The clinical significance of the poor correlation of cervical dysplasia and cervical malignancy with referral cytologic results

OBJECTIVE: We prospectively studied the diagnostic utility of our Bethesda system-based cervical cytology screening program with colposcopy and biopsy as the criterion standard. STUDY DESIGN: We prospectively collected and studied the correlation of cyt ologic, colposcopic, and histologic data in women referred for colposcopic examination because of "nonnormal" cytologic results or other risk factors. RESULTS: We found that 771 of 5585 initial colposcopic visits yielded high- grade (cervical intraepithelial neoplasia II or worse) biopsies (13.8% prev alence); 13 showed invasive cancer (0.23% prevalence). Only 132 of 771 case s of high-grade dysplasia (17%) and 5 of 13 cases of invasive cancer (38%) followed Papanicolaou smears suggesting high-grade intraepithelial lesions or cancer, with 77% being discovered after "minor" Papanicolaou smear abnor malities. High-grade disease or cancer was confirmed in 1 of 2 high-grade o r cancer Papanicolaou referrals and in 1 of 11 referrals with atypical squa mous cells of undetermined significance. CONCLUSION: Papanicolaou smears, especially those that are low grade, shoul d not be equated with histologic sampling in association with poor cytohist opathologic correlation. Most high-grade dysplasias and cancers occur in wo men with either minor Papanicolaou smear abnormalities or visible lower gen ital tract lesions or both. Colposcopy for women with any "nonnormal" scree ning result is feasible.