A comparison of liquid-based cytology with conventional cytology in cervical cancer screening.

OBJECTIVE: To clarify the performance of liquid-based cytology (LBC) and conventional methods of preparing cervical specimens for cytological screening. STUDY DESIGN: We studied 236,511 patients who participated in a population-based cervical cancer screening program conducted in the Niigata prefecture between 2005 and 2008. The percentage of unsatisfactory specimens and the disease detection rate were compared between specimens prepared by LBC and conventional methods. RESULTS: (1) The LBC method demonstrated a significantly lower percentage of unsatisfactory specimens than the conventional method (1.38 and 11.45%, respectively; p < 0.01). (2) Among the initial women, tumor lesions were detected in 0.57% of those examined with the LBC method, which was significantly higher than the positivity rate of those examined with the conventional method (0.25%; p < 0.05). Among the women with repeat screening, disease was detected in 0.08% of those examined with LBC twice, which was significantly lower than the positivity rates for those examined with the conventional method followed by the LBC method (0.11%) or the conventional method twice (0.16%; p < 0.05). CONCLUSION: The LBC method is significantly more useful than the conventional method in terms of the low adequacy rate and the high detection rate of cancer in cervical cancer screening in a localized area in Japan.

World wide web-based cytological analysis of atypical squamous cells cannot exclude high-grade intraepithelial lesions.

OBJECTIVE: It has been reported that the low level of consistency of diagnosis of atypical squamous cells cannot exclude high-grade squamous intraepithelial lesions (ASC-H) in uterine cervical cancer screening using the Bethesda System, indicating the necessity of a large-scale survey. We presented cases cytologically judged as ASC-H on our website and invited our members to give their opinions regarding the diagnosis by voting online. The Web voting results were analyzed and ASC-H was cytologically investigated. STUDY DESIGN: Virtual slides of atypical cells in cytology preparations of 53 cases were prepared and presented on a website. ASC-H cases were divided into 42 cases sampled by brush scraping and 11 cases sampled by cotton swab scraping. Fifty-three cases cytologically judged as ASC-H were classified into benign and CIN2/3, and their patterns of arrangement of atypical cells and 8 cytological parameters were morphologically investigated. RESULTS: The frequency of ASC-H diagnosis in the Web votes was low: 29.2% for brush-scraped and 26.2% for cotton swab-scraped cases. Three-dimensionality, coarse chromatin and irregular nuclei were significantly different between high-grade squamous intraepithelial lesions and benign cases. CONCLUSION: Web-based surveys showed the difference of cytological findings between high-grade squamous intraepithelial lesions and benign cases. To increase interobserver consistency, it may be useful to share information online, which avoids geographical and temporal limitations.