Title: Comparison between manual liquid based cytology and conventional Pap smear for evaluation of cervical lesions and it’s histopathological correlation in cases of epithelial abnormalities

Authors: Dr Meena Mittal, Professor Dr C. V. Kulkarni, Poorva Aggarwal

 DOI:  https://dx.doi.org/10.18535/jmscr/v6i11.22

Abstract

Introduction: Pap smear has been most widely used screening method for cervical cytology since last 50 years. Despite of it reducing morbidity and mortality from cervical cancer by detecting precancerous lesions, false negativity rate of Pap smear is very high. Manual liquid based cytology has been developed as an alternative to conventional Pap smear to overcome its drawbacks. Main advantages of MLBC over CPS are increased percentage of representative cells, better presentation on slide, increased detection of abnormal or dysplastic cell and overall reduced number of unsatisfactory smears.

Aim: to compare the number satisfactory smears and sensitivity in detecting intraepithelial abnormalities with both the techniques.

Materials and Methods: this was a prospective study done on 200 symptomatic women. The sample of each patient was collected into a preservative vial by a cytobrush for MLBC and with an Ayre spatula directly on a slide for CPS. The results were interpreted according to the Bethesda system. The cases of intraepithelial lesions on cytology were followed and confirmed by histopathology.

Results: MLBC showed slightly higher number of satisfactory smears ie. 175 (87.5 %) as compared to CPS (171 ie. 85.5%). The sensitivity of MLBC was much higher ie. 81.8% as compared to CPS which was 36.3%. The p- value was calculated as 0.15 which was not significant.

Conclusion: MLBS was better than CPS in specimen adequacy and lesser obscurance of morphology of representative cells. The number of intraepithelial lesions detected on MLBC was higher but its superiority over CPS is still debatable.

Keywords: cervical cytology, Manual liquid based cytology, conventional Pap smear, intraepithelial lesions.

References

  1. Lindsey A. Torre; Freddie Bray; Rebecca L. Siegel; Jacques Ferlay; JoannieLortet-Tieulent; AhmedinJemal. Global Cancer Statistics, 2012. CA CANCER J CLIN 2015;65:87–108: 99-100.
  2. Bojgua S; Kldiashvili E. Liquid Based Cytology Cervical Cancer Screening Program – Georgian Experience. Arch Can Res. 2016, 4: 3.
  3. Ekane, G.E.H et al. (2015) Pap smear Screening, the Way Forward for Prevention of Cervical Cancer? A Community Based Study in the Buea Health District, Cameroon. Open Journal of Obstetrics and Gynecology, 5, 226-233.
  4. Dhananjaya C; Kumari  Comparison of MLBC and Conventional Pap Smear. National Journal of Laboratory Medicine. 2017 Apr, Vol-6(2): PO32-PO37.
  5. Chinaka CC; Abudullahi M; Mohammed OM. A Comparative Study on the Use of Liquid Based Cytology and Conventional Pap Smear in Cervical Screening. Journal of Medicine and Medical Research Vol. 2(4): 40-50, July, 2014 ISSN: 2350-1502.
  6. Shaw A. Patricia. The history of Cervical Screening: The Pap Test. J Soc Obstet Gynaecol Can 2000;22(2): I I 0-14.
  7. Papanicolaou GN: New cancer diagnosis. Proceedings: The Third Race Betterment Conference. Battle Creek, Mich, Race Betterment Foundation 1928, pp. 528-534.
  8. Tan S; Tatsumura Y; George Papanicolaou (1883-1962): discoverer of the Pap smear. Singapore Med J 2015; 56(10): 586-587.
  9. Ronco G et al. Accuracy of liquid based versus conventional cytology: overall results of new technologies for cervical cancer screening randomized controlled trial. BMJ,doi:10.1136/bmj.39196.740995.BE.
  10. Deshou H et al. Conventional cervical cytology vs Liquid based cytology. Journal of cytology/Jan 2009/ Volume 26/ Issue 1.
  11. Das L et al. Integrated cervical smear screening using liquid based cytology and bioimpedance analysis. J cyt/Oct 2014/ Vol 31/ Issue 4/183-87
  12. Sherwani RK; Khan T. Conventional Pap Smear and Liquid Based Cytology for Cervical Cancer Screening – A Comparative Study. Journal of Cytology 2007; 24 (4) : 167-172.
  13. Colgan T. et al. Results of the Implementation of Liquid-Based Cytology Sure Path in the Ontario Screening Program Cancer (Cancer Cytopathol) 2004;102:362–7.
  14. Garg et al. Conventional pap (papanicoloau) smear cytology in primary screening of cervical lesions & its comparison with manual liquid based cytology. Indian Journal of Pathology and Oncology, July-September 2016;3(3);485-490.
  15. Verma K. Clinical Assessment and Correlation of Pap Smear and Liquid Based Cytology in BAD Cervix. Journal of Evolution of Medical and Dental Sciences 2014; Vol. 3, Issue 53, October 16; Page: 12277-12287, DOI: 10.14260/jemds/2014/3623.
  16. Coste J et al. Cross sectional study of conventional cervical smear, monolayer cytology, and human papillomavirus DNA testing for cervical cancer screening. BMJ Volume 326 5 April 2003.
  17. Singh V; Gupta N; Nijhawan R; Srinivasan R; Suri V; Rajwanshi. Liquid- based cytology versus conventional cytology for evaluation of cervical Pap smears: Experience from the first 1000 split samples. Ijpm.
  18. Hawaldar R et al. Comparison of conventional pap smear versus liquid based cytology in a diagnostic centre of central Madhya Pradesh. Indian Journal of Pathology and Oncology, January - March 2016;3(1);42-4.
  19. Badri Lal Patidar et al. The Comparative Evaluation of Liquid Based Cytology (LBC) and Conventional Pap Smear As a Screening Method of Cervical Cancer at Tertiary Care Center, Kota Rajasthan, India JMSCR Volume 05 Issue 03 March 2017.
  20. Singh, et al.: Liquid-based Cytology versus Conventional Cytology. International Journal of Scientifi c Study | December 2016 | Vol 4 | Issue 9.
  21. Eilter E; Midi A. Comparison of conventional and liquid-based cytology: do the diagnostic benefits outweigh the financial aspect? Turk J Med Sci 2012; 42 (Sup.1): 1200-1206.
  22. Park J. Liqui-PrepTM Versus Conventional Pap Smear. Diagnostic Cytopathology, Vol 35, No 8:488-92.
  23. Nandini NM; SM Nandish; P Pallavi; SK Akshatha; AP Chandrashekhar; S Anjali; Murali Dhar. Manual Liquid Based Cytology in Primary Screening for Cervical Cancer - a Cost Effective Preposition for Scarce Resource Settings. Asian Pacific J Cancer Prev, 13, 3645-3651

Corresponding Author

Poorva Aggarwal

Department of Pathology, Mahatma Gandhi Memorial Medical College, Indore, MP, India