The significance of hyperkeratosis/parakeratosis on otherwise normal Papanicolaou smears

OBJECTIVE: The purpose of this study was to determine whether hyperkeratosis/parakeratosis found on an otherwise normal Papanicolaou smear was associated with abnormalities after comprehensive evaluation. STUDY DESIGN: We conducted a retrospective cohort study of 566 women identified with hyperkeratosis/parakeratosis on Papanicolaou smears from a 7-year period. All women underwent repeat Papanicolaou smear, colposcopy, and biopsy as indicated. Statistical analysis included ξ² and Fisher exact tests as appropriate. RESULTS: Final abnormal diagnoses included human papillomavirus (HPV) changes (17%), mild dysplasia (5%), and moderate/severe dysplasia (0.4%). We found no carcinomas. Women younger than age 50 years were more likely to have an abnormality (34% vs 19%, relative risk 1.3, 95% CI 1.1-1.4, P < .001), primarily because of a higher prevalence of HPV changes on the biopsy specimen (21% vs 9%, relative risk 1.3, 95% CI 1.2-1.5, P < .001). CONCLUSION: Hyperkeratosis/parakeratosis on an otherwise normal Papanicolaou smear is associated with low-grade changes, particularly among reproductive-age women.