A comparative study of Pap smear and colposcopy guided biopsy in the evaluation of unhealthy cervix


  • Meenakshi Venkatesh Department of Obstetrics and Gynecology, Shri Sathya Sai Medical College and Research Institute, Tamil Nadu, India
  • Ushadevi Gopalan Department of Obstetrics and Gynecology, Shri Sathya Sai Medical College and Research Institute, Tamil Nadu, India




Cervical carcinoma, Colposcopy guided biopsy, Pap smear


Background: Cancer of cervix ranks as the third common malignancy in females worldwide. In developing countries like India, carcinoma cervix is the second commonest malignancy affecting females. In India, every year 1,26,000 new cases are identified and 67,477 deaths occur due to cervical carcinoma. Cervical carcinoma affects women of age 15-44 years and disease peaks at 55-66 years. On average, Indian women have a 2.5% risk of developing carcinoma cervix. It was estimated worldwide that every 5th woman, who suffer from cervical cancer belongs to India.

Methods: A comparative study which included 110 married women of age 20 to 65 years. Women who presented with white discharge, lower abdominal pain, post coital bleeding and post-menopausal bleeding were subjected to Pap smear and colposcopy guided biopsy.

Results: A total 53.6% women had inflammatory smear, followed by 34.5% women with normal Pap smear, 0.1% women had bacterial vaginosis, 6.4% women had LSIL and 4.5% women had HSIL. Authors found that 63.6% women had chronic cervicitis. 15.4% had chronic endo papillary cervicitis, 13.6% had CIN 1, 5.4% women had CIN 2 and 1.8% women had squamous cell carcinoma. Association of Pap smear with histopathology is statistically significant (p value <0.001).

Conclusions: Pap smear can be used as screening test for detecting premalignant lesions of cervix. Colposcopy guided cervix biopsy has got better specificity than Pap smear, so all symptomatic women should be subjected to colposcopy guided cervix biopsy to detect carcinoma at early stage.


Kalyankar VY, Kalyankar BV, Gadappa SN, Kute S. Colposcopic evaluation of unhealthy cervix and it’s correlation with Papanicolau smear in cervical cancer screening. Int J Reprod Contracept Obstet Gynecol. 2017;6:4959-65.

Garg R, Desai R. Cytologic and colposcopic evaluation of all symptomatic women at tertiary care centre. Int J Adv Med. 2017;4:799-80.

Thobbi VA, Khan F. Cervical cytology by Pap smear in reproductive population. Int J Reprod Contracept Obstet Gynecol. 2018;7:1988-92.

Vincent M. Pap smear as a screening tool for evaluating cervical dysplasia and malignancy a hospital-based study. J Evolution Med Dent Sci. 2019;8(17):1368-71.

Sharma JC, Leekha K. Awareness, positivity of Pap smear in adult females. Indian J Gynecol Oncol. 2018;16(3):46.

Shaki O, Chakrabarty BK, Nagaraja N. A study on cervical cancer screening in asymptomatic women using Papanicolaou smear in a tertiary care hospital in an urban area of Mumbai, India. J Fam Med Prim Care. 2018;7(4):652.

Sinha S, Singh V, Mishra B, Singh A. Comparing the efficacy of visual inspection of cervix with acetic acid and Lugol's iodine with Pap smear cytology in screening for cancer cervix. J Cur Res Scient Med. 2018;4(1):10.

Rajendiran S, Gopalan U, Karnaboopathy R. Evaluation of histopathology of cervix in women with unhealthy cervix. Int J Reprod Contracept Obstet Gynecol. 2017;6(3):842-5.

Vidyadhar DS, Bhattacharya DA, Bohara DS, Dwivedi DA, Agarwal DA, Gangwar DD. Comparison and correlation of cytology, colposcopy and histopathology of premalignant lesions of cervix in rural women of Barabanki district. IOSR J Dent Med Sci. 2017;16(04):13-8.

Thumoju S, Divyakolu S, Bhopal T, Gowrishetty S, Fatima SS, Ahuja YR, et al. Experiences from cervical cancer screening program conducted at low-resource areas in Telangana. Int J Med Public Health. 2018;8(3):112-5.

Das D, Kar A, Rath S, Baliarsingh SK, Prusty D, Dash AK. Cytological pattern of papanicolaou smears and detection of cervical cancers: An experience from a tertiary care center of eastern zone of India. Oncol J India. 2018;2(2):25.

Narayana G, Suchitra MJ, Sunanda G, Ramaiah JD, Kumar BP, Veerabhadrappa KV. Knowledge, attitude, and practice toward cervical cancer among women attending obstetrics and gynecology department: a cross-sectional, hospital-based survey in South India. Indian J Cancer. 2017;54(2):481.

Arya R, Arora R, Benwal D, Kumar VK, Verma S. Can visual inspection after acetic acid replace papanicolaou smear. J Evidence-Based Women’s Health J Soci. 2015;5(1):38.

Parvin Z, Naher L, Das SK, Khanam S, Rosy N. Visual inspection of cervix with acetic acid (VIA) as a screening tool for early detection of cervical pre-cancer and cancer. Faridpur Med Coll J. 2018;13(1):24-7.

Sachan PL, Singh M, Patel ML, Sachan R. A study on cervical cancer screening using pap smear test and clinical correlation. Asia-Pacific J Oncol Nurs. 2018;5(3):337.

Rana MK, Singh K, Mahajan MK, Rana AP. Clinicopathological profile of cervical carcinoma: An experience of tertiary care cancer centre. Asian Pacific J Cancer Care. 2019;4(3):83-6.

Saleh HS, El Hameid AA, Mowafy HE, Sherif HE, Abdelsalam WA. Visual inspection of the cervix with (acetic acid or lugol’s iodine) for cervical cancer screening. Gynecol Obstet (Sunnyvale). 2016;6:111.






Original Research Articles