Pap Smear and Colposcopic Examination of the Cervix in Pelvic Inflammatory Disease and other Gynaecological Conditions: A Prospective Analytical Study

Abstract

Introduction: Pap smear and colposcopy are commonly done procedures in gynaecology practice. The Pap test is a low-cost, straight forward, and widely used tool for detecting cervical cancer and preinvasive cervical abnormalities. Colposcopy is also widely used to detect Cervical Intraepithelial Neoplasia (CIN) to guide cervical biopsy sites with clinical symptoms of suspected cervical diseases. Aim: To evaluate the diagnostic implications of Pap smear and colposcopy in inflammatory cellular changes and to estimate the incidence of Cervical Intraepithelial Neoplasia (CIN)/invasive carcinoma in the study population through biopsy. Materials and Methods: This prospective analytical study was conducted at JNU Medical College, Jaipur, India, where Pelvic Inflammatory Disease (PID), and other gynecology Out Patient Department (OPD) patients without any previous diagnosis of cervical malignancy, were included in the study. A total of 150 study patients, underwent Pap smear and colposcopic examination with biopsy as the gold standard. Descriptive analysis of data was done using means and standard deviation for continuous variables and nominal variables as frequencies. The Chi-square test was applied to categorical variables to find out the association and Receiver Operating Characteristic (ROC) analysis was done to predict the diagnostic ability of Pap smear, and colposcopy in cervical pathology. Results: The mean age of the patient population was 36±3 years. The mean age at first coitus and marriage of all the women were 18.9±2.7 years and 19.5±3.4 years, respectively. Twenty (13.3%) and 5 (3.3%) cases were reported as CIN and carcinoma, respectively after colposcopic biopsy. Pap smear results showed a sensitivity of 87.7% and a specificity of 78.2%. The Positive Predictive Value (PPV) and Negative Predictive Value (NPV) were 72.8% and 68.7%, respectively. Sensitivity of the colposcopic report was 89.4% and the specificity was 98.8%. The PPV is 96.6% and NPV is 82.3% for colposcopic report. Conclusion: This study suggested that PID and gynaecology OPD patients can be better targeted with a good opportunity for screening the potential premalignant changes in the cervix by using Pap smear and colposcopy.

Keywords

• carcinoma cervix
• cervical intraepithelial neoplasia
• cervicitis
• vaginitis