“SILENT SIGNALS IN CERVICAL CYTOLOGY: MAPPING THE LANDSCAPE OF INCIDENTAL DISCOVERIES”

Abstract

Background:

Papanicolaou (Pap) smear cytology serves as a cornerstone in cervical cancer screening. While its primary focus is the detection of cervical epithelial abnormalities, incidental findings—unrelated to cervical neoplasia—are frequently encountered and may hold clinical relevance. These include infectious processes, atrophic cellular changes, the presence of endometrial cells in women beyond the expected age threshold, and cytological features suggestive of extragenital pathology. The Pap smear continues to be a simple, cost-effective, and sensitive modality for the identification of both neoplastic and non-neoplastic lesions of the cervix, making it an indispensable component of routine gynecologic evaluation.

Objective:

To evaluate the prevalence of premalignant and malignant cervical lesions and to analyse their clinic pathological characteristics for improved diagnostic interpretation and patient management.

Methods:

A retrospective observational study (n- 418 cases) was conducted on Pap smear reports from a tertiary care center between January 2023 to December 2024. Incidental findings were catalogued and correlated with age, menstrual history, and clinical background. Cytological features were reviewed in accordance with The Bethesda System. Statistical associations were analyzed using appropriate inferential tests. 

Results:

The study evaluated 418 Pap smears and found incidental cytological findings in 22.2% of cases. Incidence increased with age, especially ≥40 years (30.9%), showing significant association (χ² = 5.84, p < 0.015). Symptomatic patients—particularly those with pelvic pain and abnormal bleeding—had higher detection rates (up to 39.5%), with an odds ratio of 1.76 (CI: 1.09–2.83, p = 0.02). Cytological grading correlated with incidental findings; HSIL cases had the highest rate (80%), and the overall variation was statistically significant (F = 3.12, p = 0.027). These results underscore the clinical value of age and symptoms in predicting incidental findings on cervical cytology.

Conclusion:

Incidental findings in Pap smears, although secondary to the primary purpose of cervical cancer screening, may hold valuable clues regarding non-neoplastic gynecological conditions. Routine reporting and follow-up can enhance diagnostic yield and improve patient outcomes. Incorporating such parameters may refine cytological surveillance strategies and contribute to comprehensive women's health monitoring.