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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: July 2003 - Volume 7 - Issue 3 - p 175-183
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.

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