Characteristics of attendees with abnormal pap smear at colposcopy in a hospital in Jos and the diagnostic correlation between colposcopic findings and histologic diagnosis

Abstract

Background: Premalignant lesions of the cervix are of global concern. Cervical cancer is the commonest female genital tract malignancy in Nigeria.

Aim: This was to analyse the characteristics of women who presented for colposcopy with abnormal Pap smear result and to determine the diagnostic correlation or agreement between colposcopy and histopathology.

Methodology: The medical records of 111women with abnormal Pap smear who presented for colposcopy at the cervical cancer screening Unit of Jos University Teaching Hospital (JUTH), Jos between January 2014 to December 2016 were retrieved. The sociodemographic and clinical characteristics, cytology, colposcopy and histology diagnosis were extracted from the records and analysed using EPI INFO 3.5.4 CDC Atlanta, USA.

Results : The medical record of 111 women were retrieved. The average age of the women in this study was 46.5years with a modal age range of 41-50 years. Majority of the women had formal education with 58% having up to tertiary education. Most (54.0%) of the women were civil servants, 4.6% traders, 33.3% and 8.1% were unemployed and retired respectively. The risk factors for abnormal cytology studied during the study period include early coitache (54.1%), multiple sexual partners (25.2%), use of oral contraceptive pills (29.9%). High Grade Squamous Intraepithelial Lesion (HSIL) accounted for 71.2% of abnormal cytology results. Women with Low Grade Squamous Intraepithelial Lesion on two consecutive occasions (LSILX2) accounted for 20.7%, ASCUS, ASC-H constituted the remaining 8.1%. High Grade Cervical Intraepithelial Lesion (HGCIN) was the colposcopy diagnosis in 36.0% of women, normal was in 27% and LGCIN was in 15.3% of the women reviewed. In this study 27.4% of the women had histopathologic diagnosis of cervicitis, 21.2% had CINIII, 20.2% had CIN II and 4.0% had invasive cancer. The overall correlation between colposcopy and histology diagnosis was 50.5%. Colposcopy diagnosis was underestimated in 33.3% of cases and overestimated in 16.2% of cases after histology.

Conclusion :The average age of the women with abnormal Pap smear who presented for colposcopy was 46.5 years and were mostly women with formal education and employed. Early coitarche and multiple sexual partners were the risk factors for premalignant lesion of the cervix present in these women. The most common indication for colposcopy was HSIL and the most common colposcopy impression was HGCIN. Most of the cervical biopsies sent for histology turned out to be cervicitis. The rate of underestimation was higher especially for HGCIN. Only half of the colposcopic diagnosis correlated with histology. We suggest that biopsies should be performed when colposcopy is abnormal. Continuous retraining of colposcopist and regular auditing of colposcopy services will improve its performance in cervical screening.