Spectrum of Cervical Lesions in Pap Smear with Histopathological Concordance: A Cross-sectional Study

Abstract

Introduction: Cervical cancer is amongst the leading causes of death in females. According to the World Cancer Statistics, the global incidence of cervical cancer is 6.5% and mortality related to it is 7.5%. The most effective way to screen and thus treat in early stages is achieved by screening the patients with Papanicolaou (Pap) smear. Aim: To assess the spectrum of cervical lesions in Pap smears, classify them as per the Bethesda System of reporting Cervical Cytology and compare the cytology results with histopathology where available. Materials and Methods: The present study was a cross-sectional study carried out for a period of two months from August 2022 to September 2022 in Rohilkhand Medical College and Hospital, Bareilly, Uttar Pradesh, India. The slides of Pap smear were reported as per the 2014 Bethesda System of reporting cervical cytology. Comparison with the histopathological findings was done in cases whenever cervical biopsy or hysterectomy specimen was received. Data was collected, entered and compiled in Microsoft excel followed by analysis using software Statistical Package for the Social Sciences (SPSS) 23.0. The data was represented in frequency and validity was calculated in terms of sensitivity, specificity, Positive Predictive Value (PPV), Negative Predictive Value (NPV) and accuracy. The p-value was calculated using Chi-square test and significance was set at p<0.05. Results: All cases received during the study duration of two months were included in the study which was 400 consecutive PAP smears. Epithelial cell abnormality was seen in 17 (4.25%) cases. Atypical Squamous Cells of Undetermined Significance (ASCUS) was seen in 8 (2%) cases, Low-grade Squamous Intraepithelial Lesion (LSIL) in 2 (0.5%) cases, High-grade Squamous Intraepithelial Lesion (HSIL) in 1 (0.25%) case, Atypical Squamous Cells- cannot exclude high-grade squamous intraepithelial lesion (ASC-H) in 4 (1%) cases and Squamous Cell Carcinoma (SQCC) in 2 (0.5%) cases. Concordance with histopathathology was seen in 33 of 37 cases. The overall sensitivity, specificity, PPV, NPV and diagnostic accuracy was 90%, 88.9%, 75%, 96% and 89%, respectively. The p-value was 0.00001. Conclusion: Cases diagnosed on Pap smear as low-grade epithelial cell abnormality including ASCUS and LSIL should be kept in follow-up, whereas cases diagnosed with high-grade epithelial cell abnormality including ASC-H, HSIL or SQCC, appropriate treatment should be planned.

Keywords

• atypical squamous cells
• intraepithelial
• negative for intraepithelial lesion or malignancy