Comparison of Pap Smear and Colposcopy in the Evaluation of Unhealthy Cervix Among Women Visiting a Tertiary Care Center: A Hospital-based Descriptive Observational Study

Abstract

Aims: Cervical cancer is fourth most common type of cancer in women worldwide. Early identification of unhealthy cervix helps in reducing the disease burden. Hence, aim of this study was to compare diagnostic accuracy of colposcopy and PAP smear in evaluation of unhealthy cervix.

Methods: Observational study was conducted for a period of 2 years from June 2014 to June 2016 at tertiary care institute. After ethical approval, women of age above 21 years with unhealthy cervix were recruited. Baseline characteristics included demographics, obstetrics history and comorbidities were recorded. All women underwent pap smears, colposcopy, and cervical biopsy if required. Correlation of PAP smear and colposcopy histopathology findings as gold standard.

Results: Among 100 study women included finally, 39% were 40-49 years. Among them, only 10% were primigravida. 54% had complaint of white discharge and 10% had intermenstrual bleeding. Inflammatory atypia was reported in 60% and 55% had erosion cervix. Abnormal PAP results was seen in 88.2% of HPE-positive women whereas abnormal colposcopy results was seen in 64.7%. Difference in proportion of PAP smear, Colposcopy findings and histopathological findings were statistically significant. PAP-smear showed sensitivity of 88.2%, specificity of 74.7%, and diagnostic accuracy of 77% in predicting histopathologic findings. While, colposcopy showed better specificity of 97.6% and diagnostic accuracy of 92%.

Conclusion: PAP-smear had higher sensitivity and lower specificity while colposcopy showed better specificity and diagnostic accuracy in predicting histopathological findings.