Cyto-histo correlation of conventional Pap smear with cervical biopsy in diagnosis of precancerous and cancerous lesions of cervix

Introduction: Carcinoma of uterine cervix is the third most common cancer among women worldwide and it contributes significantly to cancer related morbidity and mortality. The incidence of cervical carcinoma is incredibly high in developing countries (almost 80%) due to lack of proper knowledge. The extensive use of cervical screening with Pap smears has considerably increased the detection of precancerous and cancerous lesions of uterine cervix. Aims: To evaluate cyto-histo correlation of precancerous and cancerous lesions of uterine cervix and to calculate the sensitivity and specificity of Pap smear in diagnosing invasive malignancy. Materials and Methods: This was a retrospective observational study conducted in the Department of Pathology, Chirayu Medical College & Hospital, Bhopal from January 2013 to April 2018. All the cases reported in Pap smear as cervical intraepithelial lesions and invasive malignancies were retrieved. We also retrieved the same cases, if they had undegone cervical biopsy for correlation. Result: During the study period total 303 cases which were positive for intraepithelial lesions and malignancies were retrieved. Out of these 303 cases we excluded 23 cases because in these cases cervical biopsy had not been done. So in the final analysis 280 cases were included. Of the 280 Pap smears, maximum cases (33.92%) were reported as low grade squamous intraepithelial lesion (LSIL), followed by high grade squamous intraepithelial lesion (HSIL) (24.28%), atypical squamous cells of undetermined significance (ASCUS) (19.64%), atypical squamous cells – cannot rule out HSIL (ASC-H) (10%). We had 23 cases of invasive malignancy which includes 21 cases of squamous cell carcinoma (SCC) and 2 cases of adenocarcinoma. There were 11 cases of atypical glandular cells of undetermined significance (AGUS). We found that total numbers of concordant cases were 68.57% (192/280) and discordant cases were 31.43% (88/280). We also found that sensitivity and specificity of cervical smear in diagnosing invasive malignancy were 61.76% and 99.1% respectively considering cervical biopsy as gold standard. Conclusion: The study revealed a good correlation between cervical cytology and cervical biopsy. We also concluded that conventional Pap smear is cost effective test for the early detection of precancerous and cancerous cervical lesions.