Dilemmas in exfoliative cytopathology of uterine cervix

Exfoliative gynaecological cytology (known as the ”Pap smear”) is used for prophylactic detection of precancerous conditions and cancer of the uterine cervix and also for control of therapy results. The Pap smear test helps to establish the diagnosis and therapeutic procedures. The National Programme of Cervical Cancer Control based on exfoliating cytology has been conducted in Poland since 2006. The previously used Papanicolaou system which divides results of cervical smear examination into 5 classes is currently replaced by the Bethesda system, established by the National Cancer Institute of America in 1988. The modi- fication of cytological reporting brought a new dilemma connected with using new terms such as the category of borderline nuclear changes or undetermined significance conditions (ASCUS/AGC). The most common problem of routine diagnosis is the degree of intraepithelial neoplasia, which represents a wide biological spectrum of lesions. It is worth men- tioning two groups of cytopathology problems: false-negative and false-positive diagnoses. Especially the former should raise our vigilance, because they have important consequences for patients. False-positive diagnoses, although less dangerous, also cause redundant costs of unnecessary therapy.