A Study of Pap Smear in a Tertiary Hospital in South India

Background: Cervical cancer accounts for the fourth most common cancer in women worldwide. Pap smear test is one of the best tests to screen for cervical cancer and enables detection in its premalignant stage. The objective of this study was to find out the prevalence of abnormal Pap smears in a tertiary care hospital and correlate with histology wherever possible. Methods: Cases were collected from archives of Department of Pathology from Jan 2013 to June 2015. A total of 1501 Pap smears were analyzed. Results: The mean age of the patients was 40.26 ± 10.72 years. Most of them were of age group 30-39 years (32.06%) followed by 40-49, 20-29 and 50-59 years (28.13%, 17.33% and 11.53% respectively). A total of 1234 (82.2%) samples were adequate for evaluation, whereas 267 (17.8%) samples were inadequate for evaluation due to low cellularity and obscurement by inflammatory cells and blood. Of 1234 smears, 1197 smears (96.92%) were negative for intraepithelial lesion and 38 smears (3.08%) were positive for intraepithelial lesion. These 38 cases included ASC-US (1.46%), ASC-H (0.32%), LSIL (0.24%), HSIL (0.41%), AGC (0.24%) and carcinoma (0.41%). ASC/SIL ratio was 2.75. Transformation zone with intraepithelial lesion was seen in 65.79% cases. About 109 biopsies could be retrieved and corelated with corresponding Pap smear, for which sensitivity was 45%, specificity 87.6%, false positive rate 12.4%, false negative rate 55%, positive predictive value 0.45% and negative predictive value 0.67%. Conclusion: Pap smear is still a relatively good method in screening cervical cancers in developing countries. Smears positive for intraepithelial lesions has to be co-related with histopathology for further management.