The rate of diagnosis of infection in patients who underwent biopsies due to cervical smear pathology

Introduction: It is known that it is difficult to distinguish the lesions caused by cervical infections in the form of chronic cervicitis from the lesions caused by preinvasive cervical changes, and this situation significantly affects the smear result. In connection with this, it seems that cervical infections lead to unnecessary interventions. In this study, we investigated the rate of tissue diagnosis as infection in cervical biopsies with abnormal pap-smear test results and obtained on clinical suspicion. Methods: In this study, we compared the smear and biopsy results of all patients who applied to the Adnan Menderes University Gynecology and Obstetrics Clinic between 01.01.2015 and 01.01.2021, and were diagnosed with tissue by performing cervical biopsy due to smear abnormality and suspicious appearance, and compared those whose tissue diagnosis was reported as chronic cervicitis, we set rates. The smears taken in our clinic were taken with a servibrush, and liquid-based cytology was studied. Biopsies were taken by colposcopy. Findings: A total of 1722 cases with smear pathology were determined for the study, and 1520 patients were found to have undergone colposcopy. When the cases with missing data were excluded, 1241 cases were evaluated. Of these, 391 (31.5%) were evaluated as normal colposcopy. In the study, among the patients with abnormal Pap smears who underwent colposcopy, chronic cervicitis was found at a rate of 43% when tissue diagnosis was made. The cases were divided into HPV positive and negative, and the tissue diagnosis was found to be chronic cervicitis in 289 (38.6%) of 748 patients with HPV association. In addition, 175 (23.4%) of them were found to be associated with HPV type 16.18 and 114 (15.2%) HPV type other positivity. When these two groups of HPV subtypes were examined within themselves, it was seen that the rate of chronic cervicitis in 509 HPV type 16.18 positive patients was 34.3%, and the rate of chronic cervicitis in 239 HPV type other positive patients was 47.6%. Pre-procedural cytology abnormalities of 102 biopsies taken in a group of 143 people thought to be caused by microorganisms other than HPV with abnormal Pap smear were 34 LSIL, 11 HSIL, 33 ASCUS, 14 ASCH, 2 AGC and 8 suspicious cytology. 28 (82.3%) patients, 6 (54.5%) patients with HSIL, 21 (63.6%) patients with ASCUS, 13 (92.8%) patients with ASC-H, 2 (100%) patients with AGC, 7(87.5%) patients with questionable cytology Tissue diagnosis was found to be chronic cervicitis in a total of 77 (75.5%) cases, including chronic cervicitis. Conclusion: Cervical infections significantly affect Pap-smear results, which is a screening test, cause cytological abnormalities and also create clinical suspicion. As a result of these conditions, a significant rate of chronic cervicitis is reported in biopsies taken. Before making a decision based on a single smear test, investigating the infection before the biopsy, treating if any, taking a second smear will reduce unnecessary procedures and will also save us from the cost of unnecessary colposcopy.