Efficacy of Colposcopy versus Pap Smear in Cervical Lesion Screening: A Comparative Study with Histopathological Correlation

Abstract

Objective: To assess the efficacy of colposcopy compared to Pap smear in detecting
cervical lesions, using histopathology as the gold standard, in women with abnormal
symptoms or cervical findings.
Methods: This prospective observational study included 500 women aged 20–60
years attending the gynecology outpatient department at Government Victoria
Hospital, Visakhapatnam, from November 2022 to April 2024. Participants
underwent Pap smear, colposcopy, and colposcopy-guided biopsy. Outcomes were
categorized as normal, cervicitis, cervical intraepithelial neoplasia (CIN I, CIN
II/III), or invasive carcinoma. Sensitivity, specificity, positive predictive value
(PPV), negative predictive value (NPV), and accuracy were calculated, with
statistical significance determined using Chi-square tests (p<0.05).
Results: Histopathology revealed 11% normal, 66% cervicitis, 13% CIN I, 8% CIN
II/III, and 2% invasive carcinoma. Pap smear sensitivity was 78.3% and specificity
94.8%, with PPV 81.8%, NPV 93.6%, and accuracy 91%. Colposcopy demonstrated
higher sensitivity (86.9%) and specificity (97.4%), with PPV 90.9%, NPV 96.1%,
and accuracy 95%. Colposcopy outperformed Pap smear in detecting high-grade
lesions (CIN II/III, invasive carcinoma). Significant associations were found between
CIN and age (mean 43.6 years), multiparity (76.6%), illiteracy (20.8%), and
symptoms like vaginal discharge (77.4%).
Conclusion: Colposcopy exhibits superior sensitivity and specificity compared to
Pap smear, enhancing the detection of cervical lesions, particularly high-grade
abnormalities. Combining both modalities optimizes screening accuracy in high-risk
populations.