Efficacy of Ki-67 antigen staining in Papanicolaou (Pap) smears in post-menopausal women with atypia--an audit.

In cervical smears from post-menopausal women with mucosal atrophy it can be difficult to distinguish atrophic epithelial cell groups from neoplastic cell groups on cytomorphological criteria only. The consequence of post-menopausal atypia is that the woman is referred for a repeat smear after local oestrogen treatment or for colposcopy. We investigated whether immunocytochemical expression of Ki-67 (MIB-1) on the primary Papanicolaou-stained smear could be of any diagnostic help. Our data showed that negative Ki-67 expression is a very reliable indicator of a normal atrophic cell pattern, and by using this method on the original smear we were able to reduce the false-positive cytologic diagnoses by 86%.