Personal view. Is it reality or an illusion that liquid‐based cytology is better than conventional cervical smears?

Herbert, Amanda; Johnson, Joanna

doi:10.1046/j.1365-2303.2001.00375.x

Cited by 24 publications

(21 citation statements)

References 17 publications

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“…Since the smear-taker was not responsible for slide preparation or fixation, slides were unlikely to be assessed as inadequate, equivocal or borderline because of poor fixation. 19 The inadequate rate in this study (5%) was high compared to most other reports. The majority (65%) were due to bleeding, with the rest being either hypocellular or acellular.…”

Section: Cytologycontrasting

confidence: 59%

Cervical screening by visual inspection, HPV testing, liquid‐based and conventional cytology in Amazonian Peru

Almonte

Ferreccio

Winkler

et al. 2007

Intl Journal of Cancer

109

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Cervical cancer is an important public health problem in many developing countries, where cytology screening has been ineffective. We compared four tests to identify the most appropriate for screening in countries with limited resources. Nineteen midwives screened 5,435 women with visual inspection (VIA) and collected cervical samples for HPV testing, liquid-based cytology (LBC) and conventional cytology (CC). If VIA was positive, a doctor performed magnified VIA. CC was read locally, LBC was read in Lima and HPV testing was done in London. Women with a positive screening test were offered colposcopy or cryotherapy (with biopsy). Inadequacy rates were 5% and 11% for LBC and CC respectively, and less than 0.1% for VIA and HPV. One thousand eight hundred eightyone women (84% of 2,236) accepted colposcopy/cryotherapy: 79 had carcinoma in situ or cancer (CIS1), 27 had severe-and 42 moderate-dysplasia on histology. We estimated a further 6.5 cases of CIS1 in women without a biopsy. Sensitivity for CIS1 (specificity for less than moderate dysplasia) was 41.2% (76.7%) for VIA, 95.8% (89.3%) for HPV, 80.3% (83.7%) for LBC, and 42.5% (98.7%) for CC. Sensitivities for moderate dysplasia or worse were better for VIA (54.9%) and less favourable for HPV and cytology. In this setting, VIA and CC missed the majority of high-grade disease. Overall, HPV testing performed best. VIA gives immediate results, but will require investment in regular training and supervision. Further work is needed to determine whether screened-positive women should all be treated or triaged with a more specific test. ' 2007 Wiley-Liss, Inc.Key words: Pap smear; hybrid capture; low-resource settings; clinical trial; screening Cervical cancer is the commonest female cancer, a major cause of death and an important public health problem in many developing countries. 1 Screening by routine cytology, using Papanicolaou stain (Pap), has had a major impact on cervical cancer rates in many developed countries, but not in any developing country despite its widespread use. 2-4 A number of other cervical screening tests have been proposed. Here, we wanted to identify the most appropriate test for use in developing countries with high rates of cervical cancer and limited resources.In Peru, as in most Latin American countries, cervical cancer is usually detected in an advanced incurable stage, despite widespread use of cytology screening. 5,6 Others have documented numerous problems of screening in Peru. Samples may be poorly collected, slides may be incorrectly labelled and some never reach the laboratory. Cytology results are sometimes wrongly transcribed or are not reported. 6 Cytology laboratories suffer from deficient infrastructure, inadequate training and supervision, staff shortages, lack of followup procedures and lack of internal and external quality control leading to suboptimal reading of cytology for which considerable expertise is required. This study was set up to investigate a variety of screening tests that may be more effective in such a setting.L...

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Section: Cytologycontrasting

confidence: 59%

Cervical screening by visual inspection, HPV testing, liquid‐based and conventional cytology in Amazonian Peru

Almonte

Ferreccio

Winkler

et al. 2007

Intl Journal of Cancer

109

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“…There are some concerns that liquid based cytology might falsely label inadequate smears as negative, and such an adverse effect would take several years to become evident in a programme with a three to five year screening interval. 12 Health technology assessment reports from New Zealand and Australia also concluded that the introduction of liquid based cytology was not justified by current evidence. 14 15 Thus, the problem of "inadequate cervical smear" will probably stay with us for some time, and it is important to understanding fully its clinical and prognostic significance.…”

Section: Discussionmentioning

confidence: 99%

“…11 This may be a result of the different criteria used by the NHSCSP, and may also reflect the longer screening interval in the UK. 12 The NHSCSP recognises inadequate smears as a major problem, being one of the main reasons for piloting liquid based cytology for primary screening in England and Wales. The clinical and prognostic significance of inadequate cervical smears is uncertain, and the NHSCSP guidance requiring women with repeated inadequate cervical smears to be referred for colposcopy has been questioned.…”

Section: Discussionmentioning

confidence: 99%

Outcome of women with inadequate cervical smears followed up for five years

Hock

Ramaiah²,

Wall³

et al. 2003

Journal of Clinical Pathology

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Background:The clinical and prognostic significance of "inadequate" cervical smear is unknown, even though women with repeated inadequate smears are referred for colposcopy in the National Health Service (NHS) Cervical Screening Programme. Aim: To follow up a cohort of women with inadequate cervical smears over the following five years to examine outcomes, including detection of high grade cervical intraepithelial neoplasia (CIN). Methods: The study comprised 1972 women with an inadequate cervical smear reported at Walsall Hospitals NHS Trust between 1 April 1995 and 31 March 1996. Results of cervical smears and biopsies taken over the following five years were reviewed to confirm the outcome. Findings: Within five years, 2.2% of women with an inadequate cervical smear developed histologically confirmed high grade CIN, which was higher than the 1.3% seen among all women with cervical smear tests reported at the same laboratory over the same period, although the difference was not significant at the 95% level of confidence. Where inadequacy resulted from or was contributed to by "polymorphs obscuring", the risk of subsequent development/detection of high grade CIN was 2.6%. Conclusions: Women with inadequate cervical smears had an increased risk of detection of high grade CIN in the following five years compared with "all women". This increased risk was not significant, although if a larger number of women had been studied significance may have been reached, so that further studies are needed. The increased risk appeared to be at least partially dependent on the reason for inadequacy.

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“…[22] To our knowledge, this is the first reported case of a primary thyroid carcinoma confirmed by LBC. Although cervical smear using LBC preparation has been described, [23] the role of LBC in thyroid aspiration cytology has yet to be explored. We expect the clinical application of LBC in thyroid fine needle aspiration cytology to help in establishing correct preoperative diagnoses.…”

Section: Bodymentioning

confidence: 99%