Examination of Deeper Levels Is Useful in Identifying High Grade Squamous Intraepithelial Lesions in Cervical Biopsies
MHT Luu, C Zhang, CJ Sung, WD Lawrence. Rhode Island Hospital, Providence; Women & Infants Hospital of Rhode Island, Warren Alpert Medical School of Brown University, Providence, RI
Background: When a cervical Pap smear shows a high-grade squamous intraepithelial lesion (HSIL), colposcopy with cervical biopsy is usually performed to confirm the diagnosis. Should pathologic examination of the initial level of the cervical biopsy fail to reveal HSIL, we routinely review the Pap smear to confirm the diagnosis and we also examine three deeper levels of the cervical biopsy to exclude HSIL deeper within the block. This study was aimed to determine the utility of examining three deeper levels in cervical biopsies to identify HSIL when initial levels are negative in patients with a review-confirmed HSIL on prior cervical Pap smears.
Design: We retrieved from our institutional pathology archives all cases during the period between January 1, 2002 and December 31, 2007 that met the following criteria: 1) a prior Pap smear had review-confirmed HSIL; 2) the initial level of the cervical biopsy showed no HSIL; 3) three deeper levels of the cervical biopsy were examined. The findings on deeper levels of the cervical biopsy were categorized into two groups: (+) HSIL on Deeper Levels and (-) HSIL on Deeper Levels. The histologic findings on deeper levels in each group were correlated with those in the subsequent cone biopsies. Chi-square test was used to compare the proportions of HSIL identified in the cone biopsies associated with either (+) HSIL on Deeper Levels or (-) HSIL on Deeper Levels noted in the prior cervical biopsy.
Results: Of a total of 217 cases that met the abovementioned criteria, 18 cases (8.3%) fell into the group of (+) HSIL on Deeper Levels, and 199 cases (91.7%) comprised the group of (-) HSIL on Deeper Levels. Eight of the 18 patients with (+) HSIL on Deeper Levels and 21 of 199 patients with (-) HSIL on Deeper Levels underwent cone biopsies. HSIL was present in 8 of 8 cone biopsies (100%) following the biopsy finding of (+) HSIL on Deeper Levels and in 7 of 21 cone biopsies (33.3%) following the biopsy finding of (-) HSIL on Deeper Levels (p<0.001).
Conclusions: Cases with (+) HSIL on Deeper Levels in cervical biopsies are more frequently associated with high grade squamous intraepithelial lesions in cone biopsies than those with (-) HSIL on Deeper Levels. Routine examination of deeper levels in cervical biopsies appears to be useful in predicting HSIL in patients with a review-confirmed Pap smear diagnosis of HSIL.
Monday, March 9, 2009 9:30 AM
Poster Session I Stowell-Orbison/Autopsy Award # 64, Monday Morning