ABSTRACT
Background: Cervical carcinoma is the fourth most common malignancy worldwide and the fourth most common cause ofdeaths due to cancer worldwide. Conventional Papanicolaou (PAP) smears were used for screening led to a drastic reductionin a number of cervical carcinoma cases, but have high false negativity. Hence, newer methods like liquid-based cytology(LBC) were introduced.Aim: The aim of the study was to compare LBC with conventional PAP smear for cervical cancer screening.Materials and Methods: This study was done on randomly selected 100 patients attending the pilot screening project at atertiary care teaching institute in South India. The sample for conventional PAP smear was taken using Ayre’s spatula andslide prepared. The sample for LBC was taken using the cytobrush, and the sample was rinsed in the fixative provided by themanufacturer. The sample was then centrifuged and slide prepared. Both the slides were then stained using the rapid PAPstain. The slides were analyzed and the following results were obtained.Results: Most of the patients who attended the screening program were in the fourth decade of life. Dysplasia was diagnosedin 26% of cases and most were in the age group of 21–40 years. Most of the cases were in the socioeconomic Class II of themodified Prasad’s classification. Dysplasia was found more in the socioeconomic Class III (12% of cases). 90% of cases startedsexual activity before 25 years of age, and out of these 90 patients, 92.3% had dysplasia. Dysplasia was more in patients withparity 3(14% of cases). 46% of cases presented with white discharge per vaginum. The cytological abnormality was found in28 cases (28%) by LBC, whereas conventional Pap smear detected an abnormality in only 22 cases (22%). 96 cases (96%)were satisfactory for evaluation on LBC and 92 cases (92%) in conventional Pap smear. ASC was found in 12% of cases inconventional PAP whereas it was detected in only 6% of cases in LBC. Low-grade squamous intraepithelial lesion (LSIL) andhigh-grade squamous intraepithelial lesion (HSIL) were found in 8% and 2% of cases in conventional PAP smear whereas itwas found in 12% and 8% of cases in LBC. No carcinoma was found in conventional PAP smear whereas 2% of cases hadcarcinoma features in LBC. Sensitivity and specificity of PAP smear in detecting LSIL was 40% and 93% whereas for HSILit is 50% and 100%. Sensitivity and specificity of LBC in detecting LSIL is 66% and 94% whereas for HSIL it was 100% and96%. Overall sensitivity and specificity for conventional PAP smear is 55.5% and 83.7% whereas for LBC it is 83% and 86.5%,respectively. There was a medium level of correlation between conventional PAP smear and LBC (r = 0.59).Conclusion: LBC is strongly advocated in the best interest of public health especially in countries like India where more numberof people are in the lower socioeconomic status category. It improves the sample quality and reduces the likelihood of falsenegative results and hence improving the efficacy of the screening programs.
ABSTRACT
OBJECTIVE: The conventional Papanicolaou smear seems to be more accurate for detecting a high-grade squamous intraepithelial lesion (HSIL) than a low-grade squamous intraepithelial lesion (LSIL). The purpose of this study was to investigate false-negative results of conventional Pap smear cytology in women with cervical conization. METHODS: This study was performed in Gynecologic Oncology Clinic of the Department of Obstetrics and Gynecology at Dankook University Medical Center from July 1, 1994 to December 31, 2004. 260 women from age 22 to 75 years had undergone conventional Papanicolaou cervical cytologic test and cervical conization. Conization was performed using ncold-knife cone' method or nlarge electrosurgical excision procedure (LEEP) cone' method. The cervical cytology were studied in comparison with histology of conization specimens. RESULTS: Of the 260 histologic diagnoses, there were 41 (15.8%) diagnoses of chronic cervicitis, 8 (3.1%) of CIN 1, 18 (6.9%) of CIN 2, 150 (57.7%) of CIN 3, 38 (14.6%) of SCC, 2 (0.8%) of AIS, 1 (0.4%) of ACC, and 2 (0.8%) of ASC. Pap cytology showed sensitivity of 97.9-98.2%, specificity of 4.9-6.7%, and false-negative rate of 1.8-2.2% according to the variables. CONCLUSION: Significantly false-negative rate of Pap cytology in women with conization was very low. And so, conventional Pap cytology is still clinically efficient for screening high-grade cervical lesions with adequate sampling technique.