scholarly journals How Liquid Based Cytology Surpasses Conventional Cytology - A Review Article

Devikala Kumaresan

Pap smear is the most widely used test for screening of cervical cancer and precancerous lesions. Liquid-based cytology is a cervical cancer screening technology that inspects cells by dissolving them in liquid and is used as a main screening tool for invasive cervical cancer. The purpose of this article is to demonstrate how fluid-based cytology has surpassed conventional cytology in the interpretation of cervical smear biopsy results in order to identify early cervical lesions in a more efficient and convenient manner, allowing for early diagnosis and treatment of cervical cancer patients and thus improving patient wellbeing.

2017 ◽  
Vol 9 (2) ◽  
pp. 159-163 ◽  
Uma Singh ◽  
Nisha Singh ◽  
Sabuhi Qureshi ◽  
Sakshi Foruin ◽  
Neha Negi ◽  

ABSTRACT Aim To evaluate and compare the efficacy of liquid-based cytology (LBC) with conventional cytology (CS) as a screening tool for cervical cancer in postmenopausal women. Materials and methods This was an observational crosssectional study conducted over one year. Subjects were recruited from patients attending the outpatient department of the Department of Obstetrics and Gynecology, King George's Medical University, Lucknow, Uttar Pradesh, India. Pap smear and LBC were taken in all subjects. In cases with suspected lesions, the discrepancy between Pap smear and LBC and colposcopy was found. Results Pap smear reported 14.3% inadequate smears in women with postmenopausal changes and 5% inadequate smears in women without postmenopausal changes. In contrast, LBC reported no inadequate smear. This difference was statistically significant (p = 0.011). Cervical neoplasia was ruled out in 53.6% cases by Pap smear and 75.8% cases by LBC. The difference was statistically significant (p = 0.002). Conclusion Liquid-based cytology offers better results in detecting cervical pathology when compared with Pap smear. Liquid-based cytology could be better as a screening method, especially in postmenopausal women in which the screening is challenging due to menopause-induced anatomical and hormonal changes. Clinical significance Cervical cancer is the most common genital cancer among Indian women. Postmenopausal women are at higher risk for developing cervical cancer. Low estrogenic state poses a challenge for detection of cervical cancer by CS in postmenopausal women. We investigated LBC as a better cervical cancer screening tool in this age group. How to cite this article Qureshi S, Singh U, Foruin S, Negi N, Agarwal G, Singh N. Liquid-based Cytology vs Conventional Cytology as a Screening Tool for Cervical Cancer in Postmenopausal Women. J South Asian Feder Obst Gynae 2017;9(2):159-163.

Bioimpacts ◽  
2020 ◽  
Vol 10 (4) ◽  
pp. 235-242
Mitra Moeinzadeh ◽  
Babak Kheirkhah ◽  
Kumarss Amini ◽  
Ali Pouryasin

Introduction: Cervical cancer is the most common female cancer in large areas of the developing world, and almost half of these cases (54%) arises in Asia, where cervical cancer is still threatening women’s health and survival, which makes it a considerable public problem. Human papillomavirus (HPV) is one of the most powerful human carcinogens. Today, it has been proven that all cervical cancers and primary precancerous lesions are caused by carcinogenic types of HPV infections. HPV genotyping can therefore evaluate the screening programs. Methods: Five hundred fifty women referring to the gynecological centers were subjected to Pap smear cell samples. The cytopathological diagnosis of obtained cervical samples was based on the Bethesda system. HPV genotyping was carried out using the INNO-LiPA HPV Genotyping Extra II Amp assay. Results: In a total of 244 HPV positive cases, single‑type HPV infec­tion was observed in 49.6%, while multi‑type HPV infections (including ≥ 2 types) were found in 45.5% of cases. Among the 110 cases with abnormal cytology results, going-over analyses led to the identification of atypical squamous cell of unknown significance (ASCUS) in 73 cases, low‑grade squamous intraepithelial lesions (LSIL) in 24 cases, and high‑grade squamous intraepithelial lesion (HSIL) in 12 cases. In these groups, the infection rate of high-risk HPV (HR-HPV) was 89%, 82%, and 100%, respectively. Conclusion: In this study, the total population of women suffering from different cervical lesions and malignancy was found to be infected with various HPV genotypes. High prevalence of HPV- 53 and HPV- 16 detected among participants with normal cytology can be considered as a tip-off development of cervical cancer among Iranian women.

Dr. Bipin Gandhi

INTRODUCTION: This high mortality rate from cervical cancer globally can be reduced by an approach that includes prevention, early diagnosis, effective screening and treatment programmes. There are currently vaccines that protect against common cancer-causing types of human papilloma virus and can significantly reduce the risk of cervical cancer. in low socioeconomic or developing countries where screening programmes are not available, diagnosing cervical cancer at an early stage and providing access to effective treatment can significantly improve the likelihood of survival. Liquid-based cytology (LBC) was introduced at around mid-1990s as an alternative technique to process the cervical samples. After that most of the developed countries has switched from conventional Pap smear to LBC. LBC has been proposed to be beneficial than Pap smear because of less number of unsatisfactory smears MATERIAL AND METHODS: This study comprises of 287 cervical samples from women visiting the Department of Obstetrics and Gynaecology over a period of 1 year.  Samples were taken and divided into two parts by split-sample technique.  Material was taken from the fornix, portio, and endocervix from all women. Slides for conventional cytology and LBC were stained according to the Pap method. LBC was considered representative if the slide contained >5000 epithelial cells. Endocervical cells were considered present if the slide contained ≥2 groups of glandular/metaplastic cells with ≥5 cells each or if the slide contained ≥10 dissociated glandular/metaplastic cells RESULTS: 287 patients were included in the study. Epithelial cell abnormality was observed in 10 cases in conventional smear while in LBC it was 11. In conventional smear pap report of Unsatisfactory, normal, atrophic, altered flora and candida was in 21,193, 21, 46 and 10 cases respectively. In LBC pap report Unsatisfactory, normal, atrophic, altered flora and candida was in 15,214, 22, 44 and 13 cases respectively. Epithelial cell abnormality was seen in 10 (3.5%) cases by both the methods. Of these 10 cases low grade squamous intraepithelial lesion was observed in 2 cases, High grade squamous intraepithelial lesion in one case, Squamous cell carcinoma in one case and atypical squamous cells of undetermined significance in 6 cases. CONCLUSION: There was a similar detection rate of epithelial abnormalities and infections in both the methods. US rate of CPS was 7.3% and 5.2% for LBC. Thus LBC can be a superior test as compared to conventional pap smear but has to reconsidered in the low-resource setting.

2021 ◽  
Vol 12 (8) ◽  
pp. 144-148
Anil Kumar Sirasagi ◽  
Arpitha K ◽  
Saara Neha ◽  
Pratima Manohar Pattar

Background: Cervical cancer in women is the second most common cancer and the commonest cause of mortality in developing countries. The introduction of Pap smear test changed the scenario of cervical cancer with an intense drop in the incidence and mortality due to invasive cervical cancer. Aims and Objective: To evaluate the patterns of cervical smear cytology and to correlate the cervical smear diagnosis with histopathological diagnosis and to assess the efficacy of Pap smears in diagnosing cervical lesions. Materials and Methods: This two-year retrospective study (January 2018 to December 2019) was done in the department of Pathology in a tertiary care hospital. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy were calculated considering histopathological diagnosis of cervical biopsy as the gold standard. Results: A total of 316 Pap smears were studied, out of which we selected 154 cases who also undergone biopsy or hysterectomy. Epithelial cell abnormalities (ECA) were found in 28 cases (18.2%). Among this the most common ECA was Atypical squamous cells of undetermined significance (ASCUS) seen in 10 cases (6.5%) followed by LSIL (5.2%), HSIL (3.2%) and SCC of cervix (3.2%). The overall correlation between cervical cytology and histopathology was found in 125 out of 154 cases (81.16%). The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of pap smear was 90.57%, 62.50%, 95.41%, 43.47% and 87.66% respectively. Conclusion: Pap smear is a simple, safe, non-invasive and effective method for detection of lesions of the cervix and ECA. Hence, better awareness and periodical cytological screening programs can help in the early detection of malignant cervical lesions and thereby reducing the morbidity and mortality related to this malignancy.

2009 ◽  
Vol 22 (2) ◽  
pp. 183-189
RA Jahan ◽  
F Rahman ◽  
SM Badruddoza ◽  
TA Nasir ◽  
ANNU Ahmed ◽  

Carcinoma of cervix is the most frequent neoplasm of female genital tract. In Bangladesh cervical cancer is the commonest malignancy of women. This high incidence of cervical cancer is attributed to the lack of screening program, particularly in the women of low socio-economic status. Invasive cervical cancer is preceded by a tong premalignant phase known as cervical intraepithelial neoplasia (CIN). The goal of cervical cancer screening is the detection and treatment of precancer before cancer develops. The aim of this study was to evaluate the test parameters using visual inspection with acetic acid (VIA) and cervical cytology in screening and early diagnosis of the precancerous lesions of cervix. This study deals with 115 cases from Gynecology Outpatient Department of Rajshahi Medical College, Rajshahi from July 2006 to June 2008. After vaginal examination Pap smear was collected, followed by VIA and punch biopsy of cervix. All the data were evaluated by standard statistical methods. The sensitivity of VIA was 94.11% while Pap smear was 64.7%. The specificity of Pap smear was 93.94% while VIA was 57.57%. These two tests may be considered as a suitable early detection technique in the developing countries where other test like HPV-DNA detection is a costly oneTAJ 2009; 22(1): 183-189

2021 ◽  
Vol 8 (16) ◽  
pp. 1009-1014
Manjunath M.R ◽  
Sheetal Sheetal

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

CytoJournal ◽  
2019 ◽  
Vol 16 ◽  
pp. 22
Ruchika Gupta ◽  
Ravi Yadav ◽  
Akhileshwar Sharda ◽  
Dinesh Kumar ◽  
Sandeep ◽  

Background: Liquid-based cytology (LBC) for cervical cancer screening offers several advantages over conventional cytology. However, the extremely high cost of the current approved devices precludes widespread application of LBC technique in resource-constrained countries. This study aimed to evaluate the performance of an indigenous low-cost LBC technique, EziPREP™ (EP), against conventional preparations (CPs) for cervical cancer screening. Materials and Methods: A cross-sectional split-sample study with consecutive cervical sampling was conducted on 515 women attending the clinic at our institute. CP smears were prepared as per the standard technique using spatula and endocervical brush followed by detaching the head of brush into the fixative vial of EP. The EP samples were processed as per the manufacturer's protocol. Both CP and EP smears were stained using standard Papanicolaou stain protocol. Both sets of smears were evaluated for staining quality, morphologic details, and cytologic diagnoses. Cytologic diagnoses were correlated with cervical biopsy findings, wherever available. Performance characteristics of the two techniques were calculated. Results: The unsatisfactory rate for CP was 1.0%, while on EP, 1.3% smears had inadequate cellular material. The staining quality and morphological details were comparable in both sets of smears. The detection of infections and epithelial cell abnormality was more, though not statistically significant in EP smears. There was a 98% concordance in cytologic diagnosis between CP and EP smears. Cytohistologic concordance was observed in 96% of cases for both CP and EP smears. Although the time taken for processing and staining of smears was higher for EP (2.5 min for EP per smear and 1.6 min for CP per smear), the screening time reduced from 6.5 min per smear for CP to 2.2 min in EP smears. Conclusion: EP provides monolayered cervical smears with vivid morphological details, leading to reduced screening time and relatively higher pick-up of infections and low-grade cervical lesions as compared to conventional smears. The availability of such low-cost devices may enable wider application of cytology-based cervical cancer screening in low-resource countries.

Chaitra Krishna ◽  
Savitha Chandraiah ◽  
Chandana Krishna

Background: Cervical cancer is the fourth commonest cancer affecting women worldwide and the second most common cancer in women aged 15-44 years. The Papanicolaou (Pap) smear has been the cornerstone of screening for cervical neoplasm for the last 50 years. Liquid-based cytology (LBC) was introduced in mid-1990s as an alternative technique to process cervical samples has many benefits over Pap. A new second generation technique, Liquiprep was introduced after a decade has the advantage of a much lower cost. However, the information available on second generation liquid based cytology is limited. The objective was to look for the efficacy of LBC and to compare it to that of conventional cytology.Methods: This hospital based comparative study was undertaken 100 women who attended gynaecology OPD during 2017 at a tertiary care hospital in Bengaluru. Two cervical smears were simultaneously prepared from each subject, one for Pap smear and another for LBC followed by colposcopy and biopsy.Results: Among the study subjects, 89% of Pap smear analysis and 100% of smears in LBC showed satisfactory smear. Cytological abnormality was detected in 11% and 21% in pap and LBC, respectively. The present study showed higher sensitivity and specificity of 100% and 75% by LBC when compared to Pap smear (55% and 100% respectively).Conclusions: The present study showed that liquid based cytology is better in detecting cervical lesions when compared to conventional smear. 

2019 ◽  
Vol 9 (4) ◽  
pp. 280-283
Mitra Modarres Gilani ◽  
Azam Sadat Mosavi ◽  
Setare Akhavan ◽  
Mehrangiz Zamani ◽  
Mohammad Ali Mohsenpour ◽  

Objectives: Invasive cervical cancer is one of the most fatal genital cancers of women which can be detected by having Pap smear in precancerous stage. Various approaches can be taken for treating or preventing the progress of these precancerous lesions. The aim of this study was to investigate the cytopathological and colposcopic response of precancerous lesions to multivitamin, mineral (multi-mineral), and coenzyme Q10 supplements. Materials and Methods: The present randomized clinical trial was conducted on 120 participants with clinical complaints or abnormal Pap smear test results. The intervention and control groups received supplemental and placebo treatments, respectively, for 3 months after a primarily Pap smear test. The Pap smear test was also performed after the treatment and patients with abnormal results were screened by colposcopy. Data were analyzed by SPSS software and P-value less than 0.05 was considered significant. Results: The percentage of participants in the intervention and control groups were 40% and 28.3% in the age range of 20-29, 26.7% and 41.7% in the age range of 30–39, and finally 33.3% and 30% over 40 years of age, respectively (P=0.19). The percentage of normalization in Pap smear test result was 83.3% and 53.3% in the intervention and control groups, respectively (P<0.001). Conclusions: It was found that short-term usage of multi-mineral and Q10 supplements may decrease the risk of cervical cancer in women with abnormal Pap smear. However, studies with larger population and longer trial period are needed for further investigation.

Bhagyalakshmi Atla ◽  
Uma Prasad ◽  
Venkata Satya Kartheek Botta ◽  
Uma Namballa ◽  
Lahari Pujari ◽  

Background: Pap smear is the conventional screening procedure for cervical cancer. Liquid based cytology has been developed as a cost effective alternative as it has a short screening time, better morphology and clean background while also providing residual material to test for HPV DNA. Therefore this study is undertaken to know the role of Liquid-based cytology in evaluating pre-malignant and malignant lesions of cervix. Objectives of current study were to study the distribution of various cervical lesions on liquid-based cytology and compare them with conventional Pap smears. To know the role of liquid-based cytology in evaluating pre-malignant and malignant lesions of cervixMethods: This study included 200 women attending to gynaecology OPD and the samples were taken for both conventional cytology and liquid based cytology. The smears were studied in detail and were interpreted as per The Bethesda system 2014 of reporting pap smears and results are recorded and compared.Results: The commonest cervical lesions on pap smears by liquid-based cytology are NILM-reactive changes (N=92, 46%), NILM Candida infection is seen in 9 cases (4.5%) and trichomonas vaginalis infection in 5 cases (2.5%). Unsatisfactory smears on LBC is less when compared to conventional smears as the coefficient of correlation is significant with p value of 0.000422 (<0.05). The number of cases with a diagnosis of ASCUS is reported more in liquid-based cytology (9 cases) when compared to conventional Pap (8 cases). The number of cases with diagnosis of HSIL, SCC is reported more in liquid based cytology (7 cases) when compared to conventional Pap (4 cases). Epithelial cell abnormality were easily diagnosed on LBC smears with significant p value of 0.002414 (<0.05).Conclusions: Liquid-based cytology has advantages of fewer unsatisfactory smears and better detection of epithelial cell abnormalities when compared to conventional Pap smears. LBC is better for the screening of premalignant and malignant lesions of cervix even though it is costly.

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