DOI: http://dx.doi.org/10.18203/2320-6012.ijrms20160520

Cytomorphological evaluation of squamous cell abnormalities observed on cervical smears in government medical college, Jabalpur, India: a five year study

Radhika Rajesh Nandwani, Sanjay Totade, Murali Gopala Krishnan

Abstract


Background: Cervical cancer is the fourth most common cancer affecting women worldwide, the most common cancer in women in several less developed countries, and now the second most common cancer in India. Cervical cytology by papanicolaou (PAP) smear test is an effective tool for detecting abnormal cytology in early stages, thus allowing early detection and treatment. The PAP smear is extremely important for detecting premalignant and malignant conditions of cervix. The study was conducted to determine; (1) Cytomorphologic incidence of various lesions of uterine cervix; (2) Categorization of detected lesions according to Bethesda system; (3) Determination of epithelial abnormalities by cervical cytology.

Methods: The settings and design of this study is a hospital based prospective study from a tertiary care centre in Central India. A total of 5813 conventional pap smear tests collected from January 2010 and December 2014 were analyzed. All patients attending outpatient department of obstetrics and gynecology for complaints of abnormal cervical discharge, dyspareunia, inter-menstrual bleeding, post-coital bleeding and lower abdominal pain were included. Various cervical pap screening camps were also done during this period. Smears were fixed and stained with hematoxylin & eosin (H&E) and papanicolaou stain were done.

Results: The overall frequency of normal, inadequate, inflammatory, and abnormal smears was 11.86%, 5.73%, 74.98% and 13.2% respectively. Atypical squamous cell carcinoma of undermined significance (ASCUS) was seen in 3.61%, squamous intraepithelial lesion (SIL) was seen in 5.36%, low grade squamous intraepithelial lesion (LSIL) was seen in 2.59% while high grade squamous intraepithelial lesion (HSIL) was seen in 2.77%. Invasive carcinoma was seen in 3.69%. The premalignant epithelial abnormalities like ASCUS, LSIL and HSIL were found to be highest in the age group of 31-50 years in our study, which correlated well with other similar studies.

Conclusions: Hence we should advocate regular cervical cytology (PAP) smear study, which can help to treat cervix lesions early before the progress into cervical cancer. Early detection is the only key to saving a woman’s life as the later the abnormalities are discovered; mortality, morbidity and treatment cost all increase.

 


Keywords


PAP smear, Screening, Cervical cancer, Premalignant lesions, ASCUS, LSIL, HSIL, SCC, Bethesda system

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References


Dhananjaya S, Aparna K. Current Status of Cancer Burden: Global and Indian scenario. Biomed Res J. 2014;1(1):1-5.

Miller AB, Chamberlain J, Day NE, Hakama M, Prorok PC. Report on a workshop of the UICC project on evaluation of screening for cancer. Int J Cancer. 1990;46:761-9.

Hakama M, Chamberlain J, Day NE, Miller AB, Prorok PC. Evaluation of screening programmes for gynaecological cancer. British Journal of Cancer. 1985;52(4):669-73.

Afrakhteh M, Khodakarami N, Moradi A, Alavi E, Shirazi FH. A study of 13315 papanicolaou smear diagnoses in Sohada hospital. J Fam Reprod Health. 2007;1:75-9.

Gakidou E, Nordhagen S, Obermeyer Z. Coverage of cervical cancer screening in 57 countries: low average levels and large inequalities. PLoS Med. 2008;5(6):e132.

Government of India - World Health Organization Collaboration Programme 2004-2005. Guidelines for cervical cancer screening programme; 2006.

Aswathy S, Quereshi MA, Kurian B, Leelamoni K. Cervical cancer screening: Current knowledge & practice among women in a rural population of Kerala, India. Indian J Med Res. 2012;136:205-10.

Murthy NS, Chaudhry K, Saxena S. Trends in cervical cancer incidence-Indian scenario. Eur J Cancer Prev. 2005;14:513-8.

Alliance for Cervical Cancer Prevention (ACCP). Planning and Implementing Cervical Cancer Prevention and Control Programs: A Manual for Managers. Seattle: ACCP;2004.

Kerkar RA, Kulkarni YV. Screening for cervical cancer: An overview. J Obstet Gynaecol India. 2006;56:115-22.

Anderson GH, Boyes DA, Benedet JL, Le Riche JC, Matisic JP, Suen KC, et al. Organization and results of the cervical cytology screening program in British Columbia. 1955-85. Br Med J (Clin Res Ed). 1988;296:975-8.

Miller AB. Cervical cancer screening programmes -Managerial guidelines. Geneva, World Health Organization, 1992.

National Cancer Institute: PDQ® Cervical Cancer Screening. Bethesda, MD: National Cancer Institute 10/26/2013. Available at: http:// www.cancer.gov/ types/cervical/ hp/ cervical-screening-pdq Accessed 10/26/2013.

Misra JS, Singh U. Results of long term hospital based cytological screening in asymptomatic women. Diagn Cytopathol. 2006;34:184-7.

Kapila K, George SS, Al-Shaheen A, Al Ottibi MS, Pathan SK, Sheikh ZA, et al . Changing spectrum of squamous cell abnormalities observed on papanicolaou smears in Mubarak Al Kabeer Hospital, Kuwait, over a 13 year period. Med Princ Pract. 2006;15:253-9.

Gupta K, Malik NP, Sharma VK, Verma N, Gupta A. Prevalence of cervical dysplasia in western Uttar Pradesh. Journal of Cytology / Indian Academy of Cytologists. 2013;30(4):257-62.

Kenneth DH, Yao SF. Cervical and vaginal cancer. In: Novak's Gynecology. 13th ed. Philadelphia: Lipincott Williams and Wilkins; 2002. pp. 471-93.

Khattak ST, Khattak I, Naheed T, Akhtar S, Jamal T. Detection of abnormal cervical cytology by pap smears. Gomal J Med Sci. 2006;4:74-7.

Pradhan N, Giri K, Rana A. Cervical cytology study in unhealthy and healthy looking cervix. N J Obstet Gynaecol. 2007;2:42-7.

Bal MS, Goyal R, Suri AK, Mohi MK. Detection of abnormal cervical cytology in Papanicolaou smears. Journal of Cytology / Indian Academy of Cytologists. 2012;29(1):45-7.

Patel TS, Bhullar C, Bansal R, Patel SM. Interpreting epithelial cell abnormalities detected during cervical smear screening- A cytohistologic approach. Eur J Gynaecol Oncol. 2004;25:725-8.

Mulay K, Swain M, Patra S, Gowrishankar S. A comparative study of cervical smears in an urban hospital in India and a population based screening program in Mauritius. Indian J Pathol Microbiol. 2009;52:34-7.

Sadan O, Schejter E, Ginath S, Bachar R, Boaz M, Menczer J, et al. Premalignant lesions of the uterine cervix in a large cohort of Israeli Jewish women. Arch Gynecol Obstet. 2004;269:188-91.

Tbistle PJ, Chirenje ZM. Cervical cancer screening in a rural population of Zimbabwe. Cent Afr J Med. 1997;43:246-51.

Gupta S, Sodhani P, Halder K, Chachra KL, Sardana S, Singh V, et al. Spectrum of epithelial cell abnormalities of uterine cervix in a cervical cancer screening programme: implications for resource limited settings. Eur J Obstet Gynecol Reprod Biol. 2007;134:238-42.

Ranabhat, SK, Shrestha R, Tiwari M. Analysis of abnormal epithelial lesions in cervical Pap smears in Mid-Western Nepal. Journal of Pathology of Nepal. 2011;1:30-3.

Saha K, Sengupta M, Mistry CJ. Cytological Findings of Conventional Cervical Papanicolaou Smears in a Tertiary care Hospital. Global Journal for Research Analysis. 2013;2(1)•ISSN No 2277 -8160.

Patel J, Choksi T, Shrivatava A, Maru A, Agnihotri A. Evaluation of cervical cytological abnormalities by using Bethesda system. PATHOLOGY AND LABORATORY MEDICINE Biennial Journal of GAPM. 2014;6(2). ISSN 0975 - 3109.

Bukhari MH, Saba K, Qamar S, Majeed MM, Niazi S, Naeem S. Clinicopathological importance of Papanicolaou smears for the diagnosis of premalignant and malignant lesions of the cervix. JCytol. 2012;29:20-5.

Misra JS, Srivastava S, Singh U, Srivastava AN. Risk-factors and strategies for control of carcinoma cervix in India: Hospital based cytological screening experience of 35 years. Indian J Cancer. 2009;46:155-9.