TOWARD OBJECTIVE QUALITY ASSURANCE IN CERVICAL CYTOPATHOLOGY - CORRELATION OF CYTOPATHOLOGIC DIAGNOSES WITH DETECTION OF HIGH-RISK HUMAN PAPILLOMAVIRUS TYPES

Using The Bethesda System, five pathologists independently diagnosed 2 00 smears that originally had been classified as ''atypical,'' and the results were correlated with concurrent detection of human papillomav irus (HPV) DNA by Southern analysis and by polymerase chain reaction a mplification. The smears were reclassified as benign reactive changes (negative), atypical squamous cells of undetermined significance, or s quamous intraepithelial lesion (SIL). Exact five-way cytologic agreeme nt was achieved in only 29% of smears, and no slide was diagnosed as a typical squamous cells of undetermined significance by all reviewers. The detection of high-risk types of HPV correlated strongly with the l ikelihood of a diagnosis of squamous intraepithelial lesion. High-risk HPV types were detected in approximately 60% of smears reclassified a s squamous intraepithelial lesion compared with 30% of those reclassif ied as atypical squamous cells of undetermined significance and 10% of negative smears (P < .001). Every smear unanimously diagnosed by the panel as squamous intraepithelial lesion was associated with detectabl e HPV DNA, mainly of high-risk types. Low-risk HPV DNA types were foun d with similar frequency in all diagnostic categories assigned by the reviewers. Based on the consistent relation between high-risk HPV dete ction and diagnoses according to the Bethesda System, the authors conc lude that HPV testing may have an important role in quality assurance in cervical cytopathology.