Factors affecting interpretation of cervical cytology


Dr. Anita Kant, Chairman & Head Department of Gynae & Obstetrics, Asian Institute of Medical Sciences, Faridabad    14 December 2022

Menopausal status affects the interpretation of cervical cytology and histology, according to the results of a recent comparative study from South Korea published in the Journal of Menopausal Medicine.1


Researchers from the Dept. of Obstetrics and Gynecology at Inje University Haeundae Paik Hospital in Busan, South Korea carried out a retrospective study to analyse the differences in histological outcomes between 477 pre-menopausal and 122 post-menopausal women who had abnormal cervical cytology. The study subjects went through a loop electrosurgical excision procedure (LEEP) between January 2010 and May 2019. The study also aimed to examine the clinical factors that led to interpretation errors causing discrepancies in the results of cytology and histology.


Cytology, in 73.4% of the premenopausal women, which showed atypical squamous cells of undetermined significance (ASC-US) or low-grade squamous intraepithelial lesions (LSIL), were confirmed to be high-grade lesions on LEEP vs only 36.4% of postmenopausal women. Whereas 27.0% of the postmenopausal women in whom cytology could not conclusively rule out high-grade squamous intraepithelial lesions (ASC-H) or high-grade squamous intraepithelial lesions (HSIL) were found to have low-grade lesions on histology compared to 11.6% in the premenopausal group.


HPV testing was done in 395 patients; 92.2% of abnormal cervical smears showed presence of high-risk HPV. The prevalence of hrHPV 16/18 was 38% and other hrHPV types was nearly 54%. The positivity rate for other hrHPVs was higher in postmenopausal women (70%) compared to premenopausal women (50%).


The clinical variables associated with overrating were postmenopausal status (adjusted odds ratio 2.77), for obesity (aOR 3.74), multigravida (aOR 0.30) and other hrHPVs (aOR 3.25). The aORs for underreporting for postmenopausal status and other hrHPV types were 0.37 and 0.55, respectively. False-positive results were higher in the postmenopausal women (27% vs 11.6%), while false-negative results were higher in the premenopausal women (73% vs 36%).


This single-center study suggests menopausal status and HPV infection as factors that may cause fallacious interpretation of the cervical cytology. These factors should be taken into consideration to avoid misinterpretation errors when analysing abnormal cervical cytological results. HPV testing is recommended to detect at-risk women.




  1. Min Seong Choi, et al. Factors associated with cyto-histological misinterpretation of cervical smear according to menopausal status. J Menopausal Med. 2022 Aug;28(2):78-84. doi: 10.6118/jmm.22023.

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