LACK OF UTILITY OF PAP SMEARS OBTAINED AT COLPOSCOPY WITH TISSUE SAMPLING

Our objective was to determine whether repeat Pap smears obtained at c olposcopy with tissue sampling yield useful information. A retrospecti ve study of 314 women who underwent colposcopy with both Pap smear and tissue sampling was performed. The colposcopic Pap smear diagnoses we re compared with the concomitant tissue and prior Pap smear diagnoses, and discrepant cases were reviewed. The repeat colposcopic Pap smear yielded a more serious diagnosis than the tissue or prior Pap smear in only 8 cases. All differences were within one Bethesda system categor y. The clinical management of these patients was not significantly alt ered by the colposcopic Pap smear diagnosis. These Pap smears represen ted 7.1% of the total Pap smears and 30% of the abnormal Pap smears ex amined by the cytology laboratory during the study period. The estimat ed Medicare reimbursement for evaluating these smears ranges from $620 0 to $7800. Repeat colposcopic Pap smears add to the cost of a colposc opic workup but offer only limited clinical benefit.