Conventional versus liquid based pap smear tests for diagnosis of cervical lesions

To compare the results of manual Liquid-based Cytology, and Conventional Pap smear as confirmed by colposcopic-guided biopsy in the diagnosis of different cervical lesions, among women attending Sohag University Hospital outpatient clinic. Three hundred ninety three women with cervical abnormalities revealed by clinical examination were evaluated by examination of cervical smears [197 manual Liquid-based Cytology and 196 Conventional Pap]. The results of the smears were confirmed by colposcopic-guided biopsy. Comparable findings were noticed by both the Conventional and the manual Liquid-based cytology as confirmed by biopsy. Each test showed 97% sensitivity and 34% specificity in detecting specific inflammation, and 86% sensitivity and 34% specificity in detecting malignancy in the cervix, with no statistical differences between them, as confirmed by biopsy. The result of the manual liquid-based test is comparable to the conventional Pap smear test in detecting different cervical lesions. In addition, it is cheaper, easy and suitable to he applied in our community

Chlamydia trachomatis and cellular DNA content in cervical ectopy

The study was conducted on 68 women with cervical ectopy referred to the Early Cancer Detection Unit of Ain Shams University Maternity Hospital from November 1997 to October 1998 to study chlamydia trachomatis infection serologically in cases of cervical ectopy and its relation to DNA abnormalities. 38 out of 68 women were diagnosed cytologically to have chlamydia trachomatis. 36 of them were also confirmed by positive IgA antibodies of chlamydia trachomatis by solid phase ELISA technique so immuno-enzymatic and cytological methods were both accurate in the diagnosis. Chlamydia was found to be the commonest infections in cervical ectopy 55.8% followed by the HIPV 35.3%. 44% of patients with cervicalectopy had inflammatory atypia, 26.5% of which were found to be chlamydia positive, low grade squamous intraepithelial lesion [LSIL] was diagnosed in 35.2% of patients, 29.4% of which were chlamydia positive and 35.3% were associated with HPV infection. On DNA analysis of chlamydia positive smears, four had aneuploidy, two slides were suspicious for aneuploidy and the rest were diploid. It can be concluded that, the immuno-enzymatic method and cytological method are accurate in diagnosis of chlamydia trachomatis which was found to be the commonest infection in cases of cervical ectopy and there is no relation between chlamydial infection and DNA changes in cervical ectopy

Cervical herpes simplex virus in Benha University Hospital clinic: cytologic, virologic and colposcopic study

Our objective was to determine the isolation rate of cervical HSV in relation to different clinical conditions and colposcopic findings, among the patients attending the outpatient clinic of Benha University Hospital and to find out the sensitivity and specificity of Papanicolaou [Pap] smear and direct fluorescence antibody stain [DFA] in relation to tissue culture. Our study comprised 250 patients. For each patient a Pap. smear was obtained and two endocervical scrapings were collected. The first one was used for staining with DFA. The second one was used for isolation of HSV-2 on monolayer of Buffalo Green Monkey kidney [BGM] cell culture. Colposcopy was done in all patients. Punch biopsy was taken from cases suggestive of squamous intraepithelial lesion. Out of the 250 patients, 36 [14.4%,] were positive for HSV by culture on BGM cells, 29 [11.6%] by DFA staining and 16 [6.4%] by Pap. smear. DFA has higher sensitivity [58.3% versus 33.3%,] and negative predictive value [93.2% versus 89.7%] than Pap smear. The virus isolation rate was not sign higher in the multigravida, multipara, patients with a history of 2 or more abortions, pregnant females, women using pills or intrauterine contraceptive device [IUCD], or patients with atypical transformation zone. The isolation rate of cervical HSV is 14.4% in the patients attending the outpatient clinic of Benha University Hospital. Pap. Smear is not useful in detection of HSV. The virus isolation rate was significantly higher in the age group [20-30 years], patients with a history of herpetic like lesions on the genitalia, patients with cervical ectopy and patients with infected typical transformation zone

Micronuclei in exfoliated cervical cells as a prospective indicator tool for cellular genotoxic damage in high risk cancer patients, cytohistologic study versus DNA ploidy

The present study is an attempt to shed led light on clinical significance of micronucleus test as part of cytopathologic examination. One hundred females from the attendants of Cyto Diagnostic Unit of Early Cancer Detection in Obstetrics and Gynecology Hospital, Ain shams University, were chosen for the present study from cases presented with unhealthy cervix. They were diagnosed cytologically as 69 cases had inflammatory disease, 26 had cervical intraepithelial neoplasia and 5 cases had cervical cancer. One hundred females with healthy cervix were chosen as a control group. The present study showed that the mean age of the study group was 35.5 +/- 8.5 years compared to 33.6 +/- 7.8 years in the control group with no statistically significant difference [P > 0.05]. The difference between cases of CIN and cancer and controls were statistically significant [P < 0.05] as regard early age of marriage, parity and past history of cervical erosion as risk factors for the occurrence of cervical intraepithelial neoplasia. The frequency of micronuclei was [1.5 +/- 1.4] among study cases compared with [1.3 +/- 1.7] in the controls. The difference was statistically significant in low SIL and HSIL [2 +/- 1.2, 3.4 +/- 0.8 respectively] [P < 0.05]. The micronucleus test was found to be more sensitive test [92.3%] than cytological examination [61.5%]. DNA image analysis was found to be more specific [90.5%] than the micronucleus test [70.3%] and cytological examination [77.1%]. MN test compared with DNA cytometry was highly sensitive parameter for detection of genotoxic chromosomal damage caused by HPV with sensitivity of 100% while specificity was 74%. Cytological examination is still the most common screening test used in early diagnosis of CIN. DNA image and MN test are important tests for early diagnosis of genetic damage but still not easily to be used on big scale. MN test should be part of routine cytologic examination of high risk patients to diagnose synergistic action of carcinogens. As the DNA image and MN test are prospective parameters so, cases with positive cytology, for SIL even if the pathology was negative must do MN test and DNA cytometry. If the two proved to be abnormal, these cases should be considered highly risk group and should be put under strict follow-up including invasive procedures

Comparison between colposcopically directed punch biopsy and large loop excision of the transformation zone [LLETZ]

The study comprises [40] women with suspected cervical intraepithelial neoplasia CIN attending the colposcopy clinic at Ain Shams Early Cancer Detection unit. All women were subjected for colposcopy. directed punch biopsy and large loop excision of the transformation zone [LLETZ]. Colposcopy was satisfactory in all women, punch biopsies were adequate for pathological examinations, the excised transformation zones were also adequate. The results of LLETZ did not agree with that of punch biopsies in [25% of cases. The pathology detected by punch biopsy was superior than LLETZ in 20% of cases. LLETZ revealed pathology greater than punch biopsy in [5%] of cases. Punch biopsy is an adequate method of diagnosis specially for smaller lesions, concerning larger, ones, it is better to have more than one biopsy or LLETZ

Vaginal and cervical cytology in cervical eversion [cervical erosion] and suspicious cervix

This study was carried out on 200 non-pregnant women, with ages ranging from 18 up to 48 years. They attended the gynaecologic outpatient clinic, at Mansoura University Hospital. They include 150 women with cervical erorsion and suspicious cervix and 50 women with clinically healthy cervices as controls. A posterior vaginal pool and cervical scraps smears were obtained from each woman using the plastic spatula and stained by Papanicolaou stain. There was an increased incidence of dysplasia among parous women than nulliparous women. Also we found 3 cases of invasive carcinoma of the cervix among the suspicious cervix group and this was proved histopathologically. The chief complaint of cases with cervical erosion was excessive vaginal discharge [57%]. The incidence of dysplasia among cervical erosion groups was 34% [41 out of 120 cases], while the incidence in the suspicious cervix group 52% [14 out of 27 cases] no cases of dysplasia had been found in the control group. We can recommend that each woman during her reproductive period must be checked up by routine cervico-vaginal cytology every 6 months to detect and early lesion which could be easily dealt with as early as possible and abort it before it grows up