Epithelial Cell Abnormalities Research Articles

Evaluation of pap smears with cyto-histopathological correlation–our experience at a tertiary care hospital in Telangana

Background: The World Health Organization states that cervical carcinoma is the fourth most common cancer among women worldwide. Pap smear is the simplest and easiest test to detect this prevalent cancer at its nascent stages. Aims and Objectives: This study aims to evaluate Pap smears using the conventional method (Bethesda 2014) and correlate the abnormal smears with cervical biopsy. Materials and Methods: The study is a combined retrospective and prospective study, from January 2021 to August 2023. Pap smears received were evaluated according to Bethesda 2014. Those cases categorized as Epithelial Cell Abnormality (ECA), were correlated with corresponding histopathology on cervical biopsy. Results: Out of the 615 pap smears in this study, 525 cases (91%) were categorized as Negative for Intraepithelial Lesion or Malignancy, 53 cases (9%) as Epithelial Cell Abnormality, and 37 cases (6%) as unsatisfactory. In the Negative for Intraepithelial Lesion or Malignancy category, 353 cases (67.2%) were reactive cellular changes including inflammation, four cases (0.7%) were squamous metaplasia, and 24 cases (4.6%) were atrophic smears. In the ECA category–21 cases (39.6%) were Atypical squamous cells of undetermined significance, two cases (3.8%) were Low-grade squamous intraepithelial lesion, five cases (9.4%) were Atypical squamous cells-cannot exclude HSIL(ASC-H), 14 cases (26.4%) were High grade squamous intraepithelial lesion (HSIL) and 3 cases (5.6%) were squamous cell carcinoma (SCC) cervix, seven cases were of ECA-glandular type (13.2%). On histopathological correlation, the maximum correlation was found for HSIL and SCC cases, 71% and 100%, respectively. Conclusion: Pap smear is a crucial screening tool to diagnose cervical carcinoma at its nascent stage. This study showed a positive correlation for high-grade lesions on Pap smears.

Comparative analysis of different cervical screening methods with special reference to the WHO recommended human papillomavirus detection at a rural tertiary care center - A pilot study

Background: Cervical cancer (Ca Cx) the 4th common cancer has a high mortality rate. Human Papilloma Virus (HPV) is chiefly responsible for a long latent period to progress from preinvasive to invasive Ca Cx. So it can be prevented by screening procedures such as visual inspection with acetic acid (VIA), conventional cervical PAP smear (CP), liquid-based cytology (LBC), and high-risk (HPV-hr) detection along with vaccination. Aims and Objectives: The study aims to determine the socio-demographic profile of Ca Cx and the most appropriate cost-effective community screening method. Materials and Methods: A prospective observational study with 80 symptomatic women of reproductive and peri/postmenopausal age groups attending the Gynecology Department who underwent VIA, CP, and LBC and thereby detected positive along with screened negative but clinically suspicious women were tested for HPV-hr detection. Results were tabulated into an Excel sheet and screening methods were compared using Chi-square test, gold standard being cervical histopathology (P<0.5 significant). Statistical software used - Graphpad Prism 9 (San Diego, CA). Results: The mean age was 43.3 years. Multiparity and early marriage were seen in 80% and 45% respectively. Inflammatory lesions were best diagnosed by CP but epithelial cell abnormality and more satisfactory smears by LBC (P<0.05). Sensitivity was highest (93.75%) in VIA, positive predictive value, and specificity in CP (91.66%, 75%). negative predictive value was highest in VIA and HPV-hr DNA (50%). Conclusion: VIA with CP/LBC is an economically viable and effective screening method for Ca Cx in developing countries along with HPV vaccination.

Evaluating Spectrum of Epithelial Cell Abnormalities in Cervical Cytology Smears with a Focus on Atypical Squamous Cells of Undetermined Significance (ASCUS): A Study in Eastern India

Background: Cervical cancer being one of the major causes of death in women living in developing countries likeIndia, this study evaluates the spectrum of epithelial cell abnormality while primarily focusing on the prevalenceof ASCUS and their correlation with predisposing factors.Materials and Methods: Descriptive type of study was conducted over 456 patients. Patients underwent perspeculum examination followed by cervical smear examination. Cervical lesions were categorized according toRevised Bethesda system, 2014.HPV detection & sequencing was done as required.Results and conclusion: ASCUS was most prevalent in the sexually active age group (7.01%). The incidence ofintraepithelial lesions among multiparous women was high (50.8%). Early coital age, smoking, poor economicconditions, multiple sexual partners, contraceptive usage and HPV infection were associated with higher chancesof squamous cell abnormality.Cervicitis, cervical erosion, and hypertrophic cervix need careful investigation for the presence of ASCUS due toits high prevalence in sexually active females in Eastern India. Henceforth, addressing these factors and spreadingawareness about early diagnosis, necessary treatment, HPV vaccination along with the maintenance of propersexual and menstrual hygiene becomes a cornerstone in the reduction of the overall burden of atypical cervicalcytology and finally, cervical cancer.

Liquid-based Cytology as a Superior Tool Compared to Conventional Pap Smear in Detecting Cervical Cancer in Suspected Cases: A Comparative Study

Abstract Introduction: Screening programs has conventional cytology such as Conventional Pap Smear (CPS) have successfully reduced cervical cancer, but newer tests like Manual Liquid-based cytology (MLBC) and Human Papillomavirus testing might enhance screening. Materials and Methods: This was a cross sectional study conducted on 175 samples was processed for CPS and MLBC. Cytobrush was used for LBC which was suspended and detached in the preservative fluid and processed by manual method. Histopathological correlation and HPV DNA testing was also done. Results: MLBC showed higher specimen adequately, cellularity, clean background and uniform distribution of cells than CPS. Conclusion: MLBC showed improved specimen adequately, better cytomorphological features and higher detection of epithelial cell abnormality.

Liquid-Based Cervical Cytology: Monitoring the Laboratory Quality Indicators.

Many developments in cervical cancer screening have happened in the past century, helping women in earlier detection of cervical cancer and its precursors. Cytology still holds the fort as being a specific test, though it suffers in sensitivity. As a part of the quality control program, the aim of the study is to determine the total number of abnormal liquid-based cervical cytology (LBC) at our center and correlate the abnormal LBC with histology and human papillomavirus (HPV) DNA test results. Retrospective analysis of 4286 LBC screening cases was carried out over a period of 5 years. For cytology-histology correlation, cervical biopsy and cytology test results were analyzed. The two-tier grading system for biopsy interpretation was used. HPV DNA test results wherever available were correlated. Of the 4286 LBC cases, 157 samples (3.7%) were unsatisfactory for evaluation, 3915 samples (91.3%) were negative for intra-epithelial lesion or malignancy, and 214 samples (5%) showed epithelial cell abnormality. ASC-US was reported in 60 cases (1.4%), ASC-H in 35 cases (0.8%), LSIL in 47 cases (1.1%), HSIL in 41 cases (1.0%), squamous cell carcinoma in a single case (0.02%), and atypical glandular cells in 30 cases (0.7%). The ASC/SIL ratio was 1.07:1. The CHC major discrepancy was calculated as 16.2%. The concordance of HSIL on cytology and biopsy as a measure of PPV is 94.4%. Of the epithelial cell abnormalities, 24 cases were positive for high-risk HPV (hrHPV). Molecular test results of 2737 samples showed HPV detected in 50 cases, of which 24 cases were positive for hrHPV. The study helped us to analyze the quality parameters of our cytopathology laboratory which are within the acceptable limits.

Cytomorphological study of pap smear and its efficacy to detect various cervical lesions

: Cervical lesions require screening for early diagnosis to differentiate between non-neoplastic and neoplastic lesions of cervix. The present research aimed to evaluate the prevalence of various cervical lesions and detect the efficacy as a screening test of pap smear for early diagnosis of cervical lesions. : The current retrospective study was conducted in the Department of Pathology, SSMC, Rewa, M.P. Total 658 cervical pap smears were retrieved, re-examined and re-classified according to the revised Bethesda system for reporting of cervical cytology, 2014. Out of 658 pap smears, 234 biopsies were available, which were re-examined histopathologically and correlation was done with their corresponding cytological findings.: Out of 658 pap smears, negative for intraepithelial lesion or malignancy (NILM) was found in 74.47% smears, while the prevalence of epithelial cell abnormalities (ECA) was 24.32%. Amongst ECA, most common (11.86%) cervical lesion was low-grade squamous intraepithelial lesion (LSIL). Diagnostic sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy for the diagnosis of pre-invasive and invasive cervical lesions was found 70.54%, 81.9%, 82.72%, 69.35% and 75.6% respectively.: The current study showed that pap smear cytology is able to detect various cervical lesions with a diagnostic accuracy of 75.6%. So, women belonging to reproductive or postmenopausal age-group should be routinely screened for cervical lesions by non-invasive pap smear method. Conclusively, early diagnosis of cervical lesions is possible, thus reducing the incidence of invasive cervical carcinoma.

The Role of the Microbiome in the Pathogenesis and Treatment of Ulcerative Colitis-A Literature Review.

Ulcerative colitis (UC) is a chronic inflammatory bowel disease affecting the colon and rectum. UC's pathogenesis involves colonic epithelial cell abnormalities and mucosal barrier dysfunction, leading to recurrent mucosal inflammation. The purpose of the article is to show the complex interplay between ulcerative colitis and the microbiome. The literature search was conducted using the PubMed database. After a screening process of studies published before October 2023, a total of 136 articles were selected. It has been discovered that there is a fundamental correlation of a robust intestinal microbiota and the preservation of gastrointestinal health. Dysbiosis poses a grave risk to the host organism. It renders the host susceptible to infections and has been linked to the pathogenesis of chronic diseases, with particular relevance to conditions such as ulcerative colitis. Current therapeutic strategies for UC involve medications such as aminosalicylic acids, glucocorticoids, and immunosuppressive agents, although recent breakthroughs in monoclonal antibody therapies have significantly improved UC treatment. Furthermore, modulating the gut microbiome with specific compounds and probiotics holds potential for inflammation reduction, while fecal microbiota transplantation shows promise for alleviating UC symptoms. This review provides an overview of the gut microbiome's role in UC pathogenesis and treatment, emphasizing areas for further research.

Cervical Cytology Findings in Renal Transplant Patients and Comparison of These Findings with Normal Population

Cervical Cytology Findings in Renal Transplant Patients and Comparison of These Findings with Normal Population

Spectrum of cervicovaginal Pap smears in newly established tertiary care medical institute.

We undertook this study to find out the spectrum of the cervical smear pattern along with the clinical profiles of patients who underwent cervical Papanicolaou (Pap) smear evaluation in our newly started tertiary care center. We also tried to find the possible clinical cause for unsatisfactory smears and factors for epithelial cell abnormality. The present study was a retrospective observational study. Pap smears cases with their clinical findings mentioned on the requisition form and cytopathology observations were retrieved from the archives of the department of pathology. Fisher's exact test was used for statistical analysis. Five hundred and ninety-four cases were included in the study. The most common age group was 36- 40 years. White discharge per vaginum was the most common clinical presentation. The negative for squamous intraepithelial lesions or malignancy was the most common interpretation (86.87%). Cervical erosion had statistically significant associations with unsatisfactory smears, while bacterial vaginosis had with satisfactory smears. Epithelial cell abnormality was seen in 4.62% patients. We observed a statistically significant association of cervical mucoid discharge, and inflammation with "no epithelial cell abnormality" cases, while postmenopausal bleeding was associated with "epithelial cell abnormality" cases. In the presence of clinical factors like cervical erosion, which may affect the quality of Pap smear, proper sampling techniques are to be used by health-care providers. The careful evaluation of Pap smears, especially in cases of cervical mucoid discharge, postmenopausal bleeding, and inflammatory smears is required to ensure that epithelial cell abnormalities are not overlooked.

The cytological pattern of cervical papanicolaou smear in a tertiary hospital of India

Background: Cervical cancer continues to be listed among the top gynecologic cancers worldwide. According to current data, it is ranked fourteenth among all cancers and fourth-ranked cancer among women worldwide. In India alone 1,30,000 new cases occur with the death toll of 70,000 per year. A “PAP’ test should be performed during the second half of the menstrual cycle (Day 14). The patient is placed in lithotomy position and the cervix is visualized by means of a speculum. The smaller end of the Ayre’s spatula is introduced through the external os and the squamocolumnar junction is scraped by rotating the spatula to 360°. Aims and Objectives: The objective of the study is to evaluate the use of the Pap smear screening method for detection of precancerous lesions. Cervical cancer accounts for 15% of all cancers in females. If treated or detected earlier, cervical cancer can be prevented. Materials and Methods: This study was done on 1000 patients during reproductive and later age groups (postmenopausal), attending Obstetric and Gynaecological Outpatient Department of Panna Dhai Hospital associated with RNTMC, Udaipur during the period of November 2012–April 2014 with history of white discharge per vagina, bleeding per vagina, pain in lower abdomen and post coital bleeding. Results: Most of the smears (90.1%) were NILM and 9.9% of smears showed cytological abnormality. Majority 834 (83.4%) of smears were inflammatory, Bacterial vaginosis was seen in 119 cases (11.9%), Candidiasis in 78 cases (7.8%), Trichomoniasis in 35 cases (3.5%), Atrophic vaginitis in 4 cases (0.4%) and Radiation changes in 4 cases (0.4%). There were 99 samples reported as having epithelial cell abnormality. Out of which 75 were LSIL, 14 were high grade squamous intraepithelial, 5 were atypical squamous cells (ASC)-US, 1 was ASC-H and 4 were squamous cell carcinoma. Conclusion: Due to high sensitivity, specificity and accuracy found in this study Pap test is proved to be highly useful to detect precancerous and cancerous lesions of cervix. From the above facts, it can be concluded that early diagnosis and prompt specific treatment of preinvasive or early stages of the disease (mainly in high risk women), reduces the prevalence of invasive carcinoma of uterine cervix.

A retrospective study on cervical cancer screening- In a newly opened tertiary care Centre in Eastern India

: One of the most prevalent cancers, cervical cancer is also the leading cause of mortality for women in underdeveloped nations. A fundamental test for finding infections and precancerous diseases is the Papanicolaou smear. This study aims to comprehend the function of cervical screening in detecting premalignant, malignant, and non-neoplastic lesions as well as the prevalence of different lesions in women who received a traditional pap smear technique. We screened women in the age group of 15-70 years who attended the Outpatient department of the Obstetrics and Gynaecology department of AIIMS, Kalyani. All women who gave consent for screening by Pap smear test were included. Of 2133 cases, most of the cases were benign comprising of Negative for Intraepithelial Lesion or malignancy (NILM) of about 1989 (93.24%) cases, 705 (33.05%) inflammatory. Atypical squamous cells of undetermined significance in 44 cases (2.06%), Atypical squamous cells cannot exclude HSIL in 3 (0.14%), low-grade squamous intraepithelial lesion (LSIL) in 11 (0.52%), high-grade squamous intraepithelial lesion (HSIL) in 5 (0.23%) women and Atypical glandular cell in 7 (0.33%). Out of 202 asymptomatic women (9.47%), 12 cases (0.56%) showed epithelial cell abnormality (8 ASCUS, 2 LSIL, 1 ASCH, 1HSIL) (Odds ratio=0.5056, Significance level, P=0.0362). Conventional Pap smear test is a very easy and cheap diagnostic tool to detect premalignant, malignant, and non-neoplastic lesions and the prevalence of various lesions. As per the American Cancer Society (ACS), a pap smear should start from 25 years to be done till 65 years (repeated after every 3 years).

The Association between Metabolic Syndrome and Epithelial Cell Abnormalities Detected on Pap Smear: A Nationwide Population-Based Study.

Several epidemiologic studies have suggested the correlation between metabolic syndrome (MetS) and cervical cancer. The identification of epithelial cell abnormalities through cervical cytology implies lesions that may lead to cervical cancer in the long term, making screening a crucial measure for its prevention. We conducted a case-control study using data from the National Health Screening Programs under the Health Insurance System of South Korea between 2009 and 2017. Among women who underwent a Pap smear during this period, 8,606,394 tests reported negative results for epithelial cell abnormalities (controls, 93.7%), while 580,012 tests reported epithelial cell abnormalities (cases, 6.3%). Of these, the incidence of MetS was significantly higher in the case group, with 21.7% of cases and 18.4% of controls meeting the MetS criteria with p-Value of less than 0.0001; however, the effect size was small with odds ratio of 1.23. Logistic regression analysis revealed increased odds of epithelial cell abnormalities in women with MetS after adjusting for associated risk factors (AOR 1.202, 95% CI 1.195-1.210, p < 0.0001). These findings indicate that women with MetS have an elevated risk of developing epithelial cell abnormalities, reinforcing the importance of regular Pap smear screening to prevent cervical cancer progression in this population.

Probenecid slows disease progression in a murine model of autosomal dominant polycystic kidney disease.

Development of autosomal dominant polycystic kidney disease (ADPKD) involves renal epithelial cell abnormalities. Cystic fluid contains a high level of ATP that, among other effects, leads to a reduced reabsorption of electrolytes in cyst-lining cells, and thus results in cystic fluid accumulation. Earlier, we demonstrated that Pkd1RC/RC mice, a hypomorphic model of ADPKD, exhibit increased expression of pannexin-1, a membrane channel capable of ATP release. In the current study, we found that human ADPKD cystic epithelia have higher pannexin-1 abundance than normal collecting ducts. We hypothesized that inhibition of pannexin-1 function with probenecid can be used to attenuate ADPKD development. Renal function in male and female Pkd1RC/RC and control mice was monitored between 9 and 20 months of age. To test the therapeutic effects of probenecid (a uricosuric agent and a pannexin-1 blocker), osmotic minipumps were implanted in male and female Pkd1RC/RC mice, and probenecid or vehicle was administered for 42 days until 1 year of age. Probenecid treatment improved glomerular filtration rates and slowed renal cyst formation in male mice (as shown in histopathology). The mechanistic effects of probenecid on sodium reabsorption and fluid transport were tested on polarized mpkCCDcl4 cells subjected to short-circuit current measurements, and in 3D cysts grown in Matrigel. In the mpkCCDcl4 epithelial cell line, probenecid elicited higher ENaC currents and attenuated in vitro cyst formation, indicating lower sodium and less fluid retention in the cysts. Our studies open new avenues of research into targeting pannexin-1 in ADPKD pathology.

Papanicolaou Smear screening in Aligarh: A Review of the Cases

ABSTRACT: Cervical cancer is the second most common cancer after breast cancer. The risk factors associated with this dreaded yet preventable cancer is age at sexual debut, parity, multiple sexual partners, use of contraceptives and smoking etc. Fortunately, the cervical cancer are preventable because of the early detection of precancerous lesions. This is made possible by the screening procedures routinely in practice such as Pap smear, visual inspection and HPV. Methodology: The study was conducted to evaluate cervical cytological abnormalities, through pap smear reported as inflammatory lesions, precancerous (CIN1/ CIN2/CIN3) and carcinoma in situ, in women who underwent pap smear screening at the hospital. Discussion and Conclusion: This was a prospective study of pap smears received in the cytopathology laboratory from January 2019 to July 2019. A total of 202 Papanicolaou smears were sent to the cytology laboratory during the 6month time period. There were 112 (55.4%) abnormal pap smears (epithelial cell abnormalities, infections and inflammatory smears). 14 (6.9%) smears were inadequate or unsatisfactory for evaluation. 89 (44%) cases had inflammatory changes whereas epithelial abnormality was seen in 23 (11%). These findings corroborate with the fact that Papanicolaou (Pap) test is an important screening tool and is a simple technique to detect precancerous cervical lesions.

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.

A Comparison of Conventional Pap Smear and Liquid-Based Cytology for Cervical Cancer Screening.

Early diagnosis and treatment of preinvasive lesions have made cervical cytology one of the most effective methods of cancer screening in industrialized nations, which have seen a sharp decline in the incidence and death of invasive cancer. The aim of this study is to compare liquid-based cytology (LBC) and conventional Pap on cervical smears. From July 2018 to June 2022, 600 patients were included in this cross-sectional study, which was done at the Pathology Department of a Tertiary Care Facility in Western Maharashtra. Of the 600 patients, 570 (95%) had good conventional Pap smear (CPS), whereas 30 (5%) had poor ones. Five hundred and ninety-two (98.6%) LBC smears were satisfactory, whereas 8 (1.4%) were unsatisfactory. Endocervical cells were seen in 294 (49%) CPS, whereas 360 (60%) LBC smears showed endocervical cells. The morphology of inflammatory cells was similar in both techniques. Hemorrhagic background was seen in 212 (35%) CPS and 76 (12.6%) LBC smears. Only two samples showed diathetic background, which was seen on both CPS and smear. Out of the satisfactory smears in the case of CPS, 512 (85%) cases were reported as negative for intraepithelial lesion or malignancy (NILM), whereas 58 (9.7%) cases were reported as epithelial cell abnormality. In LBC smears, 526 (87.3%) were reported as NILM, whereas 66 (11%) were reported as epithelial cell abnormality. Organisms were detected in 208 (34%) CPS and 162 (27%) LBC smears. Screening time was 5 ± 1 min for CPS, whereas it was 3 ± 1 min for LBC smear. Mortality will be decreased using LBC on a bigger scale in nations where many smears can be made and screened in a short amount of time, with the provision of doing human papillomavirus-based testing on the remaining sample.

Cytomorphological Variations in Pap Smears amongst Postmenopausal Women Reporting at a Tertiary Care Centre, Tamil Nadu, India

Introduction: In developing countries, cervical cancer is the leading cause of death amongst women. Since women spend one third of their lives in the postmenopausal period, which is most neglected phase, needs a technically simple, non invasive and, cost-effective screening tool for cervical cancer detection and the exact answer is the Pap smear screening test. This simple screening test when performed at regular intervals in post menopausal population, can detect precursor lesions there by reducing cervical cancer morbidity and mortality. Aim: This study was undertaken to evaluate the cytomorphological variations in Pap smears amongst postmenopausal women. Materials and Methods: In this prospective study, a total of 138 satisfactory smears were considered for study amongst 146 postmenopausal women from August 2020 to July 2022 at Bhaarath Medical College and Hospital and then evaluated and categorised based on Bethesda system for reporting cervical cytology 2014. {Reporting elements include specimen type, specimen adequacy, general categorisation, interpretation/result includes general categories of negative for Intraepithelial Lesion or Malignancy (NILM), epithelial cell abnormalities and other malignancies. Results: Out of 138 satisfactory cases, 78.26% (108 cases) 14.5% (20 cases) and 7.24% (10 cases) were diagnosed as of inflammatory/benign conditions, epithelial abnormalities and normal cytology respectively. The mean age for inflammatory/ benign lesions was 57.5 years and majority presenting with postmenopausal bleeding and white discharge. Amongst epithelial abnormalities Atypical Squamous Cells of Undetermined Significance (ASCUS) and Low-grade Squamous Intraepithelial Lesions (LSIL) were commonest. The incidence of ASCUS 7.27% (10 cases), and incidence of LSIL 2.89% (4 cases). The mean age was 57.5 years and majority of patients presented with postmenopausal bleeding and mass per vaginum. Incidence of High grade Squamous Intraepithelial Lesion (HSIL) was 2.17% (3cases), the mean age was 65.5 years and presented with white discharge and postmenopausal bleeding. Incidence of SCC was 2.17% (3 cases) and the mean age was 70.5 years, presented with, postmenopausal bleeding and white discharge. Conclusion: Pap smear is a simple, cheap, safe and gold standard diagnostic tool for screening postmenopausal women for all cervical abnormalities in particular pre-invasive and invasive lesions.

DETECTION OF ABNORMAL CERVICAL CYTOLOGY BY LBC (LIQUID BASED CYTOLOGY)

Introduction: Cancer cervix is the fourth most common cancer among women globally. It is responsible for 7.7% of all female cancer death.It takes around 15-20 years in normal immunity patients and 5-10 years in immune-compromised patients to convert precancerous lesions of the cervix into cancer cervix. Cervical cytology plays a very important role in the early diagnosis and management of these precancerous lesions to improve prognosis.quite low Pap smear sensitivity, in the range of 50%, but as low as 20%10 has been reported by some recent meta-analysis studies. LBC was introduced in the mid-1990s as an alternative technique to process cervical smear samples for cytological evaluation.11Studies of the accuracy of liquid-based preparations reports sensitivity of 61-66% and specicity of 82- 91%. A retrospective study was done at a private clinic and pathology lab in Di Materials And Methods: strict Shivpuri (MP) from 1st October 2020to 30th November 2022 on 760 patients. Inclusion criteria:-Patients in the age group of 21-65 years with complaints of abnormal vaginal discharge, intermenstrual bleeding, ostmenopausal bleeding, post-coital bleeding, dyspareunia, foul-smelling discharge, backache, and Lower abdominal pain were included in this study. Sample was taken with Broom, and Cyto-brush from the transformation zone and endocervix and placed in liquid xative buffered methanol solution and send to the pathology lab. Results Most of the patient 42% were between 31-40 years of age group. The majority 48.42% of them were educated up to High school. Most of them 84.07%were from rural back ground, multiparous 86.05%, and married 99.73%. 25% ofwomen visited OPD with complaints of abnormal vaginal discharge followed by menstrual abnormalities in 20.79%, other complaints were, Pain abdomen 16.97%, Vulval itching12.11%, Low back pain 3.95%, Dyspareunia 3.03% and others 5.13%. (Loss of weight and appetite, STD/genital warts) .9.08% women came for routine checkup. The most common nding on per speculum examination was Cervical ectopy in 33.95% .Normal cervix was found in 26.05%. Other ndings on Per-speculum examination were, Hypertrophied cervix, Inammation, Cervical Polyp, UV Prolapse/ cystocele, Cervical Ulcer ,Cervix ushed with the vagina and Cervical growth in. 20%, 9.08%, 4.34% 4.61% 3.03% 0.13% and 0.13% respectively. Out of 760 cases, 61.05% of patients were reported as negative for intraepithelial lesion (NILM). The most common non-neoplastic cytological nding was an inammatory smear in 25.00% of cases. Various Infections were found in 6.18% of cases, and epithelial cell abnormalities were found in 3.42% of cases. The most common abnormalities were ASC-US 0.92% and ASC-H 0.92%, followed by LSIL 0.53%, HSIL 0.66%, AGUS 0.26%, and SCC 0.13%. Bacterial vaginosis 2.37% was the most common infective organism found in cytology followed by Candida albicans 1.97%, Trichomonas vaginalis 1.71%, and Herpes simplex virus 0.13%. The cytology-based screening program is still the mainstay in the earl Conclusion y diagnosis of cancer cervix. To improve diagnostic accuracy as sensitivity and specicity in the eld of cervical cytology, Liquid-based cytology (LBC) is preferred. Its advantages over conventional Pap smears include proper visualization of cellular features due to a reduction in air-drying artifacts and reduced number of unsatisfactory smears. The residual specimens from the LBC technique can be used to detect human papillomavirus DNA through immune-cytochemistry if needed. thus, LBC is recommended as a cervical cytology screening tool to achieve the WHO elimination strategy.

Evaluation of the Cytonucleomorphometric Parameters for Cases Diagnosed as Squamous Cell Abnormality on Conventional Cervico-Vaginal Pap Smears.

The natural history of cervical cancer is unique that it is preceded by a precancerous condition for a long time. Morphometry as a tool can be used in early and accurate diagnosis of these precancerous and cancerous lesions. The present study aims at assessing the utility of cellular and nuclear morphometry in differentiating squamous cell abnormality from benign conditions and also differentiating the categories of squamous cell abnormalities. Forty-eight diagnosed cases of squamous epithelial cell abnormality, that is, 10 cases each of atypical squamous cell of undetermined significance (ASC-US), low-grade squamous intraepithelial lesion (LSIL), high-grade SIL (HSIL), and squamous cell carcinoma (SCC) and eight cases of ASC-H (ASC cannot exclude HSIL), were made the sample population and compared with a control population of 10 cases of negative for intraepithelial lesion or malignancy (NILM). Parameters like nuclear area (NA), nuclear perimeter (NP), nuclear diameter (ND), nuclear compactness (NC), cellular area (CA), cellular diameter (CD), cellular perimeter (CP), and nucleocytoplasmic (N/C) ratio were used. There was a significant difference in the six groups of squamous cell abnormality based on NA, NP, ND, CA, CP, and CD (P < 0.05) using one-way analysis of variance. Nuclear morphometry parameters like NA, NP, and ND were found to be the maximum for HSIL, followed by LSIL, ASC-H, ASC-US, SCC, and NILM groups in decreasing order. The mean CA, CP, and CD were found to be the maximum for NILM, followed by LSIL, ASC-US, HSIL, ASC-H, and SCC in decreasing order. On post hoc analysis, the lesions can be divided into three groups: NILM/normal; ASC-US and LSIL; and ASC-H, HSIL, and SCC, based on N/C ratio. In cervical lesions, holistic parameter of cytonucleomorphometry should be taken rather than taking nuclear morphometry only. N/C ratio is a highly statistically significant parameter that can differentiate between low-grade lesions and high-grade lesions.

Routine Pap smear screening in Pakistan: A current perspective.

Routine Pap smear screening in Pakistan: A current perspective.