PAP smear versus colposcopy in symptomatic women and women with suspicious-looking cervix

Objective: The aim of the study was to compare alternatives to human papillomavirus test, such as Papanicolaou (PAP) smear and colposcopy with histopathology in symptomatic women and those with suspicious-looking cervix. Materials and Methods: This prospective, 7-month study was conducted on 208 female patients aged ≥18 years with suspicious-looking cervix, complaining of vaginal discharge and menstrual bleeding. All patients were subjected to PAP smear, colposcopy, and colposcopy-directed biopsy. Sensitivity, specificity, and diagnostic accuracy were calculated to assess the performance of diagnostic tests. Data were analyzed using Fisher's exact tests using software R version 3.6.0. Results: Majority (166) of the patients were in the age group of 31-50 years (79.8%) and the mean age was 39.8 ± 7.9 years. Most of them had abdominal pain (65; 31.2%), white discharge (60; 28.8%), and early sexual exposure at 16-19 years (120; 57.6%) of age. PAP smear cytology revealed high-grade squamous intraepithelial lesion and low-grade squamous intraepithelial lesion (LSIL) in 4.3% and 5.8% women, respectively. Per speculum evaluation revealed cervical abnormalities in 85.6% of women. On colposcopy, low-grade infection and suspicious malignancy were noted in 28.8% and 14.4% women, respectively. The sensitivity and specificity of PAP test were 19.5% and 83.3%, respectively, whereas the corresponding values for colposcopy were 90.2% and 72.8%, respectively. Conclusions: PAP smear cytology demonstrated very poor sensitivity compared to colposcopy, especially for LSILs.