Comparison of conventional pap smear and liquid-based cytology in the screening of cervical cancer: A prospective comparative pilot study in a tertiary care centre of the sub-himalayan region.
DOI:
https://doi.org/10.51168/cnweq029Keywords:
Cervical cancer, Conventional PAP smear, Liquid-based cytology, Cervical screening, Cytology, Bethesda SystemAbstract
Background
Cervical cancer remains an important cause of morbidity and mortality among women, particularly in low- and middle-income countries. Liquid-based cytology (LBC) may improve specimen quality and reduce limitations associated with conventional Papanicolaou (PAP) smear cytology.
Objective
To compare conventional PAP smear cytology with LBC regarding specimen adequacy, cellular distribution, overlapping, morphological changes, background material, cytological interpretation, epithelial abnormalities, and screening time.
Materials and Methods
This prospective comparative pilot study was conducted at Dr Radha Krishnan Government Medical College, Hamirpur, Himachal Pradesh, from December 2021 to February 2023. A total of 440 women aged >19 years attending the gynaecology outpatient department with symptoms or abnormal cervical findings were included. Conventional PAP smear and LBC samples were collected from each participant during the same sitting and evaluated according to the Bethesda System.
Results
Adequate cellularity was observed in 430 (97.73%) conventional PAP smears and 439 (99.77%) LBC preparations (χ²=7.457, p=0.0112). Uniform cellular distribution was observed in 436 (99.09%) LBC preparations compared with none of the conventional smears. Cellular overlapping was significantly lower with LBC (25.45% vs. 97.27%; χ²=475.588, p<0.0001). Inflammatory and hemorrhagic backgrounds were also significantly reduced with LBC (p<0.0001). Unsatisfactory preparations occurred in 51 (11.59%) conventional smears compared with 1 (0.23%) LBC preparation. Epithelial abnormalities were detected in 23 conventional smears and 28 LBC preparations, with no significant difference (p=0.5639). Mean screening time was approximately 10 minutes for conventional PAP smears and 5 minutes for LBC.
Conclusion
LBC provided better specimen quality, cleaner background, reduced cellular overlapping, fewer unsatisfactory preparations, and shorter screening time, although morphological changes were more frequent.
Recommendation
LBC may be considered a useful alternative to conventional PAP smear cytology where laboratory resources and trained personnel are available.
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