Spectrum of Cervical PAP Smear in Tertiary Care Center

Background: In India cervical cancer is the leading cause of morbidity and mortality. Cancer of cervix is preventable, and can be diagnosed at the pre - malignant/pre - invasive stage with adequate and repetitive cytological screening by Papanicolaou (Pap) smears. Aim: The aim of the study is to evaluate the use of the Pap smear screening method for detection of precancerous lesions. Methods: All women who visited the outpatient gynecology clinic at civil hospital, Ahmedabad, from December 2019 to April 2020 for different clinical problems were recruited for the study. A total of 350 women who were sexually active and over 21 years of age were enrolled in the study. A clinical examination, an examination per speculum, and a vaginal examination were performed and a history taken for all women. A Pap smear was used for all women to screen for cervical cancer. The smear was obtained using an Ayrespatula and sent to the Pathology department. The Pap smear were reported by adopting ?The revised Bethesda System for reporting cervical cytology (2014 TBS)?. Results: A total of350samples were enrolled in the study. Out of 350 samples, 9 samples were unsatisfactory. Out of 341 samples which were satisfactory for evaluation14.2% (50 cases) were of NILM, 70.9 % (248 cases) were inflammatory, most of the smears showed non - specific inflammation which accounts for 61.4% (152 cases), followed by Bacterial vaginosis - 18.2% (45 cases), Trichomonas vaginalis - 8.4% (21 cases), Candida species - 6.7% (17 cases), Atrophic vaginitis - 5.3% (13 cases).12.3 % (43 cases) were of ECA. Amongst ECA, 6% cases were of ASCUS - most common age group is 30 - 39 years. 3.4% cases were of LSIL, 2% cases were of HSIL, 0.6% cases were of AGUS and 0.3% cases were of SCC. It was found that the most common clinical presentation was white and foul smelling discharge per vagina followed by uterine prolapse, cervical erosion, cervical growth and irregular vaginal bleeding. Conclusion: The most widely accepted screening method for cervical malignancy is Pap smear examination especially in developing countries like India. Pap smears can be used to diagnose inflammatory, premalignant and malignant lesions. All suspicious lesions on Pap smear should be followed by repeat Pap smear examination, colposcopy and cervical biopsy.