Pap smear versus histopathology: A comparative study in identifying cervical cancer

Background/Objective: Cervical cancer remains a major public health problem, particularly in developing countries. The aim of this study was to compare the diagnostic accuracy of traditional Pap smears with histopathology in detecting cervical cancer in a population of Iraqi women.

Methods: This cross-sectional study included 75 women who underwent both a Pap smear and a biopsy in 2024. Pap smear results were classified according to the Bethesda 2001 system and histopathological findings were used as the gold standard. To assess the diagnostic accuracy of both methods, sensitivity, specificity, positive predictive value and negative predictive value were calculated.

Results: Pap smear showed moderate sensitivity (79.2%) and specificity (86.4%) compared to histopathology. False negative and false positive results were observed. Histopathology demonstrated superior accuracy with higher sensitivity (98.0%) and specificity (99.0%). Co-testing with both methods achieved a combined sensitivity and specificity of 99.6% and 85.5%, respectively, improving overall diagnostic accuracy.

Conclusions: This study highlighted the continued relevance of the Pap smear as an accessible tool for cervical cancer screening while emphasizing the superior diagnostic accuracy of histopathology. Efforts to optimize screening programs should prioritize reducing false negatives to improve early detection and outcomes. Integrating HPV DNA testing with Pap smears could improve screening accuracy.