PROSPECTIVE CORRELATION OF CERVICOVAGINAL CYTOLOGIC AND HISTOLOGIC SPECIMENS

An effective, prospective, computer-guided method of correlation is re ported. The mechanism for identification of cases, comparison of diagn oses, and reconciliation of discrepancies are explained. The results a re similar to prior, retrospective, correlation studies. The benefits specific to this unique prospective approach include optimal capture o f cases for correlation, minimization of errors before diagnoses are r eleased to clinicians and patients, and internal standardization of di agnostic criteria. Three thousand four hundred and four consecutive pa ired cervicovaginal cytologies and biopsies were accessioned at the Pa thology Department of Duke University Medical Center over a 43-month p eriod. Of these, 481 paired cases (14%) had discordant diagnoses, defi ned as differing more than one degree of dysplasia or as dysplasia or carcinoma identified by only one modality. Additional evaluation recon ciled the diagnostic differences in 35 cases. Eighteen initial diagnos tic differences arose from cytologic screening errors, 16 from interpr etive errors by staff pathologists, and one from superficial initial h istologic sections. The remaining 446 discordances were attributed to sampling differences, The cytologic smear contained the diagnostic les ion in 40% of the cases and the biopsy the remainder, emphasizing the utility of pairing these sampling techniques in patients at risk for d ysplasia.