Diagnosis of cervical lesion by colposcopy, VIA, pap smear tests, and their correlation with histopathology in a tertiary level laboratory in Chattogram, Bangladesh
DOI:
https://doi.org/10.18203/2320-6012.ijrms20230563Keywords:
Biopsy, Cervical cancer, Cervical intraepithelial neoplasia, Colposcopy, Pap smear, VIA testAbstract
Background: Cervical carcinoma is one of the most common causes of mortality among women. This mortality rate can be reduced by early detection of cervical neoplasm by different screening tests. The main objective of this study was to diagnose cervical diseases by colposcopy, by pap smears for cytological examination as well as correlate these findings as screening tests with histopathological diagnosis.
Methods: In this cross-sectional observational study, total 143 cases were included. History was taken and clinical examination was done. Colposcopy and VIA test was done, pap smear sample was collected and reporting was made. Cytological findings were correlated with histopathology.
Results: Mean age of the study cases was 41.2±11.5 years. VIA test was positive in 98 study cases (68.5%). On colposcopy, most of the cases show neoplastic proliferation (80 cases, 55.9%). Among them, most cases were diagnosed as cervical intraepithelial neoplasia-I (CIN-I). Sixty-three (63) cases (44.1%) were non-neoplastic. Most of the biopsies was diagnosed histopathologically as cervical intraepithelial neoplasia-I (CIN-I) (20 cases, 14.0%). Association of colposcopy findings with histopathological diagnosis was done which was significant. Sensitivity of diagnosis of cervical malignancy by colposcopy was 33.33% and specificity was 98.57%.
Conclusions: The study provides good cyto-histopathology correlation in detecting different cervical lesions and malignancy with colposcopy. Although colposcopy sensitivity was low but it can be increased by adequate training and avoiding technical errors. Bethesda system is strongly recommended for adequacy of sampling to minimize inconsistency. Early and regular screening should be advised for reduction of mortality rates from cervical carcinoma.
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References
Hoque MR, Haque E, Karim MR. Cervical cancer in low‐income countries: a Bangladeshi perspective. Int J Gynecol Obstet. 2021;152(1):19-25.
World Health Organization. Reproductive Health, World Health Organization, World Health Organization. Chronic Diseases, Health Promotion. Comprehensive cervical cancer control: a guide to essential practice. World Health Organization; 2006.
Bruni LB, Barrionuevo-Rosas L, Albero G, Serrano B, Mena M, Gómez D et al. Human papillomavirus and related diseases report. ICO/IARC Information Centre on HPV and Cancer (HPV Information Centre). 2019:307.
Sankaranarayanan R, Nene BM, Shastri SS, Jayant K, Muwonge R, Budukh AM, et al. HPV screening for cervical cancer in rural India. N Engl J Med. 2009;360:1385-94.
Bodal VK, Brar BK, Bal MS, Kaur B, Kaur S, Suri AK. Correlation of pap smear with histopathological findings in malignant and non-malignant lesions of cervix. Glob J Med Res E Gynecol Obstet. 2014;14:19-23.
Solomon D, Davey D, Kurman R, Moriarty A, O'Connor D, Prey M, Raab S, Sherman M, Wilbur D, Wright Jr T, Young N. The 2001 Bethesda System: terminology for reporting results of cervical cytology. Jama. 2002;287(16):2114-9.
Malpani G, Agrawal P, Varma AV, Khandelwal N, Tignath G. Cervical pap smear study and detection of abnormal epithelial lesions and determination of its accuracy by cytohistological correlation in patients of tertiary care teaching hospital in central India. Int J Reprod Contracept Obstet Gynecol. 2016;5(7):2312-6.
Gopalani SV, Janitz AE, Campbell JE. Trends in cervical cancer incidence and mortality in Oklahoma and the United States, 1999-2013. Cancer Epidemiol. 2018;56:140-5.
King AL, Clay KE, Felmar EU, Heustis DG, Karns RM, Krahl PA, et al. The Papanicolaou smear. West J Med. 1992;156(2):202.
Wentzensen N, Massad LS, Mayeaux Jr EJ, Khan MJ, Waxman AG, Einstein MH, et al. Evidence-based consensus recommendations for colposcopy practice for cervical cancer prevention in the United States. J Lower Genit Tract Dis. 2017;21(4):216-22.
Andrews JC, Bogliatto F, Lawson HW, Bornstein J. Speaking the same language: using standardized terminology. J Lower Genit Tract Dis. 2016;20(1):8-10.
Gage JC, Schiffman M, Hunt WC, Joste N, Ghosh A, Wentzensen N, et al. Cervical histopathology variability among laboratories: a population-based statewide investigation. Am J Clin Pathol. 2013;139(3):330-5.
Singh P, Ilancheran A. The'Pap'or cervical smear and the role of colposcopy in screening for carcinoma of the cervix. Singapore Medical Journal. 1989;30(3):302-5.
Patel MM, Pandya AN, Modi J. Cervical pap smear study and its utility in cancer screening, to specify the strategy for cervical cancer control. Nat J Community Med. 2011;2(01):49-51.
Naik R, Minj AM, Panda R, Satpathi S, Behera PK, Panda KM. Cytohistological correlation and accuracy of the pap smear test in diagnosis of cervical lesions: a hospital based cross-sectional study from Odisha, India. Med Sci. 2015;3(3):242-9.
Poli UR, Bidinger PD, Gowrishankar S. Visual inspection with acetic acid (via) screening program: 7 years’ experience in early detection of cervical cancer and pre-cancers in rural South India. Indian J Community Med. 2015;40(3):203.