Cyto-histo correlation of conventional Pap smear with cervical biopsy in diagnosis of precancerous and cancerous lesions of cervix

Abstract

Introduction: Carcinoma of uterine cervix is the third most common cancer among women worldwide and it contributes significantly to cancer related morbidity and mortality. The incidence of cervical carcinoma is incredibly high in developing countries (almost 80%) due to lack of proper knowledge. The extensive use of cervical screening with Pap smears has considerably increased the detection of precancerous and cancerous lesions of uterine cervix. Aims: To evaluate cyto-histo correlation of precancerous and cancerous lesions of uterine cervix and to calculate the sensitivity and specificity of Pap smear in diagnosing invasive malignancy. Materials and Methods:This was a retrospective observational study conducted in the . All the cases reported in Pap smear as cervical intraepithelial lesions and invasive malignancies were retrieved. We also retrieved the same cases, if they had undegone cervical biopsy for correlation. Result: During the study period total 303 cases which were positive for intraepithelial lesions and malignancies were retrieved. Out of these 303 cases we excluded 23 cases because in these cases cervical biopsy had not been done. So in the final analysis 280 cases were included. Of the 280 Pap smears, maximum cases (33.92%) were reported as low grade squamous intraepithelial lesion (LSIL), followed by high grade squamous intraepithelial lesion (HSIL) (24.28%), atypical squamous cells of undetermined significance (ASCUS) (19.64%), atypical squamous cellscannot rule out HSIL (ASC-H) (10%). We had 23 cases of invasive malignancy which includes 21 cases of squamous cell carcinoma (SCC) and 2 cases of adenocarcinoma. There were 11 cases of atypical glandular cells of undetermined significance (AGUS). We found that total numbers of concordant cases were 68.57% (192/280) and discordant cases were 31.43% (88/280). We also found that sensitivity and specificity of cervical smear in diagnosing invasive malignancy were 61.76% and 99.1% respectively considering cervical biopsy as gold standard. Conclusion:The study revealed a good correlation between cervical cytology and cervical biopsy. We also concluded that conventional Pap smear is cost effective test for the early detection of precancerous and cancerous cervical lesions.

Cytohistological correlation of conventional Papanicolaou smears in cervical neoplasia at a tertiary care hospital of Nepal

“…Contrary to these, SCC was most common HPE findings among women with abnormal Pap smear accounting for 69.5 % of cases in a study by Vaishali Jain et al 26 Even though we excluded the NILM cases in Pap smear, we still found 31.5 % cases of chronic cervicitis. Similar type of findings were also observed in a study by Meenai FJ et al 22 where even after excluding NILM in Pap smear 49 ( 17.5 % ) cases of chronic cervicitis, single case of chronic cervicitis with squamous metaplasia and 6 cases of papillary endocervicitis were found.…”

“…Twelve cases of ASCUS correlated with CIN I/Koilocytic atypia and 14 cases were downgraded as chronic cervicitis in the present study. Similar finding was also observed in a study by Meenai F J et al 22 where 55 cases belonging to ASCUS category reported on cervical cytology were diagnosed as CIN I (27 cases), 24 cases were downgraded as chronic cervicitis and 4 cases were upgraded as CIN II on cervical biopsy.…”

“…It is consistent with a study by Naik R et al4 where concordance rate for malignancy was 100 percent. Whereas in a study by Vaishali Jain et al 26 corcordance rate for SCC was 83.6 % and in a study by Meenai FJ et al 22 concordance rate for SCC was 90.47 percent.…”

“…In other studies concordance is quite higher than our study. In a study by Meenai FJ et al 22 total number of concordant cases were 68.57% and discordant cases were 31.43 % respectively.…”

“…Similar results were seen in study by Fazia HAQ Nwaz et al, 11 Chaudhary RD et al, 12 Yeoh G et al 13 and Bodal V et al 14 where most common abnormal Pap smear finding was also ASCUS accounting for 47.08%, 50.0 % , 65.9 % and 25.67 % cases respectively. Whereas in studies by Naik R et al, 4 Jyothi R et al, 15 Sachan PL et al 16 , Jones B et al, 17 Vidhyadhar S et al, 18 Verma I et al, 19 Malpani G et al, 10 Joshi C et al, 20 Laxmi RC et al 21 , Meenai FJ et al 22 and Bhavani K et al 23 most common epithelial cell abnormality was LSIL accounting for 45 %, 48.93%, 60%, 62.5%, 38.88%, 41.7%, 28.16%, 47.22%, 49.43%, 33.92% and 44.26% respectively among all pre invasive and invasive cases. Contrast to all of these studies including our study, HSIL was the most common epithelial cell abnormality in study by Dhakal R et al 24 In the present study, most common HPE diagnosis among women with abnormal Pap smear diagnosis is CIN I which accounts for 39 % of cases.…”