The Cervical pap smear cytological changes with clinicopathological correlation in a sample of Iraqi patients
DOI:
https://doi.org/10.22317/imj.v5i3.1018Keywords:
Pap smear, Bethesda system, Cervical cancer screening.Abstract
Objectives: This study aimed to evaluate the role of Pap test in detecting pre-cancerous lesions in Iraqi women aged 45 years to 85 years, correlate the pap result with patient’s age, parity, number of births, number of abortions, chief complaint, and clinical cervical exam, and to evaluate the diagnostic accuracy of the pap test in correlation to histopathological examination.
Methods: Women who attended the outpatient gynaecological clinic of the Department of Obstetrics and Gynaecology at Baghdad medical city, Baghdad, Iraq, from January 2019 to January 2020 who had different chief complaints were selected for the study. Women who are 45 years to 85 years old were included in the study. A Pap smear was used for all women to screen for cervical cancer and the results were reported according to the 2014 Bethesda system. The data analysis was done utilizing statistical package for social sciences version 24 (SPSS v24).
Results: Total number of pap smears analyzed were 510, NILM (negative for intraepithelial lesions or malignancy) constituted major group 464/510 (91%) and epithelial cell abnormality were 46/510 (9%), age is significantly correlated with increasing rate of pre-neoplastic and neoplastic lesions in women and the significance of vaginal discharge & postmenopausal bleeding and its association with premalignant changes in the cervix. The sensitivity of Pap test is 94%, the Specificity was 60% and accuracy rate 74%.
Conclusion: There is significant correlation between Pap smear abnormality and increasing age, vaginal discharge and postmenopausal bleeding, were evident in this study.
References
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32) Tamboli G.D. et al. Accuracy of cytological findings in abnormal cervical smear by cyto- histological comparison. Journal of Medical Education & Research. 2013; 3(2):19-24.
33) Jain V, Vyas AS. Cervical Neoplasia Cyto- Histological Correlation (Bethesda System) A Study of 276 Cases. J Cytol Histol. 2010;1:106.
34) Anschau F, GoncalvesMAG. Discordance between Cytology and Biopsy Histology of the Cervix: What to Consider and What to Do. Acta Cytologica. 2011;55:158-62.
35) Ng AB: The cellular detection of endometrial carcinoma and its precur- sors. Gynecol Oncol. 1974;2:162–179.
36) Yancey M et al.Classification of endometrial cells on cervical cytology. Obstet Gynecol. 1990;76:1000–1005.
37) Cherkis RC et al, Patten FW: Significance of normal endometrial cells detected by cervical cytology. Obstet Gynecol. 1988; 71:242–244.
38) Massad LS et al.Updated consensus guidelines for the management of abnormal cervical cancer screening tests and cancer precursors. J Low Genital Tract Dis. 2013;17(5 suppl 1):S1–S27.
39) Alsous, M et al. Knowledge and awareness about human papillomavirus infection and its vaccination among women in Arab communities. Sci Rep. 2021;11, 786.
2) Kerkar RA, Kulkarni YV. Screening for cervical cancer: An overview. J Obstet Gynecol India 2006; 56: 115-22.
3) Patel MM, P et al. Cervical Pap smear study and its utility in cancer screening, to specify the strategy for cervical cancer control. National Journal of Community Medicine 2011; 2.
4) Padubidri VG, Daftary SN. Shaw’s textbook of Gynaecology. 14th Edn. C Elser, 2008: 359.
5) Brown AD et al, Cost effective studies on cervical cancer. Acta cytologica 2001; 45; 509-14.
6) American College of Obstetricians and Gynecologists. Cervical cancer screening and prevention. Practice Bulletin No. 157. Obstet Gynecol. 2016. January 127:e1-20.
7) Zamani, N., Management of Abnormal Cervical Cytology. J College Physic Surge Pakis, (1994): Vol.4, No.1, pp.28-9.
8) Arbyn M et al. "European Guidelines for Quality Assurance in Cervical Cancer Screening. Second Edition—Summary Document". Annals of Oncology, 2010, 21 (3): 448- 58.
9) Tsikouras, Panagiotis, et al. “Cervical cancer: screening, diagnosis and staging.†Journal of BUON, 2016, Vol. 21, No.2, pp. 320-5.
10) Nandakumar A et al. The magnitude of cancer cervix in India. Indian J Med Res 2009; 130(3): 219-21.
11) Ferlay, Jacques. “GLOBOCAN cancer incidence and mortality worldwide: IARC CancerBase No. 10.†International Agency for Research on Cancer, 2010.
12) Shanmugham D et al. Colposcopic evaluation of patient with persistant inflammatory pap smear. Sch J Appl Med Sci. 2014;2:1010–101.
13) Edelman M et al. Cervical Papanicolaou smear abnormalities in inner city Bronx adolescents: prevalence, progression, and immune modifiers. Cancer 1999;87:184-9.
14) Fonn S et al. Prevalence of pre-cancerous lesions and cervical cancer in South Africa--a multicentre study. S Afr Med J 2002;92:148-56.
15) Afrakhteh M et al. A study of 13315 papanicolaou smear diagnoses in ShohadaHospital. J Fam Reprod Health 2007;1:74–8.
16) Deshou H et al. Clinical utility of Liqui-PREPTM cytology system for primary cervical cancer screening in a large urban hospital setting in China. J Cytol 2009;26:20-5.
17) Balaha M et al. Cytological pattern of cervical Papanicolaou smear in eastern region of SaudiArabia. J Cytol 2011;28:173-7.
18) Nasreen M et al. Evaluation of Conventional Pap Test for Cervical Intraepithelial lesions and Cancer in a Tertiary Hospital of Bangladesh. Chattagram Maa-O-Shishu Hospital Medical College Journal. 2013 Jun 28;12(2):1-6.
19) Atilgan R et al. Evaluation of cervical cytological abnormalities in Turkish population. Indian JPathol Microbiol 2012;55:52-5.
20) Bukhari MH et al. Clinicopathological importance of Papanicolaou smears for the diagnosis of premalignant and malignant lesions of the cervix. J Cytol2012;29:20-5.
21) R Marahatta, S Bhattarai. Value of conventional cervical cytology as a screening test for cervical cancer. Nepal Med Coll J 2013;15(2) 223. Available from: www.nmcth.edu/images/gallery/Original%20Articles/evYjbR%20marahatta.pdf.
22) Mufti ST, Altaf FJ. Changing pattern of epithelial cell abnormalities using revised Bethesda system. Iranian Journal of Basic Medical Sciences 2014;17:779-84.
23) Kapila K et al. Trends in Epithelial Cell Abnormalities Observed on Cervical Smears over a 21-Year Period in a Tertiary Care Hospital in Kuwait. Sultan Qaboos Univ Med J 2015;15:e112-5.
24) Nair GG et al. Cytopathological pattern of cervical pap smears-a study among population of North Malabar in Kerala. Indian Journal of Pathology and Oncology. 2016 Oct;3(4):552-7.
25) Wang PD, Lin RS. Sociodemographic factors of Pap smear screening in Taiwan.Taipei Wanhwa District Health Center, Taiwan. Public Health. 1996;110:123–7.
26) Pradhan B et al. Correlation of PAP smear findings with clinical findings and cervical biopsy. Kathmandu Univ Med J (KUMJ) 2007;5:461–7.
27) Ranabhat SK et al. Analysis of abnormal epithelial lesions in cervical pap smears in mid-Western Nepal. J Pathol Nepal. 2011;1:30–3.
28) EM Ikeanyi et al. Risk Factors Associated With Cervical Intraepithelial Lesions In A Tertiary Hospital Setting. EE Okpere Vol 10, No 1 (2011) , Ebonyi Medical Journal.
29) Canadian cancer society [Internet]. Risk factors for cervical cancer. [cited 2021 june 4] Available from: https://www.cancer.ca/en/cancer-information/cancer type/cervical/risks/?region=on#Giving_birth.
30) Pradhan N et al. Cervical cytology study in unhealthy and healthy looking cervix. N J Obstet Gynaecol. 2007;2:42–7.
31) Kenneth DH, Yao SF. Cervical and vaginal cancer. In: Novak's. 13th ed. Philadelphia: Lipincott Williams and Wilkins; 2002. pp. 471–93.
32) Tamboli G.D. et al. Accuracy of cytological findings in abnormal cervical smear by cyto- histological comparison. Journal of Medical Education & Research. 2013; 3(2):19-24.
33) Jain V, Vyas AS. Cervical Neoplasia Cyto- Histological Correlation (Bethesda System) A Study of 276 Cases. J Cytol Histol. 2010;1:106.
34) Anschau F, GoncalvesMAG. Discordance between Cytology and Biopsy Histology of the Cervix: What to Consider and What to Do. Acta Cytologica. 2011;55:158-62.
35) Ng AB: The cellular detection of endometrial carcinoma and its precur- sors. Gynecol Oncol. 1974;2:162–179.
36) Yancey M et al.Classification of endometrial cells on cervical cytology. Obstet Gynecol. 1990;76:1000–1005.
37) Cherkis RC et al, Patten FW: Significance of normal endometrial cells detected by cervical cytology. Obstet Gynecol. 1988; 71:242–244.
38) Massad LS et al.Updated consensus guidelines for the management of abnormal cervical cancer screening tests and cancer precursors. J Low Genital Tract Dis. 2013;17(5 suppl 1):S1–S27.
39) Alsous, M et al. Knowledge and awareness about human papillomavirus infection and its vaccination among women in Arab communities. Sci Rep. 2021;11, 786.
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Published
2021-09-26
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Aledan NA kareem, Hussien WAL. The Cervical pap smear cytological changes with clinicopathological correlation in a sample of Iraqi patients. Iraq Med J [Internet]. 2021 Sep. 26 [cited 2024 Dec. 22];5(3):75-80. Available from: https://iraqmedj.org/index.php/imj/article/view/1018
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