Manual Liquid-based Cytology Research Articles

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.

Cost-effectiveness of artificial intelligence-assisted liquid-based cytology testing for cervical cancer screening in China

The 2021 World Health Organization (WHO) guidelines for cervical cancer screening recommend human papillomavirus (HPV) DNA or mRNA testing. Artificial intelligence (AI)-assisted liquid-based cytology (LBC) systems also have the potential to facilitate rapid scale-up of cervical cancer screening. We aimed to evaluate the cost-effectiveness of AI-assisted LBC testing, compared with the manual LBC and HPV-DNA testing, for primary cervical cancer screening in China. We developed a Markov model for a cohort of 100,000 women aged 30 years over a lifetime to simulate the natural history of cervical cancer progression. We evaluated the incremental cost-effectiveness ratios (ICER) of 18 screening strategies (a combination of the three screening methods with six screening frequencies) from a healthcare provider's perspective. The willingness-to-pay threshold (US$30,828) was chosen as three times the Chinese per-capita gross domestic product in 2019. Univariate and probabilistic sensitivity analyses were performed to examine the robustness of the results. Compared with no screening, all 18 screening strategies were cost-effective, with an ICER of $622-24,482 per quality-adjusted life-year (QALY) gained. If HPV testing after scaling up to population level screening costs $10.80 or more, screening once every 5 years using AI-assisted LBC would be the most cost-effective strategy with an ICER of $8790/QALY gained compared with the lower-cost non-dominated strategy on the cost-effectiveness frontier. Its probability of being cost-effective was higher (55.4%) than other strategies. Sensitivity analyses showed that the most cost-effective strategy would become AI-assisted LBC testing once every 3 years if the sensitivity (74.1%) and specificity (95.6%) of this method were both reduced by ≥10%. The most cost-effective strategy would become HPV-DNA testing once every 5 years if the cost of AI-assisted LBC was more expensive than manual LBC or if the HPV-DNA test cost is slightly reduced (from $10.8 to <$9.4). AI-assisted LBC screening once every 5 years could be more cost-effective than manually-read LBC. Using AI-assisted LBC could have comparable cost-effectiveness to HPV DNA screening, but the relative pricing of HPV DNA testing is critical in this result. National Natural Science Foundation of China, National Key R&D Program of China.

DIAGNOSTIC ROLE OF MANUAL METHOD OF LIQUID BASED CERVICAL CYTOLOGY

Background: The introduction of the Pap test as a screening procedure to detect precancerous lesions has helped to reduce both the incidence and mortality of cervical cancer. In order to improve the sensitivity, specicity of the Pap test there has been a shift from conventional cytology to Liquid based cytology. A disadvantage of the Liquid based cytology is the high cost automated processing equipment. On the other hand, Manual Liquid-Based Cytology is a technique that also enables cells to be suspended in a monolayer similar to Liquid based cytology and improves detection of precursor lesions, specimen adequacy and also a cost effective strategy in limited resource setting. To compare the Objective: diagnostic utility of Manual liquid-based cytology versus Conventional pap smear in cervical cancer detection on cervical smears. Materials and Methods: In this prospective comparative study, 210 samples were collected for conventional pap smears and Manual Liquid-Based Cytology to compare the two methods and to correlate with histopathological diagnosis where specimen was available. The Manual Liquid-Based Results: Cytology showed sensitivity of 100% , specicity of 91.7% while conventional smears had sensitivity of 75% and specicity of 85.7%.The diagnostic accuracy of Manual Liquid-Based Cytology was 98% and that of conventional method was 78% The p value was less than 0.005 in Manual Liquid-Based Cytology (0.0001) and CPS (0.0001) methods considering histopathology as gold standard. This study Conclusion: showed that Manual Liquid-Based Cytology has a higher sensitivity and specicity than conventional pap smears.

English

BACKGROUND A long pathological process for investigation of precursor lesion squamous intraepithelial lesion (SIL) leads to invasive cervical cancer. This SIL can be detected much earlier before the lesion progresses to invasive cancer. For greater than fifty years, screening for cancer cervix was done by conventional scrape smears and stained by Papanicolaou [Pap] stain but conventional Pap smears (CPAP) have been reported to have low sensitivity. To overcome these drawbacks manual liquid-based cytology [MLBC] was introduced. The objective of this study was to screen females for cervical cancer using CPAP and MLBC techniques and compare the results of these techniques. METHODS Cervical cytology samples were obtained from 120 non-pregnant females through specialised Uprep cytobrush with a detachable head. Thus, obtained samples were first smeared onto a clean glass slide for CPAP smear, and the whole head to cytobrush was dropped into the specialised Uprep liquid preservative medium and processed by using Uprep Cytospin machine to obtain MLBC smears. Both the smears were stained by conventional Pap stain and reported according to 2014 Bethesda system. RESULTS In this study, the CPAP method had a greater number of unsatisfactory smears than that of MLBC method which was statistically significant. MLBC identified more number of intraepithelial lesions when compared to CPAP and MLBC had an increased detection rate [IDR] of 73.68 % over CPAP. CONCLUSIONS Analysis of our results showed that MLBC had more advantages over CPAP. Since the cost effective MLBC has an improved rate of detection of abnormal lesions, MLBC can be used as a routine technique for screening of cancer cervix in India. Also, MLBC offers an important advantage of performing both human papillomaviruses deoxyribonucleic acid (HPV DNA) test and cytological analysis on a single sample. KEYWORDS Cervical Cancer, Conventional Pap Smear, Manual Liquid Based Cytology, Human Papilloma Virus (HPV DNA), Bethesda System

Cell blocks prepared from gynaecologic liquid based specimens: as a source for further ancillary techniques

Background: Cervical cancer is the second most common cancer among women worldwide and leading causes of cancer deaths amongst women. Cell blocks prepared from liquid-based specimens can serve as a useful adjunct and cell blocks can be further subjected for ancillary molecular techniques. Materials and Methods: In the present study 60 cell blocks were prepared from Manual liquid-basedcytology (MLBC) specimen collected in liquid fixative. Results were compared with cytology smears and histopathological correlation was obtained in 19 cases. P16 and Ki67 were used whenever required. Results: In the present study out of 60 cases of cell blocks 10 cases had no deposit. Of the other 50 cases, 7 cases (14%) were neoplastic and 43(86%) were non-neoplastic. The sensitivity and specificity of cell block, LBC and CPS were 75% and 93%, 66% and 84%, 50% and 70% respectively for neoplastic lesions of cervix. Concordance Rate of CB/Histopathology Vs CPS/Histopathology is 74% vs. 54%. Ki 67 and p16INK4a were used whenever sample was sufficient. Conclusion: In the present study we found that cell blocks prepared from the LBC specimens aid in the diagnosis of neoplastic lesions of cervix and are particularly valuable in distinguishing carcinoma cervix from intraepithelial lesions. Cell blocks can be further subjected to ancillary tools like immunohistochemistry and HPV- DNA testing.

Study of Efficacy of Manual Liquid Based Cytology (MLBC) in Fine Needle Aspiration Samples

Study of Efficacy of Manual Liquid Based Cytology (MLBC) in Fine Needle Aspiration Samples

Comparison of conventional smear cytology and manual liquid based cytology based on smears from normal oral exfoliated cells

Liquid-based cytology (LBC), since its inception in the 1990s, has shown significant advantages over conventional exfoliative cytology. LBC gives better results than conventional method as it not only enhances both sensitivity and specificity, but also provides material for further investigations. However, LBC requires expensive automated devices and materials, which might not be affordable for many cytopathology laboratories in countries with poor resources. In order to formulate an economic cytological procedure with the accuracy of LBC, smears made out of manual liquid based cytology (MLBC) technique was followed in this study and the results were compared with respective conventional cytology smears. To the authors’ knowledge, this is the first comparative study between MLBC and conventional method done for oral cavity in normal buccal mucosa. One hundred apparently normal subjects who reported to the outpatient department were selected after obtaining informed consent from all the subjects. Two Scrapings were made in each patient from the clinically normal appearing buccal mucosa. Both conventional and MLBC smears were stained by routine Papanicolaou technique and evaluated by three independent observers for specimen adequacy, thickness of the smear, uniformity of cell distribution, clarity or resolution of the cells, presence of background artifacts, and staining characteristics of the cells. Each parameter was graded as satisfactory; satisfactory but limited; or unsatisfactory. Number of satisfactory results obtained in MLBC smears was significantly higher than that by conventional smears. After comparison of smears prepared from conventional cytology and manual liquid-based cytology, we conclude that manual liquid-based cytology is both cost effective and also technically sound method with specific and clear results.

Graph-based segmentation of abnormal nuclei in cervical cytology

A general method is reported for improving the segmentation of abnormal cell nuclei in cervical cytology images. In automation-assisted reading of cervical cytology, one of the essential steps is the segmentation of nuclei. Despite some progress, there is a need to improve the sensitivity, particularly the segmentation of abnormal nuclei. Our method starts with pre-segmenting the nucleus to define the coarse center and size of nucleus, which is used to construct a graph by image unfolding that maps ellipse-like border in the Cartesian coordinate system to lines in the polar coordinate system. The cost function jointly reflects properties of nucleus border and nucleus region. The prior constraints regarding the context of nucleus-cytoplasm position are utilized to modify the local cost functions. The globally optimal path in the constructed graph is then identified by dynamic programming with an iterative approach ensuring an optimal closed contour. Validation of our method was performed on abnormal nuclei from two cervical cell image datasets, Herlev and H&E stained manual liquid-based cytology (HEMLBC). Compared with five state-of-the-art approaches, our graph-search based method shows superior performance.

Conventional pap (papanicoloau) smear cytology in primary screening of cervical lesions &amp; its comparison with manual liquid based cytology

Background: Conventional pap smear (CPS) examination has been the mainstay for early detection of cervical cancer. However, its widespread use has not been possible due to the inherent limitations, like presence of obscuring blood and inflammation, reducing its sensitivity considerably. Aims & Objectives: The study was performed to compare the efficacy of Manual Liquid based Cytology (MLBC) with CPS and to find out whether MLBC can be established for routine use in our laboratory setup. Materials & Methods: Cervical smears were collected by the gynaecologist using Ayre’s spatula and cytobrush for the conventional Pap smear method and are suspended in a liquid medium for manual liquid based cytology technique. In this study, cervical screening was performed in 481 cases, all were married women of reproductive age group who visited Department of Obstetrics and Gynaecology over a period of one year from July 2014 to June 2015. Slides were examined for cytomorphological parameters. The details regarding cell size, cytoplasmic and nuclear details were studied for making the diagnosis. Result: The sensitivity of CPS in detecting cervical lesions is 95% and by MLBC is 50% while the specificity was 86% with CPS technique and 69% by MLBC technique. Conclusion: The cellular features are better in MLBC as compared to CPS and also background is more clear in MLBC as there was no obscuration by RBCs or inflammatory cells while in CPS, the background is dirty due to the presence of RBCs, necrosis and inflammation. Keywords: Conventional Pap Smear, Manual Liquid based Cytology, Pap smear, Cervical cytology

Manual Liquid Based Cytology in Diagnosis of Gynecologic Pathology

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. <b>Objectives </b>: 1. To improve 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. <b>Methodology </b>: 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. <b>Results </b>: 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/HistopathologyVs CPS/Histopathology was 74% vs. 54%. <b>Conclusion </b>: MLBC is a cost effective method for detections of cancerous lesions of endometruim and cervix.

Utility of manual liquid-based cytology and conventional smears in the evaluation of various fine-needle aspiration samples.

Background:Liquid-based cytology (LBC) preparation is a way to improve and refine the fine-needle aspiration (FNA) samples. There are a few studies comparing LBC with conventional smear (CS).Aim:The present study was undertaken to evaluate the utility of manual LBC (MLBC) and CS preparations in various FNA samples.Materials and Methods:In this cross-sectional study, a total of 100 FNA samples from various anatomical sites were evaluated using MLBC and CS preparations. Cellularity, blood, informative background, monolayers, cell architecture, cytoplasmic, and nuclear preservation were compared with MLBC and CS preparations by Wilcoxon signed rank test. P < 0.05 is considered statistically significant.Results:MLBC preparations were superior to CS preparations in view of absence of blood and debris (P = 0.001), presence of monolayers (P < 0.001), and preservation of cytoplasmic (P = 0.001) and nuclear details (P = 0.001). However, no statistically significant differences were found between MLBC and CS preparations with regard to cellularity (P = 0.157), informative background (P = 0.083), and architecture (P = 0.739).Conclusion:MLBC preparations in FNAC are a safe, easy, and less time-consuming procedure, and it may have promising diagnostic value in the evaluation of FNA samples from various anatomical sites. However, the use of both MLBC and CS preparations is recommended to achieve optimal diagnostic yield.

Manual liquid based cytology for Pap smear preparation and HPV detection by PCR in Pakistan.

This study was conducted on female patients with different gynecological problems attending the gynecology out-patient departments of two tertiary care hospitals in Peshawar city of Khyber Pakhtunkhwa, Pakistan between August 2012 and October 2013. The 200 patients had an age range of 21-65 years. Smears were taken with cervical brushes and preserved in preservative medium and processed for manual liquid based cytology (MLBC) for Pap staining. Out of 200 collected samples, 30 samples were found inadequate on cytology. Of the remaining 170 samples, 164 (96.47%) were normal, 5 (2.94%) were of atypical squamous cells of unknown significance (ASCUS) and 1 (0.6%) was of high grade squamous intraepithelial lesion (HSIL). On PCR all the samples were positive for beta globin gene fragment including those reported inadequate on cytology. Out of the 5 ASCUS samples, 2 samples were positive for HPV, one each for HPV 16 and HPV 18, and the rest of the 3 samples were negative for HPV DNA. The 1 sample of HSIL was positive for HPV 16 on PCR. Out of 164 normal samples on cytology, only 1 sample was HPV 16 positive. So overall, 4 (2%) out of 200 samples were positive for HPV DNA, where 3 were HPV 16 (1.5%), and 1 was HPV 18 (0.5%) positive, and thus the ratio of infection with of HPV 16 to HPV 18 was 3:1 in the general population. In conclusion, PCR based HPV detection is a more sensitive method for screening of HPV infection than cytology as sample inadequacy does not affect the results. However, it can be combined with cytology methods in a HPV positive female to achieve the maximum results.

Efficacy of Manual Liquid Based Cytology over Conventional Cytology in Oral Squamous Cell Carcinoma

Context/Background: Oral cytology has come long way from its primitive Papanicolau days. Liquid Based cytology has shown significant advantages over conventional exfoliative cytology. However, LBC requires expensive automated devices and materials which might not be affordable for many cytopathological laboratories in countries with limited resources. Manual liquid Based Cytology (MLBC) is a technique that enables cells to be suspended in a monolayer and thus improves detection of lesions and improvement of adequacy. Aim: To study and evaluate the diagnostic efficiency and reliability of MLBC in comparison with conventional PAP smear (CPS) of oral squamous cell carcinoma. Materials and Methods: Two smear were prepared from 50 patients, clinically diagnosed with Oral Squamous Cell Carcinoma. Each smear was subjected to MLBC and CPS methods. The slides were evaluated by two pathologists for the staining characterstics of nucleus and cytoplasm. The diagnostic efficiency of each smear was evaluated by comparing the cytological diagnosis of each method with histopathological diagnosis. Results: Increased detection rate with MLBC was 29.41%. Identifying cellular atypia by MLBC was more sensitive (44%) compared to CPS (34%) with similar specificity (100%). The percentage agreement by the two methods was 77.28%. Conclusion: MLBC is an easy, cost effective technique comparable to CPS; however, it warrants further study in its potential application in screening of oral precancer and cancer.

Comparison of specimen adequacy and smear quality in oral smears prepared by manual liquid-based cytology and conventional methods.

Background:Liquid-based cytology (LBC), recommended in the mass screening of potentially malignant cervical and oral lesions, suffers from high cost owing to the use of expensive automated devices and materials. Considering the need for cost-effective LBC techniques, we evaluated the efficacy of an inexpensive manual LBC (MLBC) technique against conventional cytological technique in terms of specimen adequacy and smear quality of oral smears.Materials and Methods:Cytological samples were collected from 21 patients using a cytobrush device. After preparation of a conventional smear, the brush containing the remaining sample was immersed in the preservative vial. The preserved material was processed by an MLBC technique and subsequently, direct smears were made from the prepared cell button. Both conventional and MLBC smears were stained by routine Papanicolaou technique and evaluated by an independent observer for the thickness of the smear, cellular distribution, resolution/clarity of cells, cellular staining characteristics and the presence of unsatisfactory background/artifacts. Each parameter was graded as satisfactory; or satisfactory, but limited; or unsatisfactory. Chi-square test was used to compare the values obtained (significance set at P ≤ 0.05).Results:MLBC technique produced a significant number of satisfactory smears with regard to cell distribution, clarity/resolution, staining characteristics and background/artifacts compared to conventional methods.Conclusions:MLBC is a cost-effective cytological technique that may produce oral smears with excellent cytomorphology and longer storage life.

Manual Liquid-Based Cytology: A Clinical Pilot Study of the VitroPrep™ Cytology Processing Kit

Objective: It was the aim of this study to assess the utility of the manual liquid-based cytology (LBC) product VitroPrep™ Cytology Processing Kit (ChemQ Bioscience LLC, Research Triangle Park, N.C., USA). Study Design: This is a descriptive pilot study. Women underwent cervical sampling processed by the ThinPrep™ automated LBC system followed by cervical sampling for the VitroPrep manual system. The following criteria were assessed on a scale of 1-5 (1 = unsatisfactory, 2 = borderline, 3 = acceptable, 4 = good, 5 = excellent): monolayer cell adhesion, overall cellularity, background clarity, preservation of cellular morphology, red cell lysis, and elimination of mucus/debris. Cytological diagnosis was compared to results from ThinPrep samples. In addition, VitroPrep samples were taken prior to conization procedures and compared to pathology results. Descriptive statistics were performed. Results: Forty-two of 47 women who underwent dual cytologic sampling had satisfactory samples. All scores were 3-5, with >90% graded 4-5. The VitroPrep diagnosis correlated with the ThinPrep diagnosis in 90% (38/42) of cases. All specimens obtained from 15 women prior to conization were satisfactory and correlated abnormal cytologic findings with cervical intraepithelial neoplasia 1-3 pathology. Conclusions: The VitroPrep Cytology Processing Kit was able to provide adequate specimens for evaluation and diagnosis. This low-cost processing kit may provide a useful alternative in settings where automated LBC systems may not be feasible.

Comparison of Cervical Cell Morphology Using Two Different Cytology Techniques for Early Detection of Pre-Cancerous Lesions

Cervical cancer is an issue of foremost importance globally, specifically affecting the developing nations. Significant advances have taken place with regard to diagnosis of cervical cancer, especially with screening. Appropriate screening measures can thus reduce the incidence of cervical cancer. The most desirable screening technique should be less invasive, easy to perform, cost-effective and cover a wide range of diagnostic icons. Manual liquid based cytology (MLBC) can be considered as one of the suitable technique for screening with the above-mentioned benefits. The aim of the current study was to compare two cervical screening techniques on the basis of different morphological parameters and staining parameters by using modified acetic acid Pap staining to see the possibility of reducing time economy involved in conventional Pap staining (CPS). The study was conducted on a total 88 cases and all were analyzed with both MLBC and CPS. Forty eight cases that were regarded as satisfactory on the basis of Bethesda system by both methods were further recruited for investigation. Their morphological parameters and staining quality were compared and scored according to a scoring system defined in the study. Quality indices was calculated for both staining procedures and smear techniques.

Comparative study of manual liquid-based cytology (MLBC) technique and direct smear technique (conventional) on fine-needle cytology/fine-needle aspiration cytology samples.

Background:Liquid-based cytology technique enables cells to be suspended in a liquid medium and spread in a monolayer, making better morphological assessment. Automated techniques have been widely used, but limited due to cost and availability.Aim:The aim was to establish manual liquid-based cytology (MLBC) technique on fine-needle aspiration cytology (FNAC) material and compare its results with conventional technique.Materials and Methods:In this study, we examined cells trapped in needles hub used for the collection of FNAC samples. 50 cases were examined by the MLBC technique and compared with the conventional FNAC technique. By centrifugation, sediment was obtained and imprint was taken on defined area. Papanicolaou (Pap) and May-Grünwald Giemsa (MGG) staining was done. Direct smears and MLBC smears were compared for cellularity, background, cellular preservation, and nuclear preservation. Slides were diagnosed independently by two cytologists with more than 5 years’ experience. Standard error of proportion was used for statistical analysis.Results:Cellularity was low in MLBC as compared with conventional smears, which is expected as remnant material in the needle hub was used. Nuclei overlap to a lesser extent and hemorrhage and necrosis was reduced, so cell morphology can be better studied in the MLBC technique. P value obtained was <0.05.Conclusion:This MLBC technique gives results comparable to the conventional technique with better morphology. In a set up where aspirators are learners, this technique will ensure adequacy due to remnant in needle hub getting processed

Automation‐assisted cervical cancer screening in manual liquid‐based cytology with hematoxylin and eosin staining

Current automation-assisted technologies for screening cervical cancer mainly rely on automated liquid-based cytology slides with proprietary stain. This is not a cost-efficient approach to be utilized in developing countries. In this article, we propose the first automation-assisted system to screen cervical cancer in manual liquid-based cytology (MLBC) slides with hematoxylin and eosin (H&E) stain, which is inexpensive and more applicable in developing countries. This system consists of three main modules: image acquisition, cell segmentation, and cell classification. First, an autofocusing scheme is proposed to find the global maximum of the focus curve by iteratively comparing image qualities of specific locations. On the autofocused images, the multiway graph cut (GC) is performed globally on the a* channel enhanced image to obtain cytoplasm segmentation. The nuclei, especially abnormal nuclei, are robustly segmented by using GC adaptively and locally. Two concave-based approaches are integrated to split the touching nuclei. To classify the segmented cells, features are selected and preprocessed to improve the sensitivity, and contextual and cytoplasm information are introduced to improve the specificity. Experiments on 26 consecutive image stacks demonstrated that the dynamic autofocusing accuracy was 2.06 μm. On 21 cervical cell images with nonideal imaging condition and pathology, our segmentation method achieved a 93% accuracy for cytoplasm, and a 87.3% F-measure for nuclei, both outperformed state of the art works in terms of accuracy. Additional clinical trials showed that both the sensitivity (88.1%) and the specificity (100%) of our system are satisfyingly high. These results proved the feasibility of automation-assisted cervical cancer screening in MLBC slides with H&E stain, which is highly desirable in community health centers and small hospitals.

P5.018 Improved Diagnosis of Non-Neoplastic Conditions of Cervix by Liquid Based Cytology, Cellbock in Comparison with Conventional Pap Smear Method

Background The Papanicolaou (Pap) smear is the most successful screening test for carcinoma of cervix, mainly as a result of its simplicity, low cost, low false-negative rate and its early detection of preneoplastic lesions. It is also used to diagnose several infectious agents that manifest with specific cytologic features. The diagnoses of candida, trichomonas, herpes simplex virus, HPV and bacterial vaginosis can be reliably rendered on Pap smears. Conventional pap smear (CPS) has its limitations. False negatives in CPS may be related to inadequate sampling, inadequate transfer of the sample onto the glass slide or deficiencies in the microscopic assessment of the slide. To overcome these problems, a new slide preparation method namely the Manual Liquid Based Cytology (MLBC) was introduced, where cells are uniformly dispersed by a membrane, from a suspension of cells in a polymer solution. MLBC helps in detecting number of infestations like Candida, Leptothrix, HPV with koilocytic atypia and bacterial vaginosis, as observed by many authors and us also. MLBC, which we are following is inexpensive, cost effective method which we have adapted and are comparing it with CPS for its adequacy and utility. The other advantages, is that the residual specimens can be used for ancillary testing like immunocytochemistry by cell block preparation. Results Number of cases of bacterial vaginosis diagnosed by CPS were 8, LBC 9 and cell block were zero. trichomonas were 4, by CPS and LBC,2by cell block., herpes was 1 by all three methods,inflammatory (NILM) cases were 22 by CPS,26 by LBC,12 by cell block. Inadequate smears were 5 by CPS, NIL by LBC,25 by cell block Conclusion CPS and LBC with cell block are useful methods in detection of non neoplastic conditions of cervix. LBC has increased the diagnostic accuracy by 13% in our study.

Manual Liquid Based Cytology in Primary Screening for Cervical Cancer - a Cost Effective Preposition for Scarce Resource Settings

Conventional pap smear (CPS) examination has been the mainstay for early detection of cervical cancer. However, its widespread use has not been possible due to the inherent limitations, like presence of obscuring blood and inflammation, reducing its sensitivity considerably. Automated methods in use in developed countries may not be affordable in the developing countries due to paucity of resources. On the other hand, manual liquid based cytology (MLBC) is a technique that is cost effective and improves detection of precursor lesions and specimen adequacy. Therefore the aim of the study was to compare the utility of MLBC with that of CPS in cervical cancer screening. A prospective study of 100 cases through MLBC and CPS was conducted from October 2009 to July 2010, in a Medical College in India, by two independent pathologists and correlated with histopathology (22 cases). Morphological features as seen through MLBC and CPS were compared. Subsequently, all the cases were grouped based on cytological diagnosis according to two methods into 10 groups and a subjective comparison was made. In order to compare the validity of MLBC with CPS in case of major diagnoses, sensitivity and specificity of the two methods were estimated considering histological examination as the gold standard. Increased detection rate with MLBC was 150%. The concordance rate by LBC/histopathology v/s CPS/histopathology was also improved (86% vs 77%) The percentage agreement by the two methods was 68%. MLBC was more sensitive in diagnosis of LSIL and more specific in the diagnosis of inflammation. Thus, MLBC was found to be better than CPS in diagnosis of precursor lesions. It provided better morphology with increased detection of abnormalities and preservation of specimen for cell block and ancillary studies like immunocytochemistry and HPV detection. Therefore, it can be used as alternative strategy for cervical cancer prevention in limited resource settings.