Critical Analyses of the Introduction of Liquid-Based Cytology in a Public Health Service of the State of São Paulo, Brazil

Abstract

Objective: The aim of this study was to compare the performance of the current conventional Pap smear with liquid-based cytology (LBC) preparations. Study Design: Women routinely undergoing their cytopathological and histopathological examinations at Fundação Oncocentro de São Paulo (FOSP) were recruited for LBC. Conventional smears were analyzed from women from other areas of the State of São Paulo with similar sociodemographic characteristics. Results: A total of 218,594 cases were analyzed, consisting of 206,999 conventional smears and 11,595 LBC. Among the conventional smears, 3.0% were of unsatisfactory preparation; conversely, unsatisfactory LBC preparations accounted for 0.3%. The ASC-H (atypical squamous cells - cannot exclude high-grade squamous intraepithelial lesion) frequency did not demonstrate any differences between the two methods. In contrast, the incidence of ASC-US (atypical squamous cells of undetermined significance) was almost twice as frequent between LBC and conventional smears, at 2.9 versus 1.6%, respectively. An equal percentage of high-grade squamous intraepithelial lesions were observed for the two methods, but not for low-grade squamous intraepithelial lesions, which were more significantly observed in LBC preparations than in conventional smears (2.2 vs. 0.7%). The index of positivity was importantly enhanced from 3.0% (conventional smears) to 5.7% (LBC). Conclusions: LBC performed better than conventional smears, and we are truly confident that LBC can improve public health strategies aimed at reducing cervical lesions through prevention programs.

Atypical Squamous Cells: Cytopathological Findings and Correlation with HPV Genotype and Histopathology

“…A similar proportion was found by Fernandes et al [23] while Longatto-Filho et al [24] reported a ratio of 8 to 1. The average age of patients with ASC-US was almost 2 years below that of the ASC-H group, and this is in line with other observations [25].…”

Validation of a New Low-Cost, Methanol-Based Fixative for Cervical Cytology and Human Papillomavirus Detection

“…The majority of papers compare LBC with conventional Papanicolaou smear [2, 4, 14]. There are few studies comparing different methods of LBC.…”

“…While Siebers et al [1] showed that there is no difference between the 2 methods, others describe better sensitivity and specificity of LBC [2-4]. …”

Autocoleta cervicovaginal no rastreamento do câncer do colo do útero: aceitabilidade, detecção de Papilomavírus Humano de alto risco oncogênico e pesquisa de biomarcadores

“…reduzindo a proporção de amostras insatisfatórias através da redução de elementos que dificultam o diagnóstico86 . Outro estudo, também, refere que proporção de casos insatisfatórios foi muito mais elevada em amostras convencionais do que na LBC87 . Ainda, o índice de positividade, praticamente, dobrou ao comparar os dois métodos citológicos (3% -Pap; 5,7% -LBC).…”

“…No entanto, muitos destes países sugerem o rastreamento primário com teste para detecção de HrHPV, e a citologia, por sua maior especificidade, aplicada nas amostras com DNA de HPV positivas. Neste sentido, a LBC, além de apresentar a evolução técnica da citologia convencional, oferece um único meio de coleta que preserva os ácidos nucleicos para realização do teste para detecção do DNA do HPV e outros testes87 .O nosso estudo foi desenhado de forma sistematizada e pareada com dois grupos distintos. Uma alternativa seria colher duas amostras da mesma participante (AC e PS), no mesmo dia, mas um viés negativo na precisão da segunda amostra não poderia ser descartado, pois a amostra cervical, habitualmente, pode causar pequenos danos ao tecido cervical e consequente sangramento, além da diminuição celular que poderia ocorrer na segunda coleta205 .…”