Spectrum of epithelial abnormalities on papanicolaou smear in postmenopausal women

Abstract

The Papanicolaou (Pap) smear was introduced in 1941, became the standard screening test for cervical cancer and premalignant lesions, and is being used globally. To estimate the frequency of various epithelial abnormalities on Pap smear in postmenopausal women and assess their relation with parity, clinical symptoms and per speculum findings. Prospective Pap procedure was done on 400 postmenopausal women from November 2017 to June 2019 and smears were stained and cytological interpretation was made according to the 2014 Bethesda system.Out of 97.5% satisfactory smears, 17.9%, 26.2% and 55.9% were diagnosed as of epithelial abnormalities, normal cytology and inflammatory and other benign conditions respectively. ASCUS-mean age was 45.18 years and parity of 3. Patients were either asymptomatic or presented with white discharge. Incidence among epithelial abnormalities was 31.5% with overall incidence of 5.6%. LSIL- mean age was 48.11 years and parity of 4 and presented with white discharge and lower abdominal pain. Incidence was 37.2% among epithelial abnormalities with overall incidence of 6.7%. HSIL- mean age was 58.78 years with parity of >/=5, presented with white discharge and lower abdominal pain. Incidence among epithelial abnormalities was 27% with overall incidence of 4.8%. SCC -mean age was 58.6 years and parity of >/=5, presented with white discharge, postmenopausal bleed and something coming out of p/v. Incidence was 4.2% among epithelial abnormalities with overall incidence of 0.8%. Pap smear is a simple, cheap, safe and gold standard diagnostic tool for screening postmenopausal women.