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

1. Table 1 shows that in February 2004 there were 376 histopathological findings on the cervix of the uterus. 46% of the histopathological findings on the cervix were caused by inflammatory and hyperplastic conditions. Dysplasias were found in two-fifths of the findings (37%) and almost one-tenth (10%, i.e., 7%) are findings of intraepithelial carcinoma, i.e., invasive carcinoma. The fact that one-fifth of these findings (17%) are without data for previous cytological investigation, and that in 6% cytological investigation began simultaneously with taking the biopsy is rather concerning. Only 77% of the histological findings were indicated by a cytological analysis. Such indications are most common in dysplasias (88%), intraepithelial carcinomas (86%), inflammations and fibroses (69%) and invasive carcinomas (54%).

2. Table 1 shows that more than two-fifths (46%) of the histopathological diagnoses are inflammations and hyperplasias. This is a relatively high percentage for conditions which are diagnosed with less aggressive procedures. It is highly probable that it is due to the following: a) a relatively large number of false positive cytological findings (65 of 120, or 54%); b) a relatively large number of cytological analyses made simultaneously with biopsy (20); c) a large number of biopsies taken without previous cytological investigation (20%).

In this group of findings there is a relatively high percentage of false positive cytological findings (65 of 120, or 54%!). The largest number of these false positive findings are grouped among conditions such as HPV infections (21 of 65). They should not be treated as falsely positive since this is a consequence of erroneous coding and programming. Hence, there are 65-21 genuinely false positive findings, that is, 44 (37%, not 54%!), of which 17 are epidermidisations and 11 are inflammations. The 16 remaining false positive findings are histologically diagnosed as normal morphology (4), eversion (2), keratosis (5), leucoplakia (1), polyp (3) and hyperplasia (1). (Table 2).

3. Histopathological diagnoses of dysplasias constitute almost two-fifths of histopathological findings (37%). In 11% of these there was no previously performed cytological analysis, and in 1% the cytological smear was taken together with the biopsy, which has no information value. 88% of the histopathological analyses diagnosed as dysplasias were indicated by previously performed cytological investigation, where 16 of 122 findings are false negative (13%). (Table 1).

A completely accurate cytological prediction of a histopathological diagnosis of dysplasia in regards to its grade has not been found in any patient (0 %). In 99% of histopathologically diagnosed dysplasias this pathologic condition has been cytologically subdiagnosed, and in one (1%) it has been overdiagnosed. There are 16 false negative cytological findings.

False negative patients belong in the group of histopathological diagnoses of mild dysplasia (11 of 16), moderate dysplasia (4 of 16) and severe dysplasia (1). (Table 3).

4. In February 2004, intraepithelial neoplasia comprised 10% of cervical biopsies. In five patients (14%) there is no record of a previously performed cytological analysis. In no patients a cytological smear was taken simultaneously with biopsy (0%). In 86% of these patients the cytological finding was an indication for a histopathological analysis, where two of the findings (6%) were false negative. (Table 1).

The cytological prediction of intraepithelial neoplasia was completely accurate in 12 of 32 patients (40%). In 4 of the 32 patients (47%) the cytological diagnosis was a subdiagnosis, but it was useful since it initiated the diagnostic and therapeutic processes important to the reduction of the number of invasive carcinomas. Four patients (13%) were overdiagnosed.

There are 2 false negative cytological findings (6%). (Table 1).

5. The number of histopathological findings for invasive cervical carcinoma (26 or 7%) is lower than the number of histopathological findings for intraepithelial carcinoma (37 or 10%), which is a relatively unfavourable ratio (1:0.70). However, these figures are corrected with the analysis of the stadiums of invasive carcinomas shown below, as well as on the basis of the rejection of earlier diagnosed carcinomas.

As many as 11 of these histopathological findings were obtained without a previous cytological analysis (42%)! One smear was taken simultaneously with biopsy (4%). More than half the biopsies (54% or 14 patients) were indicated by the previously performed cytological analysis. (Table 1).

Out of the eleven accurate cytological findings, cytological diagnosis did not precisely predict invasive carcinoma in any of the patients In all the eleven accurately diagnosed patients (100%) the cytological diagnosis was a subdiagnosis; however, it was useful since it contributed to the diagnostic establishing of the realistic pathological condition.

Three cytological findings (21%) were false negative.