title: Outcome of women with inadequate cervical smears followed up for five years.
abstract: BACKGROUND
  The clinical and prognostic significance of "inadequate" cervical smear is unknown, even though women with repeated inadequate smears are referred for colposcopy in the National Health Service (NHS) Cervical Screening Programme.
  
  
  OBJECTIVE
  To follow up a cohort of women with inadequate cervical smears over the following five years to examine outcomes, including detection of high grade cervical intraepithelial neoplasia (CIN).
  
  
  METHODS
  The study comprised 1972 women with an inadequate cervical smear reported at Walsall Hospitals NHS Trust between 1 April 1995 and 31 March 1996. Results of cervical smears and biopsies taken over the following five years were reviewed to confirm the outcome.
  
  
  RESULTS
  Within five years, 2.2% of women with an inadequate cervical smear developed histologically confirmed high grade CIN, which was higher than the 1.3% seen among all women with cervical smear tests reported at the same laboratory over the same period, although the difference was not significant at the 95% level of confidence. Where inadequacy resulted from or was contributed to by "polymorphs obscuring", the risk of subsequent development/detection of high grade CIN was 2.6%.
  
  
  CONCLUSIONS
  Women with inadequate cervical smears had an increased risk of detection of high grade CIN in the following five years compared with "all women". This increased risk was not significant, although if a larger number of women had been studied significance may have been reached, so that further studies are needed. The increased risk appeared to be at least partially dependent on the reason for inadequacy.
authors.affiliation: Walsall Hospitals NHS Trust, Manor Hospital, Walsall, West Midlands WS2 9PS, UK. Hocky@wht.walsallh-tr.wmids.nhs.uk
authors.forename: Y L
authors.initials: YL
authors.lastname: Hock
authors.forename: S
authors.initials: S
authors.lastname: Ramaiah
authors.forename: E S
authors.initials: ES
authors.lastname: Wall
authors.forename: A M
authors.initials: AM
authors.lastname: Harris
authors.forename: L
authors.initials: L
authors.lastname: Marston
authors.forename: J
authors.initials: J
authors.lastname: Marshall
authors.forename: K
authors.initials: K
authors.lastname: Kendall
authors.forename: A
authors.initials: A
authors.lastname: Teale
mesh_terms: D000328:Adult; D002584:Cervix Uteri / Q000473:pathology*; D003127:Colposcopy; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D012306:Risk; D012680:Sensitivity and Specificity; D013995:Time; D017211:Treatment Failure; D002583:Uterine Cervical Neoplasms / Q000473:pathology*; D014626:Vaginal Smears; D002578:Uterine Cervical Dysplasia / Q000473:pathology*