The Diagnosis of Cervical Dysplasia in a University Hospital Using Pap Smear and Colposcopy in the Western Region of Saudi Arabia: A Correlational Study

Abstract

Objectives To assess the diagnostic performance of Pap smear screening with or without human papillomavirus (HPV) testing and colposcopy in detecting preinvasive lesions of the cervix among women with reference to histopathological findings. Materials and methods We performed a retrospective study in a tertiary care center of the clinical and pathological records of women with evocative symptomatology. The diagnostic performance of Pap smear screening and colposcopy was analyzed. The sensitivity and specificity of Pap smear screening and colposcopy in detecting preinvasive lesions of the cervix were calculated in 388 patients. Results The mean age was 45.12 years, and the most frequent gynecological symptoms included abnormal bleeding (17.2%) and postcoital bleeding (10.9%). Histopathology showed abnormal results in 26.5% of the 388 patients, including cervical intraepithelial neoplasia 1 (CIN 1; 20.4%), CIN 2 (2.8%), CIN 3 (1.3%), and SCC (1.3%). Both Pap smear screening and colposcopy were highly sensitive in detecting CIN 1+ (94.2%vs.93.2%, respectively) and CIN 2+ (100.0% vs.95.8%, respectively) intraepithelial lesions; however, Pap smears had very low specificity in detecting both CIN 1+ (8.1% vs.73.7%, respectively) and CIN 2+ (8.0% vs. 59.3%, respectively) compared with colposcopy. When combined with HPV status, the specificity of Pap smear increased considerably. Conclusion It has become a high priority to improve the efficiency of cervical cancer (CC) screening programs by optimizing the practice of Pap smear screening, increasing the test specificity, and implementing systematic cytology-HPV co-testing.

Spectrum of cervicovaginal Pap smears in newly established tertiary care medical institute

“…After excluding asymptomatic and healthy cervix cases, the most commonly reported clinical symptoms and examination findings are white discharge per vaginum, abdominal pain, abnormal bleeding, postcoital bleeding, irregular cycle, postmenopausal bleeding, intermenstrual bleeding, hypertrophied cervix, cervical erosion, bleed on touch cervix, and uterovaginal prolapse. [ 5 , 6 , 8 , 9 ] We observed white discharge per vaginum, abdominal pain, cervical mucoid discharge, and irregular cycle as common clinical symptoms, and cervical erosion, cervical hypertrophy, and bleed on touch cervix as common examination findings. In 2014 Bethesda System, the “Epithelial cell abnormality: Squamous” includes squamous intraepithelial lesion (SIL) category, which comprises a spectrum of squamous cell lesions starting from the precancerous lesions of LSIL to HSIL and invasive squamous cell carcinoma (SCC).…”

“…observed that mean age of the study population was 31.55 ± 6.66 years (ranging from 21 to 60 years) and 45.12 ± 6.66 years (ranging from 21 to 75 years), respectively. [ 6 , 8 ] The age range in our study was 21–80 years, with a mean age of 38.89 years.…”

“…However, it conflicts with the findings of Baamer et al ., who found that ASC-US (26.1%) was the most frequent interpretation category, and NILM was seen in only 8.9% of their cases. [ 8 ] NILM is a general category that may or may not be associated with organisms or other non-neoplastic cellular findings (such as squamous or tubal metaplasia, atrophy, and reactive cellular changes) but have no cellular evidence of neoplasia. [ 10 ]…”

“…observed 91% of cases with epithelial cell abnormality. [ 8 ] The different epithelial cell abnormalities in the previous studies ranged as ASC-US 0.5–26.1%, ASC-H 0.1–16.7%, LSIL 0.1–19.4%, HSIL 0.2–9.2%, SCC 0.3–0.9%, and glandular cell abnormality including adenocarcinoma 0.2–18.6%. [ 5 - 11 ] We observed ASC-US, ASC-H, LSIL, HSIL, and atypical glandular cells (NOS) in 1.52%, 0.5%, 0.34%, 1.18%, and 0.67%, respectively, within the range reported in the previous studies.…”

Unravelling the Impact of Human Papillomavirus (HPV): A Comprehensive Exploration of its Role in Cancer Progression and Global Health Challenges

“…Similarly, HPV DNA tests offer a molecular snapshot of HPV infection, providing insights into an individual's susceptibility to cervical cancer development. Equipped with this understanding, medical experts can proactively intervene, either through surveillance or treatment, halting the progression of precancerous lesions [69] [70].…”