Cytopathological pattern of cervical Pap smear according to the Bethesda system in Southwestern Saudi Arabia.

OBJECTIVE

Cervical carcinoma is an important women's health problem worldwide. The aim of this study is to evaluate the abnormal cytological entities detected by cervical Pap smear in Al-Baha region of KSA, to reclassify the cytological findings according to the recently recommended Bethesda system and to discuss the significance of Pap smear's screening programs.

METHODS

A retrospective study was designed to review the Pap smears from the archives of the Department of Pathology, King Fahad Hospital, Al-Baha over the last 10 years starting from 1994 to 2003 with correlation to the Bethesda system. Cytopathological aspects of Pap smears were reviewed with age distribution.

RESULTS

Of the 2100 cases reviewed there were 166 cases (7.9%) with epithelial abnormalities that included: atypical squamous cells of undeterminate significance (ASCUS) were seen in 58 cases (2.76%) with age peak incidence (API) between 30-39 years; atypical squamous epithelium, cannot exclude high squamous intraepithelial lesion (HSIL) was seen in 4 cases (0.19%); low grade squamous intraepithelial lesion (LSIL) including human papillomavirus was seen in 27 cases (1.3%) with API between 50-59 years and HSIL was seen in 14 cases (0.66%) with API between 40-49 years. Squamous cell carcinoma was seen in 7 cases (0.33%) with API between 50-59 years. There were 54 cases (2.57%) of atypical endocervical cells and 2 cases (0.09%) of atypical endometrial cells.

CONCLUSION

Atypical squamous cells of undeterminate significance, LSIL, HSIL, invasive cervical carcinoma and sexually related infectious diseases are less frequently encountered in Saudi women and occur at older age compared to the Western countries. Fewer women are screened for this disease in this region and health education is very important to encourage more Saudi female to have this important screening test particularly in this region of KSA.