Assessment of Pap smear specimens’ adequacy based on Bethesda System-2001 and its association with clinical factors

Document Type : Original Article

Authors

1 Assistant Professor, Department of Midwifery, School of Nursing and Midwifery, Islamic Azad University, Karaj Branch, Alborz, Iran.

2 M.Sc. of midwifery, School of Nursing and Midwifery, Iran University of Medical Science, Tehran, Iran.

3 Instructor, Department of Midwifery, School of Nursing and Midwifery, Islamic Azad University, Karaj Branch, Alborz, Iran.

Abstract

Introduction: The efficacy of screening programs in cytology of cervical cancer is dependent on the smear quality. The unsatisfactory smears are confusing to many physicians for deciding and lead to repeat the test. Assessment of the factors which may cause unsatisfactory smears would be useful in identifying the women who are at risk. Therefore, this study was performed with aim to assess the smear’s adequacy and its association with these factors and clinical symptoms.
Methods: This prospective descriptive and analytical study was performed on 1557 women who had referred to gynecology clinic of Alborz Hospital of Karaj to do Pap smear tests from Aug 2011 to Jun 2013. The Pap smear samples were taken with conventional technique and their adequacy was determined based on Bethesda system 2001. The relationship between unsatisfactory smears with age, menopausal status, vaginal infection, cervicitis, and contact bleeding was assessed. Data was analyzed SPSS software (version 13) and Chi-square test and T-test. P < 0.05 was considered significant.
Results: The frequency of unsatisfactory smears was 7.2%. Old age (P= 0.001) and menopause state (P= 0.001) were related to the results of unsatisfactory outcomes. But, there were no significant difference between vaginal infection, cervicitis, and contact bleeding with unsatisfactory Pap smears (P=0.750, P=0.640, and P=0.848, respectively).
Conclusions: Age and menopausal status increase the possibility of unsatisfactory cervical smears. For these cases, the optimal sampling techniques are suggested.  

Keywords


  1. Gilson M, Desai A, Cardoza-Favarato G, Vroman P, Thornton JA. Dose gel affect cytology or comfort in the screening papanicolau smear? J Am Board Fam Med 2006; 19(4):340-4.
  2. Novak E. Berek & Novak's Gynecology. 15th ed. Philadelphia: Lippincott Williams & Wilkins; 2012. P. 529-32.
  3. Selvaggi SM. Factors contributing to high ThinPrep® Pap test unsatisfactory rates in an academic medical center laboratory. Diagn Cytopathol 2014; 42(5):380-3.
  4. Salomon D, Davey D, Kurman R, Moriarty A, O’Connor D, Prey M, et al. The 2001 Bethesda System: terminology for reporting results of cervical cytology. JAMA 2002; 287(16):2114-9.
  5. Gavranovic L, Novak SR, Bolanca IK. Causes and frequency of unsatisfactory cervicovaginal smear. Acta Med Croatica 2011; 65(l):115-9.
  6. Owens CL, Buist DS, Peterson D, Kamineni A, Weinmann S, Ross T, et al. Follow-up and clinical significance of unsatisfactory liquid-based Papanicolaou tests. Cancer Cytopathol 2015; 123(1):59–65.
  7. Siebers AG, Klinkhamer PJ, Vedder JE, Arbyn M, Bulten J. Causes and relevance of unsatisfactory and satisfactory but limited smears of liquid-based compared with conventional cervical cytology. Arch Pathol Lab Med 2012; 136(1):76-83.
  8. Lu CH, Chang CC, Chang MC, Chen SJ, Jan YJ, Fu TF, et al. Clinical parameters associated with unsatisfactory specimens of conventional cervical smears. Diagn Cytopatol 2011; 39(2):87-91.
  9. Gupta S, Sodhani P, Sardana S, Singh V, Sehgal A. Clinical determinants and smear characteristics of unsatisfactory conventional cervicovaginal smears. Eur J Obstet Gynecol Reprod Biol 2013; 168(2):214-7.
  10. Pauin H, Geldenhuys L, Naugler C. Predictors of an unsatisfactory conventional cervical cytology smears. J Obstet Gynecol Can 2011; 33(7):725-8.
  11. Akamatsu S, Kodama S, Himeji Y, Ikuta N, Shimageki N. A comparison of liquid-based cytology with conventional cytology in cervical cancer screening. Acta Cytol 2012; 56(4):370-4.
  12. Singh VB, Gupta N, Nijhawan R, Srinivasan R, Suri V, Rajwanshi A. Liquid-based cytology versus conventional cytology for evaluation of cervical Pap smears: experience from the first 1000 split samples. Indian J Pathol Microbiol 2015; 58(1):17-21.
  13. Castle PE, Bulten J, Confortini M, Klinkhamer P, Pellegrini A, Sibers AG, et al. Age-specific patterns of unsatisfactory results for conventional Pap smears and liquid-based cytology: data from two randomized clinical trials. BJOG 2010; 117(9):1067-73.
  14. Prandi S, Beccati D, De Aloysio G, Fulgenzi P, Gabrielli M, Ghirardini C, et al. Applicability of the Bethesda system 2001 to a public health setting. Cancer 2006; 108(5):271-6.
  15. Arbyn M, Herbert A, Schenck U, Nieminen P, Jordan J, Mcgoogan E, et al. European guidelines for quality assurance in cervical cancer screening: recommendations for collecting samples for conventional and liquid-based cytology. Cytopathology 2007; 18(13):133-9.
  16. Edwards SK, Sonnex C. Influence of genital infection on cervical cytology. Sex Transm Infect 1998; 74(4):271-3.
  17. Yarandi F, Izadi N, Eftekhari Z. The frequency of unsatisfactory pap smears and genital infection. Tehran Univ Med J 2005; 62(9):735-9. (Persian).
  18. Alsharif M, Mckeon DM, Gulbahce HE, Savik K, Pambuccian SE. Unsatisfactory SurePath liquid-based Papanicolaou tests: causes and significance. Cancer 2009; 117(1):15-26.