A cytological review of smears precedeing cervical cancer diagnosis

Among the cases notified to the Romagna Cancer Registry for the population of Ravenna (Italy) between 1986 and 1990, 10 invasive cervical cancers and 32 cervical intraepithelial neoplasias (CIN) grade III were identified in patients with at least one Pap smear reported as negative during the 5 years prior to diagnosis. These specimens and those reported as 'positive' (that is, from CIN-I to invasive cancer) at the time of diagnosis were reviewed. Overall, out of the 74 smears originally reported as negative, 18 (24%) were found to be positive. The majority of the specimens which resulted to be false negative had been reported as showing minor abnormalities. Fifty true- positive smears were reviewed. Of the 23 originally reported as CIN I,6 where re-classified as showing minor abnormalities. A natural lack of reproducibility rather than a mere problem of underestimation seems to affect the classification of low grade abnormalities.