Papanicolaou Smear Discrepancy: Resolution By Review

BACKGROUND: Discrepancy between Papanicolaou smears and colposcopically directed biopsies often creates a treatment dilemma, especially when the cytologic specimen suggests a higher grade lesion than the histologic specimen. A method of side-by-side review using the Bethesda System was evaluated as a means of resolving this discrepancy between cytologic and histologic specimens. METHODS: By means of a retrospective chart review, we selected 150 patients undergoing colposcopic evaluation for abnormal cytologic findings. Thirty-eight patients had higher grade lesions on cytologic examination than on histologic examination. Twenty-four of these patients had both cytologic and histologic slides available, and these specimens were evaluated in a blinded review by a single pathologist using the Bethesda System of classification. RESULTS: Reevaluation yielded resolution of discrepancy in 19 of 24 cases, a 79.2 percent resolution. CONCLUSION: Review of cytologic and histologic specimens by an experienced pathologist using the Bethesda System can resolve many of the cases in which the cervical lesion is considered to be of a higher grade by cytologic examination than by histologic examination.