A retrospective analysis of cervical smears for detection of precancerous lesions

Correspondence: Dr Abhimanyu Jha, MBBS, MD Associate Professor, Department of Pathology Maharajgunj Medical Campus, TU, IOM, Kathmandu, Nepal Email: jhaabhimanyu@yahoo.com. Background: Diseases of the cervix are common in women. Detection of neoplastic lesions is of prime importance in the evaluation of cervical smears although their frequency is less than the non-neoplastic conditions. Reactive and inflammatory conditions, however, may mimic or obscure the dysplastic changes. The aim of this study was to evaluate the frequencies of various inflammatory, reactive and neoplastic lesions in the cervical smears.

4][5] Intraepithelial neoplasia is a very critical point in the natural history of cervical carcinoma.In present study we evaluated cervical smear findings to detect frequency of various inflammatory, reactive and neoplastic lesions.

MATERIALS AND METHODS
This was a retrospective study of 150 cases of cervical smears.Prior to the study permission was obtained from institutional review committee.The data was obtained from the medical record section and Department of Pathology at National Medical College, Birgunj, Nepal from April 2013 to April 2015.The 2001 Bethesda system was used to categorize the smears.The findings were tabulated and analyzed in Microsoft Excel vesion 2007.

RESULTS
Out of 150 cases 100 cases did not reveal any significant pathology.Age range was 20 to 60 years.Epithelial cell abnormalities were detected in 25-60 yrs of age.Epithelial cell abnormalities were detected in only 15 cases (10%) while eight cases had specific infections (table 1).Among epithelial cell abnormalities LSIL was the commonest findings (60%) followed by HSIL, AGC and squamous cell carcinoma (table 2).

DISCUSSION
Cervical cancer is one of the leading causes of mortality and morbidity among women throughout the world.In developing countries it is the most common gynecological cancer and one of the leading causes of cancer death among women.Nearly four lacs new cases of cervical cancers are diagnosed annually worldwide and 80% of them are diagnosed in the developing countries. 6There should be an effective mass screening program aimed at specific age group for detecting precancerous condition before they progress to invasive cancers. 7Detection of epithelial cell abnormality as per guidelines of Bethesda system is mainstay in the detection of precancerous lesion in cervical smears. 8 present study 10% of the cervical smears showed epithelial cell abnormalities.Mean age for epithelial cell abnormality was 40 year.Mean age was almost similar for LSIL and HSIL.Mean age of patients was 51.02±10.18years in the study of Ranabhat et al. 9 Mean age of the patients with diagnosis of LSIL was 32.3 years and for HSIL it was 40.5 years in the study of Bal et al. 10 In the study by Banik et al involving 1699 patients, the epithelial cell abnormality was seen in 8.18% cases. 11In the study of Bal et al and Ahmed et al, it was seen in 5% and 1.3% respectively, and the former study involved only 300 cervical smears and later involved 7772 cases. 11,12In this study the frequency of epithelial cell abnormality is high as compared to other studies which can be as a result of less number of cases involved in the study.
Among epithelial cell abnormalities most common finding was LSIL that was followed by HSIL, AGC and SCC.In the study of Banik et al (n=1699) LSIL was detected in 6.36% of cases, HSIL in 1.18% cases, AGC in 0.12% cases and malignancy in 0.35% of total cases. 11Considering the total cases in present study LSIL, HSIL, AGC and SCC were 0.06%, 0.02%, 0.01% and 0.006% respectively (table 2), while in the study by Ahmed et al (n=7772) these findings were, LSIL (0.19%), HSIL (0.37%), AGC (0.25%), and SCC (0.10%) respectively. 12Contrary to above studies in the study of Ranabhat et al HSIL was the commonest finding among epithelial cell abnormality. 9In present study specific infections were detected only in eight cases.In five cases it was bacterial vaginosis and in three cases it was candidiasis.In the study of Ranabhat et al Candidiasis, Trichomonisis, bacterial vaginosis and Herpes simplex infections were detected in nine cases (1%), four cases (0.45%), 67 cases (7.6%) and in three cases (0.34%) respectively unlike present study.9In the study Shurbaji et al Candida was identified in 309 (3.0%) of the 10,370 smears.Ninety-nine (72%) patients were asymptomatic, 29 (21%) had symptoms typical of candidasis, and nine (7%) had nonspecific symptoms. 13In present study although the number of cases was not comparable to the study of Shurbati et al, however, the percentage of detection of candida in cervical smears was similar and patient was asymptomatic.

CONCLUSION
Conventional cervical smear screening remains the effective method of detection of precancerous lesions of cervix.Detection of either squamous or glandular intraepithelial lesions remains mainstay in the prevention of cervical cancer.This test also contributes in detection of various infectious agents that may associated with significant morbidity and cervical carcinogenesis.