Clinical correlation of CC screening using Pap smear test

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Yasamin Hamza Sharif


Cervical Pap smear, abnormal smear, Human papilloma virus, PCR.



Background and objectives: The cervical cancer (CC) has its long pre-invasive stage, which allows for a preventive detection and possible cure. In this study, this stage was a target stage to investigate women with precancerous lesions by applying the Papanicolaou (Pap) smear test and perform a correlation study.

Patients and methods: A two-year cross sectional study was conducted, in which 200 married women (21-60 years old) were participated in the investigation, which included women with Pap-test abnormal results (atypical squamous cells of undetermined significance (ASCUS), low-grade squamous intraepithelial lesion (LSIL), and high-grade squamous intraepithelial lesions (HSIL)), which were sent to perform a polymerase chain reaction (PCR) test to detect the presence of human papillomavirus (HPV) of (6 and 11), a low-risk type, and (16 and 18), a high-risk type, with colposcopy examination and colposcopy-guided biopsy, if needed for women with abnormal colposcopy outcomes. The treatment, per severity and disease stage, was applied.

Results: The clinical presentation and pap smear results of women enrolled in the study were asymptomatic 82.5%, postcoital bleeding (PCB) was seen in (17.0 %) and intermenstrual bleeding (IMB) was seen in a single case (0.5 %). History of sexually transmitted diseases (STD) was seen in (2.5 %). Pap smear results were as following: No remarkable pathology seen in (36.0 %), Inflammatory evidence seen in (32.0 %), ASCUS was seen in (19.0 %), LSIL seen in (7.5 %) and HSIL seen in (5.5 %). Regarding human papilloma virus infection was negative in (95.0 %), low risk virus strains were seen in (1.5 %) and high risk viruses were seen in (3.5 %). Low risk HPV included 6, 11 and 42, whereas, high risk group included 5 cases of HPV16 and 2 cases of HPV 18.

Conclusions: The present work presents the Pap smear test as a highly useful, easy, technically safe, and cost-effective tool for detecting the cervical epithelial precancerous lesions, which can be used as a routine screening technique for better treatment outcomes and reducing mortality rates. The power of detection of these lesions can be potentiated when using the Pap test and HPV-PCR test together.

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1-Ferlay J ,Soerjomataram I, Dikshit R , et al. Cancer incidence and mortality worldwide: Sources , methods and major patterns in GLOBOCAN.Int J Cncer.2015;136:359-86.
2-Rosai J.Ackerman´s Surgical Pathology.2011;10th ed:1447.
3-Sreedevi A, Javed R ,and Dinesh A .Epidemiology of CC with special focus on India. Int J Women Health.2015;7;405-414.
4-Jinan J Al-Mussawy , Abdul-Hssein M Al-Faisal , Saif D Al-Ahmer, et al .Cervical abnormalities and cancer incidence in some Iraqi married women. Iraqi J Biotechnology .2019;18:58-66.
5-Jafari Shobeiri M , Halimi M,Dastranj A , et al .Screening for CC and precancerous lesions in Tabriz .MJIRI.2007;21:1-10.
6-Bal MS ,Goyal R,Suri AK , et al. Detection of abnormal cervical cytology in Paoanicolauu smear.JCytol.2012;29:45-47.
7-Patel MM,Pandya AN ,Modi J. Cervical Pap smear study and its utility in cancer screening to specify the strategy for CC control. Natl J Community Med.2011;2:49-51.
8-Jonathan S and Berek MA .Novak´s Gynecology(15th ed) united states of America.Lippincott Williams and Wiikins.2012;1305.
9-Santin AD , Zhan F , Bignotti E , et al .Gene expression profiles of primary HPV 16 and HPV 18 infected early stage CCs and normal cervical epithelium.Virology.2005;331:269-291.
10-Idestorm M,Milsom I, Andersson-ellstorm A.Knowledge and attitudes about the Pap-smear screening programme:a population based study of women aged 20-59 years .Acta Obstet Gynecol Scand .2002;81:962-970.
11-Herrington S and Ghobashy AE. CC:epidemiology and molecular characterization .Progress in Obesterics and Gynecology .16th ed.2005:323-341.
12-Burd EM. Human papilloma virus and CC.Clin Microbiol Rev.2003;8:1-17.
13-Nayar R,Wilbur DC.The Bethesda system for reporting cervical cytology: definitions ,criteria , and explanatory notes. 2015;3rd ed.
14-Nayir T,Okyay AR,Nizlican E, et al. CC screening and early diagnoses and screening center in Mersin,Turky.Asian Pac J Cancer Prev.2015;16:6909-12.
15-Maleki A ,Ahmadina E,Avazeh A ,et al. Prevalence of abnormal pap test results and related factors among women living in Zanjan , Iran. Asian Pac J Cancer Prev.2015;16:6935-9.
16-Cyrus-David M.S ,Michielitte R,Paskett ED, et al. CC risk as a predictor of Pap smear use in rural North Carolina .J Rural Health.2002:18:67-76.
17-Atilgan R,Celik A,Boztosum A , et al. Evaluation of cervical cytology abnormalities in Turkish population. Indian J Pathol Microbiol.2012;55:52-55.
18-Kulkarni PR,Rani H, Vimalambike M G , et al. Opportunistic screening for CC in a tertiary hospital in Karntaka , India.Asian Pac J Cancer Prev .2013 ;14:5101-5.
19-Bhitia K , Puri M, Gami N , et al .Persistent inflammation on Pap smear :Does it warrant evaluation ? Indian J Cancer.2011;48:220-2.
20-Barouti E,Farzaneh F,Sene A .The pathogenic micro-organism in pap vaginal smears and correlation with inflammation. J Family Reproductive Health.2013;7:23-27.
21-Verma A , Verma s ,Vashist S , ET AL.a study on CC screening in symptomatic women using pap smear in tertiary care hospital in rural area of Himachal Predesh , I ndia.Middel East Fertil Soc J.2017;22:39-42.
22-Pamini CP ,Indira N ,Chaitra R , ET AL .Cytological and colposcopic evaluation of unhealthy cervix. J Evid Med Health.2015;2:6920-7.
23-Nayani Z S ,Hendre P C .Comparisom and correlation of Pap smear with colposcopy and histopathology in evaluation of cervix.J Evol Med Dent Sci.2015;4:9236-47.
24-Magdy H B ,Mohammed S M ,Naema G , et al .Cytological pattern of cervical pap smear in eastern region of Saudi Arabia .J Cytol .2011;28:1737-7.
25-Saha D , Ghosh S ,Nath S , et al. Utility of Pap smear screening for prevention of CC . A 3 years study from rural Tripura –India. Int J Med and Dent Sci.2017;6:1456-61.
26-Green J ,De Gonzalez A B ,Smith J , et al.Human papilloma virus infection and use of oral contraceptions. Br J Cancer.2003;88:1713-1720.
27-Gayed M ,Bernatsky S ,Ramsey – Goldman R, et al. Lupus and Cancer .Lupus.2009;18:479-485.
28- Rachel Siqueira, Emmanuele P. and ortrud M. prevalence of high risk Human papillomavirus genotypes and predicators factors for CC in Brazilian women without cytological abnormalities. Adv Bioteh Micro. 2018; 8: 1-5.
30- Gnerry SL, Rosa CJ, Markowitz LE, et al. Human papillomavirus vaccine initiation among adolescent girls in high risk communities vaccine. 2011; 29: 2235-2241.
31-Swangvaree S.S., Kongkaew P., Ngamkham J. frequency and type – distribution of HPV from paraffin – embedded blocks of high grade cervical intraepithelial neoplasia lesions in Thailand. Ascian pac J cancer prev. 2013; 14: 1023 - 1026.
32-Sukvirach S., Smith J.S, Tunsakul S, et al. population based HPV prevalence in Thailand. J infect Dis. 2003; 187; 1246-1256.
33-Siriaunkgul S, Settakorn J, Sukpan K, et al. HPV detection and genotyping in Vulvar squamous cell carciroma in Thialand. Ascian pac J cancer prev. 2014; 15: 3773 – 3780.
34-Solomon D, Schiffman M, and Tarone R. Comparison of three management strategies for patients with atypical squamous cells of undetermined significance journal of the national cancer institute. 2001; 93: 293-299.