Objective: This study sought to ascertain the significance of augmented high-grade squamous intraepithelial lesion (HSIL) detection by Pap test using both conventional smear and liquid-based cytology (LBC) in a high-risk population. Study Design: We conducted a direct-to-vial study to compare the diagnostic performance of Pap smear versus LBC in a high-risk population of women referred for colposcopy at a gynecologic ambulatory clinic at the Barretos Cancer Hospital in Brazil during 2011. Results: The detection of both low-grade squamous intraepithelial lesions (LSILs) and HSILs was significantly greater (p = 0.04 and p = 0.033, respectively) in the LBC arm [84 LSIL cases (5.7%) and 148 HSIL cases (10.1%)] than in the conventional smear arm [66 LSIL cases (4.1%) and 126 HSIL cases (7.9%)]; however, no differences were found for invasive squamous carcinoma or adenocarcinoma (p = 0.678). Of 3,071 women who were examined cytologically (1,604 conventional preparations and 1,467 LBC) and colposcopically, biopsies were available for 279 conventional preparations (17.6%) and 325 LBC preparations (22.2%). No significant differences were found between the methods with respect to diagnostic performance. Conclusion: LBC was significantly superior to conventional smears for the detection of LSILs and HSILs, but these results did not influence biopsy confirmation. Both methods showed similar performances with high positive predictive values but very low sensitivities.

Longatto Filho A, Pereira SM, Di Loreto C, et al: DCS liquid-based system is more effective than conventional smears to diagnosis of cervical lesions: study in high-risk population with biopsy-based confirmation. Gynecol Oncol 2005;97:497-500.
Cox JT: Liquid-based cytology: evaluation of effectiveness, cost-effectiveness, and application to present practice. J Natl Compr Canc Netw 2004;2:597-611.
Strander B, Andersson-Ellström A, Milsom I, et al: Liquid-based cytology versus conventional Papanicolaou smear in an organized screening program: a prospective randomized study. Cancer 2007;111:285-291.
Levi AW, Chhieng DC, Schofield K, et al: Implementation of FocalPoint GS location-guided imaging system: experience in a clinical setting. Cancer Cytopathol 2012;120:126-133.
Gamarra CJ, Valente JG, Silva GA: Correction for reported cervical cancer mortality data in Brazil, 1996-2005. Rev Saude Publica 2010;44:629-638.
Longatto-Filho A, Schmitt FC: Gynecological cytology: too old to be a pop star but too young to die. Diagn Cytopathol 2007;35:672-673.
Longatto Filho A, Schmitt FC: Cytology education in the 21st century: living in the past or crossing the Rubicon? Acta Cytol 2010;54:654-656.
Solomon D, Davey D, Kurman R, et al; Forum Group Members; Bethesda 2001 Workshop: The 2001 Bethesda System: terminology for reporting results of cervical cytology. JAMA 2002;287:2114-2119.
Davey E, Barratt A, Irwig L, et al: Effect of study design and quality on unsatisfactory rates, cytology classifications, and accuracy in liquid-based versus conventional cervical cytology: a systematic review. Lancet 2006;367:122-132.
Arbyn M, Bergeron C, Klinkhamer P, et al: Liquid compared with conventional cervical cytology: a systematic review and meta-analysis. Obstet Gynecol 2008;111:167-177.
Longatto-Filho A, Maeda MY, Erzen M, et al: Conventional Pap smear and liquid-based cytology as screening tools in low-resource settings in Latin America: experience of the Latin American screening study. Acta Cytol 2005;49:500-506.
Siebers AG, Klinkhamer PJ, Grefte JM, et al: Comparison of liquid-based cytology with conventional cytology for detection of cervical cancer precursors: a randomized controlled trial. JAMA 2009;302:1757-1764.
Ronco G, Cuzick J, Pierotti P, et al: Accuracy of liquid based versus conventional cytology: overall results of new technologies for cervical cancer screening: randomised controlled trial. BMJ 2007;335:28.
Hovland S, Arbyn M, Lie AK, et al: A comprehensive evaluation of the accuracy of cervical pre-cancer detection methods in a high-risk area in East Congo. Br J Cancer 2010;102:957-965.
Franco EL, Cuzick J: Cervical cancer screening following prophylactic human papillomavirus vaccination. Vaccine 2008;26(suppl 1):A16-A23.
Schmitt FC, Longatto-Filho A, Valent A, Vielh P: Molecular techniques in cytopathology practice. J Clin Pathol 2008;61:258-267.
Arbyn M, Andersson K, Bergeron C, et al: Cervical cytology biobanks as a resource for molecular epidemiology. Methods Mol Biol 2011;675:279-298.
Wilbur DC, Black-Schaffer WS, Luff RD, et al: The Becton Dickinson FocalPoint GS Imaging System: clinical trials demonstrate significantly improved sensitivity for the detection of important cervical lesions. Am J Clin Pathol 2009;132:767-775.
Hutchinson ML, Isenstein LM, Goodman A, Hurley AA, Douglass KL, Mui KK, Patten FW, Zahniser DJ: Homogeneous sampling accounts for the increased diagnostic accuracy using the ThinPrep Processor. Am J Clin Pathol 1994;101:215-219.
Kitchener HC, Gilham C, Sargent A, et al: A comparison of HPV DNA testing and liquid based cytology over three rounds of primary cervical screening: extended follow up in the ARTISTIC trial. Eur J Cancer 2011;47:864-871.
Alves VA, Bibbo M, Schmitt FC, et al: Comparison of manual and automated methods of liquid-based cytology. A morphologic study. Acta Cytol 2004;48:187-193.
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