Research Article
Volume 1 Issue 3 - 2015
Frequency of Cervical Intraepithelial Neoplasia in the Patients Screened By Pap Smear at a Tertiary Care Setup
Shahida Akhtar1, Mehwish Malik2 and Waqar Ahmed3
1Professor and Consultant Gynaecologist, FFH & FUMC, Pakistan
2Resident Gynaecology and Obstetrics, FUMC, Pakistan
3House Officer, CMH, Pakistan
Corresponding Author: Shahida Akhtar, Professor and Consultant Gynaecologist, FFH & FUMC, Pakistan.
Received: May 16, 2015; Published: May 27, 2015
Citation: Shahida Akhtar., et al. “Frequency of Cervical Intraepithelial Neoplasia in the Patients Screened By Pap Smear at a Tertiary Care Setup”. EC Gynaecology 1.3 (2015): 100-102.
Abstract
Objective: To determine the frequency of Pap smear results in a sample of females presenting to the Gynaecology OPD of FFH Rawalpindi and to emphasize role of Cervical Cancer screening by Pap smear in reducing the incidence of Hysterectomy.
Study Design: Cross sectional study.
Duration and Setting: Our study was carried out from January to July 2014 in the Gynaecology and obstetrics department of FUMC and FFH Rawalpindi.
Materials and Methods: A sample of 222 patients presenting to the Gynaecology & obstetrics OPD with abnormal vaginal discharge and/or lower abdominal and pain were included in our study. These patients were screened using Pap smear test and the samples were sent to the Histopathology Dept of FFH Rwp. The results were analysed, frequency/percentages calculated and charts were plotted using Microsoft Excel software.
Results: Out of the 222 pap smears done, 182 (81.9%) revealed normal study, 23 (10%) chronic infection, 9 (4%) squamous intraepithelial lesion, 3 (1.35%) bacterial vaginosis while 5 (2.25%) smears were scanty. Among the 9 patients who screened positive for Squamous Intraepithelial Lesion, 7 were from post-menopausal age group whereas 2 were peri-menopausal.
Conclusion: The frequency of Cervical Intraepithelial Neoplasia in a sample of patients presenting to our tertiary care setup is 4%.
Keywords: Pap smear; CIN; SIL
Introduction
In developing countries, cervical cancer is the most common gynaecological cancer and one of the leading causes of cancer death [1]. Cervical cancers can be prevented through early detection and cervical smear is a sensitive test for it [2]. Prevention of cervical cancer has been intensively studied in order to reduce or eliminate the occurrence of this significant disease, which has a negative impact on population mortality and morbidity [3]. The ability to screen and treat women for preinvasive disease, cervical dysplasia, is the key factor leading to the reduction in the incidence of invasive cervical cancer [4].
Materials and Methods
Retrospective cross sectional survey was done from Jan 2014 to July 2014 on patients reporting to Gynaecology OPD FFH. Data was collected from cytology department where the pap smears of patients were reported. The data was analysed retrospectively, Pap smear was performed on all the patients who presented to Gynaecology OPD with complaints of chronic per vaginal discharge and lower abdominal pain, those who have normal looking cervix on visual inspection and those who do not have.
Results
Out of the 222 pap smears done, 182 (81.9%) revealed normal study, 23 (10%) chronic infection, 9 (4%) squamous intraepithelial lesion, 3 (1.35%) bacterial vaginosis while 5 (2.25%) smears were scanty. Among the 9 patients who screened positive for Squamous Intraepithelial Lesion, 7 were from post-menopausal age group whereas 2 were peri-menopausal. Our results are demonstrated in the tabulated and graphical form as follows.
Figure 1: Frequency and percentages of pap smear results.
  Normal pap smear Squamous intraepithelial lesion Chronic infection Bacterial vaginosis Scanty
Frequency 182 9 23 3 5
Percentage 81.9% 4% 10% 1.35% 2.25%
Table 1: Frequency and percentages of pap smear results.
Age Menstrual Status Cervical Findings
43 Peri menstrual Normal looking
60 Post-menopausal Cervix flushed with vagina
49 Post-menopausal Normal looking
62 Post-menopausal Cervix flushed with vagina haemorrhagic punctae on cervical lips
43 Peri menopausal Normal looking
50 Post-menopausal Unhealthy looking cervix
58 Post-menopausal Unhealthy looking cervix
60 Post-menopausal Unhealthy looking cervix
48 Post-menopausal Cervix flushed with vagina
Table 2: Age, Menstrual status and cervical findings of SIL positive patients.
Discussion
Cervical cancer is 2nd most common malignancy in sexually active females and 3rd most common gynaecological malignancy causing death. Early detection of this malignancy can prevent the morbidity and mortality associated with cervical cancer. Pap smear is easy and cost effective method for screening of such patients. In our study all the patients who presented with abnormal PV discharge were undergone Pap smear. 4% of patients were positive for squamous intraepithelial lesions with mean age of 52 years. 3 patients had normal looking cervix. Rest of the patients had unhealthy cervix. Therefore besides having normal looking cervix patient should be screened for cervical malignancy especially those who present with vaginal discharge.
Conclusion
The frequency of Cervical Intra-epithelial Neoplasia in a sample of patients presenting to our tertiary care setup is 4%. Out of these, 3 patients had normal looking cervix. Rest of the patients had unhealthy cervix. Therefore there should be a high index of suspicion of cervical malignancy in patients with abnormal vaginal discharge even if they have a normal looking cervix.
Bibliography
  1. Mayrand MH., et al. “Human Papilloma virus DNA versus Papanicolaou Screening Tests for Cervical Cancer”. The New England Journal of medicine 357.16 (2007): 1579-1588.
  2. Yeasmin S., et al. “PAP-Smear Study and its Utility in Cervical Cancer Screening in a Tertiary Care Hospital in Chittagong, Bangladesh”. Chattagram Maa-O-Shishu Hospital Medical College Journal 13.1 (2014): 1.
  3. Julinawati S., et al. “A Review of the perceived barriers within the health belief model on pap smear screening as a cervical cancer prevention measure”. Journal of Asian Scientific Research 3.6 (2013): 677-692.
  4. O'Meara AT. “Present standards for cervical cancer screening”. Current Opinion in Oncology 14.5 (2002): 505-511.
Copyright: © 2015 Shahida Akhtar., et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

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