Usefulness of papanicolaou and colposcopy-guided biopsy for the detection of cervical cancer in a second level hospital
DOI:
https://doi.org/10.51481/amc.v41i1.494Keywords:
papanicoulaou, colposcopia, cáncer de cervixAbstract
Background: The cervical smear, known as Papanicolaou or PAP, has been considered the best screening test for the detection of early cervical cancer and its precursor lesions, especially due to its low cost and simplicity of its technique, which requires no sophisticated equipment. However, there are still sope controversies on its real utility compared with other diagnostic methods, usually more complex, like the colposcopy-guided biopsy. The aim of this study was to establish the diagnostic sensibility and specificity of the cervical smear in the detection of pre-malingnant and malignant lesions, compared with the colposcopy guided biopsy.
Methods: A retrospective study was carried out in the colposcopy clinic of the Dr. Carlos Luis Valverde Vega Hospital, San Ram6n, Alajuela. The reports of all the cervical smears performed in the clinic between January and December 1997 (n=1366) were reviewed. In all the cases where the patient had a colposcopy guided biopsy taken at the same visit by the same physician (n=622), the results of both, smear and biopsy, were compared. The Pathology Department ofa third level hospital, the México Hospital, reported both the cervical smears and the biopsies.
Results: From the total 1378 cervical smears performed, areport was obtained in 1366 (99%). Ofthese, 91 % were reported as normal. Of the remaining 123 smears, 65 were reported as showing a specific infection, 56 (4%) were reported with precancerous lesions of the cervix and 2 with invasive cancer. In 622 cases (45.5%) a colposcopy guided biopsy was obtained on the same visit. Only 7 of the 51 cases where the biopsy was reported as showing a high-grade cervical lesion had the smear reported with the same alteration. In 38 of these 51 cases the smear had been reported as normal or inflammatory.
Conclusion: This study showed a diagnostic concordance bethe cervical smear and the colposcopy guided biopsy for grade lesions of 91 %, but only of 56% for the combination both low and high grade lesions. The sensitivity of the cervical smear was of 18.5% for high-grade lesions and only of 10.7% for low and high-grade lesions combined; the specificity was of 98.6% and 96.6% respectively.
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