Abstract
Abnormal uterine bleeding (AUB) is a commonly encountered complaint in gynecology department. Endometrial cancer is the fourth most common malignancy in women and the most frequent gynecological cancer in developed countries. With 5,28, 000 new cases every year, cervical cancer is the fourth most common cancer affecting women worldwide, after breast, colorectal, and lung cancers. Though the cytological examination has been the mainstay for early detection of cervical cancer, and found to be useful in detection of endometrial cancer, its widespread use has not been possible in the developing countries due to paucity of resources, man power and other facilities Its sensitivity reduces to less than 50% when there is presence of obscuring blood, inflammation or thick areas of overlapping epithelial cells. Manual Liquid Based Cytology (MLBC) is a cost effective technique that enables cells to be suspended in a monolayer and thus improve detection of precursor lesions and specimen adequacy. The residual sample can be used for other tests like Cell block and immunocytochemistry. <b>Objectives </b>: 1. To improve the diagnosis of gynecological cancers by a method called as Manual Liquid Based Cytology (MLBC). 2. To study a cost effective method of studying both endometrial and cervical cancer with help of ancillary techniques like cellblock, immunocytochemistry 3To compare the findings between conventional pap smear (CPS) and MLBC in detection of gynecological conditions of endometrium and cervix. <b>Methodology </b>: Samples were collected using Ayres spatula by split sample technique from transformation zone of cervix which included outpatients of gynecology dept. The women were aged between 20-60 years, 82 cases with bleeding history were taken to study endometrial pathology, while 100 cases of white discharge per vagina were selected to study the cervix. 60 cases were later subjected to ancillary studies like cellblock with Immunocytochemistry. Histopathological correlation was done for cases wherever possible. <b>Results </b>: The study on endometruim showed MLBC is more sensitive and specific than CPS in diagnosis of malignant lesions. The contingency coefficient for LBC/Histopathology V/s CPS/Histopathology was 0.572 V/s 0.556. It was observed for cervical lesion that increased detection rate was 150% for low grade intraepithelial lesion. The Positive predictive value for diagnosing neoplastic lesions on cell blocks was 75%, while Concordance Rate of CB/HistopathologyVs CPS/Histopathology was 74% vs. 54%. <b>Conclusion </b>: MLBC is a cost effective method for detections of cancerous lesions of endometruim and cervix.
Highlights
Endometrial carcinoma (EC) is the commonest malignancy of the female genital tract in the USA and Europe, accounting for nearly 50% of all new diagnoses of gynecological cancer [1, 2, 3]
As Manual Liquid Based Cytology (MLBC) can be used for ancillary studies like cell block study, immunocytochemistry and HPV testing, one of the ancillary techniques which we studied is cell blocks prepared from residual tissue fluids and fine-needle aspirations which can be useful adjuncts to smears for establishing a more definitive cytopathologic diagnosis. [19, 20]
82 cervical smears prepared by conventional pap and MLBC were studied, out of which 52 cases (63.4%) were reported with the presence of endometrial cells, Among the 52 cases 38 cases were identified as benign endometrial cells and 14 cases as atypical/ malignant endometrial cells
Summary
Endometrial carcinoma (EC) is the commonest malignancy of the female genital tract in the USA and Europe, accounting for nearly 50% of all new diagnoses of gynecological cancer [1, 2, 3]. Manoli et al.: Manual Liquid Based Cytology in Diagnosis of Gynecologic Pathology polycystic ovarian syndrome (PCOS), a history of infertility, alcohol abuse and antidepressant agents [8, 9, 10, 11]. Many of these factors are tightly linked to current lifestyles in developed countries. A small but significant percentage (about 2-3%) of EC is attributable to Lynch syndrome, a hereditary cancer predisposition syndrome which significantly increases the risk of colorectal, endometrial and other cancers. [1, 2] Fig-1
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