Discrepancy between Cytology and Histology in Cervical Cancer Screening: a Multicenter Retrospective Study (KGOG 1040)

• DOI: 10.3346/jkms.2021.36.e164
• Publication Date: 2021-05-31T04:51:44Z
• Authors: Yung-Taek Ouh; Ji Jeong Park; Minjoo Kang; Miseon Kim; Jae Yun Song; So Jin Shin; Seung-Hyuk Shim; Heon Jong Yoo; Maria Lee; Sung-Jong Lee; Whan Shin; Gun Oh Chong; Min Chul Choi; Chel Hun Choi; Kyung-Jin Min
• Keywords: Adult; HPV; Histology; Human papillomavirus 18 / genetics*; Biopsy; 610; Uterine Cervical Neoplasms; Cervix Uteri; Sensitivity and Specificity; Mass Screening / methods*; Biopsy / methods*; Uterine Cervical Neoplasms / virology; Uterine Cervical Neoplasms / pathology*; 03 medical and health sciences; 0302 clinical medicine; Predictive Value of Tests; 80 and over; Cervical Cytology; Humans; Mass Screening; Discrepancy; Early Detection of Cancer; Aged; Retrospective Studies; Aged, 80 and over; Vaginal Smears; Cervical Intraepithelial Neoplasia / diagnosis*; Human papillomavirus 16; Human papillomavirus 18; Cervix Uteri / pathology*; Uterine Cervical Neoplasms / diagnosis; DNA; Middle Aged; Uterine Cervical Dysplasia; 3. Good health; Viral / analysis*; Colposcopy; Cervical Intraepithelial Neoplasia / pathology; DNA, Viral; Human papillomavirus 16 / genetics*; Original Article; Female

Cervical cancer is the fourth common cancer in women worldwide. The Papanicolau test is the primary screening procedure to detect abnormal cervical cells. Colposcopy is the main procedure for discriminating high-grade cervical lesions. The study aimed at clarifying the discrepancy between cervical cytology and colposcopic biopsy histology as well as confounding factors.Eligible patients visited thirteen tertiary hospitals for colposcopic biopsy following cervical cytology and human papillomavirus (HPV) genotypes between January and December 2018. Baseline characteristics including age, body mass index (BMI), and parity were collected.In our study, 3,798 eligible patients were included. Mean age of patients was 42.7 (19-88) years and mean BMI was 22.5 (16.9-34.1) kg/m². The referred cervical cytologic findings consisted of 495 normal, 1,390 atypical squamous cells of undetermined significance, 380 atypical squamous cells cannot exclude high-grade squamous intraepithelial lesion, 792 low-grade squamous intraepithelial lesion, 593 high-grade squamous intraepithelial lesion, 79 atypical glandular cells, 46 squamous cell carcinoma, and 23 adenocarcinoma. HPV-positive findings were found in 3,008 (79.2%) patients and were not detected in 914 (24.1%) cases. The risk of unexpected low-grade lesions from histology was higher in patients > 45 years (odds ratio [OR], 2.137; 95% confidence intervals [CIs], 1.475-3.096). In contrast, the risk of unexpected high-grade lesions from colposcopic biopsy was lower in patients ≥ 45 years (OR, 0.530; 95% CI, 0.367-0.747) and HPV 16/18 infection was higher than other HPV (OR, 1.848; 95% CI, 1.385-2.469).Age and HPV genotypes were responsible for the discrepancies between cytology and histology. Precautions should be taken for women over the age of 45 in triage for colposcopy in order to avoid unnecessary testing.