Liquid-based cervical cytology

Klinkhamer, Paul J. J. M.; Meerding, Willem Jan; Rosier, Peter; Hanselaar, A. G. J. M.

doi:10.1002/cncr.11673

Cited by 95 publications

(57 citation statements)

References 36 publications

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“…Earlier publications found an increased detection rate of HSIL as summarized in several reviews. [5][6][7] More recently, some HTAs and systematic reviews 8,11,12 using stringent criteria did not show superiority of LBC over CC. Additionally, two recent large randomized studies, which were situated within organized screening programs did not observe a higher relative sensitivity of LBC for histologically confirmed CIN compared with CC.…”

Section: Discussionmentioning

confidence: 99%

“…Despite numerous scientific studies, the debate on the superiority of LBC over CC is still ongoing. [5][6][7] Health technology assessments (HTA) and meta-analysis reviews as well as two recent, large randomized trials which were conducted in the context of organized screening programs did not find a higher sensitivity of LBC for the detection of cervical intraepithelial neoplasia grade 2 and higher (CIN2þ). [8][9][10][11][12] LBC has advantages such as faster reading of slides, fewer unsatisfactory specimens, and the possibility to use residual liquid sample for testing of Human Papillomavirus (HPV) and other molecular markers.…”

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confidence: 99%

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A randomized trial comparing conventional cytology to liquid‐based cytology and computer assistance

Klug

Neis

Harlfinger³

et al. 2012

Intl Journal of Cancer

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Liquid-based cytology (LBC) has replaced conventional cytology (CC) for cervical cancer screening in some countries. However, it remains unclear whether LBC is superior to CC. A randomized controlled trial was conducted between August 2007 and March 2009 in Germany to compare LBC, alone and in combination with computer-assisted imaging technology (CAS), to CC in the detection of histologically confirmed cervical intraepithelial neoplasia (CIN). The main outcome measures were detection rates, relative sensitivities, positive predictive values (PPVs) and relative PPVs comparing LBC without and with CAS to CC. Primary histological outcome was CIN2 or higher. Included were 20,627 women participating in opportunistic cervical cancer screening at 20 gynecologic practices. The practices were randomized weekly to use LBC (n 5 11,331) or CC (n 5 9,296). Patients with positive findings were invited to expert colposcopy. The relative sensitivity of LBC versus CC using the CIN21 cut-off was 2.74 (95% confidence interval [CI] 1.66-4.53). The relative sensitivity of LBC/CAS versus CC for CIN21 was 3.17 (95% CI 1. 94-5.19). The PPV of LBC and CC for CIN21 was 48% and 38%, respectively. The PPV ratio did not differ significantly from unity. Differences between LBC and CC were smaller in some sensitivity and subgroup analyses; however, relative sensitivity of LBC remained increased. LBC without and with CAS compared with CC under the field conditions of an opportunistic screening system had a significantly higher sensitivity for the detection of CIN without deterioration of PPVs. Additional use of CAS did not further improve sensitivity of LBC. V C 2012 Wiley Periodicals, Inc.Key words: randomized controlled trial, early detection of cancer, uterine cervical neoplasm, Papanicolaou smear, liquid-based cytology, computer-assisted imaging technology Additional Supporting Information may be found in the online version of this article. Stefanie J. Klug, Jochem K€ onig and Hans Ikenberg had full access to all the data of the study. They take responsibility for the integrity of the data and the accuracy of the data analysis. Hans Ikenberg, Stefanie J. Klug, Klaus J. Neis and Werner Harlfinger take responsibility for the study concept and design. Werner Harlfinger and Klaus J. Neis take responsibility for the acquisition of data. Stefanie J. Klug, Jochem K€ onig, Veronika Weyer and Hans Ikenberg take responsibility for the analysis and interpretation of data. Stefanie J. Klug and Hans Ikenberg take responsibility for the drafting of the manuscript. All are responsible for the critical revision of the manuscript for important intellectual content. Jochem K€ onig, Veronika Weyer and Stefanie J. Klug did the statistical analysis. Werner Harlfinger, Klaus J. Neis, Armin Malter and Hans Ikenberg obtained funding. Sibylle Spieth, Friederike Brinkmann-Smetanay and Friedrich Kommoss had the administrative, technical or material support. Study supervision is by Hans Ikenberg, Werner Harlfinger, Klaus J. Neis and Stefanie J. Klug. Stefanie J. Klu...

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

A randomized trial comparing conventional cytology to liquid‐based cytology and computer assistance

Klug

Neis

Harlfinger³

et al. 2012

Intl Journal of Cancer

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“…Indeed, in a 2001 review of new cervical cytology methods for the U.S. Preventive Services Task Force and the Agency for Healthcare Research and Quality, none of the 962 potentially relevant articles met the predefined inclusion criteria. 25 The overwhelming reason for exclusion in this review and several other recent reviews [22][23][24] was the lack of an adequate reference standard such as colposcopy/histology. For example, in lieu of colposcopy/histology, LBC comparison studies often use what is known as the ''expert panel'' review of selected cytology specimens and, instead of relating test findings to the true disease status of the cervix, compare abnormal rates (e.g., the proportion with LSIL or higher) as a proxy to comparisons of test sensitivity.…”

Section: Discussionmentioning

confidence: 99%

Direct comparison of liquid‐based and conventional cytology in a South African screening trial

Taylor

Kuhn

Dupree

et al. 2005

Intl Journal of Cancer

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Our study directly compares the performance of liquid-based (LBC) and conventional cytology for detecting high-grade cervical intraepithelial neoplasia and cancer (CIN 21) in high-risk, previously unscreened women. As part of a larger randomized clinical trial assessing the efficacy and safety of a ''screen and treat'' program for cervical cancer prevention, 5,652 South African women, aged 35 to 65 years, were screened using either ThinPrep or conventional Papanicolaou cytology. The cytology method used (i.e., ThinPrep or conventional) was rotated on a 6-month basis for the duration of the study. Directly following collection of the cytology specimen, all women underwent colposcopy with endocervical curettage and biopsy of all colposcopic abnormalities. Assessment of cytology and histology results was blinded and results were compared using histology-confirmed CIN as the ''gold standard.'' The accuracy of LBC and conventional cytology was statistically equivalent, although the sensitivity of conventional cytology was at least 5 percentage points higher at all cutoff levels. For example, at a cytology cutoff level of low-grade squamous intraepithelial lesion, the sensitivity of LBC was 60.3% for CIN21 vs. 69.1% for conventional cytology and specificity was 94.1% and 94.5%, respectively. LBC specimens were significantly less likely to be ''satisfactory-but-limited-by'' (6.5% vs. 27.9%) but significantly more likely to be unsatisfactory (2.2% vs. 0.8%). Thus, in this high-risk population, the sensitivity of LBC is no greater than the sensitivity of conventional cytology. Because of the higher unit cost of LBC, low resource settings should carefully consider the potential benefits and drawbacks of LBC before adopting this new technology. ' 2005 Wiley-Liss, Inc.Key words: cervical cytology; papanicolaou (Pap) smear; liquidbased cytology; cervical intraepithelial neoplasia Conventional cytology, i.e., the Papanicolaou smear, has been the mainstay of cervical cancer screening since the 1960s and is credited with successfully reducing the incidence and mortality of invasive cervical cancer in many developed countries. 1,2 Nonetheless, the accuracy of this important screening tool remains controversial, with several large meta-analyses suggesting that both the sensitivity and specificity of cervical cytology is relatively low (30% to 87% sensitivity, 86% to 100% specificity). [3][4][5] As an alternative to conventional cytology, liquid based-cytology (LBC) was introduced in the mid-1990s. The purported advantages of LBC include a possible increase in the detection of high-grade cervical intraepithelial neoplasia (CIN 2,3 ), a reduction in the number of unsatisfactory and ''satisfactory-but-limited-by'' specimens, and providing residual cellular material for subsequent molecular testing (e.g., testing for ''high-risk'' types of HPV DNA). On the other hand, the unit cost of LBC methods is substantially more than that of conventional cytology. The substantial increase in unit cost is of particular concern in less-developed...

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“…5,6 High quality cervical screening can contribute to a reduction in the incidence and mortality of cervical cancer. 19 The results of this study suggests that HPV 16, 18 DNA test is less sensitive than Pap smear in early detection of pre-invasive disease of the cervix, and the cytology is primary to HPV DNA as a screening method.…”

Section: Discussionmentioning

confidence: 78%

The use of HPV-DNA testing combined with Pap smear in detection of pre-invasive disease of the cervix

Nwesar¹,

Salam²,

Hanafi³

et al. 2017

Int J Reprod Contracept Obstet Gynecol

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Background: Cancer cervix constitutes a major health problem worldwide. It is one of the most common female malignancy in both incidence and mortality. Cancer cervix has many risk factors, the most important one is persistent infection with one of HPV high risk types. Its morbidity and mortality can be reduced by frequent screening and early diagnosis. So that, several studies have been conducted in recent years in order to find better tests for screening for pre-invasive disease of the cervix and so early intervention and better prognosis. This study aimed to compare the sensitivity of Pap test and HPV DNA test as screening tests for pre-invasive disease of the cervix.Methods: 100 females from those attending Alexandria University gynaecologic clinic for causes rather than cancer cervix were subjected to Pap smear and cervical swab for HPV-DNA testing at the same setting. Cases of HSIL or positive HPV were subjected to VIA test, colposcopy and cervical punch biopsy was taken if aceto-whitening of the cervix or any other abnormality was found. Cases with ASCUS or LSIL were re-smeared after 3-6 months, if persistent or progressive pathology, colposcopy and punch biopsy from acetowhite areas were taken.Results: 21 cases (21%) were HPV positive and 66 cases (66%) were positive for intraepithelial lesions (37% ASCUS, 18% LSIL and 11% HSIL) with re-smearing there were 3 persistent ASCUS cases (8.1%) and 5 LSIL cases (27.78%). Colposcopy done, and biopsies were taken from 10 HSIL cases (90.1%), 5 LSIL (27.8%), 3 ASCUS (8.1%) and 10 HPV positive cases (62.5%). With significant relationship between colposcopic findings and HPV-DNA positivity and abnormal cytology. Biopsies were 18; 14 were CIN I and 4 were CIN II.Conclusions: HPV-DNA positivity has positive association with HSIL. Pap smear is an easy cheap method for screening. HPV-DNA test is less sensitive than cytology as a method for screening.

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Liquid-based cervical cytology

Cited by 95 publications

References 36 publications

A randomized trial comparing conventional cytology to liquid‐based cytology and computer assistance

A randomized trial comparing conventional cytology to liquid‐based cytology and computer assistance

Direct comparison of liquid‐based and conventional cytology in a South African screening trial

The use of HPV-DNA testing combined with Pap smear in detection of pre-invasive disease of the cervix

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