Pattern of cervical smear abnormalities using the revised Bethesda system in a tertiary care hospital in Western Saudi Arabia

OBJECTIVE: To evaluate Pap smear (PS) diagnoses at a tertiary care hospital using the revised Bethesda system, and to compare the results with other similar studies.

METHODS: We designed a retrospective study to review all PS from the Cytopathology Department of King Abdulaziz University Hospital, Jeddah, Saudi Arabia from January 2005 to December 2009.

RESULTS: Of the 7297 cases reviewed, 1254 cases (17.3%) had epithelial cell abnormalities. The categories included: atypical squamous cell of undetermined significance (ASC-US) found in 9.3%, atypical squamous cell, cannot exclude high squamous intraepithelial lesion (ASC-H) in 0.8%, low grade squamous intraepithelial lesion (LSIL) in 2.7%, and high grade squamous cell lesion (HSIL) in 0.9%. The mean age incidence (MAI) was 40 years for ASC-US, 42 years for ASC-H, 47 years for LSIL, and 45 years for MAI. Squamous cell carcinoma (SCC) was found in 0.06% with mean age incidence of 46 years. In the atypical glandular cell category, there was 3.2% atypical glandular cell of undetermined clinical significance not otherwise specified, 0.1% atypical glandular cells favoring neoplasm, and 0.08% atypical endometrial cells favoring neoplasm.

CONCLUSION: The incidence of abnormal PS has increased from previously 4.7%, to 17.3% in the present study. The ASC-US among total PS examined has also significantly increased. The increase in the number of positive PS raises concerns of whether the new BS results are an artificial increase in the prevalence and the predictive value of cytology to some extent.