PAP Smear versus Colposcopy in the Absence of HPV-DNA Testing for the Screening of Pre-malignant and Malignant Cervical Lesions

Introduction: The incidence of cervical cancer is very high in developing countries. The extensive use of cervical screening with PAP smear and colposcopy has considerably increased the detection of premalignant and malignant cervical lesions. Methods: This was a hospital-based study conducted over a period of three months. All the patients underwent gynecological examination, PAP smear and colposcopy. In case of abnormal findings in colposcopy or follow-up cytology, patients were advised for cervical biopsy. With reference to the histopathological reports, the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of PAP smear and colposcopy were evaluated. Results: The most common cytological result was Negative for Intraepithelial Lesion or Malignancy (NILM, 60%) followed by Atypical Squamous Cells of Undetermined Significance (ASCUS, 10%), Atypical Squamous Cells- cannot exclude High grade lesion (ASC-H, 6%), Low grade Squamous Intraepithelial Lesion (LSIL,10%) and High grade Squamous Intraepithelial Lesion (HSIL, 11%). In colposcopy, 60% of the patients were normal and 40% showed atypical transition zone. Histo-pathological findings among 53 patients were NILM (13.2%), cervicitis (13.2%), Cervical Intraepithelial Neoplasia I (CIN I, 28.3%), CIN II and CIN III (39.6%) and invasive carcinoma (5.66%). The sensitivity, specificity, PPV and NPV of PAP smear were 63.6%, 66.6%, 33.3%, and 87.5% respectively. Similarly sensitivity, specificity, PPV, NPV of colposcopy for abnormal cervical lesions were 87.56%, 15.38%, 76.09% and 28.57% respectively. Conclusion: In the absence of HPV-DNA testing, the combined use of PAP smear and colposcopy to detect premalignant and malignant cervical lesions increases early detection and treatment