Diagnostic value of Pap smear cytology and colposcopy in detection of cervical premalignant lesions

Abstract

Cervical cancer screening based on conventional cytology was launched in Georgia from 2008 by Georgian National Screening
Centre (GNSC). Suspicious on High Grade SIL based on the cytology (ASC-H, HSIL) and colposcopy, or punch biopsy (CIN2+) as well as persistence of CIN1 more than 2 years and/or CIN localization into cervical canal-are considered as indication for LEEP procedures. Objectives: Revealing the accuracy of PAP smear and colposcopy at GNSC. Methods: The retrospective analysis of 613 cases was performed. All woman underwent LEEP in GNSC at 2011-2017. PAP tests, colposcopy and following LEEP histopathology was done in all cases. The data were analyzed using SPSS version 21. By using descriptive indices we determined the sensitivity, specificity, positive and negative predictive value and accuracy of each method. Results: The main age of woman was 41 years (25-60). Distribution of referral cytology results was the following: AGUS- 3 (0.5%), ASC-H -65 (10.6%) ,ASCUS-113 (18.4%), HSIL-220 (35.9%), LSIL - 130 (21.2 %),NILM -82 (13.4%) Colposcopy diagnoses were: GR1-262 (42.7%), GR2-329 (53.7%), normal colposcopic findings -19 (3.1%), inadequate colposcopy -3 (0.5%). The histological investigations of LEEP specimen showed: AIS-1 (0.2%) , Carcinoma-12 (2.0%) , CIN- 304 (49.6%) , CIN2 -153 (25.0%) ,CIN3-115 (18.8%) , CIS -2 (0.3%), Negative for intraepithelial lesion 26 (4.2%) Sensitivity, Specificity, PPV and NPV of PAP test and Colposcopy diagnoses were calculated. For prediction of CIN2+ accuracy of PAP (HSIL): Se- 64.8% , Sp -86.4%. PPV -79.5% , NPV-72.5%. PAP (ASC-H/HSIL): Se- 83.4%, Sp-76.4%, PPV-72.6%, NPV-76.8% . Colposcopy : Se -83.4%, Sp -69.4% , PPV-69.3%, NPV -80.6%, accuracy of colposcopy: Se- 83.4%, Sp- 69,4%, PPV- 69.3% , NPV80.6%. Conclusion: Cytology is less sensitive but more specific, colposcopy is more sensitive but less specific for prediction of
pre malignant lesions. As the GNSC data outcomes reveals the similarities with results of other European studies they could be
considered as The National parameters for Georgia.