Cytological patterns of cervical pap smears with histopathological correlation

Abstract

INTRODUCTIONCervical cancer is common world-wide and ranks third among all malignancies for women. Eighty percent of cancer cervix are seen in developing countries, where it is the commonest cancer in woman. 1 In India women at risk for cervical cancer are 432.20 million, annual number of cervical cancer cases is 122,844, annual number of deaths is 67, 4773.2 It has been estimated that an average woman under 40yrs of age has 2% chance of developing cervical carcinoma. Studies show that cervical carcinoma does not develop suddenly from normal epithelium but is presented by a spectrum of intraepithelial neoplasia, if these lesions were untreated; up to one third of them would develop into carcinoma.No form of cancer better documents the remarkable effects of prevention, early diagnosis, and curative therapy on the mortality rate than cancer of the cervix. The accessibility of the cervix to pap testing and visual examination (colposcopy) as well as the slow progression from precursor lesions to invasive carcinoma (typically ABSTRACT Background: Cervical cancer is the most common, preventable cancer and does not develop suddenly from normal epithelium but is presented by a spectrum of intraepithelial neoplasia. Pap smear is an ideal screening and low cost effective test to detect intraepithelial neoplasia especially in developing countries but has limitations and needs confirmation by histopathology. The study aimed to determine the sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of pap smears as screening test in cervical lesions by comparing with histopathology. Methods: This is a prospective study conducted at a tertiary care centre in Department of pathology from October 2012 to September 2014. A complete clinical history and demographic status of the subjects was recorded. Conventional pap smears were reported adopting Bethesda system and biopsies were taken in cases of epithelial cell abnormality, routinely processed and stained with H&E. Results: Total number of pap smears analysed were 356. NILM (negative for intraepithelial lesions or malignancy) constituted major group 248/356 (69.64%) and epithelial cell abnormality were 98/356 (27.5%). In the present study overall sensitivity was 94.11% specificity 64.28% positive predictive value 82.75%,negative predictive value 85%,diagnostic accuracy 83.33%,concordance rate 78.2% and P value <0.001. Concordance rate for CIN I was 78.9%, for CINII and CINIII 60% and for squamous cell carcinoma 100%. Conclusion: Pap smear is simple, inexpensive and can be performed in the outpatient department. Hence, it should be recommended routinely as a method of improving reproductive health, early detection of premalignant and malignant cervical lesions.

Correlation of Cervical Pap Smear with Histopathological Diagnosis in Cervical Lesions: A 2 Years Retrospective Study

“…In our study, the majority of patients were of the age group of 41-50 years(32%)which was comparable to other studies done by Joshi et al 8 (50%), Bamanikar et al 9 (28.46%) and Parija et al 10 (37.15%) and belong to para 2(40%) which was similar to studies done by Atla et al 11 The commonest complaint was whitish discharge per vaginum (46%) which was similar to studies done by Joshi et al 8 (40%), Atla et al 11 (41%), Dhakal et al 12 (40%) and Alakananda et al 13 (51%). NILM(59.6%) was similar to studies done by Alakananda et al 13 (55%), Atla et al 11 (53%) and Joshi et al 8 (64%) but differ from Malpani et al 14 (97.96%) because in our study sample size was small and moreover we have patients mostly with specific complaints and not came for routine screening. In our study 98% cases of NILM on Pap smear correlated on histopathology which was comparable to the studies done by Atla et al 11 (93%) and Alakananda et al 13 (91%).…”

Spectrum of Cervical Cytological Lesions in Premenopausal and Postmenopausal Women

“…[10], [12][13][14], [16][17][18][19][20] Present study is concordant with them. Only few found them to be less common, second only to NILM Normal smear.…”

A comparative study of Pap smear cytology and histopathology of cervix biopsy

“…There are different methods that were studied to improve cervical screening, but cervical biopsy has been considered as the gold standard for detecting cervical lesions [18,19]. In the present study, sensitivity and specificity of cervical cytology in detecting cervical malignancy were 97 % and 74 % respectively while Dhakal et al [26] and Chhabra et al [18] had a sensitivity of 77.8% and 81% respectively and Atla et al [27] had a sensitivity of 94.11% and specificity of 64.28%.…”