Sweden has experienced an unexpected #x3e;30% increase in cervical cancer incidence among women with normal cytological screening results. We therefore performed a nationwide assessment of false-negative cytology before invasive cervical cancer. The Swedish national cervical screening registry identified 2,150 normal cytologies taken up to 10 years before 903 cases of invasive cervical cancer. The 27 cytological laboratories in Sweden were asked to rereview the slides, and all of them completed the rereview. One thousand nine hundred fifteen slides were retrieved and reviewed. Abnormalities were found in 30% of the slides, and the proportion of slides that had a changed diagnosis on rereview increased on average by 3.9% per sampling year during 2001–2016 (p #x3c; 0.03). We also asked for rereview of normal smears taken up to 42 months before a histopathologically diagnosed high-grade squamous intraepithelial lesion (HSIL) or adenocarcinoma in situ (AIS). 19/27 laboratories responded, and out of 6,101 normal smears taken before HSIL/AIS, 5,918 were retrieved and rereviewed. The diagnosis was changed in 25% of cases. In summary, we found an increasing time trend of false-negative smears taken before invasive cervical cancer. This indicates a decreased protection of normal cytology in the screening program supporting earlier findings that this is the main reason behind the recent Swedish increase in cervical cancer. We suggest that optimal cervical cancer control may be promoted by routine nationally coordinated rereview of negative smears before high-grade cervical lesions or invasive cervical cancer.
Acta Cytologica

中文翻译：

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高级别宫颈病变或浸润性宫颈癌之前正常宫颈细胞学检查的全国范围审查


瑞典出现了意想不到的#x3e；在细胞学筛查结果正常的女性中，宫颈癌发病率增加了 30%。因此，我们在浸润性宫颈癌发生前对假阴性细胞学检查进行了全国范围的评估。瑞典国家宫颈筛查登记处确定了 903 例浸润性宫颈癌病例长达 10 年的 2,150 例正常细胞学检查。瑞典的 27 个细胞学实验室被要求重新审查幻灯片，并且全部完成了重新审查。检索并审查了一千九百十五张幻灯片。 30% 的载玻片中发现异常，并且在 2001-2016 年间，每个采样年在重新审查时诊断发生改变的载玻片比例平均增加 3.9% ( p #x3c; 0.03)。我们还要求重新审查组织病理学诊断为高级鳞状上皮内病变 (HSIL) 或原位腺癌 (AIS) 之前 42 个月内采集的正常涂片。 19/27 实验室做出回应，在 HSIL/AIS 之前采集的 6,101 份正常涂片中，检索并重新审查了 5,918 份。 25% 的病例诊断发生改变。总之，我们发现在浸润性宫颈癌之前进行的假阴性涂片的时间趋势呈增加趋势。这表明筛查计划中对正常细胞学的保护减少，支持了早期发现，这是最近瑞典宫颈癌增加的主要原因。我们建议，在出现高级别宫颈病变或浸润性宫颈癌之前，通过对阴性涂片进行常规全国协调复查，可以促进最佳的宫颈癌控制。
 细胞学学报