Comparison of PAP- Smear and Colposcopy in the Absence of HPV Test for the Diagnosis of Premalignant and Malignant Cervical Lesions

Cervical cancer, the 4th most common cancer in women, is the result of precancerous intraepithelial lesions which are associated with persistent human papillomavirus (HPV) infection. Prevention through vaccination and screening is critical, but access, awareness and care gaps, especially among disadvantaged populations, contribute to high incidence, late diagnosis and higher mortality rates in the world. Aim of the Study to evaluate PAP smear and colposcopy results in comparison with the histopathological results of cervical samples in women with abnormal cytology and/ or abnormal colposcopy results, without the presence of human papillomavirus (HPV) test. This is a cross sectional study, which was carried out at Basrah Maternity and Children Hospital from 1st January 2024 to 1st January 2025 for the comparison of PAP smear and colposcopy with histopathology in the diagnosis of cervical lesions. Eligible women were interviewed, Pap smear, colposcopy and biopsy. Data collected were demographic, gynecological history, and clinical findings. Histopathology was used as a diagnostic gold standard to help with future management. 111 women (mean age 44.12±12.8 years) were included in the study, the majority being married, unemployed and poorly educated. Abnormal vaginal bleeding (75.7%) and genital infections (56.8%) were common. Abnormality detected by PAP smear, colposcopy and histopathology was 50.5%, 52.2% and 54.1% respectively, and confirmed the presence of cervical intraepithelial neoplasia CIN or carcinoma. Important results were that PAP smear had an accuracy of 81.1% (sensitivity 75.0% and specificity 78.4%) and colposcopy was slightly better with an accuracy of 82.0% (sensitivity 81.6% and specificity 82.4%). There was good agreement between both tests and histopathology with colposcopy exhibiting greater predictive values. Therapy included hysterectomy (27.0%) and conization (21.6%) emphasizing the importance of the correct early diagnosis. Colposcopy demonstrated slightly better accuracy as compared with PAP smear but the gold standard was histopathology. The high prevalence of high CIN2/3 and carcinoma calls attention to the need for timely screening, and for that, PAPsmear combined with colposcopy is useful in low resource settings.