Evaluation of cervical smears by Conventional and Liquid Based Cytology
Keywords:
Cytodiagnosis, Pap Test, Cervical cancer, Mass screening
Abstract
BACKGROUND: Cervical cancer is the second most common cancer. Screening for cervical canser is done by Pap (Papanicolaou) test by Conventional Pap Smear (CPS) or by newer technique Liquid Based Cytology (LBC). The aim of the study was to learn and compare cervical lesions on both the techniques.METHODS: This was a prospective study conducted over a 2 months period. Cervical smears were taken from 625 patients. On 25/625 patients both CPS and LBC were done. CPS and LBC were done on 300/625 patients each. The smears were processed and stained with Papanicolaou stain. Smears were studied for adequacy, cell types, inflammatory/ haemorrhagic background, organisms and reactive changes. The cervical lesions were categorised according to the Bethesda System of classification. The two techniques were compared based on certain defined parameters.RESULTS: The techniques of CPS and LBC were learnt and cervical cells were appreciated on smears. Various epithelial abnormalities could be identified. Inflammation, bacterial vaginosis, candidiasis and reactive changes were noted. Out of 25 cases taken for comparison (Table 1), 24 (96%) and 25 (100%) cases were satisfactory on CPS and LBC respectively. CPS showed more cases of severe inflammation and hemorrhagic background as compared to LBC.CONCLUSIONS: We conclude that both CPS and LBC are effective screening modalities for cervical lesions. Despite better performance of LBC in many aspects, it was felt that CPS is an equally effective tool in our settings due to the cost constraints.References
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23. Budak MŞ, Senturk MB, Kaya C, Akgol S, Bademkiran MH, Tahaoğlu AE, Yildirim A, Büyükbayram H. A comparative study of conventional and liquid-based cervical cytology. Ginekol Pol 2016;87(3):190-3.
24. Abulafia O, Pezzullo JC, Sherer DM. Performance of ThinPrep liquid-based cervical cytology in comparison with conventionally prepared papanicolaou smears: A quantitative survey. Gynecol Oncol 2003:137–44.
25. Obwegeser JH, Brack S. Does liquid-based technology really improve detection of cervical neoplasia? A prospective, randomized trial comparing the ThinPrep Pap Test with the conventional Pap Test, including follow-up of HSIL cases. Acta Cytol 2001 Sep-Oct;45(5):709-14.
26. Ilter E, Midi A, Haliloglu B, Celik A, Yener A, Ulu I, et al. Comparison of conventional and liquid based cytology: Do the diagnosis benefits outweigh the financial aspect? Turk J Med SCI. 2012;42:1200–6.
27. Davey E, Barratt A, Irwig L, Chan SF, Macaskill P, Mannes P, et al. Effect of study design and quality on unsatisfactory rates, cytology classifications, and accuracy in liquid-based versus conventional cervical cytology: A systemic review. Lancet 2006;367:122–32.
28. Sherwani RK, Khan T, Akhtar K, Zeba A, Siddiqui FA, Rahman K, et al. A comparative study of conventional pap smears and liquid based cytology. J Cytol 2007;24:167–72.
29. Bergeron C, Fagnani F. Performance of a new, liquid-based cervical screening technique in the clinical setting of a large French laboratory. Acta Cytol 2003;47:753–61.
30. Strander B, Andersson-Ellström A, Milsom I, Rådberg T, Ryd W. Liquid-based cytology versus conventional Papanicolaou smear in an organized screening program: A prospective randomized study.Cancer 2007;111:285–91.
2. ICO Information Centre on HPV and cancer. Human Papillomavirus and Related Diseases in India, 2014.
3. Nor HO, Matejka R. Challenges to cervical cancer screening in a developing country: The case of Malaysia.Asia Pacific J Cancer Prev. 2009;10:747–52.
4. World Health Survey. Geneva: WHO; 2003. WHO.
5. Gakidou E, Nordhagen S, Obermeyer Z. Coverage of cervical cancer screening in 57 countries: low average levels and large inequalities. PloS Med. 2008;5:e132.
6. Three year report of population based cancer registries 2006-2008. New Delhi: ICMR; 2010. National Cancer Registry Programme.
7. American College of Obstetricians and Gynecologists. ACOG Practice Bulletin No. 99: management of abnormal cervical cytology and histology. Obstet Gynecol 2008;112:1419–1444.
8. Hartmann K, Hall SA, Nanda K, et al. Systematic Evidence Review Number 25: Screening for Cervical Cancer. Rockville, MD: US Department of Health and Human Services; [Accessed June 10, 2016].
9. Gibb RK, Martens MG. The Impact of Liquid-Based Cytology in Decreasing the Incidence of Cervical Cancer. Reviews in Obstetrics and Gynecology 2011;4(Suppl 1):S2-S11.
10. The 1988 Bethesda System for reporting cervical/vaginal cytological diagnoses. National Cancer Institute Workshop. JAMA. 1989 Aug 18;262(7):931-4.
11. Wilbur DC, Nayar R. Bethesda 2014: improving on a paradigm shift. Cytopathology 2015 Dec;26(6):339-42.
12. BD PrepStain Slide Processor Operator’s Manual; Becton, Dickinson and Company; 2007.
13. Leopold G Koss, Myoon R Melamed. Koss Diagnostic Cytology and its Histopathologic Bases. Fifth ed: Lippincott Williams and Wilkins Publications; 2005.
14. Bal MS, Goyal R, Suri AK, Mohi MK. Detection of abnormal cervical cytology in Papanicolaou smears. Journal of Cytology / Indian Academy of Cytologists 2012;29(1):45-47.
15. Bukhari MH, Saba K, Qamar S, Majeed MM, Niazi S, Naeem S. Clinicopathological importance of Papanicolaou smears for the diagnosis of premalignant and malignant lesions of the cervix. Journal of Cytology / Indian Academy of Cytologists 2012;29(1):20-25.
16. Sharma J, Toi PCh, Siddaraju N, Sundareshan M, Habeebullah S. A comparative analysis of conventional and SurePath liquid-based cervicovaginal cytology: A study of 140 cases. J Cytol 2016 Apr-Jun;33(2):80-4.
17. Gupta N, Bhar VS, Rajwanshi A, Suri V. Unsatisfactory rate in liquid-based cervical samples as compared to conventional smears: A study from tertiary care hospital. Cytojournal 2016 Jun 10;13:14.
18. Singh VB, Gupta N, Nijhawan R, Srinivasan R, Suri V, Rajwanshi A. Liquid-based cytology versus conventional cytology for evaluation of cervical Pap smears: experience from the first 1000 split samples. Indian J Pathol Microbiol 2015 Jan-Mar;58(1):17-21.
19. Siebers AG, Klinkhamer PJ, Vedder JE, Arbyn M, Bulten J. Causes and relevance of unsatisfactory and satisfactory but limited smears of liquid-based compared with conventional cervical cytology. Arch Pathol Lab Med 2012 Jan;136(1):76-83.
20. Roghaei MA, Afshar Moghaddam N, Pooladkhan SH, Roghaie SH. Adequacy criteria and cytomorphological changes in Liquid-Prep TM versus conventional cervical cytology. SEJM 2010;11:173–82.
21. Sigurdsson K. Is a liquid-based cytology more sensitive than a conventional Pap smear? Cytopathology 2013 Aug;24(4):254-63.
22. Ronco G, Confortini M, Maccallini V, Naldoni C, Segnan N, Sideri M, Zappa M,Zorzi M, Calvia M, Giorgi Rossi P. [Health technology assessment report. Use of liquid-based cytology for cervical cancer precursors screening]. Epidemiol Prev 2012 Sep-Oct;36(5 Suppl 2):e1-e33.
23. Budak MŞ, Senturk MB, Kaya C, Akgol S, Bademkiran MH, Tahaoğlu AE, Yildirim A, Büyükbayram H. A comparative study of conventional and liquid-based cervical cytology. Ginekol Pol 2016;87(3):190-3.
24. Abulafia O, Pezzullo JC, Sherer DM. Performance of ThinPrep liquid-based cervical cytology in comparison with conventionally prepared papanicolaou smears: A quantitative survey. Gynecol Oncol 2003:137–44.
25. Obwegeser JH, Brack S. Does liquid-based technology really improve detection of cervical neoplasia? A prospective, randomized trial comparing the ThinPrep Pap Test with the conventional Pap Test, including follow-up of HSIL cases. Acta Cytol 2001 Sep-Oct;45(5):709-14.
26. Ilter E, Midi A, Haliloglu B, Celik A, Yener A, Ulu I, et al. Comparison of conventional and liquid based cytology: Do the diagnosis benefits outweigh the financial aspect? Turk J Med SCI. 2012;42:1200–6.
27. Davey E, Barratt A, Irwig L, Chan SF, Macaskill P, Mannes P, et al. Effect of study design and quality on unsatisfactory rates, cytology classifications, and accuracy in liquid-based versus conventional cervical cytology: A systemic review. Lancet 2006;367:122–32.
28. Sherwani RK, Khan T, Akhtar K, Zeba A, Siddiqui FA, Rahman K, et al. A comparative study of conventional pap smears and liquid based cytology. J Cytol 2007;24:167–72.
29. Bergeron C, Fagnani F. Performance of a new, liquid-based cervical screening technique in the clinical setting of a large French laboratory. Acta Cytol 2003;47:753–61.
30. Strander B, Andersson-Ellström A, Milsom I, Rådberg T, Ryd W. Liquid-based cytology versus conventional Papanicolaou smear in an organized screening program: A prospective randomized study.Cancer 2007;111:285–91.
Published
2017-12-19
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