title: Changing spectrum of squamous cell abnormalities observed on papanicolaou smears in Mubarak Al-Kabeer Hospital, Kuwait, over a 13-year period.
abstract: OBJECTIVE
  The aim of this study was to determine the incidence of squamous cell abnormalities in cervical cytology in Mubarak Al-Kabeer Hospital, Kuwait, and to document any change in the pattern of these lesions.
  
  
  METHODS
  Over a 13-year period (1992-2004), 86,434 cervical smears were studied in Mubarak Al-Kabeer Hospital, Kuwait. Conventional Pap smears were first examined by cytotechnicians and finally reported by cytopathologists. The smears were classified according to the modified Bethesda system. The age of presentation of squamous cell abnormalities in Kuwaiti women was analyzed.
  
  
  RESULTS
  Smears from 83,052 (96.09%) patients were found satisfactory for reporting while the remaining 3.9% was unsatisfactory. Atypical squamous cells of undetermined significance (ASCUS) were seen in 1,790 (2.2%) cases, atypical glandular cells of undetermined significance (AGUS) in 630 (0.8%) cases, low grade squamous intraepithelial lesion including human papillomavirus changes (LSIL) in 824 (1.0%) cases, high grade squamous intraepithelial lesion (HSIL) in 189 (0.2%) cases, and carcinoma in 79 (0.1%) cases of which 44 (0.05%) were squamous cell carcinoma. A comparison of average cases/annum during the study period revealed a significant increase in ASCUS from 1.13 to 2.83% (p < 0.001) and AGUS from 0.33 to 1.08% (p < 0.001). However, the percentage of LSIL, HSIL and carcinoma detected in Pap smears remained the same.
  
  
  CONCLUSIONS
  A significant linear trend (p < 0.001) was observed in satisfactory smears, ASCUS and AGUS over the years. However, no significant change was found in the detection of LSIL, HSIL and carcinoma. A reduction in the age of LSIL/HSIL and an increasing trend in the number of Kuwaiti women over the years was also observed which makes screening of young women essential in Kuwait.
authors.affiliation: Department of Pathology, Faculty of Medicine, Kuwait University. kkapila@yahoo.com
authors.forename: Kusum
authors.initials: K
authors.lastname: Kapila
authors.forename: Sara S
authors.initials: SS
authors.lastname: George
authors.forename: Azza
authors.initials: A
authors.lastname: Al-Shaheen
authors.forename: M S
authors.initials: MS
authors.lastname: Al-Ottibi
authors.forename: Shahed K
authors.initials: SK
authors.lastname: Pathan
authors.forename: Zafar A
authors.initials: ZA
authors.lastname: Sheikh
authors.forename: Bahiya E
authors.initials: BE
authors.lastname: Haji
authors.forename: Mrinmay K
authors.initials: MK
authors.lastname: Mallik
authors.forename: Dilip K
authors.initials: DK
authors.lastname: Das
authors.forename: Issam M
authors.initials: IM
authors.lastname: Francis
mesh_terms: D000293:Adolescent; D000328:Adult; D002294:Carcinoma, Squamous Cell / Q000175:diagnosis* / Q000453:epidemiology; D005260:Female; D006801:Humans; D007730:Kuwait / Q000453:epidemiology; D065006:Papanicolaou Test; D012189:Retrospective Studies; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis* / Q000453:epidemiology; D014626:Vaginal Smears / Q000379:methods*; D002578:Uterine Cervical Dysplasia / Q000175:diagnosis / Q000453:epidemiology