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The Pap Test at Follow-up Colposcopy Examinations: Usefulness in the Enhanced Detection of Cervical Neoplasia

Duggan, Máire A. MD1; Brasher, Penny PhD2; Nation, Jill MD3

Journal of Lower Genital Tract Disease: April 2004 - Volume 8 - Issue 2 - p 118-124

Objective. The frequency at which results of the Pap test performed at follow-up colposcopy examinations were more abnormal than the concurrent tissue specimens and the frequency at which the Pap result gain in high-grade squamous intraepithelial lesion (HSIL) resulted in the increased detection of cervical intraepithelial neoplasia 2,3 were investigated.

Materials and Methods. Pap test and concurrent tissue samples obtained at all follow-up colposcopy examinations in the year 2000 were coded for comparability of results and were ranked in ascending order from normal to malignant. The frequency at which the Pap test results were more abnormal than the concurrent tissue results was calculated. Results of subsequent cervical investigations were retrieved for all with a Pap test gain in diagnosis of HSIL.

Results. In 35% of 2,902 examinations (n = 1,027), the Pap test results were more abnormal than the tissue specimens. The gain in diagnosis was HSIL in 2% (63 of 2,902) and low-grade squamous intraepithelial lesion or better in 33% (964 of 2,902). Among those with a gain in HSIL, cervical intraepithelial neoplasia 2,3 or cancer was tissue-confirmed in 28 samples, for a health benefit of the Pap test of 1.0% (28 of 2,902).

Conclusions. The usefulness of the Pap test performed at follow-up colposcopy examinations for the enhanced detection of CIN 2,3 in this cohort is minimal, and the practice safely could be discontinued.

Pap tests at the follow-up colposcopy examination are of minimal use in the enhanced detection of cervical neoplasia and could safely be discontinued.

Departments of 1Pathology and Laboratory Medicine and 3Obstetrics and Gynecology and 2Division of Epidemiology, Prevention, and Screening, Tom Baker Cancer Center, University of Calgary, Calgary, Alberta, Canada

Reprint requests to: Máire A. Duggan, MD, FRCPC, Foothills Medical Center, 11th floor, 1403 - 29 Street N.W., Calgary, Alberta T2N 2T9, Canada. E-mail:

©2004The American Society for Colposcopy and Cervical Pathology