الفهرس 
Human papillomavirus and cervical cancerOnly 14 pages are availabe for public view
 |  | from | 105 |  |  |
| | | from | 105 | | |
Abstract
Cervical carcinoma is considered the fourth most common cancer worldwide among women globally. It accounts for 7% of all female malignancies in developed countries against 24% in developing countries. In 2020 there was 604,000 new cases are diagnosed and 342,000 deaths are related to it. About 90% of the new cases &deaths worldwide in 2020 occurred in low and middle income countries.
Lack of education and empowerment of women and inadequate screening programs for cervical cancer in these countries also affect this high burden.
Cervical carcinoma is a preventable condition, and considerable efforts are made to detect and treat the pre-invasive disease.
Since 1943, pap smear cytology had been used for the screening of cervical carcinoma. However, the best method of cervical cancer screening is still unclear. Literature recommends different methods for screening ranging from simple cytology (pap smear), colposcopy, and human papillomavirus (HPV) deoxyribonucleic acid (DNA) testing, or even repeat cytology.
Developed countries currently rely on cytological screening and treatment of high-grade cervical Intra-epithelial neoplasia (CIN2, CIN3), which is a precursor for cancer. However, in developing countries, no proper cytological screening protocols are available. Also, cytological screening is not sufficient for the successful identification of cancer precursors. Hence, a large number of women in the pre-invasive stage are being missed.
Digital colposcopy is used now as a triage test in cervical cancer prevention. It helps to diagnose patients in the pre-invasive stage and categorizes women more effectively related to the way of treatment. Digital colposcopy is the gold standard next step for abnormal Pap smear findings.
This study aimed to evaluate the accuracy of digital colposcopy as a comparable tool to the conventional pap smear (cytology) and the classic histopathological examination .
This cross-sectional study was carried out on 77 sexually active women, aged 20 to 65 years, presenting with chronic leucorrhoea, post-coital bleeding/spotting, or intermenstrual bleeding/spotting. All participants underwent comprehensive assessments, including history taking, general and abdominal examinations, routine laboratory investigations, and pelvic ultrasound. Pap smears were collected from the ectocervix and endocervix using Ayres spatula, while digital colposcopy utilizing equipment categorized colposcopic findings as ”normal,” ”abnormal” (further divided into ”minor,” ”major,” and ”suspicious for invasion/cancer”), ”nonspecific,” or ”miscellaneous” based on the 2011 IFCPC terminology. Colposcopy-directed biopsies were conducted for major findings or suspicious for invasion cases.
• Summary of our results:
The study found that the majority of participants were aged between 31-50 years, with the highest prevalence of premalignant and malignant cervical pathology observed in the >50 years age group (60%). Participants with parity 0 and parity 1 showed no cervical pathology, while the prevalence increased with higher parity, reaching 66.7% in the group with parity >5.
The majority of participants (71.4%) did not have any documented medical disorders, and among them, 25.5% were found to have premalignant or malignant cervical pathology. Participants with medical disorders, including hypertension (HTN) in 10.4% of the sample, diabetes mellitus (DM) in 6.5%, and both DM and HTN in 6.5%, showed a higher prevalence of premalignant and malignant cervical pathology, with rates of 62.5%, 60%, and 60%, respectively.
Among the total participants, Intrauterine Contraceptive Devices (IUCD) were the most common choice (57.1%), with 27.3% of IUCD users experiencing premalignant and malignant cases. Combined Oral Contraceptive Pills (COCS) were chosen by 14.3% of participants, with 27.3% of COCS users developing premalignant and malignant conditions. Notably, participants who reported not using any contraception (10.4%) had a higher rate of 37.5% experiencing premalignant and malignant cases. Progestin-only Pills (POPS) and Depot Medroxyprogesterone Acetate (DMPA) were each used by 5.2% of participants, and 25% of users from both groups experienced premalignant and malignant conditions. Tubal ligation was selected by 5.2% of participants and showed a significant association with premalignant and malignant cases, affecting 75% of the tubal ligation users. A smaller proportion of participants (1.3%) opted for Implanon and Misocept injections, with 100% of users experiencing premalignant and malignant conditions.
Among the study participants, the most commonly reported symptom was discharge (77.9%), with 30% of those experiencing this symptom exhibiting premalignant or malignant cervical pathology. Intermenstrual spotting/bleeding was reported by 26% of participants, and 60% of them displayed premalignant or malignant cervical pathology. Post-coital spotting/bleeding was reported by 24.7% of participants, and 42.1% of them exhibited premalignant or malignant cervical pathology. Asymptomatic participants accounted for 7.8% of the sample, with 16.7% of them displaying premalignant or malignant cervical pathology. Participants who reported something coming out per vagina constituted 3.9% of the sample, but none of them exhibited premalignant or malignant cervical pathology.
Among the colposcopic findings, the most frequently observed was a normal cervix, accounting for 33.8% of the cases. Following this, atypical vessels were identified in 20.8% of the cases, while thin aceto-whitening and dense aceto-whitening were observed in 19.5% and 15.6% of the cases, respectively.
Punctation and mosaic patterns were present in 10.4% of the cases, and genital warts were detected in 9.1% of the cases. Polyps were found in 6.5% of the cases. Regarding cervical conditions, cervical erosion was the most prevalent finding, observed in 35.1% of the cases.
The most common PAP smear finding was cervicitis, present in 54.5% of the cases, followed by mild dysplasia (12.9%), moderate dysplasia (9.1%), and cervicitis with koilocytes (6.5%). Severe dysplasia was identified in 3.9% of the cases, while atypical glandular cells were detected in 2.6% of the cases. ASC-US (Atypical Squamous Cells of Undetermined Significance) and normal PAP smear results accounted for 1.3% and 9.1% of the cases, respectively.
Among the histopathological results, cervicitis was the most common finding, present in 39% of the cases, followed by squamous metaplasia in association with cervicitis, found in 18.2% of the cases. Other findings included cervical polyps (3.9%), normal cervical tissue (6.5%), and different grades of cervical intraepithelial neoplasia (CIN). CIN1 was observed in 18.2% of the cases, CIN2 in 11.7% of the cases, and CIN3 in 1.3% of the cases. Additionally, cervical carcinoma was detected in 1.3% of the cases.