Retrospective Evaluation Study of Pap Smears in Patients with Unhealthy Cervix Attending Ain Shams Maternity Hospitals

Abstract

Background and Purpose: This study describes different types of cervical lesions diagnosed by Pap smears regarding their prevalence and clinico-pathologic correlation in Egypt. It also evaluates the cervical Pap smear as a method of early cancer detection in the cervix. Material and Methods: A retrospective study of cervical Pap smears in patients attended at the Maternity Ain Shams University Hospital, Early cancer detection unit (ECDU) in 3 years from January 2012 to December 2014. Statistical analysis done to evaluate the accuracy, specificity and sensitivity of the cervical Pap smear test. Results: In total 5054 Pap smears were screened in the study period. They were classified according to The Betheseda system 2001. Cases negative for intraepithelial lesion or malignancy constituted 96.8%, distributed as follows; Non-specific infection 53.6%, Gardenerella 6.6%, Candida 6.5%, Trichomonas vaginalis 1%, Chlamydia 1.8%, hyperplastic columnar cells 0.06% and normal smears 27%. The epithelial abnormalities constituted 3.2% and distributed as follows; Atypical squamous cell of undetermined significance (ASCUS) 0.25%, Low grade squamous intraepithelial lesion (LSIL) 2.5%, High grade squamous intraepithelial lesion (HSIL) 0.04%, Squamous cell carcinoma (SCC) 0.2%, Atypical glandular cells of undetermined significance (AGUS) 0.06%, Adenocarcinoma insitu (AIS) 0.02%, endocervical adenocarcinoma 0.04% and undifferentiated carcinoma 0.04%. The mean ages at diagnosis of women with infections, ASCUS, LSIL, HSIL, SCC, AGUS, AIS and adenocarcinoma were 39, 50.5, 38, 50, 56.5, 51.6, 52, 65 years respectively. There is a positive relation between parity and epithelial abnormalities (Mean parity=2.7). Statistical analysis and correlation between cytological and pathologic findings of cervical lesions in patients presented with unhealthy cervix (n=402) cases revealed that the Specificity of the cervical Pap smear 99.4%, Sensitivity 72.5% and Accuracy 97%. Conclusions: The detected rates of epithelial abnormalities demonstrated in this study emphasize the need of implementing an education and a screening program among Egyptian women. Cervical Pap smear, HPV vaccine, sexual education and HPV test are important prevention tools which can reduce morbidity and mortality from cervical carcinomas in the future. The cervical Pap smear test proved to be a reliable test for screening and early detection of precancerous and cancerous lesions of the cervix. To enhance its sensitivity, advanced techniques such as Liquid based cytology (LBC) should be introduced. Keywords: Pap smears, Cervical, Registry, Egypt, Betheseda system, Specificity, Sensitivity, Accuracy