Aim: To evaluate the accuracy of Pap smear and colposcopy as predictors of cervical histopathology in patients undergoing total hysterectomy for benign indications, and to determine the incidence of unexpected cervical pathology in these patients.  Study Design: Prospective observational study  Patients and Methods: One hundred women scheduled for total hysterectomy for benign indications were subjected to preoperative Pap smear and colposcopy, at Kasr Al-Ainy Hospital, Cairo University, Egypt, during the period from September 2017 to March 2018. Findings were compared with the histopathological results of the cervices of the hysterectomy specimens.  Results: Out of 100 patients included in our study, 13 had an abnormal Pap smear and 44 had abnormal findings on colposcopy. Abnormal cervical pathology was found in 30 hysterectomy specimens. Pap smear had a sensitivity and specificity of 33.3% and 95.7%, respectively, while colposcopy had a sensitivity and specificity of 96.7% and 78.6%, respectively. The incidence of unexpected cervical pathology was 66.7% depending on the Pap alone, and 3.3% when depending on colposcopy.
Conclusion: Pap smear has a good specificity, but a low sensitivity in predicting cervical histopathology. Meanwhile, colposcopy has a high sensitivity and a reasonable specificity in predicting the histopathology. Colposcopy has a higher sensitivity and specificity as a pathology predictor, when compared to Pap smear.