Cervical Cancer Screening: The Latest Research on the Impact of Different Cytology Methods

Cervical Cancer Screening: The Latest Research on the Impact of Different Cytology Methods

Cervical Cancer Screening: The Latest Research on the Impact of Different Cytology Methods
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    A succinct review of a study comparing relative effectiveness of liquid-based cytology to manually read Pap smears
    • Overview

      Comparing SurePath, ThinPrep, and conventional cytology as primary test method: SurePath is associated with increased CIN II+ detection rates.

      Rozemeijer K, Penning C, Siebers AG, Naber SK, Matthijsse SM, van Ballegooijen M, van Kemenade FJ, de Kok IM.

      Cancer Causes Control. 2016 Jan;27(1):15-25.
      doi: 10.1007/s10552-015-0678-1. Epub 2015 Oct 12.

      Background Information:

      In the previous audio abstract summarizing the results from these researchers from the Erasmus Medical Center in the Netherlands, the BMJ 2017 article described the use of LBC in the Dutch screening program and the impact on interval cervical cancers). In this second installation, we will be reviewing a previous publication from the same group, where the effectiveness of LBC will be described in terms of detecting cytological abnormalities and corresponding detection of cervical intraepithelial lesions within cervical biopsy specimens.

      Objective: To compare the relative effectiveness of liquid-based cytology, in terms of atypical cytology classification and corresponding biopsy-confirmed cervical lesions, in relation to manually read conventional Pap smears, within the Dutch cervical cancer screening program

      Design: Retrospective, population based cohort study

      Setting Population:  Nationwide network and registry of histology and cytology in the Netherlands PALGA database between January 2000 and March 2011. Population included 3,118,685 conventional smear results; 1,313,731 SurePath results; and 1,584,587 ThinPrep results.

      Exposure:  Use of SurePath LBC or ThinPrep LBC compared to manually read conventional Pap smears as primary screening tests

      Main Outcome Measurement: The detection of atypical cervical cytology grade, and the biopsy-confirmation of cervical intraepithelial neoplasia (CIN) were the indicators of relative clinical performance.

      Results: 

      • BD SurePath™ Pap test  was associated with a lower odds ratio to produce ASCUS/LSIL results and an increased odds ratio to detect CIN1 (low grade) and CIN2 lesion when compared to conventional smears
      • Hologic ThinPrep Pap test associated with a slightly higher odds ratio to produce ASCUS/LSIL results and a decreased odds ratio to detect CIN3 and cervical cancer when compared to conventional smears
      • BD SurePath™ Pap test  was associated with an 12% increased odds ratio to detect HSIL+ and a similar odds ratio to detect histology-confirmed CIN2+ lesions compared to the conventional smear (i.e., SurePath HSIL has the same positive predictive value of biopsy-confirmed detection of CIN2+ as the conventional smear).
      • Hologic ThinPrep Pap test was associated with a 4% lower odds ratio to detect HSIL+ and a similar odds ratio to detect histology-confirmed CIN2+ lesions compared to the conventional smear
      • The use of SurePath resulted in a 14% increase detection of CIN1; 14% increase detection of CIN2; 6% increase in the detection of CIN3; overall an 8% increase in the detection of CIN2+ and no change in the detection of cervical cancer relative to the conventional smear. The changes in the likelihood to detect biopsy-confirmed cervical lesions with the use of SurePath were statistically significant.
      • In contrast, ThinPrep was not associated with an increase detection of CIN1, CIN2, CIN3, CIN2+ or cervical cancer relative to the conventional smear.

      Conclusions: The authors concluded that “The impact of replacing CC by LBC as primary test method depends on the type of LBC test used. Only the use of SurePath was associated with increased CIN II+ detection, although it simultaneously increased the detection of CIN I.”

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