The Diagnosis of Cervical Dysplasia in a University Hospital Using Pap Smear and Colposcopy in the Western Region of Saudi Arabia: A Correlational Study

Abstract

Objectives To assess the diagnostic performance of Pap smear screening with or without human papillomavirus (HPV) testing and colposcopy in detecting preinvasive lesions of the cervix among women with reference to histopathological findings. Materials and methods We performed a retrospective study in a tertiary care center of the clinical and pathological records of women with evocative symptomatology. The diagnostic performance of Pap smear screening and colposcopy was analyzed. The sensitivity and specificity of Pap smear screening and colposcopy in detecting preinvasive lesions of the cervix were calculated in 388 patients. Results The mean age was 45.12 years, and the most frequent gynecological symptoms included abnormal bleeding (17.2%) and postcoital bleeding (10.9%). Histopathology showed abnormal results in 26.5% of the 388 patients, including cervical intraepithelial neoplasia 1 (CIN 1; 20.4%), CIN 2 (2.8%), CIN 3 (1.3%), and SCC (1.3%). Both Pap smear screening and colposcopy were highly sensitive in detecting CIN 1+ (94.2%vs.93.2%, respectively) and CIN 2+ (100.0% vs.95.8%, respectively) intraepithelial lesions; however, Pap smears had very low specificity in detecting both CIN 1+ (8.1% vs.73.7%, respectively) and CIN 2+ (8.0% vs. 59.3%, respectively) compared with colposcopy. When combined with HPV status, the specificity of Pap smear increased considerably. Conclusion It has become a high priority to improve the efficiency of cervical cancer (CC) screening programs by optimizing the practice of Pap smear screening, increasing the test specificity, and implementing systematic cytology-HPV co-testing.

Keywords: cervical dysplasia; colposcopy; correlations studies; histopathology; pap smear.

Figure 1. Papanicolaou smear interpretation according to the 2014 Bethesda system (N=448)

NILM: Negative for intraepithelial lesion or malignancy; ASCUS: atypical squamous cell of undetermined significance; ASC-H: atypical squamous cell cannot exclude HSIL; LSIL: low-grade squamous intraepithelial lesion; HSIL: high-grade squamous intraepithelial lesion; AGC-N: atypical glandular cells favor neoplastic; AGC-NOS: atypical glandular cells not otherwise specified; SCC: squamous cell carcinoma