Cytomorphological Evaluation of 1,000 Cases of Unhealthy Cervix to Assess Present Role of Pap Smear Screening in Developing Country
Journal Title: Journal of Pharmaceutical and Biomedical Sciences - Year 2016, Vol 6, Issue 5
Abstract
Introduction Last few decades saw a Pap smear becoming synonymous with early detection of cervical carcinoma, leading to its rapid decline worldwide. However, newer screening modalities like liquid cytology have been embraced by the developed world. The relevance of the Pap smear in developing countries like India needs to be evaluated. Objectives To assess the risk factors associated with cervical carcinoma. To correlate cyto-clinical–histopathological findings in the unhealthy cervix by Pap smear to determine its validity and feasibility. Materials and Methods Pap smears from 1,000 patients who presented in the Gynaecology department with the unhealthy cervix (discharge, bleeding or signs like erosion were clinically grouped as unhealthy) from December 2011 to May 2013 were enrolled in the study. Risk factors for cervical carcinoma were taken into consideration. The cytological results were correlated with the clinical findings and compared to the biopsy results. Results A total of 114 patients presented with epithelial cell abnormalities in cervical smears, low-grade squamous intraepithelial lesion (LSIL 4.4%) being the most common lesion. Risk factors for malignancy showed significant association with epithelial cell abnormality (P = 0.05%). Cervical smears showing epithelial cell abnormality were significantly associated with the clinical findings like discharge (P = 0.001), erosion (P-value = 0.002) and unhealthy looking cervix (P-value = 0.028). Pap smear showed 59.4% sensitivity, a positive predictive value of 95.4 and 55.9% concordance with the biopsy. Conclusion Pap smear has moderate sensitivity and high specificity. The feasibility and cost effectiveness of Pap smear to detect cervical cancer in the presence of significant risk factors and unhealthy symptoms makes it an effective screening procedure in the developing countries with limited resources and infrastructure.
Authors and Affiliations
Rajendra S. Dhaka, Shanmugasamy K, Sujata Mallick, Koteeswaran G, Dhananjay S. Kotasthane, Seetesh Ghose
Keywords
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