Cervical histologic findings and six month treatment outcomes of patients with abnormal pap smear cervical cytology attending Kenyatta National Hospital, 2008-2014

Abstract

Introduction: Cervical cancer is the third commonest malignancy among women worldwide, with over 500,000 new cases diagnosed annually, an; 275,000 deaths, 88% of these occurring in the developing countries. HPV infection is implicated in causation of cervical cancer and secondary prevention is hinged on treatment of premalignant lesions caused by this virus. Kenyatta National Hospital (KNH) follows the Pap smear, colposcopy and Loop Electrosurgical Excision Procedure (LEEP) protocol in management of Cervical Intraepithelial lesions (CIN). Study objective: To determine the colposcopy biopsy ± LEEP cervical histologic findings and six month treatment outcomes of patients with abnormal Pap smear cervical cytology attending Kenyatta National Hospital, 2008-2012 Methodology: Retrospective descriptive study was done in KNH, where medical records of patients attended to in the hospital between 2008 and 2012 were reviewed. The sample size was 197. Data was analyzed using the Statistical Package for Social Scientists (SPSS) version 17. Ethical approval was sought from KNH/UoN Ethical Review Committee (ERC). Results: The study population was a predominantly married, urban population with only 34% of them unemployed. Majority (76%) of the participants who underwent colposcopy biopsy ± LEEP had HSIL on Pap smear cytology. Nearly all the participants had an abnormal cervical histology with 78% (154/197) of them having > CIN 2. Of these 54 (27%), 46(23%), 40 (20%) and 13 (7%) had CIN 2, CIN3, CIS and invasive cancer respectively. Only 53% of records had the HIV status recorded. Patients who had a positive HIV status and high parity and age more than 35 years showed an insignificant trend of having a higher likelihood of cervical histology outcomes of > CIN 2. There was a high (63%) loss to-follow-up, for follow up Pap smear at six months after CIN treatment; of the available cytology results 85% of them were normal. Conclusion: Women undergoing colposcopy ± LEEP in KNH have a high rate of >CIN2 on cervical histology. Follow up Pap smear cytology after six months of CIN treatment with LEEP is normal for 85% of the participants who presented for followup. Treatment of CIN is justified and should be strengthened in order to reduce the incidence of invasive cervical cancer in Kenya. Poor documentation was identified as a glaring weakness.