Conventional Papanicolaou Cervical Cytologic Screening in Women for Health Check-up

Park, Choong Hak

Abstract

OBJECTIVE
The purpose of this study was to obtain an important basic data about the clinical efficacy of the conventional Papanicolaou cervical cytology as a screening tool by estimating the prevalence rate of cervical cancer and precancerous lesion in the general population roughly according to The Bethesda System (TBS).
METHODS
This study was performed in Health Check-up Center and Industrial Medicine clinic at Dankook University Medical Center from January 1, 1999 to December 31, 2001. Nine thousand and five hundred fourteen cases who had underwent conventional Papanicolaou cervical cytologic test were analyzed according to The Bethesda System (TBS). Abnormal cytologic diagnoses ((Atypical Squamous Cells of Undetermined Significance (ASCUS) or worse)) were compared with histologic diagnoses as a reference standard.
RESULTS
Followings are the results summarized. 1. Of the 9,514 patients, 8 (0.08%) were diagnosed as unsatisfactory for evaluation. Of the 9,506 cases, there were 3,919 (41.23%) cytolologic diagnoses of Within Normal Limit (WNL), 5,368 (56.47%) of Benign Cellular Change (BCC), 131 (1.38%) of ASCUS, 41 (0.43%) of Low-grade Squamous Intraepithelial Lesion (LSIL), 33 (0.35%) of High-grade Squamous Intraepithelial Lesion (HISL), 7 (0.07%) of Squamous Cell Carcinoma (SCC), 7 (0.07%) of Atypical Glandular Cells of Undetermined Significance (AGUS). There was no cytologic diagnosis of Adenocarcinom (ACC). The ASCUS/SIL ratio was 1.77. 2. The age distribution of patients were as follows: 1 case under 19 years, 719 in the 20's, 2,963 in the 30's, 2,650 in the 40's, 2,020 in the 50's, 1,042 in the 60's, 110 in the 70's, 1 over 80 years. The mean age was 44.50 years. 3. Of 9,506 cases, there were 219 abnormal cytologic diagnoses (ASCUS/AGUS or worse). Of 219 cases, 40 (18.3%) showed high-grade cytologic diagnoses (HSIL, SCC, and ACC) if ASCUS and AGUS were excluded. There was no statistically significant relation between cytologic diagnoses and ages. 4. Of 219 cases with abnormal cytologic diagnoses, 38 patients had histologic diagnoses. Of the 9 ASCUS cases, 5 (55.55%) showed positive histologic LSIL or worse diagnoses. Of the 29 cytologic LSIL or worse cases, 22 (75.9%) showed positive histologic LSIL or worse diagnoses. Of the 21 cytologic HSIL or worse cases, 18 (85.7%) showed positive histologic HSIL or worse diagnoses. Of the 4 cytologic SCC cases, 4 (100%) showed high-grade histologic diagnoses (HSIL or SCC). Of 38 cases with histologic diagnoses, 23 (60.53%) showed high-grade histologic diagnoses ((HSIL, SCC, and Adenocarcinoma in situ (AIS)). There was a statistically significant relation between cytologic diagnoses and high-grade histologic diagnoses in squamous abnormalities.
CONCLUSION
This study showed that 97.7% of cytologic diagnoses were negative and 60.5% of abnormal cytologic diagnoses (ASCUS or worse) were correlated with high-grade histologic diagnoses according to the criteria of TBS in general population. Our data also confirmed that conventional Papanicolaou cervical cytology is more accurate when a high-grade squamous intraepithelial lesion threshold is used. This study will play a relevant role in clinical practice of cervical cancer screening of general population.