RESUMEN
The most cost effective method of prevention and detection of cervical cancer is the Pap smear. In abnormal Pap smear, colposcopy, endocervical curettage and biopsy will be done. Gold standard method in detecting cervical lesion is biopsy. Now in two ways conventional Pap smear and liquid base are routine diagnostic technique in Iran and given easily and cost-effectiveness of this method in the detection of cervical lesions to determine the sensitivity the objective of this study was compare three methods of Pap smear and colposcopy in detection of any lesion to gold standard biopsy in the positive ASC cases who referred to gynecologic Oncology Clinic of shahid Sadoughi University of Medical Science. This study is a descriptive analytic in 2009-2010 years on 150 cases of patients with Atypical Squamose Cell (ASC) results in previous pap smear ,conventional pap smear, liquid based pap smear, colposcopy and cervical biopsy had been done for all patient and finally data were analyzed with chi-square statistical test on spss ver 16 saftware. Average age of patients in this study was, 42 ± 9.9 year and reason for referring patients in 35.4% of cases was due to follow-up of abnormal results of previous Pap smear, in 30% bleeding, 12% Pain and 2.6% percent of cases was checking-up. In final results of sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy any of the methods conventional and liquid based Pap smear and colposcopy were compared with cervical biopsy as a gold standard. The conventional Pap smear method had a sensitivity 51%, specificity 66.6%, PPV 96%, NPV was 8% and accuracy was 92%, about the liquid base Pap smear method, sensitivity was 55.3%, specificity was 77.7%, PPV was 97.5%, NPV was 10% and accuracy was 56/6%. About the colposcopy, sensitivity was70/9 % specificity 44/4%, PPV was 95.2%, NPV was 8/8% and accuracy was 69.3%. The relationship between sensitivity results of conventional Pap smear and colposcopy, with p<0.001 and between the results of sensitivity of liquid based cytology and colposcopy with p<0.01 relationship was significant. Colposcopy has the best efficacy in detecting any cervical lesion in compared with any other diagnostic technique. so that further studies with more detailed plans and bigger sample sizes are suggested for obtaining reliable result.
RESUMEN
BACKGROUND AND OBJECTIVES: Cervical cancer is preventable, although it is common in developing countries and Iran, where there is no defined approach to "atypical squamous cells of undetermined significance" (ASCUS) on Pap smears. This study determined the value of colposcopy in the early diagnosis of cervix cancer in females with ASCUS. MATERIALS AND METHODS: This accuracy study examined 213 ASCUS cases referred from different cities from 2007 to 2009. All patients underwent a repeated conventional Pap smear, colposcopy, endocervical curettage, and a cervical biopsy, considered the gold-standard diagnostic test. RESULTS: There was no significant relationship between age, age of first intercourse, smoking, or number of children and a positive cervical biopsy. The sensitivity and specificity of a repeat Pap smear for ASCUS were 15 and 93%, respectively, while the respective values for diagnosing cervical cancer with colposcopy were 80 and 80%. Endocervical curettage had 64% sensitivity and 100% specificity for diagnosing cervical cancer, and 11 positive neoplastic or malignant lesions reported on endocervical curettage were confirmed by biopsy. DISCUSSION: Based on the low accuracy of the Pap smear in Iran as a developing country and the need for an early diagnosis of cervical cancer, a cervical biopsy and colposcopy are recommended for these patients. Colposcopy and endocervical curettage alone are better diagnostic tools than a repeat Pap smear for unsatisfactory Pap smears.