Eleven-year review of data on Pap smears in Saudi Arabia: We need more focus on glandular abnormalities!

Abstract

BACKGROUNDWe reviewed data from Saudi Arabia on epithelial cell abnormalities (ECA) detected by Pap smear after noticing a slight increase in the incidence of cervical glandular abnormalities in our regional laboratory in recent years.OBJECTIVEClarify data on adenocarcinoma (ADCA) on Pap smears in Saudi Arabia.DESIGNDescriptive, retrospective study.SETTINGSRegional laboratory, Riyadh.PATIENTS AND METHODSWe reviewed all Pap smears of adult females between 2006 and 2016 and compared our data with previously published results from Saudi Arabia.MAIN OUTCOME MEASURE(S)Descriptive data on ECAs.RESULTSAmong 19 759 cases, atypical squamous cell of undetermined significance (ASC-US) was the most prevalent ECA (1.16%). ADCA occurred more than squamous cell carcinoma (SCC). In a comparison of published data before 2014 and after 2014 (including ours), there was a significant rise in ADCA (28 vs 48 cases; P=.004) with a significant drop in SCC, high-grade squamous intraepithelial lesions (HSIL) and low-grade squamous intraepithelial lesions (LSIL) (P<.0001, .004, and <.0001, respectively).CONCLUSIONWe recommend that pathologists and cytotechnologists be vigilant in screening Pap smears in our population, particularly for glandular abnormalities. We also recommend use of Pap smears in the initial workup of women with suspected gynecological abnormalities, regardless of evolutions in HPV testing.LIMITATIONSThe pooling of data instead of analyzing by study year.

Comparison of papanicolaou smear and human papillomavirus (HPV) test as cervical screening tools: can we rely on HPV test alone as a screening method? An 11-year retrospective experience at a single institution

“…Endometrial dilation and curettage are performed under anesthesia; however, Pap smears are easily performed. Similar to previously reported results, we found that Pap smears were useful in detection of glandular lesions [25].…”

Modelling risk assessment for cervical cancer in symptomatic Saudi women

“…On the basis of this study and previous studies, we found that it is beneficial to develop a risk prediction model that includes all significant risk factors in order to help clinicians identify high risk patients for further investigations. In Saudi Arabia as well as most of the developed countries, the pap smear test remain the first and easiest tool for cervical cancer screening 14. In this study, we quantified the risk of cervical cancer in symptomatic Saudi Arabian women.…”

“…In Saudi Arabia, the practice is to use the pap smear as a routine after delivery or if abnormal discharges occurs 14. The inadequate performance of the pap test15 focused our attention on developing a risk assessment tool that could incorporate various information on demographics, symptoms, and clinical and laboratory findings.…”

Prevalence of abnormal pap smears in the western region of Saudi Arabia from 2010 to 2022

“…This finding concurs with the findings of Al-Kadri et al ., 2015 and Nasser et al ., 2017, where n = 19,650 and 19,759, respectively, highlighting the need for greater focus on glandular abnormalities. [ 15 , 16 ] As shown in [ Table 2 ], the prevalence of abnormal Pap smears in our study was 3.05% (conventional and LBC methods); in Saudi Arabia, the prevalence rate was 14.52% in a single study due to a high rate of ASCUS, which was within the range according to their ASC/SIL ratio. [ 17 ] For detailed statistical data, see Appendix 1 and 2 .…”