Significance of cytopathologist's review of Pap tests screened as negative for intraepithelial lesion or malignancy that are positive for high-risk human papillomavirus

Abstract

Cytopathologist's review of Papanicolaou tests (PTs) screened by cytotechnologists as negative for intraepithelial lesion or malignancy (NILM) that are positive for high-risk human papillomavirus (hrHPV+) may be a useful quality control measure. From January 1, 2012 to December 31, 2012 all NILM/hrHPV+ PTs underwent cytopathologist's review before report issuance as per routine quality control procedures. HrHPV status was known at the time of screening and at final review. The rate of upgraded diagnoses resulting from the cytopathologist's review were examined. Two-year follow-up was obtained. Cytopathologist's review upgraded 250 of 1282 PTs (19.5%) by 1 step to atypical squamous cells of undetermined significance and 13 (1%) were upgraded by 2 steps or more to low-grade squamous intraepithelial lesion or higher. During the same period, significantly fewer NILM PTs (of unknown hrHPV status) were upgraded by 2 steps or more as a result of random 10% rescreening by cytotechnologists (0.2%, P < 0.001). Follow-up was available in 740 of 1282 patients (57.7%). The upgraded group was significantly more likely to be referred for colposcopy (68.3% versus 30.5%, P< 0.001) and cervical intraepithelial neoplasia (CIN) 2 or higher (CIN2+) was diagnosed in more upgraded patients (8.9% versus 3.0%, P < 0.01) than in those not upgraded. There was no significant difference in the percentage of colposcopy patients diagnosed with CIN2+ in the 2 groups, respectively (13.1% versus 9.8%, P = 0.47). cytopathologist's review of NILM/hrHPV+ PTs identified more 2-step discrepancies than routine 10% rescreening. Significantly more patients in the upgraded group were found to harbor CIN2+; however, this could be related to the higher rate of referral to colposcopy in this group.