Pattern of Pap Smears in Saudi Arabia.
Fadwa J Altaf, Shagufta T Mufti. King Abdull Aziz University, Jeddah, Western Province, Saudi Arabia
Background: Cervical cancer is an important cause of female mortality and morbidity world wide.Large number of studies emphasize that it is a preventable cancer as it is caused by Human Papiloma virus infection(HPV)and the premalignant lesions(PML) associated with this infection can be detected by Pap smear(PS).Cervical Cancer Screening Program(CCSP) is the best way for early detection of the PML.In Saudi Arabia(SA) in which there is no CCSP but there is marked increase in the incidence of abnormal cervical cytology in the last decade.This study evaluated the PS diagnosis in King Adulaiz University Hospital(KAUH) by using the Bethesda system(BS) and compare the result to a similar study from the same institution.
Design: A retrospective study was designed to review all PS from the Cytopathology department of KAUH from January 2005-December 2009.The revised BS diagnostic categories was used for the diagnosis of the PS
Results: Of the 7297 cases reviewed,there were 1254 cases(17.18%)with epithelial cell abnormalities of the total PS examined.The categories include,Atypical Squamous Cell Of Undetermined Significance(ASC-US)were seen in 674 smears(9.23%).Atypical Squamous Cell, cannot exclude High Squamous Intraepithelial Lesion were seen in 60 smears(0.82%).Low grade Squamous Intraepithelial Lesion was seen in 198 smears(2.71%).High Grade Squamous Cell Lesion was seen in 63 smears(0.86%)with mean age incidence(MAI)of 40,42,47, and 45 years respectively.Squamous Cell Carcinoma was seen in 4 smears(0.05)with mean age incidence of 46 years. In the atypical glandular cell category, the Atypical Glandular Cell Not Other Wise Specified there were 232 smears(3.17%).Seven smears(0.09%)of atypical glandular cells favoring neoplasm and 6 smears(0.08%)atypical endometrial cells favoring neoplasm with MAI of 49 and 50 years respectively.
Conclusions: The incidence of abnormal PS was increased 17.8% in comparison to the previous study done in the same institutions 4.7%.ASC-US among total Pap smears examined was significantly increased thereby pushing the number of abnormal Pap smears to a higher side.These changes could be partly to the amalgamation of ASCUS favoring reactive and those favoring neoplastic into one category within the revised BS.We recommend the initiation of HPV testing routinely for all cases with atypical PS with proper treatment and follow up in KAUH as the Bethesda recommendation.A cross-sectional study is required to evaluate the magnitude of abnormal Pap smears in the Western Region of SA with HPV sub typing before subsequent CCSP initiation.
Tuesday, March 1, 2011 9:30 AM
Poster Session III # 100, Tuesday Morning