Abnormal Pap Smear Findings Research Articles

Prevalence and Correlation between High-Risk HPV Genotypes and Pap Smear Findings in Bahrain: A Retrospective Approach

Background: Human papillomavirus (HPV) is currently the most common pathogen responsible for cervical cancer (CC), a major cause of cancer-related deaths in women. This study aimed to estimate the current HPV prevalence in Bahrain and to determine the association of high-risk HPV (HR-HPV) genotypes with cytological findings, age, and clinical history of the patients. Methods and Results: Our study used a retrospective approach. Convenience sampling was used to gather 100 cases of HPV-positive women with abnormal and normal Pap smear findings from January 2017 to April 2023 in the Cytology Department at King Hamad University Hospital. Out of 100 HR-HPV positive cases, non-16/18/45 HR-HPV was found in 62%, and 73% had abnormal Pap smear findings. Among Pap smear findings, ASC-US/ASC-H (P=0.038) and LSIL/HSIL(P=0.017) were significantly associated with HR-HPV genotypes.ASC-US was found to be more frequently associated with HPV16+non-16/18/45 HR-HRV and LSIL with HPV18/45+non-16/18/45 HR-HRV. Most HR-HPV cases (59%) were aged ≤40 years, 25% - from 41 to 50 years old, while only 16% were >50. The age group ≤40 had the highest peak with non-16/18/45 HR-HPV genotype (35%) and HPV16 (19%). The predominant genotypes for age groups 41-50 and >50 were non-16/18/45 HR-HPV types (19% and 8%, respectively). Conclusion: In Bahrain, non-16/18/45 HR-HPV infection is becoming more prevalent, with ASC-US being the most common abnormal Pap finding and the highest HPV infection in women aged 40 years or younger.Based on our findings, we recommend effective screening and vaccine programs for women aged 40 years and younger, as early detection can lower infection rates and improve recovery.

ABNORMAL FINDING OF PAP SMEAR AMONG WOMEN HOSPITAL VISITORS IN CITY OF MOSUL, IRAQ

Objective: The research aims to test the use of the Pap smear screening system to identify precancerous lesions among women in City of Mosul, Iraq. Methods: This prospective study was carried out over 1 year at the Department of Obstetrics and Gynaecology in Mosul Teaching Hospital, city of Mosul, Iraq. We screened 100 sexually active women who were more than 21 years of age. Women with different complaints, including vaginal discharge, blood‑mixed discharge, foul-smelling discharge, postcoital bleeding, intermenstrual bleeding, postmenopausal bleeding, abdominal pain, infertility, and secondary amenorrhea, were included in this study. The glass slides had been sent for cytopathological review to the pathology department. The laboratory results have been reported by the new Bethesda Cervical Cytology Reporting System 2014. The device divided the lesions narrowly into certain negative ones for intraepithelial neoplasia and with epithelial cell abnormalities (ECA) that involve squamous and glandular cells. Upon pap smear, the patient was treated accordingly. Results: The study had enrolled a total of 100 cases. All of these patients had an abnormal Pap smear finding that fell according to TBS-2014 criteria in the category of Epithelial Cell abnormality. We interviewed all patients in Detail by proforma. The data reported were statistically analyzed and were collected following observations and tests. Among the study subject, the most common abnormal findings (68.9%) were negative findings. Inflammatory constitute (15.4), and Atypical squamous cells of undetermined significance (7%) followed by LSIL (5.9) and HSIL (2.9). Conclusion: Pap smear is an effective method for screening for Cervical Lesions Precancerous and cancerous. Nevertheless, a cervical biopsy must be performed which Is gold standard if any epithelial defects are found to be confirmed in cervical cytology.

Cervical Cytological Findings among Women Attending a Tertiary Care Hospital in Sana’a, Yemen

Objective: To determine the frequency and pattern of abnormal cervical smear findings among women attending the University of Science and Technology Hospital (USTH) in Sana'a city.
 Methods: This study is a retrospective, cross-sectional study. Records of women examined by conventional Pap smears in the Histopathology Laboratory of USTH over a 4-year period (from January 2013 to December 2016) were retrieved and analyzed for abnormalities according to the Bethesda system.
 Results: Of 688 cases, 599 with satisfactory records were analyzed. The mean age of the cases was 39.18±10.23 years (range: 19–75). Epithelial cell abnormalities (ECAs) were found in 47 cases (7.8%), and these were categorized as follows: ASCUS in 4.5% (27/599) of cases followed by atypical glandular cells (AGC) (2.2%; 13/599) and LSIL (0.5%; 3/599), while ASCH and HSIL abnormalities were equally observed among 0.3% (2/599 each) of cases. Of patients positive Pap smear findings, ASCUS was the most frequent type of ECA (57.4%; 27/47) followed by AGC (27.7%; 13/47) and LSIL (6.4%; 3/47), while ASCH and HSIL were the least frequent ECAs among Yemeni patients. ECAs were significantly more prevalent among women aged >40 years (10.8%) compared with those aged <40 years (5.5%).
 Conclusions: Cervical cytological abnormalities are not uncommon among women in Yemen, where the AGC is frequent among about a third of women with abnormal Pap smear findings and affects women of different ages. This requires more attention and training of doctors to master good sample taking, preparation and diagnosis with a focus on glandular changes.

Cervical Cytological Findings among Women Attending a Tertiary Care Hospital in Sana’a, Yemen

Objective: To determine the frequency and pattern of abnormal cervical smear findings among women attending the University of Science and Technology Hospital (USTH) in Sana'a city.
 Methods: This study is a retrospective, cross-sectional study. Records of women examined by conventional Pap smears in the Histopathology Laboratory of USTH over a 4-year period (from January 2013 to December 2016) were retrieved and analyzed for abnormalities according to the Bethesda system.
 Results: Of 688 cases, 599 with satisfactory records were analyzed. The mean age of the cases was 39.18±10.23 years (range: 19–75). Epithelial cell abnormalities (ECAs) were found in 47 cases (7.8%), and these were categorized as follows: ASCUS in 4.5% (27/599) of cases followed by atypical glandular cells (AGC) (2.2%; 13/599) and LSIL (0.5%; 3/599), while ASCH and HSIL abnormalities were equally observed among 0.3% (2/599 each) of cases. Of patients positive Pap smear findings, ASCUS was the most frequent type of ECA (57.4%; 27/47) followed by AGC (27.7%; 13/47) and LSIL (6.4%; 3/47), while ASCH and HSIL were the least frequent ECAs among Yemeni patients. ECAs were significantly more prevalent among women aged >40 years (10.8%) compared with those aged <40 years (5.5%).
 Conclusions: Cervical cytological abnormalities are not uncommon among women in Yemen, where the AGC is frequent among about a third of women with abnormal Pap smear findings and affects women of different ages. This requires more attention and training of doctors to master good sample taking, preparation and diagnosis with a focus on glandular changes.

Cytologic and colposcopic evaluation of all symptomatic women at tertiary care centre

Background: Cervical cancer in India ranks as the 2nd most frequent cancer among women and the 2nd most frequent cancer among women between 15 and 44 years of age. Invasive carcinoma of cervix is preventable as it is associated with pre-invasive stage which occurs 10-15 years prior to it, thus permitting early detection by screening and leading to effective treatment and thereby reducing mortality rate with greater impact on lives saved. Objectives were to correlate the findings of Pap smear with colposcopy in evaluation of all symptomatic women; and to assess the utility of colposcopy in detecting the premalignant and malignant lesions of cervix.Methods: This was a prospective observational study of 200 symptomatic women attending the Gynecology OPD of Umaid Hospital Dr. S. N. Medical College Jodhpur, Rajasthan, India from February 2015 to October 2016. Evaluation of all symptomatic women done with Pap smear, colposcopy and biopsy in selected cases and findings were noted.Results: Commonest complaint was white discharge per vaginum in 58.5% followed by pelvic pain in 24% women. 8% women had abnormal pap smear findings with 4% of women had ASCUS, 0.5% had ASC-H, 3% had LSIL and 0.5% had HSIL,73% had inflammatory and 19% with normal smear. 38.5% had abnormal colposcopy with maximum 28% women had acetowhite lesions. Sensitivity of pap smear was 44.44% while sensitivity of colposcopy was 88.88%.Conclusions: Pap smear had poor sensitivity as compared to colposcopy. Hence simultaneous use of colposcopy has shown to increase in the rate of carcinoma cervix detection in symptomatic women.

Differential clinical characteristics, treatment response and prognosis of locally advanced adenocarcinoma/adenosquamous carcinoma and squamous cell carcinoma of cervix treated with definitive radiotherapy

To compare tumor characteristics and clinical outcome of patients with cervical locally advanced adenocarcinoma (AC)/adenosquamous carcinoma (ASC) and squamous cell carcinoma (SCC). Retrospective study. National Taiwan University Hospital, Taipei, Taiwan. All patients with cervical SCC (n=35), AC or ASC (n=194) with FIGO stage ≥IIB who received definitive radiotherapy or concurrent chemoradiotherapy (CCRT) from January 1995 to December 2009. Medical and histopathological record review. Progression-free survival (PFS), local recurrence-free survival, distant metastasis-free survival, and overall survival (OS). Compared with the SCC subgroup, patients with AC/ASC were significantly younger (p=0.007), more of them without clinical symptoms were diagnosed by abnormal Pap smear findings (p=0.043), and less responded to treatment (p=0.018). After a median follow-up of 59.3months, patients with AC/ASC had worse 5-year PFS (30.0% vs. 47.6%, p=0.044), worse 5-year distant metastasis-free survival (41.5% vs. 69.9%, p=0.005), and trends toward worse 5-year local recurrence-free survival (64.4% vs. 76.2%, p=0.165) and worse 5-year OS (41.3% vs. 58.1%, p=0.090) than patients with SCC. In univariate analysis, early FIGO stage and complete treatment response were significantly associated with PFS and OS. Histology of non-AC/ASC and Point A biologically equivalent doses in 2-Gy fractions >85Gy were significantly associated with better PFS, and CCRT was significantly associated with better OS. In multivariate analysis, complete treatment response and early FIGO stage remained significant factors for predicting better PFS and OS. Cervical AC/ASC may be more aggressive than is SCC. For cervical AC/ASC, more comprehensively effective treatments are warranted.

Prévention du cancer du col utérin (I): apport du dépistage, récents progrès et perspectives

Worldwide, cervical cancer is diagnosed annually in more than 500,000 women and accounts for 270,000 deaths, making it the second leading cause of cancer in women. In Europe, where many countries have set up screening program, cervical cancer ranks third among cancers in women. In France, cervical cancer is diagnosed in 3400-4500 women each year and kills 1000-1600. Since its introduction, Pap smear screening has transformed cervical cancer from a fatal disease into a rare condition. Despite the considerable success of this cytologic screening, Pap smears have not, as was first hoped, reduced incidence on a large scale. The principal reasons are related to the difficulties in ensuring optimum coverage of the population to be screened and in maximizing women's adherence: the success of screening depends on strict compliance with the calendar from 25 to 65 years of age. In 1/3 of cases, invasive cancers are found in women who undergo regular screening, because Pap smears are insufficiently sensitive. In 5% of cases, cancers are observed in women who were inappropriately managed after an abnormal Pap smear finding. The contribution of the HPV test to primary screening opens up promising perspectives of optimum protection. The test's sensitivity for high-grade lesions exceeds 95% and its negative predictive value exceeds 99%. The HPV test is the only test available for which a negative result provides instantaneous assurance that there is no risk of cervical cancer. The Pap smear alone, with its sensitivity of less than 70%, cannot provide this certainty. European and American guidelines recommend screening strategies based on a combined test using the Pap smear and HPV test after the age of 30 years. The impending availability of prophylactic HPV vaccines, which are expected to provide 70% protection against cervical cancer, will not affect the practice of screening, which must continue.

Distress after an abnormal Pap smear result: scale development and psychometric validation

Background. Psychological distress is severe in women who receive a report of abnormal findings on Pap smear, and may be one reason 10–61% of such women fail to undergo follow-up testing. Methods. Using the 14-question Psychosocial Effects of Abnormal Pap Smears Questionnaire (PEAPS-Q) as a basis, we developed the 23-question Cervical Dysplasia Distress Questionnaire (CDDQ), testing its internal consistency and validity with 661 women undergoing colposcopy after an abnormal Pap smear finding in a three-phase analysis. Results. Items were divided into two sets and factor analyzed separately: one addressed distress during medical procedures, and the other concerned perceived consequences of an abnormal Pap smear. The medical procedures items yielded two factors: embarrassment regarding the procedures and discomfort/tension with the procedures. Factor analysis of the second set also resulted in two factors: concern about sexual and reproductive issues and concern about health consequences. Subscales created from items loading highly on each factor had high internal consistency ( α ranged from 0.76 to 0.90) and demonstrated good concurrent validity with other psychometrically validated measures of distress. Conclusions. The CDDQ is a reliable and valid questionnaire for measuring multiple domains of distress unique to women who test positive on a cervical cancer screening test.

The Italian experience of a Pap test and speculoscopy based screening programme.

The main objective of the study was to evaluate if speculoscopy, a magnified chemiluminescent examination, combined with a Pap smear, could improve the detection of early cervical lesions compared with the Pap smear alone. Pap tests and speculoscopies were performed in two family planning centres located in the surrounding areas of Modena. Colposcopic investigations and biopsies of the uterine cervix were performed in a second level centre (Gynaecological Prevention Centre of Modena Policlinico). Histological specimens were analysed at the Section of Pathological Anatomy of Modena Policlinico. The study population comprised 1000 women aged 25-64 years, invited to undergo a Pap smear every three years in accordance with the screening programme for cervical cancer started in Modena in 1997. Midwives performed the Pap smear and speculoscopy in succession. Women with a positive Pap test and/or positive speculoscopy underwent colposcopy and, if colposcopic findings were positive, targeted punch biopsies were performed. A total of 1000 patients were subjected to cytology and speculoscopy examinations. Among these women, 10 had abnormal Pap smear findings whereas 144 had an abnormal speculoscopic pattern. Only three of 59 patients with a histological diagnosis of cervical intraepithelial neoplasia grade I (CIN I)/human papillomavirus and only three of seven patients with CIN II/CIN III had a positive Pap test. Speculoscopy combined with a Pap test can significantly increase the detection of cervical lesions when included in a screening programme.

Psychopathology in prenatally DES-exposed females: current and lifetime adjustment.

This report concerns the long-term effects of prenatal exposure to diethylstilbestrol (DES) on overall psychologic functioning in females. Thirty DES-exposed women aged 17-30 years and 30 control women with a history of abnormal Pap smear findings were interviewed with the SADS-L and completed the SCL-90-R and the PRI-Q. Both DES and PAP women showed elevated symptoms on the SCL-90-R in comparison to published norms and were similar to women with cancer, but their rates of psychiatric disorders (SADS-L/RDC) at the time of the evaluation did not differ from community norms. However, both groups met criteria for Major Depressive Disorder (lifetime) significantly above expectancy, and the DES women reported slightly more episodes than the control group. The DES women also had significantly more problems than the PAP control group in social relations with spouses and other significant persons.

The validity of Pap smear parameters as predictors of endometrial pathology in menopausal women.

Cytopathologists recognize that certain Pap smear findings are suspicious for endometrial pathology in menopausal women. To study their prognostic importance in the directed cervical smear, six parameters were used to evaluate smears for evidence of an endometrial lesion: the presence of (1) histiocytes, (2) multinucleated histiocytes, (3) nonspecific inflammation, (4) bleeding, (5) elevated squamous cell maturation index, and (6) the degree of cytologic atypicality of endometrial glandular cells, expressed as a "score" from 0 to 6. Clinical pathologic correlation of 102 women with these parameters was undertaken. A multivariable statistical analysis determined which of these six parameters was most predictive of an endometrial lesion. Cytologically "scored" endometrial glandular cells was the only parameter predictive of endometrial pathology. Its emergence as the sole prognostic cervical Pap smear parameter for endometrial pathology has not been previously reported. This predictive value was consistent even with control for bleeding history and age. Appropriate interpretation of abnormal Pap smear findings contributes substantial diagnostic information in the evaluation of the endometrium.

Sexual orientation after prenatal exposure to exogenous estrogen.

Thirty women aged 17 to 30 years with documented prenatal exposure to the nonsteroidal synthetic estrogen diethylstilbestrol (DES) were compared to thirty women of similar demographic characteristics from the same medical clinic who had a history of abnormal Pap smear findings. A subsample of the DES women were also compared to their DES-unexposed sisters. Sexual orientation in its multiple components was assessed by systematic semistructured interviews. In comparison to both control groups, the DES women showed increased bisexuality and homosexuality. However, about 75% of the DES women were exclusively or nearly exclusively heterosexual. Nonhormonal and hormonal interpretations of these findings are discussed.

Psychosexual milestones in women prenatally exposed to diethylstilbestrol

Thirty women aged 17 to 30 years with a record-confirmed history of prenatal exposure to diethylstilbestrol (DES) were compared to 30 women of similar age and demographic background with a history of abnormal Pap smear findings. Heterosocial and heterosexual histories were assessed by systematic semistructured interviews. The groups differed neither in the age at menarche nor in the age at attainment of various psychosexual milestones.