Article Type: Research Article Article Citation: Sanaa Rajab, Wasnaa A Elias, Layla G Saeed,
and Thukaa T Yahya. (2020). ABNORMAL FINDING OF PAP SMEAR AMONG WOMEN HOSPITAL
VISITORS IN CITY OF MOSUL, IRAQ. International Journal of Research
-GRANTHAALAYAH, 8(6), 174-178. https://doi.org/10.29121/granthaalayah.v8.i7.2020.233 Received Date: 20 May 2020 Accepted Date: 29 July 2020 Keywords: Pap Smear Tbs Cervical Cytology Cervical Lesions Objective: The research aims to test the use of the Pap smear screening system to identify precancerous lesions among women in City of Mosul, Iraq. Methods: This prospective study was carried out over
1 year at the Department of Obstetrics and Gynaecology in Mosul Teaching
Hospital, city of Mosul, Iraq. We screened 100 sexually active women who were
more than 21 years of age. Women with different complaints, including vaginal
discharge, blood mixed discharge, foul-smelling discharge, postcoital bleeding,
intermenstrual bleeding, postmenopausal bleeding, abdominal pain, infertility,
and secondary amenorrhea, were included in this study. The glass slides had
been sent for cytopathological review to the pathology department. The
laboratory results have been reported by the new Bethesda Cervical Cytology
Reporting System 2014. The device divided the lesions narrowly into certain
negative ones for intraepithelial neoplasia and with epithelial cell
abnormalities (ECA) that involve squamous and glandular cells. Upon pap smear,
the patient was treated accordingly. Results: The study had enrolled a total of 100 cases.
All of these patients had an abnormal Pap smear finding that fell according to
TBS-2014 criteria in the category of Epithelial Cell abnormality. We
interviewed all patients in Detail by proforma. The data reported were
statistically analyzed and were collected following observations and tests.
Among the study subject, the most common abnormal findings (68.9%) were
negative findings. Inflammatory constitute (15.4), and Atypical squamous cells
of undetermined significance (7%) followed by LSIL (5.9) and HSIL (2.9). Conclusion: Pap smear is an effective method for screening for Cervical Lesions Precancerous and cancerous. Nevertheless, a cervical biopsy must be performed which Is gold standard if any epithelial defects are found to be confirmed in cervical cytology.
1. INTRODUCTIONAccording
to World Health Organization (WHO), Cervical cancer kills more than 300,000 women
every year, and one woman is diagnosed with the disease every minute, although
it is one of the most preventable and curable forms of the disease. [1], [2] In a statement issued to coincide
with the World Cancer Awareness Day, the WHO mentioned that nine out of ten
women who die from cervical cancer live in poor countries and that if no action
is taken, the deaths from the disease will increase by 50% Almost by 2040. [3], [4] Due to the cervical cancer
screening programs conducted in many developed countries, incidences of
cervical cancer and its mortality have declined over the last fifty years. In
developed countries, however, high incidence and mortality rates continue due
to a lack of screening programs [5], [7]. According to World Cancer
figures, > 80% of all cases of cervical cancer arise in developed and
low-resource countries due to a lack of knowledge and difficulty in conducting
cytology-based screening programs. [8], [9]. Because of the long pre-invasive
stage, cervical cancer is a preventable illness. When robust screening is
implemented, early detection and appropriate treatment are possible. A Pap
smear test, which is the main screening test for the identification of
precancerous intraepithelial cervical neoplasia and the early stage of invasive
cervical cancer, may recognize early cervical epithelial changes. [10], [12] 2. MATERIALS AND METHODSThis
prospective study was carried out over 1 year at the Department of Obstetrics
and Gynaecology in Mosul Teaching Hospital, city of Mosul, Iraq. We screened
100 sexually active women who were more than 21 years of age. Women with different
complaints, including vaginal discharge, blood‑mixed discharge,
foul-smelling discharge, postcoital bleeding, intermenstrual bleeding,
postmenopausal bleeding, abdominal pain, infertility, and secondary amenorrhea,
were included in this study. Those not willing to participate in the study had
a frank growth, had been treated for cervical cancer, or were pregnant were
excluded from the study. A detailed history was taken using a predetermined
proforma that included the chief complaint and the findings of per speculum and
vaginal examinations. Written informed consent was obtained from all women. The
patients were held in a lithotomy position for a pap smear and inserted a
pervaginal bivalve self-retaining Cusco speculum to visualize the cervix. After
spinning a wooden Ayre spatula 360 ° the sample was taken from the ectocervix
with a cytobrush. The sample was smeared quickly on a labeled glass slide and
fixed in a jar with 95 percent ethyl alcohol. The glass slides had been sent
for cytopathological review to the pathology department. The laboratory results
have been reported by the new Bethesda Cervical Cytology Reporting System 2014.
The device divided the lesions narrowly into certain negative ones for
intraepithelial neoplasia and with epithelial cell abnormalities (ECA) that
involve squamous and glandular cells. Upon pap smear, the patient was treated
accordingly. 3. RESULTS AND DISCUSSIONS Table 1: Correlation
of pap smear findings with signs and symptoms
The
study had enrolled a total of 100 cases. All of these patients had an abnormal
Pap smear finding that fell according to TBS-2014 criteria in the category of
Epithelial Cell abnormality. We interviewed all patients in Detail by proforma.
The data reported were statistically analyzed and were collected following
observations and tests. Among the study subject, the most common abnormal
findings (68.9%) were negative findings. Inflammatory constitute (15.4), and
Atypical squamous cells of undetermined significance (7%) followed by LSIL
(5.9) and HSIL (2.9). Cervical cancer is the leading cause of death among
women, occurring more frequently in developing and underdeveloped countries [4], [13], [14]. ASCUS counts most abnormalities
from a pap smear in our study. In Cox. "ASCUS is not a Diagnosis but
rather vague interpretation”. The Bethesda System (TBS) has however given a
list of diagnostic criteria that have poor reproducibility with large
interobserver Variety. [15], [16]. ASCUS can be confused with other
entities such as inflammatory changes, air-drying artefactual nuclear
enlargement, atypical repair, cell degeneration, and atrophy. [17] While ASCUS in gynecological
cytology is the indeterminate or "grey field," it tends to carry a
risk of high-grade SIL or more, so patients with this definition should be
advised to follow up diligently. [18], [19] Cheung et al. research revealed
similar findings [20]. The recommendations adopted by
the American Society for Colposcopy and Cervical Pathology (ASCCP) in our
gynecological clinics recommend reflex HPV testing for patients with ASCUS or
regular pap smear after one year. [21], [23]. The ECA ASCUS was found in our
sample in 2.9 % of screened women, LSIL in 5.09 %, and HSIL in 0.48 %, findings
comparable to those of Verma's 2.5 % screened women in a survey. [24]. In women screened using the Pap
smear test, Padmini et al. [25] also reported ASCUS (8 %), LSIL
(5 %), and HSIL (3 %). A study by Nayani and Hendre found higher numbers of
LSIL (8.6 percent) and HSIL (3.8 percent) lesions [26]. In our research, 39.2 percent of
patients have seen inflammatory changes. Few studies have documented that women
with chronic inflammation have a higher risk of developing cervical
intraepithelial lesions13 After treatment plan with antibiotics Pap smear
should be repeated. In the present study, epithelial cell abnormality was seen
among 17.11 % of patients with 2 or less parity and 82.89 % with more than 2
parities. A similar finding was found in the study of Banik U et al. that
performed in Bangladesh, which observed 17.27 % and 82.73 % respectively.
Vaginal discharge (23.2 %) was the most common symptom, accompanied by
abdominal pain (11.9 %), and menstrual frequent bleeding (5.1 %). This is consistent
with a study of 39.96 % vaginal discharge, 26.63 % pain abdomen, and 12.78 %
irregular menstrual bleeding conducted in Uttar Pradesh, India. [11] 4. CONCLUSIONS AND RECOMMENDATIONS Pap
smear is an effective method for screening for Cervical Lesions Precancerous
and cancerous. Nevertheless, a cervical biopsy must be performed which Is gold
standard if any epithelial defects are found to be confirmed in cervical
cytology. The report reported A strong link between the cervical and cervical
cytology Biopsy: Biopsy. We associated in this analysis with an irregular one
Pap smears correlates with the treatment of HP, given HPE as standard gold. We
conclude the traditional Paper Smear is a cost-efficient SOURCES OF FUNDINGThis research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors. CONFLICT OF INTERESTThe author have declared that no competing interests exist. ACKNOWLEDGMENTNone. REFERENCES[6] Torre, L.A., et al., Global cancer incidence and mortality rates and trends—an update. Cancer Epidemiology and Prevention Biomarkers, 2016. 25(1): p. 16-27. [14] Jensen, M., Cervical Cancer Screening and Prevention in Central America. 2019. [22] Saslow, D., et al., American Cancer Society, American Society for Colposcopy and Cervical Pathology, and American Society for Clinical Pathology screening guidelines for the prevention and early detection of cervical cancer. CA: a cancer journal for clinicians, 2012. 62(3): p. 147-172.
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