The utility of a Manual Liquid Based Cytology in Screening for Pre-cancerous Lesion and Cervical Ca

Abstract

Liquid-based cytology is a technique that enables cells to be suspended in a liquid medium and spread in a monolayer, thereby enabling a better morphological assessment. Automated techniques have been widely used especially in the developed countries but limited in the developing countries due to cost and availability. 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. 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. The general objective of this study was to evaluate the utility of a manual liquid based cytology in screening for pre-cancerous lesion and cervical cancer. A prospective study of 295 cases was assessed for pre-cancerous lesions and cervical cancer using MLBC and CPS at Machakos County Hospital among women who were 18 years and above attending the Comprehensive Care Centre in the hospital. Convenience sampling was used to obtain the study population. Cohen Kappa test was run to determine the level of agreement between CPS and the MLBC results. There was moderate agreement between the two methods (k=0.673, 95% CI, p=0.065). Specimen adequacy was found to be better with MLBC than CPS with 12 unsatisfactory smears in MLBC and 22 in CPS. The prevalence of abnormal cervical cytology with Conventional Pap smear technique was 5.2%. There was increased detection rate of abnormal cervical cytology smears with MLBC of 85.7%. Manual liquid based cytology was found to give better results than the conventional Pap smear method in terms of specimen adequacy, clear back ground and reduced cellular overlapping with increased detection of abnormalities and preservation of specimen for future testing. Therefore, it can be used as an alternative liquid based cytology technique for cervical cancer screening in limited resource settings.