Pap test in a high‐risk population comparison of conventional and liquid‐base cytology

Abstract

Liquid-based cytology (LBC) is believed to have better sensitivity than conventional smears (CSs) and offers the possibility to perform molecular assay. The goal of this work was to study the performance of CS and LBC in a high-risk population and to compare the results with the hybrid capture (HC) II for high-risk human papillomavirus (HPV). Samples were collected from selected women with clinical suspicions of low genital tract lesion at Pérola Biygnton Hospital (São Paulo, Brazil). After CS preparation, the brush was introduced in the endocervix and a new sample was collected and rinsed in the preservative medium of the system. The residual material was used to HC2. From 925 cases, LBC was unsatisfactory in 4 (1.51%) cases and CS was unsatisfactory in 100 cases (10.81%); among theses cases HC2(+) reactions was observed in 54 (54%) CSs and 3 (21.4%) LBCs. Considering cases with atypia of undetermined significance (squamous and glandular), 85 (77.27%) cases from LBC and 44 (86.4%) from CS were positive for HC2 assay for high-risk DNA-HPV. The difference among the methods was not significant (P < 0.38). The diagnosis improvement of LBC in comparison with CS was 86% in satisfactory samples, 92.76% in undetermined atypical lesions (including glandular), 83% in positive low-grade squamous intraepithelial lesions (LSIL(+)), and 86.84% in high-grade SIL(+) (HSIL(+)). HC2(+) reactions were observed in 144 CS cases and 266 LBC cases with abnormalities. Our results have showed that LBC was superior to CS in a high-risk population to detect lesions with high concordance with HC2(+) reactions; CSs also exhibit a high concordance with HC2 assay but with inferior performance to detect lesions.

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“…By comparison with published results our LBC efficiency performed by cytocentrifugation seems better than CS. A sensitivity of 68% and the specificity of 79% has been indeed reported for the CS and similarly a sensitivity of 76% and a specificity of 86% was reported by others for the Thinprep ® [23-26]. Recently, a sensitivity and a specificity quite similar to ours was also reported for the manual LBC of Digene, respectively 75.3% and 86.4% [27].…”

Risk factors of cervical cancer after a negative cytological diagnosis in Polish cervical cancer screening programme

“…However, our analyses on a very representative population‐based material confirm higher risk of potential false negative reports of cytology when microorganisms occur in Pap smears and suggest reconsidering adequate form of triage for women with these results. Published studies point out lower rate of unsatisfactory for evaluation slides in the case of liquid‐based cytology use and more accurate result, 30–32 however, this type of screening test was not available in Poland these days and still over 99% of screening tests are conventional smears. In 2019, we have initiated a randomised health services study comparing current standard of conventional Pap to a hr‐HPV‐DNA test with reflex LBC which should lead to implementation of hr‐HPV‐DNA‐based screening in Poland.…”

Comparison of Specimen Adequacy and Smear Quality in Conventional and Liquid-Based Pap Tests

“…Liquid-Based Cytology has become a common screening test for cervical cancer in the unitedstates and also, this method was used in nearly 75% of Pap tests in 2006 and 2007 (6). Sensitivity in diagnosis and the ability to perform molecular assays with the LBC method are its advantages over CC, while it is also superior to CC for detection of lesion in high-risk patients (7). Also, LBC shows a complete elimination of most causes of unsatisfactory samples (8).…”