Diagnostic Value of Cytology and Colposcopy in Patients withAbnormal Cervical Pap Smears

A Alwan, Nada; H Al-Hadithi, Raji; S Al-Rubai, Nada

	Diagnostic Value of Cytology and Colposcopy in Patients withAbnormal Cervical Pap Smears
Al-Kindy College Medical Journal
Article 1, Volume 3, Issue 1, 2006, Pages 56-62
Authors
Nada A Alwan; Raji H Al-Hadithi; Nada S Al-Rubai
Abstract
Background: An optimal cancer detection systemfor preclinical cervical lesions should combine acytological examination with a colposcopic follow-upexamination. Detection at early pre-invasive stageprovides an opportunity for treatment to preventprogression to invasive cancer.Objective: The present study aimed at evaluationof cytology, colposcopy, and combined cytology andcolposcopy in predicting histopathological diagnosisof cervical intraepithelial neoplasia/squamousintraepithelial lesion (CIN/SIL) or other neoplasticchanges in patients with abnormal cervicalcytological findings.Methods: This prospective study was conducted inthe Cyto-colposcopy Unit of Teaching Laboratoriesand Outpatient Department of Medical City TeachingHospital over a period of one year (Sep. 2001- Sep.2002). Eighty-one married females were included inthe study. A cervical smear was taken followed by acolposcopic examination of the cervix and then apunch biopsy was taken from the suspected lesionsfor histopathological study. Estimation and evaluationof the validity parameters of cytology, colposcopy,and combined cytology and colposcopy wereperformed using different cutoff points by specialstatistical analysis.Results: Sensitivity, specificity and accuracy ofcytology in the diagnosis of CIN/SIL were 73%,93.2% and 84.0% respectively.The False–negative rate was 27%. Sensitivity,specificity and accuracy of colposcopy in thediagnosis of CIN were 83.3%, 58.5% and 70.1%respectively choosing doubtful findings as a cut-offpoint. The combination of cytology and colposcopygave the following results: sensitivity, specificity andaccuracy were 94.6%, 61.4% and 76.5% respectively;the negative predictive value (NPV) was 93.1%.When suspicious colposcopic findings were chosen asthe cut-off point, the specificity and the positivepredictive value (PPV) were higher at the expense ofsensitivity and NPVConclusion: The conventional Pap smear, avaluable tool in the evaluation of patients withabnormal cervical cytology, was found to be ofrelatively low sensitivity in predicting CIN/SIL.Colposcopy is a valuable tool too. However, thevalidity parameters showed variable figuresdepending on the different cut-off points applied forthe diagnosis of CIN/SIL. The ideal cut-off point waswhen doubtful and higher-grade colposcopic lesionsare considered positive. The combination of cytologyand colposcopy resulted in an increased sensitivityand NPV. The specificity could be further increasedor improved when the threshold was set to distinguishhigher-grade lesions (suspicious lesions) from lesserabnormalities.Key words: Colposcopy, Abnormal Pap smears,Biopsy
Keywords
colposcopy; Abnormal Pap smears; Biopsy

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