title: The significance of hyperkeratosis/parakeratosis on otherwise normal Papanicolaou smears.
abstract: OBJECTIVE
  The purpose of this study was to determine whether hyperkeratosis/parakeratosis found on an otherwise normal Papanicolaou smear was associated with abnormalities after comprehensive evaluation.
  
  
  METHODS
  We conducted a retrospective cohort study of 566 women identified with hyperkeratosis/parakeratosis on Papanicolaou smears from a 7-year period. All women underwent repeat Papanicolaou smear, colposcopy, and biopsy as indicated. Statistical analysis included chi(2) and Fisher exact tests as appropriate.
  
  
  RESULTS
  Final abnormal diagnoses included human papillomavirus (HPV) changes (17%), mild dysplasia (5%), and moderate/severe dysplasia (0.4%). We found no carcinomas. Women younger than age 50 years were more likely to have an abnormality (34% vs 19%, relative risk 1.3, 95% CI 1.1-1.4, P <.001), primarily because of a higher prevalence of HPV changes on the biopsy specimen (21% vs 9%, relative risk 1.3, 95% CI 1.2-1.5, P <.001).
  
  
  CONCLUSIONS
  Hyperkeratosis/parakeratosis on an otherwise normal Papanicolaou smear is associated with low-grade changes, particularly among reproductive-age women.
authors.affiliation: Departments of Obstetrics and Gynecology, Wilford Hall Medical Center, Lackland Air Force Base, San Antonio, TX, USA.
authors.forename: Christopher M
authors.initials: CM
authors.lastname: Zahn
authors.forename: A Wendy
authors.initials: AW
authors.lastname: Askew
authors.forename: Kevin L
authors.initials: KL
authors.lastname: Hall
authors.forename: William H
authors.initials: WH
authors.lastname: Barth
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000375:Aging / Q000502:physiology; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008875:Middle Aged; D065006:Papanicolaou Test; D027383:Papillomaviridae; D030361:Papillomavirus Infections / Q000473:pathology; D010241:Parakeratosis / Q000473:pathology* / Q000821:virology; D012189:Retrospective Studies; D014412:Tumor Virus Infections / Q000473:pathology; D014621:Vagina / Q000473:pathology; D014626:Vaginal Smears