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Short interval between two Pap smears: effect on the result of the second smear? A prospective randomized trial

  • General Gynecology
  • Published:
Archives of Gynecology and Obstetrics Aims and scope Submit manuscript

Abstract

Purpose

A repeat Pap smear is sometimes necessary after a short time interval or even immediately, when patients seek for a second opinion or due to study participation. Only limited information is available on the possible impact of a short interval between two Pap smears. Most institutions therefore practice a minimum time span of 6–8 weeks before obtaining a second smear since a short interval is commonly believed to be associated with an increase of false negative results in the second smear.

Methods

Two consecutive Pap smears were obtained from 81 women. 41 smears were processed using the conventional technique, whereas liquid-based cytology was used in the remaining 40 women. Smears were independently evaluated by four different cytopathologists. We analyzed the effect of time interval, both processing techniques and inter-observer variance in cytological evaluation.

Results

While the result of the second smear shows a tendency towards a more benign outcome (odds ratio (OR) 1.436, 95% CI 0.972–2.121), this difference was not statistically significant (p = 0.07). No significant differences were observed between conservative and liquid-based cytology (OR 1.554, 95% CI 0.659–3.667, p = 0.31). There was considerable inter-observer variability, and the observer was a strong predictor of the cytological result (OR 0.632–5.083, 95% CI 0.355–8.975, p < 0.01).

Conclusions

We document a tendency towards a more benign outcome without statistical significance in the second smear. Inter-observer variability of different cytopathologists is high and should be kept in mind when evaluating cytology results.

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Acknowledgements

We thank the cytoassistants Hilde Orend, Gerlinde Pieringer, Sabine Schmidl, Nigar Demren and Rafaela Schaal for their technical support. We are grateful to Marit Klingler and Julia Dette for their contribution in cervical smear collection. We thank Michelle Etheridge, M.A. Interpreting and Translating, for professional language editing.

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Authors and Affiliations

  1. Department for Obstetrics and Gynecology, University Hospital Munich, Grosshadern, Ludwig-Maximilians-University, Munich, Germany

    Theresa M. Kolben, Berit Boettcher, Christian J. Thaler, Thomas Kolben, Christian Dannecker, Sven Mahner & Julia Gallwas

  2. Amedes MVZ for Gynecology and Pathology Munich GmbH, Munich, Germany

    Florian Bergauer

  3. Laboratory for Cytodiagnostics, Freiburg, Germany

    Jochen Moeckel

  4. Department of Medical Informatics, Biometry and Epidemiology, University of Munich, Munich, Germany

    Alexander Crispin

Authors
  1. Theresa M. Kolben
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  2. Florian Bergauer
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  3. Jochen Moeckel
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  4. Berit Boettcher
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  5. Christian J. Thaler
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  6. Thomas Kolben
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  7. Alexander Crispin
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  8. Christian Dannecker
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  9. Sven Mahner
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  10. Julia Gallwas
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Contributions

TMK and JG: protocol/project development, data collection and management, data analysis, manuscript writing/editing. FB, JM, BB and CJT: cytopathologic evaluation. TK, SM and CD: protocol/project development, data analysis. AC: statistical analysis. All authors interpreted the results and approved the final manuscript.

Corresponding author

Correspondence to Theresa M. Kolben.

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Conflict of interest

The authors declare that they have no conflicts of interests. There was no financial support of this study. Authors state that they have full control of all primary data and that they agree to allow the Journal to review their data if requested.

Ethical standards

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The study has been approved by the Institutional Review Board of the University of Munich (Number: 257-14).

Informed consent

Informed consent was obtained from all patients.

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Kolben, T.M., Bergauer, F., Moeckel, J. et al. Short interval between two Pap smears: effect on the result of the second smear? A prospective randomized trial. Arch Gynecol Obstet 295, 1427–1433 (2017). https://doi.org/10.1007/s00404-017-4369-x

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  • DOI: https://doi.org/10.1007/s00404-017-4369-x

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