Correlation of Pap smear and colposcopic findings in relation to histopathological findings among women attending a tertiary care hospital: a two year study
Keywords:Cervical malignancy, Colposcopy, HSIL, LSIL, Pap smear
Background: Cervical malignancy is ranked second among the malignancies in females with breast carcinoma the first. Screening for cervical cancer by conventional cytology and supported by colposcopy and histopathology can easily identify the premalignant lesions and also other non-invasive inflammatory lesions of the cervix. Objective of this study was to find the correlation of Pap smear, colposcopic findings and colposcopic guide biopsy in evaluation of cervical lesions in women and to analyze the various risk factors
Methods: A prospective study for two years was conducted by department of obstetrics among women aged from 20-60 years. Socio demographic data, clinical history and examination were done and findings noted. Pap smear, colposcopy and colposcopic guided biopsy was done and findings were noted and analyzed foe sensitivity, specificity and compared with Pap smear.
Results: In present study sensitivity of Pap smear for detecting lesions above LSIL was 28%, specificity 99.32%, PPV was 93.47%, negative predictive value 76.21% and accuracy of Pap smear was 78%. The sensitivity of colposcopy in detection of low grade lesions and above came out to be 80.2%, specificity 82.14%, positive predictive value 66.78%, negative predictive value 86.78% and accuracy of colposcopy was 84.65%.The incidence of preinvasive lesions (LSIL and HSIL) was 33.6% with LSIL (19.2%) and HSIL (14.4%) and of invasive lesions was 9.6%.
Conclusions: This study suggests that accuracy of detection of cervical abnormalities is higher when cytology, colposcopic biopsy and colposcopy are used complimentarily in diagnosis of cervical lesions. Colposcopy eliminates the need for repeated follow up as in Pap smear which has low sensitivity.
World health organization. Cervical Cancer Screening in Developing Countries [Internet]. Geneva: World health organization; 2002:1-75. Available from: https://www.who.int/cancer/media/en/cancer_cervical_37321.pdf. (accessed 21 November 2014).
Bobdey S, Sathwara J, Jain A, Balasubramaniam G. Burden of cervical cancer and role of screening in India. Indian J Med Paediatr Oncol. 2016 Oct-Dec;37(4):278-285.
Pandey K, Bhogoliwal A: Cancer cervix- need for mass surveillance program specially in Rural areas. J Obstet Gynecol India. 2005;55(5):436-9.
Vinay K, Abbas AK, Aster JC. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Chicago: Elsevier Science Health Science Division; 2015.
Addis IB, Hatch KD, Berek JS. Intraepithelial disease of the cervix, vagina and vulva. Berek and Novak’s Gynaecology 14th Edn Lippincott Williams and Wilkins 2007;573.
Reid R, Scalzi P. Genital warts and cervical cancer. VII. An improved colposcopic index for differentiating benign papilloma viral infections from high-grade cervical intraepithelial neoplasia. Am J Obstet Gynecol. 1985;153(6):611-8.
Goel A, Gandhi G, Batra S, Bhambani S, Zutshi V, Sachdeva P. Visual inspection of the cervix with acetic acid for cervical Intraepithelial lesions. Dept of Obstetrics and Gynaecology, Maulan Azad medical college, new Delhi, India. Int J Gynecol Obstet. 2005;88(1):25-30.
Arora R, Vijaya K, Habeebullah S, Asha O. Colposcopic evaluation of unhealthy cervix. J Obstet Gynecol Ind. 2000;50:102-3.
Chaudhary RD, Inamdar SA, Hariharan C. Correlation of diagnostic efficacy of unhealthy cervix by cytology, colposcopy and histopathology in women of rural areas. Int J Reprod Contracept Obstet Gynecol. 2014;3(1):213-8.
Krishnegowda S, Veena MS. Efficacy of coiposcopy technique with Pap smear and histology in screening of cervical lesions. Int J Repord Contracept Obstet Gynecol. 2014;3(3):696-702.
Bal MS, Goyal R, Suri AK, Mohi MK. Detection of abnormal cervical cytology in Papanicolaou smears. J Cytol. 2012 Jan-Mar;29(1):45-7.
Shastri SS, Dinshaw K, Amin G, Goswami S, Patil S, Chinoy R, et al. Concurrent evaluation of Visual cytological and HPV testing as screening methods for the early detection of cervical neoplaisia in Mumbai, India. Bull World Healthy Organ. 2005;83(3):186-94.
Bodal VK, Brar BK. Correlation of pap smear with histopathological findings in malignant and non-malignant lesions of cervix. Glob J Med Res E Gynecol Obstet. 2014;14:19-23.
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 centre. Int J Sci Stud. 2015;3(8):55-60.
Ramesh G, Sudha R, Jayashree AK, et al. Colposcopic evaluation of unhealthy cervix. J Clin and Diagnos Res. 2012;6(6):1026-8.
Mallur PR, Desai BR, Anita D, Geeta D, Bhavana S, Pallav G. Sequential screening with cytology and colposcopy in detection of cervical Neoplasia. J South Asian Fed Obstet Gynaecol. 2009;1(3):45-8.