Prevalence and characteristics of abnormal Papanicolaou smear in Central Saudi Arabia

Abstract

Objectives:To assess the prevalence and characteristics of abnormal pap smear in the central region of Saudi Arabia.Methods:In this retrospective case control study conducted in the Departments of Obstetrics and Gynecology, and Histopathology at King Abdulaziz Medical City, Riyadh, Kingdom of Saudi Arabia, all pap smears screened for Saudi women between 2008 and 2011 were reviewed. Approximately 5000 pap smears are screened annually at King Abdulaziz Medical City utilizing the Bethesda III System (2001). All abnormal smears patients’ data were collected and compared to the data of randomly selected 200 normal smears’ patients.Results:Abnormal pap smear prevalence was found to be 4.3% (841/19,650 Saudi patients were found with atypical epithelial cells abnormalities). Its prevalence in the years 2008 was 5.7%, 2009 was 4.9%, 2010 was 4.2%, and 2011 was 2.5%. Abnormal smear patients have lower parity (p=0.001), and were less likely to use intra-uterine devices (p=0.03) compared with normal smear patients. Presence of abnormal cervical appearance was associated with increased epithelial cell abnormalities (p=0.045). The only positive history that has characterized patients with epithelial cell abnormalities was their previous history of abnormal pap smear (p=0.001). Squamous cell abnormalities were identified in 91% of the patients (767/841), and glandular cell abnormalities were identified in 9% of the patients (74/841).Conclusion:Prevalence of abnormal pap smears in central Saudi Arabia is relatively low, while advanced glandular abnormalities prevalence was observed to be high.

Histopathological Patterns and Characteristics of Abnormal Cervical Smear in Madinah Region of Saudi Arabia

“…In our study, ASCUS was seen in only 6 smears (16.2%) of the epithelial lesions, while LSIL and HSIL were the most frequent lesions, accounting for 36.8% of the total cases for each. In most Saudi studies, ASCUS represented the most common finding (Al-Kadri et al, 2015 andAltaf andMufti, 2012). Similar studies from United Arab Emirates (UAE) and Turkey reported that ASCUS was the most common category (Alzaabi and Al Muqbali, 2015;Korkmaz and Gencer, 2014).…”

“…The prevalence of ECL in the present study was 2.4%, which is one of the lowest rates of prevalence in KSA, Gulf Cooperation Council (GCC) countries, and other countries. Previous studies from different areas in KSA showed ECL prevalence rates ranging from 1.7% to 17.2% (Al-Kadri et al, 2015;Jamal and Al-Maghrabi, 2003;Al-Jaroudi andHussain, 2010 andAltaf andMufti, 2012). Regarding GCC countries, the largest study was carried in Kuwait with an evaluation of 140,404 smears throughout 21 years in which the reported prevalence rate of ECL was 4.3% (Table 4) (Kapila et al, 2015).…”

“…Cervical screening in females aged 20-24 has little or no impact on rates of invasive cervical cancer up to age 30, while screening older females leads to a substantial reduction in incidence and mortality from cervical cancer (Sasieni et al, 2009). Although a localized Saudi cervical screening program was established in 2009 to promote routine screening for cervical cancer with HPV testing for all females above the age of 30 who have been married for at least three years, Pap smear screening is still performed on an opportunistic basis in Saudi Arabia (Al-Kadri et al, 2015).…”

“…While other studies showed significant improvements in achieving the target diagnosis over time for squamous dysplasia using both modalities (Marquart et al, 2015), both types of cytological screening are considered acceptable methods of cervical cancer screening by the American College of Obstetricians and Gynecologists (ACOG Committee on Practice Bulletins-Gynecology, 2009). To unify systems of reporting cervical/vaginal cytological diagnosis, the National Cancer Institute Workshop proposed the Bethesda System of nomenclature in 1988 (Al-Kadri et al, 2015).…”

Demonstration of Abnormal Cervical Change in Papanicolaou Smears by Liquid Base Cytology

“…Presence of abnormal cervical appearance was associated with increased epithelial cell abnormalities. Squamous cell abnormalities were identified in 767 out of 841 (91%) of studied patient, and the cervical glandular epithelial abnormalities were appeared in 74 out of 841 (9%) of patients [6]. The patients with early invasive cervical cancer are asymptomatic and the cervical malignant changes not visible clinically and can be detected only during routine cervical cytological screening.…”