An article¹ written in late 2023 describes the importance of having both Pap tests and cervical biopsies examined at the same institution for more accurate diagnoses and better patient care. It focuses on the concept of cytology-histology correlation (CHC).
CHC is the process of comparing the most recent, inciting Pap test which led to the collection of the associated biopsy series. This is a crucial process in cervical cancer screening, as comparing the cells interpreted as ASCUS, AGUS, ASC-H or LSIL/HSIL to the actual tissue biopsy is an invaluable tool in the management of cervical disease, as well as being an essential educational and feedback tool for the pathologist/cytotechnologist.
In this study, researchers analyzed biopsies performed at their institution and compared the CHC of those with Pap tests done at:
• The same institution: These cases showed significantly higher agreement between the Pap test and biopsy results.
• Different institutions: These cases had a higher rate of discrepancies, especially “overcalls” where the Pap test indicated a more severe abnormality than the biopsy confirmed.
Consider the following example: an ASC-H Pap test interpretation at an outside laboratory led to a colposcopy-guided biopsy series received by us, here at PathAdvantage. Imagine that this biopsy series was negative, finding only reactive squamous metaplasia and a yeast (Candida) infection. As the Pap test was not available for correlation, these findings are left to the clinician to decide what to do next. An alternative approach, however, would be to make the inciting Pap test available at the time of the biopsy examination. Using our example, the pathologist would be able to look at the reactive cervical biopsy series, and during CHC, they would be able to say that the reactive metaplastic cells did correlate with the cells interpreted as ASC-H. In saying that the ASC-H Pap test correlated with the negative/reactive biopsy findings, the clinician and patient are granted closure and are reassured that, while appropriate follow-up is required, all relevant findings have been examined and considered.
The overall conclusion of this study matches our experience at PathAdvantage; when performing both Pap tests and biopsies at the same institution CHC accuracy is improved, and the risk of overcalls is reduced, which could lead to unnecessary anxiety and potentially inappropriate treatment for patients.
Based on these findings, the authors — and we, at PathAdvantage — strongly recommend that women have both their Pap tests and cervical biopsies performed at the same institution, whenever possible. This ensures optimal accuracy in diagnosis and reduces the risk of misinterpretations that could impact patient care.
REFERENCES
1: Nikolaus Y, Mujumdar V, Padgaonkar P, Buchanan E, Goldberg A. Cytology-histology correlation of cervical Papanicolaou
smears and biopsies performed at a single institution compared to those performed at different institutions.
Cytopathology. 2023 Jan;34(1):61-65. doi: 10.1111/cyt.13182. Epub 2022 Oct 12. PMID: 36148769.