A Comparative Study of Manual Liquid-Based Cytology with the Conventional Pap Smear for Cervical Cancer Screening in a Tertiary Care Hospital of Mandya, Karnataka
BACKGROUND A long pathological process for investigation of precursor lesion squamous intraepithelial lesion (SIL) leads to invasive cervical cancer. This SIL can be detected much earlier before the lesion progresses to invasive cancer. For greater than fifty years, screening for cancer cervix was done by conventional scrape smears and stained by Papanicolaou [Pap] stain but conventional Pap smears (CPAP) have been reported to have low sensitivity. To overcome these drawbacks manual liquid-based cytology [MLBC] was introduced. The objective of this study was to screen females for cervical cancer using CPAP and MLBC techniques and compare the results of these techniques. METHODS Cervical cytology samples were obtained from 120 non-pregnant females through specialised Uprep cytobrush with a detachable head. Thus, obtained samples were first smeared onto a clean glass slide for CPAP smear, and the whole head to cytobrush was dropped into the specialised Uprep liquid preservative medium and processed by using Uprep Cytospin machine to obtain MLBC smears. Both the smears were stained by conventional Pap stain and reported according to 2014 Bethesda system. RESULTS In this study, the CPAP method had a greater number of unsatisfactory smears than that of MLBC method which was statistically significant. MLBC identified more number of intraepithelial lesions when compared to CPAP and MLBC had an increased detection rate [IDR] of 73.68 % over CPAP. CONCLUSIONS Analysis of our results showed that MLBC had more advantages over CPAP. Since the cost effective MLBC has an improved rate of detection of abnormal lesions, MLBC can be used as a routine technique for screening of cancer cervix in India. Also, MLBC offers an important advantage of performing both human papillomaviruses deoxyribonucleic acid (HPV DNA) test and cytological analysis on a single sample. KEYWORDS Cervical Cancer, Conventional Pap Smear, Manual Liquid Based Cytology, Human Papilloma Virus (HPV DNA), Bethesda System