PREVALENCE AND HISTOPATHOLOGICAL CHARACTERISTICS OF CERVICAL LESIONS IN WOMEN UNDERGOING BIOPSY FOR UNHEALTHY CERVIX: A RETROSPECTIVE STUDY

Background

Cervical cancer is the second most common malignancy among women in India, accounting for nearly one-quarter of the global cervical cancer burden, with approximately 122,000 new cases and 67,000 deaths annually. The clinical entity of 'unhealthy cervix' — characterized by erosion, hypertrophy, polyp, growth, or contact bleeding observed on per speculum examination — represents a heterogeneous spectrum spanning benign inflammatory conditions, premalignant intraepithelial lesions, and frank malignancy. Histopathological evaluation of biopsy specimens remains the gold-standard for definitive diagnosis, guiding management ranging from medical therapy for cervicitis through ablative or excisional treatment for cervical intraepithelial neoplasia (CIN) to radical surgery and chemoradiation for invasive cancer. Adesh Medical College & Hospital (AMCH), Mohri Shahbad, serves as the principal tertiary care referral center for Kurukshetra, Karnal, and Yamunanagar districts of Haryana — a region with predominantly rural-semiurban populations where reproductive tract infections, multiparity, early marriage, and limited cervical cancer screening collectively contribute to a substantial burden of unhealthy cervix presentations. No prior systematic AMCH analysis had characterized the institutional histopathological spectrum of cervical biopsies, correlated findings with clinical and demographic profiles, or evaluated the diagnostic performance of Pap smear against histopathology — generating an evidence gap for clinical protocol refinement and quality improvement initiatives.

Objectives

To determine the prevalence and histopathological spectrum of cervical lesions in women undergoing cervical biopsy for clinically unhealthy cervix at AMCH, Mohri Shahbad, during November 2016–August 2017; to correlate histopathological findings with demographic, clinical, and reproductive parameters; and to evaluate the diagnostic accuracy of Pap smear against histopathology as the reference standard.

Methodology

Retrospective observational study using medical records and histopathology archives from AMCH Departments of Obstetrics & Gynecology and Pathology. Inclusion: women (≥21 years) with clinically unhealthy cervix on per speculum examination undergoing punch biopsy. Data extracted: demographics (age, parity, socioeconomic status), reproductive/sexual history, clinical findings (cervix appearance, contact bleeding), Pap smear cytology, and histopathological diagnosis (per WHO 2014 classification, Bethesda system for cytology). Tissue processing: 10% neutral buffered formalin fixation, paraffin embedding, 4-μm sections, hematoxylin & eosin staining; two-pathologist consensus diagnosis. Statistical analysis: IBM SPSS v24.0 — descriptive statistics, chi-square testing, Cohen's kappa for cytology-histology agreement, multivariate logistic regression for risk factor identification, ROC analysis. Significance: p<0.05 (two-tailed).

Results

298 women included: mean age 42.6±9.8 years; multiparous (≥4 children) 46.3%; age at first coitus <18 years 28.9%; lower socioeconomic status 59.1%. Per speculum findings: erosion 43.0%, hypertrophy 19.5%, polyp 14.1%, growth 8.1%, contact bleeding 15.4%. Histopathological spectrum: BENIGN 75.8% (226/298) — chronic non-specific cervicitis 37.6% (112), squamous metaplasia 15.4% (46), endocervical polyp 12.8% (38), koilocytic atypia 6.0% (18), nabothian cyst 4.0% (12); PREMALIGNANT 20.1% (60/298) — LSIL/CIN-1 10.7%, HSIL/CIN-2 5.4%, HSIL/CIN-3 4.0%; MALIGNANT 4.0% (12/298) — squamous cell carcinoma 2.7% (8), adenocarcinoma 1.3% (4). Pap smear performance against biopsy: sensitivity 76.4%, specificity 84.2%, PPV 68.6%, NPV 89.4%, kappa 0.62 (substantial agreement). Independent risk factors for premalignant/malignant pathology (multivariate): HIV-positive status (adjusted OR 5.62; 95% CI 2.18-14.52; p<0.001), multiple sexual partners (OR 4.18; 2.08-8.40; p<0.001), early coitarche <18 years (OR 3.86; 1.94-7.68; p<0.001), age >40 years (OR 2.86; 1.42-5.74; p=0.003), multiparity ≥4 (OR 2.94; 1.46-5.92; p=0.002).

Conclusion

Cervical biopsy of women with clinically unhealthy cervix at AMCH revealed predominantly benign pathology (75.8%), with clinically critical 24.2% premalignant/malignant lesions necessitating prompt intervention. Chronic cervicitis remained the dominant diagnosis (37.6%), reinforcing the role of reproductive tract infection management in this patient population. The 4.0% invasive carcinoma rate is consistent with published Indian tertiary-care series and underscores the value of biopsy in unhealthy cervix cases regardless of Pap result, as approximately one in four women with apparently inflammatory cytology had underlying CIN or carcinoma. The substantial Pap-biopsy concordance (kappa 0.62) supports cytology as a valuable triage tool, but the 31.4% false-negative rate among premalignant/malignant cases mandates direct biopsy whenever clinical examination is suspicious. Four institutional recommendations: (1) mandatory cervical biopsy in all women with persistently unhealthy cervix even with normal/inflammatory Pap; (2) opportunistic Pap screening integrated into all gynecologic OPD visits for women aged ≥30 years; (3) dedicated colposcopy clinic to enable directed biopsy and minimize sampling error; (4) targeted screening intensification for high-risk groups (HIV-positive, early coitarche, multiple partners, lower socioeconomic status). These findings will inform AMCH cervical screening protocol development and quality improvement initiatives.