Discordance between cytologic and histologic reports in cervical intraepithelial neoplasia. Results of a one-year audit.
In order to investigate the factors contributing to cases in which the cytology and histology reports of cervical intraepithelial neoplasia (CIN) differ, we assessed the impact of careful review of the biopsy and its corresponding cervical smear. In a one-year audit of all cervical biopsies we found that 18.8% of biopsy-smear pairs disagreed by at least two grades of CIN. Following review the mismatch rate fell by 47%, mainly due to a drop in the number of cases in which the smear showed less severe CIN than did the biopsy. The proportion of cases in which the cytologic impression of CIN was greater than the histologic was changed little. The fall in the mismatch rate was seen after review of the smears, while a similar review of the histology did not alter the rate of mismatch. Neither the presence of koilocytotic changes on either cytology, histology or both, nor the size of the biopsy (punch vs. cone/hysterectomy) influenced the occurrence of such discrepancies. A similar review of the smears and biopsies of matching cases of CIN revealed no significant changes. This suggests particular difficulties of interpretation in the mismatching cases. In those cases with persistent mismatch an additional element of sampling error must be assumed to be the main cause even though all smears were considered of adequate quality.
Rasbridge
S A
SA
Department of Histopathology, St. Thomas Hospital, London, England.
Nayagam
M
M
D001706:Biopsy; D002584:Cervix Uteri / Q000473:pathology*; D003127:Colposcopy; D005260:Female; D006801:Humans; D008485:Medical Audit; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D002583:Uterine Cervical Neoplasms / Q000473:pathology; D014626:Vaginal Smears; D002578:Uterine Cervical Dysplasia / Q000473:pathology*