A Comparative Study of Conventional Pap Smear and Liquid-Based Cytology

Cervical cancer is a major health issue globally, particularly in developing countries where it remains a leading cause of cancer-related deaths among women. In Georgia, it ranks as the fifth most frequent cancer among women overall and the third among women aged 15-44 years. Approximately 1.60 million women aged 15 years and older in Georgia are at risk of developing cervical cancer. Annually, about 327 women are diagnosed, and 204 die from the disease. Screening for cervical cancer is crucial for reducing incidence and mortality rates. While the conventional Pap smear has been the primary screening method, its limitations in sensitivity and sample adequacy have led to the development of liquid-based cytology (LBC).

This study analyzed 1000 cervical cytology samples from women aged 18-65 years in Georgia, who were gynecologically asymptomatic and not vaccinated for HPV. The median age was 37 years. Informed consent was obtained for all participants. Samples were collected using ThinPrep reagents (Hologic) and processed within 2 h. Smears were prepared using the ThinPrep 2000 Processor, fixed in absolute alcohol for 30 min, and stained according to the Papanicolaou protocol. The Bethesda 2001 System terminology was used for reporting. Smears were evaluated by light microscopy and archived per Georgian medical data requirements.

The study found significant differences between the two screening methods. LBC showed a higher rate of satisfactory smears and better detection rates for negative for intraepithelial lesion or malignancy-NILM (89.4% vs. 80.3% for conventional Pap smear). Unsatisfactory smears were significantly lower with LBC (1.33% vs. 7.33%). Detection rates for atypical squamous cells of undetermined significance (ASCUS), atypical squamous cells, cannot exclude high grade squamous intraepithelial lesion (ASC-H), low grade squamous intraepithelial lesion (LSIL), and high grade squamous intraepithelial lesion (HSIL) were also improved with LBC, indicating higher diagnostic accuracy.

LBC outperforms the conventional Pap smear in cervical cancer screening by providing higher sample adequacy, better detection rates, and greater diagnostic accuracy. Implementing LBC more widely in Georgia could enhance early detection rates and reduce cervical cancer incidence and mortality, particularly in high-risk populations. These findings support the adoption of LBC as a superior screening method in clinical practice.