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Right-Sided Ectocervical Lesions May Be Associated with False-Negative Cytology Among Women with Histologic Cervical Intraepithelial Neoplasia 2 or 3

Jeronimo, Jose MD1; Castle, Philip E. PhD, MPH1; Herrero, Rolando MD, PhD2; Sherman, Mark E. MD1; Bratti, M. Concepcion MD, MPH2; Hildesheim, Allan PhD1; Alfaro, Mario MD2; Morales, Jorge MD2; Hutchinson, Martha L. MD3; Burk, Robert D. MD4; Lorincz, Attila PhD5; Wacholder, Sholom PhD1; Rodríguez, Ana Cecilia MD, MPH2; Schiffman, Mark MD, MPH1

Journal of Lower Genital Tract Disease:
Original Articles

Background. The association between the location of an ectocervical lesion and the sensibility of cytologic screening has not been adequately evaluated.

Methods. We evaluated the proportion of false-negative cytologic interpretations using three independent cytologic interpretations (conventional, PapNet, and ThinPrep) according to lesion location in 111 women with histologic cervical intraepithelial neoplasia 2 or 3 of a population-based study of cervical neoplasia conducted in Guanacaste, Costa Rica. Semiquantitative measures of human papillomavirus viral load were also considered.

Results. Lesions on a women's right ectocervix were associated with more frequent false-negative results than lesions on left ectocervix for each of the cytologic methods or when the most severe interpretation was considered (p = .004). Right-sided lesions had nonsignificantly lower viral loads than left-sided lesions (p = .2).

Conclusions. Cervical intraepithelial neoplasia 2 or 3 located on the right side of the cervix may be poorly sampled with broom samplers in some settings, resulting in false-negative cytologic results.

Author Information

1Division of Cancer Epidemiology and Genetics, The National Cancer Institute, Rockville, MD; 2Proyecto Epidemiologico Guanacaste, San Jose, Costa Rica; 3Womens and Infants' Hospital, Providence, RI; 4Cancer Research Center, Albert Einstein College of Medicine, Bronx, NY; and 5Digene Corporation, Gaithersburg, MD

Reprint requests to: Jose Jeronimo, MD, Division of Cancer Epidemiology and Genetics, National Cancer Institute, 6120 Executive Blvd., MSC 7234, Bethesda, MD 20892. E-mail:

©2003The American Society for Colposcopy and Cervical Pathology