Abstract

PREVALENCE OF CERVICAL INTRAEPITHELIAL LESIONS AND RISK FACTORS AMONG WOMEN ATTENDING AL ELWEIYA MATERNITY TEACHING HOSPITAL/ TUMOR WOMEN CENTER DEPARTMENT IN 2021

Rafif Nemah Hassoni*, Hiba Dhari Al Ameri and Besmah Mohammed Ali

ABSTRACT

Introduction: Cancer of the cervix is an increasing health problem and an important cause of mortality in women worldwide. The incidence of cervical cancer arises worldwide it ranks 12 among Iraqi women. Cervical cancer is a preventable disease due to the long preinvasive stage. Early detection and appropriate treatment are possible if robust screening is implemented. Early cervical epithelial changes can be identified by a Pap smear test, which is the primary screening test for detection of precancerous cervical intraepithelial neoplasia and the early stage of invasive cervical cancer. A Pap screening done in association with an HPV DNA test increases the sensitivity for early detection of precancerous lesions. Objectives: The study was conducted to find the prevalence and risk factors of abnormal cervical intraepithelial lesions among women attending Al-Elweiya Maternity Teaching Hospital/ Tumor Women Center department. Methods: A cross-sectional study conducted on 190 cases who were asymptomatic or with different compliant evaluated by conventional pap smear in Al Elweiya Maternity Teaching Hospital between August to December 2021. Cervical lesion then classified according to Bethesda system into: Negative for intraepithelial lesion or malignancy (NILM), ASCUS, atypical squamous cells cannot exclude HSIL (ASC-H), low-grade squamous intraepithelial lesion (LSIL), and high grade squamous intraepithelial lesion (HSIL). Patients with abnormal cytological results referred to coloposcopic biopsy and managed according to WHO guideline. Results: Out of 190 women most of patients 181 (95.3%) were married; mean age of marriage was (19.63 ±5). Vaginal discharge was the presenting symptom in (34.7%). NILM was the most prevalent cytological result 171 (90.0%) followed by ASCUS, HSIL, LSIL, and ASCH (5.8 %, 2.1%, 1.6%, 0.5%) respectively. Regarding risk factors women within 30-50 years age group and those with positive test for high-risk human papilloma virus (HR HPV) showing significant association with cytological abnormalities (P<0.004and P<0.001) respectively. Significant association between pap test and histology was observed (P<0.001) with CIN1 being the prevalent cervical dysplasia 26.3%. Pap test showed 94.2% accuracy in detecting premalignant cervical lesions with good sensitivity, specificity, positive predictive value (PPV) and, negative predictive value (NPV) (90%, 94.4%,47.3%,99.4%) respectively. Conclusion: Pap smear test is effective, and easily applicable, method for diagnosing precancerous lesions with high diagnostic accuracy, so it is highly reliable. Well organized screening program not only at tertiary level is recommended as there is noticeable increase in early marriage of Iraqi women and change in lifestyle.

Keywords: Cervical cancer, Risk factors, Pap test.