EVALUATION OF ATYPICAL AND LOW-GRADE CERVICAL CYTOLOGY IN PRIVATE-PRACTICE

Objective: To evaluate the adequacy of cytology alone for diagnosis of grade of cervical intraepithelial neoplasia (CIN) and to study perfor mance of cytology, human papillomavirus (HPV) testing, and colposcopy in the evaluation of cytologic findings suggesting low-grade squamous intraepithelial lesions (SIL), or atypical squamous (ASCUS) or atypica l glandular (AGCUS) cells of undetermined significance. Methods: Stand ard gynecologic and cytologic evaluation and colposcopic inspection as an additional screening approach were performed on women with no prio r hysterectomies screened in a private practice between January 1, 199 3, and August 1, 1995. Among these 7651 women, 367 had ASCUS, AGCUS, o r SIL cytology or clinically or colposcopically visible cervical lesio ns. Sensitivity, specificity, and relative risk of CIN in the 367 wome n were compared by colposcopic, cytologic, histologic and virologic di agnoses. Results: The sensitivity bf all non-negative Papanicolaou sme ars for CIN 2-3 and cancer was 92%, combined cytologic categories of h igh- and low-grade SIL were 59%, and high-grade SIL alone was 22%. Col poscopy was performed in all 367 patients, and positive findings led t o biopsies in 48%. Colposcopy bf patients with ASCUS increased detecti on of CIN 2-3 by 32% and CIN 1 by 48%. Cervical cytology was false neg ative in 8% of patients with CIN 2-3 and in 14% of those with CIN 1. T hese cases of CIN were detected by screening colposcopic inspection. H igh-risk HPV DNA was positive in 41% of women with CIN 2-3, and in 25% of those with CIN 1. The positive predictive value of ASCUS cytology increased from 5% to 42% for CIN 2-3 and from 30% to 85% for all grade s of CIN in patients carrying high-risk HPV DNA. Virologic studies did not add to an increase in the sensitivity for CIN 2-3 among women in the low- and high-grade SIL cytology groups. Conclusion: Because of th e limited sensitivity of the high-grade SIL cytologic category for CIN 2-3, we recommend that all women with ASCUS, AGCUS, low- or high-grad e SIL cytology be recalled for colposcopy, with biopsy only when indic ated by colposcopic findings. (Obstet Gynecol 1998;92:601-7. (C) 1998 by The American College of Obstetricians and Gynecologists.).