Abstract
BackgroundMany women undergoing cervical screening as part of a national South African screening programme may be positive for HIV. The performance of liquid-based cytology (LBC) on samples from HIV-positive women needs to be determined.ObjectivesThe performance of the Cellslide® automated LBC system was evaluated as a possible alternative to conventional cytology in a national cervical cancer screening programme.MethodsSplit samples from 348 HIV-positive women attending an HIV treatment clinic in Johannesburg, South Africa were examined by conventional cytology and monolayer LBC methods. All samples were stained, examined and reported in the same manner. Cytotechnologists were blinded to the conventional smear diagnosis if the LBC smear was screened and vice versa.ResultsThe same percentage of inadequate smears (1.4%) was obtained by conventional cytology and LBC. Atypical squamous cells of undetermined significance were observed in 5.2% of conventional smears and 4.0% of LBC smears. Low-grade squamous intraepithelial lesions were found in 35.6% of conventional smears and 32.7% of LBC smears. Only one conventional smear was categorised as atypical squamous cells – cannot exclude a high-grade lesion, whereas five such cases were identified on LBC. High-grade squamous intraepithelial lesions were seen in 21.6% of conventional smears and 23.3% LBC smears. No invasive carcinoma was identified.ConclusionThe performance of the Cellslide® LBC system was similar to that of conventional cytology in this population of high-risk HIV-positive women, indicating that it may be introduced successfully as part of a cervical cancer screening programme.
Highlights
Cervical cancer is a significant cause of morbidity and mortality in South Africa
A high percentage of abnormal smears were identified with both methods, and a diagnosis of negative for intraepithelial lesion/malignancy (NILM) was found for only 125 (35.9%) by conventional cytology and 129 (37.1%) by Cellslide®
LSIL was the most frequently diagnosed epithelial abnormality (124 [35.6%] by conventional cytology and 114 [32.7%] by Cellslide®). Both preparation methods diagnosed a substantial number of high-grade squamous intraepithelial lesions (HSIL) cases (75 [21.6%] by conventional cytology and 81 [23.3%] by Cellslide®)
Summary
Split samples from 348 HIV-positive women attending an HIV treatment clinic in Johannesburg, South Africa were examined by conventional cytology and monolayer LBC methods. All samples were stained, examined and reported in the same manner. Cytotechnologists were blinded to the conventional smear diagnosis if the LBC smear was screened and vice versa
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