Abnormal pap smear and negative colposcopy: how to avoid over/underdiagnosis and over/under treatments
Francesco Sopracordevole1 – , Mariasole Fichera1 –
1 – Complex organizational structure of Oncological Gynecology, Oncological Reference Center of Aviano – IRCCS – National Cancer Institute, Aviano
Corresponding Author: Francesco Sopracordevole
Satisfactory and negative colposcopy with abnormal pap smear poses problems of diagnostic accuracy and subsequent diagnostic-therapeutic management, to avoid both diagnostic delays and overtreatments. The purpose of this work is to provide information on the diagnostic-therapeutic management for these cases in the context of the cost-benefit balaratio for the patient.
The most significant papers in the international literature on the subject of negative colposcopy and the use of random cervical biopsies in these cases were reviewed. The current SICPCV 2019 recommendations were considered. The risk factors for invasive neoplasia were considered: the cyto- logy for referral to colposcopy, the persistence of the cytological lesion, the characteristics of the woman (fertile age, menopausal status).
In women with negative colposcopy and ASC-US / LSIL pap smear, follow-up with excision in case of persistent cytological alteration at 24 months is indicated. In case of AGC, the endocervix and, if necessary, the endometrium should be evaluated. Immediate diagnostic excision is indicated for AGC-H positive lesion. This may be the first choice in postmenopau- sal women with ASC-H / HSIL, in other cases excision is indicated in case of persistence of the cytological abnormality. Currently, there is no evidence accepted by the Guidelines / Recommendations of Italian scientific societies to support the execution of random biopsies in case of abnormal pap smear and negative colposcopy.
The diagnostic-therapeutic management in case of an abnormal pap smear and negative colposcopy is well defined and reduces the risks of over/underdiagnosis and over/under-treatment for the woman, as well as providing reassurance for the action of the gynecologist. The whole process, and above all the diagnosis of negative colposcopy, must be reliable. The guidelines/recommendations of scientific societies remain the point of reference for safe therapeutic-diagnostic management.
Keywords: negative colposcopy; pap smear; random cervical biopsy; uterine cervix; prevention.
Available in LRIOG Nr.1 – 2022