Accuracy of Papanicolaou smears in cervical cancer patients treated with radiochemotherapy followed by radical surgery.

Papanicolaou (Pap) smears are part of the follow-up program for patients with cervical cancer treated with radiochemotherapy. After therapy, residual neoplastic cells may be rare, seldom exfoliate, and may demonstrate many alterations, which creates a risk of inaccurate results. We report a study of 65 patients who received radiochemotherapy before radical surgery. For each patient, we compared smear results with results from histologic examination of the whole cervix. The Pap smear was "negative for cancer" in 50 cases, "positive for cancer" in 6 cases, and detected atypical squamous cells of undetermined significance in 9 cases. Histologic examination revealed a complete pathologic response (pR0) in 26 cases and a partial pathologic response (pR1) in 27. In 12 cases, no pathologic response (pR2) was shown. Comparison of these results showed that the Pap test had a sensitivity of 0.16, a specificity of 0.96, a negative predictive value of 0.83, a positive predictive value of 0.42, and an accuracy of 0.46.