{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,4]],"date-time":"2026-07-04T02:35:42Z","timestamp":1783132542452,"version":"3.54.6"},"reference-count":23,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2022,9,13]],"date-time":"2022-09-13T00:00:00Z","timestamp":1663027200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2022,9,13]],"date-time":"2022-09-13T00:00:00Z","timestamp":1663027200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Sci Rep"],"abstract":"<jats:title>Abstract<\/jats:title><jats:p>The objective of this study was to conduct a 2-year follow-up of individuals having unsatisfactory reports of Pap smears and to analyze the contributing factors. This was a retrospective study at a medical center that performed about 5000\u20136000 Pap smears annually in Eastern Taiwan. Women who had unsatisfactory results due to scant cellularity between January 1, 2015\u2013December 31, 2016, were included in this study. The control group comprised age-matched women with normal Pap smears at a 1:4 ratio, during the same period. The clinical characteristics and the 2-year outcomes were followed. Patients who were unavailable for follow-up assessments or who had insufficient clinical information were excluded. Student\u2019s <jats:italic>t<\/jats:italic>-test and chi-square test were used for continuous and categorical variables, respectively. Statistical significance was defined as a <jats:italic>p<\/jats:italic>-value\u2009&lt;\u20090.05. A total of 887 Pap smears were included. A total of 717 and 170 women had normal Pap and unsatisfactory Pap tests, respectively. After excluding women who were unavailable for follow-up, the final analysis included 248 and 67 women with normal and unsatisfactory Pap tests, respectively. The mean age was not significantly different between the two groups (49.97\u2009\u00b1\u200910.69 and 51.61\u2009\u00b1\u200911.28\u00a0years in the unsatisfactory Pap and control groups, respectively [<jats:italic>p<\/jats:italic>\u2009&gt;\u20090.05]). The percentage of menopause and vaginal discharge were significantly different between the two groups. Multivariate analysis revealed that premenopausal status, increased discharge were associated with the risk of unsatisfactory Pap tests. Of the 67 women with unsatisfactory Pap tests, all tested negative for any malignancies at a 2-year follow-up assessment. Women with increased vaginal discharge and without menopause were at an increased risk of having an unsatisfactory Pap test. Our results indicate that an unsatisfactory Pap smear due to scant cellularity might not increase the risk of intraepithelial neoplasia or cancer after 2 years. Further, large-scale studies with longer follow-up periods are required.<\/jats:p>","DOI":"10.1038\/s41598-022-19784-3","type":"journal-article","created":{"date-parts":[[2022,9,13]],"date-time":"2022-09-13T18:03:37Z","timestamp":1663092217000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Clinical characteristics and a 2-year follow-up of unsatisfactory conventional Pap smears: a retrospective case\u2013control study"],"prefix":"10.1038","volume":"12","author":[{"given":"Chin-Tzu","family":"Tien","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pei-Chen","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chi-Jui","family":"Chen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dah-Ching","family":"Ding","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2022,9,13]]},"reference":[{"key":"19784_CR1","doi-asserted-by":"publisher","first-page":"e191","DOI":"10.1016\/S2214-109X(19)30482-6","volume":"8","author":"M Arbyn","year":"2020","unstructured":"Arbyn, M. et al. Estimates of incidence and mortality of cervical cancer in 2018: A worldwide analysis. Lancet Glob. Health 8, e191\u2013e203 (2020).","journal-title":"Lancet Glob. Health"},{"key":"19784_CR2","doi-asserted-by":"publisher","first-page":"e14848","DOI":"10.1097\/MD.0000000000014848","volume":"98","author":"Y-C Kau","year":"2019","unstructured":"Kau, Y.-C. et al. Trend and survival outcome in Taiwan cervical cancer patients: A population-based study. Medicine 98, e14848 (2019).","journal-title":"Medicine"},{"key":"19784_CR3","doi-asserted-by":"publisher","first-page":"102","DOI":"10.1097\/LGT.0000000000000525","volume":"24","author":"RB Perkins","year":"2020","unstructured":"Perkins, R. B. et al. 2019 ASCCP risk-based management consensus guidelines for abnormal cervical cancer screening tests and cancer precursors. J. Low. Genit. Tract Dis. 24, 102\u2013131 (2020).","journal-title":"J. Low. Genit. Tract Dis."},{"key":"19784_CR4","first-page":"231","volume":"11","author":"R Sharma","year":"2020","unstructured":"Sharma, R., Ambroise, M. M., Ramdas, A. & Ravichandran, K. Predictors of unsatisfactory conventional Pap smears. J. Midlife. Health 11, 231\u2013235 (2020).","journal-title":"J. Midlife. Health"},{"key":"19784_CR5","doi-asserted-by":"publisher","first-page":"271","DOI":"10.1002\/cncy.21521","volume":"123","author":"R Nayar","year":"2015","unstructured":"Nayar, R. & Wilbur, D. C. The Pap test and Bethesda 2014. Cancer Cytopathol. 123, 271\u2013281 (2015).","journal-title":"Cancer Cytopathol."},{"key":"19784_CR6","doi-asserted-by":"publisher","first-page":"S33","DOI":"10.1016\/j.jasc.2019.08.079","volume":"8","author":"C Prater","year":"2019","unstructured":"Prater, C. et al. Decreasing the incidence of unsatisfactory pap smears in gynecologic cytology. J. Am. Soc. Cytopathol. 8, S33\u2013S34 (2019).","journal-title":"J. Am. Soc. Cytopathol."},{"key":"19784_CR7","doi-asserted-by":"crossref","unstructured":"Nayar, R. & Wilbur, D. C. The Bethesda system for reporting cervical cytology: Definitions, criteria, and explanatory notes. (2015).","DOI":"10.1007\/978-3-319-11074-5"},{"key":"19784_CR8","first-page":"938","volume":"52","author":"D-C Ding","year":"2007","unstructured":"Ding, D.-C., Hsu, S., Chen, S. S. & Hsu, Y.-H. Pap smears with reactive cellular changes: A prospective study. J. Reprod. Med. 52, 938\u2013940 (2007).","journal-title":"J. Reprod. Med."},{"key":"19784_CR9","doi-asserted-by":"publisher","first-page":"725","DOI":"10.1016\/S1701-2163(16)34958-1","volume":"33","author":"H Paulin","year":"2011","unstructured":"Paulin, H., Geldenhuys, L. & Naugler, C. Predictors of an unsatisfactory conventional cervical cytology smear. J. Obstet. Gynaecol. Can. 33, 725\u2013728 (2011).","journal-title":"J. Obstet. Gynaecol. Can."},{"key":"19784_CR10","doi-asserted-by":"publisher","first-page":"906","DOI":"10.1016\/j.tjog.2020.09.018","volume":"59","author":"C-J Chen","year":"2020","unstructured":"Chen, C.-J., Hong, M.-K. & Ding, D.-C. Effective reduction in inadequate Pap smears by using a saline-lubricated speculum and two glass slides. Taiwan. J. Obstet. Gynecol. 59, 906\u2013909 (2020).","journal-title":"Taiwan. J. Obstet. Gynecol."},{"key":"19784_CR11","doi-asserted-by":"publisher","first-page":"474","DOI":"10.1002\/cncy.20110","volume":"118","author":"C-H Lu","year":"2010","unstructured":"Lu, C.-H. et al. Should adequacy criteria in cervicovaginal cytology be modified after radiotherapy, chemotherapy, or hysterectomy?. Cancer Cytopathol. 118, 474\u2013481 (2010).","journal-title":"Cancer Cytopathol."},{"key":"19784_CR12","doi-asserted-by":"publisher","first-page":"214","DOI":"10.1016\/j.ejogrb.2013.01.010","volume":"168","author":"S Gupta","year":"2013","unstructured":"Gupta, S., Sodhani, P., Sardana, S., Singh, V. & Sehgal, A. Clinical determinants and smear characteristics of unsatisfactory conventional cervicovaginal smears. Eur. J. Obstet. Gynecol. Reprod. Biol. 168, 214\u2013217 (2013).","journal-title":"Eur. J. Obstet. Gynecol. Reprod. Biol."},{"key":"19784_CR13","doi-asserted-by":"publisher","first-page":"1662","DOI":"10.1002\/ijc.31568","volume":"143","author":"LH Thamsborg","year":"2018","unstructured":"Thamsborg, L. H., Napolitano, G., Larsen, L. G. & Lynge, E. Impact of HPV vaccination on outcome of cervical cytology screening in Denmark-A register-based cohort study. Int. J. Cancer 143, 1662\u20131670 (2018).","journal-title":"Int. J. Cancer"},{"key":"19784_CR14","doi-asserted-by":"publisher","first-page":"87","DOI":"10.1002\/dc.21329","volume":"39","author":"C-H Lu","year":"2011","unstructured":"Lu, C.-H. et al. Clinical parameters associated with unsatisfactory specimens of conventional cervical smears. Diagn. Cytopathol. 39, 87\u201391 (2011).","journal-title":"Diagn. Cytopathol."},{"key":"19784_CR15","doi-asserted-by":"publisher","first-page":"42","DOI":"10.5958\/2394-6792.2016.00010.7","volume":"3","author":"H Ranjana","year":"2016","unstructured":"Ranjana, H. & Sadhna, S. Comparison of conventional pap smear versus liquid based cytology in a diagnostic centre of central Madhya Pradesh. Indian J. Pathol. Oncol. 3, 42\u201347 (2016).","journal-title":"Indian J. Pathol. Oncol."},{"key":"19784_CR16","doi-asserted-by":"publisher","first-page":"738","DOI":"10.1309\/GA19KPY3YLMKVWYU","volume":"123","author":"AL Adams","year":"2005","unstructured":"Adams, A. L. et al. Clinical significance of unsatisfactory conventional pap smears owing to inadequate squamous cellularity defined by the Bethesda 2001 criterion. Am. J. Clin. Pathol. 123, 738\u2013743 (2005).","journal-title":"Am. J. Clin. Pathol."},{"key":"19784_CR17","doi-asserted-by":"publisher","first-page":"592","DOI":"10.1136\/jcp.56.8.592","volume":"56","author":"YL Hock","year":"2003","unstructured":"Hock, Y. L. et al. Outcome of women with inadequate cervical smears followed up for five years. J. Clin. Pathol. 56, 592\u2013595 (2003).","journal-title":"J. Clin. Pathol."},{"key":"19784_CR18","doi-asserted-by":"publisher","first-page":"59","DOI":"10.1002\/cncy.21490","volume":"123","author":"CL Owens","year":"2015","unstructured":"Owens, C. L. et al. Follow-up and clinical significance of unsatisfactory liquid-based Papanicolaou tests. Cancer Cytopathol. 123, 59\u201365 (2015).","journal-title":"Cancer Cytopathol."},{"key":"19784_CR19","doi-asserted-by":"publisher","first-page":"20","DOI":"10.1590\/1516-3180.2013.7070004","volume":"133","author":"F L\u00f3pez-Alegr\u00eda","year":"2015","unstructured":"L\u00f3pez-Alegr\u00eda, F., De Lorenzi, D. R. S. & Poblete, O. Q. Follow-up of women with inadequate Pap smears: A prospective cohort study. Sao Paulo Med J 133, 20\u201327 (2015).","journal-title":"Sao Paulo Med J"},{"key":"19784_CR20","doi-asserted-by":"publisher","first-page":"e068776","DOI":"10.1136\/bmj-2021-068776","volume":"377","author":"M Rebolj","year":"2022","unstructured":"Rebolj, M. et al. Extension of cervical screening intervals with primary human papillomavirus testing: Observational study of English screening pilot data. BMJ 377, e068776 (2022).","journal-title":"BMJ"},{"key":"19784_CR21","doi-asserted-by":"publisher","first-page":"524","DOI":"10.1016\/S0140-6736(13)62218-7","volume":"383","author":"G Ronco","year":"2014","unstructured":"Ronco, G. et al. Efficacy of HPV-based screening for prevention of invasive cervical cancer: Follow-up of four European randomised controlled trials. Lancet 383, 524\u2013532 (2014).","journal-title":"Lancet"},{"key":"19784_CR22","doi-asserted-by":"publisher","first-page":"321","DOI":"10.3322\/caac.21628","volume":"70","author":"ETH Fontham","year":"2020","unstructured":"Fontham, E. T. H. et al. Cervical cancer screening for individuals at average risk: 2020 guideline update from the American Cancer Society. CA Cancer J. Clin. 70, 321\u2013346 (2020).","journal-title":"CA Cancer J. Clin."},{"key":"19784_CR23","doi-asserted-by":"publisher","first-page":"15","DOI":"10.1007\/s10552-015-0678-1","volume":"27","author":"K Rozemeijer","year":"2016","unstructured":"Rozemeijer, K. et al. Comparing SurePath, ThinPrep, and conventional cytology as primary test method: SurePath is associated with increased CIN II+ detection rates. Cancer Causes Control 27, 15\u201325 (2016).","journal-title":"Cancer Causes Control"}],"container-title":["Scientific Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.nature.com\/articles\/s41598-022-19784-3.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41598-022-19784-3","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41598-022-19784-3.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,9,13]],"date-time":"2022-09-13T18:05:36Z","timestamp":1663092336000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.nature.com\/articles\/s41598-022-19784-3"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,9,13]]},"references-count":23,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2022,12]]}},"alternative-id":["19784"],"URL":"https:\/\/doi.org\/10.1038\/s41598-022-19784-3","relation":{},"ISSN":["2045-2322"],"issn-type":[{"value":"2045-2322","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,9,13]]},"assertion":[{"value":"1 July 2022","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"5 September 2022","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"13 September 2022","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"The authors declare no competing interests.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"15393"}}