Liquid-based Cytology Technique Research Articles

Co-infection of human papillomavirus and herpes simplex virus-2 with cervical dysplasia among women in Kaduna State, Nigeria

Background: The epidemiology of human papillomavirus (HPV) and co-infections with herpes simplex virus type 2 (HSV-2) remains poorly characterized in Africa. High risk HPV (hrHPV) infection is the primary cause of 99.7% all cervical cancer especially in the presence of genital ulcer disease (GUD) which is usually caused by HSV-2. Herpes simplex virus-2 might interact directly with hrHPV to increase the risk of cervical cancer. Co-infection of HPV and HSV-2 in asymptomatic women could provide a clue to early diagnosis of cervical cancer and this could aid in the development of new strategies for effective management and improvement of the quality of life of women who are infected. If the synergy between HPV and HSV-2 can be prevented, there may be significant reduction of the incidence of cervical cancer. Methodology: This was a descriptive cross-sectional study of 515 randomly selected apparently healthy women of reproductive age whose cervical samples were screened for HPV and HSV-2 in Kaduna State, Nigeria. The cervical samples were collected by liquid-based cytology (LBC) for detection of cervical epithelial cell abnormalities (CEA) and molecular detection of HPV and HSV-2 using conventional polymerase chain reaction (PCR) assay. Extracted viral DNAs from the samples were amplified by convectional PCR using specific hrHPV (HPV 16,18, 31 and 45) primer sets and a broad spectrum MY09/11 and GP5+/6+ primers for a wider range of HPV genotypes while HSV-2 DNA was detected by florescence-based PCR assay with HSV-2 gG primers and probes. Results: PCR assay revealed that 14.7% (n=76) of the 515 selected women harbored HPV, HSV-2 or both. The prevalence of HPV, hrHPV, HSV-2 and HPV/HSV-2 co-infection among in the study participants are 11.8% (n=61), 9.3% (n=48), 5.6% 4% (n=29) and 2.3% (n=12) respectively. The frequency of HPV detection in HSV-2 infected participants (41.4%, 12/29) was significantly higher (OR=6.295, p<0.0001) than in HSV-2 negative participants (10.1%, 49/437), but only co-infections of HPV-31 (p=0.004) and HPV-18 (p=0.040) with HSV-2 were significantly associated. Cervical cytology reports on the smears revealed prevalence of cervical epithelial abnormalities (CEA) of 16.7% (n=86), with cervical dysplasia prevalence of 6.4% (n=33), consisting of high grade squamous intraepithelial lesion (HGSIL) of 1.6% (n=8), low grade squamous intraepithelial lesion (LGSIL) of 4.1% (n=21) and atypical squamous cells of uncertain significance (ASCUS) of 0.8% (n=4). The frequency of HPV detection in women with cervical dysplasia (93.9%, 31/33) was significantly higher (OR=14.22, p<0.0001) than in women without cervical dysplasia (6.2%, 30/482), and all HPV genotypes were significantly associated (p<0.05) with cervical dysplasia except HPV 16 (p=0.051). Also, the frequency of HPV/HSV-2 co-infection among women with cervical dysplasia (15.2%, 5/33) was significantly higher than among women without cervical dysplasia (1.5%, 7/482) (OR=12.12, p<0.0001). Comparing women with cervical inflammatory and atrophic changes (n=53), women with cervical dysplasia (HGSIL, LGSIL and ASC-US) had significantly higher frequency of HPV infection (χ2=42.829, p=0.000), HSV-2 infection (χ2=25.140, p=0.001) and HPV/HSV-2 co-infections (χ2=66.602, p=0.000). Conclusion: Co-infection rate of hrHPV and HSV-2 among women in Kaduna State is 2.3%. Demographic factors significantly influencing the rate of co-infections included age and marital status. In spite of the screening method using the traditional Pap smear, GUD and cervical cancer continues to be a major public health problem, thus more sensitive and specific methods such as liquid based cytology technique and polymerase chain reaction for early detection of cervical dysplasia and hrHPV or HSV-2 in asymptomatic women should be adopted for routine use

"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.

Comparison of liquid based cytology and conventional smears on lymph node aspirates: A cytomorphological study.

In an era of minimally invasive and rapid diagnostic technologies, fine-needle aspiration cytology (FNAC) is most useful when it comes to patients with lymphadenopathies especially of the cervical region. Liquid-based cytology (LBC) is an alternative processing method which is used for both gynecological and non-gynecological samples. Because of the remarkable advantages of LBC smears in gynecological samples, nowadays, many studies have been done to assess its utility in various other lesions. Hereby, with the help of this study, we would like to evaluate the efficiency of LBC smears in comparison to conventional FNAC smears conventional smears (CS) on lymph node aspirates. A retrospective study was done over a 1-year period in which 253 cases of lymph node aspirates were included in the study. The slides were prepared using standard conventional and LBC techniques and compared for adequacy, cellularity, cell architecture, necrosis, background debris, presence of cells in monolayer sheets, and nuclear/cytoplasmic details. Of the total 253 cases, 171 (67.6%) were and 67 (26.5%) were diagnosed as non-neoplastic and malignant, respectively. Although the LBC smears were useful in the diagnosis of malignant cases, they did pose some challenges especially in the non-neoplastic lymph node aspirates due to loss of the background necrosis. In addition, the cellular yield in LBC smears was low in comparison to CS. LBC smears from lymph node aspirates results in better diagnostic accuracy for malignant cases due to better cellular and nuclear details. However, for non-neoplastic etiology, it should not be considered better than CS as loss of the background necrosis and inflammation may result in an incorrect diagnosis.

Prediction of lymph node status in patients with surgically treated head and neck squamous cell carcinoma via neck lavage cytology: A pilot study.

Neck dissection is a standardized surgical procedure for patients with head and neck squamous cell carcinoma (HNSCC) and plays a critical role in the choice of adjuvant treatment based on histopathological findings. Saline irrigation is routinely performed at the end of surgery. However, this irrigant is not used for diagnostic purposes. Intraoperative irrigation of the neck dissection wound was performed in 56 patients with HNSCC (N=93 neck dissections), and the cytological suspension obtained was processed via the liquid-based cytology (LBC) technique, Papanicolaou staining, and immunocytochemical staining. Microscopic preparations were screened for the presence of tumor cells and classified as positive, borderline, or negative. These results were correlated with the histopathological and clinical data. Neck lavage LBC demonstrated high diagnostic value in detecting lymph node metastases (N+) with extracapsular spread (ECS), with a specificity, sensitivity, negative predictive value, and positive predictive value of 93.1%, 100%, 100%, and 80%, respectively. Tumor cells were detected in 4.8% of N- cases, 20% of N+ cases without ECS, and 100% of N+ cases with ECS. Receiver operating characteristic curve analysis showed an area under the curve of 0.8429 for the prediction of N+ (p<.0001) and 0.9658 for the prediction of N+ with ECS (p<.0001). Differential lavage cytology can provide valid and rapid information on the lymph node status in patients with HNSCC and showed an excellent correlation with histopathology. Thus, neck lavage LBC may facilitate faster and more reasonable planning of adjuvant treatment and help improve the therapeutic management of patients with HNSCC.

Influence of sexually transmitted infections on the cervical cytological abnormalities among Iranian women: A cross-sectional study.

Sexually transmitted infections (STIs) are one of the world's most severe health challenges. The existence of STIs such as human papillomavirus (HPV) might cause cervical cell changes leading to cervical cancer. This study aims to assess the association of STIs with cervical cytological abnormalities and genital warts among women in northeastern Iran. This cross-sectional study was carried out on 190 women referred to the central laboratory of Academic Center for Education, Culture, and Research, Mashhad, Iran from March to July 2022. The presence of genital infections caused by Chlamydia trachomatis, Neisseria gonorrhoeae, Mycoplasma genitalium, and Herpes simplex viruses (1 and 2) were assessed using the real-time polymerase chain reaction method. HPV genital infection was detected based on the principles of reverse hybridization, and cellular changes in the cervix were examined by the liquid-based cytology technique. The mean age of participants was 35.33 8.9 yr. 34 different HPV genotypes were detected in all HPV-positive cases, and the most common genotype was low-risk HPV6. No significant association was found between STIs and cervical cytology abnormalities. The prevalence rates of sexually transmitted pathogens among HPV-positive and HPV-negative individuals were 10.9 and 1.6%, respectively. The frequency of genital warts was significantly higher in cases with multiple infections of high- and low-risk HPV genotypes. High percentages of the participants with non-HPV STIs and HPV infection had normal cervical cytology. It is advised to use STIs and HPV diagnostic tests along with cytology examinations for cervical cancer screening.

Relationship between a deep learning model and liquid-based cytological processing techniques.

Artificial intelligence (AI)-based cytopathology studies conducted using deep learning have enabled cell detection and classification. Liquid-based cytology (LBC) has facilitated the standardisation of specimen preparation; however, cytomorphology varies according to the LBC processing technique used. In this study, we elucidated the relationship between two LBC techniques and cell detection and classification using a deep learning model. Cytological specimens were prepared using the ThinPrep and SurePath methods. The accuracy of cell detection and cell classification was examined using the one- and five-cell models, which were trained with one and five cell types, respectively. When the same LBC processing techniques were used for the training and detection preparations, the cell detection and classification rates were high. The model trained on ThinPrep preparations was more accurate than that trained on SurePath. When the preparation types used for training and detection were different, the accuracy of cell detection and classification was significantly reduced (P < 0.01). The model trained on both ThinPrep and SurePath preparations exhibited slightly reduced cell detection and classification rates but was highly accurate. For the two LBC processing techniques, cytomorphology varied according to cell type; this difference affects the accuracy of cell detection and classification by deep learning. Therefore, for highly accurate cell detection and classification using AI, the same processing technique must be used for both training and detection. Our assessment also suggests that a deep learning model should be constructed using specimens prepared via a variety of processing techniques to construct a globally applicable AI model.

Diagnostic significance of GATA 3, TTF-1, PTH, chromogranin expressions in parathyroid fine needle aspirations via immuonocytochemical method.

Additional studies may be needed when evaluating parathyroid fine needle aspirates (FNA) due to cytomorphologic similarities. The liquid-based cytology (LBC) is an effective cytology method which provides additional slides for ancillary techniques. We aimed to examine the immunocytochemical (ICC) GATA 3, TTF-1, which chromogranin and PTH expressions and to determine their diagnostic importance in parathyroid FNAs which were prepared via LBC technique. In total, 45 parathyroid FNA cases were examined in our laboratory for 12-month period. Thirty five cases without cell blocks were included in the study. Ten cases were excluded from study (five cases were nondiagnostic, five cases had cell blocks). For main LBC cytology slides SurePath pap test kit was used. For ICC study 4 PAP-stained LBC slides were obtained from each case's residual material. The slides were then stained with GATA 3, TTF-1, PTH and chromogranin. Of 35 cases, 8 were male and 27 were female. The mean age of the cases was 52.25 ± 11.44 (range 27-72). The mean diameter of the lesions was 18.54 ± 7.66 mm (range 6-32 mm).The most used antibody was TTF-1 (in all 35 cases). The positivity rates were 84.8%, 83.9% and 81.8% for GATA 3, PTH and chromogranin, respectively. TTF-1 was completely negative in 100% of cases. All patients had high PTH washout values (29 patients, PTH washout value was >5000 pg/mL). In 30 cases, histopathologic follow-up was available. The cyto-histological correlation was 100%. Based on the PTH washout values for cases without resection, the diagnostic accuracy of FNA was determined as 100% in detecting the parathyroid origin. Among the antibodies, the most specific and sensitive antibody was TTF-1 (100%). The sensitivity values of the antibodies indicating parathyroid origin for GATA3, PTH and chromogranin were 86.67%, 83.33% and 81.82%, respectively. The addition of ICC studies applied to LBC slides is also very helpful in diagnosis, especially in FNAs with limited material such as parathyroid. GATA3 is a more reliable ICC marker determining parathyroid origin. In differentiation from thyroid origin, the addition of TTF-1 to the ICC panel increases the diagnostic accuracy to 96.67%. Although PTH and chromogranin have lower sensitivity, they are still reliable markers to detect parathyroid origin.

Deep Learning and Transfer Learning Methods to Effectively Diagnose Cervical Cancer from Liquid-Based Cytology Pap Smear Images

As cervical cancer is considered one of the leading causes of death for women globally, different screening techniques have emerged. As the Papanicolaou technique generates high numbers of false negatives due to only testing 20% of a sample, the liquid-based cytology technique was developed to test 100% of the sample and improve accuracy. However, as the larger sample size has made it difficult to detect the lesion images through a microscope, studies have looked for ways to intelligently analyze sample. The aim of this study is to develop an artificial intelligence image recognition system that detects the lesion level of cervical cancer of liquid-based Pap smears under the Bethesda classification of cancer (NI/LSIEL/HSIEL/SCC). For this purpose, six activities were carried out: dataset selection, data augmentation, optimization, model development, evaluation and system construction. A dataset built from publicly available Pap smear images and passed through data augmentation algorithms generated a total of 2,676 images. Two models, ResNet50V2 and ResNet101V2, were developed under Deep Learning and Transfer Learning protocols. The evaluation showed that the ResNet50V2 model obtained better performance, where the classification of HSIL and SCC type images obtained a precision of 0.98 and achieved an accuracy of 0.97. Finally, the system based on the ResNet50V2 model was built and its performance was validated.

Assessment of the diagnostic usefulness of liquid-based cytology. The impact of modifications.

The technique of liquid-based cytology (LBC) is of increasing diagnostic value in non-gynecological cytology. The purpose of the present study was to validate modifications to stages of the LBC process and to assess the diagnostic usefulness of the LBC technique. Between May 2021 and January 2022, atotal of 484 samples were prepared from routine cytology tests carried out in the Department of Tumor Pathology of The Greater Poland Cancer Center. The material was obtained from fine-needle aspiration biopsies and fluid samples. One hundred cases were selected for the research described in the article. The slides were prepared using the Becton Dickinson Totalys SlidePrep device. Based on the research, it was concluded that predominantly the LBC technique gives better results than aconventional smear because the background, which would otherwise make it difficult to assess preparations, was eliminated. Additionally, in LBC preparations the cellularity was increased, and the cells were arranged in amonolayer system, which improves the image quality. The introduction of modifications to the LBC method facilitated the process of sample preparation, without adversely affecting the quality of the obtained material.

DETECTION OF ABNORMAL CERVICAL CYTOLOGY BY LBC (LIQUID BASED CYTOLOGY)

Introduction: Cancer cervix is the fourth most common cancer among women globally. It is responsible for 7.7% of all female cancer death.It takes around 15-20 years in normal immunity patients and 5-10 years in immune-compromised patients to convert precancerous lesions of the cervix into cancer cervix. Cervical cytology plays a very important role in the early diagnosis and management of these precancerous lesions to improve prognosis.quite low Pap smear sensitivity, in the range of 50%, but as low as 20%10 has been reported by some recent meta-analysis studies. LBC was introduced in the mid-1990s as an alternative technique to process cervical smear samples for cytological evaluation.11Studies of the accuracy of liquid-based preparations reports sensitivity of 61-66% and specicity of 82- 91%. A retrospective study was done at a private clinic and pathology lab in Di Materials And Methods: strict Shivpuri (MP) from 1st October 2020to 30th November 2022 on 760 patients. Inclusion criteria:-Patients in the age group of 21-65 years with complaints of abnormal vaginal discharge, intermenstrual bleeding, ostmenopausal bleeding, post-coital bleeding, dyspareunia, foul-smelling discharge, backache, and Lower abdominal pain were included in this study. Sample was taken with Broom, and Cyto-brush from the transformation zone and endocervix and placed in liquid xative buffered methanol solution and send to the pathology lab. Results Most of the patient 42% were between 31-40 years of age group. The majority 48.42% of them were educated up to High school. Most of them 84.07%were from rural back ground, multiparous 86.05%, and married 99.73%. 25% ofwomen visited OPD with complaints of abnormal vaginal discharge followed by menstrual abnormalities in 20.79%, other complaints were, Pain abdomen 16.97%, Vulval itching12.11%, Low back pain 3.95%, Dyspareunia 3.03% and others 5.13%. (Loss of weight and appetite, STD/genital warts) .9.08% women came for routine checkup. The most common nding on per speculum examination was Cervical ectopy in 33.95% .Normal cervix was found in 26.05%. Other ndings on Per-speculum examination were, Hypertrophied cervix, Inammation, Cervical Polyp, UV Prolapse/ cystocele, Cervical Ulcer ,Cervix ushed with the vagina and Cervical growth in. 20%, 9.08%, 4.34% 4.61% 3.03% 0.13% and 0.13% respectively. Out of 760 cases, 61.05% of patients were reported as negative for intraepithelial lesion (NILM). The most common non-neoplastic cytological nding was an inammatory smear in 25.00% of cases. Various Infections were found in 6.18% of cases, and epithelial cell abnormalities were found in 3.42% of cases. The most common abnormalities were ASC-US 0.92% and ASC-H 0.92%, followed by LSIL 0.53%, HSIL 0.66%, AGUS 0.26%, and SCC 0.13%. Bacterial vaginosis 2.37% was the most common infective organism found in cytology followed by Candida albicans 1.97%, Trichomonas vaginalis 1.71%, and Herpes simplex virus 0.13%. The cytology-based screening program is still the mainstay in the earl Conclusion y diagnosis of cancer cervix. To improve diagnostic accuracy as sensitivity and specicity in the eld of cervical cytology, Liquid-based cytology (LBC) is preferred. Its advantages over conventional Pap smears include proper visualization of cellular features due to a reduction in air-drying artifacts and reduced number of unsatisfactory smears. The residual specimens from the LBC technique can be used to detect human papillomavirus DNA through immune-cytochemistry if needed. thus, LBC is recommended as a cervical cytology screening tool to achieve the WHO elimination strategy.

Diagnostic Value of Preparing Additional Liquid-Based Cytology Slides and Cell Blocks from Residue Material in Thyroid fine Needle Aspiration.

After liquid-based cytology (LBC) technique developed for cervical cytology, it has been used for nongynecological samples and has been very successful. It offers having extra slides of the samples for further examination and ancillary tests. Moreover, cell blocks can be formed from the residue material. The study aimed to evaluate the importance of preparing a second LBC slide or a cell block from the residue material of thyroid fine needle aspiration (FNA) samples to reach a definitive diagnosis in cases diagnosed as nondiagnostic (ND) after the first slide. Seventy five cases diagnosed as ND after the first slide were included in study. For 50 cases, the second LBC slides were prepared (LBC group); for 25 cases, cell block was performed from residue material (CB group). Two groups were compared in terms of reaching a definitive diagnosis. At the end of secondary procedures, a definitive diagnosis was reached in a total of 24 cases (32%). Twenty of 50 cases (40%) in LBC group reached a definitive diagnosis while four cases (16%) in the CB group reached a definitive diagnosis. Achieving a definitive diagnosis was found statistically higher in the LBC group in which the second slide was formed compared to the CB group (P =0.036). Preparing a second slide with LBC method is more purposive than preparing a cell block from the residue material of thyroid FNA samples. Reducing the percentage of ND cases will protect patients from complications and morbidity that may arise from repeated FNA.

Evaluation of Breast, Lymph Node, and Thyroid Fine Needle Aspiration Cytology by Liquid Based Smears and Conventional Smears

Introduction: Fine needle aspiration cytology (FNAC) is a first-line investigation for palpable lumps and is a highly cost-effective and accurate investigative technique. It is a safe, simple, rapid, minimally invasive technique. Liquid-based cytology (LBC) has been used in gynecologic-cytology for over three decades. Many laboratories have adopted LBC technique for exfoliative and FNA samples. We undertook the present study to compare the advantages and disadvantages of conventional and liquid based cytology preparations. Aim of the study: To evaluate the diagnostic accuracy of LBC and Conventional smears in fine needle aspiration cytology samples from breast, lymph nodes, and thyroid tissue. Materials and methods: FNA material from accessible sites such as palpable breast lumps, thyroid, and lymph nodes were collected from 100 patients and was processed by two different methods, i.e., Conventional smears and by LBC. Various parameters on the slides were considered and compared for both the preparations. Out of 100 FNA samples, 51% were of Thyroid, 34% were of lymph node and 15% were of breast lumps. Observations and results: Adequate cellularity and better architecture was present in conventional smears than LBC preparations. Background material was less, and monolayers were better in the LBC preparations. Informative background material (i.e. Colloid, lymphoglandular bodies, etc) was more in cases of Conventional smears. The nuclear and cytoplasmic details were nearly equally good in both the preparations. Conclusion: Both these methods have their own advantages and disadvantages. Before incorporating LBC as a routine method, pathologists should familiarize themselves with all the aspects of LBC.

Diagnostic utility of conventional and liquid-based cytology in the management of thyroid lesions; an institutional experience.

Objectives:Liquid-based cytology (LBC) is becoming a useful method in evaluating both gynecological and nongynecological preparations. Many studies have been conducted these days to see the quality of LBC in diagnosing thyroid lesions and its role is yet to be standardized. This study has been done to pick the cytomorphological features of thyroid lesions on LBC and to compare them with the conventional cytology of these lesions.The objective of the study is to evaluate the efficacy of thyroid fine-needle aspiration cytology processed by LBC as compared to conventional smears.Material and Methods:A prospective study has been done on 53 cases of thyroid lesions using standard conventional and LBC techniques.Results:In most of the cases, the cytological features are similar in conventional cytology smears and LBC, but the colloid film and the lymphocytic component show a clear picture on direct smears, whereas nuclear and cytoplasmic details are better evaluated in LBC slides. The preservative solution used in LBC could be efficiently used for the application of immunocytochemical and molecular techniques.Conclusion:LBC does not represent as a valid alternative to conventional cytology but it can be considered as a diagnostic utility process especially due to the possibility of applying additional techniques which enhance the efficacy of the cytological diagnosis of thyroid lesions.

Cervical cancer screening using liquid-based cytology (LBC) in a secondary care hospital in Northeast India

According to the latest National Cancer Registry Programme (NCRP 2020) report, India had the highest incidence rate of cervical cancer (27.7 per 100,000) in Asia and also cervix uteri was the leading anatomical site of cancer in women population of Nagaland (16.4%). Lack of access to healthcare and awareness has led to the increased cases of cervical cancer, in particularly the resource-limited areas. A retrospective study involving 711 samples of cervical smears of women collected in the Department of Gynaecology were analysed between May 2019-May 2021 at CIHSR hospital. The objective of this study was to address this preventable cancer burden and also to determine a fraction of pap cervical smear finding through LBC in a secondary level hospital in Dimapur, Nagaland. 711 Pap smears using LBC technique were processed in the Department of Pathology of which 20 samples (2.81%) yielded unsatisfactory result or were rejected. Of the remaining 691 samples, 16.35% (113/691) had abnormal results. The Bethesda System (TBS-2014) for cervical cancer screening was used for classifying the categories, of which ASC-US was 48.67% (55/113), LSIL 7.96% (9/113), ASC-H 22.12% (25/113), High grade squamous intraepithelial lesion (HSIL) 17.69% (20/113), Squamous cell carcinoma 2.65% (3/113) and adenocarcinoma 0.88% (1/113). The chief complaints among women with abnormal cytology were pain in the lower abdomen (27.4%), white discharge per vaginum (22.1%) and bleeding per vaginum (15.0%). This study determines the first retrospective analysis of Pap smear finding through LBC in the state and highlights the deficiency of effective screening programme and testing facilities.

The effects of intrauterine device on cervico-vaginal smears with liquid-based cytology technique: A North-Eastern Anatolia region study in Turkey.

Intrauterine device (IUD), is one of the most efficient methods of contraception. The aim of study to investigate the effects of intrauterine device in cervicovaginal smears with liquid based cytology technique in our patient population. Cervicovaginal smears of 5492 patients who sought the services of the pathology department in a sixmonth period were reviewed retrospectively. Samples were prepared with liquid based cytology technique. The patients using IUD as contraceptive method (n= 562 cases) were included in the study. The samples taken with the conventional method were excluded from the study. The results were categorized according to the Bethesda system. The age range of the patients was 18-61 years (mean age: 34.6). The most common diagnosis was "negative for intraepithelial lesion or malignancy" (97.2%). In 307 patients (54.6%) there were infection and only in 93 out of them (30.2%) a specific agent was detected. Actinomyces (11%) were recorded as the most common infectious agent, followed by Gardnerella vaginalis (2.8%) and Candida species (2.4%). There were reactive changes in 134 cases (23.8%). In 13 cases (2.3%) epithelial cell abnormalities were detected. The most common cytopathologic diagnosis was ASC-US (atypical squamous cells of undetermined significance) in patients who had epithelial cell abnormalities (2.1%). In conclusion, IUDs increase the frequency of genital infection by disrupting the genital flora. In our study the most frequent agent was Actinomyces, and this rate was higher than some studies. This high rate for Actinomyces may be associated with IUDs that are frequently used for contraception in Erzurum province with long term uses.

Comparison of Conventional Pap Smears versus Liquid Based Cytology for Clinicopathological Patterns of Cervical Lesions at a Tertiary Care Centre, Bangalore, India

Introduction: Conventional Pap Smear (CPS) technique has been the mainstay for early detection of cervical cancer. However, its extensive use has not been possible due to the limitations, like presence of obscuring blood and inflammation, reducing its sensitivity markedly. False negativity of CPS is also very high so Liquid Based Cytology (LBC) was introduced. Aim: To compare cytomorphological patterns, diagnostic utility and adequacy of smears of cervical lesions on CPS and LBC. Materials and Methods: This study was a Prospective descriptive study, conducted in Department of Pathology of Dr. B R Ambedkar Medical College and Hospital, Bangalore for 19 months during November 2018 to May 2020 on 250 cases. The samples were taken with cervix-brush. First, a CPS was prepared and was immediately alcohol-fixed. After that same brush head was rinsed in LBC vial containing methanol. Statistical analysis was done using Statistical Package for Social Sciences 22.0 (SPSS) and R environment 3.2.2 for data analysis. Results: Most of the patients were in the fourth decade of life and 160 cases (64%) presented as white discharge per vaginum. Total 231 (92.4%) smears were satisfactory on CPS and 233 (93.2%) smears on LBC. The number of Low grade Squamous Intraepithelial Lesions (LSIL) increased from 4 cases (1.6%) in CPS to 6 cases (2.4%) in LBC in this study. Rate of detection of High grade Squamous Intraepithelial Lesion (HSIL) was more with LBC (11 cases, 4.4%) compared to that of CPS (7 cases, 2.8%). It was seen that in this study, sensitivity and specificity of LBC is better than CP in detecting LSIL and HSIL, but except specificity of CP was more than LBC in detecting LSIL. Present study showed overall sensitivity of 77.1% in CP and 94.3% in LBC and specificity of 97.2% and 100% in CP and LBC, respectively. The p-value calculated was &lt;0.001 which was highly significant. Conclusion: The LBC technique showed clear background, well preserved cytomorphological details, removal of extra mucus, blood and inflammatory cell infiltrate as compared to CPS technique. Atypical cells or abnormal cells were seen better and were detected more by LBC as compared to CPS.

Comparison of Morphological Similarities and Differences between Liquid-Based Cytology and Conventional Techniques of Serous Effusion Cytology Specimens

Introduction: The aim of this study is to discover a fast and efficient method for the diagnosis of serous effusion cytology specimens by comparing the cytomorphological features of SurePath (SP) smears and smears prepared by cytospin. After the macroscopic features of the incoming material were recorded, it was divided into 2 for conventional technique (CT) and liquid-based technique. Cytospin was used for CT and SurePath for liquid-based technique in this study. Materials and Methods: 243 serous effusions (33 thoracentesis and 92 paracentesis fluids, 118 peritoneal lavage fluids) were investigated. After shaking the effusion gently, it was centrifuged for 5 min at 1,250 rpm for cytospin smear. SP smear was prepared according to the “BD PrepStain slide processor”. Two smears were prepared with these 2 methods and then stained with Papanicolaou. The smears were examined under a light microscope in terms of fixation, background, cellularity, nucleus, and structural features. All statistical analysis of the data was performed using the SPSS 17.0 software. For each microscopic feature, the χ² test was used to assess the significance of the relationship between cytospin and SP, and level of agreement in between the methods was assessed using the kappa statistic. Results: A statistically significant difference was observed between the 2 methods in background (p < 0.001), cellularity (p < 0.001), nucleus features (p < 0.001), and structural features (p < 0.05). There was no significant difference in fixation. Low level of agreement was observed with the kappa statistic in fixation, background, and cellularity. Moderate level of agreement was observed in the nucleus and structural feature groups with the kappa statistic. Discussion/Conclusion: Although there are advantages of liquid-based technique such as standardized fixation and cleaner background, since the cellular and background components required for morphological analysis and diagnosis are better preserved in cytospin, it is considered to be better to use liquid-based technique not alone but together with CT.

Diagnostic value of liquid-based cytology test in intrathoracic lymph nodes and lung lesions sampled by endobronchial ultrasonography-transbronchial needle aspiration.

Liquid-based cytology (LBC) has begun to be used in non-gynecological samples such as endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA). This study aims to investigate the diagnostic value of LBC in intrathoracic lymph nodes and lung lesions sampled with EBUS-TBNA. In total, 174 cases that underwent EBUS-TBNA between July 2020 and February 2021 were included (75 and 99 cases were prepared using conventional and LBC methods, respectively). The two groups were compared in terms of diagnostic categories, number of slides, cell blocks, slides per location, locations sampled, immunohistochemical studies, sensitivity, specificity, and diagnostic accuracy. The percentages of malignant, suspicious for malignancy, benign, and non-diagnostic (ND) cases were 51.8%, 1.1%, 39.6%, and 7.5%, respectively. The LBC and conventional group (CG) had similar rates in the diagnostic categories, except for ND (3.0% and 13.3%, respectively). The sensitivity of LBC and CG were 90.4% and 85.7%, respectively. There were no differences in the specificity and diagnostic accuracy between groups. There was a statistically significant difference between groups in terms of the number of slides, number of slides per location, number of cell blocks, and locations sampled (p < .001, p < .001, p < .05, p < .05). The LBC technique can be used for samples taken with EBUS-TBNA. Rapid fixation and the absence of artificial problems greatly reduce the rate of ND samples in LBC slides. Other important advantages are a lower number of slides to examine and a greater number of cell blocks.

Comparison of EUS-guided conventional smear and liquid-based cytology in pancreatic lesions: A systematic review and meta-analysis.

Background and study aims Endoscopic ultrasound (EUS)-guided fine-needle aspiration (EUS-FNA) has limitations of inadequate sampling and false-negative results for malignancy. It has been performed using conventional smear (CS) cytology with rapid on-site evaluation (ROSE) with reasonable diagnostic accuracy. An alternative to ROSE is liquid-based cytology (LBC). Commonly used LBC techniques include precipitation-based (SurePath™) and filtration-based (ThinPrep ® , CellPrep ® ). Data regarding the diagnostic efficacy of LBC compared with CS are limited. Methods Multiple databases were searched through March 2020 to identify studies reporting diagnostic yield of EUS-guided CS and LBC in pancreatic lesions. Pooled diagnostic odds and rates of performance for the cytologic diagnoses of benign, suspicious, and malignant lesions were calculated. Diagnostic efficacy was evaluated by pooled rates of accuracy, sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV). Results Nine studies with a total of 1308 patients were included in our final analysis. Pooled diagnostic odds of CS cytology were 1.69 (CI 1.02–2.79) and 0.39 (CI 0.19–0.8) for malignant lesions when compared to filtration-based and precipitation-based LBC techniques, respectively. For CS, precipitation-based and filtration-based LBC, pooled diagnostic accuracy was 79.7 %, 85.2 %, 77.3 %, sensitivity was 79.2 %, 83.6 %, 68.3 %, and specificity was 99.4 %, 99.5 %, 99.5 %, respectively. Conclusions The precipitation-based LBC technique (SurePath™) had superior diagnostic odds for malignant pancreatic lesions compared with CS cytology in the absence of ROSE. It showed superior accuracy and sensitivity, but comparable specificity and PPV. Diagnostic odds of CS cytology in the absence of ROSE were superior to the filtration-based LBC technique (ThinPrep ® , Cellprep ® ) for diagnosing malignant pancreatic lesions.

S0053 Comparison of EUS-Guided Conventional Smear Cytology and Liquid Based Cytology in Pancreatic Lesions: A Systematic Review and Meta-Analysis

INTRODUCTION: EUS guided fine needle aspiration (EUS-FNA) has limitations of inadequate sampling and false-negative results for malignancy. Traditionally it has been performed using conventional smear (CS) cytology with sub-optimal diagnostic accuracy. The addition of rapid on-site evaluation (ROSE) to CS has been shown to improve sensitivity and sample adequacy. However, ROSE is not available in all healthcare centers. An alternative to ROSE is liquid-based cytology (LBC). Commonly used LBC techniques include precipitation-based (SurePath™) and filtration-based (ThinPrep®, CellPrep®). Data regarding the diagnostic efficacy of LBC compared to CS without ROSE is limited. METHODS: Multiple databases were searched through March 2020 to identify studies reporting diagnostic yield of EUS-guided CS and LBC in pancreatic lesions. Pooled diagnostic odds and rates of performance for the cytologic diagnoses of benign, suspicious, and malignant lesions were calculated. Diagnostic efficacy was evaluated by pooled rates of accuracy, sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV). RESULTS: 9 studies with a total of 1308 patients were included in our final analysis. None of the included studies utilized rapid on-site evaluation (ROSE). CS cytology performed significantly better than filtration-based LBC technique in diagnosing suspicious, and malignant pancreatic lesions [OR = 1.69 (1.02–2.79); P = 0.04, OR = 0.47 (0.27–0.8); P = 0.006]. For benign lesions, outcomes of the two techniques were comparable. Precipitation-based LBC performed significantly better than CS cytology in diagnosing malignant pancreatic lesions [OR = 0.39 (0.19–0.8); P = 0.01], but this effect was not seen with respect to benign lesions. For CS, precipitation-based and filtration-based LBC, pooled diagnostic accuracy was 79.7%, 85.2%, 77.3%, sensitivity was 79.2%, 83.6%, 68.3%, and specificity was 99.4%, 99.5%, 99.5%, respectively. CONCLUSION: Precipitation-based LBC technique (SurePath™) had superior diagnostic odds for malignant pancreatic lesions compared to CS cytology in the absence of ROSE. It showed superior accuracy and sensitivity, but comparable specificity and PPV. Diagnostic odds of CS cytology in the absence of ROSE were superior to filtration-based LBC technique (ThinPrep®, Cellprep®) for diagnosing malignant pancreatic lesions. In the absence of ROSE, precipitation-based LBC should be preferred over conventional smear technique in EUS-guided sampling of pancreatic lesions.Figure 1.: Odds Ratio - Forest Plot.Figure 2.: Pooled Rate - Forest Plot.