Trends in epithelial cell abnormalities observed on cervical smears over a 21-year period in a tertiary care hospital in Kuwait

This study aimed to analyse trends in epithelial cell abnormalities [ECAs] in cervical cytology at a tertiary care hospital in Kuwait. ECAs in 135,766 reports were compared over three seven-year periods between 1992 and 2012. Conventional Papanicolaou [Pap] smear tests were used in the first two periods and ThinPrep [Hologic Corp., Bedford, Massachusetts, USA] tests were used in the third. Significant increases in satisfactory smears, atypical squamous cells of undetermined significance [ASCUS] and atypical glandular cells of undetermined significance/atypical glandular cells [AGUS/AGCs] were seen in the second and third periods [P <0.001]. No significant increases were observed among low-grade squamous intraepithelial lesions [LSILs] or high-grade squamous intraepithelial lesions [HSILs] [P >0.05]. An increase was noted in carcinomas between the first and second periods although a significant decline was seen in the third [P <0.014]. Satisfactory smears, ASCUS and AGUS/AGC increased during the study period although no significant increases in LSILs, HSILs or carcinomas were observed

Correlation of fine needle aspiration cytological features of extra-pulmonary tuberculous lesions with detection of acid fast bacilli-Mubarak Al Kabeer hospital, Kuwait experience

To correlate the spectrum of cytomorphological changes in fine needle aspirates [FNA]of extrapulmonary tuberculous lesions with the demonstration of acid fast bacilli [AFB] by Ziehl-Neelsen [ZN] staining and culture of the mycobacterial organism Prospective, from January 2008 to August 2009 Mubarak Al Kabeer Hospital, Kuwait Three hundred and eighty-one patients with suspected tuberculosis FNA was done on lymph nodes [313 cases, 82%], soft tissue [37 cases, 10%], breast [24 cases, 6%], thyroid [3 cases, 1%] and epididymis [4 cases, 1%]. Papanicolaou and / or May-Grunwald-Giemsa [MGG] stained smears were classifiedinto:Group A: granulomas with necrosis [n=202,53%], Group B: granulomas alone [n=59, 15.5%], Group C: acellular necrosis alone [n=53, 13.9%] and Group D: acute inflammatory exudate [n=67,17.6%]. The cytomorphological features of extra-pulmonary tuberculosis in FNA were correlated with AFB demonstration by ZN staining and mycobacterial culture. The AFB positivity by ZN stain was 46.6, 7.9, 58.1 and 22% in groups A, B, C and D respectively. Culture was positive in 53.1, 6.7, 56 and 15.4% in groups A, B, C and D respectively. In 32 out of 109 cases both ZN staining and culture were positive. In 77 cases negative for AFB the culture was positive in 31.2% and negative in 68.8%. Evaluation of all FNA from suspected cases of tuberculosis should include staining for AFB and culture for mycobacteria

Changing spectrum of squamous cell abnormalities observed on papanicolaou smears in Mubarak Al-Kabeer Hospital, Kuwait, over a 13-year period

The aim of this study was to determine the incidence of squamous cell abnormalities in cervical cytology in Mubarak Al-Kabeer Hospital, Kuwait, and to document any change in the pattern of these lesions. Over a 13-year period [1992-2004], 86,434 cervical smears were studied in Mubarak Al-Kabeer Hospital, Kuwait. Conventional Pap smears were first examined by cytotechnicians and finally reported by cytopathologists. The smears were classified according to the modified Bethesda system. The age of presentation of squamous cell abnormalities in Kuwaiti women was analyzed. Smears from 83,052 [96.09%] patients were found satisfactory for reporting while the remaining 3.9% was unsatisfactory. Atypical squamous cells of undetermined significance [ASCUS] were seen in 1,790 [2.2%] cases, atypical glandular cells of undetermined significance [AGUS] in 630 [0.8%] cases, low grade squamous intraepithelial lesion including human papillomavirus changes [LSIL] in 824 [1.0%] cases, high grade squamous intraepithelial lesion [HSIL] in 189 [0.2%] cases, and carcinoma in 79 [0.1%] cases of which 44 [0.05%] were squamous cell carcinoma. A comparison of average cases/annum during the study period revealed a significant increase in ASCUS from 1.13 to 2.83% [p < 0.001] and AGUS from 0.33 to 1.08% [p < 0.001]. However, the percentage of LSIL, HSIL and carcinoma detected in Pap smears remained the same. A significant linear trend [p < 0.001] was observed in satisfactory smears, ASCUS and AGUS over the years. However, no significant change was found in the detection of LSIL, HSIL and carcinoma. A reduction in the age of LSIL/HSIL and an increasing trend in the number of Kuwaiti women over the years was also observed which makes screening of young women essential in Kuwait

Distribution of human papillomaviruses in women

To study the distribution of human papillomviruses [HPV] in women in Kuwait using hybrid capture assay and their correlation with the severity of cervical lesions based on cytological diagnosis and to establish the relationship if any between the quantity of the viral load and the degree of severity of cervical lesions. Study sample included 181 women in the age range of 20-68 years, attending the Out-Patient Department of Gynaecology of the Al-Farwaniya Hospital and six polyclinics in Kuwait during the years 1997-1998. Cervical smears were interpreted according to the modified Bethesda System. HPV DNA was detected using a chemiluminescent-based Digene hybrid capture assay. Of the 181 women studied, the cytodiagnosis was as follows: normal and inflammation 139 [76.8%], atypical squamous cells of undetermined significance [ASCUS] and atypical glandular cells of undetermined significance [AGUS] 26 [14.4%] and squamous intra-epithelial lesion [SIL] 16 [8.8%]. High-risk HPV DNA had a very low prevalence in women with normal and inflammation cytology, i.e. 1.4% in contrast to women with SIL lesions which had a positivity of 68.8%. ASCUS and AGUS group had 7.7% high-risk HPV DNA positivity. The quantity of viral load was directly related to the increase in the severity of the lesions. High-risk HPV DNA was detected in a significantly higher proportion of women with SIL lesions as compared to those with normal cytology [p < 0.0001]. Furthermore, the viral load of high-risk HPV DNA was directly related to the severity of the cervical lesions, relative light unit ratios being >20 in the majority of SIL lesions