Cervical Cancer in Women with Inflammatory Pap Smears

Abstract

In spite of preventive measures such as Papanicolaou cervical cytological analysis and, more recently, vaccination against HPV infection, cancer of the uterine cervix continues to be one of the most frequent causes of mortality among women worldwide, particularly in developing countries. In this prospective study, sixty patients with inflammatory Pap smears had a colposcopy with directed biopsies. The average age of our patients was 42 years. Results showed that colposcopy is normal in 10% of women. It showed normal transformations, ectropion, a colpotis and polyp at 8.33%, 21.66%, 13.33% and 5% respectively. It was able to detect changes with Grade I atypical transformations (28.33%), and Grade II atypical transformations in 13.33% of cases. The biopsies were objectified dysplasia and carcinoma in 24.13% of cases with carcinoma in situ, micro invasive squamous cell carcinoma and invasive carcinoma glandular. Moreover, we detected HPV-specific antibodies in sera of these patients. Results showed that six patients (10%) showed a positive reactivity to at least one of the HPV-16 or HPV-18 antigens and sera showed different reactivity to the different antigens with the following percentages: 5%, 3%, 2%, 3% and 3% for L1 HPV-16, E6 HPV-16, E7 HPV-16, E6 HPV-18 and E7 HPV-18 respectively. Among patients having positive antibody response, 83.33% were cases of dysplasia and carcinoma. We concluded that the Pap smear, examination of key screening for cervical cancer, is a screening test without diagnostic value and more specifically any inflammatory Pap smear should be considered a positive test and led to further investigations. Moreover, colposcopy is an exam that is performed on an outpatient basis; it allows a detailed study of the cervix and reduces the negative rate of cytology. In addition, early detection of HPV antibodies could help the follow-up of patients.

Pap Smear for Screening of Carcinoma Cervix

“…22,23 Persistent inflammatory cervical smears can lead to chronic irritation and can be fertile soil for neoplastic transformation. 24 In our study the incidence of normal cervical smears is low as most of the patients were attending gynaecology clinic for some complaints and none of the patient was volunteer for cervical cancer screening. 23,24 In our study, the diagnoses of LSIL was in seven cases (6.14 %) out of total of 114 cases.…”

“…24 In our study the incidence of normal cervical smears is low as most of the patients were attending gynaecology clinic for some complaints and none of the patient was volunteer for cervical cancer screening. 23,24 In our study, the diagnoses of LSIL was in seven cases (6.14 %) out of total of 114 cases. This establishes the importance cervical Pap smears in diagnosing precancerous lesions of cervix.…”

Evaluation of Pap Smear And HPV VLP Serology in Clinically Suspected Cases Of Cervical Cancer in Perimenopausal Women in A Tertiary Care Centrein Kolkata

“…Achour et al detected HPV-specific antibodies in sera of 60 women, with inflammatory Pap smears, of reproductive, perimenopausal and post-menopausal age group. [22] Results showed that six patients (10%) (showed a positive reactivity to at least one of the HPV-16 or HPV-18 antigens and sera showed different reactivity to the different antigens with the following percentages: 5%, 3%, 2%, 3% and 3% for L1 HPV-16, E6 HPV-16, E7 HPV-16, E6 HPV-18 and E7 HPV-18 respectively. [22] They had used GST capture ELISA for measuring anti-HPV antibodies, [22] unlike VLP L1 ELISA used in the present study.…”

“…[22] Results showed that six patients (10%) (showed a positive reactivity to at least one of the HPV-16 or HPV-18 antigens and sera showed different reactivity to the different antigens with the following percentages: 5%, 3%, 2%, 3% and 3% for L1 HPV-16, E6 HPV-16, E7 HPV-16, E6 HPV-18 and E7 HPV-18 respectively. [22] They had used GST capture ELISA for measuring anti-HPV antibodies, [22] unlike VLP L1 ELISA used in the present study. They concluded that Serology is not in itself a diagnostic method but must be kept in consideration for monitoring patients with an inflammatory cervical smear.…”

“…Similarly, the determination of these antibodies by GST-capture ELISA and Luminex can help monitor vaccination programs on a large scale. [22] Yepinget al in 1999 evaluated the serological assays for HPV as screening tests for invasive cervical cancer . Serum samples were collected from 194 patients of cervical cancer.…”