Prevalence of altered cervical cytological pattern: Aretrospective study in females visiting tertiary care hospital

Abstract

Background: Cervical cancer is one of the major causes of morbidity and mortality in India. Pap smear is a simple, noninvasive, cost-effective and sensitive tool to detect various non-neoplastic and neoplastic lesions of cervix. The objective of this study was to estimate the prevalence of cervical cytological pattern in a tertiary care centre; by using conventional Papanicolaou (Pap) smears for the screening of inflammatory, premalignant and malignant lesions of the cervix. Methods: This cross-sectional study is based on 574 patients who attended the outpatient Department of Obstetrics and Gynecology, during the period between Jan 2015 to Feb 2017. Pap smears were prepared from patients presenting with complaints like vaginal discharge, post-coital bleeding, inter-menstrual bleeding, dyspareunia, and pain in lower abdomen. Conventional Papanicolaoustained smears were classified as per Bethesda 2001 nomenclature. Results: Prevalence of altered cervical cytological pattern was 75.59% amongst females visiting hospital. A total of 574 cervical pap smears were studied, out of which 66 were inadequate. Out of 508 cases, 448 cases were of NILM [including 324 (63.78%) inflammatory lesions and 124 (24.41%) normal smears] and 60 (11.81%) cases of epithelial lesions. The epithelial lesions prevalence rate was ASCUS (5.7%), LSIL (1.4%) and HSIL (1.4%), AGUS (0.78%), SCC (0.6%) and endometrial carcinoma (0.2%). Conclusions: This study shows relatively high prevalence of epithelial abnormalities with increasing age, parity, women with clinical lesions on per speculum findings. Malignancy was more common in sixth and seventh decade and intraepithelial lesions/dysplasia was seen mostly in fourth and fifth decade. Inflammatory lesions were more common in younger age group. Pap smear should be advised as a routine screening procedure; as it is a simple, cheap, safe and practical diagnostic tool for early detection of cervical cancer in high risk group population. It also helps in diagnosis of inflammatory lesions including the identification of causative organism and atrophic changes.

Spectrum of Pap smear cytology according to The Bethesda System 2014

“…On cytological examination, 863 (84%) were found satisfactory and 154 cases (15%) were unsatisfactory. This finding was in concordance with the study conducted by Sharma HB et al, 18 Gidwani RK et al 19 NILM was the most common cytological finding, seen in 833 females (96.8%). Epithelial cell abnormality was seen in 30 cases (3.2%) included ASCUS in 0.6% cases, ASC-H in 0.2% cases, LSIL in 1.3% cases and HSIL in 1.0% case.…”

“…Single case of Squamous Cell Carcinoma was also seen in female of more than 50 year of age. The results are similar with the findings of Bal MS et al 12 ,Gupta K et al 20 and Gidwani RK et al 19 as they showed that maximum cases of LSIL was found in 40-49 year age group while HSIL and SCC was found in females above 50 years of age.…”

Utility of Papanicolaou’s smears in the diagnosis of premalignant and malignant lesions of the cervix in a tertiary care centre of South Gujarat, India

“…Similar findings were observed by Reddy et al, and Nikumbh et al 1 Majority of the smears (96.3%) were reported Negative for intraepithelial lesion or malignancy. The findings were comparable to those observed by Mulay et al, Bhavani et al, Das et al and Gupta et al 22,25,29,31 Various infectious lesions were also comparable with other studies. In present study, bacterial vaginosis was the most common infectious lesion (23.6%) which was comparable with the study of Malpani et al and Ranabhat et al 8,32 Viral changes were seen in 0.4% in present study which was comparable with the study of Nikumbh et al 1 and the study of Ranabhat et al 8 Follicular cervicitis were seen in 0.1% in present study which was comparable with the study of Mulay et al 22 Mixed infection were seen in 2% in Mulay et al and 0.47 % in Ranabhat et al, whereas 0.43% in present study.…”