Study of vaginal cytology in reproductive age group women attending tertiary care teaching hospital
Abstract
Introduction-Lesions of the cervix are the commonest causes of chronic ill health in gynecologicalpractices. The cervix is a specially modified part of uterus with a histological and physiological entity of its own. It probably constitutes the most neglected and damaged part of female body.The accurate study of these vaginal and cervical lesions are needed because of chronic disability of the patient in the form of low backache, vaginal discharge, primary or secondary sterility and later predisposition to malignancy.
Materials and Methods- A total of 200 smears were studied from 200 women of reproductive age group attending gynecologicaloutpatient department and antenatal clinic of sultaniaZanana hospital, Bhopal who complained of symptoms like backache, discharge, and irregular vaginal bleeding. A detailed clinical and vaginal examination was done in every case and smears were collected for exfoliative cytology.Analysis of results were done by Odds ratio and multivariate logistic regression.
Results- 200 clinically diagnosed cases of benign lesions of cervix were taken up for detailed clinical and cytological study. Erosion was the commonest among all benign lesions, which was 58.5% . Next common lesion was chronic cervicitis 20%, chronic cervicitis with erosion 9%, 7% endocervicitis, 2% cervical polyp, 0.5% carcinoma cervix,and 3 % showed metaplasia on cytological examination.
Conclusion-Nonmalignant cervical lesions are extremely common, of these , cervical erosion and non- specific cervicitis are most frequently encountered.These are frequent cause of morbidity in women of reproductive age group, which if neglected progresses to malignancy with significant morbidity and mortality. Close follow up and histiologic examinations are necessary to avoid unnecessary spread of neoplastic disease and untimely death of patients. awareness about diseases in women of reproductive age group and diagnostic utility ofpapanicolau smear test is also a must.
Downloads
References
C adenovirus.J ClinPathol. 2004 Jun;57(6):612-7.
2. Toews HA. The abnormal PAP smear: A rationale for followup. Can Fam Physician 1983;29:759-62.
3. National Cancer Registry Programme (NCRP, ICMR). Timetrends in cancer incidence rates: 1982-2005. Bangalore:NCRP; 2009.
4. Papanicolaou GN, Traut HF. The diagnostic value of vaginalsmears in carcinoma of the uterus. Am J ObstetGynecol 1941;42:193-206.
5.world health organization.cervical cancer screening programme managerial guidelines.Geneva :WHO;2006Annals of Oncology 17 (Supplement 8): viii9–viii14, 2006 symposium article doi:10.1093/annonc/mdl982.Available fromnonc.oxfordjournals.org cited on feb 2015.
6.Guidelines for cervical cancer screening program Recommendations of expert group meeting. Government of india - world health organization collaborative programme(2004-2005), Department of Cytology &Gynaecological Pathology Postgraduate institute of medical education and Reasearch, chandigarhIndia,November 2006.Available from http://screening.iarc.fr/doc/WHO_India_CCSP_guidelines_2005.pdf cited on feb 2015.
7. Screening for Cervical Cancer Recommendations and Rationale; US Preventive Services Task Force Recommendations, 2003. Available from http://www.ahrq.gov/clinic/3rduspstf/cervcan/cervcanrr.pdf. [Last accessed 2011 Nov 09]. Cited on feb 2015
8. Nandkumar A, Ramnath T, Chaturvedi M. The magnitude ofcancer cervix in India. Indian J Med Res 2009;130:219-21. Available from www.ncbi.nlm.nih.gov Cited on feb2015
9. Rader AE, Rose PG, Rodriguez M, Mansbacher S, Pitlik D,Abdul-Karim FW. Atypical Squamous cells of undeterminedsignificance in women over 55.Comparison with the generalpopulation and implications for management.ActaCytol1999;43:357-62.8. Available from onlinelibrary.wiley.com/doi/10.1002/cncr.10140/pdf Cited on feb 2015 .
10. Burja IT, Thompson SK. Atypical glandular cells ofundetermined significance in women over age 55. ActaCytol1999;43:356-7.Available from www.amhsjournal.org/article.Cited on feb2015 .
11.Rana S, Jairajpuri ZS, Jetley S. Cervical smear cytology on routine screening in a semi urban population in New Delhi: A review of 610 cases. Arch Med Health Sci 2013;1:131-5 Available from http://www.amhsjournal.org/text.asp?2013/1/2/131/123025Cited on feb 2015 .
12. Demirhindi H, Nazhcan E, Akbaba M. Cervical cancerscreening in Turkey: A community based experience after60 years of Pap Smear usage. Asian Pac J Cancer Prev2012;13:6497-500. Available from www.amhsjournal.org/articleCited on feb2015 .
13. Roeters AM, Boon ME, van Haaften M, Vernooij F, BontekoeTR, Heintz AP. Inflammatory events as detected in cervicalsmears and squamous intraepithelial lesions. DiagnCytopathol 2010;38:85-93. Available from www.ncbi.nlm.nih.govCited on feb2015 .
14. Bukhari MH, Majid M, Qamar S, Niazi S, Syed SZ, Yusuf AW,et al. Clinicopathological study of Papanicolaou (Pap) smearsfor diagnosing of cervical infections. Diagn Cytopathol2010;40:35-41. Available from www.amhsjournal.org Cited on feb2015 .
15. Tirone NR, Souza CE, Michelin MA, Murta EF. Frequency ofinfectious agents for vaginitis in patients with a cytologicaldiagnosis of atypical squamous cells of undeterminedsignificance.Eur J GynaecolOncol2008;29(2):144-7. Available from http://www.ncbi.nlm.nih.gov Cited on feb2015 .
16. Rimdusit P, Yoosook C, Srivanboon S, Sirimongkolkasem R,Pumeechockchai W. Prevalence of genital herpes simplexinfection and abnormal vaginal cytology in late pregnancy inasymptomatic patients. Int J GynaecolObstet 1989;30:231-6. Available from www.amhsjournal.orgCited on feb2015 .
17. Wihite LN. An overview of screening and early detection ofgynaecologic malignancies.Cancer. 1993 Feb 15;71(4 Suppl):1400-5. Available from http://www.ncbi.nlm.nih.govCited on feb2015 .
18. Martin-Hirsch P, Lilford R, Jarvis G, Kitchener HC. Efficacyof cervical-smear collection devices: A systematic reviewand meta-analysis.Lancet. 1999 Nov 20;354(9192):1763-70. Available from http://www.ncbi.nlm.nih.govCited on feb2015 .
19. Solomon D, Davey D, Kurman R, Moriarty A, O’Connor D,Prey M, et al. The 2001 Bethesda System: Terminology forreporting results of cervical cytology. JAMA 2002;287:2114-9.avilable from http://www.ncbi.nlm.nih.govCited on feb 2015 .
20. Rader AE, Rose PG, Rodriguez M, Mansbacher S, Pitlik D,Abdul-Karim FW. Atypical Squamous cells of undeterminedsignificance in women over 55.Comparison with the generalpopulation and implications for management.ActaCytol1999;43:357-62.Available from http://www.ncbi.nlm.nih.gov Cited on feb2015 .
21. Moyer VA. U.S. Preventive Services Task Force. Screeningfor cervical cancer: U.S. Preventive Services Task Forcerecommendation statement..Ann Intern Med. 2012 Jun 19;156(12):880-91, W312. doi: 10.7326/0003-4819-156-12-201206190-00424. available from http://www.ncbi.nlm.nih.gov Cited on feb 2015 .
22. Afrakhteh M, Khodakarami N, Moradi A, Alavi E, Shirazi FH.A study of 13315 Papanicolaou smear diagnoses in Sohadahospital. J FamReprod Health 2007;1:75-9. Available from www.ncbi.nlm.nih.gov Cited on feb2015 .
23. Jamal A, Al Maghrabi JA. Profile of PAP smear cytology in thewestern region of Saudi Arabia. Saudi Med J 2003;24:1225-9. Available from http://www.ncbi.nlm.nih.govCited on feb2015 .
24. Altaf FJ. Cervical cancer screening with pattern of papsmear. Review of multicenter studies. Saudi Med J
2006;27:1498-502.Available from http://www.ncbi.nlm.nih.gov Cited on feb2015 .
25. Kapila K, George SS, Al-Shaheen A, Al Ottibi MS, PathanSK, Sheikh ZA, et al. Changing spectrum of squamous cellabnormalities observed on papanicolaou smears in MubarakAl Kabeer Hospital, Kuwait, over a 13 year period. Med PrincPract 2006;15:253-9.Available from http://www.ncbi.nlm.nih.gov Cited on feb2015 .
26. Balaha MH, Al Moghannum MS, Al Ghowinem N, Al OmranS. Cytological pattern and cervical Papanicolaou smear ineastern region of Saudi Arabia. J Cytol 2011;28:173-7.Available from www.jcytol.org/article.Cited on feb 2015.
OAI - Open Archives Initiative
