Online ISSN: 2515-8260

Keywords : screening


COMPARATIVE STUDY OF LIQUID-BASED CYTOLOGY VERSUS HPV DNA FOR SCREENING OF CERVICAL CANCER AT A TERTIARY HOSPITAL

Virta Chauhan, Sajan Bijyal

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 2129-2137

Background: Among Indian women, cervical cancer is the most common form of genital malignancy. Cytology (conventional or liquid-based) & HPV DNA used for diagnostis of cervical cancer. Present study was aimed to compare liquid-based cytology versus HPV DNA for screening of cervical cancer at a tertiary hospital.
Material and Methods: Present study was single-center, prospective, observational study, conducted women between the ages of 21 - 65 years, with white discharge per vaginum, post coital bleeding or irregular bleeding, unhealthy cervix on speculum examination.
Results: In present study, 220 women were evaluated for LBC & HPV DNA testing. Mean age of women was 42.91 ± 6.19 year, mean age at marriage was 17.41 ± 3.63 years & mean duration of sexual life was 26.81 ± 8.63 years. Majority were from lower socioeconomic status (57.27 %). Common chief-complaint was white PV discharge (64.55 %), Post coital bleeding PV (19.55 %) & intermenstrual bleeding PV (15.91 %). On per-speculum examination cervical erosion (40.45 %) was common finding. Common mode of contraception used was tubectomy (49.55 %), while 28.64 % women were not using any contraceptive. In present study, common LBC findings were Inflammatory / reactive changes (48.18 %), Non-specific inflammation (10.91 %), Candida (5.45 %), Trichomonas vaginalis (3.64 %), Bacterial vaginosis (0.91 %), Atrophy (1.36 %). Pathological findings were ASCUS  (5.00 %), ASC-H (0.91 %), LSIL (0.45 %), HSIL  (0.91 %), HSIL with suspicious of invasion (0.45 %) & Squamous Cell Carcinoma (2.27 %). Normal findings were noted in 18.64 % women while 2 smears were labelled as unsatisfactory smear. HPV DNA was positive in 15.45 % women.  HPV DNA was significantly associated with pathological LBC report (low grade, high grade & neoplasia).
Conclusion: HPV testing in comparison to LBC was more effective, but it is costlier for application as population screening tool.

STUDY OF SPECTRUM OF CERVICAL LESIONS ON PAP SMEARS AND GYNECOLOGICAL CYTOHISTOLOGIC CORRELATION -WHEREVER FEASIBLE, IN A RURAL TERTIARY TEACHING COLLEGE HOSPITAL

Dr. Ashwini Rege-Gundawar, Dr. Sneha Joshi

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 3671-3693

Introduction: Cervical carcinoma (Ca Cx) is a high incidence malignancy in India (6–29% of all cancers in women). The Pap smear test is a proven effective measure for reducing cervical carcinoma incidence. Lack of population level screening program in India corresponds with the detection of most cervical lesions at a late stage of disease (stage II or stage III) with consequent high mortality and morbidity. The hospital where this study was conducted offers Pap smear free of cost.
Aims & Objectives:

1.      To study the spectrum of cervical lesions by analyzing the results of Pap smear tests -for a period of one year.
2.      To evaluate clinical utility of Pap smear testing by studying histopathological correlation- wherever feasible, for the same one-year period.

Materials and Methods: Retrospective observational study conducted by retrieving data for 1 year, pertaining to conventional Pap smear tests and related histopathological examination reports.
Results ([1]): Of 808 Pap smear tests done, 788 (97.5%) were satisfactory for evaluation. These were reported using, “The Bethesda system for evaluation of cervical pathology (2014)”. Results were divided into: i) Inflammatory (70.56%), ii) NILM (23.60%), iii) Atrophic (3.42%) and iv) Epithelial cell abnormalities [ECA] (2.41%). The ECAs included ASCUS, LSIL, HSIL and SCC. The inflammatory Pap smears included 28 cases of Trichomonas vaginalis, 7 cases of Yeast, (likely Candida) infection, and 2 cases with presence of blue wool like microorganisms morphologically resembling Actinomyces. Histopathological report association was done for 118 (14.97%) cases. Of these, 112 (94.91%) cases were reported as inflammatory pathology and 6 (5.08%) cases as ECAs. The ECAs included 3 HSILs, 2 LSIL/inflammatory changes and 1 case of SCC. All 118 cases were reported with 100% concurrence rate for cytopathology –histopathology correlation.
Conclusions: 1) Pap smear is a good screening as well as diagnostic test. 2)However more significant yield towards prevention of Ca Cx will be achieved by adding supplemental testing e.g., HPV DNA testing.3) Concentrated efforts need to be made to target screening efforts towards older age group women and also towards follow up and treatment of the Positive Pap smear cases

Outcome of cervical cancer screening using Pap smear test on a target population

Dr. Shruti Bhavi Patil

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 122-126

Objective: To evaluate the use of Pap smear screening method for detection of precancerous
lesions.
Methods: Women working in police department and female family members of men working
in police department were screened for Ca cervix. A total of 67 women were recruited for the
study. A clinical examination per speculum and per vaginal examination were performed and
a history taken for all women. A pap smear was used for all women to see for cervical cancer.
The smear was obtained using Ayer’s spatula and spread over a marked glass slide which was
placed in 95% ethyl alcohol and sent to department of Pathology for cytopathological
examination. All data were recorded using a predesigned proforma.
Results: Most women were in age range of 30-50 years. The common complaint was white
discharge per vagina occurring in about 30% of individuals, abdominal pain was in 8.95% of
them, irregular menstrual cycle in 12.78% and 40.29% of them did not have any complaints.
Out of 67 ladies 61 (92.1%) pap smears were taken and 6 were not taken due to post
hysterectomy status or because they were menstruating. The test was negative for malignancy
in 68.6% of individuals and 11% of individuals had inflammatory smear due to infections
with trichomoniasis, bacterial vaginosis or candidiasis. Atypical cells were detected in 2.98%
women and they were advised colposcopy and guided biopsy. 5% of individuals had
unsatisfactory smear due to inadequate sample.
Conclusion: A Pap smear is simple, noninvasive, cost-effective, and easy to perform for
detection of precancerous lesions in a gynecological patient. Awareness about screening in
general population is needed. Women with an abnormal Pap test should undergo a
colposcopy and guided biopsy.

Subclinical Hypothyroidism in Pregnancy: A Review

Dr. Ritimukta Panda; Dr. Kavya Sudha; Dr. K.Jaya Sri; Dr. Rachita Sarangi; Dr. Bhagirathi Kar; Dr. Gangadhar Sahoo

European Journal of Molecular & Clinical Medicine, 2020, Volume 7, Issue 6, Pages 1443-1446

Pregnancy-reference levels of Subclinic hypothyroidism (SCH), along with normal level of serum thyroxine, are called high thyroid stimulation hormone level (TSH).
Autoimmune Thyroiditis is also common in patients of subclinical hypothyroidism. Subclinical Hypothyroidism in pregnancy is the cause of some adverse obstetric consequences. Changes in the metabolism of thyroid hormones during pregnancy needs to be kept in mind, while diagnosing thyroid abnormalities. There is a jump in the obstetric and neonatal results, like preterm delivery, miscarriage, fetal growth restriction, preeclampsia, gestational diabetes mellitus, low birth weight, abruptio placentae and poor Apgar scores at birth. Treatment with Cevothyroxine therapy may help reduce some of these adverse effects, however there is restricted evidence to provision it. The behavior of subclinical hypothyroidism should target maternal TSH concentrations of less than 2.5mIU/L. However there is a lack of recommendation for the official starting dose of levothyroxine. So, individualised low doses of levothyroxine can be started and thereafter titred to the maintain the TSH in the target level