Comparative study of conventional papanicolaou smear and cytospin smear in cervical cancer screening.

Abstract

Background: Cervical carcinoma is the second most common malignancy in women worldwide after breast cancer, but is the most common among women in developing countries. Cytological screening leads to a reduction in the rate of invasive cancer of uterine cervix. The present study highlights the use of cytospin i.e, manual method of liquid based cytology in preparing cervical smears which is a cost effective alternative in low resource settings to improve the efficacy of Pap smears. Objectives: 1. To study the conventional Papanicolaou smears according to the Bethesda system of classification, 2014. 2. To study the cytospin Papanicolaou smears according to the Bethesda system of classification, 2014. 3. To compare efficacy of cytospin Papanicolaou smears with conventional Papanicolaou Smears in cervical cancer screening based on Bethesda system of classification, 2014. Materials and methods: A prospective study of 134 samples was carried out in the Department of Pathology, B.L.D.E.U’S Shri B M Patil Medical College, Hospital & Research Centre, Vijayapur by split smear technique for conventional Pap smear and liquid-based cytology during 1st December 2014 to 30th June 2016. Cervical cytology samples from women from 18-65 years attending the Obstetrics and gynaecology Out Patient Department weretaken by using Ayre’s spatula and one slide was prepared and immediately fixed in fixative and the residual material was rinsed in fixative then spun in cytospin to obtain direct smear. Both smears were stained by Pap stain. Results: Of the 134 cervical cytospin smears studied, 3 were unsatisfactory, 118 were non-neoplastic and 13 were neoplastic lesions. The most common neoplastic lesion was LSIL and HSIL accounting for 4 cases each followed by ASCUS, squamous cell carcinoma and adenocarcinoma. Cytospin showed significant difference in the morphological features compared to conventional. Interpretation and Conclusion: Cytospin method of manual liquid based cytology is strongly recommended in the best interest of public health as it improves the sample quality, reduces the likelihood of false negative results and better morphology. It over comes the limitation of conventional smear as it significantly reduces unsatisfactory smears, improves specimen adequacy, detects more intraepithelial lesion. It is of value as an alternative more effective screening strategy in low resource settings, like developing countries including India where women are at high risk for developing cervical cancer.