Exploring a Paired Perspective: Significance of Reporting the Presence of Cannon Balls and the Absence of Lactobacilli on Pap Smears.

INTRODUCTION: Cannon balls are a frequently observed finding in inflammatory Pap smears. Though associated with Trichomonas vaginalis (TV) and bacterial vaginosis (BV), variability in their interpretation and association exists. Additionally, reporting the presence or absence of normal flora (lactobacilli) is still a matter of debate. MATERIALS AND METHODS: This was a retrospective study done over a period of 1.5 years in the cytopathology section of a tertiary care center. The objectives were to determine the association between inflammation, cannon balls, and lactobacilli with infectious etiology, and also to assess the association between different grades of inflammation and cannon balls. RESULTS: Of the 300 Pap smears analyzed, 96.3% were inflammatory. Cannon balls were present in 34.6% of inflammatory smears, and infectious organisms were found in 38.8% of cases, with BV being the most common finding. A notable association was observed between the presence of cannon balls and BV and TV, but not with Candida. The absence of lactobacilli showed a strong link to the presence of cannon balls, suggesting a role in microbiome imbalance. While the odds ratio suggested an increased likelihood of cannon balls with inflammation severity, the association was not statistically significant. CONCLUSION: The study found a significant association between cannon balls and BV and trichomoniasis (TV), with the strongest link to BV. However, no significant association was observed between inflammation severity and the presence of cannon balls. Additionally, the absence of lactobacilli as an indicator of infection was noted, implying the importance of mentioning this negative finding in the Pap smear reports.