"specimen adequacy and effect of human papillomavirus in cervicovaginal smears with squamous intraepithelial abnormality"

abstract-cervicovaginal cytology is still a widely used cancer screening method that is well established in most countries. the present study aims at detecting and classifying squamous intraepithelial abnormalities and effects of certain infectious agents, particularly the cytopathic effects of human papillomavirus (hpv) in a series of cervicovaginal smears, according to the bethesda system (tbs). the significance of specimen adequacy in revealing squamous intraepithelial abnormalities (siea) was also evaluated. overall, 9066 smears were examined according to tbs. for interpretation of atypical squamous cell of undetermined significance (ascus), certain quality control (qc) guidelines were considered. while stressing on koilocytic atypia, the full spectrum of cytologic alterations due to hpv was investigated. of all smears, 79% were satisfactory for evaluation and 15% were inadequately satisfactory due to absence of the endocervical/transformation zone (ec/tz) component. the proportion of siea was significantly (p< 0.05) higher in smears having such a component. of 246 cases with siea, 173 (1.90%) cases were classified as ascus, 46 (0.50%) as low grade squamous intraepithelial lesion (lsil), and 27 (0.26%) as high grade squamous intraepithelial lesions (hsil). of the latter, 19 cases demonstrated hpv effects. ascus was the most frequent diagnosis for which qc criteria were fulfilled. on the basis of our study the adequacy of specimen is of paramount significance, with particular emphasis on the presence of ec/tz component.