Longitudinal analysis of histologic high-grade disease after negative cervical cytology according to endocervical status.

BACKGROUND

There is concern that Papanicolaou (Pap) smears without an endocervical component may be associated with the incomplete detection of abnormalities.

METHODS

Four cohorts of women with initial negative Pap smear reports and an additional Pap smear obtained within 36 months were established from a statewide database. The endocervical status of the entry smear and subsequent smears, respectively, among the cohort women was as follows: Cohort A: present and present; Cohort B: absent and present; Cohort C: present and absent; and Cohort D: absent and absent. The subsequent incidence of histologic high-grade disease was calculated for each cohort.

RESULTS

No significant differences were evident in the incidence of histologic high-grade disease between Cohorts A and B (standardized incidence ratio for Cohort B compared with Cohort A = 0.89; 95% confidence interval, 0.67-1.12). Cohorts C and D had significantly less high-grade disease compared with Cohorts A and B.

CONCLUSIONS

The findings of the current study indicate that early repeat testing of women whose Pap smears are negative but lack an endocervical component is not justified because no higher rate of histologic high-grade abnormality was evident on longitudinal follow-up even when later smears included an endocervical component.