Nor Hayati, Othma
(2010)
5th International Asia Pacific Organization
Istanbul, Turki
03-07 April2010.
Other.
Pusat Pengajian Sains Perubatan.
(Submitted)
Abstract
This retrospective study was to determine the effectiveness of cervical cytology
screening in detecting high grade squamous intraepithelial lesions and squamous cell
carcinoma using histopathology as the gold standard. All cases diagnosed as CIN II, CIN
Ill and squamous cell carcinoma by histopathology from 2002 to 2006, seen in 2
Hospitals; Hospital Universti Sains Malaysia [HUSM] and Hospital Raja Perempuan
Zainab II [HPRZ] were included in the study. For each case, the cervical cytology results
were traced. The cytology results were divided into 3 categories: 'concordant", 'minor
discordant' and 'major discordant'. The concordance rate between cytological diagnoses
and histopathological diagnoses was determined. The smears from the 'minor
discordant' and 'major discordant' categories were traced and the smears were
subjected to rescreening. The 2001 Bethesda system was used to classify the revised
diagnoses of rescreening.
There were 182 cases of CIN 2, CIN 3 and invasive squamous cell carcinoma diagnosed
by histopathological examination. We found that only 56% of the cases had a previous
Pap smear. Of the patients who had received Pap smears, 63.7% of the cytological
diagnoses were concordant', 17.6% were in the 'major discordant' category and 18.6%
were in minor discordance with the histopathological diagnoses. The concordance rate
between the histopathology and Pap smears was statistically significant (P<O.OS).
24 (23.5%) smears from the 'major discordant' and 'minor discordant' categories were
subjected to repeat cytology examiantion. The revised diagnoses of the re-examination
..
were similar to the initial screening diagnoses in 6(30%) smears. In 18(70%) smears the
revised diagnoses were changed. The false negative rate was 17.6% and the sensitivity
of Pap smear was 82.4%.
This study shows, Pap smear was found to be underutilised in 23.5% of cases, where it
was used for diagnosis rather than for screening. We noted there is a higher diagnostic
error in laboratory that has a higher workload.
In conclusion, Pap smear is effective in detecting high grade squamous intraepithelial
lesions and squamous cell carcinoma with a high sensitivity. The false negative rate is
within acceptable range.
Actions (login required)
 |
View Item |
