Proportion and Pattern of Epithelial Cell Abnormalities in Cervical SmearsA Retrospective Study

Introduction: Cervical cancer is a leading cause of mortality andmorbidity among women worldwide. Approximately, 90% deathsdue to cervical cancer occur in developing countries like India.Papanicolaou (Pap) smear test is an efficient, cost-effectivescreening tool to identify epithelial abnormalities in the preinvasiveand early invasive stages of cervical cancer. Knowledge of theproportion and pattern of abnormal Pap smears in the localpopulation is essential to ensure the early detection and treatmentof precancerous lesions of cervix, thereby reducing the morbidityand mortality resulting from cervical cancer, which at present ispreventable to a large extent.Aim: To estimate the proportion of cervical epithelial abnormalitiesin the local population and describe the morphological patterns ofabnormalities employing the 2014 revised Bethesda system.Materials and Methods: This was a retrospective, hospital recordbased descriptive study conducted in a tertiary care centre inKerala, India from January 2016 to December 2018. Altogether,9330 cervical smears stained using Pap method were retrievedfrom slide archive and evaluated. Data was collected from casenotes, request forms and cytology registers. Morphological analysiswas done using the revised 2014 Bethesda system. Proportionof smears showing epithelial cell abnormalities and categories ofepithelial abnormalities were expressed as percentages.Results: A total of 9330 samples were studied. The proportion ofepithelial abnormalities was 1.70%, of which Atypical SquamousCells of Undetermined Significance (ASCUS) was the most frequent(1.38%), followed by Atypical Squamous Cells cannot exclude anHigh-grade squamous intra epithelial lesion (Atypical squamouscells-H) [HSIL (ASC-H)] (0.13%). Women with epithelial abnormalitiesbelonged to a wide age range of 31-70 years, with majority in the41-50 years age group. Most of the patients with abnormal Papsmears (62.3%) had normal looking or unremarkable cervix.Conclusion: The proportion and pattern of cervical epithelialabnormalities in the local population of Kerala is comparable tothat of developed nations. Patients for cervical cancer screeningcannot be selected based on clinical features or appearance ofcervix. Even in the absence of gynaecologic complaints, screeningfor cervical cancer must be done at regular intervals and Papsmear test should be employed as a routine screening procedurefor all women above 30 years of age. Special measures need tobe taken to ensure that postmenopausal females are screened forcervical cancer.