An example of the monthly comment on the Correlation between Cytology and Histopathology (February 2004)

6. In February 2004 there was a total of 4,971 cytological findings. Understandably, a large majority of these findings was negative (84%). Cytological findings marked ASCUS (ASC) comprise 1.34%, 13.90% are dysplasias, 0.62% intraepithelial carcinomas and 1.74% invasive carcinomas. There were, in the wider sense, 16.1% positive findings (Table 6).

7. Among the negative cytological findings there are numerous technically unsatisfactory ones. 976 have irrelevant subsequent histological findings. Clearly, in a large majority of the patients (97%), a subsequent histopathological analysis was not made and it was, understandably, unnecessary. In 48 patients (1%) the clinicians decided to take a biopsy. It was done simultaneously with the cytological smear in 13 patients (27%), while in 35 patients (73%) biopsy was taken after the smear. Among these 35 patients, the biopsy confirmed the benign cytological diagnosis in 22 patients (63%), while 13 patients (27%) had false negative findings. (Table 6). These 13 patients with false negative findings were histopathologically diagnosed with mild dysplasia (9), moderate dysplasia (2) and severe dysplasia (2). (Table 7).

8. Table 6 shows that in all the findings, the diagnosis of ASCUS (ASC) is within the allowed value of 1.34% or 8.34% of the positive or non-negative findings. It is also clear why 55% or 82% of these patients did not have a subsequent biopsy. After the cytological diagnosis of ASCUS (ASC), 12 patients had biopsies (18%), 4 of them simultaneous (33%) and 8 subsequent (67%). Out of these, five are accurate (subdiagnosed) and three are false positive (38%). These three false positive patients were histopathologically diagnosed with epidermidisation (2) and HPV infection (1). (Table 8).

9. Among the positive cytological findings (691), dysplasias have the highest incidence. They represent 13.90% of all the findings in February 2004, i.e., 86.05% of all the positive, non-negative findings. Since they include all types of dysplasias, the percentage of patients without a subsequent histopathological analysis (57%) is relatively low, and the percentage of patients with subsequent biopsy is relatively high (43%). However, more than two-thirds of these biopsies (64%) were taken simultaneously with the smears, while in only 74 patients (36%) biopsies were taken subsequent. Out of these, in 69 patients (64%) cytological findings are accurate; in 30 patients (43%) they are completely accurate in regard to the stage of dysplasia, in 12 patients (17%) they are subdiagnosed and in 27 patients (39%) they are overdiagnosed. 38 of the 107 patients (36%) are false positive. This figure is corrected by the fact that it includes 12 patients with HPV infection which, due to erroneous coding and programming, is calculated as false positive. Hence, false positive are 38-12= 26 or 24%. (Table 6).

Histopathological diagnosis of the false positive cases is epidermidisation (12 of 26), inflammation (4 of 26), polyp (1 of 26), eversion (3 of 26) and normal morphology (2 of 26). (Table 9).

10. In February 2004, 31 patients were cytologically diagnosed with carcinoma in situ, which comprises 0.62% of all cytological findings or 3.86% of all positive non-negative findings. Nine of the patients are without a subsequent histopathological analysis, which means that in 22 patients (71%) a histological analysis was made, in three of them simultaneously (14%) and in 19 subsequently (86%). Out of these 19 patients, the cytological diagnosis was accurate in 15 patients (79%): in 8 of them (53%) the histopathological diagnosis of intraepithelial neoplasia was accurately predicted, and 7 (47%) were sub-diagnosed.

Four patients are false positive (21%). (Table 6).

Two of them were histopathologicaly diagnosed with HPV infections, and the other two as chronic inflammations (Table 10).

11. Table 6 shows that in the month reported, 14 invasive cervical carcinomas were cytologically diagnosed. It comprises 0.28% of all the cytological findings in this month, or 1.74% of all positive, non-negative findings. Two of the cases are without a subsequent histopathological analysis (14%). In the other 12 patients a subsequent histopathological analysis was made (86%), where in three cases the histopathological analysis was made simultaneously (25%) and in nine (75%) it was done subsequently on the basis of the indications by the cytological diagnosis. This diagnosis is accurate in 8 patients (89%): it is completely accurate in two patients (25%) who had subsequent biopsies after the positive cytological diagnosis for invasive cervical cancer, while in 6 patients (75%) the cytological diagnosis was a subdiagnosis – carcinoma in situ (3), mild dysplasia (1) and severe dysplasia (2). (Table 11)

One cytological finding is false positive (11%). (Table 6).

It was histopathologically established as HPV infection (Table 11).