Accuracy Of Pap Smear Research Articles

Cytology and High-Risk Human Papillomavirus Test for Cervical Cancer Screening Assessment.

Background: A new nationwide screening strategy was implemented in Germany in January 2020. No data are available for women referred to certified dysplasia units for secondary clarification after primary diagnosis by a local physician. We therefore investigated combined testing with Papanicolaou smears and high-risk human papillomavirus (hrHPV) and compared the data with the final histological findings. Methods: Between January 2015 and October 2020, all referred women who underwent colposcopy of the uterine cervix in our certified dysplasia unit were included. Cytology findings were classified using the Munich III nomenclature. Results: A total of 3588 colposcopies were performed in 3118 women, along with Pap smear and hrHPV co-testing, followed by histology. Women with Pap II-p (ASC-US) and a positive hrHPV co-test had a 22.4% risk for cervical intraepithelial neoplasia (CIN) 3/high-grade squamous intraepithelial lesion (HSIL). The risk of CIN 3/HSIL was 83.8% in women with Pap IVa-p (HSIL) and a positive hrHPV co-test. A positive hrHPV co-test increased the risk for HSIL+ (OR 5.942; 95% CI, 4.617 to 7.649; p < 0.001) as compared to a negative hrHPV co-test. Conclusions: The accuracy of Pap smears is comparable with the screening results. A positive hrHPV test increases the risk for HSIL+ fivefold. Colposcopy is necessary to diagnose HSIL+ correctly.

Epithelial Cell Abnormality in Cervical Pap Smear with Histopathological Correlation among Patients of a Tertiary Care Centre in Eastern Nepal

Background: Cervical cancer is a leading health problem among women all over the world with significant mortality and morbidity in developing countries like Nepal. Pap smear is an effective and cost efficient diagnostic technique for cervical lesions. This study aims at histopathological correlation of cervical Pap smears.&#x0D; Materials and Methods: A cross sectional study was conducted from January 2020 to January 2022 in Pathology department of Nobel Medical College Teaching Hospital (NMCTH). 119 cases of cervical Pap smear were reported using the Bethesda system and correlated with histopathological examination findings for various epithelial cell abnormalities. Analysis was done using SPSS software version 20.&#x0D; Results: Out of 5110 smears examined, 119 were positive for epithelial cell abnormalities. Cellular abnormality was commonly seen between 31-60 years of age. Low grade Squamous Intraepithelial Lesion was the commonest lesion found. Pap smear findings had good concordance rates with histopathological findings for individual lesions. The overall sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of Pap smear were 84%, 23.1%, 89.9%, 15% and 77.3% respectively.&#x0D; Conclusion: Pap smear has a good diagnostic accuracy, sensitivity and positive predictive value in diagnosing cervical lesions in comparison to histopathological examination

A STUDY OF CORRELATION OF PAP SMEAR AND COLOPOSCOPY WITH HISTOPATHOLOGICAL FINDINGS IN CASES OF UNHEALTHY CERVIX

BACKGROUND: Cervical malignancy is the second most common among the malignancies in females, with breast carcinoma the first. Screening of unhealthy cervix by pap smear and supported by colposcopy and histopathology can easily identify the premalignant lesions and also other non-invasive inflammatory lesions of the cervix. OBJECTIVES: To correlate Pap smear and Colposcopy findings with histopathological findings in detecting premalignant lesions in the unhealthy cervix. MATERIALS AND METHODS:A prospective observational study was conducted on 100 symptomatic, sexually active women of 20-60 years. Pap smears and colposcopy was done for all 100 women who came with complaints of white discharge per vagina, intermenstrual, postcoital, or postmenopausal bleeding. The final correlation of the Pap smear and colposcopy was based on histopathology reports. RESULTS: In the present study, the sensitivity of Pap smear for detecting lesions above LSIL was 82.3%, specificity 96.9%, PPV was 93.3%, negative predictive value 91.4% and accuracy of Pap smear was 92%. The sensitivity of colposcopy in the detection of low-grade lesions and above came out to be 94.1%,specificity 87.8%,positive predictive value 80%,negative predictive value 96% and accuracy of colposcopy was 90%. CONCLUSION: This study suggests that the accuracy of detection of cervical abnormalities is higher when cytology, colposcopic guided cervical biopsy and colposcopy are used complimentarily in the diagnosis of cervical lesions. Colposcopy abolishes the need for repeated follow-up as in Pap smear and helps to reduce false-negative cases.

A two year retrospective study of cytohistopathological correlation of cervical smear in a tertiary care hospital

Background: Cervical cancer in women is the second most common cancer and the commonest cause of mortality in developing countries. The introduction of Pap smear test changed the scenario of cervical cancer with an intense drop in the incidence and mortality due to invasive cervical cancer.&#x0D; Aims and Objective: To evaluate the patterns of cervical smear cytology and to correlate the cervical smear diagnosis with histopathological diagnosis and to assess the efficacy of Pap smears in diagnosing cervical lesions.&#x0D; Materials and Methods: This two-year retrospective study (January 2018 to December 2019) was done in the department of Pathology in a tertiary care hospital. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy were calculated considering histopathological diagnosis of cervical biopsy as the gold standard.&#x0D; Results: A total of 316 Pap smears were studied, out of which we selected 154 cases who also undergone biopsy or hysterectomy. Epithelial cell abnormalities (ECA) were found in 28 cases (18.2%). Among this the most common ECA was Atypical squamous cells of undetermined significance (ASCUS) seen in 10 cases (6.5%) followed by LSIL (5.2%), HSIL (3.2%) and SCC of cervix (3.2%). The overall correlation between cervical cytology and histopathology was found in 125 out of 154 cases (81.16%). The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of pap smear was 90.57%, 62.50%, 95.41%, 43.47% and 87.66% respectively.&#x0D; Conclusion: Pap smear is a simple, safe, non-invasive and effective method for detection of lesions of the cervix and ECA. Hence, better awareness and periodical cytological screening programs can help in the early detection of malignant cervical lesions and thereby reducing the morbidity and mortality related to this malignancy.

ROLE OF CYTOLOGY AND COLPOSCOPY DIRECTED BIOPSY IN EVALUATION OF CLINICALLY SUSPICIOUS CERVIX

Background: Cervical cancer is the second most common cancer among women in developing countries. Cervical cancer is a deadly disease once it reaches the invasive stages but out of all the female genital tract cancers, it is the only preventable cancer if detected in its early stages and the disease is almost 100% curable with accurate screening and early detection. Traditional screening for cervical cancer is done with papanicolaou smear test, colposcopic examination and colposcopic directed biopsy for histopathology. Obejective: To evaluate efficacy of both cytology and colposcopy directed biopsy in evaluation of clinically suspicious cervix. Patients and Methods: Cross sectional study on 300 patients with clinically suspicious cervix attending the outpatient Department of Obstetrics and Gynecology, at the Hospital of Al-Azher Assiut University. Results: Pap smear had a sensitivity of 25.5% and a specificity of 87% which was attributed to the high number of false negative smears. Accuracy of pap smear was 76.7%. Colposcopy showed a sensitivity of 82% and a specificity of 81%. Sensitivity was more than pap smear but specificity was less than pap smear. * Accuracy of colposcopy was found to be 81% which was comparatively more than that of pap smear (77%). Conclusion: It is evident that colposcopy is definitely more sensitive and accurate than pap smear. By combining pap smear with colposcopy, we can maximize the sensitivity and specificity of cancer cervix screening. Both the result of cytology and colposcopy should be compared to those of histopathology, that histopathology remain the main method of diagnosing the precursors of neoplastic cervical lesion.

ROLE OF CYTOLOGY AND COLPOSCOPY DIRECTED BIOPSY IN EVALUATION OF CLINICALLY SUSPICIOUS CERVIX

Background: Cervical cancer is the second most common cancer among women in developing countries. Cervical cancer is a deadly disease once it reaches the invasive stages but out of all the female genital tract cancers, it is the only preventable cancer if detected in its early stages and the disease is almost 100% curable with accurate screening and early detection. Traditional screening for cervical cancer is done with papanicolaou smear test, colposcopic examination and colposcopic directed biopsy for histopathology. Obejective: To evaluate efficacy of both cytology and colposcopy directed biopsy in evaluation of clinically suspicious cervix. Patients and Methods: Cross sectional study on 300 patients with clinically suspicious cervix attending the outpatient Department of Obstetrics and Gynecology, at the Hospital of Al-Azher Assiut University. Results: Pap smear had a sensitivity of 25.5% and a specificity of 87% which was attributed to the high number of false negative smears. Accuracy of pap smear was 76.7%. Colposcopy showed a sensitivity of 82% and a specificity of 81%. Sensitivity was more than pap smear but specificity was less than pap smear. * Accuracy of colposcopy was found to be 81% which was comparatively more than that of pap smear (77%). Conclusion: It is evident that colposcopy is definitely more sensitive and accurate than pap smear. By combining pap smear with colposcopy, we can maximize the sensitivity and specificity of cancer cervix screening. Both the result of cytology and colposcopy should be compared to those of histopathology, that histopathology remain the main method of diagnosing the precursors of neoplastic cervical lesion.

Accuracy of Pap Smear in Cervical Cancer Screening

Accuracy of Pap Smear in Cervical Cancer Screening

Evaluation of coloscopic and Pap’s smear findings among visual inspection with acetic acid cases in detection of precancerous lesion of cervix against histopathology

Background: Cervical cancer is the commonest cancer in women in developing countries. Visual inspection with acetic acid (VIA) is much popular method as primary screening modalities in low resource setting.Whereas Pap smear is well recognized and popular in developed countries. Colposcopy is recognized as the best method for detection of cervical cancer and cervical intraepithelial neoplasia (CIN) as secondary screening. The present study was intended to compare the accuracy of Pap smear and colposcopy in the detection of pre-invasive cervical lesion in VIA positive cases.&#x0D; Methods: This cross sectional study was carried out in the Colposcopic Clinic of Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka over a period of 1 year from August 2015. All consecutive VIA positive cases were included the study.&#x0D; Results: Mean age of the VIA positive women was 36.9 years with peak age group being 31-40 years (44.0%). Nearly three-quarters of the women (74.0%) were in their 3" and 4 decades of life. Among VIA positive women, 35.0% were Pap positive and 55.0% were colposcopically positive and 41.0% were histopathologically positive. Pap smear had low sensitivity (53.7%) and high specificity (78.0%). Using Pap smear nearly half (46.3%) of the precancerous lesion were escaped. Whereas colposcopy findings, revealed high sensitivity (90.2%) and specificity (69.5%). Both Pap and colposcopy was judged against histopathological diagnosis. Over 40.0% of the VIA positive women were diagnosed as CIN confirmed by histopathology. Strength of agreement test using Kappa statistics revealed a moderate agreement between Pap smear test and colposcopy (49.5%).&#x0D; Conclusion: The study concluded that colposcopy has a high sensitivity, optimum specificity and moderate agreement against histopathology in relation to Pap smear. Pap smear has very little role whereas colposcopy has significant role for diagnosis of CIN. So, it would be adopted and encouraged to do the colposcopy where it is possible.&#x0D; Bangladesh Med Res Counc Bull 2019; 45: 103-107

Diagnostic accuracy of pap smear in detection of cervical cancer

Diagnostic accuracy of pap smear in detection of cervical cancer

Diagnostic Value of Pap Smear and Colposcopy in Non-benign Cervical Lesions

Objectives: Cervical cancer is a very common and lethal condition; however, owing to longstanding premalignant lesions, it is possible to prevent morbidity and mortality by screening tests. Pap smear, colposcopy, and biopsy are among the main modalities in this regard, however there is no consensus on the diagnostic utility of the first 2 methods. This study sought to examine the diagnostic utility of Pap smear, colposcopy, and cytology in evaluating the non-benign cervical lesions. Materials and Methods: A cross-sectional study was carried out between 2014 and 2016 in an out-patient setting at Alzahra teaching hospital of Tabriz University of Medical Sciences. After obtaining informed consent, all 315 participants with abnormal Pap test underwent colposcopy and biopsy from the abnormal areas. Cervical biopsy was considered as a gold standard and the diagnostic values of Pap smear and colposcopy were individually compared by calculating sensitivity, specificity, positive predictive value, negative predictive value, and likelihood ratio. Results: The mean age of patients was 38.49±10.31 years (17-68 years). On the basis of biopsy findings, non-benign cervical lesions were present in 31 cases (9.8%). Accordingly, the sensitivity, specificity, positive predictive value, negative predictive value, and positive likelihood ratio of Pap smear in revealing non-benign cervical lesions were 77.4%, 69.7%, 21.8%, 95.6%, 70.7%, and 2.55%, and for colposcopy, were 90.3%, 90.9%, 51.9%, 98.9%, 90.8%, and 99.2%, respectively. Conclusions: Based on our results, the colposcopy is a sensitive and specific method in differentiating benign cervical lesions from non-benign cervical lesions. The accuracy of Pap smear is intermediate in this regard, and the utility is limited. Therefore, this method should not be considered as the main criterion for decision making.

Pap test accuracy and severity of squamous intraepithelial lesion.

Cytology smears and guided biopsies are the most widely used diagnostic standards for cervical cancer (CC) screening in the developing countries. To evaluate the performance of conventional cytology in estimating the presence and grade of cervical disease against the reference standard of histopathology. After primary screening for CC, directed biopsies were performed and compared with histopathology results. Papanicolaou (Pap) smears and biopsies from 3194 women in the age group of 14-98 years were included. Cytology results were provided by doctors who performed the cervical biopsies. The accuracy of Pap smear was measured by sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) calculated using the statistical analysis program PSPP 0.7.8. The sensitivity of conventional cytology (Pap smear) for women with low-grade cervical intraepithelial neoplasia or less serious lesions (CIN1-) was 93% and specificity was 73%. The sensitivity and specificity of cytology for women with high-grade cervical intraepithelial neoplasia or cancer (CIN2+) was 64% and 84%, respectively. Cytology is a sufficiently sensitive test for detection of cervical lesions and can be used as a primary testing tool to triage.

Role of PAP smear N cervical biopsy in unhealthy cervix

Carcinoma of cervix is the third most common cancer in women worldwide &amp; most common female cancer in many developing countries like India. The present study was done with an objective to correlate the finding in women with unhealthy cervix by cytology and cervical biopsy and to assess the utility of these in detecting the premalignant and malignant lesions of the cervix. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of Pap smear were compared with cervical biopsy which was taken as confirmatory. Majority of patients were from age group of 31- 40 years (41%). The mean age of cervical intraepithelial neoplasia (CIN) and invasive carcinoma are 50.6% and 49.37%. Majority of cases with abnormal cervical lesion were in the multiparous women (parity from 2 to 4) which constituted 88 (73.34%) cases out of 120 cases. The mean parity of neoplastic lesions was around 3.35 and for invasive carcinoma it was around 4.42 in the present study. The incidence of CIN (45%) and invasive carcinoma (77.14%) was found to be higher among the low socio- economic group. CIN and invasive carcinoma was more prevalent among the illiterates, in the study 50% of CIN and 57.15% of invasive carcinoma cases was found among the illiterates. The incidence of CIN was 40% and of invasive carcinoma was 67.18% in women who were married before 20 years of age. Majority of women complained of excessive white discharge per vaginum (68.34%) and among them 13.12% (16/82) of women had CIN. In the present study 94% cases of postmenopausal bleeding were diagnosed to have CIN and invasive carcinoma and 51.54% cases of irregular bleeding were diagnosed to have CIN and invasive carcinoma. The gross appearances of cervix revealed cervical erosion in 38.34% (46/120) of cases, rest of the cases showed growth in 27.5%, congestion in 10%, Hypertrophy with congestion seen in 5.84%, Hypertrophy with erosion was seen in 11.66% and polyp was found in 4.16% of cases. Majority of cases with invasive carcinoma showed growth in the cervix (94.2% cases). In the present study pap test revealed inflammatory smears in 55% of cases, mild dysplasia in 5.84%, moderate dysplasia in 6.66%, severe dysplasia in 5.84% and invasive carcinoma was seen in 22.5% of cases. Sensitivity of pap smear was 86.5% and specificity was 92.18% in the present study. The positive predictive value was 90.7% and the negative predictive value 89.4 %. The accuracy of pap smear was found to be 90%.

Comparison of Pap smear, visual inspection with acetic acid, and digital cervicography as cervical screening strategies

To compare the sensitivity, specificity, positive and negative predictive values (PPV and NPV), and accuracy of Pap smear, visual inspection with acetic acid (VIA) and digital cervicography (DC). This is a cross-sectional study on 100 women in the age group of 20-60 years, sequentially using the Pap test, the VIA, and the DC for screening. All women underwent colposcopic biopsy as the gold standard in comparing the methods. Of the total of 100 women with the mean age 36.0 years, 17 cases were recognized positive for abnormal cervical cell by gold standard. The sensitivity, specificity, PPV, NPV, and accuracy of the Pap test, the VIA, and the DC were 23.5, 100, 100, 86.5, and 87%; 62.5, 98.8, 90.9, 93.2, and 92.9%; and 46.7, 97.6, 77.8, 91, and 89.8%, respectively, for cervical neoplasia. The Pap test had low sensitivity but high specificity, whereas VIA had a high sensitivity in addition to being easy and low-cost. Adjuvant methods of screening such as VIA can be a valuable alternative to the Pap test for cervical cancer screening in low-resource settings.

Abstract PL02-04: Cancer screening in developing countries

Abstract PL02-04: Cancer screening in developing countries

The comparative evaluation of clinical screening in combined tests [cytology (ThinPrep(R)), HPV DNA test (Hybrid capture(R) II),cervicography] for uterine cervical cancer

Objective : Since the accuracy of Pap smear for cervical neoplasm has been questioned, a number of adjunctive tests have been developed. The purpose of this study was to evaluate which protocol is the most effective screening test among cervical cytology (ThinPrep(R)), HPV DNA test (Hybrid capture(R) II) and cervicography. Methods : We chose 252 patients who were underwent the biopsy among 829 patients who visited our hospital for cervical cancer screening test. These 252 patients were engaged in this study simultaneously. They underwent triple combined test [cervical cytology (ThinPrep(R)), HPV DNA test (Hybrid capture(R) III, cervicography] and colposcopic-directed biopsy or biopsy on operation for diagnostic evaluation. Results : The triple combined test showed a sensitivity of 96.0%, while double combined test [cervical cytology (ThinPrep(R))+cervicography] showed a sensitivity of 89.0%, the other double combined test [cervical cytology (ThinPrep(G))+HPV DNA test (Hybrid capture(R) III] showed a sensitivity of 86.7%. Cervicography showed a specificity of 75.4% (highest among the single test), positive predictability of 89.8% (also highest). Conclusion : The sensitivity of cervical cytology was markedly improved by combination with HPV DNA test and cervicography. So the triple combined tests which improved the high false negative rate of cervical cytology may be a new effective method as a cervical cancer screening test, if the effectiveness could be confirmed by mass screening study.

The false negative rate of cervical smears in high risk HIV seropositive and seronegative women.

We undertook a prospective study of cytology and concurrent colposcopically directed biopsies of both Human Immunodeficiencey Virus seronegative (HIV-) and seropositive (HIV +) women at high risk for cervical intraepithelial neoplasia (CIN) to determine the accuracy of Pap smears in this population. Women were recruited from a sexually transmitted disease clinic and a women's prison in eastern Massachusetts. All were interviewed, blood was tested for HIV with CD4 counts done in 101 of the 102 HIV + women, and all received a pelvic exam that included a conventional Pap smear, a Thinprep test, and colposcopy with directed biopsies and endocervical curettage. A total of 184 women volunteered. 82 were HIV- and 102 were HIV+. The prevalence of CIN in HIV+ women was 37%, more than twice the 17% prevalence of CIN in HIV-women (P = 0.002). When Atypical Squamous Cells of Undetermined Significance (ASCUS) findings were included with "negative" cytology, the conventional Pap smear false negative rates for HIV- and HIV+ women were 21% and 37%, respectively. When ASCUS was included with "positive" cytology, the false negative rates dropped to 14.3% for HIV- women and 10.5% for HIV+ women. We conclude that ASCUS diagnoses comprised the majority of false negatives in HIV+ women.

Accuracy of Pap Smear and Mammogram Self-reports in a Southwestern Native American Tribe

The use of Pap smears and mammograms in the Native American population is not well documented and the validity of women's self-reports is unknown. The purpose of this study was to examine the agreement between women's self-reports of their Pap smear and mammogram histories with their medical records in one Native American tribe. Two hundred fifty-one women between the ages of 35 and 65 answered questions regarding their Pap smear and mammogram histories. These women then underwent an education program and one year later they again answered questions about their Pap smear and mammogram histories. Two hundred four of the original 251 women completed the education program and the second questionnaire. On the first questionnaire, 51.0% of women's claims to have received a Pap smear within the past 12 months were verified by the record audit and 69.2% of claims of receiving a mammogram within the past 12 months were verified. On the second questionnaire, 46.7% of women who said they had received a Pap smear within the past 12 months had their claims verified by their records, and 45.2% of women's claims of receiving a mammogram within the past 12 months were verified. These results suggest that patient recall alone should not be used to determine date of last procedure.

Accuracy of Pap Smear and Colposcopy in the Detection of Condyloma of the Cervix

ABSTRACT Because of a perceived failure to detect many cases of cervical condyloma, the cervical cytologic and colposcopic findings were retrospectively reviewed in 150 patients referred for colposcopy to evaluate abnormal cytology. Colposcopic findings, cytology slides, and histologic specimens were reviewed in concert. Pap smear and colposcopy were equally effective in detecting the presence of cervical condyloma (58% and 57%, respectively). The inability of the colposcope consistently to distinguish between mild dysplasia and flat condyloma, and the paucity of koilocytes on many Pap smear specimens accounted for the relatively high percentage of patients with condyloma on biopsy not detected previously. Biopsy thus remains the cornerstone in the diagnosis of subclinical HPV infection of the cervix, and Pap smear is equally as effective as colposcopy in screening for this disease.