Liquid-based Papanicolaou smears without a transformation zone component: should clinicians worry?

doi:10.1016/S0029-7844(02)01998-1

Obstetrics & Gynecology

Volume 99, Issue 6, June 2002, Pages 1053-1059

https://doi.org/10.1016/S0029-7844(02)01998-1 Get rights and content

Abstract

OBJECTIVE:

To evaluate whether ThinPrep smears without versus those with a transformation zone component were more likely to have falsely negative cytology findings.

METHODS:

Women aged 18–50 (N = 4389) attended one of three Planned Parenthood clinics between 1997 and 2001 for screening by ThinPrep Papanicolaou and polymerase chain reaction-based human papillomavirus (HPV) DNA testing. Women with 1) any cytologic abnormality, 2) high-risk HPV types, and 3) a random sample with normal Papanicolaou and negative HPV tests were offered repeat cytology, colposcopy, and biopsy. Cytology and biopsy diagnoses at the colposcopy visit were reviewed according to the presence (n = 3689) or absence (n = 700) of a transformation zone component at screening.

RESULTS:

Among women with normal cytology at screening, histologic detection of at least cervical intraepithelial neoplasia grade 2 (odds ratio 1.3, 95% confidence interval 0.5, 3.3) at colposcopy did not differ significantly between transformation zone-positive and zone-negative smears. Histologically confirmed cervical intraepithelial neoplasia grade 1 was detected more often among smears lacking a transformation zone component (odds ratio 2.0, confidence interval 1.0, 3.8). Transformation zone-negative smears were more common among older women, current oral contraceptive users, those past the 14th day of their last menstrual period, and those negative for high-risk HPV types.

CONCLUSION:

Absence of a transformation zone component in a screening ThinPrep Papanicolaou test was not associated with missed high-grade lesions. Based upon our data, we do not recommend repeat screening of reproductive-aged women with negative liquid-based tests and no cytologic evidence of a transformation zone component.

Section snippets

Materials and methods

The population consisted of women attending three Planned Parenthood of Western Washington clinics between 1997 and 2001. Informed consent was obtained from all study participants. The study protocol was approved by the Institutional Review Board of the University of Washington. Women who were pregnant, chronically immune impaired, without a cervix, or had prior treatment for cervical neoplasia (including electrocautery, cryocautery, conization, laser surgery, or loop electrosurgical excision

Results

During the first 4 years of the study, 4389 women aged 18–50 were screened (mean age 25.2 years). Overall, 700 smears (15.9%) lacked a transformation zone component. The possibility that patient’s age, current OC use, abnormal Papanicolaou history, time since last menstrual period, gravidity, lifetime number of male sex partners, and douching or vaginal medication use might influence the collection of cells from the transformation zone was considered (Table 1). The percentage of transformation

Discussion

Several studies have reported that, in comparison to a conventional Papanicolaou smear, the ThinPrep Papanicolaou test is more likely to be classified as “satisfactory but limited” because of the absence of a transformation zone component, with estimates of this finding ranging from 9.8%12 to 20.0%.13 In our study, 15.9% of screening ThinPrep smears lacked a transformation zone component. However, absence of a transformation zone component did not compromise cytologic-based detection of

Acknowledgements

We thank Tiffany Harris for assistance with project management, Alison Starling and Akhila Balasubramanian for data management, and Kim Tomlinson, Nicole Cosentino, Shanda Bush, Kristin Jay, Emily Woodburne, and Sandra Reilley for their clinical work on this project.

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^☆: This study was supported in part by grant CA34493 from the National Cancer Institute and the STD/AIDS Predoctoral and Postdoctoral Training Program (NIAID AI0714P).

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Original researchLiquid-based Papanicolaou smears without a transformation zone component: should clinicians worry?☆

Abstract

Section snippets

Materials and methods

Results

Discussion

Acknowledgements

Lancet

Lancet

Lancet

The contribution of endocervical smears to cervical cancer detection

Acta Cytol

Negative smears in women developing invasive cervical cancer

Acta Obstet Gynecol Scand

The adequate Papanicolaou smear revisited

Diagn Cytopathol

The significance of endocervical cells in the diagnosis of cervical epithelial changes

Acta Cytol

Rates of condyloma and dsyplasia in Papanicolaou smears with and without endocervical cells

Diagn Cytopathol

Analysis of cervical smears obtained within three years of the diagnosis of invasive cervical cancer

Acta Cytol

Relationship between the diagnosis of epithelial abnormalities and the composition of cervical smears

Acta Cytol

Original research
Liquid-based Papanicolaou smears without a transformation zone component: should clinicians worry?☆