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Table of Content - Volume 20 Issue 2 - November 2021


 

Cervical cytology study by Papanicolaou (PAP) smear screening in tertiary hospital in Surat, Gujarat

 

Ami K Jagirdar1, Brijeshkumar J Sapariya2*, Shilpa Samir Patel3, Moxa B Parmar4, Kinjal D Patel5

1Assistant Professor, 2Associate Professor, 3Tutor, 4, 5Resident Doctor, Department of Pathology, SMIMER Medical College, Surat, INDIA.

Email: nyasabs@gmail.com

 

Abstract              Background: To study the role of Pap smear in detecting neoplastic and non-neoplastic lesions of cervix. Methods: This is prospective study of 300 women with age group 20 to 80 years was carried out from July 2018 to September 2018 cytology section of pathology department, SMIMER, Surat, India. Pap smears were prepared, fixed, stained and carefully examined. Results: In present study, negative intraepithelial Lesion Or malignancy was the most common with 146 cases (48.66%) followed by reactive cellular changes with 96 cases (32%), then atrophy with 28 cases (9.33%), low-grade squamous intraepithelial lesions (LSIL) with 7 cases (2.3%), high grade squamous intraepithelial lesions (HSIL) with 4 cases (1.3%). The average age of women for all the epithelial abnormalities was more than 40 years. Conclusion: This study will increase awareness of the Pap test and cervical cancer, thereby paving a way for the prevention of Cervical Cancer.

 

INTRODUCTION

In India, cervical cancer is the most common woman-related cancer, killing 1 woman every 8 minutes. According to a recent study the burden of cancer of the cervix is increasing in India.  The Papanicolaou cervical cytology test is capable of detecting cervical cancer at an early stage and is used widely in developed countries, where it has decreased both the incidence and mortality of cervical cancer. [1-26]. Even today, many developing countries lack the facility to carry out widespread Pap screening.3 Histopathological examination is the gold standard. This correlation is also useful for continuous quality improvement and better management system which is must for many cytological laboratories that apply the Bethesda system in their diagnosis.4-5

Aims and Objectives: To Study the role of Pap smear in detecting neoplastic and non-neoplastic lesions of cervix in various age groups to see the spectrum of lesions in patients of SMIMER.

 

MATERIAL AND METHODS

Study area: SMIMER, Surat, Gujarat.

Study design: Prospective Study in patients.

The present study is prospective study and carried out in the duration of July 2018 to September 2018. Total 300 women with age ranges from 20 -70 years during routine Cytological screening at Gynaec OPD in SMIMER, Surat, India. A detailed clinical history was taken in each case and prior to bimanual examination; a scrape smear was taken from the squamocolumnar junction of the cervix with the help of Ayre’s spatula and immediately fixed in absolute alcohol. The smears were stained with Papanicalaous technique and cytologically graded according to the Bethesda system of classification of 2001.6 As routine all the cases of LSIL and HSIL were subjected to cervical biopsy. Four different types of STDs were also investigated into these smears namely Trichomonas vaginalis, Candida albicans, Herpes simplex and HPV infection. The Trichomonal and Candidal infection were reported on the individual presence of the pathogen in the smear. In present study, we have conducted Pap test in female who voluntarily consented to undergo this test. During the period July 2018 to September 2018 all female came for Pap smear test were included in the study irrespective of presence of co-morbid medical illnesses like diabetes mellitus, hypertension, thyroid disease, renal conditions, etc. Those who presented with excessive white discharge per vaginum, bleeding per vaginum, irregular menstruation, pelvic pain and dyspareunia were considered as symptomatic. Pregnant women and hysterectomy women were excluded from study. Before taking the Pap smear we ensured that the patient was not menstruating.

 Procedure of sampling:

The epithelial cell abnormalities particularly the squamous epithelial abnormality has been categorized into atypical squamous cells (ASC) including ASC of undetermined significance (ASC-US) and ASC cannot exclude high grade squamous intraepithelial lesions (ASC-H) and squamous intraepithelial lesion (SIL). SIL was again subdivided into low-grade squamous intraepithelial lesion (LSIL) and high-grade squamous intraepithelial lesion (HSIL). Frank invasive malignancy was termed as squamous cell carcinoma. Suspected cases were counselled and were advised to undergo colposcopic examination and biopsy for histopathological examination.


 

RESULTS

Total 300 cases were analyzed for above mentioned period. The age of women range from 20 to 60 years with an average age of more than 40 years. The most of the women who were attended were in age group of 30 - 39 years (Table 1).

 

Table 1: Age- wise distribution of total number patients

Age (in years)

No. of cases

Percentage (%)

20-29

35

11.7

30-39

106

35.3

40-49

102

34

50 or >

57

19

Total

300

100

Chief complaints of the women were vaginal discharge followed by pain in abdomen, intermenstrual bleeding, post coital bleeding and others. 16 (5.3%) smears were found to be unsatisfactory for evaluation. The negative for intraepithelial lesion were 146 cases (48.66), reactive cellular changes associated with inflammation 96cases (32%) and atrophic changes 28 cases (9.33%). In Epithelial Cell Abnormalities: ASCUS was 3 cases (1%), LSIL 7cases (2.3%), HSIL 4 cases (1.3%). All premalignant and malignant lesions had mentioned in Table 2 and their age-wise distributions were mentioned in Table 3. The average age of women for all the epithelial abnormalities was 40 years.

 

Table 2: Finding of pap smear cytology.

Sr. No

Diagnosis

No.

%

1

Unsatisfactory for Evaluation (U E)

16

5.3

2

Negative for Intraepithelial Lesion/Malignancy(NILM)

146

48.7

3

Reactive cellular changes

96

32

4

Atrophic Smear

28

9.3

5

ASCUS

3

1

6

Low grade Squamous Intraepithelial lesion (LSIL)

7

2.3

7

High grade Squamous Intraepithelial Lesion (HSIL)

4

1.3

8

Squamous Cell Carcinoma

0

0

9

AGUS

0

0

Total

 

300

100

 

Table 3: Age wise finding of Pap smear cytology.

Age (in years)

U E

NILM

Reactive

Atrophic

ASCUS

LSIL

HSIL

SCC

No. Of cases %

20-29

3

22

10

0

0

0

0

0

35 ( 11.7%)

30-39

3

42

56

4

0

1

0

0

106 (35.3%)

40-49

6

53

27

9

1

4

2

0

102(34%)

50 or >

4

29

3

15

2

2

2

0

57(19%)

Total

16

146

96

28

3

7

4

0

300 (100%)

The cases which were diagnosed on smear as epithelial cell abnormalities were followed and colposcopy biopsy was done and the final histopathology biopsy was done as shown in table 4.

Table 4: Colposcopy Biopsy for confirmation.

PAP report

No Of case

Histopathological diagnosis

LSIL

7

Mild Dysplasia CIN I

HSIL

4

Severe Dysplasia CIN III

DISCUSSION

 The results of present study and their correlation with other workers are discussed below in following Table 5.

 

Table 5

Age (in years)

Pragya Sharma et al.

(2010)7 DELHI

Malay Bajpai (2016) 8

UP

Present Study

SMIMER

20-29

190

111

35

30-39

24

103

106

40-49

 

102

50 or >

 

86

57

Total

214

300

300

In the present study, reactive cellular changes are reported more in age groups of 30 -39 years while Negative for Intraepithelial lesions are seen more in age group of 40 – 49 years. LSIL and HSIL are seen more in age group of more than 40 years.

 


CONCLUSIONS

Cervical cancer is the most common malignancy in women in developing country like India. Pap test is a cheap, safe and practical diagnostic tool for early detection of cervical lesions in high risk group, so it should be established routine screening procedure. This study emphasizes the importance of Pap smears for early detection of Premalignant and Malignant lesions of Cervix.

 

Contributors

AKJ conceived the idea, supervised the data collection. She will act as guarantor for the paper. She collected data, helped in analysis and prepared the initial draft of the paper. BJS, SSP, MBP and KDP provided support, and encouragement to carry out this study, helped in analysis and drafting the manuscript.

 

REFERENCES

  1. World Health Organization: WHO. Comprehensive cervical cancer control: a guide to essential practice; 2006.
  2. Ranbhat S, Dhungana G, Neupane M etal. Pap smear coverage and effect of knowledge and attitude regarding cervical cancer on utilization of the test by women in Udaipur district of Nepal: Journal of Chitwan Medical College 2014; 4(10): 31-35.
  3. Saraswathi KS, Aljabir F. Importance of Papanicolau (Pap) smear in Cervical Cancer screening intertiary care hospital scholars research library 2012,4(5):1558-1559.
  4. Cioc AM, Julius CJ, Proca DM, Tranovich VL, Keyhani- Rofagha S. Cervical biopsy/cytology correlation data can be collected prospectively and shared clinically. Diagn Cytopathol. 2002;26(1):49–52.
  5. Mulligan NJ, de las Morenas A, Soto-Wright V, O’Brien MJ. Percentages of cervical cytologic diagnoses as a quality assurance method. Acta Cytol. 1998;42(4):928–32.
  6. Solomon D, Davey D, Kurman R, Moriarty A, O'Connor D, et al. (2002) The 2001 Bethesda System: terminology for reporting results of cervical cytology. JAMA 287: 2114-2119.
  7. Pragya Sharma, Manju Rahi, and Panna Lal. A Community-based Cervical Cancer Screening Program among Women of Delhi using Camp Approach: Indian J Community Med. 2010; 35(1): 86–88.
  8. M Bajpai, A Raina, S Dwivedi et al. A study of Pap smears in a tertiary care hospital: IOSR-JDMS, 15(2) Ver. II (Feb.2016), pp: 93-95.










 

 






















 








 




 








 

 









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