Document Type: Original Research


1 Department of Pathology, Metabolic Disease Research Center, Qazvin University of Medical Sciences, Qazvin, Iran

2 General Physician, Qazvin University of Medical Sciences, Qazvin, Iran

3 Qazvin University of Medical Sciences, Qazvin, Iran

4 Department of Reproductive Health, Tarbiat Modarres University, Tehran, Iran

5 Department of Epidemiology, Qazvin University of Medical Sciences, Qazvin, Iran


Background & Objective: Premalignant lesions of cervix have increased dramatically in recent years. Early diagnosis and management of abnormalities have an effective role in preventing the invasion of the disease and also in timely treatment. This study aimed to compare diagnostic methods in the detection of squamous cell abnormalities with abnormal Pap smear test.
Methods: This cross-sectional study was performed on 1000 women with abnormal Pap smears in 2007-2018. Sampling was performed with simple method. All samples were subjected to an immediate assessment of colposcopy and histopathology if suspected. The checklist included demographic information as well as symptoms, cytopathology, colposcopy and histopathology findings. Data analysis was performed using descriptive and statistical analysis (P<0.05).
Results: A significant relationship between histopathology and Pap smear findings was found (P=0.009), also there was a significant correlation between histopathology and colposcopy findings (P=0.001). However, there was no significant relationship between clinical symptoms and histopathology findings (p=0.8). Sensitivity , specificity , positive and  negative predictive value of Pap smear were 43%, 65.9%, 75.4%, 32.2% and of colposcopy were 74.7%, 39.5%, 75%, 39.1%, and of clinical symptoms were 72.6%, 28.1%, 71.1%, 29.7%, respectively.
Conclusion: Pap smear findings have the appropriate diagnostic accuracy in comparison with colposcopy and histopathology findings for screening and diagnosis of squamous intra-epithelial lesions. Also, there was higher sensitivity of colposcopy compared with Pap smear to detect cervical lesions. Therefore, it is advisable to use these methods simultaneously.


Main Subjects

  1. Shrestha AD, Neupane D, Vedsted P, Kallestrup P. Cervical cancer prevalence, incidence and mortality in low and middle income countries: a systematic review. Asian Pac J Cancer Prev 2018;19(2):319-24. [DOI:10.1111/ecc.13207] [PMID]
  2. Daniyal M, Akhtar N, Ahmad S, Fatima U, Akram M, Asif HM. Update knowledge on cervical cancer incidence and prevalence in Asia. Asian Pac J Cancer Prev. 2015 Jun 18;16(9):3617-20. [DOI:10.7314/APJCP.2015.16.9.3617] [PMID]
  3. Momenimovahed Z, Salehiniya H. Cervical cancer in Iran: integrative insights of epidemiological analysis. BioMedicine 2018 Sep;8(3): 37-44. [DOI:10.1051/bmdcn/2018080318] [PMID] [PMCID]
  4. Khorasanizadeh F, Hassanloo J, Khaksar N, Taheri SM, Marzaban M, Rashidi BH, Sari AA, Zendehdel K. Epidemiology of cervical cancer and human papilloma virus infection among Iranian women-Analyses of national data and systematic review of the literature. GynecolOncol 2013 Feb 1;128(2):277-81. [DOI:10.1016/j.ygyno.2012.11.032] [PMID]
  5. Taheri N, Fazel A, Mahmoodzadeh H, Omranpour R, Roshandel G, Gharahjeh S, Sedaghat SM, Poorabbasi M, Moghaddami A, Semnani S. Epidemiology of female reproductive cancers in Iran: results of the Gholestan Population-based Cancer Registry. Asian Pac J Cancer Prev 2014;15(20):8779-82. [DOI:10.7314/APJCP.2014.15.20.8779] [PMID]
  6. Riahi S, Mokhtari AM, Vali M, Abdzadeh E, Mohseni S, Salehiniya H, et al. Incidence and mortality rate of cervix cancer in Iran from 1990 to 2016: A systematic review and meta-analysis. J Contemp Med Sci. 2019; 5(1):1-7.
  7. Jalilvand S, Shoja Z, Nourijelyani K, Tohidi HR, Hamkar R. Meta-analysis of type-specific human papillomavirus prevalence in Iranian women with normal cytology, precancerous cervical lesions and invasive cervical cancer: Implications for screening and vaccination. J Med Virol 2015; 87(2): 287-95. [DOI:10.1002/jmv.24053] [PMID]
  8. Wardak S. Human Papillomavirus (HPV) and cervical cancer.Med DoswMikrobiol. 2016;68(1):73-84.
  9. Golubović M, Lopičić M, Terzić N, Đurović M, Mugoša B, Mijović G. Presence of histopathological premalignant lesions and infections caused by high-risk genotypes of human papillomavirus in patients with suspicious cytological and colposcopy results: A prospective study. Vojnosanit Pregl 2017;74(1):24-30. [DOI:10.2298/VSP150205143G] [PMID]
  10. Sørbye SW, Suhrke P, Revå BW, Berland J, Maurseth RJ, Al-Shibli K. Accuracy of cervical cytology: comparison of diagnoses of 100 Pap smears read by four pathologists at three hospitals in Norway. BMC ClinPathol 2017 Dec;17(1):18. [DOI:10.1186/s12907-017-0058-8] [PMID] [PMCID]
  11. Schlichte M, Guidry J. Current cervical carcinoma screening guidelines. J Clin Med 2015 May;4(5):918-32. [DOI:10.3390/jcm4050918] [PMID] [PMCID]
  12. Baasland I, Hagen B, Vogt C, Valla M, Romundstad PR. Colposcopy and additive diagnostic value of biopsies from colposcopy‐negative areas to detect cervical dysplasia. Actaobstetricia et gynecologicaScandinavica 2016 Nov;95(11):1258-63. [DOI:10.1111/aogs.13009] [PMID] [PMCID]
  13. Nayar R, Wilbur DC. The pap test and Bethesda 2014. Actacytologica 2015;59(2):121-32. [DOI:10.1016/j.jasc.2015.03.003] [PMID]
  14. Barut MU, Kale A, Kuyumcuoğlu U, Bozkurt M, Ağaçayak E, Özekinci S, et al. Analysis of sensitivity, specificity, and positive and negative predictive values of smear and colposcopy in diagnosis of premalignant and malignant cervical lesions. Med SciMonit 2015; 21: 3860-3867. [DOI:10.12659/MSM.895227] [PMID] [PMCID]
  15. Karimi-Zarchi M, Peighmbari F, Karimi N, Rohi M, Chiti Z. A comparison of 3 ways of conventional pap smear, liquid-based cytology and colposcopy vs cervical biopsy for early diagnosis of premalignant lesions or cervical cancer in women with abnormal conventional pap test. IJBS. 2013 Dec;9(4):205-10.
  16. Savitha TS, Sapna W. A comparison of pap smear, colposcopy and colposcopy directed biopsy in evaluation of unhealthy cervix. J Evolution Med Dent Sci. 2015 Mar 12;4(21):3639-47. [DOI:10.14260/jemds/2015/524]
  17. Maar M, Wakewich P, Wood B, Severini A, Little J, Burchell AN, Ogilvie G, Zehbe I. Strategies for increasing cervical cancer screening amongst first nations communities in Northwest Ontario, Canada. Health Care Women Int. 2016 Apr 2;37(4):478-95. [DOI:10.1080/07399332.2014.959168] [PMID] [PMCID]
  18. Crosby RA, Hagensee ME, Vanderpool R, Nelson N, Parrish A, Collins T. Community-based screening for cervical cancer: a feasibility study of rural Appalachian women. STD. 2015 Nov;42(11):607. [DOI:10.1097/OLQ.0000000000000365] [PMID] [PMCID]
  19. Verma I, Jain V, Kaur T. Application of Bethesda system for cervical cytology in unhealthy cervix. J ClinDiagn Res. 2014 Sep;8(9):26-30. [DOI:10.7860/JCDR/2014/9620.4893] [PMID] [PMCID]
  20. Sreedevi A, Javed R, Dinesh A. Epidemiology of cervical cancer with special focus on India. Int J Womens Health. 2015;7:405-14. [DOI:10.2147/IJWH.S50001] [PMID] [PMCID]
  21. Maraqa B, Lataifeh I, Otay L, Badran O, Nouri YQ, Issam I, Al Hussaini M. Prevalence of Abnormal Pap Smears: A Descriptive Study from a Cancer Center in a Low-Prevalence Community. Asian Pac J Cancer Prev. 2017;18(11):3117.
  22. Cheraghi F, Jolodarian P, Masoumi K, Forouzan A, Jafari RM. Comparison Results of Pap Smear and Colposcopy and Histopathology in Women with Post-Coital Bleeding. J ObstetGynaecol Res. 2015 Jan 1;8(1):10-5. [DOI:10.3923/rjog.2015.10.15]
  23. Meevasana V, Suwannarurk K, Chanthasenanont A, Tanprasertkul C, Bhamarapravatana K, Pattaraarchachai J. Is the correlation between Papanicolaou smear and histopathology results affected by time to colposcopy. Asian Pac. J. Cancer Prev. 2014 Jan 1;15(4):1527-30. [DOI:10.7314/APJCP.2014.15.4.1527] [PMID]
  24. Müller K, Soergel P, Hillemanns P, Jentschke M. Accuracy of colposcopically guided diagnostic methods for the detection of cervical intraepithelial neoplasia. Geburtshilfe Frauenheilkd. 2016 Feb;76(02):182-7. [DOI:10.1055/s-0041-111504] [PMID] [PMCID]
  25. Farzaneh F, Tamim,I M, Amiri Z, Alizadeh K. [The value of Pap smear in detecting cervical neoplasia compared with histopathologic findings in patients referred to Taleghani Hospital, Tehran 2007-2009. Pajoohandeh J .2011;16(2):92-7.
  26. Kohli B, Arya SB, Goel JK, Sinha M, Kar J, Tapasvi I. Comparison of PAP Smear and Colposcopy in Detection of Premalignant Lesions of Cervix. Journal of SAFOMS. 2014 Jan 1;2(1):5. [DOI:10.5005/jp-journals-10032-1023]
  27. Lofters A, Vahabi M, Glazier RH. The validity of self-reported cancer screening history and the role of social disadvantage in Ontario, Canada.BMC Public Health. 2015 Dec;15(1):28. [DOI:10.1186/s12889-015-1441-y] [PMID] [PMCID]
  28. Mitteldorf CA. Cervical cancer screening: from Pap smear to future strategies. J Bras Patol Med Lab. 2016 Sep;52(4):238-45. [DOI:10.5935/1676-2444.20160040]
  29. Yagnik AS, Singh R. A Prospective Study of comparison Pap's Smear, Vili's Test and Colposcopy In cervical cancer screening. Int J Med Res Health Sci. 2016;5(4):50-7.
  30. Abali R, Bacanakgıl BH, Celık S, Aras O, Koca P, Boran B, et al. Histopathological correlation of squamous cell abnormalities detected on cervical cytology. Turk PatolojiDerg. 2011 May;27(2):144-8. [DOI:10.5146/tjpath.2011.01063] [PMID]
  31. Akhter S, Bari A, Hayat Z. Variability study between Pap smear, Colposcopy and CervicalHistopathology findings. J Pak Med Assoc. 2015 Dec 1;65(12):1295-9.
  32. ZamaniM, Torabian S . Evaluation the Colposcopic and Histologic Findings in Oncology Ward Of Fatemieh Hospital, Hamadan, Iran. IJOGI. 2013;16(78):1-6
  33. Castanon A, Landy R, Michalopoulos D, Bhudia R, Leaver H, Qiao YL, et al. Systematic Review and Meta-Analysis of Individual Patient Data to Assess the Sensitivity of Cervical Cytology for Diagnosis of Cervical Cancer in Low- and Middle-Income Countries. J Glob Oncol. 2017;3(5): 524-38. [DOI:10.1200/JGO.2016.008011] [PMID] [PMCID]
  34. Kousha A, Najmi M, Mahdavi A, Mogheysi A,Qanbari A, Maleki A, et al. A collection of basic interventions for non communicable diseases in Iran's primary health care system. First ed. Iran: Mojasame, 2017:72.