Comparative Analysis of Cervical Cytological Findings in Premenopausal and Postmenopausal Women Using Liquid-Based Cytology: A Retrospective Study from a Tertiary Care Center

Abstract

Author(s): Varsha U Reddy*

Background: Cervical cancer remains a major cause of cancer-related morbidity and mortality among women worldwide, particularly in low- and middle-income countries where screening coverage remains suboptimal. Cervical cytology plays a pivotal role in the early detection of premalignant and malignant cervical lesions. Hormonal and physiological changes associated with menopause significantly influence cervical cytomorphology and may affect the spectrum of cytological findings. Aim: To analyze and compare the spectrum of cervical cytological findings in premenopausal and postmenopausal women undergoing cervical cancer screening at a tertiary care teaching hospital. Materials and Methods: This retrospective observational comparative study was conducted in the Department of Pathology at Vydehi Institute of Medical Sciences and Research Centre, Bengaluru. A total of 762 cervical cytology samples were evaluated, of which 749 satisfactory smears were included in the final analysis. Cervical samples were processed using Liquid-Based Cytology (LBC) and interpreted according to The Bethesda System for Reporting Cervical Cytology (TBSRTC), 2014. Women were categorized into premenopausal and postmenopausal groups based on menopausal status. Comparative analysis was performed using the Chi-square test, and odds ratios (ORs) with 95% confidence intervals (CIs) were calculated. A p-value of <0.05 was considered statistically significant. Results: Of the 749 satisfactory smears, 439 (58.6%) were obtained from premenopausal women and 310 (41.4%) from postmenopausal women. Inflammatory smears were the most common cytological finding and were significantly more frequent among premenopausal women than postmenopausal women [240/439 (54.7%) vs. 98/310 (31.6%); p<0.001]. Atrophic smears and atrophic smears with inflammation were significantly more common among postmenopausal women, accounting for 24.2% and 11.9% of cases, respectively (p<0.001). Postmenopausal women demonstrated significantly increased odds of exhibiting atrophic smears (OR=8.44; 95% CI: 4.81–14.81) and atrophic smears with inflammation (OR=19.70; 95% CI: 6.01–64.51). Epithelial cell abnormalities were uncommon and accounted for only 0.7% of satisfactory smears. Two cases of ASC-US were identified among postmenopausal women, while isolated cases of LSIL, HSIL, and squamous cell carcinoma were observed in premenopausal women.

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