Applicability of On-Site Evaluation of Cervical Cytology Smears Stained with Toluidine Blue to Reduce Unsatisfactory Results

Abstract

<b><i>Introduction:</i></b> Carcinoma of the uterine cervix is a major health problem faced by Indian women. Screening techniques like visual inspection with acetic acid, Lugol’s iodine, Papanicolaou smear, and human papillomavirus DNA testing have been suggested. Pap smear is a simple, safe, cost-effective, and reliable technique used for screening cervical lesions. Rapid on-site evaluation (ROSE) using the 1% aq. toluidine blue staining method has been less studied in cervical cytology. <b><i>Materials and Methods:</i></b> Our study was a prospective study done over a period of 2 years. All the cervical cytology smears were reported as per the Bethesda system 2014. Rapid stain using aqueous toluidine blue (1%) and conventional Pap stain was done on the smears received. <b><i>Results:</i></b> We evaluated a total of 1,300 cases, with 97.6% satisfactory samples. The spectrum of cases included 96.3% of negative for malignancy cases (including bacterial vaginosis, trichomonas, candida, and atrophic smears), atypical squamous cell of undetermined significance and atypical squamous cells cannot exclude high-grade squamous intraepithelial lesion in 0.5% cases, low-grade squamous intraepithelial lesion and high-grade intraepithelial lesion in 0.3% cases, squamous cell carcinoma in 0.3% cases, and atypical glandular cells/adenocarcinoma in 0.2% cases. Turnaround time was within 48 h in 77% cases. With rapid stain, our unsatisfactory rate was reduced from 12% to approx. 2.4%. <b><i>Conclusion:</i></b> ROSE has been attempted on routine FNA cytology samples with success. However, the use of ROSE in cervical cytology has not been attempted to date. Lower unsatisfactory rate is an important indicator for the successful implementation of cervical cancer screening technique.

Spectrum of cervicovaginal Pap smears in newly established tertiary care medical institute

“…[ 10 ] The NILM is the most common category reported in cervicovaginal Pap smears ranging from 68% to 96.31%. [ 5 - 7 , 9 ] In accordance with the results of earlier studies, we also found NILM in 86.87% of the cases (the most common interpretation category). However, it conflicts with the findings of Baamer et al ., who found that ASC-US (26.1%) was the most frequent interpretation category, and NILM was seen in only 8.9% of their cases.…”

“…observed most common age group of screening patients was 31– 40 years, followed by 41–50 years. [ 7 ] Sharif YH and Baamer et al . observed that mean age of the study population was 31.55 ± 6.66 years (ranging from 21 to 60 years) and 45.12 ± 6.66 years (ranging from 21 to 75 years), respectively.…”

“…The unsatisfactory smears ranged from 1% to 12.1% in the previous studies. [ 5 , 7 , 11 ] Tummidi et al . observed the most unsatisfactory smears in cases with only one Pap smear slide.…”

Utility of the Proposed Sydney System for Classification of Fine-Needle Aspiration Cytopathology of Lymph Node: A Retrospective Study at a Tertiary Care Center

“…Our study had a significantly lower number of L1 cases with the implementation of ROSE. The utility of ROSE has been tested and implemented in various other studies and sites [[3], [19], [20]], and we highlight the same in lymph nodes for the first time in literature.…”

“…ROSE has been implemented in routine cytopathology practice for a long in various sites, i.e., breast, soft tissue, lymph nodes, thyroid, cutaneous sites, deep-seated lesions, and very recently in gynecological smears [3,[18][19][20]. It has been proved to be an adjunct to FNAC in reducing the unsatisfactory rates in ranges from 15-47% to 4-23% depending on the site of FNA [3].…”