Differences  between  definitive  arbitrary    histopathological diagnosis of   cervical  intraepithelial carcinoma and previous cytological and biopsy findings.   2005,2006,2007,2008.    N = 624

Table 1.

Difference between definitive arbitrary histopathological diagnosis of  cervical intraepithelial carcinoma and previous cytological findings. 2005,2006,2007,2008.   (See Graph 1 and Table 4)                                                                                N = 624

 2 : patients with definitive histopathological diagnosis of Carcinoma in situ cervicis   uteri  made on operative or  conisation material.
 3 ; exact previous cytological diagnosis of carcinoma in situ cervicis uteri.
 4 ; cytological subdiagnosis   ;  5 : cytological overdiagnosis   ;  6 : negative cyt.diagnosis
 7 : exact cytological diagnosis of carcinoma in situ cervicis uteri
 8 ; cytological subdiagnosis   ;   9 : cytological overdiagnosis
10 : almost one previous false negative cytological finding
11 : Without known previous cytological examinations                     

C  o  m  e  n  t  s   o f  Table 1.

41% of patients with Ca in situ have one known previous cytological finding,

39% have more than one known cytological findings and  for 20% we have not information of previous cytological examinations.

Almost one fifth or 19% of the patients with cervical in situ carcinoma  (13%+6%) have exact cytological diagnosis of intraepithelial neoplasia.Almost one third or 30% of the patients are cytologically subdiagnosed with various stade of CIN or HPV infection (16%+14%). 11% (9%+2%) of the patients are cytologically overdiagnosed.One fifth or 20%  (3%+17%) of the patients were cytologically negative (3% of patients with only one cytological finding and 17% of patients with more than one cytological finding. with at least one false negative). 

If  122 patients without known previous cytological examination are excluded (624 – 122 =502) then the corresponding percentages are 23%,39%,14% and 25%. It is obvious that the proportion of exact cytological diagnoses is rather small (19 % or 23%).
Proportion of subdiagnose and overdiagnoses are rather great (30% or 39% and 11% or 25%,respectfully). Percentage of false negative cytological findings is also great  (20% or 25%,respectfully).

Graph 1.

Differences between definitive arbitrary histopathological diagnosis of  cervical intraepithelial carcinoma and previous cytological findings. 2005,2006,2007,2008                                                                                       N = 624.

 Table 2.

Differences   between   definitive   arbitrary   histopathological diagnosis of  cervical   intraepithelial   carcinoma and previous histopathological findings. 2005,2006,2007,.  and 2008.  See Graph 2 and Table 4)                                        N = 624.                                                                   

 2 : patients with definitive histopathological diagnosis of Carcinoma in situ cervicis        uteri, made on operative or conisation material.
 3 ; exact  previous histopathological diagnosis of carcinoma in situ cervicis uteri.
 4 ; previous histopathological underdiagnosis  (Dysplasias,HPV etc) 
 5 : previous histopathological overdiagnosis   (invasive carcinoma)
 6 : negative  previous histopathological diagnosis  ;
 7 : without known previous histopathological examinations

 C  o  m  e  n  t  s    o  f    T  a  b  l  e   2.

Great majority or almost two third ,   58%  of patients have exact previous histopathological diagnosis of intraepithelial neoplasia.

However, one third,  33% of patients having cervical in situ carcinoma were subdiagnosed histopathologicaly on previous biopsy examinations.

Graph  2.Differences between definitive arbitrary histopathological diagnosis of  cervical intraepithelial carcinoma and previous histopathological findings. 2005,2006,2007,.2008.                                                                                      N = 624.

Table 3.Accuracy of  previous   histopathological   diagnosis according pathologists,   correlated  with   definitive histopathological diagnosis of cervical intraepithelial carcinoma.  (See Graph 3a,3b and 3c)          N = 282.  

* 2005 = VII-XII   ;  
 acc      :     accurate previous histopathological diagnosis
 inacc  : inaaccurate previous histopathological diagnosis (mainly dysplasias)

C o m e n t s  o f  T a b l e 3.

“X” and “Y” are senior pathologists and they signed almost one tenth (85%)of all previous histopatology findings of biopsy material .
Two third (65%) of previous biopsy histopathological findings are accurate,and one third (35%) is inaccurate.
Pathologist “X” have 70% of accurate previous histopathological findings and 30% inaccurate.
Similar results have pathologist “Y” with 60% accurate previous histopathological diagnosis and 40% inaccurate.
Inaccurate  diagnosis are mainly subdiagnoses (various dysplasias)
Pathologist “X” shows a decline of percentage of accurate findings (76% in 2005, 71% in 2006 and 53% in 2007),
Pathologist “Y” shows amelioration of percentage of accurate findings (51% in 2005, 67% in 2006 and 56% in 2007).

Similar amelioration can be seen in yunger pathologists “Z” and “W”.

Graph 3a.              Accuracy of  previous  histopathological diagnosis correlated   with    definitive   histopathological  diagnosis of  cervical intraepithelial carcinoma.                                                              N=468.

Graph 3b.Accuracy of  previous  histopathological diagnosis of individual  pathologists,   correlated  with  definitive histopathological diagnosis of cervical intraepithelial carcinoma. N=468.

  Upper part of the columne = inaccurate previous  histopathologycal findings

Graph 3c.

Accuracy of  previous  histopathological diagnosis of individual  pathologists,   correlated  with  definitive histopathological diagnosis of cervical intraepithelial carcinoma.  N=82

  First columne      :    accurate previous histopathologycal findings.
  Second columne  : inaccurate previous histopathologycal findings.

Table 4.-

Compare the  data in  Table 1 and 2 with those   data,
of a French series of 585 definitive diagnosis of Cervical Carcinoma in situ**.

·          9+78=87 patients (87 of 585=14.6%)  with 132 false negative smears are reclassified as follows:  27(20%) reclassified as HSIL     ;     10 (10%) reclassified as LSIL ;  10 (10%) as ASCUS, 17 were unsatisfactory and 79 (59%) remained negative.

** Bergeron C. et all.: Cervical smears histories of 585 women with biopsy-proven carcinoma in situ. Acta Cytol 1997 Nov-Dec;41(6) : 1676-80.

In an another series from Kiel , analyzing 1194  patients with cone biopsy findings of cervical Carcinoma in situ, cumulated  1971-1979,  “ 92 or 8% was free of pathological epithelium despite positive prefindings. “  Dietl J et all.: Epidemiological and diagnosis analyses of 1194 cone biopsies.  Geburtshilfe Frauenheilkd 1981 Mar,41(3) : 173 – 8.

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In a series from Sheffild, UK, : “Exact correlations were identified between the highest grade lesions on cone biopsy and those in 63% of punch biopsies and 49% of cervical smears.” Heatley MK,Bury JP :Cytopathology,1998 Apr;9(2) 93-9

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In a series from Japan : “The accuracy rate of punch biopsy was 66% (100 of 151) compared by conisation.”  Acta Cytol 1996 Mar-Apr;40(2):241-6.

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In a series from Athens,Greece : “807 conisations; of these 206 (25%) were negative.”J Reprod Med 2003 Aug;48(8):617-21
 

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