Screening for cervical cancer has resulted in the reduction of incidence of cancercervix and its complications. Papsmear has been used for the screening purpose since 1940’s but studies have shown that the sensitivity of a single Pap test is low and it has high false negative rate .This is said to be due to improper sampling and ineffective interpretation. In Papsmear only 20% of the scraped cells in the Ayer’s spatula are transferred to the slide while smearing, which is done manually. Therefore alternative screening methods which overcome these pitfalls in Papsmear is developed, one such method is LiquidBasedCytology where all the scraped cells in the cyto brush are transferred in the liquid transport medium to the laboratory where it is processed and a uniform thin layer of smear is prepared in the laboratory than manually. This study is done for evaluating the performance of LiquidBasedCytology and for doing comparativestudy of the sensitivity of LBC and the conventional Pap method.
This is to certify that this dissertation in "A COMPARATIVESTUDY & ANALYSIS OF OUTCOMES OF PAPSMEAR VERSUS LIQUIDBASEDCYTOLOGY WITH HISTOLOGY AS REFERENCE STANDARD IN CANCERCERVIXSCREENING" is a work done by Dr.M.S.MANICKADEVI, under my guidance during the period 2004 - 2007. This has been submitted in partial fulfillment of the award of M.D. Degree in Obstetrics and Gynaecology, (Branch -II) by the Tamil Nadu Dr.M.G.R. Medical University, Chennai - 600 032.
methods are available like cytology by Papsmear, visual inspection of cervix with acetic acid and/or Lugol’s iodine, HPV- DNA Test, Liquidbasedcytology etc. Papsmear is an effective method of cervical cancerscreening. It is the laboratory method to examine the exfoliated or scraped cells to detect dysplasia. It is a simple routine outpatient procedure which is less expensive, with minimal or no side-effects, easy to do with higher specificity, done without anesthesia. It also detects various infection and inflammation with characteristic cytological appearances. Before 2012 cervical cancerscreening guidelines of the American College of Obstetricians and Gynecologists (ACOG), American Cancer Society (ACS) and U.S. Preventive Services Task Force (USPSTF) differed on age to start and how often to get screened for cervical cancers. In 2012, all the three-organization recommended that: 6
Conventional cervical cytology is a simple, cost effective method of cervical cancerscreening that has been in use for more than 50 years and is still a highly effective screening procedure. It is widely used because of easy method of preparation of slides and interpretation of results. In our study most of the Conventional preparations showed cellular overlapping, inflammatory cells, blood and mucus that obscure the epithelial cell morphology which was much reduced in LP &MLBC. Inspite of this conventional cytology is a sensitive method of cervical screening and it detected all cases of intraepithelial lesions in our study. Comparison of morphological details and results of cervical cytology smears by all the three methods showed that LiquiPrep method provides more representative sample with reduced obscuring material which allows better morphological evaluation. LP method also generated higher number of satisfactory smears compared to conventional smears & MLBC. In addition LP method detects more cases of intraepithelial lesions when compared to MLBC.
The Papsmear has been utilized for cervical cancerscreening for more than 50 years. Despite being credited with a 70% reduction in mortality for cervical cancer, the false negative rate is still a cause for concern. It is widely acknowledged that two third of the overall false negative rate can be attributed to sampling errors. 11 Liquidbasedcytology has been developed to address the sampling problems of conventional Papsmear. In our study, 200 women were screened and their interpretation by both methods was compared. Most of the symptomatic patients who were screened belonged to the age group 36-45 years (36.5%) followed by 25-35 years (35.5%) which was similar to Sherwani et al 12 who studied 160 random cases out of which 48.1% cases belonged to fourth decade of life. Positive cases in which epithelial abnormalities were seen such as ASCUS, LSIL and HSIL were found to be positive mostly between age group 46- 55 years i.e. 12 patients (42.8 %) similar to other studies like that of Terence Colgan et al. 13 Most common symptom, was irregular bleeding in 57.5 % cases (115 cases), followed by pain lower abdomen in 54.5 % cases (109 cases) and post menopausal bleeding seen in 15 % cases (30 cases) and growth or ulceration over cervix seen in 5 % cases (10 cases). This was discordant with most of the other studies which observed white discharge per vaginum as the complaint in most of the patients
Cervical carcinoma is the most common malignancy among women in developing nations.  In India, cervical cancer ranks number one among genital cancer in females with an annual incidence of more than 132,000 and around 74,000 deaths every year.  It is a potentially preventable cancer. It is preceded by premalignant lesions which may take 5-15 years to progress to invasive cancer. If detected and treated timely, preinvasive disease has 100 per cent cure rate with simple surgical procedure, while advanced cancers have less than 35 per cent survival rate. Fortunately, cervix is that portion of the genital tract which is easily accessible to examination and screening.
INTRODUCTION: In developing country like India cervical malignancy is a common, preventable and curable cause of morbidity and mortality .Worldwide papsmear is the most commonly used screening test for cervical lesions .VIA guided biopsy has been defined to be the gold standard method in diagnosing precancerous lesions of the cervix & used in evaluation and management of cervical lesions. In present study we compare clinical performance of Visual Inspection With acetic acid (VIA), as a simple screening test and if it (VIA) would be an adequate alternative to PAPSMEAR , in the screening for cancercervix in low resource settings. METHOD: A cross sectional study was conducted in a tertiary care referral institute in 100 symptomatic women of 30-70 years. PAP smears were performed by the conventional method and VIA was done for all 100 women who came with complaints of white discharge per vagina, intermenstrual, or postcoital bleeding, etc. Final correlation of the PAPsmear and VIA were based on biopsy reports.
The details of the study have been explained to me in writing and the details have been fully explained to me. I am aware that the results of the study may not be directly beneficial to me but will help in the advancement of medical sciences. I confirm that I have understood the study and had the opportunity to ask questions. I understand that my participation in the study is voluntary and that I am free to withdraw at any time, without giving any reason, without the medical care that will normally be provided by the hospital being affected. I agree not to restrict the use of any data or results that arise from this study provided such a use is only for scientific purpose(s). I have been given an information sheet giving details of the study. I fully consent to participate in the study titled ” DIAGNOSTIC EFFICACY OF THIN PREP PREPARATION(LIQUIDBASEDCYTOLOGY) IN COMPARISON TO CONVENTIONAL PAPSMEAR AS A PRIMARY SCREENING TOOL FOR CERVICAL LESIONS.”
This is a comparative prospective study conducted at the Department of Pathology and Department of Obstetrics and Gynaecology, government medical college, Datia for the period of 11 months from April 2018 to February 2019. Data collection was done from women attending Gynaecology OPD with complaints of symptoms related to cervical lesion and unhealthy cervix at government medical college hospital, Datia were included in study after written consent. The study includes total 80 subjects. Total No. of Papsmear examined (both LBC and CPS) are 160
The Norwegian co-ordinated CC screening programme was introduced in 1995 and 71% of the women 25–69 years of age in Norway had a Papsmear in 1998 to 2000 . More than 50% of the CC cases diagnosed however among the remaining group of non-participants, consti- tuting a population at high-risk of cervical cancer . To minimize the costs of early detection of CC for society, only women without a normal Papsmear in a three years period are identified from the registry files and are invited to be screened . Not all women attend following the invitation; in a Swedish study it was reported that non- attendance to cervical screening was positively associated with time-consuming and economical barriers . The peak age of incidence of pre-cancerous lesions of the cervix peaks with the occurrence of pregnancies in the age range 25–35 [15,16]. From this perspective, antepartum care presents an opportunity to offer a Papsmear to women who otherwise might not go for routine health check-ups, and a means to increase coverage of the pro- gramme. Screening of this population can however cause "over-screening" given many of these women might have had a Pap shortly before the start of the pregnancy. Under- standing the potential differences in the actual pattern of Papsmear taking activity among pregnant and non-preg- nant women would help public health policy makers to recognise conflicting attitudes towards screening and to evaluate the effect of antepartum Papsmear as a routine activity.
There are multiple screening techniques including con- ventional cytology (CC) and liquidbasedcytology (LBC). 2 CC, also called the Papanicolaou or Pap test has been around for over 50 years and has been the standard screen- ing technique in Germany since screening began in the 1970s. 2,11,12 The test involves a sample of cells being taken from the cervix and smeared directly onto a glass slide. 13 Since then, LBC has been introduced in a number of developed countries, such as New Zealand, the United Kingdom and the United States of America. 14 – 16 With LBC, the sample of cervical cells is collected and rinsed in a vial of preservative solution. 11 The vial containing the suspended cells in solution is transferred to a cytology processor that is used to place a uniform layer of cells on a slide. 13 It has been reported that LBC yields a better representation of the cells than CC and fewer inadequate results. 13,17 LBC also has the advantage that the residual liquid sample can also be used for HPV testing, if required. 2 The current German guidelines invite women for an annual cytology cervical screen, although these guide- lines are changing. 18,19 From 2020, women between 20 and 34 years of age will be offered an annual cytology cervical screen. Women who are 35 years of age and above (with no upper age limit) will be offered a combined cytology and HPV test every three years. 19 The objective of this study was to investigate the cost- effectiveness and cost-bene ﬁ t of cervical screening with
Bangalore to compare HPV DNA test with Papsmear in the screening of cervical neoplasia (CIN I, CIN II, CIN III and Squamous Cell Carcinoma). Study was conducted over the period of 24 months from August 2011 to June 2013.The history of each patient was obtained following which a general physical and gynecological examination was performed. All patients underwent routine cervical smearcytology and HPV DNA test. Papsmear in women aged more than 30 years is done routinely as the protocol of the hospital. For HPV DNA test, consent was taken in high risk patients, example women with contact bleeding, recurrent vaginal discharge, hypertrophied cervix and cervical erosion on clinical findings.
Cytology is the study of cells. Each cell performs its predestined function and passes away to leave its place to a new cell. This fundamental biological law finds a most typical expression in the epithelial tissues, i.e., the skin and the mucous membranes. These tissues, because of their exposure to the action of extraneous factors, are subjected to an extensive falling or shedding of their superficially located cells. As these cells are lost, their places are promptly taken by new cells growing from undifferentiated basal layer of epithelium, which is endowed with an inherent high potentiality for proliferation and growth. The Indian Council of Medical Research (ICMR) stated that in 2016 the total number of new cancer cases is expected to be around 14.5 lakh and the figure is likely to reach nearly 17.3 lakh new cases in 2020. Over 7.36 lakh people are expected to succumb to the disease in 2016 while the figure is estimated to shoot up to 8.8 lakh by 2020. Data also revealed that only 12.5 per cent of patients come for treatment in early stages of the disease. Among females, breast cancer topped the list and among males mouth cancer, the study said.
VIA is based on the premise that the majority of preinvasive and invasive cervical lesions are visible on examination by the naked-eye after application of acetic acid. It involves insertion of a vaginal speculum and application of 3%–5% acetic acid solution using a cotton swab. After 5 minutes, the cervix is inspected under illumination of a halogen lamp. If there is an acetowhitening area present, the result of the test is positive. The test is negative when there is no acetowhitening area. The normal squamous epithelium tissue of the cervix is pink. On application of acetic acid, cervical intraepithelial neoplasia (CIN) lesion takes on a white color due to the increased precipitation of nuclear proteins and cytokeratins in the cervical epithelium. 9
abnormalities. After the application of 5% acetic acid and Lugol's iodine over the cervix and the abnormal areas are identified and treated according to the findings. The colposcopy, Papsmear, Liquid-basedcytology, colposcopy-directed biopsy are the four methods by which the cervix can be studied for evidence of early malignant change. They are simple OPD procedures requires no anesthesia. In present study, we compare the efficiency of colposcopic VIA, VILI, LIQUIPREP TM, and conventional papsmear; as a screening procedure for carcinoma cervix. We can also do the correlation between cytological and histological findings with cervical biopsy as the gold standard, the correlation between colposcopy and histological findings with cervical biopsy as the gold standard and compare the efficacy between conventional Papsmear with liquid-basedcytologysmear, compare the cytological and visual inspection findings with colposcopic directed biopsies. 5,6 Also, we evaluate the
LiquidBasedcytology techniques reduce the average lifetime number of smear tests for a woman primarily from the reduction of inadequate slide production and consequential reduction in rescreening. The average number of Colposcopies is expected to increase as the number of borderline and screening test results increases. The differences in sensitivity and specificity between LBC, PAPsmear and colposcopy in detection of premalignant lesions were analyzed using the chi square test. The sensitivity of LBC (89.5%) was significantly higher than sensitivity of PAPsmear (47.37%). P <0.001. The specificity of PAPsmear (95.06%) was higher than LBC (77.16%). The statistical analysis between LBC and PAPsmear; LBC and colposcopy were significant (P=0.000<0.05)
The following observations were made in present study and the results were analysed. The mean age was44.09 ±5.19 years in the study population, the lowest age was 35 years and the highest age was 57 years. (95% CI 43.15 to 45.03). The mean age at marriage was 18.32±2.63 years, the lowest age was 13 years and the highest age was 25 years. (95% CI 17.84 to 18.79), and mean duration of married life was 25.58 ± 6.63 years with minimum of 14 years and maximum of 45 years in the study population (95%CI 24.38 to 26.78). Among the study population the number of women in parity P1, P2, P3, P4, P5 and P6 were 3 (2.50%), 69 (57.50%), 30 (25.00%),8 (6.67%), 7 (5.83%), and 3 (2.50%) respectively. The majority 88 (73.33%) of the study population underwent tubectomy. The proportion of women using a barrier method of contraception and OCPS was 7(5.83%) and 3(2.50%) respectively. Regarding socio economic status 66 (55.00%) were in lower class, 50 (41.67%) were in middle class and 4 (3.33%) were in upper class (Table 1).
A conservative estimate of global prevalence based upon 2000 data suggests that there are nearly 1.4 million cases of clinically recognized cervical cancer (based on the number of patients still alive five years after diagnosis).1 The vast majority of these cases occurred in developing countries. This estimate reflects the accumulation of cases each year and the fact that few women in developing countries receive treatment. Current knowledge of the natural history of cervical cancer suggests that two to five times as many women may have potential precursor conditions of cervical cancer as have invasive cancer. Therefore, as many as 7,000,000 women worldwide may have high-grade dysplasia that should be identified and treated.
In this study, due consideration was given to age, sex, site of effusion, clinical and radiological findings, to arrive at a final diagnosis and also to identify the primary malignant lesion. Maximum samples were in the age group of 51–70 years. Least number of patients were in the age group of 15–30 years. Male: female ratio was1:1.18. Similar findings were observed by Khan et al. and Dey et al. 19,24 The present study results for primary lesions were correlating with the Sears and Hajduand Johnstonstudies. 25,26 Sears and Hajdureported that the most common primary neoplasms causing pleural effusions were carcinoma of the breast (24%), followed by lung (19%) and lymph reticular system (16%), and in 15% of the cases the primary site was unknown. In our study for pleural fluid analysis, carcinoma of the breast (30%) was the most common primary followed by primary in the lung (25%) and gastrointestinal tract (20%) and in 10% of the cases the primary site was unknown. Most of the pleural effusions were of the adenocarcinoma type.
Then the women were subjected to Colposcopy examination—machine details as ASCON model AC-3- 2000SN with green filter with ELMOCCD, TV camera and CTV display, focal length 250mm and magnification 7.5 X – 10 X and working distance of 25cm. If complete transformation zone was not visualized, Colposcopy was termed as “Unsatisfactory”. The green filter was also used to study vessels. Acetic acid (5%) and Lugol’s iodine were used. Abnormal Colposcopy findings like aceto-white area and abnormal iodine staining areas were