Cervical cytology: an audit in a Singapore teaching hospital.

ABSTRACTObjectives: To describe the cervical cytologydiagnoses and cyto-histological correlation in theDepartment of Pathology, National University ofSingapore in 1997 and to compare the data withinternational figures.Methods: A database search of all cervical cytologycases diagnosed in the department in 1997 as wellas follow-up biopsies was carried out. The data wasthen critically analysed.Results: 10,207 cases were reviewed. 96% of thecases had a diagnosis of “negative”. Under 1% ofcases were labelled as “inadequate”. “Atypia” wasdiagnosed in 1% and dysplasia and/or malignancywas diagnosed in 1%. These figures correlate wellwith international data. Of the dysplasia cases,78% were followed by biopsy. Of the high-gradedysplasia cases that were biopsied, 97% of thebiopsy diagnoses were within the acceptableconcordance range with the cytology diagnosesand in only 3% was there a significant discrepancy.Of the cases diagnosed as atypia, 39% weresubsequently biopsied at the same institutionas the next procedure and only one showed highgrade dysplasia. A total of six cases showed asignificant discrepancy between the cervicalcytology result and the subsequent biopsydiagnosis and these were reviewed to elucidatethe reasons for the discrepancies.Conclusion: The cervical cytology service is of ahigh diagnostic standard. A subset of patientsis probably being prematurely biopsied and maybenefit from having a repeat smear instead.Specific clinical protocols regarding subsequenttherapy following cytology results and closercyto-histological correlation are two main areaswhere the cytology service can be improved.Keywords: cervix, cytology, review, screening,ASCUS