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Conventional cytology versus liquid based cytology for evaluation of cervical smears – A study of 300 cases

Rupali Bavikar, Meesha Zaheer, Archana Buch, Rajeshwari Raishankar, Rumaanah Khan, Charusheela Gore.

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Background: Over the years, different studies conducted have established the advantages of liquid based cytology(LBC) over conventional preparations(CP) in cervical smears screening. However, the high cost of machinery required for the preparations still limits its usage in low-resource countries. This study aims to evaluate the performance of a low cost LBC method, EziPREP™ technique against conventional preparations for cervical screening.
Materials and Method: This was a cross sectional study comprising of 300 consequtive cervical samples over a period of 2 year. CP smears were prepared as per the standard technique using ayre’s spatula while for LBC sample was obtained on endocervical brush followed by detaching the head of brush into the fixative vials of LBC. The LBC samples were processed as per the manufacturer's protocol. Both CP and LBC smears were stained using standard Papanicolaou stain & H&E stain protocol. Slides were analysed by two pathologists independently.
Results: The unsatisfactory rate for CP was 5%, main cause being obscuring haemorrhage and inflammation, whereas on LBC samples it was 1.4%, owing to inadequate cellular material. Uniform distribution was more in LBC smears, with minimal overlapping.
The morphological details were comparable in both sets of smears.
The pathogenic organisms, like Gardenella(31%) & Candida(20%) were detected in more CP smears, Trichomonas was seen equally in both smears(3%).
There was a 98% concordance in cytologic diagnosis between CP and LBC smears.
Screening time was notably reduced in LBC smears (3±1minutes vs 5±1 minutes for CP)
Conclusion: This low-cost LBC method holds promise in providing monolayered cervical smears with a clear background. It might carve the way for inclusion of liquid based cytology methods for cervical cancer screening on a larger scale in the low resourse countries.

Key words: Cervical cancer screening, Conventional cytology, Liquid Based Cytology, EziPREP™

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