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Objective Methods Results Conclusions Over the past decade, liquid‐based cytology has replaced conventional cytology for cervical cancer screening in many countries, including Japan. We aimed to evaluate the efficacy of liquid‐based cytology using a large database and compare two major liquid‐based cytology platforms, SurePath and ThinPrep, to conventional cytology.Cervical cancer screening data were collected from the Japan Cancer Society between 2015 and 2019. The efficacy of liquid‐based and conventional cytology in detecting cervical intraepithelial neoplasia (CIN) was evaluated. Detection rates and positive predictive values were compared using a Poisson regression model.We collected data of 3,918,149 participants, including 2,248,202 conventional cytology, 874,807 SurePath and 795,140 ThinPrep smears. The detection rate of CIN2 or more was 1.14 times higher using SurePath than that using conventional cytology (95% confidence interval [CI], 1.09–1.20; p < 0.001). Contrastingly, the detection rate of CIN2 or more was 0.91 times lower using ThinPrep (95% CI, 0.86–0.96; p < 0.001). The detection rates of CIN3 or more did not differ significantly between SurePath and conventional cytology (detection rate ratio, 1.04; 95% CI, 0.97–1.12; p = 0.224). The positive predictive value ratios of CIN2 or more were 0.80 using SurePath (95% CI, 0.76–0.84; p < 0.001) and 0.83 using ThinPrep (95% CI, 0.79–0.87; p < 0.001) compared with conventional cytology.Liquid‐based cytology, particularly SurePath, was useful for detecting CIN2 or higher in population‐based cervical cancer screening. Further widespread use of liquid‐based cytology methods would lead to efficient detection of cervical precancerous lesions. [ABSTRACT FROM AUTHOR]

Purpose: In conventional cytology, preparation of a specimen by wet fixation for Papanicolaou stain is potentially subject to dry effect or cell loss which may make cytologic interpretation difficult or even impossible. We have been routinely making an additional smear for rehydration with normal saline (rehydration method) before wet fixation to overcome the above shortcomings. Methods: We reviewed malignant pleural effusion and ascites 15 cases each in our cytology laboratory over the past 1 year. Four slides of each specimen were made. Two were air‐dried for Liu's stain (a Romanowsky stain) and the other two were wet‐fixed for Papanicolaou stain. The air‐dried smears were also served as retained cellularity control. One of the two wet‐fixed smears was processed as a control of preservation of nuclear detail whereas the other one stayed air‐dried for 10 minutes and then covered with normal saline (rehydration method) for 80 seconds before wet fixation. Results: There was minor cell loss (P = .032). The cells appeared larger with good preservation of nuclear detail (P < .0001 by two‐sided Wilcoxon rank sum test) but no red blood cells retained on the slide after rehydration. Conclusion: The rehydration method can effectively minimise cell loss, enlarge and preserve the cytological features of malignant cells with haemolysis. This method is simple, practical and good for cytological screening for tumour cells and interpretation especially in a bloody smear. We recommend that the rehydration method be part of traditional cytopreparatory work of wet fixation for Papanicolaou stain in conventional body fluid cytology. [ABSTRACT FROM AUTHOR]

Abstract: Objective: To explore the value of flow cytometric (FCM) analysis of cerebrospinal fluid (CSF) in the diagnosis of central nervous system involvement in adult patients with acute lymphoblastic leukemia (ALL) during follow‐up. Methods: A total of 2871 CSF samples from 357 adult patients with newly diagnosed ALL between the year of 2009 and 2015 were analyzed retrospectively. These patients were divided into 3 groups according to CSF results, FCM+/conventional cytology (CC)+ group, FCM+/CC− group, and FCM−/CC− group, respectively. The overall survival (OS) of the three groups was analyzed. Results: Fifteen (4.2%) and 26 (7.3%) patients' CSF samples were FCM+/CC+ and FCM+/CC−, respectively. The remaining 316 (88.5%) patients' samples were FCM−/CC−. The 2‐year OS for the FCM+/CC+, FCM+/CC−, and FCM−/CC− groups was 40.0%, 20.6%, and 64.2%, respectively (P < .001). There was no statistically significant difference in OS between FCM+/CC+ and FCM+/CC− patients (P = .195). In multivariate analysis, a high WBC count and LDH level were independent risk factors for central nervous system involvement in adult patients with ALL. Conclusions: FCM demonstrated a superior sensitivity over conventional cytology in the diagnosis of central nervous system involvement in adult patients with ALL. FCM+/CC− patients showed a similar survival with FCM+/CC+ patients, suggesting that an isolated FCM‐positive status holds clinical significance. [ABSTRACT FROM AUTHOR]

Objective The aim of the present study was to compare the cytomorphological features and cytopathological diagnoses in thyroid aspiration materials prepared by SurePath® ( SP) and conventional cytology ( CC). Materials and methods Fine needle aspiration (FNA) materials from 180 thyroid nodules were divided into two groups to prepare three conventional smears and one SP slide. Twenty-nine cytomorphological features of thyroid lesions were compared in the CC and SP slides. The Kappa coefficiency was determined for each. The cytopathological diagnosis of CC and SP were compared. Results The feature with the lowest Kappa coefficient was the haemorrhagic background, whereas nuclear molding had the highest Kappa coefficient. The rates of the atypical and suspicious cytopathological diagnostic categories were decreased, whereas the rates of benign and malignant categories were increased in SP. When the cytopathological diagnoses of CC and SP were compared with the histopathological diagnoses of the 31 thyroidectomy materials, the results were similar. Conclusion The common problems seen in CC, such as an excessive number of slides, a haemorrhagic background and air drying artefact in the SP method were not encountered. Through these advantages, the rate of the indeterminate cytopathological diagnosis was low in SP. In addition to those advantages, the increased rates of non-diagnostic cases, the difficulty in evaluating the cytomorphologic features owing to tridimensional structures and the smaller size of the cells and the presence of tridimensional structures uninterpreted microscopically were the disadvantages of SP. The present results showed that SP could be used instead of CC in thyroid cytopathology. [ABSTRACT FROM AUTHOR]

Objectives: Our objectives were to determine the reproducibility of cytological specimen interpretation between two pathologists in human immunodeficiency virus (HIV)-infected women (from the VIHGY, ANRS C017 study of human papillomavirus genital pathology among HIV-positive women) and to analyse the improvement, if any, between conventional and liquid-based cytology (LBC) interpretations. Materials and methods: A sample of all abnormal and 40% of randomly selected normal Papanicolaou (Pap) tests was randomly ordered and read blindly by a second pathologist using the revised Bethesda terminology 2001. For both conventional and liquid-based preparations, unweighted and Cicchetti-Allisonweighted kappa and their 95% confidence intervals (CIs) were calculated. Kappa values were then compared using the Altman rule to classify the reproducibility of cytological specimen interpretation. Results: Two hundred and seventy-seven conventional Pap tests were reviewed, including 79 abnormal and 10 unsatisfactory results. Overall agreement between the two observers was 78%, with an estimated Cicchetti- Allison-weighted kappa of 0.69 (95%CI, 0.61-0.77). The corresponding values for the 268 LBCs, including 123 abnormal and two unsatisfactory results, were 84% and 0.82 (95%CI, 0.76-0.87), respectively. The reproducibility of LBC interpretations was significantly higher than that of conventional preparations (P = 0.009) and, for both laboratories, the percentages of unsatisfactory results were significantly lower for LBC. Conclusion: In HIV-infected women in the combination antiretroviral therapy era, the strength of agreement was better for LBCs than for conventional preparations, with a lower percentage of unsatisfactory results. When available, LBC should be preferred because of its higher reproducibility. [ABSTRACT FROM AUTHOR]

Human-papillomavirus (HPV) DNA testing has been proposed as an alternative to primary cervical cancer screening using cytological testing. Review of the evidence shows that available data are conflicting for some aspects. The overall goal of the study is to update the performance of HPV DNA as stand-alone testing in primary cervical cancer screening, focusing particularly on the aspects related to the specificity profile of the HPV DNA testing in respect to cytology. We performed a meta-analysis of randomized controlled clinical trials. Eight articles were included in the meta-analysis. Three outcomes have been investigated: relative detection, relative specificity, and relative positive predictive value (PPV) of HPV DNA testing versus cytology. Overall evaluation of relative detection showed a significantly higher detection of CIN2+ and CIN3+ for HPV DNA testing versus cytology. Meta-analyses that considered all age groups showed a relative specificity that favored the cytology in detecting both CIN2+ and CIN3+ lesions whereas, in the ≥30 years' group, specificity of HPV DNA and cytology tests was similar in detecting both CIN2+ and CIN3+ lesions. Results of the pooled analysis on relative PPV showed a not significantly lower PPV of HPV DNA test over cytology. A main key finding of the study is that in women aged ≥30, has been found an almost overlapping specificity between the two screening tests in detecting CIN2 and above-grade lesions. Therefore, primary screening of cervical cancer by HPV DNA testing appears to offer the right balance between maximum detection of CIN2+ and adequate specificity, if performed in the age group ≥30 years. [ABSTRACT FROM AUTHOR]

Anton G, Peltecu G, Socolov D, Cornitescu F, Bleotu C, Sgarbura Z, Teleman S, Iliescu D, Botezatu A, Goia CD, Huica I, Anton A-C. Type-specific human papillomavirus detection in cervical smears in Romania. APMIS 2010. Although Romania has one of the highest incidence of cervical cancer in Europe (30 new cases/100 000 women), little is known about the distribution of the human papillomaviruses (HPV) genotypes in this population. We seek to determine the distribution of HPV genotypes in women with normal and abnormal cervical cytology. We analyzed 460 cervical cytology specimens from women who self-referred to the gynecologic clinic. HPV was detected and genotyped using the commercially available INNOLiPA (INNOGENETICS NV) kit based on the reverse hybridization principle. HPV DNA was detected in 279 cases (60.7%) with a median age of 32.9 years. In HGSIL (High Grade Squamous Intraepithelial Lesion) cytology, the presence of HPV DNA was confirmed in 82.7% of cases. The most frequent high-risk genotype was HPV16, found in 32.6% of HPV-positive samples. The next common high-risk genotypes were HPV18, HPV31 and HPV51. Our findings on the distribution and frequency of the HPV genotypes in Romanian population confirmed the utility of the current available HPV vaccines, HPV16 and 18 being detected in 28.7% of cases in the investigated area. [ABSTRACT FROM AUTHOR]

Please cite this paper as: Castle P, Bulten J, Confortini M, Klinkhamer P, Pellegrini A, Siebers A, Ronco G, Arbyn M. Age-specific patterns of unsatisfactory results for conventional Pap smears and liquid-based cytology: data from two randomised clinical trials. BJOG 2010;117:1067–1073. Objective To investigate the rate of unsatisfactory cervical cell samples in liquid-based cytology (LBC) versus conventional cytology (CC) by age. Design Randomised clinical trials. Setting Population-based cervical cancer screening in the Netherlands and Italy. Population Asymptomatic women invited for screening enrolled in two randomised trials: Netherlands ThinPrep® versus conventional cytology (NETHCON; 39 010 CC, 46 064 LBC) and New Technologies in Cervical Cancer Screening (NTCC; 22 771 CC, 22 403 LBC). Methods Comparison of categorical variables using Pearson’s chi-square test, logistic regression and trend tests. Main outcome measures Proportion of unsatisfactory samples, ratio of LBC versus CC, and variation by 5-year group. Results In NETHCON, a lower percentage of LBC samples were judged to be unsatisfactory compared with CC samples (0.33 versus 1.11%). There was no significant trend in unsatisfactory results by age group for conventional cytology ( Ptrend = 0.54), but there was a trend towards an increasing percentage of unsatisfactory results with increasing age for LBC ( Ptrend < 0.001). In NTCC, a lower percentage of LBC samples were judged to be unsatisfactory compared with conventional cytology (2.59 versus 4.10%). There was a decrease in the unsatisfactory results by age group with conventional cytology ( Ptrend < 0.001) and with LBC ( Ptrend = 0.01), although the latter trend arose from the 55–60-years age group ( Ptrend = 0.62 when excluding this group). Conclusions The clinical trial in which the results were collected and the cytologic method used were the most important determinants of unsatisfactory cytology. In all situations, the proportion of unsatisfactory samples was lower in LBC compared with CC. The effects of age depended on the criteria used to define unsatisfactory results. [ABSTRACT FROM AUTHOR]

Objective: To compare the use of liquid-based cytology (LBC) with conventional cytology (CC) in the assessment cervical intraepithelial neoplasia (CIN) prior to colposcopy. Design: Retrospective Cohort Study. Methods: Liquid-based cytology and CC findings were compared with colposcopic assessment and directed cervical biopsy in terms of sensitivity and specificity for high grade lesions only and for any abnormalities. The degree of correlation was sought. Secondary outcomes were unsatisfactory rate and cost. Results: A total of 1961 women had colposcopy of whom 528 had cervical biopsy. LBC and CC have similar sensitivity and specificity for both high-grade lesions and any abnormalities. In comparison with cervical biopsy, LBC and CC sensitivity for high-grade disease was 89.1% and 88.6% respectively and for any abnormalities, the sensitivity was 86.6% and 87.0%. Specificity for high-grade disease was 83.1% and 84.7% and for any abnormalities, the specificity was 53.8% and 56.4%. The unsatisfactory rate was significantly lower in LBC 4.38% compared to 1.84% ( P < 0.001). However, the use of LBC was associated with an additional cost of A$1496 for each unsatisfactory smear avoided. Conclusion: In high prevalence setting, LBC showed no statistically significant difference in sensitivity and specificity from CC for the detection of CIN. A reduction in unsatisfactory smears was evident, but at significant additional cost. [ABSTRACT FROM AUTHOR]

Objective: The purpose of this study was to examine the utility of SurePath-liquid-based cytology (LBC) compared to conventional cytological preparations (CCP) in the identification of endometrial carcinoma. Methods: During a 13-month period, direct endometrial samples were collected from 120 patients using the Uterobrush. The material comprised 30 cases each of endometrial carcinoma, proliferative endometrium, secretory endometrium and atrophic endometrium. The following points were investigated:(i) the frequency of cell clumps in endometrial carcinoma; (ii) the area of cell nuclei; (iii) overlapping nuclei. Results: (i) Comparison of the frequency of cell clumps with irregular protrusion pattern and papillo-tubular pattern showed no statistically significant difference in either type of cell clump between CCP and LBC. (ii) Comparison of the nuclear area of cells showed a sequential decrease from endometrial carcinoma to secretory endometrium, to proliferative endometrium and to atrophic endometrium, which was significant in CCP and LBC. (iii) Nuclear area was significantly lower with LBC compared with CCP in endometrial carcinoma, secretory endometrium and proliferative endometrium but not atrophic endometrium. (iv) Comparison of the degree of overlapping nuclei showed a sequential decrease from endometrial carcinoma to proliferative endometrium, to secretory endometrium and to atrophic endometrium, which was significant in both CCP and LBC. (v) Comparison of the degree of overlapping nuclei between CCP and LBC showed no significant difference for normal types of endometrium, but LBC had significantly higher values ( P < 0.0001) in endometrial carcinoma than in CCP. Conclusions: The results of this study revealed that applying diagnostic criteria used in CCP to LBC was easy to achieve, because LBC had excellent cytoarchitectural preservation and cells were well presented. Although we have not examined all cytological features of malignancy and have not considered atypical hyperplasia, we believe that this method may be a useful tool in the diagnosis of endometrial cytology. [ABSTRACT FROM AUTHOR]

Abstract: Objective: To evaluate the 2 methods of cytologic screening to detect abnormalities of the cervical epithelium. Methods: This study with 3 groups of women was performed at Selcuk University Meram Medical School between January 2004 and March 2006. In one group (paired sample for specimen collection) women were screened with conventional cytology; in another group (paired sample for specimen collection) they were screened with liquid-based cytology; and in the third group (split sample for specimen collection) they were screened by both methods. Results: The rate of unsatisfactory results was lower in the liquid-based than in the conventional cytology group (6.1% vs. 2.6%; P <0.05). More smears containing atypical squamous cells of undetermined significance were detected by the liquid-based method, but the difference was not statistically significant. Also, no statistically significant differences between liquid-based and conventional cytology were observed in the detection of other epithelial abnormalities (P >0.05). Conclusion: The liquid-based and conventional cytology methods were found to be equivalent in the detection of cervical epithelial abnormalities. [Copyright &y& Elsevier]

Objective: To analyse the correlation between cytomorphological criteria in smears with atypical glandular cells (AGC) or adenocarcinoma in situ (AIS) and human papillomavirus (HPV) reflex test results with different neoplastic histological diagnoses, particularly to distinguish between glandular and squamous neoplasia. Methods: A series of 155 women with glandular abnormalities in their conventional cervical smears was included: 106 with AGC, 35 with AGC associated with high-grade squamous intraepithelial lesion (HSIL) and 14 with AIS. Two reviewers evaluated 35 cytomorphological criteria and hybrid capture II (HCII) was performed in all cases. Colposcopy was carried out in all cases and biopsy in 126/155. For statistical purposes, predictive values and odds ratio (OR) were calculated, followed by chi-square automatic interaction detection. Results: Histology detected 56 cases of squamous and 17 of glandular intraepithelial or invasive neoplasia. Predictive values of the papillary groups and feathering criteria for glandular neoplasia were, respectively, 80.0% and 73.3%. Feathering was the criterion with the highest OR for distinguishing glandular from squamous neoplasia and also for distinguishing between glandular and non-neoplastic diagnosis. Rosettes and pseudostratified strips did not perform as well. Multivariant Classification and Regression Trees analysis identified feathering as the best criterion for distinguishing between glandular, squamous and non-neoplastic diagnoses regardless of HPV status. Conclusions: Feathering was the best criterion for predicting glandular neoplasia. [ABSTRACT FROM AUTHOR]