Rehydrated Air-Dried Pap Smears as a Cost-Effective Alternative to Conventional Cytology in Low-Resource Settings: A...

Cervical cancer is still a significant public health problem, especially in low- and middle-income countries. Rehydration of air-dried smears (RADS) has been developed as an alternative technique to overcome limitations associated with conventional wet fixation. The present study was undertaken to compare rehydrated air-dried Pap smears with conventional wet-fixed smears (WFS) for evaluation of cervical lesions, with emphasis on smear adequacy, cytomorphological features, and diagnostic concordance using the Bethesda system.

A hospital-based cross-sectional comparative study was conducted on 282 women undergoing cervical cytology. Three smears were prepared from each sample: one conventional WFS and two rehydrated air-dried smears. Smears were stained using the standard Papanicolaou technique and evaluated for adequacy, cellularity, background features, cytolysis, artifacts, nuclear features, cytoplasmic staining, and diagnostic concordance using the Bethesda system.

Rehydrated air-dried smears demonstrated higher adequacy rates than WFS (275 (97.5%) vs 254 (90.1%)). Red blood cell obscuration (13 (4.6%) vs 127 (45.0%)), cytolysis (11 (3.9%) vs 33 (11.7%)), and air-drying artifacts (15 (5.3%) vs 50 (17.7%)) were significantly reduced in rehydrated smears. Nuclear borders (263 (93.3%) vs 245 (86.9%)) and chromatin quality (271 (96.1%) vs 234 (83.0%)) were better preserved in rehydrated smears. Diagnostic concordance between WFS and rehydrated smears was high at 276 (97.9%), with a Cohen's kappa value of 0.975 indicating almost perfect agreement.

Rehydrated air-dried Pap smears performed similarly to conventional WFS in the diagnosis of cervical lesions. The technique showed better adequacy, cleaner background, satisfactory nuclear and cytoplasmic detail, and high diagnostic concordance. Rehydrated air-dried smears could be a practical and efficacious replacement for standard wet fixation, particularly in resource-limited settings.