PAP Smear versus Colposcopy in the Absence of HPV-DNA Testing for the Screening of Pre-malignant and Malignant Cervical Lesions
DOI:
https://doi.org/10.22502/jlmc.v10i1.487Keywords:
Colposcopy, Cytology, PAP smear, Pre-malignant, Invasive carcinomaAbstract
Introduction: The incidence of cervical cancer is very high in developing countries. The extensive use of cervical screening with PAP smear and colposcopy has considerably increased the detection of premalignant and malignant cervical lesions. Methods: This was a hospital-based study conducted over a period of three months. All the patients underwent gynecological examination, PAP smear and colposcopy. In case of abnormal findings in colposcopy or follow-up cytology, patients were advised for cervical biopsy. With reference to the histopathological reports, the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of PAP smear and colposcopy were evaluated. Results: The most common cytological result was Negative for Intraepithelial Lesion or Malignancy (NILM, 60%) followed by Atypical Squamous Cells of Undetermined Significance (ASCUS, 10%), Atypical Squamous Cells- cannot exclude High grade lesion (ASC-H, 6%), Low grade Squamous Intraepithelial Lesion (LSIL,10%) and High grade Squamous Intraepithelial Lesion (HSIL, 11%). In colposcopy, 60% of the patients were normal and 40% showed atypical transition zone. Histo-pathological findings among 53 patients were NILM (13.2%), cervicitis (13.2%), Cervical Intraepithelial Neoplasia I (CIN I, 28.3%), CIN II and CIN III (39.6%) and invasive carcinoma (5.66%). The sensitivity, specificity, PPV and NPV of PAP smear were 63.6%, 66.6%, 33.3%, and 87.5% respectively. Similarly sensitivity, specificity, PPV, NPV of colposcopy for abnormal cervical lesions were 87.56%, 15.38%, 76.09% and 28.57% respectively. Conclusion: In the absence of HPV-DNA testing, the combined use of PAP smear and colposcopy to detect premalignant and malignant cervical lesions increases early detection and treatment.
Downloads
References
Cancer, WHO. Cancer Fact Sheets: Cervical cancer [Internet]. IARC, World Health Organization; 2016. Available from: https://gco.iarc.fr/today/data/pdf/fact-sheets/cancers/cancer-fact-sheets-16.pdf
Subedi K. Correlation of colposcopy with biopsy in cases of abnormal cervical cytology. Nepal Journal of Obstetrics and Gynaecology. 2019;14(1):36-9. DOI: Subedi, K. (2019). Available from: https://www.nepjol.info/index.php/NJOG/article/view/26625
Prasad D, Sinha A, Mishra U, Parween S, Raman RB, Goel N. Colposcopic evaluation of cervix in symptomatic women and its correlation with Pap smear. A prospective study at a tertiary care center. J Family Med Prim Care 2021;10(8):2923-2927. PMID: 34660425 DOI: https://doi.org/10.4103/jfmpc.jfmpc_1208_20
Kalyankar VY, Kalyankar BV, Gadappa SN, Kute S. Colposcopic evaluation of unhealthy cervix and it’s correlation with Papanicolau smear in cervical cancer screening. International Journal of Reproduction, Contraception, Obstetrics and Gynecology. 2017;6:4959-65. DOI: https://dx.doi.org/10.18203/2320-1770.ijrcog20175008
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. International Journal of Scientific Study. 2015;3(8):55-60. Available from: http://www.ijss-sn.com/uploads/2/0/1/5/20153321/ijss_nov_oa13.pdf
Chaudhary RD, Inamdar SA, Hariharan C. Correlation of diagnostic efficacy of unhealthy cervix by cytology, colposcopy and histopathology in women of rural areas. International Journal of Reproduction, Contraception, Obstetrics, Gynecology. 2014;3(1):213-8. Available from: https://www.ijrcog.org/index.php/ijrcog/article/viewFile/821/767
Upadhyay J, Garg S. Correlation of pap smear and colposcopic finding with directed biopsy in detection of cervical neoplasm. Tropical Journal of Pathology and Microbiology. 2017;3(4):396-400. Available from: https://pathology.medresearch.in/index.php/jopm/article/view/108/215
Kujur P, Joshi C. Application of the 2014 Bethesda system for reporting of cervical/ vaginal cytological lesions. Journal of Evolution of Medical and Dental Sciences. 2015;4(98):16366-71. DOI: http://dx.doi.org/10.14260/jemds/2015/2419
Jyothi R, Gupta P, Rao R, Sood PL, Parasher N. Correlation between Colposcopy, Cytology and Histopathology in High-risk Patients for Cervical Cancer in Perimenopausal Women in Himachal Pradesh, India. Journal of South Asian Federation of Menopause Societies. 2013;1(1):21-3. Available from: https://www.jsafoms.com/doi/JSAFOMS/pdf/10.5005/jp-journals-10032-1005
Thakur R, Srivastava A, Natu N. Correlation of pap smear and colposcopy in relation to histopathological finding in detection of pre malignant lesion of cervix. Scholars Journal of Applied Medical Sciences. 2016;4(9):3449-3453. Available from: https://journals.indexcopernicus.com/search/article?articleId=1780420
Mohanty J, Mohanty BK. Risk Factors in Invasive Carcinoma of cervix. Journal of Obstetrics and Gynecology of India. 1991;403-6. Available from: https://jogi.co.in/storage/articles/files/filebase/Archives/1991/feb/1991_403_406_Feb.pdf
Nair RV, Anitha R, Ashok VG. Comparative study of pap smear and colposcopic finding in patient with vaginal discharge attending OPD in tertiary care center. Indian Journal of Obstetrics and Gynecology Research. 2017;4(3):274-7. Available from: https://www.ijogr.org/article-details/4667
Mhaske M, Jawadekar SJ, Saundale SG. Study of association of some risk factors and cervical dysplasia/cancer among rural women. National Journal of Community Medicine. 2011;2(2):209-12. Available from: https://njcmindia.com/index.php/file/article/view/1882
Dadkhah F, Alishah N. A comparative study on colposcopy directed biopsy and pap smear tests in patient with abnormal pap smear. Iranian Journal of Pathology. 2006;1(1):13-16. Available from: https://ijp.iranpath.org/article_8894.html
Shaki O, Chakraborty BK, Nagraja N. A study on cervical cancer screening in asymptomatic women using Papanicolau smear in a tertiary care hospital in an urban area Mumbai, India. J Family Med Prim Care. 2018;7(4):652-7. PMID: 30234033 DOI: https://doi.org/10.4103/jfmpc.jfmpc_313_17
Gandavaram J, Pamulapati BR. Correlation of pap smear and colposcopic finding in relation to histopathological findings among women attending tertiary care hospital. a two year study. International Journal of Reproduction, Contraception, Obstetrics and Gynecology. 2019;8(6):2163-8. DOI: https://dx.doi.org/10.18203/2320-1770.ijrcog20192132
Sachan PL, Singh M, Patel ML, Sachan R. A study on cervical cancer screening using pap smear test and clinical correlation. Asia Pac J Oncol Nurs. 2018;5(3):337-41. PMID: 29963597 DOI: https://doi.org/10.4103/apjon.apjon_15_18
OÄŸlak SC, Obut M. Comparison of pap smear and colposcopy in the absence of HPV test for the diagnosis of pre malignant and malignant lesions. Eastern Journal of Medicine. 2020;25(2):299-304. DOI: https://dx.doi.org/10.5505/ejm.2020.21548
Cheragji F, Jolodarian P, Masoumi K, Forouzan A, Jafari RM. Comparison results of pap smear and colposcopy and histopathology in women with post coital bleeding. Research Journal of Obstetrics and Gynecology. 2015;8(1):10-15. DOI: https://dx.doi.org/10.3923/rjog.2015.10.15
Downloads
Published
Issue
Section
License
- The Journal of Lumbini Medical College (JLMC) publishes open access articles under the terms of the Creative Commons Attribution (CC BY) License which permits use, distribution and reproduction in any medium, provided the original work is properly cited.
- JLMC requires an exclusive licence to publish the article first in its journal in print and online.
- The corresponding author should read and agree to the following statement before submission of the manuscript for publication,
- License agreement
- In submitting an article to Journal of Lumbini Medical College (JLMC) I certify that:
- I am authorized by my co-authors to enter into these arrangements.
- I warrant, on behalf of myself and my co-authors, that:
- the article is original, has not been formally published in any other peer-reviewed journal, is not under consideration by any other journal and does not infringe any existing copyright or any other third party rights;
- I am/we are the sole author(s) of the article and have full authority to enter into this agreement and in granting rights to JLMC are not in breach of any other obligation;
- the article contains nothing that is unlawful, libellous, or which would, if published, constitute a breach of contract or of confidence or of commitment given to secrecy;
- I/we have taken due care to ensure the integrity of the article. To my/our - and currently accepted scientific - knowledge all statements contained in it purporting to be facts are true and any formula or instruction contained in the article will not, if followed accurately, cause any injury, illness or damage to the user.
- I, and all co-authors, agree that the article, if editorially accepted for publication, shall be licensed under the Creative Commons Attribution License 4.0. If the law requires that the article be published in the public domain, I/we will notify JLMC at the time of submission, and in such cases the article shall be released under the Creative Commons 1.0 Public Domain Dedication waiver. For the avoidance of doubt it is stated that sections 1 and 2 of this license agreement shall apply and prevail regardless of whether the article is published under Creative Commons Attribution License 4.0 or the Creative Commons 1.0 Public Domain Dedication waiver.
- I, and all co-authors, agree that, if the article is editorially accepted for publication in JLMC, data included in the article shall be made available under the Creative Commons 1.0 Public Domain Dedication waiver, unless otherwise stated. For the avoidance of doubt it is stated that sections 1, 2, and 3 of this license agreement shall apply and prevail.
Please visit Creative Commons web page for details of the terms.
