Pattern of abnormal Pap smears in developing countries : A report from a large referral hospital in Saudi Arabia using the revised 2001 Bethesda System

Abstract

BACKGROUNDReports describing the frequency and pattern of abnormal Pap smears in developing countries using the revised Bethesda system for Pap smear are few. We studied the pattern of cervical intraepithelial lesions and carcinoma detected in Pap smears of Saudi females in the western region of Saudi Arabia using the revised system.METHODSAll cervical Pap smears reported in the Department of Pathology of King Abdulaziz Medical City, Jeddah, from 1 January 1998 to 31 August 2005 were reclassified according to the revised system with age ranges identified.RESULTSOf 5590 sufficient smears, 261 (5%) were identified as abnormal and were further classified as atypical squamous cells of undetermined significance (ASC-US) (103 cases, 40%), atypical squamous cells of high grade (6 cases, 2%), low-grade squamous intraepithelial lesions (LSIL) (56 cases, 22%), high-grade squamous intraepithelial lesions (HSIL) (31 cases, 12%), glandular cell abnormalities (30 cases, 11%) and invasive squamous cell carcinoma (21 cases, 9%). The ASC-US/SIL ratio was 1.9%. Invasive adenocarcinoma accounted for 14 cases (4%) with a similar age range as invasive squamous cell carcinoma.CONCLUSIONAlthough this study showed a lower incidence and a wider age range of cervical epithelial cell abnormalities than others published internationally, the results emphasize the need for a well-organized cervical screening program supplemented by larger national studies on the pattern of cervical abnormalities in this country. The information provided in this study will encourage use of the Pap smear as a screening method for cervical cancer in developing countries.

Cytological pattern of cervical papanicolaou smear in eastern region of Saudi Arabia

“…[89] Two studies showed similar prevalence to our current findings. [1011] The mean age of the cases diagnosed as SCC was 35.8 years. The average age of SCC in all the Saudi studies was nearly similar.…”

HPV Infection in Cervical and Other Cancers in Saudi Arabia: Implication for Prevention and Vaccination

“…Studies profiling Pap smears examined at University Hospitals have revealed precursor lesions of cervical cancer (14, 18–20). A study combining HPV detection with Pap test in 100 women undergoing voluntarily cervical cytological screening have found 6% HPV-positive cases that consisted of 5% high-risk and 1% low risk HPV (21).…”

Human papillomaviruses in cervical specimens of women residing in Riyadh, Saudi Arabia: a hospital-based study

“…Most of the published data about cervical changes among women in Saudi Arabia did not investigate the existence of HPV [9][10][11][12]. Aside from a few studies [13][14][15][16], there is insufficient information about HPV prevalence and its involvement in cervical cancer in Saudi Arabia, especially from population-based studies.…”

“…The majority of these genotypes are harmless. However, some are classified as low risk, causing genital warts (HPV- 6,11,40,42,43,44,53,54,61,72,73, and 81), while others were considered high risk (HPV- 16,18,31,33,35,39,45,51, 52, 56, 58, 59, and 68) for cervical cancer [3,4]. HPV-16 and HPV-18 are globally believed to be directly involved in the cervical carcinogenesis process [5][6][7].…”