Comparison and Correlation of PAP Smear, Colposcopy and Histopathology in Symptomatic Women and Suspicious Looking Cervix in a Tertiary Hospital Care Centre

Aims and objectives:  To study the socio demographic parameters of women with symptomatic and suspicious looking cervix.  To compare and correlate the findings of papsmear, colposcopy and histopathology in detecting premalignant lesions of cervix. Material and Methods: This was a prospective observational study conducted from 01/02/07 to 28/02/09 in the Department of Obstetrics and Gynaecology. Pap smear was performed by the conventional method and Colposcopy was done for all 52 sexually active women who came with complaints of discharge per vagina, inter menstrual or post coital bleeding and women with an abnormal pap smear. Final correlation of pap smear and colposcopy were based on histopathology. Results: 80.8% of women were in the age group of 30-50 years. 94.2% of women were literate and multiparous. 26.9% of women were willing to undergo the tests due to awareness and fear of cancer. Commonest complaint was white discharge per vaginum in 26.9% and polygamy in 21.1% of their husbands. Per speculum examination revealed abnormalities in 86.5% of women. There was no history of use of oral contraceptives (OC), intrauterine contraceptive device (IUCD) in 53.9% of women. Only 32.7% had used IUCD. 1.9% of women were treated for sexually transmitted disease in the past. Use of tobacco in the form of smoking or chewing tobacco products were encountered in 7.7% and 11% of women respectively. However, 32.7% were exposed to passive smoking. Child marriage and early marriage were prevalent in 13.5% of women (<15 years) and 68.75% of women(<18 years) respectively.82.7% of women had a normal pap smear, high grade squamous intraepithelial lesion in 3.8%. Colposcopy findings suggestive of low grade infection and high grade or suspicious of malignancy in 55.8% and 25.2% of women respectively. Final histopathology correlated with a diagnosis of CINII/CIN III in 3.8% of women. 63.5% had a report of chronic cervicitis with metaplasia. Overall pap smear had a poor sensitivity compared to colposcopy, 19.5% vs 90.24% (p<0.001) respectively. Pap had a better specificity though not significantly compared to colposcopy, 83.33% vs 72.73%(p<0.3) respectively. Descriptive statistical analysis has been used in the present study.