title: Incidental finding of abnormal cervical pathology in hysterectomy specimens after normal preoperative Papanicolaou smears in Thammasat University Hospital.
abstract: BACKGROUND
  To investigate abnormal cervical histopathology (ACH) from hysterectomy specimens with normal preoperative Papanicolaou (Pap) smears.
  
  
  METHODS
  Medical records from May 2009 to April 2012 were retrospectively reviewed of subjects from whom hysterectomy specimens were taken in Thammasat University Hospital. All had normal preoperative Pap smears. ACH was the primary outcome. A p-value less than 0.05 was considered significant. A total of 483 subjects with an average age of 50.5 years were recruited. Benign cases of enlarged uterus and pelvic mass were present in 94% (430/483). Endometrial and ovarian cancer were found at 6.2 and 4.7%, respectively. In hysterectomy specimens there were 19 (4%) cases of ACH. Silent ACH with benign disease, endometrial and ovarian cancers were 1.2% (5/430), 33.3% (10/30) and 17.4% (4/23), respectively. The negative predictive value (NPV) and false negative rate of Pap smears were 96 and 4%, respectively. ACH in malignant cases were 27.9% (12/43) and 20% (2/10) in adequate (APS) and inadequate (IPS) Pap collection groups, respectively. ACH in benign condition were 0.68% (2/292) and 2.2% (3/138) in APS and IPS, respectively. ACH was more often found in hysterectomy specimens with indication of malignancy than benign conditions with statistical significance. One third of preoperative stage I endometrial cancer cases had cervical involvement.
  
  
  CONCLUSIONS
  Silent ACH in normal preoperative Pap smear was 4 %. Inadequate Pap smear collection is still the major problem in this study. Reducing inadequate Pap smear collection could reduce the false negative rate.
authors: Department of Obstetrics and Gynaecology, Faculty of Medicine, Thammasat University, Rangsit Campus, Pathum Thani, Thailand E-mail : k_suwannarurk@ yahoo.com.
authors: Pong-anan
authors: PA
authors: Chundarat
authors: Komsun
authors: K
authors: Suwannarurk
authors: Kornkarn
authors: K
authors: Bhamarapravatana
authors: Junya
authors: J
authors: Pattaraarchachai
authors: Yuthadej
authors: Y
authors: Thaweekul
authors: Karicha
authors: K
authors: Mairaing
authors: Yenrudee
authors: Y
authors: Poomtavorn
mesh_terms: D000328:Adult; D000368:Aged; D002584:Cervix Uteri / Q000473:pathology / Q000601:surgery; D055088:Early Detection of Cancer; D016889:Endometrial Neoplasms / Q000175:diagnosis* / Q000473:pathology; D005188:False Negative Reactions; D005260:Female; D006785:Hospitals, University; D006801:Humans; D007044:Hysterectomy; D033162:Incidental Findings; D008875:Middle Aged; D010051:Ovarian Neoplasms / Q000175:diagnosis* / Q000473:pathology; D010053:Ovary / Q000473:pathology; D065006:Papanicolaou Test; D012189:Retrospective Studies; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis* / Q000473:pathology; D014626:Vaginal Smears