Correlation between cervical colposcopic findings, PAP smear and Liquid Based Cytology (LBC) in cervical cancer

Background: Cervical cancer remains a major public health problem, particularly in developing countries where access to effective screening programs is limited. Early detection of premalignant cervical lesions through screening modalities such as Papanicolaou (Pap) smear, Liquid-Based Cytology (LBC), and colposcopy can significantly reduce morbidity and mortality. This study was taken with the intension of integration of colposcopy with Pap smear and LBC which significantly enhances the diagnostic accuracy of cervical cancer screening. Methods: This prospective observational study was conducted in the Department of Obstetrics and Gynaecology, Era’s Lucknow Medical College and Hospital, Lucknow, over 24 months. A total of 100 women aged 21-65 years who were sexually active for at least three years. All participants underwent Pap smear, LBC, and colposcopic examination using Visual Inspection with Acetic Acid (VIA) and Lugol’s Iodine (VILI). Colposcopic findings were graded using the SWEDE scoring system. Results: Vaginal discharge (54%) and lower abdominal pain (49%) were the predominant presenting complaints. Pap smear findings were negative in 85% of cases, while LBC was negative in 83%. HSIL was identified in 5% of women by both modalities. Most participants (91%) had low SWEDE scores (0-4). A significant association was observed between higher SWEDE scores and cytological abnormalities on both Pap smear and LBC (p < 0.001). Sixty percent of women with HSIL demonstrated SWEDE scores of 7-10. Agreement between Pap smear and LBC was excellent (?=0.895, p < 0.01). Both Pap smear and LBC demonstrated identical diagnostic performance with sensitivity of 68.18%, specificity of 100%, positive predictive value of 100%, negative predictive value of 91.76%, and overall accuracy of 93%. Colposcopy showed a sensitivity of 40.91%, specificity of 100%, and diagnostic accuracy of 87%. Conclusion: A strong correlation exists between cervical cytological findings and colposcopic SWEDE scores. Pap smear and LBC demonstrated excellent concordance and comparable diagnostic performance, supporting the use of LBC as a reliable alternative to conventional cytology. SWEDE scoring effectively stratifies lesion severity and complements cytological evaluation, facilitating early detection and appropriate management of cervical epithelial abnormalities.