Cervical cytology by pap smear in reproductive population

Vidya A. Thobbi, Farheen Khan


Background: The present hospital-based study was conducted to study the incidence of various cervical epithelial abnormalities such as infection, dysplasia and early cervical cancer changes in reproductive age population and its correlation with age, parity, socioeconomic status, clinical symptoms and cervical biopsy findings.

Methods: A prospective study was conducted in 300 women of reproductive age group. The cervical smear was taken from all patients by means of the scrape technique using the Ayre’s spatula. Pap smear results were considered as positive (abnormal) when they are ASCUS, LSIL, HSIL or Invasive lesion. On persistence of unhealthy cervix/inflammatory smear after a course of antibiotic, direct cervical punch biopsy was taken.

Results: Inflammatory smears were seen in 88.0%, ASCUS in 5%, LSIL in 1.4%, HSIL in 0.3% and invasive carcinoma in 0.3% patients. Direct cervical punch biopsy was taken from 13 cases out of 264 with inflammatory smear. Most of these patients had cervicitis (12 cases) while 1 case showed CIN stage 2. All cases of ASCUS and LSIL had infection which showed chronic cervicitis on biopsy. HSIL and Invasive carcinoma showed CIN stage 2 and Carcinoma as their biopsy findings.

Conclusions: The Pap smear is a simple, safe, practical and cost-effective method for early detection of cervical cancer and its precursors. In developing countries like India, it is the most logical screening modality although it has a very low sensitivity, but detection rates could be further improved using liquid-based cytology and the use of endocervical cytobrush.


Cervical biopsy, Cervical carcinoma, Cervical cytology, Pap smear

Full Text:



Nandini NM, Nandish NM, Pallavi P, Akshatha SK, Chandrashekhar AP, Anjali S, et al. Manual liquid-based cytology in primary screening for cervical cancer-a cost effective preposition for scarce resource settings. Asian Pac J Cancer Prev. 2012;13:3645-5.

ICO Information Centre in HPV and Cancer (Summary Report 2014-08-22) Human Papillomavirus and Related Diseases in India. 2014.

Kavatkar AN, Nagwanshi CA, Dabak SM. Study of a manual method of liquid based cervical cytology. Indian J Pathol Microbiol. 2008;51:190.

Reagan JW, Scott RB. The detection of cancer of the uterine cervix by cytological study. Am J Obstet Gyneco1. 1951;62:1347-52.

Usho S. Relevance of cytological services in India today. J Obst Gynecol lndia. 1986;379.

Moyer VA. Screening for cervical cancer: U.S. preventive services task force recommendation statement. Ann Internal Med. 2012;156(12):880-92.

Colgan TJ. Responding to Bethesda system reports. Can Fam Physician. 2001;47:1452-30.

Gupta S, Sodhani P. Spectrum of epithelial cell abnormalities of uterine cervix in a cervical cancer screening programme: implications for resource limited settings. Eur J Obstet Gynecol Reprod Biol. 2007;134:238-42.

Aswads G, Gargash H. Cervical smear abnormalities in the United Arab Emirates: a pilot study in the Arabian Gulf. Acta Cytol. 2006;50:41-7.

Blomfield PI, Lancashire RJ, Woodman CB. Can women at risk of cervical abnormality be identified? BJOG. 1998;105:486-92

Charkravarty BN. Atypical cervical epithelial changes in relation to carcinoma of cervix. J Obstet Gynaecol India. 1975;26:870-8.

Prabhakar BR, Arora RK, Vadehra PL, Nagpal BL. Incidence and pattern of cancer in Amritsar (Punjab) (a ten-year retrospective study 1974-1983). Indian J Pathol Microbiol. 1988;31(2):8.

Singh VK, Jain R. Prevalance of premalignant and malignant cervical lesions. J Obstet Gynecol India 1984;34:539-43.

Mukherjee C. Cervix and premalignant lesions. J Obstet Gynecol. 1984;82:124-47.

Desai P. Cytopathology of uterine cervix using Bethesda system in 2800 screened individuals. J Obstet Gynaecol India. 1992;43:403-7.

Balaha MH. Cytological pattern of cervical Papanicolaou smear in eastern region of Saudi Arabia. J Cytol. 2011;28(4):173-7.

Sariya U. Relevance of cytology services in India today. Indian J Obstet Gyneco1. 1985;36:379-84.

Sharma S, Sharma A, Sinha U, Chanchlani R. Comparative study of evaluation of sensitivity and specificity of cytology and colposcopy for detection of precancerous lesions of cervix. J Evol Med Dental Sci. 2013;2(50):9697-701.

Rathee S. Detection of uterine cervical dysplasia and carcinoma cervix by cervical smears: a clinicopathological analysis of 1181 cases. Indian J Obstet Gynecol. 1984;34:863-7.

Padmanabhan H, Oumachigui A, Sankaran V, Rajaram P. J Obst Gynecol lndia. 1990:107-112.

Joshi C, Kujur P, Thakur N. Correlation of Pap smear and colposcopy in relation to histopathological findings in detection of premalignant lesions of cervix in a tertiary care acentre. Int J Sci Stud. 2015;3(8):55-60.

Massad LS, Collins YC, Meyer PM. Biopsy correlates of abnormal cervical cytology classified using the Bethesda system. Gynecol Oncol. 2001;82(3):516-22.