การศึกษาความสัมพันธ์ระหว่างผลการตรวจทางเซลล์วิทยาที่ผิดปกติของปากมดลูกและผลการตรวจชิ้นเนื้อ ทางพยาธิวิทยา: Correlation of the Abnormal Cervical Cytology and the Histopathology Examination

Teerapong Wongwiboolchai

Authors

Teerapong Wongwiboolchai Sunprasitthiprasong Hospital

Keywords:

Cervical cytology, Histopathology, Cervical cancer, Sensitivity, Specificity

Abstract

Background: Cervical cytology (Pap smear) is widely used for cervical cancer screening but has limitations in sensitivity and specificity. Histopathology is considered the gold standard for diagnosing cervical lesions. Understanding the correlation and diagnostic performance of both methods is crucial for establishing appropriate screening guidelines.
Objective: To investigate the correlation and diagnostic performance of cervical cytology compared to histopathology in patients with abnormal cervical cytology.
Methods: A Retrospective analytical study was conducted by reviewing the medical records of patients with abnormal Pap smear results who underwent histopathological confirmation at Sunpasitthiprasong Hospital, Ubon Ratchathani, from October 1, 2021, to September 30, 2024, using purposive sampling. Agreement was analyzed using Cohen's kappa coefficient. Diagnostic performance was evaluated by calculating sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy, using HSIL/CIN2+ as the cut-off point.
Results: A total of 349 patients were recruited, with an average age of 45.70 ± 12.79 years. The most common Pap smear result was ASC-US (51.3%). The most common biopsy result was LSIL/CIN1 (34.1%). The concordance between the results of both methods was low (Cohen's kappa = 0.105, p < 0.001), with higher concordance in high-grade lesions (HSIL 75.0%, Adenocarcinoma 83.3%), but low in ASC-US cases (only 12.8% had lesions with level HSIL/CIN2 or higher). Diagnostic efficiency was found to be Sensitivity = 38.26% (95% CI: 29.7-47.5%), Specificity = 94.44% (95% CI: 90.7-96.7%), Positive Predictive Value = 77.19%, Negative Predictive Value = 75.68%, Accuracy = 75.93% When comparing sample collection methods, it was found that Conventional Pap smear had higher sensitivity than Liquid-based cytology (48.48% vs. 24.49%), but Accuracy was not significantly different (p = 0.583). The age group 40 years and over had higher sensitivity than the group younger than 40 years (45.00% vs 22.86)
Conclusion: The Pap smear demonstrated low sensitivity (38.26%), missing over half of the lesions, but maintained high specificity (94.44%). The concordance with histological findings was fair. Patients with any grade of cytologic abnormality require close follow-up, especially those younger than 40 years of age. The integration of HPV DNA testing as a co-test is recommended, alongside continuous quality assurance improvements.
Keywords: Cervical cytology, Histopathology, Cervical cancer, Sensitivity, Specificity

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