Pap Smears - is it an effective screening method for cervical neoplasia? - An experience with 2289 cases

Abstract

A total of 2289 consecutive Pap smears received by pathology departments of 2 Institutions, Hospital Universiti Sains Malaysia (HUSM) (596 smears) and Hospital Kota Bharu (HKB) (1693 smears) were analysed. Based on the Bethesda system on analysing Pap smears, only 832 (36.3%) smears were found to be adequate while 1356 (59.2%) smears were inadequate and 101 (4.1%) smears were not possible to be interpreted cytologically due to poor fixation. Of the 832 adequate smears, 68 (8.2%) smears had cervical intraepithelial neoplasia (CIN) changes and 1.1% showed frank cancer while the rest of these smears showed inflammatory lesions. The cause of the inflammatory process in descending order were infection by Human Papilloma virus 21.2% (94 smears) candida 7.8% (34 smears), trichomonas 3.2% (14 smears) while in the majority the organisms were not identified. Inadequate smears were seen in all age groups and in descending order were from age groups 31 to 40 years: 40.8%; 21 to 30 years: 37.6%; 41 to 50 years 13.8%; 17 to 20 years: 4.1%; 61 to 70 years 0.6% and above 71 years 0.5%. The inferences which could be drawn from this study were: (i) there is a deficiency in knowledge of correct Pap smear sampling technique, (ii) The conventional tool used for sampling (wooden Ayre spatula) is not optimum, (iii) refresher course on how to obtain adequate cervical samples is needed, (iv) the use of cytobrush would improve endocervical sampling.