Specificity Of Pap Smear Research Articles

Pre-Malignant Lesions of Cervix in Female Attending a Tertiary Hospital of Nepal

Introduction: Cervical cancer is killing Nepali women in gross even though cervical cancer is preventable with time-tested screening strategies in Nepal. Detection of premalignant lesions of cervix is preliminary step for early treatment and to minimise the tragedy of death. The aim of this research is to corelate the Pap smear, colposcopy and guided biopsy findings with histopathology to detect premalignant lesion of cervix.Methods: A prospective observational study conducted among 145 women attending gynaecology OPD with symptoms during reproductive age 21-65 years. Collection of Pap smear was conducted by conventional method, colposcopy and guided biopsy in selected women were performed and the sample was sent to pathology department for histopathological confirmation.Results:The pre-malignant lesions in cytology were ASCUS (Atypical Squamous Cells of Undetermined Significance) 11%, ASC-H (Atypical Squamous cell- cannot exclude High Grade)1.3 %, LSIL (Low Grade Intraepithelial Lesion)28.2 %, and HSIL (High Grade Intraepithelial Lesion) 7.5 %. The colposcopy detected 54.4% atypical transformation zone. The histopathology detected Cervical Intra-epithelial Neoplasia I (CIN I) 26.1%, CIN II 11.7%, and CIN III 7.5%. The sensitivity of Pap smear and colposcopy was 83%, the specificity of Pap smear was 88%, and colposcopy was 98%.The positive predictive value(PPV)were 89% and 98 %, negative predictive value(NPV) were 81%and 83%.and accuracy was 88 % and 98% in Cytology and Colposcopy.Conclusions:Pap smear and colposcopy were effective tools to detect premalignant lesions of cervix in comparison to histopathological findings.

Role of cervical cytology in the detection of uterine glandular lesions

Background: Diagnosis of atypical glandular cells (AGCs) is challenging to the cytopathologist due to the overlapping features of various neoplastic and nonneoplastic lesions. The aim of this study was to assess the utility of conventional Papanicolaou (Pap) smears in detecting uterine glandular lesions. Materials and Methods: Archived records of all histopathologically diagnosed endometrial adenocarcinoma and endocervical adenocarcinoma during the study period were identified. Corresponding Pap smears, if available, were retrieved. In addition, all cytologically reported AGCs and adenocarcinoma during the same period were retrieved. Pap smears of histopathology discordance cases were reviewed. The prevalence of AGC and sensitivity and specificity of Pap smears in detecting glandular lesions were calculated. Results: The prevalence of AGC was 0.65%. There were 11 false negatives and 10 false positives initially, which were reduced to 6 and 5, respectively, after the review. The sensitivity and specificity of Pap smear in detecting AGC was 72.9% and 99.81% initially, which improved marginally to 81.8% and 99.9%, respectively. Conclusions: The prevalence of AGC in Pap smears is low with a moderate sensitivity and good specificity. As the association of clinically significant lesion is high, all cases with AGC diagnosis must be followed up with colposcopic and histopathologic examination of uterus and cervix.

Colposcopic evaluation of cervix in symptomatic women and its correlation with Pap smear. A prospective study at a tertiary care centre.

Introduction:Back in India, cervical cancer is the second most frequent cancer in women (aged 15–45 years) following breast cancer, accounting for nearly 14% of all female cancer cases. The aim of this study is to yell the findings of pap smear with colposcopy and directed biopsy (if needed) and to evaluate the usefulness of colposcopy in discovering the premalignant and malignant lesions of the cervix.Methods:This is a prospective observational analysis of 150 symptomatic women attending the gynecology OPD of Indira Gandhi Institute of Medical Sciences, Patna, for a period of one year from 2019 to 2020. Assessment of symptomatic women was completed with a pap smear, colposcopy, and biopsy in selected instances.Statistical Analysis Used:MS Excel spreadsheet application, SPSS v23 (IBM Corp.), was used for data analysis.Results:The expression age (years) has been 34.68 ± 8.05. The sensitivity and specificity of pap smear were 91.7% and 45.45%, respectively, whereas the sensitivity and specificity of colposcopy were 83.3% and 72.72%, respectively, in the present study.Conclusions:Pap smear had low specificity as compared to colposcopy. Hence simultaneous use of colposcopy has shown to rise in the rate of carcinoma cervix discovery in symptomatic women.

Cyto-histo correlation of conventional Pap smear with cervical biopsy in diagnosis of precancerous and cancerous lesions of cervix

Introduction: Carcinoma of uterine cervix is the third most common cancer among women worldwide and it contributes significantly to cancer related morbidity and mortality. The incidence of cervical carcinoma is incredibly high in developing countries (almost 80%) due to lack of proper knowledge. The extensive use of cervical screening with Pap smears has considerably increased the detection of precancerous and cancerous lesions of uterine cervix. Aims: To evaluate cyto-histo correlation of precancerous and cancerous lesions of uterine cervix and to calculate the sensitivity and specificity of Pap smear in diagnosing invasive malignancy. Materials and Methods: This was a retrospective observational study conducted in the Department of Pathology, Chirayu Medical College & Hospital, Bhopal from January 2013 to April 2018. All the cases reported in Pap smear as cervical intraepithelial lesions and invasive malignancies were retrieved. We also retrieved the same cases, if they had undegone cervical biopsy for correlation. Result: During the study period total 303 cases which were positive for intraepithelial lesions and malignancies were retrieved. Out of these 303 cases we excluded 23 cases because in these cases cervical biopsy had not been done. So in the final analysis 280 cases were included. Of the 280 Pap smears, maximum cases (33.92%) were reported as low grade squamous intraepithelial lesion (LSIL), followed by high grade squamous intraepithelial lesion (HSIL) (24.28%), atypical squamous cells of undetermined significance (ASCUS) (19.64%), atypical squamous cells – cannot rule out HSIL (ASC-H) (10%). We had 23 cases of invasive malignancy which includes 21 cases of squamous cell carcinoma (SCC) and 2 cases of adenocarcinoma. There were 11 cases of atypical glandular cells of undetermined significance (AGUS). We found that total numbers of concordant cases were 68.57% (192/280) and discordant cases were 31.43% (88/280). We also found that sensitivity and specif

Diagnostic Accuracy of Cervical Pap Smear and Colposcopy in Detecting Premalignant and Malignant Lesions of Cervix.

The objective of this study was to determine the diagnostic accuracy of pap smear and colposcopy in detecting the premalignant and malignant lesion of the cervix. In this cross-sectional study, a total number of 160 women who presented with abnormal clinical problem or routine checkup during a 6-month period were included. All the patients underwent pap smear and colposcopy by the same gynecologists team, and finally, cervical biopsy was performed in all the individuals. The demographic and clinical characteristics as well as the obstetrics history were recorded. The diagnostic accuracy of each test was calculated according to the biopsy as gold standard. The sensitivity, specificity, positive predictive value (PPV), and negative predictive values (NPV) were recorded and compared between two modalities. Overall, we included a total number of 160 patients with mean age of 37.6 ± 7.32 (ranging from 24 to 63) years. The sensitivity and specificity of pap smear were found to be 47.19% and 64.79%, respectively. The PPV and NPV of the pap smear were calculated to be 88.69% and 38.46%, respectively. The sensitivity and specificity, PPV, and NPV of the colposcopy were calculated as 64.72%, 52.74%, 76.32%, and 95.41%, respectively. The overall diagnostic accuracy of the pap smear and colposcopy was reported to be 82.2% and 96.3%, respectively. The results of this study demonstrate that colposcopy has a higher diagnostic accuracy in detecting cervical premalignant and malignant lesions compared to the pap smear.

Role of various screening techniques in detecting preinvasive lesions of the cervix among symptomatic women and women having unhealthy cervix.

Cervical cancer which is preventable, occurs due to humanpapiloma virus infection and results in a preinvasive condition called cervical intraepithelial neoplasm (CIN) before the development of cancer. Majority of the patients with CIN or early stage of cervical cancer present with symptoms such as abnormal vaginal discharge or bleeding, and unhealthy looking cervix. Selectively screening these symptomatic patients, can detect more number of positive cases and also most effective screening technique for these selective patients can be advocated. All married women between 21 and 65 years attending gynecology outpatient department of a tertiary care health center in Central India and having unhealthy cervix or abnormal vaginal discharge were included. All women were subjected to Pap smear, visual inspection under acetic acid (VIA), visual inspection under Lugol's iodine (VILI) and colposcopy. Biopsy was taken in all cases. Diagnostic value of each screening method was determined in terms of sensitivity, specificity, positive predictive value and negative predictive value. Out of 352 patients, around 20% of them were found to have abnormal cytology. The sensitivity and specificity of Pap smear was found to be 34% and 94%. But colposcopy has high sensitivity and low specificity, i.e., 99% and 31%, respectively. On the other hand the sensitivity and specificity of VIA and VILI are comparable i.e., 65% and 45% and 64% and 48% respectively. Pap smear shows high positive predictive value among all, i.e., 85% and colposcopy shows 58% for the same. Pap smear carries low sensitivity but high positive predictive value. As compared to Pap smear, VIA and VILI are more sensitive and are of low cost. Colposcopy can be considered as a preferred method of screening due to its extremely high sensitivity.

Evaluation of Sensitivity and Specificity of Pap Smear, LBC and HPV in Screening of Cervical Cancer

Cervical cancer ranks as the fourth leading cause of female cancer in the world, and it is the second most common female cancer in women aged 15–44 years. Strict implementation of screening programs has led to a large decline in cervical cancer incidence and mortality in developed countries. In contrast, cervical cancer remains largely uncontrolled in high-risk developing countries because of ineffective or no screening. Conventional Pap smear method has been the mainstay of most of the screening programs since decades. However, this technique is not without limitations and the sensitivity and specificity of cervical cytology are relatively low. To overcome the limitations of conventional Pap smear, liquid-based cytology was introduced in 1990s as a better tool for processing cervical samples. HPV testing alone or with cytology triage is currently increasingly being used as a primary screening approach for cervical neoplasia. The present study was undertaken to evaluate sensitivity and specificity of conventional Pap smear, liquid-based cytology and HPV DNA in our setting. This study was conducted in Gynecological Oncology unit at Indira Gandhi Institute of Medical Sciences, Patna, Bihar. In total, 1500 women were enrolled in this study and sample was taken for conventional cytology, liquid-based cytology and HPV DNA. The smears were studied in detail and were interpreted as per the Bethesda system of reporting Pap smears. The results were compared and analyzed statistically. Approximately 5% patients having epithelial cell abnormalities on Pap smear, 5.33% on LBC and 6.86% had abnormal report on HPV DNA testing. Unsatisfactory smears were more commonly reported by conventional method (7.2%) than by liquid-based method (1.62%), and this difference is statistically significant. There was no difference in the detection of epithelial cell abnormalities by both the methods. Sensitivity of Pap smear, LBC and HPV DNA was 75.80%, 76.47% and 89.89%, respectively. Specificity of Pap smear, LBC and HPV DNA was 98.05%, 98.93 and 98.00%, respectively. LBC has been found to be more superior to conventional smears only with respect to lesser number of unsatisfactory smears.

CERVICAL DISEASES

Objectives: The aim of our study is to compare the efficacies of Pap smearcytology, colposcopy and histopathology, in diagnosis of cervical diseases. Study Design:Cross sectional cohort study. Period: One year from June 2013 to June 2014. Setting:Tertiary care hospital in Karachi, Pakistan. Method: The patient population n=145 consistedof women ranging from age 18 to 80 years old, who had come to the outpatient clinics for avariety of symptoms. Pap smear, colposcopy and histopathology was done for women who hadsymptoms like recurrent vaginal discharge, postcoital bleeding and other diseases of the cervix.Findings were noted on a proforma and all the patients signed a duly informed consent. Datawas analyzed using SPSS version 23. Results: The mean age was 45 +/- 9 years (between24 – 75 years), the parity was 5 +/- 4, normal colposcopy findings were found in n= 66 women,while abnormal findings were found in n=79 women. In the abnormal colposcopic finding groupn=63 had abnormal histopathology (p<0.001) abnormal histopathology was found in n=11women who had normal colposcopic findings (16.67% false negative), the calculated sensitivityand specificity of colposcopy was determined to be 86% and 79%. For pap smear abnormalitywas found in n= 49 patients, out of which n=29 had abnormal findings on histopathology aswell. And for colposcopy and pap smear out of n= 78 patients who had abnormal colposcopicfindings, abnormal pap smear was found in only n= 28 patients. And out of those who hadnormal colposcopy n= 67, n= 21 had abnormal pap smear (False positivity of 31.34%) similarlyout of those who had normal pap smear n= 96, n= 44 had abnormal histopathology (falsenegativity of 45.83%). The calculated sensitivity and specificity of pap smear was 38.8% and71.8% respectively. Conclusion: We have concluded that there is a strong correlation betweenfindings of colposcopy and histopathological diagnosis, but when it comes to the diagnosismade by pap smear and colposcopy and pap smear and histopathology the correlation is weakand not consistent.

English

Objectives: The aim of our study is to compare the efficacies of Pap smearcytology, colposcopy and histopathology, in diagnosis of cervical diseases. Study Design:Cross sectional cohort study. Period: One year from June 2013 to June 2014. Setting:Tertiary care hospital in Karachi, Pakistan. Method: The patient population n=145 consistedof women ranging from age 18 to 80 years old, who had come to the outpatient clinics for avariety of symptoms. Pap smear, colposcopy and histopathology was done for women who hadsymptoms like recurrent vaginal discharge, postcoital bleeding and other diseases of the cervix.Findings were noted on a proforma and all the patients signed a duly informed consent. Datawas analyzed using SPSS version 23. Results: The mean age was 45 +/- 9 years (between24 – 75 years), the parity was 5 +/- 4, normal colposcopy findings were found in n= 66 women,while abnormal findings were found in n=79 women. In the abnormal colposcopic finding groupn=63 had abnormal histopathology (p<0.001) abnormal histopathology was found in n=11women who had normal colposcopic findings (16.67% false negative), the calculated sensitivityand specificity of colposcopy was determined to be 86% and 79%. For pap smear abnormalitywas found in n= 49 patients, out of which n=29 had abnormal findings on histopathology aswell. And for colposcopy and pap smear out of n= 78 patients who had abnormal colposcopicfindings, abnormal pap smear was found in only n= 28 patients. And out of those who hadnormal colposcopy n= 67, n= 21 had abnormal pap smear (False positivity of 31.34%) similarlyout of those who had normal pap smear n= 96, n= 44 had abnormal histopathology (falsenegativity of 45.83%). The calculated sensitivity and specificity of pap smear was 38.8% and71.8% respectively. Conclusion: We have concluded that there is a strong correlation betweenfindings of colposcopy and histopathological diagnosis, but when it comes to the diagnosismade by pap smear and colposcopy and pap smear and histopathology the correlation is weakand not consistent.

Can Visual Inspection after Acetic acid replace Papanicolaou smear

Objective The aim of this study was to determine the sensitivity and specificity of acetic acid application to the cervix as a screening test for cervical cancer and to compare it with Papanicolaou smear and correlate it with histopathology of colposcopy-directed biopsy. Setting The study was conducted in a tertiary care centre. Design The study was conducted as a prospective trial. Materials and methods Papanicoloau smear was taken, and the cervix was visualized after application of 5% acetic acid. Women with positive Pap smears or positive naked eye acetic acid test (NEAT) were subjected to colposcopy and directed biopsies were obtained. Results The sensitivity of NEAT was higher than that of Pap smear (80.3 vs. 24.5%), and the specificity of Pap smear was higher than that of NEAT (95.3 vs. 21.2%). Conclusion NEAT may serve as an adjunct to routine Pap smear to pick up additional 50% of premalignant lesions. It is not capable of replacing Pap smear because of its low specificity. The high false-positive rate of the acetic acid test may be due to the large number of unhealthy cervices (57.6%).

English

AIMS & OBJECTIVES: The sensitivity and specificity of pap smear and colposcopic scrape cytology were compared to colposcopic punch biopsy in present study for screening cervical abnormalities. Method: 60 multiparous women of 25-55 years age group were subjected to conventional pap smear, colposcopic directed scrape cytology and colposcopic punch biopsy after VIA and both the cytology and histopathology findings were noted, sensitivity and specificity of pap cytology colposcopic cytology were compared to biopsy. Results: Sensitivity & specificity of colposcopic cytology was much higher than pap and was near to punch biopsy, sensitivity and specificity of pap is 41% & 66% respectively, sensitivity and specificity of colposcopic cytology is 66%, 83% respectively hence it was concluded that colposcopic cytology can be more effective screening than pap in centres with colposcope and colposcopist.

Complementary Procedures in Cervical Cancer Screening in Low Resource Settings

To evaluate the efficacy of pap smear, HPV DNA testing and colposcopy and to determine the approach for cervical cancer screening in low resource settings. Eight hundred non pregnant married women above 30years of age were studied and subjected to pap smear examination. Hysterectomised women were excluded from the study. Selected patients were followed by HPV DNA testing by Hybrid Capture II method, colposcopy and biopsy. Sensitivity, specificity, Positive predictive value (PPV), Negative predictive value (NPV), diagnostic accuracy and kappa value (k) were calculated for each screening test. Out of eight hundred women with mean age 36.5±5.94years undergoing pap smear, ASCUS was found in 66(8.25%), ASC-H in 2(0.25%), LSIL in 48(6%), HSIL in 8(1%), inflammatory in 540(67.5%). Out of 260 women who underwent HPV DNA testing, 120 (46.15%) had abnormal cytology and/or positive HPV DNA test (Group I, n=120) and 140(53.8%) had dual negative results (Group II, n=140) HPV DNA test was found positive in 64 women (53.3%) in Group I. Sensitivity and specificity of pap smear was 69.2 and 63.72% while for HPV DNA testing was 92.3 and 84% respectively. PPV and NPV of pap smear, HPV DNA testing and colposcopy was 18, 40, 76.4% and 94.7, 98.9, 100% respectively. Diagnostic accuracy of pap smear (k=0.14), HPV DNA test (k=0.70) and colposcopy (k=0.81) was 64.29, 84.9, and 96.8% respectively. Combining pap smear & HPV DNA testing (k=0.25) increased the sensitivity and NPV to 100%. Sensitivity and diagnostic accuracy of HPV DNA test is more than that of pap smear and the test is not influenced by inflammatory conditions of vagina. In low resource settings, women with ASCUS and LSIL on cervical cytology should be subjected to HPV DNA test and only if found positive should be referred for colposcopy thereby reducing colposcopy referrals. Women with HSIL should be directly subjected to colposcopy guided biopsy. Using this approach, most of the preinvasive cervical lesion will be detected but few cases will still be missed among inflammatory smears, if HPV DNA testing is not supplemented.

Role of VIA and PAP Smear in the Diagnosis of Cervical Precancers: A Study of 115 C ases

Carcinoma of cervix is the most frequent neoplasm of female genital tract. In Bangladesh cervical cancer is the commonest malignancy of women. This high incidence of cervical cancer is attributed to the lack of screening program, particularly in the women of low socio-economic status. Invasive cervical cancer is preceded by a tong premalignant phase known as cervical intraepithelial neoplasia (CIN). The goal of cervical cancer screening is the detection and treatment of precancer before cancer develops. The aim of this study was to evaluate the test parameters using visual inspection with acetic acid (VIA) and cervical cytology in screening and early diagnosis of the precancerous lesions of cervix. This study deals with 115 cases from Gynecology Outpatient Department of Rajshahi Medical College, Rajshahi from July 2006 to June 2008. After vaginal examination Pap smear was collected, followed by VIA and punch biopsy of cervix. All the data were evaluated by standard statistical methods. The sensitivity of VIA was 94.11% while Pap smear was 64.7%. The specificity of Pap smear was 93.94% while VIA was 57.57%. These two tests may be considered as a suitable early detection technique in the developing countries where other test like HPV-DNA detection is a costly oneTAJ 2009; 22(1): 183-189

Resultados histológicos e detecção do HPV em mulheres com células escamosas atípicas de significado indeterminado e lesão escamosa intra-epitelial de baixo grau na colpocitologia oncológica

OBJETIVOS: avaliar o desempenho da colpocitologia oncológica (CO) e da Captura de Híbridos II (CHII) para o diagnóstico de lesão cervical histológica significativa (NIC2/3) em mulheres encaminhadas com CO contendo atipias celulares de significado indeterminado (ASCUS) ou lesão escamosa intra-epitelial de baixo grau (LSIL). MÉTODOS: estudo de corte transversal no qual foram incluídas 161 mulheres encaminhadas, entre agosto de 2000 e setembro de 2002, devido a CO com resultado de ASCUS ou LSIL. As mulheres responderam a questionário específico sobre características sociodemográficas e reprodutivas e foram submetidas a exame ginecológico com coleta de CO e CHII, sendo realizada colposcopia com eventual biópsia de áreas suspeitas. Foi aplicado o teste do qui-quadrado para as associações da idade, uso de condom, uso de anticoncepcional oral e tabagismo com os resultados da CHII. Foram calculados a sensibilidade, especificidade, valor preditivo positivo e valor preditivo negativo da CO e da CHII para detectar NIC2/3. Todos os cálculos foram realizados com intervalos de confiança estatística de 95%. RESULTADOS: sessenta e sete porcento das mulheres com menos de 30 anos de idade tiveram testes positivos para o HPV. A CO e CHII tiveram sensibilidade de 82% em detectar NIC2/3 quando considerados como positivos ASCUS, LSIL ou HSIL. Quando se consideram como positivas apenas as CO com HSIL, este exame apresenta acentuado ganho de especificidade (de 29 para 95%) e valor preditivo positivo (de 12 para 50%), superando a CHII, porém com redução igualmente significativa de sua sensibilidade (de 82 para 41%). CONCLUSÕES: nossos resultados indicaram grande potencial da CHII para detectar mulheres com NIC2/3 entre as pacientes com ASCUS/LSIL na CO de encaminhamento.