Investigation of 208 consecutive cases of cervical cone biopsies with regard to indication, negative samples and quality control.
OBJECTIVE
To analyze factors in preoperative management and cytologic screening leading to a conization specimen free of neoplasia.


METHODS
From January 2001 through December 2003, cervical conization was performed on 208 consecutive cases at the Gynecologic Department, Krankenhaus Lainz, Vienna. Indications for cone biopsy were based on suspicious internal and/or external conventional cytologic screening results followed by punch biopsies in selected cases.


RESULTS
Benign cervical lesions were diagnosed in 22 women (10.6%). Histologic results in negative cone biopsies were cervicitis (n = 12), infection with HPV without cervical intraepithelial neoplasia (n = 1), tubal metaplasia (n = 4) and combined diagnoses indicating no neoplasia (n = 5). Regarding cytologic screening results prior to conization, long-lasting infections with HPV can cause repeated findings of cells of unknown origin or reversible mild to moderate dysplasia eventually leading to conization specimens free of neoplasia. Furthermore, tubal metaplasia is a frequent pitfall in misinterpretation of cytologic smears.


CONCLUSIONS
Reevaluation of cytologic screening results after the final histologic diagnosis becomes available following cone biopsy is a key issue in continuous quality assurance for the diagnostic procedure. In this article we also present a method of stratifying screening results according to the correctness of the results. Along with other established measures of diagnostic performance, this may support benchmarking and interpretation of the overall cytologic screening quality.
Weigl
Gerhard
G
Jakob-Erdheim-Institut für Pathologie und Klinische Bakteriologie, Krankenhaus Lainz der Stadt Wien, Vienna, Austria. gerhard.weigl@wienkav.at
Pokieser
Wolfgang
W
Schuller
Beatrix
B
Weigert
Monika
M
Ulrich
Walter
W
Sevelda
Paul
P
Breitenecker
Gerhard
G
D000328:Adult; D000368:Aged; D001706:Biopsy / Q000379:methods; D002584:Cervix Uteri / Q000473:pathology*; D005260:Female; D006801:Humans; D008875:Middle Aged; D030361:Papillomavirus Infections / Q000150:complications; D011785:Quality Assurance, Health Care; D011786:Quality Control; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D002578:Uterine Cervical Dysplasia / Q000175:diagnosis* / Q000473:pathology* / Q000821:virology