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Is This the End of the Line for the Moderate Dyskaryotic Smear?

Harry, Vanessa N. MRCOG; Narayansingh, Gordon V. FRCOG; Parkin, David E. MD, FRCOG

Journal of Lower Genital Tract Disease: January 2008 - Volume 12 - Issue 1 - p 20-23
doi: 10.1097/lgt.0b013e31813429c6
Original Articles
Spanish Translation

Objective. The British Society for Clinical Cytology has recently proposed that the terminology for cervical smear reporting is to be changed from a 3-tier system (mild, moderate, severe dyskaryosis) to a 2-tier system of low-grade and high-grade dyskaryosis. This modification eliminates the central category of moderate dyskaryosis which would be incorporated into the high-grade group. The aim of this study was to investigate the role of the moderate dyskaryotic smear in clinical practice.

Materials and Methods. A retrospective review of all women who were referred for colposcopy because of a moderate dyskaryotic smear was carried out for a 6-month period. Data collected included colposcopic impression, procedure performed and final histopathology. Two cytologists who were unaware of the original smear report were asked to reclassify these smears using the new 2-tier system. Their findings were compared with the documented colposcopic and histopathology results.

Results. One hundred women with moderate dyskaryotic smears were referred for colposcopy during the study period. Most of these were reclassified as high-grade dyskaryosis using the new system. Fifty-six (72%) of the moderate dyskaryotic smears which were correctly regraded as high grade by cytologist 1 were found to have cervical intraepithelial neoplasia 2/3 on final histopathology, whereas for cytologist 2, 66 (68%) were found to have high-grade cervical intraepithelial neoplasia.

Conclusion. There is no clinical benefit in retaining the term moderate dyskaryosis. This study emphasizes the need for a uniform 2-tier system.

There is no clinical benefit in retaining the term moderate dyskaryosis.

Department of Gynecological Oncology, Aberdeen Royal Infirmary, Aberdeen, Scotland, United Kingdom

Reprint requests to: Vanessa N. Harry, MRCOG Ward 43, Department of Gynecological Oncology, Aberdeen Royal Infirmary, Foresterhill, Aberdeen, Scotland, AB25, 2ZN, United Kingdom. E-mail:

©2008The American Society for Colposcopy and Cervical Pathology