The Correlation of Papanicolaou Smears and Clinical Features to Identify the Common Risk Factors for Cervical Cancer: a Retrospective and Descriptive Study From a Tertiary Care Hospital in Trinidad

Background: Cervical cancer, the fourth most frequent cancer in women, is associated with the human papilloma virus (HPV). This study focuses on identifying any risk factors and clinical findings for abnormal cervical cytology and histopathology in relation to the Trinidad and Tobago population. Some risk factors include early age of first coitus, high number of sexual partners, high parity, smoking, and use of certain medications such as oral contraception. This study is aimed to identify the significance of Papanicolaou (pap) smears and to identify the common risk factors that contribute to the development of premalignant and malignant cervical lesions. Method: A three-year retrospective, descriptive study of cervical cancer was conducted at the Eric Williams Medical Sciences Complex to assess the risk factors and clinical findings using cervical cytology and histopathology data of patients with premalignant lesions. The subject population included 215 female patients aged 18 years and older who had the following documented abnormal cervical cytology: (ASCUS), ASC-H, LSIL, HSIL, Atypical Glandular cells, HPV, Adenocarcinoma, Invasive Squamous Cell Carcinoma. Histopathology records were analysed for thirty-three of these patients. Patients’ information were recorded on data collection sheets adapted from the North Central Regional Health Authority’s cytology laboratory standardised reporting format request form (Appendix I). Results and findings: The data were analysed via Statistical Package for Social Sciences (SPSS) software edition 23 using frequency tables and descriptive analysis. The sample mean age of the population was 36.7 years, first age of coitus was 18.1 years, number of sexual partners was 3.8 and number of live births was 2. LSIL was the most popular abnormal finding, 32.6 %, followed by HSIL, 28.8% and ASCUS, 27.4%. Most histopathological reports resulted in CIN I and II.Conclusion: The major risk factors observed for cytology abnormalities and premalignant lesions were early age of coitus, high number of sexual partners, and no use of contraception.Patients mostly presented as asymptomatic despite obtaining abnormal cytology results. Hence, regular pap smear screening should continue to be highly encouraged.

Prevalence, Types, and Factors of HPV Infection Among Women With Abnormal Cervical Cytology Screening at Ramathibodi Hospital

Background: Cervical cancer is the second leading cancer among Thai women. Human papillomavirus (HPV) is the most common cause of cervical cancer. HPV16 and HPV18 are the most prevalence types in women with cervical cancer. Objectives: To study the prevalence and types of HPV infection and its associated risk factors among women with abnormal cervical cytology screening. Methods: This cross-sectional study purposively recruited 376 women who had abnormal cervical cytology screening by liquid-based cytology at the outpatient clinic, Ramathibodi Hospital from August 2015 until March 2016. HPV genotyping was done by the polymerase chain reaction (PCR). Analysis of the personal characteristics was done using descriptive statistics. Results: The prevalence of HPV infection was 41.5%. Among them, a single infection was found in 78.8% of women. The most common genotypes were HPV16 (8.5%) and HPV52 (7.7%). But HPV18 was found in only 1.9%. The characteristic which was significantly associated with HPV infection was age, nulliparity, and high-graded dysplasia (P < .05). Conclusions: High prevalence rate of HPV infection was found among women with abnormal cytology. High-risk HPV prevalence and type distribution may be useful for public health authorities in assessing the cervical screening program.

Comparison of Monopolar Electrosurgical Conization and the Loop Electrosurgical Excision Procedure in the Management of High-Grade Squamous Intraepithelial Lesion

Objectives: To compare the performance and outcomes of monopolar electrosurgical conization (MESC) or the loop electrosurgical excision procedure (LEEP) in the treatment of high-grade squamous intraepithelial lesion (HSIL).Methods: This retrospective study included 554 patients diagnosed with HSIL through biopsy. The study used either LEEP or MESC for cervical conization. Additionally, the medical records of these patients, including the basic information, status of the excision margin, cone depth, cone width, fragmentation, complication, and the results of a 6-month follow-up after conization, were reviewed.Results: Compared to MESC, LEEP had a significantly higher rate of positive endocervical margin (3.77 vs. 8.65%; p = 0.018), burn injury of the margin (4.90 vs. 10.38%; p = 0.016) and a lower rate of adequate cone depth (83.40 vs. 89.62%; p = 0.034). In addition, LEEP was significantly more likely to cause fragmentation (p = 0.000). There was, however, no significant difference in the rate of abnormal cervical cytology and positive high-risk HPV (hrHPV) between these two groups, 6 months after cervical conization.Conclusion: Both LEEP and MESC appeared to be equally effective in the clinical treatment of HSIL. Nonetheless, MESC resulted in a better pathological outcome with regard to the status of the margin, tissue fragmentation, and cone depth.

Frequency of abnormal cervical cytology in symptomatic women.

Objective: To estimate the frequency of abnormal cervical cytology detected by Pap smear. Study Design: Cross Sectional Study. Setting: Department of Obstetrics and Gynaecology Gambat Institute of Medical Sciences Gambat, Khairpur Sindh. Period: November 2018 to June 2019. Material & Methods: A total of 160 women with the complaint of heavy vaginal discharge and moderate to servere lowere abdominal pain more than 6 weeks were included in this study. Per speculum examination of cervix was carried out with the help of cuscos speculum before PAP smear and finding were noted, After labeling the sample was sent to histopathology for cytological examination. Results: The average age of the patient’s was 37.68±7.46 years. Percentage of normal smears 10%, advance disease 1.3% and percentage of inflammatory smear is 63.8% while frequency of abnormal cervical cytology was observed in 25% in which CIN-1 was 12.5%, CIN-2 was 11.3% and CIN-3 was 1.3%. Conclusion: Our population have large numbers of undiagnosed cervical diseases. Therefore, Pap smear testing should be widely used throughout Pakistan to reduce the incidence of cervical cancer.

Type Specific Human Papilloma Virus Prevalence and Distribution in Women with Abnormal Cervical Cytology: A Single Centre Retrospective Observational Study in the Emirate of Abu Dhabi

Background: Human papillomavirus (HPV) infection is a major cause of cervical cancer and premalignant dysplasia. The prevalence and distribution of different high-risk HPV genotypes can affect HPV vaccination strategies and the design of cervical cancer prevention programs. Objective: Here, we aimed to determine the prevalence of different HPV genotypes in women with abnormal cervical cytology in the United Arab Emirates (UAE), evaluate correlations between HPV genotypes and the degree of cervical dysplasia, and observe distributions of HPV genotypes across different age groups. Methods: The study included 442 women who underwent HPV genotyping at our institution between January 2018 and September 2019. A retrospective chart review was conducted for all 442 cases, and data were collected from hospital records. Results: The overall HPV positivity rate was 56.1%. The prevalence of high-risk HPV was 48%. 35.4% of patients had multiple high-risk HPV strains, whereas 64.6% had a single high-risk HPV strain. The most common high-risk HPV genotype was HPV-16 (15.2%), followed by HPV-31 (11.7%), HPV-53 (8.9%), HPV-66 (8.6%), and HPV-51 (8.3%). The prevalence of HPV-18 was only 3.8%. The high-risk HPV positivity rate increased from 39% in women with atypical squamous cells of undetermined significance (ASCUS) to 81% in women with low-grade squamous intraepithelial lesions (LSILs), 81.3% in women with atypical squamous cells cannot rule out high-grade lesions, and 80% in women with high-grade squamous intraepithelial lesions (HSILs). The multiple high-risk HPV strain positivity rate increased from 32.4% in ASCUS to 44.7% in LSIL and 62.5% in HSIL. Increased HPV positivity rates and prevalence of HPV-16 were noted with increasing severity of cervical dysplasia. Decreased HPV positivity was observed with increasing age. Conclusion: Overall, because the prevalence and distribution of different high-risk HPV genotypes affect HPV vaccination strategies, our findings may be useful for the design of cervical cancer prevention programs.

Distribution of HPV genotypes among women with abnormal cytology results in Alberta, Canada

Background: Persistent infection with a subset of human papillomavirus (HPV) genotypes can cause abnormal cytology and invasive cervical cancer. This study examines the circulating HPV genotype strains in a local population of the province of Alberta (a largely unvaccinated population) to establish baseline frequency of vaccine and non-vaccine genotypes causing abnormal cervical cytology. Method: Remnant liquid-based cytology specimens from the Alberta Cervical Cancer Screening Program (March 2014–January 2016) were examined. Only specimens from women who had a cytology grading of atypical squamous cells of undetermined significance or higher were included. HPV genotype was determined for all samples, and results were stratified by demographics and cytology results. Results: Forty-four unique HPV genotypes were identified from 4,794 samples. Of the 4,241 samples with a genotype identified, the most common genotypes were HPV 16, 18, 31, and 51, with 1,599 (37.7%), 441 (12.2%), 329 (7.8%), and 354 (8.4%), respectively. HPV9 vaccine genotypes made up 73.2% of these genotyped samples. Compared with specimens in which HPV9 vaccine genotypes were not detected, those with a genotype covered by the HPV9 vaccine were from younger women (33 y [interquartile range {IQR] 28 to 42] versus 40 y [IQR 32 to 51]; p < 0.00001). Conclusions: The baseline distribution of HPV genotypes in this largely unvaccinated population indicates that the HPV 9 vaccine provides good protection from high-risk HPV infections. Determining the frequency of genotypes causing abnormal cytology in this population post–vaccine implementation will be important to assess efficacy of vaccination and monitor for any potential genotype replacement.