Spectrum of Epithelial Cell Abnormality (ECA) and Cyto-Histopathological Correlation: A Hospital Based Prospective Study

Abstract

Objective: To determine the spectrum of cervical cytology and its correlation with histopathological findings in a tertiary care centre.

Methods: This was a hospital based prospective study conducted in the Vinayaka Missions Medical College & Hospital, Karaikal, Puducherry, India (tertiary care centre) between June 2022, and May 2023.

Results: Of the 442 requests for cytological examination – 5.2% were found to be unsatisfactory for evaluation, 80.8% smears were negative for intraepithelial lesion and malignancy and 7.9% had an epithelial cell abnormality (ECA). The distribution of smears showing signs of inflammation and atrophic changes were 5.0% and 1.1% respectively. Of the ECA, 14.3% had atypical squamous cells cannot exclude high-grade squamous intraepithelial lesion (ASC-H), 8.6% had low-grade squamous intraepithelial lesion (LSIL), 14.3% had high grade squamous intraepithelial lesion (HSIL), 11.4% had invasive squamous cell carcinoma, 2.8% had adenocarcinoma, and 5.7% had atypical glandular cells of undetermined significance (AGUS). Cytology and histopathology showed high rates of concordance for malignant lesions and AGUS. The assessment of diagnostic accuracy demonstrated the strength of cytology in identifying invasive squamous cell carcinoma and adenocarcinoma with 100% sensitivity, specificity, PPV, and NPV. However, variations were observed in the accuracy of identifying HSIL, LSIL, and negative cytology (NILM).

Conclusion: The high diagnostic accuracy for malignancies reinforces the pivotal role of cytology in identifying clinically significant lesions. However, the variations observed in the accuracy of identifying pre-neoplastic lesions call for a nuanced approach, potentially incorporating adjunctive testing and tailored surveillance strategies.