Study of Manual Liquid Based Cytology in Diagnosis of Gynecologic Pathology

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. Objectives: 1. Toimprove 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. Methodology: 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. Results: 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/Histopathology Vs CPS/Histopathology was 74% vs. 54%. Conclusion: MLBC is a cost effective method for detections of cancerous lesions of endometruim andcervix. It has been found to be useful in both Endometrial and cervical cytology in increasing the detection of infection and neoplastic conditions of female genital tract.