Abstract
The main goal was to evaluate the performance of liquid-based cytology (LBC) versus conventional cytology (CC) of cervical smears tests performed in Unified Health System (SUS) of Vale do Ribeira, São Paulo, Brazil. It is a comparative study between CC historical data (31,500) and prospective samples of LBC (9,764). All samples followed the internal quality control criteria of the Cytology Laboratory at Adolfo Lutz Institute (CL-IAL). LBC was performed using BD Sure Path recommendations. The Z-test was used with a 5% significance for comparison of proportions (p < 0.05). The smears were diagnosed as positive in 7.80% of cases by CC technique and 11.57% for LBC, with a significant difference in cases of atypical squamous cells of undetermined significance - ASC-US (4.52% to 6.98%), low-grade squamous intraepithelial lesion -LSIL (1.82% to 3.48%) and atypical glandular cells - AGC (0.54% to 0.26%). Statistical difference in the percentage of unsatisfactory samples (3.50% to 0.25%) was observed. LBC technique reduces artifacts of preparation and assessment of samples, resulting in reduction of unsatisfactory samples while increases the percentage of positives. We conclude that the implementation of LBC in the SUS is feasible due to the standardization and improvement of the quality of the samples.
References
Monsonego J, Bosch FX, Coursager P, Cox JT, Franco E, Frazer I. Cervical câncer control, priorities and new directions. Int J Cancer. 2004;108:329-33.
Ministério da Saúde. Instituto Nacional de Câncer José Alencar Gomes da Silva (INCA). Estimativa 2012. Incidência de câncer no Brasil. Rio de Janeiro, RJ 2011. [2012 mai 16]. Disponível em: [http:// www.inca.gov.br/estimativa/2012]
Quinn M, Babb P, Jones J, Allen E. Effect of screening on incidence and mortality from cancer of the cervix in England: evaluation based on routinely collected statistics. BMJ 1999;318:904-8.
Mattosinho de Castro Ferraz MG, Nicolaou MG, Stavale JN, Fochi J, Castelo A, Dores GB et al. Cervical biopsy-based comparations of a new liquid-based thinlayer preparation with convencional Pap smear. Diagn Cytopathol 2004;30:220-6.
Hutchinson ML, Isenstein LM, Goodman A, Hurley AA, Douglass KL, Mui KK, et al. Homogeneous sampling accounts for the increased diagnostic accuracy using the ThinPrep® Processor. Am J Clin Pathol 1994;101:215-9.
Beerman H, van Dorst EB, Kuenen-Boumeester V, Hogendoorn PC. Superior performance of liquid-based versus conventional cytology in a population-based cervical cancer screening program. Gynecol Oncol 2009;112:572-6.
Ronco G, Cuzick J, Pierotti P, Cariaggi MP, Dalla Palma P, Naldoni C, Ghiringhello B, Giorgi-Rossi P, Minucci D, Parisio F, Pojer A, Schiboni ML, Sintoni C, Zorzi M, Segnan N, Confortini M. Accuracy of liquid based versus conventional cytology: overall results of new technologies for cervical cancer screening: randomised controlled trial. BMJ 2007;335(7):1-7.
Longatto-Filho A, Pereira SMM, di Loreto C, Utagawa ML, Makabe S, Maeda MYS, Marques JA, Santoro CLF, Castelo A. DCD liquid-based system is more effective than conventional smears to diagnosis of cervical lesions: study in high-risk population with biopsy-based confirmation. Gynecol Oncol 2005;97:497-500.
Davey E, Barratt A, Irwig L, Chan SF, Macaskill P, Mannes P, Saville AM. Effect of study design and quality on unsatisfactory rates, cytology classifications, and accuracy in liquid-based versus conventional cervical cytology: a systematic review. Am J Obstet Gynecol 2005;192(2):414-21.
Arbyn M, Bergeron C, Klinkhamer P, Martin-Hirsch P, Siebers AG, Bulten J. Liquid compared with conventional cervical cytology: a systematic review and meta-analysis. Obstet Gynecol. 2008;111(1):167-77.
Instituto Brasileiro de Geografia e Estatística. PNAD 2005: pesquisa nacional por amostra em domicílios. IBGE.
Stabile SAB, Evangelista DHR, Talamonte VH, Lippi UG, Lopes RGC. Estudo comparativo dos resultados obtidos pela citologia oncótica cérvico-vaginal convencional e pela citologia em meio líquido. Einstein. 2012; 10(4):466-72.
Alves VAF, Castelo A, Longatto-Filho A, Vianna MR, Namiyama G, Lorincz A et al. Performance of the DNA-Citoliq liquid-based cytology system compared with convencional smear. Cytopathology 2006;17:86-93.
Girianelli VR, Santos Thuler LC. Evaluation of agreement between convetional and liquid-based cytology in cervical cancer early detection based on analysis of 2,091 smears: esperiences at the Brazilian National Cancer Institute. Diagnostic Cytopathology 2007;35:545-9.
Fregnani JHTG, Scapulatempo C, Haikel RL, Saccheto T, Campacci N, Mauad EC et al. Could alarmingly high rates of negative diagnoses in remote rural áreas be minimized with liquid-based cytology? Preliminar results from the RODEO study team. Acta Cytologica 2013;57(1):69-74.
Protocolo do método manual BD SurePathTM, Papanicolaou em meio líquido. In: BD PrepstainTM System: Guia resumido para treinamento técnico do usuário, 2008.
Alves VAF, Lima MEN, Utagawa ML, Maeda MYS. Programa de controle de qualidade em citologia ginecológica do Instituto Adolfo Lutz: estratégias e análise crítica dos resultados de sua implantação-piloto. Rev Ass Med Brasil 1991;37(1):36-42.
Brasil. Ministério da Saúde. Secretaria de Atenção à Saúde. Instituto Nacional de Câncer. Coordenação de Prevenção e Vigilância. Nomenclatura Brasileira para laudos citopatológicos e condutas preconizadas: recomendações para profissionais de saúde. 3ª edição. Rio de Janeiro: INCA, 2012.
Altman DG. Practical Statistics for Medical Research. Boca Raton: Chapman & Hall/CRC, 8ª ed., 611p.
Fontaine D, Narine N, Naugler C. Unsatisfactory rates vary between cervical cytology samples prepared using ThinPrep and SurePath platforms: a review and metaanalysis. BMJ Open 2012;2(2).e000847. doi:10.1136/bmjopen-2012-000847
Harrison WN, Teale AMJ, Jones SP, Mohammed MA. The impact of the introduction of liquid based cytology on the variation in the proportion of inadequate samples between GP practices. BMC Public Health 2007;7:191-5.
Beerman H, van Dorst EB, Kuenen-Boumeester V, Hogendoorn PC. Superior performance of liquid-based versus conventional cytology in a population-based cervical cancer screening program. Gynecol Oncol 2009;112:572-6.
Siebers AG, Klinkhamer PJ, Arbyn M, Raifu AO, Massuger LF, Bulten J. Cytologic detection of cervical abnormalities using liquid-based compared with conventional cytology: a randomized controlled trial. Obstet Gynecol. 2008;112(6):1327-34.
Schiffman M, Solomon D. Liquid-Based Cytology vs Conventional Cytology in Detecting Cervical Cancer-In reply. JAMA. 2010;303(11):1034-5.
This work is licensed under a Creative Commons Attribution 4.0 International License.
Copyright (c) 2015 Daniela Etlinger-Colonelli, Sonia Maria Pereira de Oliveira, Monique Camila Basso, Silvia D’Andretta Iglezias, Luzia Setuko Umeda Yamamoto, Yuriko Ito Sakai, Julia de Carvalho, Camilo Lelis Feres, Rosemeire Oliveira Lima Rodrigues, Celso di Loreto