High grade abnormalities following an 'inconclusive' smear.
OBJECTIVE
The National Health and Medical Research Council (NHMRC) recommends a report of 'inconclusive possible high grade epithelial abnormality', but many laboratories only report 'inconclusive' with reference to any possible high grade disease elsewhere in the report. This study was performed to determine possible reasons for cytological difficulties resulting in this category of report and to determine the rate of significant disease within this category.


METHODS
Retrospective record review. Clinical details were extracted without patient-identifying data.


METHODS
Gynaecological Oncology Department, King George V/Royal Prince Alfred Hospital.


METHODS
Two hundred patients referred with the cytological abnormality.


METHODS
An adequate colposcopic diagram documenting size, distribution and grade of lesion was required. All patients had colposcopy with management according to colposcopic and histological results as appropriate to their disease.


METHODS
Colposcopic features, topography and size of any lesion, histological results, treatments performed and subsequent review of untreated patients.


RESULTS
Colposcopy found high-grade lesions in 43% and carcinoma in 1%. Histopathology found 49% and 4% respectively. Treatment was performed in 124 patients. Inflammation was found in 27%, a small lesion in 43% and endocervical disease in 21%.


CONCLUSIONS
The high rate of endocervical disease, inflammation and small lesions may explain the cytological difficulties leading to an 'inconclusive' result. The authors believe that the term 'inconclusive' alone does not adequately convey the high level of risk faced by these patients.
Valmadre
S
S
Colposcopy Service, Sydney Gynaecological Oncology Group, King George V and Royal Prince Alfred Hospitals, New South Wales, Australia.
Atkinson
K
K
Houghton
R
R
Carter
J
J
McKenzie
P
P
Russell
P
P
Dalrymple
C
C
D000293:Adolescent; D000328:Adult; D000368:Aged; D002584:Cervix Uteri / Q000166:cytology*; D003127:Colposcopy; D005260:Female; D006801:Humans; D008499:Medical Records; D008875:Middle Aged; D009517:New South Wales / Q000453:epidemiology; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D002583:Uterine Cervical Neoplasms / Q000453:epidemiology* / Q000473:pathology*; D014626:Vaginal Smears / Q000145:classification / Q000592:standards*