A COMPARISON OF UTERINE CERVICAL CYTOLOGY AND BIOPSY RESULTS - INDICATIONS AND OUTCOMES FOR COLPOSCOPY

Background. There is some debate in the literature over the proper app roach to the patient with a mildly abnormal cervical cytologic finding . One current approach for handling low-grade cytologic abnormalities is to perform colposcopy and biopsy if atypia, human papillomavirus (H PV) changes, or mild dysplasia is noted on cytologic examination. If a Papanicolaou (Pap) smear shows inflammation without atypia, the test is repeated after 3 months, and if inflammation does not clear, colpos copy is performed. This study was undertaken to determine whether the above recommendations are appropriate. Methods. In a 1-year period, 12 5 patients underwent colposcopy and biopsy. Results were reviewed and compared. Results. Of 47 patients with smears showing human papillomav irus (HPV) changes, 68% had a higher grade abnormality (dysplasia) on biopsy; 15% had moderate or severe dysplasia. Of eight patients with a typia, 63% had dysplasia on biopsy. Of 41 patients with mild dysplasia on Pap smear, 37% had moderate dysplasia or higher grade disease on b iopsy. Of nine patients with persistent inflammation on cytologic exam ination, biopsy showed 56% with inflammation, 33% with mild dysplasia, and 11% normal. Conclusions. Patients who presented with minimal Pap smear abnormalities such as HPV changes or atypia are likely to have a worse histologic diagnosis, with approximately two thirds showing dys plasia. Patients with persistent inflammation are less likely to have dysplasia. The results support our aggressive approach toward minimall y abnormal smears and our consideration of inflammation without atypia as a separate and lower risk category.