Video monitoring of smear-taking at colposcopy: relationship to cytology.
OBJECTIVE
To investigate the reasons why cervical smears occasionally fail to reflect the underlying pathology in the cervix even when the smear is taken at colposcopy.


METHODS
A randomised study of three different smear-taking devices.


METHODS
A colposcopy clinic.


METHODS
Women attending the colposcopy clinic.


METHODS
A smear was taken from 172 nulliparous and 100 multiparous women at colposcopy and the procedure was monitored on a video-imaging system. The cytological findings were compared with the biopsy report in 147 nulliparous and 85 multiparous women.


METHODS
Accuracy of cytology and the effect of a range of variables on the accuracy of cytology.


RESULTS
Sampling of the transformation zone was incomplete in 15% of nulliparous women and 8% of multiparous women. Univariate analysis of a range of variables including parity, type of sampling devices, completeness of sampling of the transformation zone, size of the transformation zone, size of the lesion (aceto-white area) and location of the squamo-columnar junction showed that the accuracy of cytology was influenced by all these factors except for parity and smear-taking devices. Multivariate analysis showed that the location of the squamo-columnar junction, the size of the transformation zone area, the size of the aceto-white area and the ratio of the aceto-white area to the area of the transformation zone influenced the accuracy of cytology.


CONCLUSIONS
Women with large transformation zone areas (>30.03 mm(2)) and/or small aceto-white lesions (<7.01 mm(2)) are more likely to have an inaccurate cytology reports than women with small transformation zone and women with larger aceto-white areas. A ratio of the aceto-white area to the area of the transformation zone of 0.22 or less increases the risk of disagreement between the cytological and histological findings.
Al-Awadhi
Rana M
RM
Department of Histopathology and Cytology, Imperial College School of Medicine at Hammersmith Hospital, Du Cane Road, London W12 0NN, UK.
Mansell
Elizabeth
E
Chong
Swee
S
Chow
Carl
C
Singer
Albert
A
Coleman
Dulcie V
DV
D000328:Adult; D003127:Colposcopy / Q000379:methods*; D005260:Female; D006801:Humans; D008875:Middle Aged; D015999:Multivariate Analysis; D002583:Uterine Cervical Neoplasms / Q000473:pathology*; D014626:Vaginal Smears / Q000295:instrumentation / Q000379:methods*; D014741:Video Recording; D002578:Uterine Cervical Dysplasia / Q000473:pathology*