‘' TO COMPARE THE DIAGNOSTIC UTILITY OF PAPANICOLAU SMEAR AND COLPOSCOPIC EXAMINATION IN THE DIAGNOSIS OF CANCER CERVIX IN WOMEN PRESENTING WITH UNHEALTHY CERVIX IN S.M.S MEDICAL COLLEGE JAIPUR''

Abstract

Background: Cervical cancer is the third most common cancer in world, over 500,000 new cases of invasive cervical cancer are diagnosed annually worldwide. (1,2) .So early detection and treatment of premalignant lesions is the principle objective of cervical cancer screening programme. Primary screening test for the cervical cancer are pap smear cytology, visual methods - visual inspection after acetic acid(VIA) and lugol's iodine (VILI),and HPV-DNA based testing. Pap smear is a primary screening tool for cervical cancer. Colposcopy is stereoscopic examination of the epithelia of cervix, the lower genital tract and anogenital area at a magnication of x6 to x40. Colposcopy is most commonly used in the evaluation of abnormal or inconclusive cervical cancer screening tests.(3) Colposcopy is a globally accepted method for detection of early carcinoma Cervix, because it provides quicker results and guides the site of biopsy.(4) The present study aims to compare the diagnostic utility of Papanicolaou smear and colposcopic examination in the diagnosis of cancer cervix in women presenting with unhealthy cervix. Method: A hospital based cross section study was undertaken in 200 Women (18-65 yrs) who attended Department of Obstetrics and Gynaecology, SMS Medical College, Jaipur were recruited for study. After applying inclusion and exclusion criteria written and informed consent were taken from all study participants. A detailed medical, surgical, obstetric and menstrual history were taken. After doing perspeculum and pervaginal examination pap smear and colposcopy were done,and colposcopy guided cervical biopsy was done and sent for histopathology examination. Two Results: hundred cases were recruited in our study the Mean value of age(years) of study subjects was 37.34 ± 7.9, majority of cases belongs to age group 31-40 years i.e 102(51%) cases. Women presented with complaints of white discharge are maximum i.e [109(54.50%)] cases of patients, followed by lower abdominal pain [40(20.00%)], In our study we found that PAP smear test was 79.55% sensitive and 91.55% specic for predicting CIN. And, colposcopy was 100% sensitive and 71.17% specic for predicting CIN. Thus in the present study we observed that colposcopy had high sensitivity as compared to pap smear in diagnosing CIN but pap smear had high specicity (91.55% Vs 71.17%). We also observed that if colposcopic RCI score is less than 5 then there are 100% chances of CIN I/II (NPV=100%). Conclusion:Carcinoma cervix is preventive disease as it has a long preinvasive state which can be detected by screening and then can be treated subsequently both pap smear and colposcopy can be used reliably to detect precancerous lesion in women with unhealthy cervix according to statistical analysis of our study colposcopy appears to be better tool than pap smear for diagnosis of precancer cervix. The accuracy of colposcopy is dependent on the training, expertise and skill of the operator, but use of objective score i.e reid index, Swede score make it less operator dependents