Clinicopathological correlation of uterine cervical lesions with focus on premalignant and malignant lesions

Abstract

Background: Cervical cancer ranks as the most frequent cancer among women in Nepal and the first most frequent cancer among women between 15 and 44 years of age. The objectives of the study are to find the incidence of premalignant and malignant cervical conditions and to correlate histopathological diagnosis with that of clinical diagnosis.
 Materials and Methods: This was a retrospective study carried out at Kathmandu University Hospital. All cervical biopsy done from January 2009 to December 2018, were included in the study. A proforma was created in which relevant demographic data like age, sex along with clinical findings, gross and histopathological findings were collected.
 Results: Mean age of patients with cervical intraepithelial lesion- 1, 2 and 3 was 43.5 years, 48 years and 43.4 years respectively. The most common diagnosis was cervical polyp were (38.65%) followed by 52 cases (15.9%) of unhealthy cervix which bleeds easily on touch and 42 (12.8%) cases of inflammatory condition. Clinical diagnosis of carcinoma of cervix comprised of 42 cases (12.8%). On histopathology, 51(15.6%) cases had invasive carcinoma of which 48 (94.1%) were squamous cell carcinoma, two (3.92%) were adenocarcinoma, and one (1.9%) was of small cell carcinoma. In 33 cases (78.57%), clinical examination was correctly able to identify the invasive cancer. The sensitivity rate of diagnosing cancerous and precancerous lesions by clinical examination and cervical pap smear was 80.95 percent.
 Conclusions: Proper clinical history, examination, pap smearing and biopsy report helps through appropriate clinical intervention and prevents development of advanced stage of cervical carcinoma

Screening for Cervical Cancer by Sequential Examination of the Cervix

“…Pap -smear failed to diagnose malignant changes in one patient where the report showed HSIL plus CIN III but no malignant cells, compared to the colposcopic examination which showed an abnormal transformation zone where biopsy confirmed the diagnoses of squamous cell carcinoma diagnosis of SCC was2% in our study compared to 6.2% in (16) , Besides pap-smear failed to diagnose CIN changes in 11 patients one of which shown to be squamous cell carcinoma, compared to 9 missed cases in (16) this may be due to poor interpretation of the cytological examination of our labs or maybe an error in technique.…”

“…CIN changes diagnosed by cervical smear alone were 18 cases (18%) versus 9% in (8). This figure increased to 29 cases (29%) when combining the results of colposcopy and biopsy compared to 31 cases in (8,16).…”

“…showed CINI changes in (20%) opposed to 32%, CIN II in 7% compared to (17%) & CIN III in (3%) compared to 5% in (16).…”

“…16) where (15.9%) of cases show an unhealthy cervix which bleeds easily on touch; clinical diagnosis of carcinoma of cervix comprised (12.8%) of their cases compared to (9.4%) in our analyses. Higher detection rates in their analyses can be due to a higher sample size and wider inclusion criteria (16).…”