Liquid-Based Cytology Compared to Conventional Cytology for Diagnosis of Cervical Intraepithelial Neoplasia: A Single-Center Experience

Abstract

Introduction: Cervical carcinoma is the fourth most common gynecologic cancer. Screening assays that include the conventional cytology (CC) have a sensitivity and specificity far from optimal; however, liquid-based cytology (LBC) may overcome some limitations. The objective is to compare the screening accuracy of LBC and CC in individuals suspected of having precancerous lesions. Introduction Cervical carcinoma is a widely spread public health problem, representing the fourth most common gynecologic cancer. Notably, 85% of the global burden occurs in less developed regions of the world, where it is estimated to be 12% of all cancers diagnosed in women [1]. In Mexico, between the years of 1989 and 2004, the mortality rate for cervical carcinoma was reduced to 2.94 per 100,000 women by the strengthening of screening programs for precancerous cervical lesions and a lower birth rate [2]. Since 2011, cervical cancer is the second cause of cancer-related mortality among Mexican women accounting for 10.4% of deaths in women with cancer. In contrast, in developed countries the mortality rate associated to cervical cancer has decreased by 70-80% in the last Materials and Methods: A prospective, single center study, recruited individuals from a tertiary-level center. In all participants, CC and LBC were performed. Clinical, cytologic and histopathologic results were collected. Bethesda System was used and agreement of two of three cytopathologists was necessary to assign a positive or negative result. Cervical biopsy was performed in participants with abnormal findings. Results: Two-hundred participants were included, CC and LBC were negative for intraepithelial lesion or malignancy, 66 and 56 cases (62.86% vs 53.33%, p=0.162) respectively. Cytologic results were confirmed by cervical biopsy, were 13/17 (76.47%) were both negative in CC and LBC. Both cytology tests found 7/23 (30.43%) cases with high-grade squamous intraepithelial lesions. CP and LBC identified 4/7 (57.14%) carcinomas. Sensitivity and specificity for LBC and CP were (40% and 76%) and (51% and 77%), respectively. The area under the curve for the LBC was 0.58 (CI95%, 0.47-0.69) and CC was 0.64 (CI95%, 0.52-0.75), with no significant difference (p=0.24). Conclusion: Considering no statistically differences in the results and the outlay of LBC, implementation of LBC should be used for molecular-based detection and genotyping when human papillomavirus may offer additional benefits when screening for cervical carcinoma.