Mon, Apr 21, 2025
1- Postgraduate, Department of Pathology, Vydehi Institute of Medical Sciences and Research centre, Bangalore, India
2- ASSOCIATE PROFESSOR, Department of Pathology, Vydehi Institute of Medical Sciences and Research centre, Bangalore, India ,drshilpahpt@gmail.com
3- HOD & PROFESSOR, Department of Pathology, Vydehi Institute of Medical Sciences and Research centre, Bangalore, India
2- ASSOCIATE PROFESSOR, Department of Pathology, Vydehi Institute of Medical Sciences and Research centre, Bangalore, India ,
3- HOD & PROFESSOR, Department of Pathology, Vydehi Institute of Medical Sciences and Research centre, Bangalore, India
Abstract: (725 Views)
Abstract :Background : Cervical cancer, which was once a leading cause of cancer mortality in women, has seen a significant decline in death rates due to effective screening, early diagnosis, and treatment. The Pap test, a standard screening method, remains valuable but exhibits limitations such as false-positives and false-negatives.Atrophy-related changes, a common occurrence in aging women, can complicate Pap smear interpretationAim:This article aims to bring attention to the intricacies of cervical carcinoma screening, focusing on the interpretation of atrophy-related changes in Pap smears and Hence, minimise intervention.Materials and Methods : This retrospective study, conducted over nearly seven years,in the deprtment of Pathology in a tertiary care centre (Vydehi Institute of Medical Sciences and Research Centre,Bengaluru) evaluates cases with intra-epithelial abnormalities or malignancies in cervical cytology Pap smears, with a specific emphasis on cases displaying atrophy-related changes.Results : A total of 11680 cervical cytology smears were reviewed.56 cases were interpreted to have epithelial abnormalities like Atypical squamous cells of undetermined significance (ASCUS),Squamous intra epithelial lesion (SIL) – Low grade and High Grade and Malignancy,of these 40 smears also had atrophy related changes.Follow up Biopsies were available in 22 cases, of which Atrophy and Epithelial abnormalities existed in 16 cases.The positive predictive value of Cervical Smear cytology to detect epithelial abnormalities in smears with co-existing atrophy related changes is only 50%.Conclusion : The article emphasizes the importance of cautious interpretation to avoid over-diagnosis of epithelial abnormalities in the presence of atrophy-related changes.
References
1. Li Y, ShoyeIe O, Shidham V B. Pattern of cervical biopsy in cases with cervical cytology interpreted as higher than low grade in the background with atrophic cellular changes. CytoJournaI. 2020; 17: 12. [View at Publisher] [DOI] [PMID] [Google Scholar]
2. He WQ, Li C. Recent global burden of cervical cancer incidence and mortality, predictors, and temporal trends. Gynecol Oncol. 2021; 163(3): 583-592. [View at Publisher] [DOI] [PMID] [Google Scholar]
3. Sachan PL, Singh M, Patel ML, Sachan R. A Study on Cervical Cancer Screening Using Pap Smear Test and Clinical Correlation. Asia Pac J Oncol Nurs. 2018; 5(3): 337-341. [View at Publisher] [DOI] [PMID] [Google Scholar]
4. Kumar V, Abbas A, Aster J C. Robbins & Cotran Pathological Basis of Disease. 10th edition. Philadelphia : Elsevier ; 2020: 996-1001. [View at Publisher]
5. Stoler MH, Jenkins D, Bergeron C. The pathology of cervical precancer and cancer and its importance in clinical practice. InHuman Papillomavirus. Academic Press. 2020; 85-109. [View at Publisher] [Google Scholar]
6. DeMay RM. Cytopathology of false negatives preceding cervical carcinoma. Am. J. Obstet. Gynecol. 1996; 175: 1110–1113. [View at Publisher] [DOI] [PMID] [Google Scholar]
7. Nayar R. Wilbur David. The Bethesda system for reporting Cervical Cytology .4th edition. New York and London : Springer ; 2015. pp 18-54. [DOI] [Google Scholar]
8. Vrdoljak-Mozetič D, Štemberger-Papić S, Verša Ostojić D, Rubeša R, Klarić M, Eminović S. Pitfalls in Gynecological Cytology: Review of the Common and Less Frequent Entities in Pap Test. Acta Cytol. 2024; 68(3): 281-298. [View at Publisher] [DOI] [PMID] [Google Scholar]
9. Patton AL, Duncan L, Bloom Phaneuf G, Zafar N. Atypical squamous cells, cannot exclude a high-grade intraepithelial lesion and its clinical significance in postmenopausal, pregnant, postpartum, and contraceptive-use patients. Cancer . 2008; 114:481 - 8. [View at Publisher] [DOI] [PMID] [Google Scholar]
10. Bulten J, de Wilde PC, Boonstra H, Gemmink JH, Hanselaar AG. Proliferation in "atypical" atrophic pap smears. Gynecol Oncol . 2000 ; 79 : 225-9. [View at Publisher] [DOI] [PMID] [Google Scholar]
11. Tabrizi AD. Atrophic Pap smears, differential diagnosis and pitfalls: A review. Int J Women's Health Reprod Sci . 2017 ; 6: 2-5. [View at Publisher] [DOI] [Google Scholar]
12. Crothers BA, Booth CN, Darragh TM, Means MM, Souers RJ, Thomas N, et al. Atrophic vaginitis: Concordance and interpretation of slides in the college of american pathologists cervicovaginal interlaboratory comparison program in gynaecologic cytopathology . Arch Pathol Lab Med . 2012 ; 136 : 1332-8. [View at Publisher] [DOI] [PMID] [Google Scholar]
Send email to the article author
| Rights and permissions | |
 |
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
Enamad
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.