PAP SMEAR CYTOLOGICAL FINDINGS IN WOMEN WITH ABNORMAL VISUAL INSPECTION TEST RESULTS REFERRED TO KENYATTA NATIONAL HOSPITAL.

ABSTRACT

1. BACKGROUND

Cervical cancer is one of the top killers of women especially in developing countries. The challenge of cost in establishing cytology and/or Human Papilloma Virus (HPV) for mass screening for cervical cancer in these areas prompted adoption of visual inspection techniques as alternative screening methods for cervical cancer. Kenyatta National Hospital (KNH) receives women with abnormal visual inspection test results from peripheral health care centres for further management.

2. STUDY OBJECTIVES

Broad objective: To determine the Pap smear cytological findings in women with abnormal visual inspection test results referred to KNH.

Specific Objectives; the primary objectives were to  determine the pattern of cervical epithelial cell abnormalities, to determine infective and other non-neoplastic findings in cervical smears in women with abnormal VIA/VILI referred to KNH and to compare VIA/VILI and Pap smear results.

The secondary objectives were to compare VIA/VILI, Pap smear and colposcopy results against the gold standard biopsy where colposcopy and biopsy shall be done. Another secondary objective is to determine sensitivity VIA/VILI, Pap smear and colposcopy for detection of cervical intraepithelial neoplasia for cases where colposcopy and biopsy shall be done.

 

3. STUDY DESIGN

This wasa cross-sectional descriptive study.

4. METHODOLOGY

Study area: the study was conducted at KNH in the Family planning clinic, cytology laboratory and histology laboratory facilities.

Study population: consenting women 18 years and above with abnormal VIA/VILI referred to KNH for further management. A total of 227 women were recruited.

Specimen collection, processing and reporting: Pap smears were collected by qualified health care personnel, processed by the investigator using Papanicolaou staining procedure, reported by the investigator and signed out by a pathologist. Results from women who underwent colposcopy and biopsy were compared with Pap smear and VIA/VILI findings.

5. DATA MANAGEMENT AND ANALYSIS PLAN

Socio-demographic data for study participants was summarized as graphs and charts. Cytological, VIA/VILI and colposcopy results were compared with biopsy results using Wilcoxon rank test and McNemar test where appropriate. All statistical tests were performed at 5% level of significance (95% confidence interval) using SSPS version 17.0 software.

6.  RESULTS

All participants in this study (232) had positive result for visual inspection tests (VIA/VILI). Of these, 57 (24.6%) had a report of ASCUS or worse while the rest 175 (75.4%) had the report of negative for intraepithelial lesion or malignancy (NILM). 5 (2.2%) were reported as ASCUS, 13 (5.6%) were LSILs, 4 (1.7%) were AGCs, 1 (0.4%) was ASC-H, 20 (8.6%) were HSILs and 18 (7.8%) were reported as invasive carcinoma. Three confirmatory tests available by the time of report writing indicated the sensitivity of Pap smear as 100% As follows; 1 CIN2, 1CIN3 and 1carcinoma both on colposcopy and histopathology resports.

11 (4.7%) were reported as having infection as follows; Bacterial vaginosis 5(2.2%), Candida 4(1.7%), Herpes simplex 1(<1%) and Trichomoniasis 1(<1%). 42 (18.1%) of study participants were postmenopausal women contrary to the recommendation visual inspection tests should not be used in this population.

7. CONCLUSIONS

Greater number of Pap smear results were normal with higher proportion (over half ) of women with abnormal tests having significant lesion deserving further management. Pap smear was very sensitive in detection of lesion of HSIL and above. Infection detected rate was very low than expected and possible reason has been discussed.

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