Diagnostic Three Slides Pap Test Compared to Punch Biopsy and Endocervical Curettage in Confirmed HSIL+ Diagnosis.

Roberta Rubeša-Mihaljević,Snježana Štemberger-Papić,Danijela Vrdoljak-Mozetič,Damjana Verša Ostojić,Morana Dinter,Marko Klarić

doi:10.3390/diagnostics11060942

Roberta Rubeša-Mihaljević, Snježana Štemberger-Papić + Show 4 more

Open Access

https://doi.org/10.3390/diagnostics11060942

Copy DOI

Journal: Diagnostics	Publication Date: May 25, 2021
Citations: 4	License type: CC BY 4.0

Affiliation: University of Rijeka

Abstract

Objective: The aim of the study was to evaluate the accuracy of the diagnostic Pap test (DPT) on three slides and punch biopsy and endocervical curettage (PB/ECC) compared with the final biopsy material in the detection of high-grade squamous intraepithelial lesion (HSIL). Materials and methods: Patients treated with conization after previous DPT and PB/ECC were analyzed. The findings of the DPT and PB/ECC as well as of the endocervical brush cytology and ECC were compared with the final conus histology. Results: 150 patients were analyzed, and final histology verified 145 cases of HSIL and 3 cancers. The percentage of confirmed HSIL cytology was 97%, while for PB/ECC it was 79% with 30/145 false negative results. The correlation between Pap test and PB/ECC showed that the diagnostic accuracy of DPT is significantly higher (p < 0.0001). Endocervical brush cytology confirmed HSIL+ in the endocervical canal in 83% and ECC in 35% of cases (p < 0.0001). Conclusion: The DPT on three slides enables better detection of HSIL compared to PB/ECC, particularly for lesions localized in the endocervical canal sampled with a cytobrush. A high quality DPT could represent a surrogate for PB/ECC and open the possibility of direct access to therapeutic procedure.

Highlights

According to Croatian national guidelines for the management of cervical intraepithelial lesions, colposcopy is recommended in patients with an abnormal Pap test detected in screening programs [12]
In order to assess the role of Pap tests in the management of cervical lesions, especially in the era of primary human papilloma virus (HPV) screening, the aim of this study was to compare the results of diagnostic Pap test (DPT) and targeted punch biopsy and endocervical curettage (PB/ECC) with the final histological diagnosis of squamous high-grade cervical lesions
Most patients with high-grade squamous intraepithelial lesion (HSIL)-detected lesions were in the age group between 35 and 39 years

Summary

Introduction

Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affiliations. In order to ensure an optimal specimen that will accurately locate the lesion, cytological samples of the posterior fornix of vagina, ectocervix and endocervix are taken on three separate slides [14] Ancillary testing such as p16/Ki-67 dual staining and HPV testing may be performed in order to achieve the correct diagnosis. This gives the opportunity to the gynaecologist to have simultaneously a DPT and/or PB/ECC report as confirmation of high grade dysplasia before deciding the type of final excision treatment. In order to assess the role of Pap tests in the management of cervical lesions, especially in the era of primary HPV screening, the aim of this study was to compare the results of DPT and targeted PB/ECC with the final histological diagnosis of squamous high-grade cervical lesions. These results may contribute to determine better the position of cytology as a valuable diagnostic tool in the diagnostic management of cervical dysplasia

Study Population

Methods

Statistical Analysis

Results

Colposcopic Findings

DPT Findings

Diagnostic