title: A review of histological outcomes from peri-menopausal and post-menopausal women with a cytological report of possible high grade abnormality: an alternative management strategy for these women.
abstract: OBJECTIVE
  To investigate the histological outcomes of women with cytological reports of possible high grade abnormality and to determine if patient age may be a clinically significant factor in determining the presence of high grade disease for this cytological category.
  
  
  METHODS
  Using annual quality reports supplied by the Queensland Pap Test Register, the histological outcomes for 2054 women with possible high grade cytological reports over a 4 year period were investigated to determine the clinical significance of this category in older aged women. Women in the total study group were aged between 16 and 84 years and outcomes were divided into women aged under 40 years and 40 years and over as well as those aged under 50 years and 50 years and over. Cytomorphological features were compared to determine if there were any significant differences between the outcome groups.
  
  
  RESULTS
  The histological confirmation rate for high grade disease for all women was 53.1%. The incidence of histologically confirmed high grade disease was significantly higher in women aged under 40 years (59.7%) compared to women aged 40 years and over (40.3%) (p = 0.001). This was also true for women aged under 50 years compared to those aged 50 years and over (55.8% versus 37.5%) (p = 0.001). When the smears from these women were reviewed, a predominance of mature intermediate and superficial cells was evident in the background of the majority of slides in all histological outcome categories. Many of the smears in the negative outcome group showed reactive, reparative or inflammatory changes.
  
  
  CONCLUSIONS
  The currently mandated Australian management guideline for women with a cytology report of possible high grade disease is referral for colposcopic and histological examination. Since the incidence of high risk human papillomavirus (HPV) decreases with age, a less invasive strategy may be to test women in these older age groups for high risk HPV before proceeding to colposcopy.
authors.affiliation: Cytology Department, QML Pathology, Brisbane, Queensland, Australia. jenny.halford@qml.com.au
authors.forename: Jennifer
authors.initials: J
authors.lastname: Halford
authors.forename: Kylie-Ann
authors.initials: KA
authors.lastname: Walker
authors.forename: James
authors.initials: J
authors.lastname: Duhig
mesh_terms: D000230:Adenocarcinoma / Q000453:epidemiology / Q000473:pathology* / Q000628:therapy; D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001315:Australia / Q000453:epidemiology; D002294:Carcinoma, Squamous Cell / Q000453:epidemiology / Q000473:pathology* / Q000628:therapy; D018450:Disease Progression; D005260:Female; D006801:Humans; D008875:Middle Aged; D017698:Postmenopause; D002578:Uterine Cervical Dysplasia / Q000453:epidemiology / Q000473:pathology* / Q000628:therapy; D002583:Uterine Cervical Neoplasms / Q000453:epidemiology / Q000473:pathology* / Q000628:therapy; D014626:Vaginal Smears; D055815:Young Adult