Cervical cytology diagnostic screening findings in pap smears: Insights from a Saudi tertiary center

Cervical cancer is one of the most preventable malignancies, yet it remains a significant public health concern in countries with limited screening uptake, including Saudi Arabia. Cytology remains the primary screening method in such settings, identifying both neoplastic and non-neoplastic conditions. This retrospective cross-sectional audit evaluated Pap smears processed at a tertiary hospital, focusing on adequacy, prevalence of abnormal diagnoses, age distribution, and ancillary findings. A total of 551 smears were reviewed, of which 535 (97.1%) were satisfactory; the unsatisfactory rate was 3.9%, within the recommended <5% benchmark. Among satisfactory smears, most were negative for intraepithelial lesion or malignancy (NILM, 86.91%; 95% CI 83.6–89.6), while abnormal cytology constituted 9.16% (95% CI 7–11.9). High-grade squamous intraepithelial lesions, squamous cell carcinoma, or adenocarcinoma were identified in 0.75%, and invasive carcinoma in 0.2%. The ASC/SIL ratio was 2.5, consistent with international quality assurance standards. Non-neoplastic findings were frequent, including inflammatory/reactive changes (43.4%), atrophy (7.3%), and organisms such as Candida spp. (3.9%) and Actinomyces spp. (1.3%). Age data were available for 535 women, with no significant association between age and abnormal cytology (χ² = 6.12, p = 0.295). Logistic regression showed higher odds of abnormal findings in women aged ≥65 years (OR 2.83, 95% CI 0.84–9.58), although this was not statistically significant (p = 0.09). These findings demonstrate a higher prevalence of abnormal cytology than recent Saudi reports but within regional variability. They underscore the value of Pap smears in cancer prevention and women’s health, while supporting integration of HPV-based screening.