Interpretation Overlap of Endometrial Cells with Clinically Significant Lesions in Cervical Cytology (Pap) Smears: ThinPrep Experience at Large Tertiary Care Laboratory with Community Outreach

Abstract

Introduction: The aim of this study was to determine the incidence of squamous cell abnormalities in cervical smears seen in Mubarak Al-Kabeer Hospital and document any change in the pattern of these lesions. Materials and Methods: Over a 21 year period (1992-2012), 140404 cervical smears were studied. Conventional Pap (till 2005) and ThinPrep smears were first screened by cytotechnologists and finally reported by cytopathologists. The smears were classified according to the modified Bethesda System. Results: Smears from 135766 patients were found satisfactory for reporting. The unsatisfactory smears comprised 3.30% of the total smears. Atypical squamous cells (ASC) were seen in 3222 cases (2.37%); atypical glandular cells (AGC) were seen in 1092 cases (0.80%); low grade squamous intraepithelial lesions including human papilloma virus changes (LSIL)1299 cases (0.96%); high grade squamous intraepithelial lesions (HSIL)-294 cases (0.22%)and carcinoma 118 cases (0.09%) of which 61 cases were squamous cell carcinoma. Comparison of average cases/annum during the study period revealed a significant increase in ASC from 1.39% to 2.68% (p<0.0001) and AGC from 0.42 to 0.93% (p<0.001). However, percentage of LSIL, HSIL and carcinoma detected in Pap smears remained the same. Conclusions: A significant linear trend (p<0.001) was observed in satisfactory smears, ASC and AGC over the years. However, no significant change was found in the detection of LSIL, HSIL and carcinoma. A reduction in the age of LSIL/HSIL and a trend of increase in the Kuwaiti women over the years was also observed which makes screening of young women essential in Kuwait.