Review of negative and low-grade cervical smears in women with invasive cervical cancer after the first 3 years of the national cervical screening programme in Slovenia.
OBJECTIVE
The purpose of the study was to perform a national review of negative, low-grade and inadequate smears reported during the latest screening period before cervical cancer diagnosis in 2006, after the first 3 years of the screening programme.


METHODS
Among 162 new cervical cancer cases there were 47 (29%) without previous cytology, 47 (29%) with one high-grade smear prior to diagnosis and 68 (42.0%) with at least one previous negative, low-grade, atypical or inadequate smear 1-40 months before diagnosis. Of the latter 68 cases, 37 patients with 59 smears (together with 118 control slides) were included in the review as 31 had smears reported at laboratories no longer operating. Findings were related to the last cytology report before diagnosis as well as to histological type and stage of the cancer.


RESULTS
In our study group, 19 (51%) of 37 patients had squamous cell carcinoma, 15 (41%) adenocarcinoma and 3 (8%) adenosquamous carcinoma, compared with 121 (75%), 26 (16%), 12 (7%), respectively, and 3 (2%) other types, for all carcinomas. Twenty-one of 37 women also had high-grade cytology prior to diagnosis of cancer. Women with previous cytology (with or without recent high-grade smears) were more likely to have stage I cancers than those without cytology (P < 0.0001). The expert group upgraded 17/33 smears in the patients with squamous carcinomas, which was more than in those with adeno- and adenosquamous carcinomas (5/24, P < 0.05).


CONCLUSIONS
As expected, a higher proportion of smears preceding adenocarcinomas were true negative. Under-diagnosed smears were not related to cancer stage or last cytology report before diagnosis.
Department of Pathology and Cytology, Celje Teaching Hospital, Celje, Slovenia.
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Repše-Fokter
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Pogačnik
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Snoj
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Primic-Žakelj
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Fležar
D000230:Adenocarcinoma / Q000453:epidemiology / Q000473:pathology*; D000328:Adult; D000368:Aged; D018196:Carcinoma, Adenosquamous / Q000453:epidemiology / Q000473:pathology*; D002294:Carcinoma, Squamous Cell / Q000453:epidemiology / Q000473:pathology*; D003581:Cytodiagnosis / Q000706:statistics & numerical data*; D055088:Early Detection of Cancer / Q000379:methods; D005188:False Negative Reactions; D005260:Female; D006801:Humans; D008875:Middle Aged; D009367:Neoplasm Staging; D017524:Slovenia / Q000453:epidemiology; D013997:Time Factors; D002583:Uterine Cervical Neoplasms / Q000453:epidemiology / Q000473:pathology*; D014626:Vaginal Smears / Q000379:methods