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Article
Diagnostic Value of Cytology and Colposcopy in Patients withAbnormal Cervical Pap Smears

Authors: Nada A Alwan --- Raji H Al-Hadithi --- Nada S Al-Rubai’ee
Journal: Al-Kindy College Medical Journal مجلة كلية الطب الكندي ISSN: 18109543 Year: 2006 Volume: 3 Issue: 1 Pages: 56-62
Publisher: Baghdad University جامعة بغداد

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Abstract

Background: An optimal cancer detection system
for preclinical cervical lesions should combine a
cytological examination with a colposcopic follow-up
examination. Detection at early pre-invasive stage
provides an opportunity for treatment to prevent
progression to invasive cancer.
Objective: The present study aimed at evaluation
of cytology, colposcopy, and combined cytology and
colposcopy in predicting histopathological diagnosis
of cervical intraepithelial neoplasia/squamous
intraepithelial lesion (CIN/SIL) or other neoplastic
changes in patients with abnormal cervical
cytological findings.
Methods: This prospective study was conducted in
the Cyto-colposcopy Unit of Teaching Laboratories
and Outpatient Department of Medical City Teaching
Hospital over a period of one year (Sep. 2001- Sep.
2002). Eighty-one married females were included in
the study. A cervical smear was taken followed by a
colposcopic examination of the cervix and then a
punch biopsy was taken from the suspected lesions
for histopathological study. Estimation and evaluation
of the validity parameters of cytology, colposcopy,
and combined cytology and colposcopy were
performed using different cutoff points by special
statistical analysis.
Results: Sensitivity, specificity and accuracy of
cytology in the diagnosis of CIN/SIL were 73%,
93.2% and 84.0% respectively.
The False–negative rate was 27%. Sensitivity,
specificity and accuracy of colposcopy in the
diagnosis of CIN were 83.3%, 58.5% and 70.1%
respectively choosing doubtful findings as a cut-off
point. The combination of cytology and colposcopy
gave the following results: sensitivity, specificity and
accuracy were 94.6%, 61.4% and 76.5% respectively;
the negative predictive value (NPV) was 93.1%.
When suspicious colposcopic findings were chosen as
the cut-off point, the specificity and the positive
predictive value (PPV) were higher at the expense of
sensitivity and NPV
Conclusion: The conventional Pap smear, a
valuable tool in the evaluation of patients with
abnormal cervical cytology, was found to be of
relatively low sensitivity in predicting CIN/SIL.
Colposcopy is a valuable tool too. However, the
validity parameters showed variable figures
depending on the different cut-off points applied for
the diagnosis of CIN/SIL. The ideal cut-off point was
when doubtful and higher-grade colposcopic lesions
are considered positive. The combination of cytology
and colposcopy resulted in an increased sensitivity
and NPV. The specificity could be further increased
or improved when the threshold was set to distinguish
higher-grade lesions (suspicious lesions) from lesser
abnormalities.
Key words: Colposcopy, Abnormal Pap smears,
Biopsy


Article
Prevalence of HPV Genotype in Cervical Cells Among Iraqi Patients with Abnormal Pap Smears.

Author: Mohammed I. Mezaal , Nada A.S. Alwan , Ismail H. Aziz , Maad M. Shalal
Journal: Iraqi Journal of Biotechnology المجلة العراقية للتقانات الحياتية ISSN: 18154794 Year: 2017 Volume: 16 Issue: 2 Pages: 19-27
Publisher: Baghdad University جامعة بغداد

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Abstract

Cervical cancer is a leading cause of malignant related mortality among women specifically in developing countries. Research evidence has shown that Human Papilloma virus (HPV) is one of the most common sexually transmitted infections and the cause of the vast majority of cervical cancer cases. This study was designed to determine the prevalence of molecular 16 and 18 genotypes of HPV among Iraqi patients with abnormal Pap smear findings by utilizing endpoint real time PCR for qualitative detection.The study included 90 Pap smear specimens belonging to women complaining from gynecological problems and another ten specimens obtained from apparently healthy women. Samples were collected from two major Oncology hospitals in Baghdad during the period from April, 2015 to April, 2016. Total DNA (genomic, mitochondrial, and viral) isolated from the Pap smear samples for molecular studies was examined utilizing genomic DNA purification kits of Qiagen ( QIAamp DNA Mini Kit /Germany).Pap smear cytological examination revealed that lesions in the forms of ASCUS, LSIL, HSIL and Squamous Carcinoma were observed in 23.3. 22, 20 and 3.3% respectively. The molecular detection method (Real Time PCR) showed that 16 and 18 genotypes were demonstrated in 23% of patients with HPV infections. An effective method has been used for detection of HPV genotypes yielding higher sensitivity by using global diagnostics kit.

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