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Updated: May 18, 2026
Collection, Isolation, and Flow Cytometric Analysis of Human Endocervical Samples
Published on: July 6, 2014
Liquid-Based Cytology in Cervical Cancer Screening: A Systematic Review and Meta-Analysis
Gerd Böhmer1, Claudia Stolte1, Tobias Vogelmann2
1IZD Hannover, Hannover, Germany.
Introduction:
While the conventional Papanicolaou (Pap) smear has long been the cornerstone of cervical cancer (CC) screening, it presents well-documented limitations in sample collection, processing, and interpretation. Liquid-based cytology (LBC) was introduced to address these drawbacks by offering more uniform cell samples and enabling standardized evaluation. However, due to ongoing debate and conflicting study results regarding their comparative diagnostic accuracy, a rigorous evidence-based assessment is needed. The objective of this systematic review and meta-analysis was to systematically assess the diagnostic accuracy of LBC compared to conventional Pap cytology in the detection of cervical precancerous and cancerous lesions.
Methods:
PubMed and Cochrane Library were systematically searched. Comparative studies of LBC and conventional Pap cytology in primary CC screening were included. Outcomes included unsatisfactory sample rate, abnormal histology-confirmed cytology detection rate (ADR) CIN2+ lesions (cervical intraepithelial neoplasia), squamous cell carcinoma (SCC), and glandular abnormalities. Random-effects models were used to estimate risk ratios (RRs). A two-sided p value of 0.05 was used to determine statistical significance.
Results:
Ninety-seven studies were included. LBC had a lower unsatisfactory sample rate than conventional Pap cytology (RR: 0.63, 95% CI: 0.47-0.85, p = 0.003). The detection rate of SCC was similar (RR: 1.77, 95% CI: 0.96-3.26, p = 0.07). The glandular abnormality detection rate showed no overall difference (RR: 1.23, 95% CI: 0.75-2.02, p = 0.42), but a subgroup analysis (FDA-approved tests) showed superiority of LBC (RR: 1.52, 95% CI: 1.18-1.96, p = 0.001). LBC had a 35% higher abnormal cytology detection rate confirmed by histology (RR: 1.35, 95% CI: 1.20-1.52, p < 0.0001) and a 27% higher detection of confirmed CIN2+ abnormalities (RR: 1.27, 95% CI: 1.11-1.45, p = 0.0006).
Conclusion:
LBC improves CIN2+ and histology-confirmed abnormal detection rates while reducing unsatisfactory samples, supporting its use in CC screening. SCC detection rates were similar. Findings suggest that LBC, particularly when using FDA-approved tests, enhances glandular abnormality detection. Further research should evaluate its cost-effectiveness in low-resource settings.
