Modern Approach to Cervical Cancer Screening Program – Georgian Experience

Abstract

1. Abstract 1.1.Objective:The study aimed to pilot the modern approach to cervical cancer screening program, which means the application of liquid based cytology and chromogenic in situ hybridization(CISH) for human papillomavirus (HPV) genotyping on atypical cervical smears. 1.2.Materials and Methods:1293 cervical cytology samples have been analyzed in country of Georgia. The samples had been collected and processed by the usage of materials and equipment provided by Hologic. Prepared smears were post-fixed in 96% ethanol and stained accordingly with Papanicolau protocol. The Bethesda 2001 system terminology was employed for reporting and diagnoses of cervical smears. Patients with diagnosed atypia were recalled for obtaining of material for HPV genotyping. This has been performed by usage of CISH method. 1.3.Results:The negative for intraepithelial lesion or malignancy (NILM) category was equal to 1156 cases (89.40%). Other categories in decreasing order were atypical squamous cells of undetermined significance (ASCUS) with 104 cases (8.04%), low grade squamous intraepithelial lesion (L-SIL) with 8 cases (0.62%), high grade squamous intraepithelial lesion (H-SIL) with 1 cases (0.08%), atypical squamous cells, cannot exclude high grade intraepithelial lesion (ASC-H) with 21 case (1.63%) and atypical glandular cells of undetermined significance (AGUS) with 3 case (0.23%). Cellularity was lower in liquid based cytology (LBC) as compared with conventional smears (CS). Also, nuclear overlap was significantly less observed compared to CS. The smear background was notably cleaner and cell morphology was better evaluated in LBC. In terms of Trichomonas and Candida detection, LBC was superior compared to CS. Doderlein lactobacilli were seen in significantly lesser amounts and were mainly situated in close vicinity to the squamous epithelial cells. Due to lack of pretreatment, the degree of inflammation was better assessed in CS. 1.4.Conclusion:Our experience shows that LBC is superior to CS in the evaluation of cell morphology and detection of certain microorganisms such as Trichomonas and Candida. The degree of inflammation is better assessed with CS. CISH is effective and easy for implementation method for HPV genotyping on cervical smears. There has been revealed 76.12% concordance in average between genotyping results and cytopathology findings of routine screening.