Gynecol 2013;121:829-846.
10.
Massad LS, Collins YC, Meyer PM: Biopsy correlates of abnormal cervical cytology classified using the Bethesda system. Gynecol Oncol 2001;82:516-522.
11.
Ferris DG, Litaker MS: Prediction of cervical histologic results using an abbreviated Reid Colposcopic Index during ALTS. Am J Obstet Gynecol 2006;194:704-710.
12.
Walker P, Dexeus S, De Palo G, Barrasso R, Campion M, Girardi F, Jakob C, Roy M: International terminology of colposcopy: an updated report from the International Federation for Cervical Pathology and Colposcopy. Obstet Gynecol 2003;101:175-177.
13.
Apgar BS, Brotzman GL, Spitzer M: Colposcopy, Principles and Practice: An Integrated Textbook and Atlas, ed 2. Philadelphia, Saunders Elsevier, 2008.
14.
Gage JC, Hanson VW, Abbey K, Dippery S, Gardner S, Kubota J, Schiffman M, Solomon D, Jeronimo J: Number of cervical biopsies and sensitivity of colposcopy. Obstet Gynecol 2006;108:264-272.
15.
Pretorius RG, Zhang WH, Belinson JL, Huang MN, Wu LY, Zhang X, Qiao YL: Colposcopically directed biopsy, random cervical biopsy, and endocervical curettage in the diagnosis of cervical intraepithelial neoplasia II or worse. Am J Obstet Gynecol 2004;191:430-434.
16.
Melnikow J, Nuovo J, Willan AR, Chan BK, Howell LP: Natural history of cervical squamous intraepithelial lesions: a meta-analysis. Obstet Gynecol 1998;92:727-735.
17.
David O, Cabay RJ, Pasha S, Dietrich R, Leach L, Guo M, Mehrotra S: The role of deeper levels and ancillary studies (p16(Ink4a) and ProExC) in reducing the discordance rate of Papanicolaou findings of high-grade squamous intraepithelial lesion and follow-up cervical biopsies. Cancer 2009;117:157-166.
18.
Solomon D, Stoler M, Jeronimo J, Khan M, Castle P, Schiffman M: Diagnostic utility of endocervical curettage in women undergoing colposcopy for equivocal or low-grade cytologic abnormalities. Obstet Gynecol 2007;110:288-295.
© 2013 S. Karger AG, Basel
2013
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.