Department of Pathology, Sisli Hamidiye Etfal Health Application and Research Center, Health Sciences University, Istanbul, Turkey.
Department of Pathology, Sisli Hamidiye Etfal Health Application and Research Center, Health Sciences University, Istanbul, Turkey,
Acta Cytol. 2024;68(1):54-59. doi: 10.1159/000536663. Epub 2024 Feb 6.
Liquid-based cytology (LBC) has replaced conventional smear (CS) in the world. In this study, through a series with a large number of cases, we aimed to make a comparison and general evaluation in all groups, primarily epithelial abnormalities, according to LBC and CS methods. This study was carried out in a private pathology laboratory located in a metropolitan city, where cytological materials sent from many clinics were examined.
There were 165,915 cases whose smears were examined between 2012 and 2020, most of them conventional (131,224 CS, 34,691 LBC). Cases were evaluated on the basis of the Bethesda 2014 classification and divided into sub-diagnostic categories after they were divided into two main groups as "with epithelial abnormalities" and "without." χ2 and Fischer's precision statistical tests were conducted using SPSS 23.0 package. In the CS process, cervical samples were obtained using an endocervical brush and a spatula. Cells were directly spread onto the slides and promptly fixed in 95% ethanol, followed by staining with the standard Papanicolaou stain. For LBC ThinPrep, cervical specimens were gathered using a cervix brush. The brush was washed in a vial and discarded. Finally, cells were isolated through vacuum filtration and transferred to the slide using air pressure.
Squamous cell abnormalities (atypical squamous cells of undetermined significance [ASC-US], atypical squamous cells - cannot exclude high-grade squamous intraepithelial lesion [ASC-H], low-grade squamous intraepithelial lesion [LSIL], high-grade squamous intraepithelial lesion [HSIL], squamous cell carcinoma, atypical glandular cells of undetermined significance) were reported in 5,696 (3.43%) cases. ASC (ASC-US + ASC-H)/SIL ratio (1.36/2.04) was found to be 0.67 (recommended Bethesda ratio is <3). ASC-US (p < 0.001), ASC-H (p < 0.001), and HSIL(p < 0.001) detection rate of LBC was found to be significantly higher than CS. ASC-US (1.8/1.2), ASC-H (0.08/0.008), and HSIL (0.6/0.3) case ratios of LBC/CS were found to be significantly higher in LBC. LSIL (1.72/1.66) rate was similar.
LBC is superior to CS in detecting epithelial lesions. In addition to being used as a screening method, it is clear that it makes a great contribution to reducing cervical carcinomas due to HPV typing. Definitive comments regarding comparison of methods on reactive changes and microorganism detection are challenging. Preanalytical factors might account for these situations.
液基细胞学（LBC）已在世界范围内取代传统涂片（CS）。在这项研究中，我们通过大量病例的系列研究，旨在根据 LBC 和 CS 方法，对所有组（主要是上皮异常）进行比较和总体评估。本研究在一家位于大都市的私人病理实验室进行，该实验室检查了来自许多诊所的细胞学材料。
2012 年至 2020 年间共检查了 165915 例涂片，其中大部分为传统涂片（131224 例 CS，34691 例 LBC）。根据 2014 年巴氏分类法对病例进行评估，并分为两个主要组：“有上皮异常”和“无上皮异常”。使用 SPSS 23.0 包进行 χ2 和 Fischer 精确检验。在 CS 过程中，使用宫颈刷和刮刀获取宫颈样本。细胞直接涂在载玻片上，立即用 95%乙醇固定，然后用标准巴氏染色染色。对于 LBC ThinPrep，使用宫颈刷收集宫颈标本。将刷子在小瓶中清洗并丢弃。最后，通过真空过滤将细胞分离出来，并使用气压将其转移到载玻片上。
报告了 5696 例（3.43%）鳞状细胞异常（非典型鳞状细胞意义不明[ASC-US]、非典型鳞状细胞-不能排除高级别鳞状上皮内病变[ASC-H]、低级别鳞状上皮内病变[LSIL]、高级别鳞状上皮内病变[HSIL]、鳞状细胞癌、非典型腺细胞意义不明）。发现 ASC（ASC-US+ASC-H）/SIL 比值（1.36/2.04）为 0.67（推荐的巴氏比值 <3）。LBC 检测 ASC-US（p <0.001）、ASC-H（p <0.001）和 HSIL（p <0.001）的阳性率明显高于 CS。ASC-US（1.8/1.2）、ASC-H（0.08/0.008）和 HSIL（0.6/0.3）的 LBC/CS 病例比在 LBC 中明显更高。LSIL（1.72/1.66）的检出率相似。
LBC 比 CS 更能检测上皮病变。除了作为一种筛查方法外，它在减少 HPV 分型引起的宫颈癌方面也做出了巨大贡献。关于方法比较在反应性变化和微生物检测方面的明确评论具有挑战性。这些情况可能是由于分析前因素造成的。
