Analysis of Cervico-vaginal (Papanicolaou) smears, in girls 18 years and under

The study was conducted retrospectively at the Queen Elizabeth Hospital and a private laboratory in Barbados to determine the types of epithelial abnormalities in cervico-vaginal Papanicolaou (Pap)-stained smears, and their clinical implications in Barbadian girls, 18 years and under, during the five-year period January 1995 to December 1999. Two hundred and sixty-five Pap smears from 236 patients were examined and the gynaecological history, initial and repeat Pap smear diagnoses, and histology reports of these patients were analyzed. Of the 236 first-visit smears, 94 (39.8 percent) were abnormal with 36 (15.3 percent) displaying cytological features of squamous intra-epithelial lesions (SIL), (33 low grade and 3 high grade). A diagnosis of atypical squamous cells of undetermined significance (ASCUS) was reported in the remaining 58 (24.5 percent) abnormal smears, of which 35 (60.3 percent) were suspected to be related to human papillomavirus (HPV) infection. Twenty-two (23.4 percent) of these 94 patients, who had abnormal smears of either ASCUS or low grade squamous intra-epithelial lesions (LSIL) were re-evaluated within six to twelve months of the initial abnormal Pap smear diagnosis. Eight of these 22 patients (36.4 percent) had histological diagnosis of LSIL inclusive of cervical intra-epithelial neoplasia grade 1 (CIN 1) and condylomata. High-risk HPV DNA types were detected in two of these eight patients (25 percent). The study confirms that sexually active teenage girls are at risk of developing SIL and high-risk HPV infection. Screening of sexually active teenage girls by Pap smears followed by other appropriate investigative procedures is recommended. (AU)

Abnormal Papanicolaou (PAP) smears at UWI, 1997-1999 [abstract]

OBJECTIVE: Our aim was to document the distribution of epithelial abnormalities diagnosed on Pap smears in the Department of Pathology, the University of the West Indies (UWI), Mona, Jamaica, and to determine the likelihood of the prescence of clinically significant disease on biopsy for a given cytological diagnosis. METHODS: We reviewed the results of all Pap smears accessioned in the Cytology Unit of the Department of Pathology, over the 3-year period 1997-1999 and collated the epithelial abnormalities using a hybrid cervical intraepithelial neoplasia (CIN)/Bethesda system. We calculated the atypical squamous cells of undetermined significance (ASCUS) rate, the CIN rate and the ASCUS/CIN ratio. Follow-up histology results were obtained from the departmental files. The likelihood ratios (LRs for clinically significant disease on histology for each cytological category were calculated. RESULTS: During the study period a total of 21,144 Pap smears were accessioned, 1,324 (6.3 percent) of which showed epithelial abnormalities. These abnormal Pap smears were most prevalent in the 21-30 year age group (37.5 percent of patients). The distribution of epithelial abnormalities was: ASCUS 34.7 percent, atypical glandular cells of undetermined significance (ASCUS) 1.1 percent, ASCUS/AGUS 0.2 percent, CIN 141.4 percent, CIN II 12.5 percent, CIN III 8.3 percent, sqaumous cell carcinoma (SCC) 1.3 percent, adenocarcinoma (AC) 0.3 percent and vaginal intraepithelial neoplasia (VAIN) II/III 0.2 percent. The CIN rate, ASCUS rate and ASUCS/CIN ratio were 3.9 percent, 2.2 percent and 0.6 respectively. Histological follow-up was available for 477 (36 percent) cases. The LRs for clinically significant disease for the following cytological diagnoses were: AGUS: 0.08, ASCUS: 0.31, CIN I: 1.12, CIN II: 2.01 and CIN III: 3.38. All cases of SCC, AC and VAIN with histological follow-up were shown to be clinically significant. CONCLUSIONS: There was a relatively low incidence of epithelial abnormalities in Pap smears seen at the UWI during the study period with ASCUS and CIN 1 compromising the majority of cases. Biopsy follow-up showed an increasing likelihood for the presence of clinically significnat disease with increasing degrees of epithelial atypia on Pap smear. (AU)

Knowledge, attitudes and practices of women ages 25-54 years in Hanover with regards to cancer of the cervix

Cervical cancer is the most common cancer among women in developing countries and the second most common worldwide. Screening with cervical smear plus adequate follow up therapy can achieve a major reduction in both incidence and mortality ... Objective: to determine the knowledge, attitudes and practices of women age 25-54 years in Hanover with regards to cancer of the cervix and the importance of cancer screening. METHOD: This is a descriptive study to clarify the knowledge of cancer of the cervix and pap smear as a method of screening for this disease ... Four health centres were randomly selected. Systematic sampling was done using the patient's register to select two hundred women who were interviewed. RESULTS: Data analysis is presented for 150 women. Mean age of the women was 34.0 ñ 6.9 years. Most of the women were single 44.7 percent followed by married 29.3 percent and 22.7 percent who lived in common-law union. Most women attended secondary school (46.0 percent), 46.0 percent were employed. Mean gravidity (pregnancy) was 3.66 ñ 2.14, 54.7 percent reported that they had children from previous relationships. The average reported age of first sexual exposure was 16.6 ñ 2.5, 9.3 percent had sexually transmitted disease. In describing cancer of the cervix 61.0 percent stated that it was cancer of the mouth of the womb, 29.3 percent said it was cancer of the womb. Knowledge of risk factors for cancer of the cervix included early sexual activity 76.7 percent, multiple partners 60.7 cigarette smoking 37.3 percent, sexually transmitted diseases 28.0 percent, family history 2.0 percent. 80 percent of the clients knew what a pap smear is and 77.9 percent did pap smears. 46.0 percent had pap smear 2 years or less and 5+ years 31.0 percent. 68.4 percent were done at the health centres. 71.3 percent received results. 22.7 percent feared pap smear, with the main reason due to pain of the procedure 53.8 percent. CONCLUSION: It was observed in the study that most of the women were indulging in behaviour that put them at high risk of cancer of the cervix yet many of them were not aware that they were at risk for cancer of the cervix yet many of them were not aware that they were at risk. Some were afraid of the pap smear, which would allow them early detection and treatment of cervical cancer. Therefore health education will have to be done to motivate them to participate in the screening (AU)

Vaginitis emphysematosa associated with an abnormal Pap smear

Vaginitis emphysematosa is an uncommon inflammatory condition that is aetiologically linked to trichomonal or gardenerella infection, and has been associated with immunosuppressive disorders. The disease does not have deleterious sequelae and resolves on treating the underlying infection. We describe a case in which the disease predominantly affected the cervix to an abnormal pap smear and colposcopic investigation. (AU)

Follow-up of clients with abnormal papanicalaou smears identified at the Cornwall Regional Hospital for the period January 1997 to December 1997 and January 1999 to June 2000

A cross sectional study was conducted at the Cornwall Regional Hospital for the period January 1997 to December 1997 and January 1999 to June 2000 on clients with abnormal Papanicalaou smears identified at the hospital's laboratory. One hundred and thiry-five (135) clients were included in the study. The clients reside in the four parishes of the Western Region (St. James, Hanover, Trelawny and Westmoreland). Relevant data were abstracted from the clients' dockets. Clients were then contacted and interviewed to assess what follow-up procedure and treatment is available to women after identification of an abnormal Pap smear. Among the 135 clients in the study, 71.9 percent cases were from St. James, 5.9 percent were from Hanover, 13.3 percent were from Trelawny and the remaining 8.9 percent were from Westmoreland. While most of the cases were from St. James, the more severe cases (CIN II, CIN III, CIS and invasive carcinoma) were from the other parishes. There was 68.1 percent (92) respondents. Seventy five percent of the clients who were identified with abnormal smear were referred or told to do a confirmatory test to see if the first result was cancerous. The study revealed that approximately 34.8 percent were treated with 26 percent not treated due to varying reasons such as lack of time, because they thought it was not necessary, they had no time or money and under the advise of their health practitioner. The other 39.1 percent were never followed-up to see if treatment was necessary. Cone biopsies (which may also be used as a confirmatory test) were the most common form of treatment (57.1 percent). Seventy five percent of the clients who accessed treatment were treated at the Cornwall Regional Hospital (AU)

The use of the rapid papanicolaou staining method in fine needle aspiration cytology of the breast at the University Hospital of the West Indies

OBJECTIVE: The aim was to determine the efficacy of the rapid Papanicolaou staining method (RPSM) in fine needle aspiration (FNA) cytology of breast lesions. METHODS: In a prospective study performed between May 1999 and June 2000, FNA specimens were obtained from patients attending the surgical out-patient and breast imaging services of the UHWI for the assessment of breast leisons. One-half of the slides from each specimen were stained by the RPSM, which reduces routine staining time by 80 percent (rapPaps), and the other half stained by the routine Papanicolaou method (routPaps). Specimens that were inadequate based on rapid assessment were immediately repeated. For each group of slides the smear quality, cytologic diagnoses and results of any related biopsy specimens were documented. The concordance between the cytology diagnoses and between the cytologic and histologic diagnoses was determined. RESULTS: One hundred specimens were obtained from 90 patients (M:F = 1:8; average age 42.3 years). RapPaps averaged 2.9 slides per case and routPaps 3.4; 71 percent and 77 percent of rapPaps and routPaps, respectively, had adequate cellular material, and 84 percent and 85 percent of these groups, respectively, displayed satisfactory cellular preservation. There was 83 percent, 52 percent and 56 percent concordance between rapid and routine cytologic diagnoses, rapid and histologic diagnoses, and routine and histology diagnoses, respectively. Non-concordance was due to lack of cellular material in 14/17 (82 percent), 12/23 (52 percent) and 10/21 (48 percent) cases, respectively. Of the remainder, 6 cases represented major diagnostic discrepancies in which atypical cytologic smears were confirmed to be benign lesions on histology. CONCLUSION: These findings show that staining FNA specimens by the rapid Papanicolaou method allows for accurate cytology evaluation of breast leisons at UHWI. The handling of cytologic specimens by this method can be an important cost- and time- saving strategy in the management of patients presenting to the out-patient services. (Au)

The significance of atypical squamous cells of undetermined significance in Barbados - Poster abstract

OBJECTIVE: To evaluate the significance of a Papanicolaou (Pap) cervico-vaginal smear diagnosis of atypical squamous cells of undertermined significance (ASCUS) using cytohistologic correlation and to determine the ASCUS squamous intraepithelial lesions (SIL) ratios of five cytopathology laboratories. DESIGN AND METHODS: A combined retrospective and prospective study was undertaken to evalute the histologic diagnoses of the biopsies from patients who attended the colposcopy clinic at the Queen Elizabeth Hospital with the Pap smear cytologic diagnosis of ASCUS during the period, January 1 - April 15, 1998. The laboratory from which the Pap reports were issued was recorded. RESULTS: During this three and a half month period three hundred and sixty-four (364) patients with abnormal smears diagnosed at five different cytology laboratories were investigated. One hundred and fifty (42.1 percent) patients has a Pap smear diagnosis of ASCUS, followed by 161 (46.5 percent) SIL, 130 (35.8 percent) wit low grade intraepithelial lesions (LSIL) and 31 (10.7 percent) high grade intraepithelial lesions (HSIL). Three cases with ASCUS were subsequently excluded from the study because of insufficient data. The histologic diagnosis of the remaining 147 biopsies from patients with the Pap smear diagnosis of ASCUS were LSIL 49 (33.6 percent), HSIL 9 (6.2 percent), atypia/metaplasia 66 (45.2 percent) and inflammation/normal 23 (15.1 percent). The overall ASCUS/SIL ratio was 0.90 and the individual laboratory ratios ranged from 0.25 to 1.70 with a mean of 0.84 ñ 0.63. CONCLUSION: The histologic diagnosis of a cervical cytologic smear assessed as ASCUS may vary from normal to HSIL. Just under 40 percent are likely to be SIL with LSIL predominant. The ASCUS/SIL ratios of Barbadian cytopathology laboratories are less than the ASCUS/SIL ratio (2.0-3.0) suggested by the 1992 NCI Workshop at Bethesda. Hence a diagnosis of ASCUS in Barbados requires careful follow-up.(AU)

A behaviour risk factor survey in Jamaica

A population based probability sample of 958 persons (454 males and 504 females) aged 15 to 49 years was surveyed in Jamaica in late 1993 for lifestyle and behaviour risk factors. Demographic characteristics of the sample were comparable to the general population. 60 percent of persons visited a private doctor the last time that they were ill. Based on self-reporting, 18 percent of the women and 8 percent of the men had never their blood pressure taken. 40 percent of the women had never had a Papanicolaou smear, 29 percent had never had a breast examination and 33 percent said that they were overweight compared with 18 percent of men. Smoking cigarettes and marijuana was more common among men (36 percent) than women (11 percent) as were drinking alcohol (79 percent of men, 41 percent of women) and heavy alcohol use (30 percent of men, 9 percent of women). Injuries requiring medical attention in the previous five years were reported by 40 percent of the men and 15 percent of the women. 34 percent of the men and 12 percent of the women regularly carried a weapon and 18 percent of the sample had participated in or witnessed at least one violent act in the previous month. Most of the people interviewed used a contraceptive method; 10 percent were not sexually active. Significantly more men than women had two or more sexual partners in the previous year (54 percent vs 17 percent, p<0.001) or reported ever having a sexually transmitted disease (29 percent vs 9 percent, p<0.001). Younger persons were more sexually active and more likely to use condoms during the most recent sexual intercourse. Higher socio-economic status and educational level generally had a more positive effect on health behaviour. This survey provides vital information relevant to planning health promotion campaigns and assessing their success.(AU)

An analysis of cervico-vaginal (Papanicolaou) smears in girls 18 years and under

During the two year period, January 1995 to December 1996 124 cervico-vaginal smears from 109 girls 18 years old and younger were examined. The gynaecological history, cytology reports, histological and cytological follow-up reports were analyzed to determine the demographics, common infections, epithelial abnormalities and follow-up management in this age group. The mean age was 17.4 with a range of 15-18 years. Twenty-five percent were gravid and 4.5 percent multigravida. The teen delivery/termination ratio was 0.73:1. The most common specific infection was yeast and, suspected infection, HPV .39 percent had normal smears, 14.7 percent inflammatory epithelial changes, 36 percent atypical squamous cells of undetermined significance (ASCUS), 8.3 percent low grade squamous intra-epithelial lesions (LGSIL) and 1.0 percent high grade intra-epithelial lesions (HGSIL). The ASCUS/SIL ratio was 3.9. Only 40 percent of patients with cytologic diagnosis of SIL and 28 percent with ASCUS had follow-up by repeat smear and/or colposcopy, endocervical curettage and guided cervicals biopsy. Five (45 percent) of the followed up patients had LGSIL inclusive of CIN 1 and condyloma. These results indicate that sexually active girls are risk of developing SIL and those with a diagnosis of ASCUS should be adequately followed up.(AU)

Knowledge, attitudes and practices of women regarding pap smears - abstract

The aims of the study were to assess women's knowledge, attitudes and practices regarding cervical cancer and screening, to see how knowledge influences attitudes and how both influence practice, and to examine certain social and demographic correlates. Between January 29, 1996 and February 29, 1996, 209 female patients, aged 19 years and over, were interviewed in the Casualty Department of the University Hospital of the West Indies. A questionnaire measuring knowledge, attitudes and practices regarding Pap smears and cervical cancer and selected characteristics of the patients and their partners were administered by a single interviewer. Quota sampling methodology was employed. Most of the respondents (98 percent) had heard about Pap smears, but the majority did not know that its main purpose is to help in the prevention of cervical cancer, as opposed to its detection. Only a majority of patients knew what the cervix is and that it is the part of the body that Pap smears are concerned with. The majority of respondents had positive attitudes with respect to cervical screening. However, having positive attitudes and possessing knowledge about Pap smears did not significantly influence compliance with screening, and apathy accounted for a significant portion of non-compliance. If a nationwide screening programme is to be successful, patient motivation and behaviour modification will need to be addressed. (AU)

External quality assessment of cervical vaginal cytology laboratory screening in the Caribbean - abstract

A model external quality assessment of cervical/vaginal cytology laboratory screening (PAP Smear) programme was piloted during 1996 to assess the proficiency of cytopathologists and cytotechnologists and to provide an opportunity for review/and reassessment of results as an integral component of continuous quality improvement of cytology services in the Caribbean. Eight pathologists and 22 cytotechnologists/technicians from seven Caribbean laboratories participated in this survey which consisted or reviewing eight reference slides provided by the Laboratory Proficiency Testing Program (LPTP, Ontario). The overall agreement with the LPTP results ranged from 5 percent to 63 percent in cytotechnologists as compared to cytopathologists (13 percent to 73 percent). The percentage agreement for severe dysplasia was between 22 percent (cytotechnologists) and 25 percent (cytopathologists), while better rates were observed for invasive carcinoma (60 - 63 percent). Inflammatory effects ere missed by both cytotechnologists (73 percent) and cytopathologists (49 percent). Moderate dysplasia was missed by both categories of laboratory professionals. There was a wide inter-laboratory variation of results as compared eith the LPTp (0 to 100 percent). Generally, laboratory professionals have placed greater emphasis on cervical biopsy, repeat smear, and provided guarded reports on PAP smears. The data show that there is a wide variation in the interpretation and reporting of cervico-vaginal cytology smears in Caribbean laboratories. Hence, there is an urgent need for continuous quality assessment and improvement of cervical cancer cytology screening services in the Caribbean (AU).

The epidemiology of cervical cancer: a comparison of early and late disease - abstract

Sixty patients with a diagnosis of cervical cancer were interviewed. 30 patients with early disease were compared with 30 patients with late disease to determine if their epidemiological variables were similar and to determine if access to health care and Pap Smear utilisation were similar. The results showed that while risk factors and access to health care were similar the patients with late disease were older [mean age 55.5 versusn 45 years (p=0.006) of a higher parity [mean parity 5.3 versus 3.3 (p =0.004)], mainly from the lowest social class, or those who had never had a Pap smear (20 percent versus 0 percent) or who had a Pap smear infrequently (15 percent versus 60 percent routine screening) and 1.1 versus 4.9 mean life time number of Pap smears (p =0.006). (AU)

Knowledge, attitude and practice of women and their partners regarding cancer of the cervix

Cancer of the uterine cervix accounts for 16 percent of all malignancies in Jamaica. It is by far the most common female cancer and accounts for about three quarters of all pelvic malignancies. The alarming incidences of cervical cancer in the population at risk clearly indicated the urgent need for early detection by cytological screening programmmes. It is important for developing countries such as Jamaica with limited financial resources to define high risk areas where the yield of preclinical cancer is expected to be high. The effectiveness of cervical cancer screening is more likely to be improved by extending testing to women who are not currently being screened and improving the accuracy of Pap smears than by efforts to increase the frequency of testing. Studies have shown that those at greatest risk for cervical cancer are the very women least likely to have access to testing (Kleinman, J. C., Kopstein, A., 1981). Inadequate Pap testing is most common among poor, uninsured persons, the elderly and persons living in rural areas. In addition, Pap test are to be recommended by the physician based on the presence of risk factors (early onset of sexual intercourse, history of multiple sex partners and low socio economic status). In this study 100 women attending the clinic at Social and Preventive Medicine along with their partners who reside in the August Town and Hermitage area (which is considered to be in the low socio-economic high risk) were interviewed to ascertain their knowledge attitude and practice regarding cancer of the cervix. Women who were over 30 years were significantly less likely to know what cancer of the cervix was (p < 0.05), there was no statistical difference between marital status and knowing about cancer of the cervix. Those who had higher than primary education and had children were more than four times more likely to know about cancer of the cervix. Fifteen percent of the study population have never had a pap smear while 67.3 percent had not had one in eight years. Most respondents had a positive attitude towards cancer of the cervix; they felt that someone with the disease needed family support and could be cured if detected early. (AU)

The use of the Papanicolaou smear as a screening tool for the detection of early carcinoma of the cervix in a university community

The aim of this study was to identify factors whichmight influence the use of the Papanicolaou (Pap) smear as a screening tool for the early detection ofcarcinoma of the cervix within a university staff population. The study was conducted on the Mona Campus of the University of the West Indies, Kingston, Jamaica, between July 1995 and February 1996. The different union groupings were used as a proxy for educational level and socioeconomic status. These union groups were West Indies Group of University Teachers (WIGUT), representing academic and senior administrative staff, Mona Non-Academic Staff Union(MONASA) representing non-academic/junior administrative staff and University and Allied Workers Union (UAWU) representing ancillary staff. A questionnaire was administered to a random sample of forty persons from the female members of each group, giving a total sample size of one hundred and twenty. There was an overall 72.5 percent response rate - 80 percent in the WIGUT group, 70 percent in the MONASA group and 67.5 percent in the UAWU group. Results showed that while 95.4 percent of the respondents were able to correctly identify early detection of cervical cancer as the main use of the Pap smear and all respondents thought that it was important to have regular Pap smears, only 51.7 percent actually had them regularly. A breakdown of Pap smear frequency by union group showed the lowest rate in the UAWU group. This group also had the highest overall level of risk factors for cervical cancer. It was also noted that members of the UAWU were more likely to use the facilities of the University Health Centre when they did Pap smears as compared to the use of private facilities by the other groups. Based on the findings it was recommended that any Pap smear educational or promotional programme on the Mona Campus should be focussed on the UAWU group which was shown to have the greatest need of this service and was most likely to make use of the University Health Centre facilities(AU)

Genital tract infections in sexually active women in Barbados

Ninety-eight women attending three different clinics were prospectively studied for the presence of genital tract infections, including Chlamydia trachomatis. Of these 98 women, 35 were presenting to a polyclinic with symptoms of genital tract infection, 55 were attending an antenatal clinic for their first visit, and 8 referred to a colposcopy clinic because of an abnormal Papanicolaou smear were included. Gonorrhoea was detected in one patient, syphilis in two, and Trichomonas vaginalis in six. Candida albicans and Chlamydia trachomatis were each detected in 18 patients, while the most common condition was bacterial vaginosis, detected in 35 patients. The prevalence of these infections was lowest in patients referred for colposcopy and highest in the women attending the antenatal clinic, Chlamydia trachomatis was the most common sexually-transmitted pathogen detected in this population. These data emphasise the need for an aggressive approach to the diagnosis and treatment of chlamydial infection in females (AU)

A Cervical smear review in women developing cervical carcinoma with particular reference to age, false negative cytology, and the histologic type of the carcinoma - abstract

A review of all available cervical smears from 96 consecutive women diagnosed as having invasive cervical carcinoma during 1985 - 1991 was undertaken. The purpose of the study was to determine the incidence of confirmed negative smears prior to the histologic diagnosis of carcinoma and to investigate the relationship between the duration and grade of smear abnormality, the patient's age and the histological types of cervical carcinoma. The slides of the smears were mixed and examined "blind" by at least two pathologists separately. The degree of concordance was 95 percent. Thirty-four patients had microinvasive disease and 62 had invasive carcinoma. Review of 54 smears initially reported as "negative" revealed that 44 (81 percent) were assessed as abnormal; 42 ( 44 percent) of the 96 patients in this study had abnormal cytology reported correctly at varying time intervals prior to diagnosis of carcinoma and there was inadequate clinical follow-up of 16/42 (38 percent) of these women with knowm abnormality. The review revealed that 43 (70 percent) of the 61 younger (< 40 years) women had significant or high grade abnormality in smears (or histology) taken > 1 year before diagnosis of carcinoma. This study revealed that 81 percent of the reviewed smears were falsely reported as negative. There is evidence to suggest that the preinvasive phase of cervical cancer may be shorter in younger women and the less common types of cervical cancer occur more frequently in this group. The combination of inadequate clinical follow-up and false negative cytology may have allowed a significant proportion of these women to develop invasive cervical carcinoma (AU)

Cervical cytology quality control cytological and histological correlation at a private laboratory in Barbados - abstract

In this study, the cytological and histological diagnoses made during a six and a half-year period were compared with the aim of assessing the diagnostic accuracy of cervical cytology in a small private laboratory. There were 3486 cases biopsied, 40 (1.2 percent) cases with previous inadequate cervical smears, 195 (5.6 percent) cases with normal cytology and the remaining 3251 (93.2 percent) with abnormal cytological diagnoses. The overall concordance between the cytological and histological diagnoses was 63.9 percent. The greatest concordance was in cases with cytodiagnosis of CIN grade 3 (CIS) and invasive carcinoma combined 100/112 (89.3 percent), and the lowest with normal cytodiagnosis 75/195 (38.5 percent) cases. The significant histological diagnoses of the discordant cases were CIN 22.6 percent, condyloma 15.3 percent and carcinoma 1.1 percent. Fifty percent of the carcinomas diagnosed by cytology were of endometrial origin. Significant discordance occurred in cases with cytodiagnosis of HPV infection and CIN, in that 113 cases with cytodiagnosis of HPV infection/codyloma had histological diagnosis of CIN, and 156 cases with the cytodiagnosis of CIN had histological diagnosis of condyloma. The sensitivity rate for the diagnosis of HPV infection or condyloma by cytology was 632/1214 (52 percent). Most of the cases with inadequate smears had histodiagnosis of cervicitis with inflammatory atypia. This study has shown that the cytological evaluation of the severity of significant cervical abnormalities was a reliable guide for the clinician to the proper management of the patient (AU)