Conventional Pap Smear Research Articles

COMPARATIVE EVALUATION OF PAP SMEAR WITH HISTOPATHOLOGY IN CERVICAL LESION ACCORDING TO THE 2014 BETHESDA SYSTEM: AN INSTITUTIONAL STUDY

Objectives: The objective of this study is to evaluate the efficacy of a pap smear using The 2014 Bethesda System (TBS) for the diagnosis of premalignant and malignant lesions of the uterine cervix. Methods: A prospective study was conducted in the Department of Pathology at the institution from November 2015 to October 2017. Fifty patients with an unhealthy cervix have undergone conventional Pap smears and histopathological biopsies with the suspicion of cervical malignancy or premalignancy attending the Obstetrics and Gynecology Outpatient Department. The obtained smears were arranged according to TBS. The tissue biopsies have been processed routinely and they are stained with hematoxylin and eosin for histopathological diagnosis. Furthermore, cases such as non-neoplastic, metastatic lesions, and recurrent cases were excluded from this study. Results: The common age group has been identified as between 41 and 60 years and patients had low educational levels. Sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy observed in this study were 89.28%, 63.63%, 64.1%, 72.72%, and 72% respectively. Conclusion: Pap smear is a simple, effective, inexpensive procedure that can be routinely used as a screening tool for screening cervical cancer. TBSs also provide a standard approach for cytological evaluation that helps in the early detection of premalignant and malignant cervical lesions.

Comparison of cervical cancer screening models based on Pap and HPV tests in Tbilisi, Georgia.

The objective of this study was to evaluate the effectiveness of human papillomavirus HPV test with HPV16/18 genotyping and liquid-based cytology (LBC) triage as a primary screening method for cervical cancer compared to conventional Pap test in women undergoing routine cervical cancer screening in Tbilisi. Cross-sectional, prospective study was conducted, where 1,000 enrolled women aged 30-60 years during one visit underwent conventional Pap smear and Hr-HPV testing (Roche Cobas system). Women with any positive screening results were referred for further evaluation and remaining cells from the Cell Collection Medium vial were used for LBC. The study calculated sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) for each screening method and receiver-operating characteristic (ROC) curve to evaluate the accuracy of each diagnostic method in identifying people with CIN2+ diseases. The HPV test with HPV16/18 genotyping and LBC triage demonstrated higher sensitivity (76.9%), specificity (71.6%), and PPV (34.5%) compared to conventional Pap tests (p < 0.05). NPV was also high with the HPV test (94.1%). The HPV test alone had the highest sensitivity (92.3%) and NPV (96.7%), but lower specificity (41.4%) and PPV (22.6%) than the HPV test with HPV16/18 genotyping and LBC triage (p < 0.05). Comparing the areas under the curve (AUCs), only the HPV with HPV16/18 genotyping and LBC triage showed a statistically significant difference when compared to conventional Pap (0.71 vs. 0.55, p = 0.03) and high figures of AUC 0.71 (95% CI: 0.58-0.85) suggesting that HPV test with HPV16/18 genotyping and LBC triage is a more reliable screening method for detecting CIN2+ disease and preventing cervical cancer, than other screening modality. The results suggest that the HPV test with HPV16/18 genotyping and LBC triage is a more effective primary screening method compared to conventional Pap tests. This information should be the basis for transition from cytological screening to HPV testing in Georgia.

Efficacy of Liquid-based Cytology vs Conventional PAP Smear in a Tertiary Care Hospital in Northeast Bihar: A Retrospective Study

Efficacy of Liquid-based Cytology vs Conventional PAP Smear in a Tertiary Care Hospital in Northeast Bihar: A Retrospective Study

"Modernizing Cervical Cytology Screening with Liquid-Based Methods at Community-Level Hospitals: A Much-Needed Breakthrough for India".

Cervical cancer still ranks highest causing cancer-related morbidity and mortality in women in India. It is prudent to emphasise and implement cervical cancer screening strategies in the population efficiently and with regular intervals. Conventionally, PAP smear cytology is obtained by wooden spatula-Ayre's spatula. To improve sensitivity and specificity of the procedure and detection rate, better techniques of cells retrieval are available mainly liquid-based cytology (LBC), with help of cyto-brush. Literature has consistently proven efficiency of the technique and also reduced the proportion of inadequate sampling. We conduct this study to compare both the techniques and efficiency in a community hospital from data over 6years,to asses its role and benefits among Indian women. To compare conventional PAP smear and liquid-based cytology techniques analysing detection rates of positive lesions (CIN and also includes ASCUS and malignant), incidence of inadequate sampling, efficiency and cost-effectiveness. This is retrospective study at tertiary care obstetric hospital affiliated to government-run medical college in a metropolitan city of Mumbai. Data are retrieved from the Pathology Department, Medical Records Department, laboratory books and OPD registers. Pap's smear sampling was done mainly from OPD with all indications including routine tests as a part of gynaecological evaluation and screening, as well as for suspicious lesions on inspection. Group A consists women who had conventional PAP smear test for 3years (Dec 2015-Nov 2018) and Group B had women who benefited by LBC method for 3years (Dec 2018-Nov 2021). COVID-19 pandemic majorly affected the routine gynaecological OPD practice during 2021 as hospital was COVID facility hospital. Demographic parameters and presentations were comparable and similar. LBC methods have higher detection rate for positive reports, including ASCUS. But results were comparable in both groups and not statistically different. Importantly, incidences of inadequate sampling are reduced significantly with the LBC method. Unsatisfactory smears war high in Group A (7.752%) compared to Group B (3.712%) p-value 0.005, stating the increased rate of requirement of sending repeat smears, which involves higher engagement of time, resources and active participation from healthcare personnel. Good detection rates and significantly low rates of unsatisfactory smears make LBC rational and cost-effective. These are the times to switch to liquid-based cytology techniques, especially at the community level hospitals; in order to detect more women with cervical premalignant as well as malignant neoplastic lesions and to save lives. This can be made possible by emphasising the policy makers to incorporate these services through quality resources.

Annotated Pap cell images and smear slices for cell classification

Machine learning-based systems have become instrumental in augmenting global efforts to combat cervical cancer. A burgeoning area of research focuses on leveraging artificial intelligence to enhance the cervical screening process, primarily through the exhaustive examination of Pap smears, traditionally reliant on the meticulous and labor-intensive analysis conducted by specialized experts. Despite the existence of some comprehensive and readily accessible datasets, the field is presently constrained by the limited volume of publicly available images and smears. As a remedy, our work unveils APACC (Annotated PAp cell images and smear slices for Cell Classification), a comprehensive dataset designed to bridge this gap. The APACC dataset features a remarkable array of images crucial for advancing research in this field. It comprises 103,675 annotated cell images, carefully extracted from 107 whole smears, which are further divided into 21,371 sub-regions for a more refined analysis. This dataset includes a vast number of cell images from conventional Pap smears and their specific locations on each smear, offering a valuable resource for in-depth investigation and study.

Evolution of Pathological Techniques for the Screening of Cervical Cancer: A Comprehensive Review.

The evolutionary journey of cervical cancer screening has been a major medical success story, considering the substantial role it has played in dwindling the disease burden. Through sustained collaborative efforts within the medical community, significant advances have been made from the humble yet path-breaking conventional Pap smear to the current automated screening systems and human papillomavirus(HPV) molecular testing. With the integration of artificial intelligence into screening techniques, we are currently at the precipice of circumventing the pitfalls of manual cytology readings and improving the efficiency of the screening systems by a significant margin. Despite the technological milestones traversed, the high logistics and operational cost, besides the technical know-how of operating the automated systems, can pose a major practical challenge in the widespread adoption of these advanced techniques in cervical cancer screening programs. This would suggest the need to adopt strategies that are tailored to the demands and needs of the different settings keeping their limitations in mind. This review aims to take the reader through the entire evolutionary journey of cervical cancer screening programs, highlight the individual merits and demerits of each technique, and discuss the recommendations from the major global guidelines.

Role of Conventional Pap Smear in Current Times

Abstract Cervical cancer is the fourth most common malignancy among females after breast, colon, and lung cancers and a leading cause of mortality among gynecologic malignancies. Over 85% of new cases are diagnosed in resource-limited countries. Several screening techniques have been developed to detect precancerous changes timely. The most common of which is conventional Pap smear (CPS). It is based on the cytological and morphology assessment of exfoliated cervical cells to detect preinvasive lesions of the cervix. Despite high specificity, a single Pap test has a low-to-moderate sensitivity. CPS can have false-negative and false-positive results because of inadequate sampling and slide preparation and errors in laboratory detection and interpretation. To overcome these shortcomings, liquid-based cytology (LBC) was introduced. LBC can be a better alternative to CPS because of a lower rate of unsatisfactory smears. The liquid reserve can be used for ancillary testing, such as human papillomavirus DNA tests (as reflex test and co-test). The cost of this technique is a limiting factor. In most of the developed countries, CPS is replaced by the LBC. There are several studies with conflicting results, and no method has been shown to be superior in terms of all parameters. Relevant studies were searched using PubMed/MEDLINE and Google Scholar. This article puts forward the results of various studies comparing the efficacy of CPS and LBC and highlights the advantages and disadvantages of both methods.

Comparison of Conventional Pap Smear With Liquid-based Cytology for Screening of Cancer Cervix

Abstract Objective: The objective of the study was to compare conventional Pap smear (CPS) and liquid-based cytology (LBC) by the split technique method in terms of satisfactory/unsatisfactory smear, the prevalence of inflammatory smear, and cellular atypia. Materials and Methods: This cross-sectional study was carried out between 2017 and 2019 after obtaining ethics committee approval. A total of 200 women were recruited for the study attending the gynecology outpatient clinic with various symptoms, such as discharge per vaginum, dysmenorrhea, infertility, and pain abdomen, and after obtaining written informed consent. Pregnant women, women with pelvic inflammatory disease, and cases with obvious cervical lesions or growth were excluded. Pap smear was taken with a Rovers Cervex-Brush. The split sample technique was followed wherein using one side of the brush conventional slide was prepared and fixed with cytospray. The brush head was detached and suspended in the preservative fluid for LBC. Both CPS and LBC were sent for examination. The same experienced pathologist examined the samples. The qualitative variables were compared using the Mcnamer test to compare the prevalence of unsatisfactory smear, inflammatory smear, and cellular abnormalities between CP and LBC. The categorical variables were presented in number and percentage (%) and continuous variables were presented as mean ± standard deviation and median. P &lt; 0.05 was considered statistically significant. Results: The maximum number of patients (62.5%) belonged to the fourth decade of life. The mean age was 39 years. A total of 93% of women were from the urban areas while 7% belonged to the rural areas. The majority of the women (78.5%) were multiparous and around 43% were second para. Pap smear reports were satisfactory in 93.5% of women in CPS, while 99% of reports were satisfactory in LBC. The difference between CPS and LBC in terms of the prevalence of satisfactory/unsatisfactory smear was statistically significant with a P = 0.0064. Dense inflammation reported by all LBC smears was reported as the same in CPS. The strength of agreement between CPS and LBC was not strong in terms of different grades of inflammation with a kappa value of 0.24. There was no difference in the reporting of cellular atypia between both methods. Conclusions: CPS and LBC are equal in terms of detection of inflammation and epithelial cell abnormality. Infections were also detected by both the screening methods CPS and LBC. The only thing which makes LBC better is the rate of satisfactory smears and the benefit of adding human papillomavirus DNA testing possible only in LBC.

Role of Geminin as a Tool for Augmenting Accurate Diagnosis of Cervical Neoplasia.

To determine the role of geminin as a tool for differentiating various types of cervical intraepithelial neoplasia (CIN) and cervical carcinoma (CC). Seventy women newly diagnosed with CIN or CC undergoing cervical biopsy were included; their clinical profile, human papilloma virus (HPV) positivity, and colposcopy findings were noted, and biopsy tissue was analyzed for geminin content. On geminin immunohistochemistry, 100% of women with CIN3 and 96.29% of women with CC had geminin two plus or more. When analyzed as ordinal variables, there was a significant correlation (spearman's rho 0.35, p 0.01) between geminin and biopsy results (CIN1, CIN2, CIN3, and CC). Screening tests for cervical cancer, like conventional pap smears, liquid-based pap smears, and triaging with HPV, have limitations. It is important to be able to differentiate between high-grade lesions, invasive cancer, and low-grade lesions. The detection of geminin in these cells may aid in the confirmation of the diagnosis and ensure adequate treatment. Cervical intraepithelial lesions and carcinoma cervix demonstrated a correlation between increased geminin expression in CIN1 vs. CC and CIN2 vs. CC. Geminin may be a potential surrogate marker for higher-grade cervical lesions, and further research is needed to corroborate evidence in this direction.

PAP-test: Possibilities and Limitations

Cervical cancer (CC) progresses slowly, and the cytological screening increases the likelihood of early detection of precancerous lesions. Cytology of the cervix is one of the primary methods of effective CC diagnosis, which, thanks to early detection and timely treatment, leads to a stable decrease in morbidity and mortality from invasive CC. The results of many studies have shown that the specificity of the conventional Pap smear test is approximately 80–100%, its sensitivity ranges from 30% to 80%, and the rate of inadequacy of this method is from 5% to 25%. With traditional smear preparation, only a small percentage of collected cells end up on the slide, while abnormal cells may be discarded and not analyzed. When viewing the slide, cells that have dried and clumped together may interfere with the visualization of atypical cells. To overcome these limitations, in 1996, as an alternative to the traditional Pap test, liquid cytology was presented – the technology of preparing slides on which the cells are placed in a single layer. This technology outperformed the conventional Pap test with improved fixation, reduced obscuring factors, and standardized cell transfer. In liquid cytology samples are collected by fully immersing the cytobrush in a vial containing a preservative liquid, whereby the cells are preserved and fixed simultaneously, unlike conventional smears where the sample is applied to a glass slide and fixed separately. Today, two main methods of preparation based on liquid cytology are known: ThinPrep and SurePath. The results of cytology are described according to the Bethesda system. The Bethesda classification is widely accepted because it corresponds to the clinical presentation, reproduces the nature of the lesions, and is therefore treatmentoriented with a desirable follow-up procedure. The indisputable advantage of the Pap test by liquid cytology is the ability to perform both cytological and molecular studies, in particular HPV, in one sample. This capability facilitated the implementation of a two-step strategy when HPV testing is used as a triage test for ASC-US or low-grade squamous intraepithelial lesion cytology, or when cytology is used to triage HPV-positive women.

Should Liquid-Based Cytology (LBC) be Preferred than Conventional Pap Smear (CPS): A Comparative Analysis.

To study the cytomorphological differences of both techniques and to study the relative advantages and limitations of both techniques. A total of five hundred cases were collected. The conventional Pap smears (CPS) were prepared with cytobrush, and the same brush head was suspended in LBC vial and processed by SurePath. Of the 500 cases studied, the age ranged from 21 to 80years with a mean of 40.02. The number of satisfactory smears in CPS and LBC was 490 and 496 cases, respectively. In conventional method, 417 cases (83.4%) and LBC 430 cases (86.0%) were inflammatory smears. The number of LSIL was 18 in conventional method and 15 in LBC. HSIL was 11 in CPS and 10 in LBC, and 8 squamous cell carcinoma cases were seen in LBC. Histopathological correlation was observed in 19 cases of which LBC showed sensitivity and specificity of 100%. LBC may be considered better than conventional Pap smear due to better adequacy, clarity of background, detection of infections and increased sensitivity and specificity in detecting LSIL and HSIL.

Deep Learning-based Ensemble Approach for Conventional Pap Smear Image Classification

Cervical cancer screening allows the early signs of precancerous abnormalities in the cervix before they develop into invasive cancer. The Pap Smear is a widely used screening for early detection and prevention of cervical cancer. In many remote areas, the number of cytologists available to interpret pap smear screening tests is insufficient. This lack of personnel makes the test interpretation very time-consuming. To address this, deep learning techniques have been employed to detect cervical cancer cells and support cytologists. Therefore, an integrative approach with deep learning models and the ensemble techniques such as the maximum occurrence and the maximum probability score of cervical cells was proposed. The multi-cell assessment of the Pap smear slide allowed aggregate predictions of single cervical cell images using the proposed method. The classification results between pre-trained deep learning models and the proposed method were compared. In the experimental results, the proposed method can achieve an accuracy score of more than 97%, while the best pre-trained deep learning model can attain an accuracy score of more than 85%. Hence, the proposed method may have the potential to assist physicians or cytologists in the classification of cervical cell types for Pap Smear images.

Comparative analysis of different cervical screening methods with special reference to the WHO recommended human papillomavirus detection at a rural tertiary care center - A pilot study

Background: Cervical cancer (Ca Cx) the 4th common cancer has a high mortality rate. Human Papilloma Virus (HPV) is chiefly responsible for a long latent period to progress from preinvasive to invasive Ca Cx. So it can be prevented by screening procedures such as visual inspection with acetic acid (VIA), conventional cervical PAP smear (CP), liquid-based cytology (LBC), and high-risk (HPV-hr) detection along with vaccination. Aims and Objectives: The study aims to determine the socio-demographic profile of Ca Cx and the most appropriate cost-effective community screening method. Materials and Methods: A prospective observational study with 80 symptomatic women of reproductive and peri/postmenopausal age groups attending the Gynecology Department who underwent VIA, CP, and LBC and thereby detected positive along with screened negative but clinically suspicious women were tested for HPV-hr detection. Results were tabulated into an Excel sheet and screening methods were compared using Chi-square test, gold standard being cervical histopathology (P&lt;0.5 significant). Statistical software used - Graphpad Prism 9 (San Diego, CA). Results: The mean age was 43.3 years. Multiparity and early marriage were seen in 80% and 45% respectively. Inflammatory lesions were best diagnosed by CP but epithelial cell abnormality and more satisfactory smears by LBC (P&lt;0.05). Sensitivity was highest (93.75%) in VIA, positive predictive value, and specificity in CP (91.66%, 75%). negative predictive value was highest in VIA and HPV-hr DNA (50%). Conclusion: VIA with CP/LBC is an economically viable and effective screening method for Ca Cx in developing countries along with HPV vaccination.

Comparison of visual inspection of Cervix with acetic acid with conventional pap smear in the detection of colposcopic biopsy proved cervical intraepithelial neoplasia in women presenting in Tertiary Care Hospital

Comparison of visual inspection of Cervix with acetic acid with conventional pap smear in the detection of colposcopic biopsy proved cervical intraepithelial neoplasia in women presenting in Tertiary Care Hospital

Liquid-based Cytology as a Superior Tool Compared to Conventional Pap Smear in Detecting Cervical Cancer in Suspected Cases: A Comparative Study

Abstract Introduction: Screening programs has conventional cytology such as Conventional Pap Smear (CPS) have successfully reduced cervical cancer, but newer tests like Manual Liquid-based cytology (MLBC) and Human Papillomavirus testing might enhance screening. Materials and Methods: This was a cross sectional study conducted on 175 samples was processed for CPS and MLBC. Cytobrush was used for LBC which was suspended and detached in the preservative fluid and processed by manual method. Histopathological correlation and HPV DNA testing was also done. Results: MLBC showed higher specimen adequately, cellularity, clean background and uniform distribution of cells than CPS. Conclusion: MLBC showed improved specimen adequately, better cytomorphological features and higher detection of epithelial cell abnormality.

Conventional PAP Smear or Liquid-Based Cytology, The Better Screening Tool for Cervical Cancer: a Comparative Study at a Tertiary Care Center in North-East India

Conventional PAP Smear or Liquid-Based Cytology, The Better Screening Tool for Cervical Cancer: a Comparative Study at a Tertiary Care Center in North-East India

The Efficiency of Cervical Pap and Comparison of Conventional Pap Smear and Liquid-Based Cytology: A Review

The Efficiency of Cervical Pap and Comparison of Conventional Pap Smear and Liquid-Based Cytology: A Review

Digitizing Conventional Pap Smear Education: An Interactive Web-Based Open-access Tool

Digitizing Conventional Pap Smear Education: An Interactive Web-Based Open-access Tool

False-Positive Atypical Endocervical Cells in Conventional Pap Smears: Cyto-Histological Correlation and Analysis

Introduction: Endocervical glandular atypia is relatively rarely diagnosed by Pap smears. A significant proportion of follow-up histological samples show no premalignant or malignant lesions. The observed cytomorphological findings in premalignant glandular lesions overlap with histologically proven reactive lesions. Methods: A total of 45 conventional Pap smears diagnosed as atypical endocervical cells, not otherwise specified (AEC, NOS) with human papillomavirus (HPV) status available were blindly evaluated in a search for 38 cytomorphological features representing background, architectural, cellular, and nuclear features. Of the cases, 30 represented histologically proven benign changes, and 15 represented histologically proven adenocarcinoma in situ (AIS) or endocervical adenocarcinoma (EAC) cases. The benign biopsies were re-evaluated, and the associations of the cytomorphological features or combinations of them with specific histological features and entities were statistically examined. Results: The most frequent histological findings in the benign group were squamous metaplasia, inflammation, tubal metaplasia, and microglandular hyperplasia. The statistical analysis revealed cytological features associated with squamous metaplastic changes, inflammation, and microglandular hyperplasia. Unfortunately, no cytomorphological feature was sufficiently specific to confidently leave the lesion without follow-up and histological correlation. Degeneration and nuclear crowding were the most salient features that distinguished the instances of glandular atypia with benign follow-up histology from those with histologically proven AIS or EAC (26.7 vs. 60.0%, p = 0.030, and 50.0 vs. 86.7%, p = 0.017). Conclusion: Additional methods besides cytomorphology are required to reliably distinguish smears with AEC, NOS harbouring only benign histological changes from those exhibiting endocervical glandular malignancy.

Optical imaging for early detection of cervical cancer: state of the art and perspectives.

Cervical cancer is one of the major causes of death in females worldwide. HPV infection is the key cause of uncontrolled cell growth leading to cervical cancer. About 90% of cervical cancer is preventable because of the slow progression of the disease, giving a window of about 10 years for the precancerous lesion to be recognized and treated. The present challenges for cervical cancer diagnosis are interobserver variation in clinicians' interpretation of visual inspection with acetic acid/visual inspection with Lugol's iodine, cost of cytology-based screening, and lack of skilled clinicians. The optical modalities can assist in qualitatively and quantitatively analyzing the tissue to differentiate between cancerous and surrounding normal tissues. This work is on the recent advances in optical techniques for cervical cancer diagnosis, which promise to overcome the above-listed challenges faced by present screening techniques. The optical modalities provide substantial measurable information in addition to the conventional colposcopy and Pap smear test to clinically aid the diagnosis. Recent optical modalities on fluorescence, multispectral imaging, polarization-sensitive imaging, microendoscopy, Raman spectroscopy, especially with the portable design and assisted by artificial intelligence, have a significant scope in the diagnosis of premalignant cervical cancer in future.