Cytomorphological spectrum of papanicolaou smears - a hospital based retrospective study

Abstract

Cervical cancer is second most common cancer of women in India. Screening of cervical cytology by simple papinocolou smear is an effective tool to detect premalignant lesions of cervix. Present study was retrospectively done to determine the cytomorphological spectrum of various cervical lesions and categorize them according to Bethesda system .All the patients presenting in gynaecological OPD and health camps with gynaecological complaints were included and subjected for PAP smear. Most common complaint and physical examination finding was abnormal vaginal discharge (46.3%) and erosion on cervix (46%) respectively. A total of 300 cervical smears were evaluated out of which 22 (7.3%) cases were unsatisfactory for evaluation, 49 (16.3%) were Negative for intraepithelial lesion or malignancy (NILM) and 196(65.3%) of NILM inflammatory category. Epithelial cell abnormality were seen in 33 (11%) with ASCUS in 15 (5%), LSIL in 12 (4%) and HSIL in 6(2%) cases. Maximum number of abnormal cases 15 (5.3%) were in age range 40-49. Cases of carcinoma were not encountered. The study enforces the significance of PAP smear screening in all the women at appropriate interval for reducing prevelance of cervical cancer in developing country like India. INTRODUCTIONCancer cervix is a disease of global burden and stands as third most common cancer in women worldwide (Sreedevi A et al 2015). In India it is second most common cancer with a peak incidence 55-59 years (Dhananjaya S et al 2014) Mortality varies eighteen fold between the different regions of the world, with rates ranging from less than 2 per 100,000 in Western Asia, Western Europe and Australia/New Zealand to more than 20 per 100,000 in Melanesia, Middle and Eastern Africa as per GLOBACON cancer fact sheet. According to world health organization approximately 80% of cervical cancer deaths occurred in developing countries. In India the mortality rate varies between 9.8-17.5 per 100,00. Without urgent intervention, deaths due to cervical cancer are projected to rise by almost 25% over the next 10 years. (Consul S et al 2012) The high mortality rates is attributable to the presentation of patient at later stages of disease. It is partly contributed because of subtle clinical features of disease.Most of the disease comes into attention only after the onset of symptoms and unfortunately in late stages. One of the major management challenges encountered is late presentation, as more than 56.0% of the cases present in stages III and IV. (Eze JN et al 2013). Data suggest that more than half of cervical cancer cases could be prevented through adequate screening. Fifty percent of women diagnosed with cervical cancer have never undergone cervical cytology testing and another 10% have not received screening in the five years preceding their diagnosis. Furthermore, cervical cancer is very rare among screened women as less than 10 per 100,000 annual (Sokol RJ et al2003). This outlines the significance of regular and periodic screening of all sexually active women. The cancer in spite o...

A retrospective study on cervical cancer screening- In a newly opened tertiary care Centre in Eastern India

“…O et al 20 whereas K K Innaniya et al 15 reported 41-60 years as the most common age group. In our study Negative for intraepithelial lesion or malignancy (NILM) was seen in 93.24% which was similar in a study done by Sachan PL et al, 16 Sharma A et al, 18 K.K Innaniya et al, 15 Bhattacharya N B et al, 8 Verma A. et al 19 However, Kumar N et al 10 and Shaki O et al 20 In the present study ASCUS, ASC-H, LSIL, HSIL, and AGUC NOS were 2.06 %, 0.14%, 0.52%, 0.23%, and 0.33% respectively. No squamous cell carcinoma case was found.…”

“…The most common chief complaint was vaginal discharge which was like in other studies. 13,14,16,[18][19][20] The most common age group of presentation in our study was 31-40 years which was like the study done by Ninder kumar et al, 10 Rana et al, 17 Verma A et al, 19 Shaki. O et al 20 whereas K K Innaniya et al 15 reported 41-60 years as the most common age group.…”

“…These findings were in concordance with the findings of a study done by Rana et al 17 in which ASCUS(1.24%) is the most common epithelial cell abnormality followed by LSIL (0.83%). Other studies, done by Sharma et al 18 also reported the same findings of the most common epithelial cell abnormality being ASCUS (5.0%) followed by LSIL (4%). But Sachan et al, 16 Mishra R et al, 13 and Verma et al 19 reported LSIL (5.09%, 2.7%, and 5.5 respectively) as the most common epithelial cell abnormality followed by ASCUS (2.9%, 0.92% respectively).…”

“…Few other studies showed that the incidence of unsatisfactory smear is quite high (12.1%, 8.3%, 7.3%, and 6.42%). 10,13,14,18 The main reason for inadequacy in our study was low squamous cellularity and obscuration of the field by inflammation and blood. The most common chief complaint was vaginal discharge which was like in other studies.…”