Prevalence of abnormal Papanicolaou smears and cytohistological correlation: A study from Aga Khan University Hospital, Pakistan

Abstract

Objectives: To determine the prevalence of abnormal Papanicolaou (Pap) smears in patients visiting the gynecologic outpatient department at Aga Khan University Hospital, Karachi (AKUH) and their cytohistologic correlation. This data was also compared with other international institutions. Methods: A database search of all abnormal cervical cytological cases diagnosed in the gynecologic outpatient department at Aga Khan University Hospital in the last 10 years (i.e. from 1994 to 2004), as well as their follow-up biopsies, was carried out. The data was then analyzed. Results: Of the 66 617 Pap smears reviewed, 95% of cases had a diagnosis of ‘negative’, 2% of smears were labeled as ‘inadequate’, 0.54% Pap smears showed dysplastic changes, and 0.14% were labeled as ‘malignant’. These numbers are less than figures in Western countires, but are comparable with Asian figures. The pick-up rate for abnormal Pap smears was 8/1000, while the overall concordance rate was 74%; positive predictive values for high-grade cervical lesions and for carcinomas was high 92–100%, respectively; while for ASCUS and low-grade cervical lesion was 35% and 67%, respectively. A total number of 8 cases were identified where there was a discrepancy between cytological and histological diagnosis, they were reviewed critically. Conclusion: In most of the developing countries effective Pap screening faces certain barriers. This includes limited or poor quality of cytology services. In a low-resource country like Pakistan there is a subset of patients (those with atypical cellular abnormalities) who may benefit from repeat smears instead of early cervical biopsies. In order to improve the efficacy of our cytology services, we need to develop specific clinical protocols for subsequent management of abnormal smears

Histopathological Vs. cytological findings in cervical lesions (Bethesda System 2001) – A comparative study

“…(Table 2) Concordant 38 76 Table 50 100 In the present study, the overall concordance rate was 76%which is comparable to other studies e.g. Study by Nawaz [6] (a study from Aga Khan University, Pakistan) where the concordance rate was74%. The other studies like Saha"s [7], Yeoh [8] & Rasbridge [9] has concordance rates as 60%, 52% and 81.2% respectively (Table 3).…”

“…The study by Nawaz [6]showed overall concordance rate of 74%. A total 8 numbers of cases were discrepant.…”

Cytohistopathological correlation of Papanicolaou smears: a hospital based study

“…20,21 As shown in Table 2, Nawaz et al (2005) showed 74% correlation while Rasbridge et al (2005) showed 81.2% correlation between cytology and biopsy in their study which was 57% in the present study and which was increased to 92.8% within one degree of histopathological abnormality. 22,23 The overall accuracy of Pap smear reporting was 84.6% by Naik et al whereas the present study showed 82.1% accuracy. 18 Nevertheless relatively low correlation of accepted, histologically specific cytologic classification with the biopsy diagnoses is disappointing and raising some question as to the reliability of the very specific cytologic diagnosis is borderline lesions.…”

Cervical Pap smear study and detection of abnormal epithelial lesions and determination of its accuracy by cytohistological correlation in patients of tertiary care teaching hospital in central India

“…[9][10][11] Concordance rate for SCC [ Figure 3(b)] in our study was 88.89 % as compared to 100% concordance rate reported by Saha et al, 97.33% by Nawaz et al and 60% by Yeoh et al 9,10,12 In our study, the overall sensitivity of pap smear was 86.61%; specificity was 73.33%, PPV was 96.49 %, NPV was 39.29% and diagnostic accuracy was 85.21%. The diagnostic accuracy in our study was comparable to Naik (Table 5).…”