Role of PAP smear N cervical biopsy in unhealthy cervix

Carcinoma of cervix is the third most common cancer in women worldwide & most common female cancer in many developing countries like India. The present study was done with an objective to correlate the finding in women with unhealthy cervix by cytology and cervical biopsy and to assess the utility of these in detecting the premalignant and malignant lesions of the cervix. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of Pap smear were compared with cervical biopsy which was taken as confirmatory. Majority of patients were from age group of 31- 40 years (41%). The mean age of cervical intraepithelial neoplasia (CIN) and invasive carcinoma are 50.6% and 49.37%. Majority of cases with abnormal cervical lesion were in the multiparous women (parity from 2 to 4) which constituted 88 (73.34%) cases out of 120 cases. The mean parity of neoplastic lesions was around 3.35 and for invasive carcinoma it was around 4.42 in the present study. The incidence of CIN (45%) and invasive carcinoma (77.14%) was found to be higher among the low socio- economic group. CIN and invasive carcinoma was more prevalent among the illiterates, in the study 50% of CIN and 57.15% of invasive carcinoma cases was found among the illiterates. The incidence of CIN was 40% and of invasive carcinoma was 67.18% in women who were married before 20 years of age. Majority of women complained of excessive white discharge per vaginum (68.34%) and among them 13.12% (16/82) of women had CIN. In the present study 94% cases of postmenopausal bleeding were diagnosed to have CIN and invasive carcinoma and 51.54% cases of irregular bleeding were diagnosed to have CIN and invasive carcinoma. The gross appearances of cervix revealed cervical erosion in 38.34% (46/120) of cases, rest of the cases showed growth in 27.5%, congestion in 10%, Hypertrophy with congestion seen in 5.84%, Hypertrophy with erosion was seen in 11.66% and polyp was found in 4.16% of cases. Majority of cases with invasive carcinoma showed growth in the cervix (94.2% cases). In the present study pap test revealed inflammatory smears in 55% of cases, mild dysplasia in 5.84%, moderate dysplasia in 6.66%, severe dysplasia in 5.84% and invasive carcinoma was seen in 22.5% of cases. Sensitivity of pap smear was 86.5% and specificity was 92.18% in the present study. The positive predictive value was 90.7% and the negative predictive value 89.4 %. The accuracy of pap smear was found to be 90%.