Abstract
BackgroundAs the population ages in developed countries, the number of Pap smears for cervical cancer screening of older women is increasing. There is concern that cervical atrophy may cause misinterpretation of results for this segment of the population. The present study evaluated the accuracy of screening for high-grade intraepithelial lesions (HSILs) in women younger or older than 50 years, to determine whether aging affects cytological interpretation.MethodsPatients with HSIL cytology (N = 1565) were dichotomized into those aged 20–49 years or aged ≥ 50 years. Association between histology results and age was examined. Pearson’s chi-squared test and Cochran-Armitage trend test were used for statistical analysis.ResultsThe positive predictive value (PPV) for cervical intraepithelial neoplasia (CIN)2 and worse was 65.2% (62/95) in older women but 87.3% (482/552) in younger women (p < 0.001). Older patients had a significantly lower PPV (p = 1.69 × 10–8). Separately analyzing chronic cervicitis, CIN1 and overt cancer grouped together, compared with another group composed of CIN2 and CIN3, we found that the PPV for CIN2 and CIN3 was lower in older than in younger women [44.2% (42/95)-vs-82.4% (455/552), p < 0.001], respectively.ConclusionsHSILs are associated with a wide range of disease categories as age increases, and the accuracy of HSIL interpretation is lower in older women.
Highlights
Cervical cancer is the fourth most common cancer in women worldwide [1]
Pap smears are used for cervical cancer screening; the Bethesda system is widely accepted for their interpretation
Comparing the patients with CIN2 and worse (CIN2 +), we found that positive predictive value (PPV) for this group was significantly lower (p < 0.001) in older (65.2%, 62/95) than younger (87.3%, 482/552) patients, as shown in Table 1 and Fig. 2
Summary
Pap smears are used for cervical cancer screening; the Bethesda system is widely accepted for their interpretation. Most women with cytological results showing high-grade intraepithelial lesions (HSILs) according to the Bethesda system will have biopsy-confirmed cervical intraepithelial neoplasia (CIN) or CIN3 identified at the time of colposcopy. As the population ages in developed countries, the number of Pap smears for cervical cancer screening of older women is increasing. The present study evaluated the accuracy of screening for high-grade intraepithelial lesions (HSILs) in women younger or older than 50 years, to determine whether aging affects cytological interpretation. Conclusions HSILs are associated with a wide range of disease categories as age increases, and the accuracy of HSIL interpretation is lower in older women
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