Pattern of epithelial cell abnormality in Pap smear: A clinicopathological and demographic correlation

Abstract

Background:In the low resource settings of a developing country, a conventional Papanicolaou (Pap) test is the mainstay screening system for cervical cancer. In order to counsel women and to organize a public health system for cervical cancer screening by Pap smear examination, it is imperative to know the pattern of premalignant and malignant lesions. This study was undertaken to find out the prevalence of an abnormal Pap smear, in a tertiary hospital of a developing country, and to carry out a clinicopathological and demographical analysis for establishing the pattern of epithelial cell abnormality in a Pap smear.Materials and Methods:A cross-sectional descriptive study was carried out in a total of 1699 patients who underwent Pap smear examination. The prevalence of epithelial cell abnormality in the Pap smear was calculated in proportions / percentages. Specimen adequacy and reporting was assessed according to the revised Bethesda system.Results:Among the total of 1699 patients who had their Pap smear done, 139 (8.18%) revealed epithelial cell abnormality. Altogether 26 smears revealed high-grade lesions and malignancy, most of which were found to be in women belonging to the 30 – 39 and ≥ 45 age group. A total of 75 (53.96%) women were in the 20 – 44 age group and 64 (46.04%) were in the ≥ 45 age group. A bimodal age distribution was detected in the epithelial cell abnormality, with the bulk being diagnosed in patients aged 45 or above. Overall one-third of the patients with an abnormal Pap smear result showed healthy cervix in per vaginal examination.Conclusions:A raised prevalence of epithelial cell abnormality reflects the lack of awareness about cervical cancer screening. Women aged 45 or above harbor the bulk of premalignant and malignant lesions in the Pap smear, signifying that these women are among the under users of cytological screening.

Abnormal Pap Smear Results in Outpatient Attendees in a Tertiary Care Center in Kathmandu, Nepal

“…In our study, 3.6% of sample ware excluded from study due to sample inadequacy or being unsatisfactory which was lower than reported by 16,17,19,22,23 Bacterial vaginosis (1.9%) was the commonest organism isolated in our study which is same as reported by other studies done in Nepal and India. The percentage reported in these study vary from 3.3% to 7.6%.…”

Study of cervical pap smears in a tertiary care hospital of south Gujarat, India

“…6,11 Edelman et al, studied Pap smears from 29295 females over a period of one year and the Pap smear abnormalities were as follows: 9.9% ASC-US, 2.5% LSIL, 0.6% HSIL, and 0.2% invasive cancer. 12 Study by Banik U revealed the following scenario: 0.18% ASC-US, 0.12% Atypical glandular cells (AGC), 6.36% LSIL, 1.18% HSIL and 0.35% malignancy. In our study shows ASCUS 0.77%, ASC-H 0.35%, HSIL 0.35%, SCC 0.14% and AGUS 0.28%.…”

Uterine Cervical Smear Patterns In Females Attending A Teaching Hospital In Rural Eastern Uttar Pradesh, INDIA.

“…Edelmen et al [12] studied 29,295 females in one year and found ASCUS in 9.9 %, L SIL in 2.5 %, H SIL in 0.6 %, invasive carcinoma cervix in 0.2 %. In a study conducted by Urmila Banik et al [3] in Bangla Desh in 2010 they found ,ASCUS -0.18 %, AGC-0.12%, L SIL-6.36 % ,H SIL-1.18 % , and malignancy -0.35 %. According to another study in Brazil [10] on 18,22,441 pap smears in 5 years, L SIL was found in the age group of 15-30 years, high grade lesions including cancer cervix were found in women aged 40 years and above.…”

“…[2] .Rubin in 1910 mentioned about the structural changes in the cervical epithelium surrounding invasive cancer. These structural changes were considered as a manifestation of early cervical cancer [3]. It was George Papanicoloau who ushered in the golden era of Pap smear cytology in the year 1920.…”

“…Smears showing no epithelial abnormalities are specified as Negative for intraepithelial lesion or malignancy (NILM) in the revised Bethesda System. [3] Pap smear screening has lead to a drastic reduction in the incidence of invasive cervical cancer in many countries across the world. Various studies show that a majority of cervical cancer mortality is from the low and middle income group of countries.…”