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Indian Journal of Pathology and Oncology


Pap smear study of health insured patients covered under employees' insurance scheme in a tertiary care hospital


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Author Details: Suganthi K., Rajalakshmi V., Meenakshisundaram K., Shanmugapriya S.

Volume : 4

Issue : 2

Online ISSN : 2394-6792

Print ISSN : 2394-6784

Article First Page : 282

Article End Page : 289


Abstract

Background: Cancer of the cervix is a leading cause of morbidity and mortality among women worldwide. Papanicolaou smear test is the best screening method for detecting premalignant lesions and to diagnose cervical cancer.
Objectives: The objective of the study was to find out the distribution of abnormal Pap smears in our hospital which caters to the low socio-economic group with health insurance cover. To evaluate the effectiveness of Pap smears in population with access to health care.
Materials and Method: An analysis of 9189 Pap smears received in the department of Pathology as a part of routine clinical work up and screening protocol from January 2012 to July 2016 were taken. Comparison of our data with other population based studies world over was carried out.
Results: The mean age of the patients was 40.18+ 9.7 years. Most of them were of age group 31-40 years (38.1%), followed by 41-50 years (32.3%), 21-30 years (17.2%), 51-60 years (9.1%), >60 years (3.1%) and <20 years (0.2%). A total of 8,939 (97.3%) samples were adequate for evaluation whereas 250 (2.7%) samples were inadequate for opinion. Of 8,939 smears, 8585 smears (96.4%) were negative for intraepithelial lesions and 236 smears (2.64%) showed epithelial cell abnormalities. The 236 cases included ASC-US (1.12%), ASC-H (0.05%), LSIL (0.50%), HSIL (0.85%), Squamous cell carcinoma (0.09%) and AGC (0.01%). Three sixty three Pap smears (negative smears 272, positive smears 91) had corresponding punch biopsy and hysterectomy specimens for cyto-histology correlation study. The sensitivity of Pap smear in our study was 68.5%, specificity was 94.89%, positive predictive value of 81.3% and Negative Predictive value of 90.27% and Diagnostic accuracy of 88.4%.
Conclusion: Pap smear is a screening tool for early detection of precancerous lesion and prevents cancer as there is a long latent phase before they progress to frank malignancy. The prevalence of abnormal pap smears in our study correlated with the other studies in India. Our patients though belong to lower socioeconomic group; they are covered under health insurance scheme and have access to the health care facility. However public awareness regarding the utility of this test should be enhanced so that more women will benefit.

Keywords:
Papanicolaou Smear (PAP), Screening, Epithelial Cell Abnormalities