PAP SMEAR AS A SCREENING TOOL FOR EVALUATING CERVICAL DYSPLASIA AND MALIGNANCY- A HOSPITAL-BASED STUDY.

Corresponding Author:
Monica Vincent,
Flat C2, Mayayaga Apartment,
25 Promenade Road, Cantonment,
Trichy-620001, Tamilnadu, India.
E-mail: drmonicavincent@gmail.com

ABSTRACT

BACKGROUND

In women, cervical cancer is one of the most common cancers and the most researched disease. Pap smear is a cost-effective method for regular screening of population for early detection of pre-neoplastic and neoplastic lesions of cervix. We wanted to assess the usefulness of the Pap test as an initial screening tool for examination of the cervix by comparing the results in biopsy specimens and recording the data as positive and negative for dysplastic changes. We also wanted to subject the ‘suspicious of malignancy’ biopsy tissues to IHC for p16INK4a, a diagnostic marker for all degrees of cervical dysplasia and cervical cancer to correlate the findings.

METHODS

Women visiting the Department of Obstetrics and Gynaecology, presenting with complaints of pain abdomen, white discharge P/V, irregular menstrual bleeding, postmenopausal bleeding, mass per vagina or for  regular health check-up were included in the study. Suspicious of malignancy cases were followed by biopsy or hysterectomy. The cytological findings were correlated with histopathological findings in such cases. Finally, these suspicious of malignancy cases were subjected to IHC- p16INK4a marker.

RESULTS

In the present study, a total of 2234 Pap smear cases were studied and 96 out of 2234 cases were followed by histopathological study. Out of 2234 cases, 41 (1.83%) were suspicious of malignant lesions, 1686 cases (75.47%) were inflammatory, 495 cases (22.15%) were normal and 12 cases (0.53%) smears were unsatisfactory for evaluation. Among 41 suspicious of malignant cases, 11 cases (26.83%) were HSIL and 27 cases (65.85%) were LSIL. The sensitivity of cervical cytology was 91.6% and specificity was 86.9% in the present study. Out of 41 cases of suspicious of malignancy, only 22 cases were histopathologically correlated and subjected to IHC p16INK4a marker. Out of 22 histopathologically correlated cases, 11 cases turned out to be cervicitis (50%) were negative for HPV infection. Remaining 11 cases were premalignant and malignant (50%) and were positive for HPV infection.

CONCLUSIONS

The outcome of this study reveals sensitivity of 91.6% suggesting that Pap smear is an essential primary tool for screening of cervical cancer. It is also simple and cost-effective procedure that can be performed in the outpatient department. Thus, combination of Pap smear screening test and confirmation with p16INK4aIHC marker will certainly reduce the high mortality caused due to cervical cancer with underlying HPV infection, as well as alleviate the suffering caused by the disease.