COLPOSCOPIC EVALUATION OF POST-MENOPAUSAL WOMEN WITH NORMAL CERVICAL CYTOLOGY

Abstract

1. Introduction The most common genital cancer seen in Indian women is Carcinomacervix Its incidence is approximately 1 in 53 Indian women during their lifetime compared to 1 in 100 in developed countries. In women ≥ 50 years where the lifetime risk of cervix cancer is estimated as 3.5%, which can be reduced to 0.8% with screening. Pap smear evaluation alone is inadequate for predicting the precancerous lesions in postmenopausal women due to hypoestrogenic changes of menopause which makes it difcult to differentiate atrophic cellular changes from other pathologic conditions, giving more false negative results which can be reduced if combines with colposcopy examination and guided biopsy wherever needed 2. Aim & Objective To diagnose intraepithelial lesions in postmenopausal patients with normal cytological ndings and to assess the usefulness of cytological screening, colposcopy, and colposcopy-directed biopsy in these patients. 3. Material And Method- A retrospective study was carried out from 1st January 2018 to 31 October 2022 at a colposcopy clinic, in district Shivpuri M.P. on 104 post-menopausal females of age group 45-68 years. After detailed history and examination, a pap smear in all 104 patients was taken. All patients with negative cytology reports for Intra epithelial lesions with persistent symptoms and suspicious signs were subjected to colposcopy. 23 Patients with positive Colposcopic ndings were subjected to Colposcopic guided biopsy. histopathological evaluation was done. 4. Result This study analyzed 104 postmenopausal patients who had Pap smear reports with NILM (Negative for intraepithelial Lesion or Malignancy). 58% of the patients were referred by other Doctors. The most common post-menopausal age group nd in this study was between 45-55 (52.88%), Most of the patients were of a low socioeconomic group (54.81%), Multipara (3-5 parity 66.35%). with a history of menopause of 5-10 years (49.04%) duration. Only 5.77% of patients had 3 Pap smear reports with them, and a history of smoking was present in 6.73% of cases. The most common presenting symptom was discharge PV (47.11%) followed by Foul smelling bloody discharge (14.42%). Post-coital bleeding (12.5%), Post-menopausal bleeding (8.65%), and dyspareunia (4.80%). On colposcopy, (77.89%) of cases had normal Colposcopic ndings while (22.11%) had abnormal Colposcopy ndings. In 17.30% of cases, LSIL was suspected, in 4.80% of cases HSIL was suspected on colposcopy Colposcopy-guided biopsy was done in 23 (22.11%) patients with suspected CIN. On histopathology 9.61% of cases were positive for intraepithelial lesions, CIN1 was found in 7.69%, and CIN2 in 1.92%. Carcinoma in situ and Invasive carcinoma were not found in any case. 10(9.61%) out of 104 patients had cervical intraepithelial neoplasia diagnosed on colposcopy-guided biopsy and histopathology report. 5. Conclusion- In our study, despite the Pap smear report as NILM (Negative for intraepithelial lesion or malignancy). ,10(9.61%) out of 104patients had cervical intraepithelial neoplasia diagnosed on colposcopy guided biopsy, thus we recommend, the combined use of cervix cytology, colposcopy, and histopathology in postmenopausal cervix cancer screening evaluation to improve the diagnosis of the cervical intraepithelial lesion.