Cervical Cancer Screening By Cytology, Colposcopy and Their Correlation with Histopathology. (original) (raw)
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Journal of Family Medicine and Primary Care, 2021
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.
Role of cytology, colposcopy and colposcopic directed biopsy in the evaluation of unhealthy cervix
International Journal of Reproduction, Contraception, Obstetrics and Gynecology, 2016
Cervical cancer is the second most common cancer among women in developing and underdeveloped countries, amounting to 80% of the global burden of this disease. 1 India bears over a tenth of the global burden of cancers. 2 As per latest data of India from GLOBOCAN 2012, top three cancers in female are breast, cervix uteri and colo-rectum. 2 Cervical cancer is a deadly disease once it reaches the invasive stages but out of all the female genital tract cancers, it is the only preventable cancer if detected in its early stages. It is possible to prevent deaths due to cervical cancer through various strategies that target women >30 yr for screening and treatment. 3 The introduction of Papanicolaou test led to significant reduction in mortality and morbidity in developed countries. The screening coverage in Asian countries is low and is 2.6-5 per cent in India. 4 In India, unhealthy cervix is a common finding on per speculum examination in gynaecology Out Patient Department (OPD) and it is recommended to do the cervical cytology to detect any epithelial cell abnormality.
IOSR Journals , 2019
It was a prospective comparative study conducted in gynecology OPD of Burdwan Medical College and Hospital on 100 women attending OPD with complains of white discharge, irregular menstruation, post coital bleeding or post-menopausal bleeding. Pap smear, colposcopy with application of 3% acetic acid and on spot cervical biopsy in indicated cases was done. 71% of women were in the age group 20-40 years. 54% had parity of 3 to 4. 69% of women presented with complain of white discharge. 88% had normal Pap smear, 1% had LSIL, 2% had HSIL and 4% had ASCUS on Pap smear. 40% of women had aceto-white reaction on colposcopy, 6% had low grade lesions and 54% had normal colposcopy findings. Final histopathology correlated with a diagnosis of CIN 2/3 in 6%, CIN 1 in 1% and squamous cell carcinoma in 4%, while 89% had chronic nonspecific cervicitis. 72.72% of all those with a positive histopathology presented with complain of white discharge and positivity increased as the parity increased. Overall sensitivity of Pap smear was72.72% which was much lower as compared to colposcopy (100%). But the specificity of Pap smear was 95.5% and of colposcopy was 67.42%. Hence colposcopy is a superior test for the screening of cervical cancer as it is more sensitive than Pap smear in detecting precancerous lesions.
International Journal of Reproduction, Contraception, Obstetrics and Gynecology, 2014
Background: The objective was to assess the sensitivity and specificity of pap smear and colposcopy and to study the socio demographic parameters of women with unhealthy cervix. Methods: This was a prospective observational study conducted from August 2011-August 2013 in the Department of Obstetrics and Gynaecology. Pap smear was performed by the conventional method and colposcopy was done for all 200 sexually active women who came with complaints of discharge per vagina, inter menstrual or post coital bleeding. Colposcopy results were analysed. Final correlation of pap smear and colposcopy were based on histopathology. Results: There were 200 samples that were suitable for statistical analysis. The sensitivity of colposcopy was 79.37%, specificity 81.02%, positive predictive value 65.79%, negative predictive value 89.52% respectively and accuracy was 80.5%. Pap smear had a sensitivity of 25.4%, specificity of 99.27%, positive predictive value of 94.12%, negative predictive value of 74.32%, and accuracy of 76.0% respectively. Conclusions: Pap smear had a poorer sensitivity compared to Colposcopy but a better specificity than colposcopy. Hence it may be better to utilise both tests as they complement each other in screening of premalignant lesions of cervix.
Role of Colposcopy in the Evaluation of Unhealthy Cervix and Cervical Intraepithelial Neoplasia
Journal of Evidence Based Medicine and Healthcare, 2020
BACKGROUND Invasive cancer of cervix is preventable because it has a long pre-invasive phase, cervical cytology screening is possible, and the treatment of pre-invasive lesions is effective. There are various methods available for screening of cervical precancerous and cancerous lesions like Visual Inspection by Acetic Acid (VIA), Visual inspection by Lugol's Iodine (VILI), conventional pap smear, liquid based cytology, colposcopy and HPV DNA testing. But, negative cytology does not rule out cervical intraepithelial lesions (CIN) completely. In this study we have studied patients with symptoms, abnormal appearing cervix, and patients with abnormal cytology by colposcopy to detect intraepithelial neoplasia of cervix. METHODS In this cross-sectional observational study of 149 subjects, women attending outpatient department of Obstetrics and Gynaecology who were symptomatic for recurrent and persistent vaginal discharge, postcoital bleeding, menstrual abnormalities were examined by per speculum examination and cervical cytology obtained. In indicated patients, colposcopy was done and colposcopic directed biopsy of lesions was taken for evaluation and the results compared. RESULTS Colposcopy showed accurate estimation in 57.89% cases, over estimation in 36.84% cases and under estimation in 5.26% cases. Sensitivity of colposcopy in our study was 98.30%. Specificity of colposcopy in present study was 57.30%. Positive predictive value of colposcopy in our study was found to be 68.75%, negative colposcopy value was 96.66%. Prevalence of CIN in our study group was found to be 39.43%. CONCLUSIONS Colposcopy was found to be useful in understanding the morphology of the cervical lesions, both of the benign and neoplastic and this was very helpful in planning their management. In spite of less specificity and less positive predictive value in our study, a detailed colposcopic evaluation of cervix with a guided biopsy is recommended as an important diagnostic method for the detection of precancerous lesions and early cervical cancer.
International Journal of Health Sciences and Research, 2012
Objective: Worldwide, cervical cancer is the 2nd most common cancer in women. 80% of all the cases of cervical cancer occur in the developing countries. Cervicovaginal cytology (Pap) is an effective means of screening for cervical lesions. The objective of this study is to determine the prevalence of abnormal cervical lesions with respect to clinicopathological and social aspect of cancer screening in rural India. Material and Methods: This was hospital based study of 930 Pap smears. The time period was from June 2004 to June 2009. The patients presented with leucorrhoea, low back pain, irregular vaginal bleeding, dyspareunia were included. Unsatisfactory smears and patients without clinical history and age were excluded from the study. The 2001 Bethesda system of interpretation of smears was used as a guideline. Result: In this study, leucorrhoea was the main common complaint (69.3%) followed by low backache (33.5%). Majority (36.5%) of the patients belongs to 3-4 decades with mean...
THE PROFESSIONAL MEDICAL JOURNAL, 2016
The aim of our study is to compare the efficacies of Pap smear cytology, 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 consisted of women ranging from age 18 to 80 years old, who had come to the outpatient clinics for a variety of symptoms. Pap smear, colposcopy and histopathology was done for women who had symptoms 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. Data was analyzed using SPSS version 23. Results: The mean age was 45 +/-9 years (between 24-75 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 group n=63 had abnormal histopathology (p<0.001) abnormal histopathology was found in n=11 women who had normal colposcopic findings (16.67% false negative), the calculated sensitivity and specificity of colposcopy was determined to be 86% and 79%. For pap smear abnormality was found in n= 49 patients, out of which n=29 had abnormal findings on histopathology as well. And for colposcopy and pap smear out of n= 78 patients who had abnormal colposcopic findings, abnormal pap smear was found in only n= 28 patients. And out of those who had normal colposcopy n= 67, n= 21 had abnormal pap smear (False positivity of 31.34%) similarly out of those who had normal pap smear n= 96, n= 44 had abnormal histopathology (false negativity of 45.83%). The calculated sensitivity and specificity of pap smear was 38.8% and 71.8% respectively. Conclusion: We have concluded that there is a strong correlation between findings of colposcopy and histopathological diagnosis, but when it comes to the diagnosis made by pap smear and colposcopy and pap smear and histopathology the correlation is weak and not consistent.
Journal of SAFOMS, 2017
Introduction: Cervical cancer is the second most common cancer in women worldwide, and it is the principal cancer of women in most developing countries, where 80% of cases occur. This disease is preventable by screening and treatment of preinvasive condition. All sexually active women are at risk of acquiring a human papillomavirus (HPV) infection that may lead to cervical cancer in the future. Cervical cancer is a preventable disease as the different screening, diagnostic, and therapeutic procedures are effective. The screening procedures are visual inspection of cervix with acetic acid (VIA), Pap smear, colposcopy, and HPV deoxyribonucleic acid test. Among them, colposcopy is effective in screening, taking colposcopy-directed biopsy as well as treatment of cervical intraepithelial neoplasia (CIN), such as cold coagulation, cryotherapy, and loop electrosurgical excision procedure. Hence, there is an obvious need to subject the women with VIA-positive report to colposcopy and directed biopsy. This study is done to evaluate the role of colposcopy in evaluation of VIA-positive cases. Objective: Colposcopic evaluation of VIA-positive cases and detection of precancerous lesion of cervix for early management. Materials and methods: This was a cross-sectional study done among married female patient aged 22 to 65 years, who had VIA-positive report, and attending the colposcopy clinic in the Department of Obstetrics and Gynecology of Sir Salimullah Medical College and Mitford Hospital from January 2014 to December 2016. Colposcopy-directed punch biopsy was taken from the abnormal colposcopic appearance and specimen sent for histopathological examination. Results: Out of 97 cases, all had VIA-positive acetowhite areas. But colposcopy revealed that 76.29% had CIN and invasive lesions, while 23.71% had either normal or inflammatory lesions. Colposcopy-directed punch biopsy revealed that 59.79% cases had positive lesions like CIN or invasive carcinoma and 40.21% had neither CIN nor invasive lesions. Among positive lesions, about 34.02% had CIN I, 3.09% had CIN II, 0% had CIN III, and 22.68% had invasive carcinoma. In this study, sensitivity and specificity of colposcopy examination were found 94.83 and 51.28% respectively. Conclusion: Cervical cancer presents as major cause of morbidity and mortality, especially in developing countries like Bangladesh. In developing countries, the various screening programs are implemented for its early detection and treatment. It is evident that colposcopy plays a very important role in early diagnosis and treatment of preinvasive and early invasive carcinoma of cervix. So wide use of colposcopy in screening program of Bangladesh can reduce many young women's morbidity and mortality.
Cervical Cytology Associated with Leucorrhea in Rural Women of India
2019
Vaginal discharge is the major gynaecological symptom complained by the rural women in India. The detailed cytological investigation is thus necessary to find out the relation between this symptom with predisposing factors of carcinoma cervix. Cervical cancer screening is in progress in the villages of Lucknow West under the auspices of Era's Lucknow Medical College and Hospital Lucknow since May 2013 and till November 2018, a total of 2665 women have been cytologically examined.The vaginal discharge was complained by 1024 of these women and cytological findings have been analyzed in them in relation to different predisposing factors of cervical carcinogenesis. Inflammatory smears was found to the major component of cytology material in 1024 leucorrhic women (49.5%) while squamous intraepithelial lesions of cervix (SIL) was seen in 19.4% of cases. The inflammation was specific in 50.3% of cases and sexually transmitted diseases (STD) like Cocobacilli and Candida was most commonl...
Cervical Cytopathology in women attending rural area at Tertiary Care Hospital
IP Innovative Publication Pvt. Ltd., 2017
Aims and Objectives: Cervical cancer has always been a growing concern in developing countries like India. Prevent ability at pre malignant/pre invasive stages has yearned the need for studying screening methods in detail. This study recapitulates the importance of PAP smear as affordable, sensitive screening method and need for repetitive and continuous testing in preventing invasive cancer. Material and Methods: The prospective study spanning for a year (July 2015 to June 2016) consisted of 1990 patients who presented with various gynecological symptoms. All patients were screened by cervical smear stained with PAP stain. Evaluation of the smears carried out by cytopathologist as per The 2001 Bethesda reporting system. Results: 1990 patients study showed inflammatory lesion 1164 (58.49%), metaplasia 46 (2.31%), LSIL 10(0.50), HSIL 4(0.20%), SCC 12(0.60%), ASCUS 72 (3.62%), AGUS 2 (0.1%), atrophy 52(2.61%), inadequate for evaluation 238(11.97%) and 390(19.6%) didn't show any significant pathology. Majority of the patients in our study had non neoplastic inflammatory lesions. Neoplastic lesions (premalignant and malignant) were observed in 100 (5.02%) patients and were seen in 41-70 years age group. Conclusion: The cervical neoplasia is common in 41-70 years, and they can be subjected to repeated Pap screening program to detect the early lesions (dysplasia) and treated appropriately to prevent cervical cancer.