Pre-Malignant Lesions of Cervix in Female Attending a Tertiary Hospital of Nepal

Abstract

Introduction: Cervical cancer is killing Nepali women in gross even though cervical cancer is preventable with time-tested screening strategies in Nepal. Detection of premalignant lesions of cervix is preliminary step for early treatment and to minimise the tragedy of death. The aim of this research is to corelate the Pap smear, colposcopy and guided biopsy findings with histopathology to detect premalignant lesion of cervix.
Methods: A prospective observational study conducted among 145 women attending gynaecology OPD with symptoms during reproductive age 21-65 years. Collection of Pap smear was conducted by conventional method, colposcopy and guided biopsy in selected women were performed and the sample was sent to pathology department for histopathological confirmation.
Results:The pre-malignant lesions in cytology were ASCUS (Atypical Squamous Cells of Undetermined Significance) 11%, ASC-H (Atypical Squamous cell- cannot exclude High Grade)1.3 %, LSIL (Low Grade Intraepithelial Lesion)28.2 %, and HSIL (High Grade Intraepithelial Lesion) 7.5 %. The colposcopy detected 54.4% atypical transformation zone. The histopathology detected Cervical Intra-epithelial Neoplasia I (CIN I) 26.1%, CIN II 11.7%, and CIN III 7.5%. The sensitivity of Pap smear and colposcopy was 83%, the specificity of Pap smear was 88%, and colposcopy was 98%.
The positive predictive value(PPV)were 89% and 98 %, negative predictive value(NPV) were 81%and 83%.and accuracy was 88 % and 98% in Cytology and Colposcopy.
Conclusions:Pap smear and colposcopy were effective tools to detect premalignant lesions of cervix in comparison to histopathological findings.