A study of epithelial cell abnormalities of cervical cytology by Bethesda categorization with histopathological correlation in a rural tertiary care hospital – An institutional experience
Govindasamy Revathi, Subramanian Kalaivani Selvi, Saravanan Srivani, Erli Amel IvanABSTRACT
Introduction:
Carcinoma cervix is the most common cancer among women in India. Cervical cytology detects 90% of epithelial abnormalities and preinvasive conditions. Though histopathology is the gold standard for confirmation, cervical cytological smear findings can be used as an excellent screening tool for diagnosing cervical cancer at its early stage. Hence, we aimed to compare the cervical cytology diagnosis with biopsy findings in our institution.
Objectives:
To study the distribution of epithelial cell abnormalities in cervical PAP smear and to correlate with the histopathological findings.
Methodology:
This was a retrospective descriptive study carried out in the Department of Pathology for 2 years. The study included conventional cervical smears, which was reported as abnormal epithelial abnormality. Cyto-histopathological correlation was done in cases where biopsy details were available. The frequency of epithelial cell abnormalities, atypical squamous cell (ASC)/squamous intraepithelial lesion (SIL) ratio, and positive predictive value (PPV) were calculated manually.
Results:
A total of 3281 cervical PAP smears were examined; there were 165 (5%) cases of ASCs of undetermined significance (ASCUS), 32 (0.97%) cases of ASCs-high-grade intraepithelial lesions cannot be excluded (ASC-H), 10 (0.30%) cases of low-grade SIL (LSIL), 12 (0.36%) of high-grade SIL (HSIL), 4 (0.1%) cases of squamous cell carcinoma (SCC), 2 (0.06%) cases of atypical glandular cells not otherwise specified (AGNOS), and 1 (0.03%) case of endocervical adenocarcinoma. The ASC/SIL ratio is 9. Cyto-histopathology correlation was possible in 65 cases. PPV for ASCUS is (35%), ASC-H (50%), LSIL (75%), HSIL (75%), SCC (100%), AGNOS (0%), and adenocarcinoma (100%).
Conclusion:
ASCs were the most common epithelial abnormality. PPV was high for high-grade intraepithelial lesion and malignancies. Thus, PAP smear remains an effective tool for detecting epithelial cell abnormalities at regular intervals.