PAP SMEAR HISTORY IN WOMEN WITH LOW-GRADE CYTOLOGY PRIOR TO CERVICAL CANCER DIAGNOSIS

Aim: The aim of the study was to re-examine all Pap smears taken from women in the year 2000 who were diagnosed with cervical cancer despite the fact that their previous cervical smears had failed to detect high grade change. Material and methods: 281 women were diagnosed with cervical cancer in Norway in the year 2000. Of these a total of 47 women with histologically verified invasive cervical cancer had previous Pap smears diagnosed as unsatisfactory or low-grade (ASCUS, LSIL).The number of smears taken for each of these women between 1992 and 2000 varied from 1-11 making a total of 268 smears potentially available for re-examination. 44 women had a smear taken within 12 months of surgery; these smears were excluded from the study. A total of 252 were retrieved and comprise the study population. The smears were re-assessed at the laboratory of origin and then independently re-examined by two cytopathologists and two cytotechnologists with long experience of cytological diagnostics. Each examiner registered features of the smears and concluded with a diagnosis. The results of re-examination by the cytopathologists and cytotechnologists were regarded as consensus when all four or three of four were in agreement with regard to the following outcomes: • Normal • Cytology follow-up indicated (unsatisfactory, ASCUS, LSIL) • Immediate biopsy indicated (ICC, HSIL, ACIS, AGUS). Results: Among the 47 cases there were 35 squamous cell carcinomas, 10 adenocarcinomas and 2 other types. 38 cases were in Stage I, 6 in Stage II, one each in stage III and IV and one unknown. None of the smears were found to be normal. In 75% of cases consensus was achieved. Among these, 30% of unsatisfactory smears were up-graded to HSIL or ICC. Among the ASCUS smears 75% were up-graded to HSIL and all cases of LSIL were up-graded. On re-examination at the laboratory of origin the first diagnosis leading to immediate biopsy was discovered at 4.2 years prior the original diagnosis and in the study indication for biopsy was found at 5.4 years. Conclusions: This study shows that high-grade lesions could have been detected up to 5 years earlier. However, the screening scenario is essentially different to the re-examination scenario. These cases may possess characteristics difficult to detect in routine examination. The cytological characteristics of these smears will be the subject of further analyses.