Manual Liquid Based Cytology in Primary Screening for Cervical Cancer - a Cost Effective Preposition for Scarce Resource Settings

Conventional pap smear (CPS) examination has been the mainstay for early detection of cervical cancer.However, its widespread use has not been possible due to the inherent limitations, like presence of obscuring bloodand inflammation, reducing its sensitivity considerably. Automated methods in use in developed countries maynot be affordable in the developing countries due to paucity of resources. On the other hand, manual liquid basedcytology (MLBC) is a technique that is cost effective and improves detection of precursor lesions and specimenadequacy. Therefore the aim of the study was to compare the utility of MLBC with that of CPS in cervical cancerscreening. A prospective study of 100 cases through MLBC and CPS was conducted from October 2009 to July2010, in a Medical College in India, by two independent pathologists and correlated with histopathology (22cases). Morphological features as seen through MLBC and CPS were compared. Subsequently, all the cases weregrouped based on cytological diagnosis according to two methods into 10 groups and a subjective comparison wasmade. In order to compare the validity of MLBC with CPS in case of major diagnoses, sensitivity and specificityof the two methods were estimated considering histological examination as the gold standard. Increased detectionrate with MLBC was 150%. The concordance rate by LBC/histopathology v/s CPS/histopathology was alsoimproved (86% vs 77%) The percentage agreement by the two methods was 68%. MLBC was more sensitive indiagnosis of LSIL and more specific in the diagnosis of inflammation. Thus, MLBC was found to be better thanCPS in diagnosis of precursor lesions. It provided better morphology with increased detection of abnormalitiesand preservation of specimen for cell block and ancillary studies like immunocytochemistry and HPV detection.Therefore, it can be used as alternative strategy for cervical cancer prevention in limited resource settings