Effect of 2 referral intervals on diagnostic discordance between cytology and histology at a colposcopy clinic.
OBJECTIVE
To determine the effect of the time interval between cervical cytology screening and histology at treatment on grade of cervical disease.


METHODS
In a retrospective cross-sectional study at a colposcopy clinic in Soweto, Johannesburg, South Africa, data were compared from women with cytologic abnormalities referred for colposcopy between April 2003 and June 2010 to determine whether early (≤ 180 days) or late (> 180 days) referral had an impact on dysplasia grade.


RESULTS
In the early and late referral groups, there were 213 (13.43%) and 201 (14.63%) women, respectively, with upgrading of cervical dysplasia (P=0.35), and 1373 (86.57%) and 1173 (85.37%) women, respectively, with downgrading or no change (P=0.35). Risk factors for upgrading were HIV infection (odds ratio [OR], 1.63; P<0.001) and condom use (OR, 1.30; P=0.02). Four cases (0.68%) of invasion among women with low-grade squamous intraepithelial lesion (LSIL) and 50 cases (2.11%) among women with high-grade SIL (HSIL) were not detected by cytology. Risk factors for invasive disease on histology were age (OR, 1.09 per year; P<0.001), parity (OR, 1.32 per pregnancy; P<0.001), and HSIL on cytology (OR, 3.17; P=0.03).


CONCLUSIONS
There was no difference in the up- or downgrading of cervical dysplasia between the 2 referral groups.
Department of Obstetrics and Gynecology, Chris Hani Baragwanath Hospital, University of the Witwatersrand, Johannesburg, South Africa. fsaayman@hotmail.com
Francois
F
Saayman
Cyril J
CJ
Van Gelderen
Pam
P
Michelow
Eunice J
EJ
Van Den Berg
Yasmin
Y
Adam
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D003127:Colposcopy / Q000592:standards*; D003430:Cross-Sectional Studies; D005260:Female; D006678:HIV; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy; D006801:Humans; D008875:Middle Aged; D060787:Neoplasm Grading; D009361:Neoplasm Invasiveness; D010298:Parity; D011247:Pregnancy; D012017:Referral and Consultation / Q000592:standards*; D012189:Retrospective Studies; D012307:Risk Factors; D013019:South Africa; D013997:Time Factors; D002578:Uterine Cervical Dysplasia / Q000150:complications / Q000175:diagnosis* / Q000473:pathology; D002583:Uterine Cervical Neoplasms / Q000150:complications / Q000175:diagnosis* / Q000473:pathology; D055815:Young Adult