title: Examination of sources of diagnostic error leading to cervical cone biopsies with no evidence of dysplasia.
abstract: At our institution, 17% of cervical conization specimens are reported as negative for dysplasia or malignancy. To identify sources of error, we reviewed 53 negative conization specimens and their prior and follow-up cytology, biopsy, and endocervical curettage specimens. Examination of deeper-level sections and p16 immunostaining were performed on all conization specimens and selected biopsy specimens. Dysplasia was detected in 26% (14/53) of conization specimens. Twenty-eight percent (15/53) of cones were truly negative, and the presurgical material had been overcalled as high-grade squamous intraepithelial lesions (HSIL). Forty-five percent (24/53) of cones were truly negative and HSIL was confirmed in the presurgical material. Of these, 11% (6/53) showed subsequent evidence of residual dysplasia and 26% (14/53) were negative on further follow-up. Deeper-level sections, p16 immunostains, and consensus review may help identify squamous dysplasia in conization specimens and may prevent the overdiagnosis of HSIL on cervical biopsies.
authors.affiliation: Dept of Pathology, UC San Diego Health System, 200 W Arbor Dr, MC8720, San Diego, CA 92103-8720, USA.
authors.forename: Alison
authors.initials: A
authors.lastname: Carrigg
authors.forename: Crystal
authors.initials: C
authors.lastname: Teschendorf
authors.forename: Deirdre
authors.initials: D
authors.lastname: Amaro
authors.forename: Noel
authors.initials: N
authors.lastname: Weidner
authors.forename: Ann
authors.initials: A
authors.lastname: Tipps
authors.forename: Ahmed
authors.initials: A
authors.lastname: Shabaik
authors.forename: Michael R
authors.initials: MR
authors.lastname: Peterson
authors.forename: Grace Y
authors.initials: GY
authors.lastname: Lin
authors.forename: Farnaz
authors.initials: F
authors.lastname: Hasteh
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D014408:Biomarkers, Tumor / Q000032:analysis; D001706:Biopsy; D002584:Cervix Uteri / Q000601:surgery*; D019092:Conization; D019941:Cyclin-Dependent Kinase Inhibitor p16 / Q000096:biosynthesis; D003951:Diagnostic Errors / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008875:Middle Aged; D011230:Precancerous Conditions / Q000175:diagnosis* / Q000378:metabolism; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis* / Q000378:metabolism; D055815:Young Adult; D002578:Uterine Cervical Dysplasia / Q000175:diagnosis* / Q000378:metabolism
chemical_list: D014408:Biomarkers, Tumor; D019941:Cyclin-Dependent Kinase Inhibitor p16