Cytologic, colposcopic and histopathologic correlations of LSIL and HSIL in reproductive and menopausal patients with hyperkeratosis.

The significance of hyperkeratotic cells in Pap smear is not yet fully understood. Hyperkeratosis represents benign structural change of cervical squamous epithelium, which may mask displastic lesions and make an accurate colpo-cytological examination difficult. We investigated the cytologic, colposcopic and histopathologic correlations of low grade squamous intraepithelial lesion (LSIL) and high grade squamous intraepithelial lesion (HSIL) in hyperkeratotic patients, in order to estimate the influence of hyperkeratosis on the accuracy of cyto-colposcopic examination. We examined conventional Pap smears of 766 reproductive and 384 menopausal women. Patients with hyperkeratotic cells in Pap smear were subsequently investigated by colposcopy and in case of colposcopically proved hyperkeratosis, direct biopsy with subsequent histopathological examination of H&E stained sections were performed. LSIL was found in 2,74% and 1,08% of Pap smears, whilst CIN1 was detected in 6,46% and 4,85% of biopsy specimens inreproductive and menopausal women respectively. ASC-H/HSIL were found in 2,74% and 2,71% of Pap smears and CIN2/3 in 4,18% and 7,76% of biopsy specimens in reproductive and menopausal women respectively. The reliability of Pap test significantly decreases under the presence of hyperkeratosis and it must be an indication for colposcopy. In cases of colposcopically proved hyperkeratosis direct biopsy with subsequent histopathological examination must be performed.