Pattern of Abnormal Pap smears in developing countries: a report from a large referral hospital in Saudi Arabia using the revised 2001 Bethesda System Dr Layla s abdullah, md, frcpc



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Pattern of Abnormal Pap smears in developing countries: a report from a large referral hospital in Saudi Arabia using the revised 2001 Bethesda System

Dr Layla S Abdullah, MD, FRCPC, MIAC*

Consultant Pathologist/ Assistant Professor

Department of pathology &laboratory medicine

King Abdulaziz University Hospital

Jeddah/Saudi Arabia

*Corresponding Author:

Dr Layla S Abdullah, MD, FRCPC, MIAC*

Consultant Pathologist/ Assistant Professor

Department of pathology &laboratory medicine

King Abdulaziz University Hospital

Jeddah/Saudi Arabia

Email: layla2abdullah@hotmail.com

Abstract:

OBJECTIVE: To retrospectively study the frequency and pattern of cervical intraepithelial lesions and carcinoma detected in PAP smears of Saudi females in western region of Saudi Arabia using the revised 2001 Bethesda system of cervical smear reporting in an effort to reemphasize the urgent need for organized cervical screening programs in developing countries such as Saudi Arabia .Materials & Methods: all cervical PAP smears reported in the department of Pathology of King Abdulaziz medical city/Jeddah in the period from beginning of January 1998 to end of August 2005 is carried out and adequate cervical cytology smears are reviewed and reclassified according to the revised 2001 Bethesda system of Pap smear reporting .The total number and percentages of each type of positive smears are identified and correlated with the patient's age. Results: Out of the 5590 sufficient smears, a total of Two hundred and sixty one (261, 5%) smears were identified as positive for cervical epithelial abnormalities. In the positive smears category, one hundred and three(103 ,40%) smears were classified as atypical squamous cells of undetermined significance( ASC-US) with age range of 15-65 years, six(6,2%) cases as atypical squamous cells of high grade (ASC-H)with age range of 36-70 years, fifty six(56,22%) as low grade squamous intraepithelial lesions(LG SIL) with age range of 18-67 years, thirty one (31 ,12%) as high Grade squamous intraepithelial lesions(HGSIL)with age range of 26-89 years, The invasive squamous cell carcinoma accounted for 21 cases(9%)with age range of 28-78 years. The ASCUS/SIL ratio was (1.9%)



.The glandular cell abnormalities were as follows: The atypical endocervical cells,NOS is identified in ten(10,4%)cases ,the atypical endometrial cells,NOS in nine(9,3%)cases and atypical glandular cells ,NOS in eleven(11,4%) cases. The age range for the above three abnormalities was 29-72 years. Invasive adenocarcinoma of either endocervical or endometrial origin accounted for 4 %( 14 cases) of all positive cases with similar age range as invasive Squamous cell carcinoma. Conclusion: this study, and in agreement with other local studies, show a lower incidence of cervical intraepithelial cell abnormalities and cervical cancer with a wider age range. The need for larger nationwide studies and well organized cervical screening program is stressed.

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