Comparison of Conventional Pap Smears versus Liquid Based Cytology for Clinicopathological Patterns of Cervical Lesions at a Tertiary Care Centre, Bangalore, India

Abstract

Introduction: Conventional Pap Smear (CPS) technique has been the mainstay for early detection of cervical cancer. However, its extensive use has not been possible due to the limitations, like presence of obscuring blood and inflammation, reducing its sensitivity markedly. False negativity of CPS is also very high so Liquid Based Cytology (LBC) was introduced. Aim: To compare cytomorphological patterns, diagnostic utility and adequacy of smears of cervical lesions on CPS and LBC. Materials and Methods: This study was a Prospective descriptive study, conducted in Department of Pathology of Dr. B R Ambedkar Medical College and Hospital, Bangalore for 19 months during November 2018 to May 2020 on 250 cases. The samples were taken with cervix-brush. First, a CPS was prepared and was immediately alcohol-fixed. After that same brush head was rinsed in LBC vial containing methanol. Statistical analysis was done using Statistical Package for Social Sciences 22.0 (SPSS) and R environment 3.2.2 for data analysis. Results: Most of the patients were in the fourth decade of life and 160 cases (64%) presented as white discharge per vaginum. Total 231 (92.4%) smears were satisfactory on CPS and 233 (93.2%) smears on LBC. The number of Low grade Squamous Intraepithelial Lesions (LSIL) increased from 4 cases (1.6%) in CPS to 6 cases (2.4%) in LBC in this study. Rate of detection of High grade Squamous Intraepithelial Lesion (HSIL) was more with LBC (11 cases, 4.4%) compared to that of CPS (7 cases, 2.8%). It was seen that in this study, sensitivity and specificity of LBC is better than CP in detecting LSIL and HSIL, but except specificity of CP was more than LBC in detecting LSIL. Present study showed overall sensitivity of 77.1% in CP and 94.3% in LBC and specificity of 97.2% and 100% in CP and LBC, respectively. The p-value calculated was <0.001 which was highly significant. Conclusion: The LBC technique showed clear background, well preserved cytomorphological details, removal of extra mucus, blood and inflammatory cell infiltrate as compared to CPS technique. Atypical cells or abnormal cells were seen better and were detected more by LBC as compared to CPS.