The Usefulness of the Pap Test Taken at the First Colposcopy Examination in the Enhanced Detection of Cervical Neoplasia

摘要

Objective. To determine the diagnostic gain, clinical value, and health benefit of the Pap test taken at the first colposcopy examination by investigating the frequency in which the result of the test was more abnormal than the results of the referral Pap test that triggered the examination, the tissue samples taken at that examination, or both. Materials and Methods. The laboratory information system (LIS) was searched for all first colposcopy examinations and their referral Pap tests. The Pap tests and tissue samples were coded for comparability of diagnosis and ranked in ascending order from normal to malignant. The LIS or patient charts, or both, were searched for follow-up information on the more abnormal colposcopy Pap test results. Results. There were 1,633 women having a first colposcopy examination. In 116 (7%), the colposcopy Pap test was more abnormal than the other samples. In 81 (5%), the diagnostic gain was a low-grade squamous intraepithelial lesion, and in 25 (1.5%), the gain was a clinically valuable high-grade squamous intraepithelial lesion (HSIL). High-grade squamous intraepithelial lesion (CIN 2,3) or adenocarcinoma in situ (AIS) was tissue confirmed in 21 of the 116 women, conferring a health benefit of 1.3% on the colposcopy Pap test. Conclusions. The health benefit of the Pap test taken at the first colposcopy examination in terms of the increased detection of HSIL (CIN 2,3) or AIS is minimal and the practice could safely be discontinued.