Abstract
The purposes of this study were to determine the prevalence and predictive value to detect significant neoplasia and invasive lesions, and to evaluate the correlation between clinical and histopathology of women with squamous cell carcinoma (SCCA) on Siriraj liquid-based cervical cytology (Siriraj-LBC). The computerized database of women who underwent Siriraj-LBC at Siriraj Hospital, Mahidol University from January 2007 to December 2010 were retrieved. The hospital records of women with SCCA cytology were reviewed. The prevalence of SCCA cytology was 0.07%. A total of 86 women, mean age was 58.1 years. Sixty-one women (70.9%) were post-menopausal. Overall significant pathology and invasive gynecologic cancer were detected in 84 women (97.7%) and 71 women (82.5%), respectively. The positive predictive values for detection of significant neoplasia and invasive lesion were 97.7% and 82.6%, respectively. The cervical cancer was diagnosed in 69 women and among these 58 women were SCCA. Thirteen women (15.1%) had cervical intraepithelial neoplasia (CIN) 3 and two women (2.3%) had cervicitis. The sensitivity and specificity of colposcopy for cervical cancer detection in SCCA cytology were 83.3% and 75%, respectively. Median follow up period was 17.6 months and 64 patients were alive without cytologic abnormality. The final histopathology of SCCA cytology in our populations demonstrated a wide variety, from cervicitis to invasive cancer and the most common diagnosis was invasive cervical cancer. Colposcopy with biopsy and/or endocervical curettage and loop electrosurgical excision procedure should be undertaken to achieve histologic diagnosis.
Highlights
Cervical cytology is accepted worldwide for early detection of cervical neoplasia since the inception of the conventional Pap smear
The 2001 Bethesda Terminology System implemented the criteria for determining the squamous cell cytologic abnormalities as atypical squamous cells (ASC), low-grade squamous intraepithelial lesion (LSIL), high-grade squamous intraepithelial lesion (HSIL) and squamous cell carcinoma (SCCA) (Solomon et al, 2002)
The previous publications reported the rate of serious pathology and invasive lesions in women with SCCA cytology on conventional smears were 2697.9% and 15-33.3%, respectively (Massad et al, 2001; Charoenkwan et al, 2006)
Summary
Cervical cytology is accepted worldwide for early detection of cervical neoplasia since the inception of the conventional Pap smear. The previous publications reported the rate of serious pathology and invasive lesions in women with SCCA cytology on conventional smears were 2697.9% and 15-33.3%, respectively (Massad et al, 2001; Charoenkwan et al, 2006). Benign or cervical intraepithelial neoplasia (CIN) 2-3 pathologies were detected in 13% and 51% of patients, respectively (Massad et al, 2001). A retrospective study in 48 patients with SCCA abnormality on their conventional Pap smear found cervical cancer and high grade squamous intraepithelial lesions in 16 and 24 patients, respectively (Charoenkwan et al, 2006). The management of squamous cell carcinoma abnormality type has no unique guidelines, and using the strategies as recommended for HSIL cytology by the American Society for Colposcopy and Cervical Pathology (ASCCP) (Wright et al, 2007)
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