Eleven-year review of data on Pap smears in Saudi Arabia: We need more focus on glandular abnormalities!

Abstract

BACKGROUND: We reviewed data from Saudi Arabia on epithelial cell abnormalities (ECA) detected by Pap smear after noticing a slight increase in the incidence of cervical glandular abnormalities in our regional laboratory in recent years. OBJECTIVE: Clarify data on adenocarcinoma (ADCA) on Pap smears in Saudi Arabia. DESIGN: Descriptive, retrospective study. SETTINGS: Regional laboratory, Riyadh. PATIENTS AND METHODS: We reviewed all Pap smears of adult females between 2006 and 2016 and compared our data with previously published results from Saudi Arabia. MAIN OUTCOME MEASURE(S): Descriptive data on ECAs. RESULTS: Among 19759 cases, atypical squamous cell of undetermined significance (ASC-US) was the most prevalent ECA (1.16%). ADCA occurred more than squamous cell carcinoma (SCC). In a comparison of published data before 2014 and after 2014 (including ours), there was a significant rise in ADCA (28 vs 48 cases; P=.004) with a significant drop in SCC, high-grade squamous intraepithelial lesions (HSIL) and low-grade squamous intraepithelial lesions (LSIL) (P<.0001, .004, and <.0001, respectively). CONCLUSION: We recommend that pathologists and cytotechnologists be vigilant in screening Pap smears in our population, particularly for glandular abnormalities. We also recommend use of Pap smears in the initial workup of women with suspected gynecological abnormalities, regardless of evolutions in HPV testing. LIMITATIONS: The pooling of data instead of analyzing by study year.