A Comparative Evaluation Between Cervical Cytology and Viral Biomarkers in Early Detection of Cervical Intraepithelial Lesions.

Abstract

Cervical cancer is a public health problem in developing countries like India, so much so that India alone accounts for one-quarter of the worldwide burden of cervical cancers.[1] It is the one of the leading causes of cancer mortality, accounting for 17% of all cancer deaths among women aged between 30 and 69 years. Every year in India, 122,844 women are diagnosed with cervical cancer and 67,477 die from the disease.[2] Cervical cancer is a leading form of cancer among women living in low resource regions of the world and often kills women at young age when they are still raising families. Cervical cancer due to its slow progression from precancerous lesions to frank malignancy and easy accessibility to examination, is highly amenable to screening. The three screening modalities are Cervical Cytology Screening (Pap Smear), Visual Inspection, and HPV DNA test. Squamous intraepithelial lesions are viewed as precancerous lesions exhibiting many of the morphological characteristics of invasive carcinomas, identication of these entities is the focus of cervical screening. Persistence of high-risk HPV infection after initial infection is highly predictive of a lifetime risk of pre-invasive and invasive cervical neoplasia. The HPV genotype seems to be the most important factor in persistence, with HPV-16 and HPV-18 being the most likely to persist. The aim of this study was to evaluate concurrently the efcacy of Cervical cytology, HPV PCR methods for risk assessment in an attempt to dene the most efcient combination, so as to know which one is more applicable and accurate in cervical cancer screening strategies. The present prospective observational study was conducted in Department of Pathology, NSCB medical college and hospital, Jabalpur, M.P. from 1st February 2019 to 31st July 2020, with the primary aim of to assess cytomorphological incidence of various lesions of uterine cervix by Bethesda system and to study the biomarker HPV-DNA testing by PCR in case of abnormal cervical ndings and to correlate the ndings and results of cytology with the histopathology reports. This study had a total population of 140 women who attended the gynaecology OPD and fullled the inclusion criteria were enrolled in study. Per speculum examination was done and Pap smear examination was taken followed by colposcopy guided cervical biopsy in the symptomatic females. Out of 140 ,60 samples were tested for high HPV 16 and 18 using RTPCR. The maximum numbers of the patients were in third decade of life, followed by fourth decade. Maximum numbers of cases were reported as inammatory smear. ASCUS and HSIL was seen commonly in the age group of 31 to 40 years. Most common presenting complaint was white discharge 55.71 % .Erosive cervicitis (41.4%) was the most common histopathological nding. HPV DNAtesting showed only 6.7 % positivity. 16.67 % Of squamous intraepithelial lesions were positive for HPV and the most prevalent HPV genotype was found to be HPVtype 16. Conclusion: Pap smear evaluation and HPVtyping are most efcient combination for mass cervical screening programmes