How Liquid Based Cytology Surpasses Conventional Cytology - A Review Article

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.

Association of Cervical Intraepithelial Lesions in Women with Genital Warts; A Cytological and Molecular Study

Background: Cervical cancer is a major health concern worldwide, according to the World Health Organization. It is now the fourth most common cancer after breast, colorectal and lung cancers in women worldwide. It is also the world's third most common cause of cancer death in women. objective of the study is to clarify association between genital warts & cervical intraepithelial lesions using cervical smear cytology with real time PCR. Methods: The study was carried out at The Department of gynecology & dermatology in Tanta University Hospitals. 50 patients were included started from June 2019 to June 2020. Results: From June 2019 to June 2020, 50 married women with genital warts are include in the study. Ten women out of 50 were married twice. Number of pregnancies ranged from 0 to 4 with a median (IQR) of 2.56. As regard LSIL group; 6 patients were infected by low risk HPV genotypes while only 2 patients had a mixed infection with high risk HPV genotypes. While all HSIL patients were infected by high risk HPV genotypes. Conclusions: The cytological characteristics of HPV on cervical smear appear to be non-specific. Therefore, PCR for HPV should be made use of as an adjunct to cervical smears in high risk patients to diagnose and follow up early cervical intraepithelial lesions.

Is there any possibility of uterine sarcoma, STUMP and benign myoma variants in the patients operated for myoma uteri

Malignant pathologies may be observed in the histopathological examination of the patients who were operated with the diagnosis of myoma uteri. We aimed to investigate the rates of detection of uterine sarcoma, smooth muscle tumor of uncertain malignant potential and benign myoma variants who were operated due to myoma uteri. Patients who were operated with the diagnosis of myoma uteri between 2012-2018 were included. Patients with and without malignant pathology were compared in terms of their characteristics. The malignancy was encountered in 39 patients (1.5%) among 2583 patients. A significant difference was found between the patients with and without malignancy in terms of age, admission complaints, and cervical smear results. Patients in the malignant group were found to be older (52.5±11.0 vs 48.1±6.1, p=0.016). Postmenopausal bleeding was significantly a more common complaint in the malignant group (p=0.028). The rate of abnormal cytology in the cervical smear results in the malignant group was 5.1% (p=0.004). Pathology reports of the patients who were operated for myoma uteri may result with malignancy. In the preoperative evaluation, it is necessary to pay attention to the patients’ characteristics, to evaluate the risk factors for the possibility of a malignancy.

A two year retrospective study of cytohistopathological correlation of cervical smear in a tertiary care hospital

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.

Rates of cervical screening amongst females admitted to the psychiatric inpatient hospital in Jersey, Channel Islands

AimsPatients with enduring mental health conditions are known to have higher morbidity and mortality rates than the general population. It has been identified that this is due to lifestyle risk factors, medication side effects and barriers to receiving physical health care. National screening programmes; including cervical screening, save lives, however depends upon patient engagement. We hypothesised that due to the factors stated above, psychiatric inpatients are more at risk of cervical cancer and less likely to engage in cervical screening. This study aimed to assess the cervical screening history of patients discharged from the psychiatric inpatient hospital in Jersey, Channel Islands.MethodUsing computerised laboratory records, the cervical smear history of female patients discharged from the paychiatric inpatient hospital was analysed. Inclusion criteria were: being aged between 25–64 years and having a cervix in situ. Exclusion criteria were total hysterectomy. Cervical smear history was compared to the national guidelines of having routine smears every 3 years for women aged 25–49 and every 5 years for women aged between 50–64 years.ResultIn the period 1 December 2019–1 December 2020 there were 45 females discharged from the psychiatric inpatient hospital that fit the inclusion criteria. 26 (58%) were up to date with their cervical smears in accordance with national guidelines. 12 (27%) had previously had a smear but were not up to date. 19 smears were done at the GP, 13 at the sexual health clinic and 6 at gynaecology clinic. 7 (16%) had never had a cervical smear. Of these 7 patients it was identified that one patient was in a same sex relationship and one was a victim of sexual assault.Conclusion58% of women discharged from the psychiatric inpatient hospital were up to date with their smears. This is down from the 72.2% coverage rate of the general population. Although this was a small study, it highlights that engagement with cervical screening amongst psychiatric inpatients is less than the general population. Admission presents a crucial contact between patients and healthcare services and this could be utilised to engage patients in physical health screening. Cervical screening history could be checked upon admission and patients not adequately screened, assisted to make an appointment on discharge.

Comparison between Thin Prep® Preparation (Liquid Based Cytology) and Conventional Pap Smears of Cervical Smear Cytology Lesions – A Study from Kanyakumari, Tamilnadu, India

BACKGROUND The major cause of mortality among women is cancer of the uterine cervix. It is the second most common cancer worldwide. Pap smear is done as a method of cervical screening to detect precancerous and cancerous lesions of the cervix. Early detection of these lesions prevent the number of deaths from cervical cancer. Liquid based cervical cytology was developed to improve the diagnostic accuracy of pap smears. The main purpose of this study was to compare the profile of distribution of cervical smear cytology lesions obtained by thin prep preparation (liquid based cytology) and conventional pap method among women in the age group of 25 – 60 yrs. METHODS This is a cross sectional study done among 110 women from the outpatient department of Obstetrics and Gynaecology. Conventional and liquid based cytology smears were taken simultaneously from the same women and reported according to the 2001 Bethesda system. RESULTS Majority of the women included in this study fall in the age group of 41 - 50 years [65 (59.1 %)]. Women with a history of persistant vaginal infection were 13 (11.8 %). Out of the 110 pap smears taken by both conventional and liquid based methods, unsatisfactory smears were not detected in liquid based cytology and 6 (5.5 %) unsatisfactory smears were found in conventional pap method. In liquid based cytology, inflammatory smears were detected more (80 %), atrophic smears (2.7 %), smears with features of atypical squamous cells of undetermined significance (ASCUS) were 4.5 %, low-grade squamous intraepithelial lesion (LSIL) were 3.6 %, and smears with high-grade squamous intraepithelial lesion (HSIL) were 0.9 %. Epithelial cell abnormalities were found to be high in liquid based cytology. CONCLUSIONS Abnormal epithelial lesions were detected more in liquid based cytology (thin prep method). The number of unsatisfactory smears were found to be decreased when compared to conventional pap method. KEY WORDS Bethesda Cervical Cytology, Cervical intraepithelial lesion, Conventional Pap Smear, Liquid Based Cytology Smear

P63 Improving cervical smear uptake through an Automated Voice Messages Reminder

National cervical screening programs have played a pivotal role in the prevention of cervical cancer. However, practices across the UK have reached an all-time low in cervical screening uptake. This study aimed to assess the efficacy of implementing an automated voice message reminder within the local general practice (GP) telephone triage system and explore the reasons which deter eligible patients away from cervical screening. A 20-second voice-message reminder in the telephone queue was played, addressing key risk factors along with a message from a child who lost his mother to cervical cancer. From the anonymised GP database, weekly new smear test bookings were monitored from 4 weeks prior until 2 weeks after the intervention was implemented. To qualitatively assess factors which deter patients away from screening, female patients were randomly sampled to fill in an anonymous questionnaire. The use of a low-cost 20 second voice message in the telephone queue across UK GP practices could be an effective method to increase cervical smear test coverage towards the national target of 80%. 35 questionnaire responses were received, main themes reported for not attending screening include embarrassment(37%), busy schedule(32%) and cultural differences(24%). In the week following the intervention, cervical smear tests increased more than 2-fold, from an average of 12 to 26 smears per week. This could be partly due to the convenient timing of voice recording, reminding them to book both appointments simultaneously and the child’s emotive message.