Journal List > Korean J Cytopathol > v.19(2) > 1006514

Korean J Cytopathol. 2008 Sep;19(2):111-118. Korean.
Published online September 30, 2008.  https://doi.org/10.3338/kjc.2008.19.2.111
Copyright © 2008 The Korean Society for Cytopathology
Diagnostic Accuracy of Cervicovaginal Cytology in the Detection of Squamous Epithelial Lesions of the Uterine Cervix; Cytologic/Histologic Correlation of 481 Cases
So-Young Jin, M.D., Sang Mo Park, M.D., Mee Sun Kim, M.T., K.A.C., Yoon Mi Jeen, M.D., Dong Won Kim, M.D. and Dong Wha Lee, M.D.
Department of Pathology Soonchunhyang University Hospital, Seoul, Korea.
Received July 19, 2008; Accepted September 03, 2008.

Abstract

Background

Cervicovaginal cytology is a screening test of uterine cervical cancer. The sensitivity of cervicovaginal cytology is less than 50%, but studies of cytologic/histologic correlation are limited. We analyzed the diagnostic accuracy of cervicovaginal cytology in the detection of the squamous epithelial lesions of the uterine cervix and investigate the cause of diagnostic discordance.

Materials and Methods

We collected a total of 481 sets of cervicovaginal cytology and biopsies over 5 years. The cytologic diagnoses were categorized based on The Bethesda System and the histologic diagnoses were classified as negative, flat condyloma, cervical intraepithelial neoplasia (CIN) I, CIN II, CIN III, or squamous cell carcinoma. Cytohistologic discrepancies were reviewed.

Results

The concordance rate between the cytological and the histological diagnosis was 79.0%. The sensitivity and specificity of cervicovaginal cytology were 80.6% and 92.6%, respectively. Its positive predictive value and negative predictive value were 93.7% and 77.7%, respectively. The false negative rate was 19.4%. Among 54 false negative cytology cases, they were confirmed by histology as 50 flat condylomas, 2 CIN I, 1 CIN III, and 1 squamous cell carcinoma. The causes of false negative cytology were sampling errors in 75.6% and interpretation errors in 24.4%. The false positive rate was 7.4%. Among 15 false positive cytology cases, they were confirmed by histology as 12 atypical squamous cells of undetermined significance (ASCUS) and 3 low grade squamous intraepithelial lesions (LSIL). The cause of error was interpretation error in all cases. The overall diagnostic accuracy of cervicovaginal cytology was 85.7%.

Conclusions

Cervicovaginal cytology shows high overall diagnostic accuracy and is a useful primary screen of uterine cervical cancer.

Keywords: Uterine cervix; Neoplasms; Cytology; Diagnostic accuracy

Figures


Fig. 1
Cytologic findings of false negative case. A few irregular clusters and scattered atypical cells mimicking atrophic vaginitis are seen on inflammatory background(A : Papanicolaou stain). A cluster of atypical cells with hyperchromasia and coarse clumping of nuclear chromatin and high N/C ratio is found with scattered single atypical cells(B : Papanicolaou stain). Sections of the uterine cervix demonstrate microinvasive squamous cell carcinoma (C : H&E).
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Tables


Table 1
Cytologic-histologic correlation of squamous epithelial lesions of uterine cervix
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Table 2
Diagnostic accuracy of cervicovaginal cytology
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Table 3
Causes of error of false positive cases in cervicovaginal cytology
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Table 4
Causes of error of false negative cases in cervicovaginal cytology
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Table 5
Diagnostic accuracy of cervicovaginal cytology in the literatures
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