Proportion and Pattern of Epithelial Cell Abnormalities in Cervical Smears- A Retrospective Study

Abstract

Introduction: Cervical cancer is a leading cause of mortality and morbidity among women worldwide. Approximately, 90% deaths due to cervical cancer occur in developing countries like India. Papanicolaou (Pap) smear test is an efficient, cost-effective screening tool to identify epithelial abnormalities in the preinvasive and early invasive stages of cervical cancer. Knowledge of the proportion and pattern of abnormal Pap smears in the local population is essential to ensure the early detection and treatment of precancerous lesions of cervix, thereby reducing the morbidity and mortality resulting from cervical cancer, which at present is preventable to a large extent. Aim: To estimate the proportion of cervical epithelial abnormalities in the local population and describe the morphological patterns of abnormalities employing the 2014 revised Bethesda system. Materials and Methods: This was a retrospective, hospital record- based descriptive study conducted in a tertiary care centre in Kerala, India from January 2016 to December 2018. Altogether, 9330 cervical smears stained using Pap method were retrieved from slide archive and evaluated. Data was collected from case notes, request forms and cytology registers. Morphological analysis was done using the revised 2014 Bethesda system. Proportion of smears showing epithelial cell abnormalities and categories of epithelial abnormalities were expressed as percentages. Results: A total of 9330 samples were studied. The proportion of epithelial abnormalities was 1.70%, of which Atypical Squamous Cells of Undetermined Significance (ASCUS) was the most frequent (1.38%), followed by Atypical Squamous Cells cannot exclude an High-grade squamous intra epithelial lesion (Atypical squamous cells-H) [HSIL (ASC-H)] (0.13%). Women with epithelial abnormalities belonged to a wide age range of 31-70 years, with majority in the 41-50 years age group. Most of the patients with abnormal Pap smears (62.3%) had normal looking or unremarkable cervix. Conclusion: The proportion and pattern of cervical epithelial abnormalities in the local population of Kerala is comparable to that of developed nations. Patients for cervical cancer screening cannot be selected based on clinical features or appearance of cervix. Even in the absence of gynaecologic complaints, screening for cervical cancer must be done at regular intervals and Pap smear test should be employed as a routine screening procedure for all women above 30 years of age. Special measures need to be taken to ensure that postmenopausal females are screened for cervical cancer.