Cervical Epithelial Abnormalities Research Articles

Co-infection of human papillomavirus and herpes simplex virus-2 with cervical dysplasia among women in Kaduna State, Nigeria

Background: The epidemiology of human papillomavirus (HPV) and co-infections with herpes simplex virus type 2 (HSV-2) remains poorly characterized in Africa. High risk HPV (hrHPV) infection is the primary cause of 99.7% all cervical cancer especially in the presence of genital ulcer disease (GUD) which is usually caused by HSV-2. Herpes simplex virus-2 might interact directly with hrHPV to increase the risk of cervical cancer. Co-infection of HPV and HSV-2 in asymptomatic women could provide a clue to early diagnosis of cervical cancer and this could aid in the development of new strategies for effective management and improvement of the quality of life of women who are infected. If the synergy between HPV and HSV-2 can be prevented, there may be significant reduction of the incidence of cervical cancer. Methodology: This was a descriptive cross-sectional study of 515 randomly selected apparently healthy women of reproductive age whose cervical samples were screened for HPV and HSV-2 in Kaduna State, Nigeria. The cervical samples were collected by liquid-based cytology (LBC) for detection of cervical epithelial cell abnormalities (CEA) and molecular detection of HPV and HSV-2 using conventional polymerase chain reaction (PCR) assay. Extracted viral DNAs from the samples were amplified by convectional PCR using specific hrHPV (HPV 16,18, 31 and 45) primer sets and a broad spectrum MY09/11 and GP5+/6+ primers for a wider range of HPV genotypes while HSV-2 DNA was detected by florescence-based PCR assay with HSV-2 gG primers and probes. Results: PCR assay revealed that 14.7% (n=76) of the 515 selected women harbored HPV, HSV-2 or both. The prevalence of HPV, hrHPV, HSV-2 and HPV/HSV-2 co-infection among in the study participants are 11.8% (n=61), 9.3% (n=48), 5.6% 4% (n=29) and 2.3% (n=12) respectively. The frequency of HPV detection in HSV-2 infected participants (41.4%, 12/29) was significantly higher (OR=6.295, p<0.0001) than in HSV-2 negative participants (10.1%, 49/437), but only co-infections of HPV-31 (p=0.004) and HPV-18 (p=0.040) with HSV-2 were significantly associated. Cervical cytology reports on the smears revealed prevalence of cervical epithelial abnormalities (CEA) of 16.7% (n=86), with cervical dysplasia prevalence of 6.4% (n=33), consisting of high grade squamous intraepithelial lesion (HGSIL) of 1.6% (n=8), low grade squamous intraepithelial lesion (LGSIL) of 4.1% (n=21) and atypical squamous cells of uncertain significance (ASCUS) of 0.8% (n=4). The frequency of HPV detection in women with cervical dysplasia (93.9%, 31/33) was significantly higher (OR=14.22, p<0.0001) than in women without cervical dysplasia (6.2%, 30/482), and all HPV genotypes were significantly associated (p<0.05) with cervical dysplasia except HPV 16 (p=0.051). Also, the frequency of HPV/HSV-2 co-infection among women with cervical dysplasia (15.2%, 5/33) was significantly higher than among women without cervical dysplasia (1.5%, 7/482) (OR=12.12, p<0.0001). Comparing women with cervical inflammatory and atrophic changes (n=53), women with cervical dysplasia (HGSIL, LGSIL and ASC-US) had significantly higher frequency of HPV infection (χ2=42.829, p=0.000), HSV-2 infection (χ2=25.140, p=0.001) and HPV/HSV-2 co-infections (χ2=66.602, p=0.000). Conclusion: Co-infection rate of hrHPV and HSV-2 among women in Kaduna State is 2.3%. Demographic factors significantly influencing the rate of co-infections included age and marital status. In spite of the screening method using the traditional Pap smear, GUD and cervical cancer continues to be a major public health problem, thus more sensitive and specific methods such as liquid based cytology technique and polymerase chain reaction for early detection of cervical dysplasia and hrHPV or HSV-2 in asymptomatic women should be adopted for routine use

Prevalence of cervical dysplastic lesions in cervical smears from Baghdad city: a single centre study.

To assess the association of demographic and clinical features of patients with clinicopathological markers in cases of abnormal Pap smear. The retrospective study was conducted from July 2020 to June 2021 at Al-Elwiya Maternity Teaching Hospital, Baghdad, Iraq, and comprised data from January 2019 to June 2020 of women who underwent Pap-smear. Data was retrieved for patients' age, marital status, smoking status, clinical symptoms at presentation, findings of clinical and cytological examinations, as well as follow-up or human papillomavirus testing data where applicable. Data was analysed using SPSS 26. Of the 560 women with mean age 40.42±10.211 years, 26(4.6%) were attending the hospital for routine check-ups/screening, and 12(2.1%) for follow-up screening with previous abnormal Pap-tests, while the rest had been referred for medical consultation. The most common diagnosis was negative for intraepithelial lesion or malignancy 403(72%) Cervical epithelial abnormalities were seen in 136(24.3%) cases, and, of them, 12(8.8%) returned for follow-up. Epithelial abnormalities had a significant association with age, clinical presentation, and clinical examination results (p<0.05), while it had a non-significant relation with marital and smoking statuses (p>0.05). The majority of subjects were referred cases, with routine cervical screening being <5%. Increasing public awareness about the importance of cervical screening and follow-up is essential.

Pap smear: A preventive approach to screening, diagnosis and management of cervical abnormalities at a tertiary care hospital

Background: Cervical cancer is the second most common cancer among women accounting for 17.7% among all cancers in women. A major contributing factor to the high incidence of the disease in developing countries is due to the lack of efficient screening programmes. The Papanicolaou smear has been well utilized for initial screening of cervical epithelial alterations in order to identify pre-cancerous lesions. Methods: A retrospective observational study was conducted among women who visited gynecological out patient department over 6 months for clinical problem. Pap smear of 600 gynaecology patients of age group 21-60 years were collected. The patients with abnormal epithelial lesions were subjected to cervical punch biopsy. The variables were expressed as frequency and percentages. Results: It was noted that out of the 600 women who had Pap smear screenings, 124 of them had abnormal results. The study participants were divided into two age groups: 43.67% and 30%, respectively, with the 31–40 year old age group coming in first. The majority of them (87.17%) experienced vaginal discharge, and 62.67% reported experiencing abdominal pain. Atypical Squamous Cells of Undetermined Significance (ASCUS) accounted for 38.70% of the epithelial cell abnormalities, followed by Bacterial vaginosis (24.19%) and Trichomonas vaginosis (12.91%). Conclusion: Thus, we draw the conclusion that every woman in the reproductive age group should have a Pap smear test performed because it is an extremely helpful, easy, affordable, and safe method of identifying pre-cancerous cervical epithelial abnormalities.

Cervical Cytology-Histopathology Concordance and Role of Dual Immunomarkers in Biopsy Samples of Uterine Cervix: A Cross-sectional Study from a Tertiary Care Hospital of West Bengal, India

Introduction: Cervical cancer is one of the leading causes of cancer deaths. Liquid-based cervical cytology enables the detection and diagnosis of the disease at an early stage. p40 is a specific immunomarker that distinguishes squamous cell carcinomas from other cervical carcinomas with glandular and neuroendocrine differentiation. Aim: To determine the role of Liquid-based Cytology (LBC) in the early detection of premalignant and malignant lesions of the uterine cervix and its concordance with histopathological findings. Materials and Methods: This cross-sectional study was conducted at the Institute of Post Graduate Medical Education and Research (IPGME&amp;R), Kolkata, West Bengal, India, over a period of one year and six months (from October 2020 to March 2022). Cervical samples were collected from a total of 200 females, and the materials were processed using the BD SurePath™ LBC method. The cytologically confirmed cases were biopsied, and histopathological concordance was established. Immunohistochemical (IHC) staining for p40 and p63 was performed using the peroxidase-antiperoxidase method to differentiate between premalignant, malignant squamous, and glandular lesions of the uterine cervix. For quantitative analysis, all cells were counted in 10 random fields at 400x magnification, and p63 and p40 were expressed as a percentage of positive cells per the total number of counted cells. Cases were considered positive if 5% or more of the tumour cell nuclei showed brown nuclear staining. The mean percentage positivity of p63 and p40 nuclear staining of all the cases in each category was calculated for non neoplastic and precursor/neoplastic lesions of the cervix. Results: Among the 200 cases evaluated by LBC, 169 (84.5%) were non neoplastic, and the remaining 31 (15.5%) were precursor/neoplastic lesions. The vast majority (126 cases, 63%) were inflammatory smears, followed by 20 cases (10%) that were Negative for Intraepithelial Lesion or Malignancy (NILM). Total of 40 cases were followed-up with biopsy and histopathology, and concordance with the cytological diagnosis was evaluated. Among 40 cases, 23 were precursor/ neoplastic on histopathology, and seven cases that were non neoplastic on Histopathological Examination (HPE) had been correctly diagnosed on LBC, giving a concordance rate of 75%. The overall sensitivity, specificity, Positive Predictive Value (PPV), and Negative Predictive Value (NPV) of LBC were 92%, 46.6%, 74.1%, and 77.7%, respectively, considering histological diagnosis as the gold standard. Regarding IHC expression on histopathology, the mean positivity of p40 and p63 for non neoplastic lesions was 9.40% and 10.06%, and for precursor/neoplastic lesions, 47.44% and 46.4%, respectively. Adenocarcinoma-in-situ and adenocarcinoma were negative for both p40 and p63. Conclusion: Cervical cytology is a less invasive, cost-effective, and simple procedure to diagnose cervical epithelial cell abnormalities. Cytological-histopathological concordance revealed that LBC is a sensitive diagnostic method. The comparison between non neoplastic and neoplastic lesions of the cervix revealed a statistically significant difference with respect to the mean percent positivity of p40 and p63 IHC staining. Both of these markers can be used to differentiate squamous cell carcinoma from adenocarcinoma of the cervix.

Cervical Cytology-Histopathology Concordance and Role of Dual Immunomarkers in Biopsy Samples of Uterine Cervix: A Cross-sectional Study from a Tertiary Care Hospital of West Bengal, India

Introduction: Cervical cancer is one of the leading causes of cancer deaths. Liquid-based cervical cytology enables the detection and diagnosis of the disease at an early stage. p40 is a specific immunomarker that distinguishes squamous cell carcinomas from other cervical carcinomas with glandular and neuroendocrine differentiation. Aim: To determine the role of Liquid-based Cytology (LBC) in the early detection of premalignant and malignant lesions of the uterine cervix and its concordance with histopathological findings. Materials and Methods: This cross-sectional study was conducted at the Institute of Post Graduate Medical Education and Research (IPGME&amp;R), Kolkata, West Bengal, India, over a period of one year and six months (from October 2020 to March 2022). Cervical samples were collected from a total of 200 females, and the materials were processed using the BD SurePath™ LBC method. The cytologically confirmed cases were biopsied, and histopathological concordance was established. Immunohistochemical (IHC) staining for p40 and p63 was performed using the peroxidase-antiperoxidase method to differentiate between premalignant, malignant squamous, and glandular lesions of the uterine cervix. For quantitative analysis, all cells were counted in 10 random fields at 400x magnification, and p63 and p40 were expressed as a percentage of positive cells per the total number of counted cells. Cases were considered positive if 5% or more of the tumour cell nuclei showed brown nuclear staining. The mean percentage positivity of p63 and p40 nuclear staining of all the cases in each category was calculated for non neoplastic and precursor/neoplastic lesions of the cervix. Results: Among the 200 cases evaluated by LBC, 169 (84.5%) were non neoplastic, and the remaining 31 (15.5%) were precursor/neoplastic lesions. The vast majority (126 cases, 63%) were inflammatory smears, followed by 20 cases (10%) that were Negative for Intraepithelial Lesion or Malignancy (NILM). Total of 40 cases were followed-up with biopsy and histopathology, and concordance with the cytological diagnosis was evaluated. Among 40 cases, 23 were precursor/ neoplastic on histopathology, and seven cases that were non neoplastic on Histopathological Examination (HPE) had been correctly diagnosed on LBC, giving a concordance rate of 75%. The overall sensitivity, specificity, Positive Predictive Value (PPV), and Negative Predictive Value (NPV) of LBC were 92%, 46.6%, 74.1%, and 77.7%, respectively, considering histological diagnosis as the gold standard. Regarding IHC expression on histopathology, the mean positivity of p40 and p63 for non neoplastic lesions was 9.40% and 10.06%, and for precursor/neoplastic lesions, 47.44% and 46.4%, respectively. Adenocarcinoma-in-situ and adenocarcinoma were negative for both p40 and p63. Conclusion: Cervical cytology is a less invasive, cost-effective, and simple procedure to diagnose cervical epithelial cell abnormalities. Cytological-histopathological concordance revealed that LBC is a sensitive diagnostic method. The comparison between non neoplastic and neoplastic lesions of the cervix revealed a statistically significant difference with respect to the mean percent positivity of p40 and p63 IHC staining. Both of these markers can be used to differentiate squamous cell carcinoma from adenocarcinoma of the cervix.

Spectrum of Pap smear cytology according to The Bethesda System 2014

Carcinoma of cervix is one of the leading cause of mortality in women across the world. Papanicolaou smear is a valuable screening tool for the neoplastic lesions of cervix. Present study was carried out to do clinicocytological correlation of cervical lesions and to find out the spectrum of cervical lesions in study population. An observational study was conducted at Pathology department in Muzaffarnagar Medical College, Muzaffarnagar. Total 1,017 females were enrolled, scrape smears from the cervix were taken and processed using Papanicolaou's method of staining. These stained smears were examined under microscope and classified according to latest The Bethesda System 2014. Out of 1017 cases, 84.9% (863) smears were classified satisfactory according to 2014 The Bethesda System. Majority of cases (350 cases, 40.5%) belonged to age group of 31-40 years. NILM was the most common cytological finding seen in 340 females (39.3%). The epithelial abnormalities including Atypical Squamous Cells (ASCUS, ASC-H), Squamous Intraepithelial Lesion (LSIL, HSIL) and Squamous Cell Carcinoma were seen in 3.2% of total cases. LSIL found in 1.3% cases and HSIL formed 1.0%. Single case of SCC was detected. Cervical epithelial abnormalities are common in Indian females. Pap smear is the most convenient and OPD test to detect epithelial abnormalities in early phase. Awareness regarding the Pap screening should be encouraged to lessen the morbidity and mortality caused by Carcinoma Cervix.

Pattern and predictors of cervical epithelial cell abnormalities among unscreened and under-screened women in Lagos, Nigeria: a cross-sectional study.

Women who had never undergone cervical screening (CS) or who have infrequent CS are at increased risk of having cervical epithelial cell abnormalities (CECA) that may lead to cervical cancer (CCa). Our study determined the pattern and factors that predict the occurrence of CECA among unscreened and under-screened women in Lagos, Nigeria. This was an analytical cross-sectional study among 256 consenting sexually active women between 21 and 65 years who attended a community CS programme in Surulere, Lagos, Nigeria, in June 2019. Information on socio-demographic, reproductive, sexual, behavioural and clinical characteristics were collected and a Pap smear test was done. Women with abnormal cervical cytology were followed up and given appropriate treatment. Data analysis was done using Statistical Package for Social Sciences version 23. Descriptive statistics were computed using frequencies and association was tested using odd ratio. The participants' mean age was 42.7 ± 10.3 years, majority were married (79.9%) and were human immune deficiency syndrome (HIV) negative (63.1%). The prevalence of CECA was 9.8%. Atypical squamous cell of undetermined significance and atypical squamous cell cannot exclude high-grade squamous intraepithelial lesion were the most common CECA with prevalence rates of 7.4% and 2.0%, respectively. Having a partner with multiple sexual partners (adjusted odd ratio (AOR) = 19.23), being HIV positive (AOR = 25.61), giving birth for the first time before the age of 26 years (AOR = 5.55) and presence of a combination of either abnormal vaginal discharge, contact bleeding or an unhealthy cervix on clinical examination (AOR = 13.65) independently predicted the occurrence of CECA. There is a need to prioritise CS for women with these risk factors to prevent CCa and reduce the burden of the disease in our environment.

Cervical Epithelial Abnormalities and Associated Factors among HIV-Infected Women in Lagos, Nigeria: A Cytology-Based Study

Introduction: As it may not be feasible to provide cervical cancer screening services to all HIV-infected women in most resource-limited settings, there is a need to identify those who are most at risk. We determined the prevalence, patterns, and associated factors of cervical cytological abnormalities among HIV-infected women in Lagos, Nigeria. Methods: This descriptive cross-sectional study was conducted among HIV-infected women at the adult HIV treatment and colposcopy clinics of a university teaching hospital in Lagos, Nigeria, between October 2018 and December 2019. A cervical sample was collected from each woman to detect cervical cytological abnormalities. Results: Of the 593 enrolled women, cervical cytological abnormalities were present in 40 (6.7%). Most (37.5%) of the women with cytological abnormalities had atypical squamous cells of undetermined significance. Age at coitarche (<20 vs. ≥20 years: adjusted odds ratio, 2.42; 95% confidence interval, 1.21–4.83, p = 0.01) was the only factor that was independently associated with cervical epithelial abnormalities. Conclusion: The prevalence of cervical cytological abnormalities in our study is lower than most previous reports in Africa. Sexual debut at an early age was significantly associated with cytological abnormalities. It is necessary to confirm the findings of this study through a well-designed and adequately powered longitudinal study.

Clinical Correlation between Cervical Cancer Screening Using Pap Smear Test

Objective: The study's objective is to evaluate the effectiveness of the Pap smear screening procedure for identifying precancerous lesions. Study Design: Prospective study Place and Duration: Department of Pathology, Nishtar Medical University Multan, From 1st October, 2021 to 31 March, 2022. Methods: There were 162 females had age 18-50 years were presented in this study. All of the women were given a complete physical examination, including a speculum exam and a vaginal exam, and their medical histories were recorded. Women's cervical cancer screenings often involved a Pap smear. Using an Ayre spatula, a smear was collected and spread over a labelled glass slide before being stored in 95% ethyl alcohol and delivered to the Pathology Department for cytopathological testing. SPSS 24.0 was used to analyze all data. Results: Among 162 females, 45 (27.8%) had age 18-30 years, 73 (45.1%) were aged between 31-40 years and 44 (27.2%) patients had 41-50 years. Mean BMI of the females was 22.4 ±6.52 kg/m2. Frequency of smokers was 4 (2.5%). Most common complaint was vaginal discharge, followed by irregular menstrual cycle and abdominal pain. We found that 63 (32.7%) cases had no pathology, frequency of inflammatory was 49 (30.2%) cases, atypical squamous cells of undetermined significance (ASUS) was 28 (17.3%), low-grade squamous intraepithelial lesions (LSILs) was 8 (4.9%) and high-grade squamous intraepithelial lesions (HSILs) was 5 (3.1%). As per HPV, low risk and high risk virus was found in 11 (6.8%) cases. Conclusion: The Pap smear is an easy, quick, and inexpensive way to check for cervical epithelial precancerous abnormalities. It has the potential to be employed as a routine screening tool, leading to better treatment outcomes and lower death rates. Increased detection of these lesions is facilitated by the Pap test and the HPV-PCR test. Keywords: Cervical Cancer, Pap smear Test, HPV, Pathology

Colposcopic Findings in Patients of Cervical Erosion at Tertiary Center

Background: India has a population of approximately 450 million women 18 years of age and older who are at a risk of developing cervical cancer. Recent studies state that nearly every year 122844 women are diagnosed with cervical cancer and approximately 67477 die from cervical cancer. Cervical cancer ranks as the 2nd most frequent cancer among women in India. Cervical erosion is one of the commonest clinical finding in women attending Gynecology outpatient department for various reasons. Cervical erosion which is an abnormality of the cervical epithelium covering ectocervix, has a varied significance. It could be a premalignant or a malignant lesion. Persistent inflammation leads to increased cellular turnover. Cervical cancer can be prevented by detecting precancerous lesions by screening and treating them in time. Inspite of the overall high incidence and mortality rates, cervical cancer is considered as the most preventable and treatable form of major cancer through early diagnosis and appropriate treatment of pre invasive and invasive disease. Early detection of cervical epithelial abnormality is important as it helps to prevent progression to CIN and invasive cancer thereafter. Aim: To study the colposcopic findings in patients of cervical erosion. Material and methods: A prospective observational study was carried out in the time interval from October 2019 to September 2021 at Rural Medical College, Loni. Women diagnosed to have cervical erosion on per speculum examination were enrolled for the study. A total 140 females were studied. Women attending gynecological Outpatient department for various complaints and diagnosed to have cervical erosion on per speculum examination were enrolled in the study. Colposcopy was done using 3% acetic acid and 50% Lugol’s iodine. Colposcopy was done and it was interpreted using the Reid’s Colposcopic Index which is an objective method of colposcopically grading the severity of premalignant cervical lesions. ................

Does Liquid-Based Technology Improve Detection of Cervical Epithelial Abnormalities and Worth in Low Resource Setting?

Introduction: Cervical cancer is the most frequent cancer among Nepalese women. Aims: This study was undertaken to assess the strength of liquid-based cytology (LBC) and conventional Pap smear (CPS) in detecting cervical dysplasia/cancer, and assess feasibility of LBC in our setting. Methods: It was a cross-sectional study. Samples were collected from 312 patients for CPS and LBC by split sampling technique. Smears were interpreted according to the Bethesda System. The results between two methods were compared and analyzed statistically by applying Chi-square and t-tests. Results: There was no significant difference in adequacy rates, representativeness, detection of organisms and epithelial abnormalities between two methods. Neutrophils, haemorrhage, mucus and debris were more in CPS than LBC (P value &lt;0.05). Conclusion: We didn’t find significant difference between two methods in detecting cervical epithelial abnormalities. The high cost of LBC makes CPS still a better option in the countries with low resource setting.

A study of cytopathological pattern of cervical papanicolaou smear examination in women between 20 - 75 years of age group

Background: Cancer of uterine cervix is a leading cause of mortality and morbidity among women worldwide. The primary cause of this cancer is infection with human papillomavirus. Pap smear is a simple, safe, non-invasive and cost effective method for the detection of pre-cancerous, cancerous and benign lesions of cervix.Aim: To study the cytological patterns of cervical Pap smears in 766 cases and to classify the cytological abnormalities based on the Bethesda system 2014.Materials and methods: A retrospective study of total 766 cases of cervical smears was done at Pathology department, GMERS Medical College and Civil Hospital, Sola, Ahmedabad over a period of 1.5 years starting from 1st January 2020 to 30th June 2021. Women between 20 -75 years of age group were included in the study. Cervical smears were taken by obstetrics and gynaecology department and were received at pathology department, stained by using rapid Papanicolaou staining technique and studied by using light microscopy.Results: we studied total 766 cases out of which 26(3.40%) smears were unsatisfactory for evaluation. Out of these 740 cases, most common were inflammatory lesions-382 cases (49.86%).Cervical epithelial cell abnormalities including ASCUS-5 cases (0.67%), ASC-H -2 cases (0.24%), LSIL- 6 cases (0.78%), HSIL-1 case (0.13%) and AGC-NOS – 1 case (0.13%) were detected in our study. Majority of the cases were belonging to 31-40 years of age group -364 cases(47.50%) followed by 41-50 years-260 cases (33.94%).Conclusion: Pap smear is an easy, simple, safe and noninvasive method of cervical examination. By using Pap smear as a screening test, it is possible to detect malignant lesions at an earlier stage.

Clinico-pathological Analysis of Cervical Pap Smear in Patients Attending Gynecology OPD of a Medical College

Background: Cervical cancer ranks the most common cancer among Nepalese women. Cervical and vaginal infections constitute the most common gynecological problems. Through Pap smear screening, early diagnosis, follow up and treatment, morbidity and mortality can be reduced by 70% and 80% respectively. &#x0D; Methods: This retrospective study was conducted to know the incidence of abnormal cervical epithelial lesions and cervico-vaginal infections. It was carried out in the Outpatient Department of Gynecology at Chitwan Medical College from April 2018 to March 2019. The data were collected and standard statistical analysis done using Microsoft Excel 2007. &#x0D; Results: The most prevalent cervical epithelial cell abnormality was atypical squamous cells of undetermined significance (3.43%) whereas the least common was low grade squamous intraepithelial lesion (0.21%). The most prevalent cervical vaginal infection was Bacterial vaginosis (12.30%) whereas the least prevalent was Trichomoniasis (0.29%). The majority of the women with epithelial cell abnormality were in the age group of 31-40 years whereas the lowest number in the age group less than 20 years. The highest prevalence of cervical vaginal infection was in the reproductive age group (31-50 years) and the lowest in the age above 51 years. Most of the patients had multiple symptoms like vaginal discharge, genital itching, whereas only (20.17%) visited for routine screening. &#x0D; Conclusion: Atypical squamous cells of undetermined significance and Bacterial vaginosis were the most common finding in Pap smear test representing abnormal cytology of cervix and cervicovaginal infection respectively.

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

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.

Association between obesity and abnormal Papanicolau(Pap) smear cytology results in a resource-poor Nigerian setting

BackgroundThough obesity is associated with some malignancies, its association with cervical cancer is still inconclusive. This study was aimed at determining if there was an association between obesity and cervical epithelial cell abnormalities (CEA).MethodsThis was a cross-sectional comparative study of obese and non-obese women at the Cervical Cancer Screening Clinic, University of Nigeria Teaching Hospital (UNTH), Enugu between January, 2012 and June, 2013. The participants whose body mass index (BMI) were ≥ 30 kg/m2 were classified as obese (200 women) while those whose BMI were < 30 kg/m2 were classified as non-obese (200 women) and the two groups were consecutively recruited at the ratio of 1:1. Pap smear cytology, random blood sugar (RBS) and human immune-deficiency virus (HIV) screening was done for all the participants. Data was analyzed with SPSS version 20. Categorical variables were analyzed using McNemar’s test and Chi-squared test. Logistic regression analysis was used to determine the influence of socio-demographic characteristics on cervical epithelial cell abnormalities. The level of significance was set at ≤0.05.ResultsAmong the obese women, 152(76%) had negative for intra-epithelial lesion or malignancy (NILM) while 48(24%) had cervical epithelial cell abnormalities (CEA). Also 182(91%) non-obese women had NILM while the remaining 18(9%) had CEA. The prevalence of CEA among all the study participants was 16.5%. There was an association between obesity and CEA[OR (95%CI) = 1.353(1.013–1.812); P-value = 0.04].CEA were significantly more common among women who were 40 years and above and single/separated women as well as widows (P-value = < 0.05).ConclusionThere was an association between obesity and CEA. This underscores the need for a positive behavioural change among women in order to stem the tide of this public health problem.

Clinicopathologic importance of atypical glandular cells in cervico-vaginal cytology

Objective:To analyze the histopathologic outcomes of patients with atypical glandular cells (AGC) in cervicovaginal cytology examinations.Material and Methods:Patients with AGC in cervicovaginal cytology were included in this study between March 2011 and March 2018 and patient data were collected retrospectively among all cytology results. AGC classification of cervicovaginal cytology were based on the Bethesda 2001 classification system.Results:The total prevalence of cervical epithelial cell abnormality and AGC were found as 4.2% and 0.2%, respectively, in the study cohort. AGC-favor neoplasia (AGC-FN) was the subgroup of AGC with the highest malignancy rate with 62.5% (p=0.06). The incidence of malignancy in the postmenopausal group (33.3%) was detected higher than in the premenopausal group (8.3%) (p=0.07).Conclusion:The probability of malignancy in AGC-FN cytology is more commonly associated with malignancy in the postmenopausal group. Therefore, histopathologic examination is strongly recommended in these patients with AGC smears because of the high risk for malignancy in this group.

Impact of introduction of endocervical brush on cytologic detection of cervical epithelial cell abnormalities: A clinical audit of 13-years’ experience at a cancer research centre

ObjectiveTo study the temporal trends in cytologic detection of cervical epithelial cell abnormalities (ECA) and to evaluate the impact of introduction of endocervical brush sampling on detection of ECA. Study designThis was a cross-sectional study of conventional cervical smears collected over a 13 year period (2006–2018). The study was divided into two time periods (TP)-TP1 (2006−2014, 67,437 smears) using only extended tip Ayre’s spatula and TP2 (2015−2018; 36,746 smears) when Cytobrush Papsmear kit (Ayre’s spatula + endocervical brush) was used. The unsatisfactory rate and detection rate of ECA was compared between the two TPs. ResultsThe unsatisfactory rate reduced from 4.7 % in TP 1–1.5% in TP2 (P < 0.001). The frequency of ECA was 1.5 % in TP1 and 1.9 % in TP2 (P < 0.001). A significantly higher number of ASC-H and HSIL were detected in TP2. There was a substantial improvement (3.7 times) in detection of glandular abnormalities overall (P < 0.001), as also for both the qualifiers AGC- NOS (4.4 times) and AGC- FN (3.3 times) in TP2. ConclusionsCervical sampling using combined spatula and endocervical brush reduces the unsatisfactory rate and improves the detection of both squamous and glandular precancerous lesions. Hence, this sampling procedure should be recommended for all laboratories practicing conventional cervical cytology.

Role of Pap smear in the screening of cervical cancer: A hospital based study

Background: Incidence of cervical cancer has decreased in the developed world due to use of Pap smear as a screening tool. It has been proven as a sensitive screening tool for cervical cancer but its coverage is very low in Nepal. The objective of this study is to find out the incidence of cervical epithelial cell abnormality, its demographic distribution and common presenting symptoms.&#x0D; Materials and Methods: This retrospective comparative study was conducted in Nobel Medical College and Teaching Hospital, Biratnagar, Nepal. A total of 950 patients attending gynecological department with various symptoms were enrolled. Only 902 patients were included in the study after excluding inadequate samples.&#x0D; Results: The mean age of patient was 37.94 ± 12.74 years with minimum age of 18 and maximum age of 79 years. The mean age of patients with epithelial abnormality was 47.88 ± 8.87 years. The highest number of Atypical squamous cells of undetermined significance was observed between 51-60 years (1.1%) whereas Low and High grade squamous intraepithelial lesion were mostly observed between 41-50 years (3.2% and 0.4% respectively). The most common symptom was vaginal discharge (41.6%) followed by pain abdomen (23.1%).&#x0D; Conclusions: Pap smear is a cost effective, sensitive and simple screening test for cervical premalignant and malignant lesions.

Inter observer variability among gynecologists in manual cervix image analysis for detection of cervical epithelial abnormalities

Inter observer variability among gynecologists in manual cervix image analysis for detection of cervical epithelial abnormalities

Spectrum of lesions in papanicolaou smears: An institutional study

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