Papanicolaou smear sensitivity for the detection of adenocarcinoma of the cervix - A study of 49 cases

BACKGROUND, Papanicolaou smear sensitivity for cervical adenocarcinoma (CVC A) is not well established. Also uncertain are the relative contributions t o falsely negative diagnoses of sampling, screening, and interpretive error s. METHODS, Papanicolaou smears were identified from all patients at our insti tutions with biopsy-proven cervical adenocarcinoma from 1988-1998. All avai lable negative and unsatisfactory smears were reviewed. RESULTS. Of 49 patients with CVCA, 66 smears initially diagnosed as negativ e and 4 smears initially diagnosed as unsatisfactory from 30 patients were identified. Thirty-two negative smears and 4 unsatisfactory smears from 19 patients were available for review. The retrospective diagnoses in the case s initially called negative were: unsatisfactory in 2, negative in 15, and atypical glandular cells consistent with either adenocarcinoma in situ (AIS ) or CVCA in 15. Three of four smears initially called unsatisfactory had n eoplastic glandular cells identified retrospectively. The 18 falsely negati ve or falsely Unsatisfactory smears were from 13 patients obtained up to 5 years before biopsy diagnosis. These smears contained neoplastic cells like ly to have been mistaken for lower segment endometrial cells (LUS) or endoc ervical cells with tubal metaplasia (TM) in 11, reactive endocervical cells in 6, and both in 1. In 16 of the 18 smears, the abnormal cells were abund ant, although preservation was suboptimal in 6. CONCLUSIONS. Sensitivity of a single Papanicolaou smear for CVCA was betwee n 45% and 76% depending on the classification of negative slides that were not available for review, comparable to previously reported sensitivity for AIS. The diagnostic false-negative or false-unsatisfactory rate in reviewe d smears was 50% (18 of 36). Diminished sensitivity is due to the under rec ognition of glandular neoplasia resembling LUS, TM, or reactive endocervica l cells. Cancer (Cancer Cytopathol) 2001;93:8-15. (C) 2001 American Cancer Society.