Five-year follow-up after cervical cytology and histology discordance: A retrospective cohort study.

Abstract

Cervical smear cytology and colposcopic biopsy histology are prone to error at both collection and interpretation stages, leading to a large number of discordant cases. Investigation of five-year outcomes for women who have cervical cytology that is discordant and higher grade than histology results. A retrospective cohort study was carried out for 111 women with cervical cytology discordant and higher grade than histology, after cytopathological review, over a three-year period. Five-year follow-up data were reviewed to identify the highest level of pathology seen within five years from the discordance. Women with atypical squamous cells with possible high-grade change (ASC-H) cytology and negative biopsy (n=28) had a 46% chance of high-grade histological disease within 5years; with cervical intraepithelial neoplasia grade 1 (CIN1) histology (n=20), this was reduced to 30%. With high-grade cytology and negative histology (n=23), 48% had high-grade disease within five years, including one case of invasive disease; with CIN1 histology 50% had high-grade disease within five years. This study demonstrates a 30-50% chance of high-grade disease within five years, in the setting of ASC-H or high-grade cytology with a negative or low-grade colposcopic biopsy. This highlights that in the setting of cytology and histology discordance, at least one of the tests indicating high-grade pathology warrants the need for treatment or close ongoing surveillance.