Abstract

ABSTRACT:

Background: Cervical cancer ranks as the fourth most prevalent cancer globally, posing a significant public health challenge. Early detection is vital to reducing mortality and improving survival outcomes. Pap smear, colposcopy, and histopathological examination are pivotal diagnostic tools in identifying premalignant cervical lesions. While Pap smear is widely used for cervical cancer screening, colposcopy offers a magnified visual assessment of the cervix, and histopathological examination serves as the gold standard for definitive diagnosis. Objective: This study aimed to compare the diagnostic accuracy of Pap smear and colposcopy against histopathological examination in detecting premalignant and malignant cervical lesions among symptomatic women. Patients and Methods: A cross-sectional study was conducted at the Gynecology Outpatient Department of Maternity Teaching Hospital in Erbil City, Kurdistan Region, Iraq, from January 1 to August 31, 2023. A total of 150 women presenting with postcoital bleeding, vaginal discharge, or intermenstrual bleeding were enrolled. Cervical cancer symptoms were identified by a senior gynecologist. Colposcopy was performed by a specialist gynecologist, and Pap smears were collected by the researcher. Histopathological examination, serving as the reference standard, was conducted in the hospital laboratory. Diagnostic performance metrics, including sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy, were calculated. Results: Colposcopy demonstrated a sensitivity of 84.5%, specificity of 100%, PPV of 90.4%, NPV of 65.2%, and accuracy of 82.6%. In comparison, Pap smear showed a sensitivity of 88%, specificity of 94.4%, PPV of 100%, NPV of 70.2%, and accuracy of 88.6%. Pap smear outperformed colposcopy in diagnostic accuracy for detecting cervical lesions. Conclusion: Pap smear demonstrated superior diagnostic accuracy over colposcopy for cervical lesions. Combined use enhances evaluation of symptomatic women, yet limitations like Pap smear’s lower NPV and colposcopy’s reduced sensitivity underscore the necessity for integrated diagnostic approaches to optimize cervical cancer detection.