Genital cytology in obstetric and gynecologic patients. A four-year study☆☆☆

Abstract 1.1. Cytologic interpretations were made on 51,022 smears from 15,217 obstetric and gynecologic patients in a four-year study. 2.2. Technical procedures and classification of cytology are substantially those of Papanicolaou and colleagues. Classification of cervical cytologic atypicalities as studied in smears from pregnant women is recommended. 3.3. Only 12.3 per cent of the women studied had what were judged to be normal elements in smear preparations whereas some degree of benign abnormalities was encountered in 80.4 per cent. 4.4. False-negative and false-positive percentages of error are given. Various methods of calculating the false-positive error are illustrated and criticized. 5.5. A total of 594 genital cancers was studied by smear preparations, of which 447, or 75.2 per cent, consisted of squamous-cell carcinoma of the cervix. Adenocarcinoma of the uterus comprised 80, or 13.4 per cent of the total number. Thirty-two (29 squamous-cell and 3 adenocarcinomas), or 6.8 per cent of the cervical cancers, occurred in cervical stumps. 6.6. Ninety-five intraepithelial carcinomas of the cervix were studied. These represent 0.62 per cent of all patients studied, 0.65 per cent of the patients who did not have malignancy, and 17.5 per cent of the neoplastic squamous lesions of the cervix. The ratio of intraepithelial carcinoma to squamous-cell carcinoma of the cervix was 1:4.7. 7.7. Cold-knife conization of the cervix is considered to be the method of choice to provide adequate material for the diagnosis of intraepithelial and early invasive carcinoma of the cervix. The punch biopsy method missed 18.5 per cent of the lesions. 8.8. The number of patients who had intraepithelial and squamous-cell carcinoma of the cervix are presented graphically according to age groups. 9.9. The importance of correlating smear interpretations with corresponding pathologic studies is emphasized. 10.10. The cost of cytologic studies is estimated to be as follows: $0.90 per smear; $3.00 per new patient; $2.00 per visit; $75.00 per malignancy studied. 11.11. It is suggested that many intraepithelial carcinomas of the cervix will not be detected unless women as young as 20 years of age have routine cytologic studies made. 12.12. It is strongly suggested that efforts be made to standardize reports of cytologic interpretations, the staining procedure, classification, and the statistical methods employed. 13.13. The method is of value for broad screening purposes, providing the interpretations are properly controlled. The detection of early cervical neoplasms is, perhaps, its greatest value. The identification for future study of the cervices which exfoliate benign but definite atypicalities of the epithelium is important.