Abstract
Background: Pap smear examination has been universally used as an effective screening tool for early detection of cervical carcinoma. The aim of this study was to assess the utility of Cervical Acid Phosphatase staining as an adjunct to routine Pap smear testing to improvethe sensitivity and specificity of routine Pap smear examination for cervical cancer detection.
 Materials and Methods: Cervical smears were taken from patients attending the gynecology department and a few cervical cancer screening programmes. One set of slides were alcohol fixed and stained with rapid pap stain and another set of slides were fixed in a special fixative and stained with Cervical Acid Phosphatase -Pap stain. The nuclear features of these Cervical Acid Phosphatase stained dysplastic cells was studied on Pap stain to diagnose cervical intraepithelial lesion/ malignancy.
 Results: Out of 489 cases included in the study 6 cases were diagnosed with intraepithelial lesion/ malignancy. On Cervical Acid Phosphatase -Pap stain 2 of the cases diagnosed as inflammatory smears on pap stain showed Cervical Acid Phosphatase positivity and thus were re evaluated. Mild nuclear atypia was observed in the Cervical Acid Phosphatase positive cells and these cases were diagnosed as Low grade squamous intraepithelial lesion and later biopsy proven to be Cervical intraepithelial Neoplasia I. Therefore Cervical Acid Phosphatase -Pap test was 100% sensitive and specific for cervical cancer detection.
 Conclusions: With 100% sensitivity Cervical Acid Phosphatase -Pap test satisfies the criteria of an efficient screening test.
Highlights
Cervical cancer is the second most common cancer in India accounting for 22.86% of all cancer cases in women.[1]
Cervical smear cytology has been widely used as a screening tool for cervical cancers; it has significant rates of false positive & false negative results. 5,6Various techniques have been developed to improve the cervical cancer detection rates like thin prep cervical cytology, use of magnified chemiluminescent screening examination with pap smear (Papsure), detection of HPV DNA by hybrid capture (HC 2) or polymerase chain reaction tests, telomeric repeat amplification protocol (TRAP), Fourier-transform infrared spectroscopy (FTIR) and immunocytochemical detection of p16INK4a protein.[7]
In our study we found that cervical acid phosphatase (CAP)-pap test is of great use in selecting smears for re screening
Summary
Cervical cancer is the second most common cancer in India accounting for 22.86% of all cancer cases in women.[1] One woman dies of cervical cancer in India every 8 minutes.[2] Cervical cancer screening using papanicolaou stain has been successful in early detection and proper management of cervical cancer.[3] According to a recent survey done by Karthigeyan et al rural women are higher risk of developing cervical cancer as against their urban counterparts.[4] we conducted this study to screen the rural women of our area for cervical cancer using dual tests namely cytomorphology and cytochemistry. Pap smear examination has been universally used as an effective screening tool for early detection of cervical carcinoma. The aim of this study was to assess the utility of Cervical Acid Phosphatase staining as an adjunct to routine Pap smear testing to improvethe sensitivity and specificity of routine Pap smear examination for cervical cancer detection
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