A comparative analysis of conventional and SurePath liquid-based cervicovaginal cytology: A study of 140 cases

Comparative Analysis of Conventional Cytology and Liquid-Based Cytology in the Detection of Carcinoma Cervix and its Precursor Lesions

Context

The conventional smears (CS) and Liquid based cytology (LBC) are important tools to detect carcinoma cervix and its precursor lesions.

Aims

The present study was done to compare the cytomorphological features of cervical lesions using both techniques and compare with the histopathological diagnosis.

Settings and Design

This was a prospective observational study over a period of 1.5 years at a tertiary care hospital.

Methods and Material

A total of 969 women in the age group of 21-65 years presenting with either routine screening or complaints of vaginal bleeding, discharge, or pelvic pain were enrolled for the study. Both the CS and LBC smears were analyzed and compared with the corresponding histopathology diagnosis. The data was analyzed using Statistical Package for the Social Sciences (SPSS) software and P values <0.05 were considered significant.

Results

There were 8.57% unsatisfactory smears in CS as compared to 0.5% in LBC smears. Liquid-based cytology was superior to conventional preparations in terms of smear adequacy, lesser hemorrhagic and inflammatory background, and presence of more endocervical cells. Liquid-based cytology showed a better yield in detecting all the types of epithelial cell lesions with a concordance rate of 73.9% between the two techniques. On histopathology correlation of these lesions, LBC had a higher sensitivity (96.67%) and diagnostic accuracy (99.08%) as compared to CS (73.33% and 92.66%, respectively).

Conclusions

Liquid-based cytology is superior to conventional cytology for the detection of epithelial cell lesions. Reduction in the unsatisfactory smears, a cleaner background, and better representation of the sample are more significantly appreciated on LBC in contrast to CS.

A Comparison of Conventional Pap Smear and Liquid-Based Cytology for Cervical Cancer Screening

Objectives

Early diagnosis and treatment of preinvasive lesions have made cervical cytology one of the most effective methods of cancer screening in industrialized nations, which have seen a sharp decline in the incidence and death of invasive cancer. The aim of this study is to compare liquid-based cytology (LBC) and conventional Pap on cervical smears.

Materials and Methods

From July 2018 to June 2022, 600 patients were included in this cross-sectional study, which was done at the Pathology Department of a Tertiary Care Facility in Western Maharashtra.

Results

Of the 600 patients, 570 (95%) had good conventional Pap smear (CPS), whereas 30 (5%) had poor ones. Five hundred and ninety-two (98.6%) LBC smears were satisfactory, whereas 8 (1.4%) were unsatisfactory. Endocervical cells were seen in 294 (49%) CPS, whereas 360 (60%) LBC smears showed endocervical cells. The morphology of inflammatory cells was similar in both techniques. Hemorrhagic background was seen in 212 (35%) CPS and 76 (12.6%) LBC smears. Only two samples showed diathetic background, which was seen on both CPS and smear. Out of the satisfactory smears in the case of CPS, 512 (85%) cases were reported as negative for intraepithelial lesion or malignancy (NILM), whereas 58 (9.7%) cases were reported as epithelial cell abnormality. In LBC smears, 526 (87.3%) were reported as NILM, whereas 66 (11%) were reported as epithelial cell abnormality. Organisms were detected in 208 (34%) CPS and 162 (27%) LBC smears. Screening time was 5 ± 1 min for CPS, whereas it was 3 ± 1 min for LBC smear.

Conclusion

Mortality will be decreased using LBC on a bigger scale in nations where many smears can be made and screened in a short amount of time, with the provision of doing human papillomavirus-based testing on the remaining sample.

Efficacy of careHPV™ human papillomavirus screening versus conventional cytology tests for the detection of precancerous and cancerous cervical lesions among women living with HIV-1 in Lao People's Democratic Republic

BACKGROUND

In the Lao People's Democratic Republic (Lao PDR), cervical cancer is the third leading cause of women cancer.

AIMS

The objective of this cross-sectional study was to compare the efficacy of careHPV™ test versus conventional Pap smear or Siriraj liquid-based cytology in the detection of cervical cancer in women living with human immunodeficiency virus type 1 (HIV-1).

MATERIALS & METHODS

Overall, 631 women consented to participate. Four cervical specimens were taken for the purpose of conventional Pap smear, Siriraj liquid-based cytology, careHPV™ test, and HPV-16 genotyping. The exact McNemar test was used to compare the efficacy and diagnostic performance of the tests.

RESULTS

Of the 631 women with follow-up, 331 were human papillomavirus (HPV) negative. High-grade squamous intraepithelial lesions were found in 37 women, biopsy-proven high-grade cervical intraepithelial neoplasia in 50 women, and invasive carcinoma in seven women. The proportion of women with high-grade cervical lesion or carcinoma detected after abnormal careHPV™ test was higher (6.02%; 95% confidence interval [CI]: 4.4-8.1) than that detected by conventional Pap smear (4.59%; 95% CI: 3.2-6.5). careHPV™ and HPV-16 genotyping had, respectively, the highest sensitivity (80.8%; 95% CI: 67.4-89.5) and specificity (92.2%; 95% CI: 89.8-94.2). HPV-16 was the most frequently detected genotype.

CONCLUSIONS

careHPV™ test represents a screening option in Lao PDR, particularly in women living with HIV-1 because of higher prevalence of chronic HPV in this population.

High-risk human papillomavirus test in anal smears: can it optimize the screening for anal cancer?

OBJECTIVE

The current method for screening anal cancer is anal cytology, which has low sensitivity. Since high-risk human papillomavirus (HR-HPV) is associated with almost 90% of cases of anal cancer, the objective of this study is to evaluate whether testing for HR-HPV can optimize the screening.

DESIGN

Prospective study with patients enrolled in a screening program for anal dysplasia. Considering high-resolution anoscopy (HRA)-guided biopsy as the gold standard for diagnosis of high-grade squamous intraepithelial lesions, the diagnostic performance of anal cytology, HR-HPV testing, and the combination of both was calculated.

SETTINGS

A single center for anal dysplasia.

PARTICIPANTS

A total of 364 patients (72% males, 82% HIV-positive).

INTERVENTION

Patients underwent anal cytology, HR-HPV test, and HRA-guided biopsy of the anal canal.

MAIN OUTCOME MEASURES

Ability of cytology and HR-HPV test (individually and combined) to detect high-grade squamous intraepithelial lesions, and analysis of the cost of each diagnostic algorithm.

RESULTS

Cytology alone was the cheapest approach, but had the lowest sensitivity [59%, 95% confidence interval (CI) 46-71%], despite of highest specificity (73%, 95% CI 68-78%). Cotesting had the highest sensitivity (85%, 95% CI 74-93%) and lowest specificity (43%, 95% CI 38-49%), and did not seem to be cost-effective. However, HR-HPV testing can be used to triage patients with normal and atypical squamous cells of undetermined significance cytology for HRA, resulting in an algorithm with high sensitivity (80%, 95% CI 68-89%), and specificity (71%, 95% CI 65-76%), allied to a good cost-effectiveness.

CONCLUSION

HR-HPV testing is helpful to optimize the screening in cases of normal and atypical squamous cells of undetermined significance cytology.

Diagnostic Efficacy of Liquid-Based Cytology in Endoscopic Ultrasound-Guided Fine Needle Aspiration for Pancreatic Mass Lesions During the Learning Curve: A Retrospective Study

OBJECTIVES

The diagnostic yield of endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) cytology widely varies depending on the treatment method used. Liquid-based cytology (LBC) has gained popularity in the gynecological field because of its efficacy in collection of target cells and simplicity in the manipulation of specimens. Since the introduction of EUS-FNA at our institution, we have used LBC for the diagnosis of pancreatic mass lesions. This study aims to investigate the diagnostic efficacy of EUS-FNA with LBC in patients with pancreatic mass lesions during the learning curve for EUS-FNA.

METHODS

In this study, we retrospectively enrolled 222 patients with pancreatic mass lesions who were diagnosed using EUS-FNA with LBC between 2011 and 2016. The diagnostic yields for EUS-FNA with LBC for pancreatic mass lesions were evaluated.

RESULTS

The diagnostic sensitivity, specificity, and accuracy for malignancy were found to be 93.9%, 95.1%, and 94.1%, respectively.

CONCLUSIONS

This study suggests that EUS-FNA with LBC for specimens provides good diagnostic efficacy in patients with pancreatic mass lesions even during the learning curve for EUS-FNA.

Can LBC Completely Replace Conventional Pap Smear in Developing Countries

Background

A number of screening techniques have been developed to reduce the incidence of cervical cancer, most common of which is conventional Pap smear (CPS) being overtaken by liquid-based cytology (LBC) in most of the developed countries. There are a number of studies with conflicting results, and no method has been shown superior in terms of all parameters. LBC was introduced in our hospital in 2014, and we planned to do a study and compare results of the two techniques. This study aims to compare the two methods in terms of sensitivity, specificity, positive predictive value and negative predictive value, turnover time, cost-effectiveness, sample adequacy. This study has been done in 100 women with unhealthy cervix to increase the output.

Method

This was a prospective observational study. A total of 100 women fulfilling the inclusion criteria were subjected to screening test. In first 50 cases, first conventional Pap smear was taken and then LBC, and in remaining 50 cases, first LBC and then conventional Pap smear were taken; this was done to remove bias.

Results

The number of unsatisfactory slides was reduced with LBC, and turnover time was less for LBC. The detection of ASCUS was increased with LBC, but the detection of higher-grade lesions (HSIL and SCC) was equal with both tests.

Conclusion

The superiority of LBC with respect to reduction in the number of unsatisfactory slides and less turnover time is being offset with increased detection of low-grade lesions subjecting women to further testing increasing the cost of programme and anxiety among women. It is difficult to say that it can completely replace conventional Pap smear in low-resource settings.

Comparative Analysis of Modified Liquid-Based Cytology and CytoRich Red Preparation in Assessment of Serous Effusion for Cancer Diagnosis

Objective: We aimed to compare the cytomorphological diagnosis in serous effusion and quality of background between modified liquid-based cytology (modified-LBC) and CytoRich Red (CRR) preservative. Methods: We used an experimental study design: 110 fresh serous effusions were received from 50 cases negative for malignant effusions and 60 cases positive for malignant effusions. All fresh serous effusions were processed using both the CRR solution and the modified-LBC preparation. Blind sample slides were interpreted for cytomorphological diagnosis and the quality of background by 2 cytotechnologists. Result: All cases had the same diagnosis irrespective of the method. There was no statistically significant difference in the cytological diagnosis between the CRR and modified-LBC preparations (p>0.999). The quality of the background smear for the CRR preparation was clean (54%), moderate in 42%, and poor in 4%. By comparison, the modified-LBC preparation was clean in 46%, moderate in 47%, and poor in 7%. The difference between the quality of background smears between the two methods was not statistically significant (p= 0.527). Conclusion: There was no statistically significant difference in the diagnosis or quality of background between CRR and modified-LBC preparations. The serous effusion specimen prepared by modified-LBC solution was less expensive than CRR. The modified-LBC could be an alternative preparation when commercial preparations are too expensive.

Cervical Cancer Detection between Conventional and Liquid Based Cervical Cytology: a 6-Year Experience in Northern Bangkok Thailand

Objectives:

To determine the prevalence of abnormal Papanicolaou (Pap) smear, cervical intraepithelial neoplasia (CIN) 2 or higher and cancer between conventional Pap smear (CPP) and liquid based Pap smear (LBP).

Methods:

This retrospective study was conducted at Bhumibol Adulyadej Hospital, Bangkok, Thailand between January 2011 and December 2016. Data was collected from medical records of participants who attended for cervical cancer screening test. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy for detecting CIN 2 or higher were evaluated by using the most severity of histopathology reports.

Results:

A total of 28,564 cases were recruited. Prevalence of abnormal Pap smear from CPP and LBP were 4.8 % (1,092/22,552) and 5.7 % (345/6,012), respectively. Percentage of unsatisfactory smears in CPP (52.3%) was higher than LBP (40.5%). From CPP and LBP, cervical cancer percentages were 0.2 and 0.1, respectively. Sensitivity, specificity, PPV, NPV and accuracy of CPP and LBP for detection cancer were 42.5 vs 26.1%, 99.9 vs 100.0%, 69.8vs 75.0%, 99.7 vs 100.0 % and 99.7 vs 99.7%, respectively.

Conclusion:

Prevalence of abnormal cervical cytology and cancer from CPP and LBP were 4.8/0.2 and 5.7/0.1 percent, respectively. Unsatisfactory smear of LBP was less than CPP. Sensitivity, specificity, PPV, NPV and accuracy of CPP and LBP for detection CIN 2 or higher and cancer were comparable.