title: Adenocarcinomas in the cervicovaginal Papanicolaou smear: analysis of a 12-year experience.
abstract: We attempted to reassess the significance of cervicovaginal Papanicolaou smear(s) in identifying adenocarcinoma (AC) by comparing Papanicolaou smears with histopathology in a pool of 188 patients. The first part of study dealt with 95 patients, seen over a 12-yr period (1975-1986), who had tissue diagnosis of cervical or endometrial AC, all with prior papanicolaou smears available. Of the 95 patients, Papanicolaou smears were positive and/or inconclusive for uterine AC in 37 (38.9%) and falsely negative in 58 (61.1%) patients. Of the latter, six were either positive and/or inconclusive for squamous carcinoma and moderate to severe dysplasia; thus, the effective detection rate (sensitivity) for malignancy and related condition of Papanicolaou smears was 45.3% (43 of 95). The second part of the study concerned the analysis of 130 patients with 148 Papanicolaou smear in whom cytologic diagnosis positive and/or inconclusive for AC was made during the same study period. Tissue diagnoses were available in 107 of these as follows: AC and glandular hyperplasia in 66 patients (61.7% predictive value), with 11 (10.3%) from extrauterine sources; squamous carcinoma in 12 and moderate to severe dysplasia in 5, totalling 17 patients (15.9%); miscellaneous conditions (polyps, radiation change, and glandular atrophy) in 11 patients (10.3%); and no pathologic change in 13 patients (12.1%). The effective predictive value of positive and/or inconclusive Papanicolaou smears for all malignancy and related states is 77.6%.
authors.affiliation: Harris County Hospital District, Houston, TX.
authors.forename: H S
authors.initials: HS
authors.lastname: Kim
authors.forename: D
authors.initials: D
authors.lastname: Underwood
mesh_terms: D000230:Adenocarcinoma / Q000175:diagnosis / Q000473:pathology*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005188:False Negative Reactions; D005189:False Positive Reactions; D005260:Female; D006801:Humans; D008875:Middle Aged; D009367:Neoplasm Staging; D065006:Papanicolaou Test; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D014594:Uterine Neoplasms / Q000175:diagnosis / Q000473:pathology*; D014626:Vaginal Smears