Published: 2016-12-29

Study of abnormal cervical cytology in papanicolaou smears in a tertiary care center

Bindu Singh Gaur, Vivek Khare, Rohan Gupta


Background: Cancer cervix is a leading cause of mortality and morbidity in developing countries like India most probably due to lack of proper screening facilities in the rural and suburban areas or due to the lack of awareness amongst the women of developing countries. Cervical cancer is the fourth most common cancer in the world. Developing countries accounted to about 80% of the global burden. This study was conducted to highlight the importance of Pap smear study in differentiating premalignant and malignant lesions.

Methods: This retrospective study was conducted among 1000 cervical pap smears of women with age group 20 to 75 years coming to the cytology section of pathology department, L.N. Medical College and Research centre, Bhopal, India between the time periods of 1st January 2015 to 31st December 2015. All the smears were reported as per the 2014 Bethesda system.

Results: In this study, maximum cases were of negative for intraepithelial lesion or malignancy 754 cases (75.4%) followed by low-grade squamous intraepithelial lesion with 74 cases (7.4%) (followed by high-grade squamous intraepithelial lesion with 12 cases (1.2%) then atypical glandular cells of undetermined significance 12 cases (1.2%) and minimum number of carcinoma cases 08 (0.8% - including 0.6% of squamous cell carcinoma and 0.2% of adenocarcinoma).

Conclusions: Cervical cytology by Pap smear is an important tool for early detection of premalignant and malignant lesions of cervix. Regular Pap smear screening should be conducted in vulnerable age group.


Pap smear, Cervical cancer, Cervical intraepithelial neoplasia, The Bethesda system

Full Text:



Papanicolaou GN, Traut HF. The diagnostic value of vaginal smears in carcinoma of the uterus. Am Jr Obstet Gynecol. 1941;42:193-205.

Patel MM, Pandya AN, Modi J. Cervical pap smear study and its utility in cancer screening, to specify the strategy for cervical cancer control. National Journal of Community Medicine.2011;2(1).

Khan MS, Raja FY, Ishfaq G, Tahir F, Subhan F,

Kazi BM, Karamat KA. Pap smear screening for Precancerous conditions of the cervical cancers. Pak J Med. Res.2005;44(3):111-3.

The 2001 Bethesda System.Terminology for reporting results of cervical cytology. JMA.2002; 287: 2114.

Maryem A, Ghazala M, Arif HA,Tamkin K. Smear pattern and spectrum of premalignant and malignant cervical epithelial lesions in postmenopausal Indian women: a hospital based.

Study. Diagnostic Cytopathology; 40(11):976-983, 2011.

Jonathan S.B. Berek and Novak’s Gynaecology. 14th ed. Philadelphia: Lippincott William Wilkins. 2006;569-75.

Leopold K. The new bethesda system for reporting results of smears of uterine cervix.

Journal of National Cancer Institute. 1990;82(12):988-90.

Richart RM. A modified terminology for cervical intraepithelial neoplasia. Obst Gynecol. 1990;75:131-3.

Pradhan B, Pradhan SB, Mital VP. Correlation of pap smear findings with clinical findings and cervical biopsy. Kathmandu Univ Med J. 2007;5(4):461-7. Accesed on03/12/2015.

Nandakumar A, Ramnath T, Chaturvedi M. The magnitude of cancer cervix in India. Indian J Med Res. 2009;130(3):219-21.

World - both sexes estimated incidence by age. Accessed October 30, 2015. Available from:

National Centre for Disease Informatics Research, National Cancer Registry Programme, ICMR Three Year Report of Population Based Registries, 2009-2011 Bangalore, India. NCDIR-NCRP (ICMR) 2014.

National Centre for Disease Informatics Research, National Cancer Registry Programme, ICMR Time Trends in Cancer Incidence Rates, 1982-2010 Bangalore, India. NCDIR-NCRP (ICMR )2013

Karuna J, Charulata R. Acritical review of cases of cervical erosion. Jr of Obst and Gyneccol. 1979;42:227-30.

Yajima A, Mori T, Sato S, Suzuki M. Effect of cytological screening on the detection of cervical carcinoma. J of Obst and Gyneccol. 1982;59(5):565-68.

Beinton A, Palintasa, Barrett Conner. Estrogen depressive symptoms in postmenopausal women. J of Obst and Gyneccol. 1986;80(1):30-3.

Mital K, Agarwal U, Sharma VK, Jaiswal TBL. Evaluation of cytological an histological examination in precancerous and cancerous lesions amongst gynaecological diseases. Indian J of Obst and Gyneccol. 1989;42(8):713-5.

Chauhan SH, Tayal OK, Kalia IJ. Detection of uterine cervical dysplasia and carcinoma cervix. Indian J of Obst and Gyneccol. 1990;17:419-21.

Spinilla A, Christiansenc, Belynger D. The study of infection in cervical cytomorphology; Br Jr of Obst and Gyneccol. 1997;20(5):398-409.

Tabrizi SN, Tappan R, Flense D. The infectivity of HPV and HSIL. Br J of Obst and Gyneccol. 1999;42(3):167-71.

Thomas A, Corrara, Majoria MA, Kumar KR. The bethesda system recommendation in reporting benign endometrial cells in cervical smears from postmenopausal women published by American Cancer Society. Indian Jr of Pathol Microbial. 2002;25(1):134-8.

Karuma, Gaspanal V, Van-Dan Brule R. The clinical profile and cervical cytomorphology. Indian Jr Of Pathol Microbial. 2003;46(2):179-89.

Mishra JS, Panday S. The reporting of cervical smear according to The Bethesda system with symptomatic postmenopausal women. J of Cytol. 2005;43(4):13-17.

Sherwani RK, Khan T, Akhtar K, Zeba A et al. Conventional Pap smear and Liquid Based Cytology for Cervical Cancer Screening: a Comparative Study. Jr of Cytol. 2007;24(4):167-72.

Kulkarni AM. Pattern of epithelial cell abnormalities in pap smear According to bethesda system in south western maharastra. J Obstet Gynaecol India. 2014;4(2).

Bal MS, Goyal R, Suri AK, Mohi MK. Detection of abnormal cervical cytology in papanicolaou smears. J Cytol. 2012;29(1):45-7.

Bamanikar SA, Baravkar DS, Chandanwale SS, Dapkekar P. Study of cervical pap smears in a tertiary hospital. Indian Medical Gazette. 2014.

Verma I, Jain V, Kaur T. Bethesda system for cervical cytology in unhealthy cervix. J Clin Diagn Res. 2014;8(9).

Jena A, Bharthi T, Siva Kumar Reddy YK, Manilal B,Patnayak R, Phaneendra BV. Papnicolaou (pap) test screening of staff members of a tertiary care teaching hospital in South India. JClin Sci Res. 2012;1:174-7.