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Manual Liquid Based Cytology in Primary Screening for Cervical Cancer - a Cost Effective Preposition for Scarce Resource Settings

  • Nandini, N.M. ;
  • Nandish, S.M. ;
  • Pallavi, P. ;
  • Akshatha, S.K. ;
  • Chandrashekhar, A.P. ;
  • Anjali, S. ;
  • Dhar, Murali
  • Published : 2012.08.31

Abstract

Conventional pap smear (CPS) examination has been the mainstay for early detection of cervical cancer. However, its widespread use has not been possible due to the inherent limitations, like presence of obscuring blood and inflammation, reducing its sensitivity considerably. Automated methods in use in developed countries may not be affordable in the developing countries due to paucity of resources. On the other hand, manual liquid based cytology (MLBC) is a technique that is cost effective and improves detection of precursor lesions and specimen adequacy. Therefore the aim of the study was to compare the utility of MLBC with that of CPS in cervical cancer screening. A prospective study of 100 cases through MLBC and CPS was conducted from October 2009 to July 2010, in a Medical College in India, by two independent pathologists and correlated with histopathology (22 cases). Morphological features as seen through MLBC and CPS were compared. Subsequently, all the cases were grouped based on cytological diagnosis according to two methods into 10 groups and a subjective comparison was made. In order to compare the validity of MLBC with CPS in case of major diagnoses, sensitivity and specificity of the two methods were estimated considering histological examination as the gold standard. Increased detection rate with MLBC was 150%. The concordance rate by LBC/histopathology v/s CPS/histopathology was also improved (86% vs 77%) The percentage agreement by the two methods was 68%. MLBC was more sensitive in diagnosis of LSIL and more specific in the diagnosis of inflammation. Thus, MLBC was found to be better than CPS in diagnosis of precursor lesions. It provided better morphology with increased detection of abnormalities and preservation of specimen for cell block and ancillary studies like immunocytochemistry and HPV detection. Therefore, it can be used as alternative strategy for cervical cancer prevention in limited resource settings.

Keywords

Manual liquid based cytology;pap smear;cervical screening;low cost method

References

  1. Abulafia O, Pezzullo JC, Sherer DM (2003). Performance of Thin-prep liquid based cervicalcytology in comparison with conventionally prepared Papanicolaou smears: quantitative survey. Gynecol Oncol, 90, 137-44. https://doi.org/10.1016/S0090-8258(03)00176-8
  2. Alves VAF, Bibbo M, Schmitt FC, et al (2004). Comparison of manual and automated methods of liquid based cytology. A morphologic study. Acta Cytol, 48, 187-93. https://doi.org/10.1159/000326314
  3. Atkins KA (2003). Liquid based preparation in Gynaecological and non-gynaecological specimens, Ed Niael Kirsham, Neil A . Progress in Pathology, Chap 5; 6. Cambridge University Press, 101-14.
  4. Austin RM, Ramzy I (1998). Increased detection of epithelial cell abnormalities by liquid based gynaecologic cytology preparations. A review of accumulated Data. Acta Cytol, 42, 178-84. https://doi.org/10.1159/000331543
  5. Baandrup U, Bishop JW, Bonfiglio TA, et al (2000). Sampling, sampling errors and specimen preparation. Acta Cytol, 44, 944-8. https://doi.org/10.1159/000328614
  6. Baker JJ (2002). Conventional and liquid based cervicovaginal cytology. A comparison study with clinical and histologic Follow-up. Diagn Cytopathology, 27, 185-8. https://doi.org/10.1002/dc.10158
  7. Bergeron C, Masseroli M, Ghezi A, et al (2000). Quality control of cervical cytology in high risk women PAPNET system compared with manual rescreening. Acta Cytol, 44, 151-7. https://doi.org/10.1159/000326353
  8. Bernstein SJ, Sanchez-Ramos L, Ndubisi B (2001). Liquid based cervical cytologic smear study and conventional papanicaloau smears : a meta analysis of prospective studies comparing cytologic diagnosis and sample adequacy. Am J Obstet Gynecol, 185, 308-17. https://doi.org/10.1067/mob.2001.116736
  9. Bishop JW, Bigner SH, Colgan TJ, et al (1998). Multicenter masked evaluation of autocyto PREP thin layers with matched conventional smears including initial biopsy results. Acta Cytol, 92, 189-97.
  10. Crum CP (2007). The female genital tract: pathologic basis of disease. In Kumar V et al (Eds.) Robinson's Pathologic Basis of Disease. WB Saunders Company, Philadelphia, USA, 1073-5.
  11. Davey D, Zarbo RJ (2003). Introduction and commentary, strategic science symposium. Arch Pathol Lab Med, 127, 927-9.
  12. Deshou H, Changhua W, Quiyan L, et al (2009). Clinical utility of LiquiPrep cytology system for primary cervical cancer screening in a large urban hospital setting in China. J Cytology, 26, 20-5. https://doi.org/10.4103/0970-9371.54863
  13. Ferlay J, Shin H, Bray F, et al (2010). Estimates of worldwide burden of cancer in: GLOBOCAN 2008. Int J Cancer, 127, 2893-917. https://doi.org/10.1002/ijc.25516
  14. Johnson T, Maksem JA, Belshein BL, et al (2000). Liquid based cervical cell collection with brushes and wooden spatulas. Diagn Cytopathol, 22, 86-91. https://doi.org/10.1002/(SICI)1097-0339(200002)22:2<86::AID-DC5>3.0.CO;2-4
  15. Kavatkar AN, Nagwamshi CA, Dabaks M (2008). Study of a manual method of liquid based cervical cytology. Indian J Pathology and Microbiology, 59, 190-4.
  16. Lee, Kelly D, Gravitt PE, et al (2006). Validation of a low cost, liquid based screening method of cervical intraepithelial neoplasia. Am J Obst & Gynaecology, 195, 965-70. https://doi.org/10.1016/j.ajog.2006.02.001
  17. Maksem JA, Finnomore M, Belsheim BL, et al (2001). Manual method for liquid based cytology. A demonstration using 1,000 Gynaecological cytologies collected directly to vial and prepared by a smear - slide technique. Diagn Cytopathology, 25, 334-8. https://doi.org/10.1002/dc.2166
  18. McGoogan E, Colgan T, Remzy J, et al (1998). Cell preparation methods and criteria for sample adequacy. IAC Task Force summary. Acta Cytol, 42, 25-32. https://doi.org/10.1159/000331532
  19. NCCP (2006). Guidelines for cervical cancer screening programme, Department of Cytology & Gynaecological Pathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
  20. NCRP (2006). Consolidated report of population based cancer registries 2001-2004, Indian Council of Medical Research, New Delhi, India.
  21. Papillo JL, Zarcka MA, StJohn TL (1998). Evaluation of the ThinPrep Pap test in clinical practice: A seven month, 16, 314-Case experience in northern Vermont. Acta Cytologica, 42, 203-8. https://doi.org/10.1159/000331547
  22. Park LA, Lee SN, Chae SW, et al (2001). Comparing the accuracy of ThinPrep Pap tests and Conventional Papanicolaou Smears on the basis of the histologic diagnosis. A clinical study of women with cervical abnormalities. Acta Cytol, 45, 525-31. https://doi.org/10.1159/000327859
  23. Richard K, Dziura B, Hornish A (1999). Cell block preparation as a diagnostic technique complimentary to fluid based monolayer cervico-vaginal specimens. Acta Cytol, 43, 69-73. https://doi.org/10.1159/000330957
  24. Pinto A P , Degen M , Villa L L, Cibas E S (2012). Immunomarkers in gynaecologic cytology the search for the ideal biomolecular papanicolaou test. Acta Cytol, 56, 109-21 https://doi.org/10.1159/000335065
  25. Sherwani RK, Khan T, Aktar K, et al (2007). Conventional pap smear and liquid based cytology for cervical cancer screening-A comparative study. J Cytology, 24, 167-72. https://doi.org/10.4103/0970-9371.41888
  26. Syrjanen K, Di Bonito L, Goncalves L, et al (2010). Cervical screening in Mediterranean countries: Implications for the future. Cytopathology, 21, 359-67. https://doi.org/10.1111/j.1365-2303.2010.00795.x
  27. Szarewski A,Ambroisine L,Cadman L, Austin J, Ho L,Terry G et all(2008).Comparison of predictors for high-grade cervical intraepithelial neoplasia in women with abnormal smears. Cancer Epidemiol Biomarkers Prev, 17, 3033-42 https://doi.org/10.1158/1055-9965.EPI-08-0508

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