The Correlation between Squamous Cell Abnormalities by Liquid based Cytology and Histopathology

Objective: To evaluate the correlation between squamous cell abnormalities by liquid-based cytology and histopathology, and to evaluate the accuracy of liquid-based cytology in detecting cervical squamous cell abnormalities.Methods: A total of 943 patients with squamous cell abnormalities by liquid-based cytology underwent colposcopic examination from June 2014 until May 2017. The final histopathology was defined as the most severe lesion from colposcopic directed biopsy, excision procedure or hysterectomy.Results: A majority of abnormal cytology was LSIL (45.6%), followed by ASCUS, HSIL, ASC-H and SCC (29.6%, 13.5%, 9.7%, and 1.7%, respectively). LSIL/ASCUS cytology was confirmed to be CIN1 or less in approximately 90% of patients but coexisting high-grade lesions (CIN2/3) occurred in about 10% and invasive cancer was less than 1%. HSIL and ASC-H cytology yielded about 50% and 25% high-grade lesions, respectively; coexisting invasive cancer was diagnosed in 10.2% and 1.1%, respectively. Invasive cancers were diagnosed in 43.8% of patients with SCC cytology. The accuracy of liquid-based cytology for detecting cervical squamous cell abnormalities was 79.8%. There was a moderate correlation between cervical cytology and histopathology (Kappa=0.43, 95% CI=0.36-0.50).Conclusion: The correlation between cervical cytology and histopathology remained moderate. Despite, acceptable accuracy rate, it should only be used as a screening test. About 10% of the high-grade lesion was found in low-grade cytology and 10% of invasive lesion co-existed in high-grade cytology. Therefore, pathological confirmation should be made before definitive management especially in areas with high incidence of cervical cancers.