Introduction: WellPrep® (WP), a fully automated, one-step liquid-based cytology (LBC) platform using an all-in-one closed chamber, has recently been developed as a next-generation LBC technology. This study aimed to evaluate the diagnostic performance and cytomorphologic features of WP regarding cervical cytology and also to compare WP with the SurePathTM (SP), one of the most widely used LBC systems used worldwide. Methods: Cervicovaginal samples were taken from 212 females who enrolled in the study, and each sample was split and subsequently used for WP and SP LBC. Following the exclusion of seven cases with insufficient quality, a total of 205 cases were used for subsequent analysis. Among them, 75 (36.6%) received histologic follow-up. All cases were interpreted according to the Bethesda System, while three experienced pathologists evaluated their cytomorphologic features. Results: The diagnostic concordance rate between the two LBC technologies was 84.4% (kappa = 0.776). Furthermore, the diagnostic concordance rates between SP and histology and between WP and histology were 73.3% (kappa = 0.516) and 70.7% (kappa = 0.497), respectively. The two LBC methods showed comparable sensitivity, specificity, and area under the curve (AUC) for histologic HSIL+ (SP: sensitivity 82.8%, specificity 84.8%, and AUC 0.838; WP: sensitivity 79.3%, specificity 87.0%, and AUC 0.831). No significant difference was found regarding the sensitivity, specificity, and AUC between SP and WP (p = 0.586, p = 0.670, and p = 0.924, respectively). In terms of cytomorphologic features, WP revealed more often than SP the presence of coarse chromatin (p = 0.031) and mitoses (p = 0.008) but less commonly perinuclear clearing (p = 0.001). Conclusion: This is the first study demonstrating that WP has a comparable performance to SP. In conclusion, WP may be an alternative LBC technology for cervical cancer screening.

Sung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A, et al. Global cancer Statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2021 May;71(3):209–49.
Gibb RK, Martens MG. The impact of liquid-based cytology in decreasing the incidence of cervical cancer. Rev Obstet Gynecol. 2011;4(Suppl 1):S2–11.
Alaghehbandan R. Performance of the CellSolutions Glucyte liquid-based cytology in comparison with the ThinPrep and SurePath methods. Acta Cytologica. 2013;57(2):189–97.
Jesdapatarakul S, Tangjitgamol S, Nguansangiam S, Manusirivithaya S. Liqui-Prep® versus conventional Papanicolaou smear to detect cervical cells abnormality by split-sample technique: a randomized double-blind controlled trial. Diagn Cytopathol. 2011 Jan;39(1):22–7.
Chong Y, Baek KH, Kim JY, Kim TJ, Lee EJ, Kang CS. Comparison of EASYPREP(®) and SurePath(®) in thyroid fine-needle aspiration. Diagn Cytopathol. 2016 Apr;44(4):283–90.
Perkins RB, Guido RS, Castle PE, Chelmow D, Einstein MH, Garcia F, et al. 2019 ASCCP risk-based management consensus guidelines for abnormal cervical cancer screening tests and cancer precursors. J Lower Genital Tract Dis. 2020 Apr;24(2):102–31.
Nayar R, Wilbur DC. The pap test and bethesda 2014. Cancer Cytopathol. 2015 May;123(5):271–81.
Beerman H, van Dorst EB, Kuenen-Boumeester V, Hogendoorn PC. Superior performance of liquid-based versus conventional cytology in a population-based cervical cancer screening program. Gynecol Oncol. 2009 Mar;112(3):572–6.
Pan QJ, Hu SY, Zhang X, Ci PW, Zhang WH, Guo HQ, et al. Pooled analysis of the performance of liquid-based cytology in population-based cervical cancer screening studies in China. Cancer Cytopathol. 2013 Sep;121(9):473–82.
Siebers AG, Klinkhamer PJJM, Grefte JMM, Massuger LFAG, Vedder JEM, Beijers-Broos A, et al. Comparison of liquid-based cytology with conventional cytology for detection of cervical cancer precursors: a randomized controlled trial. Jama. 2009 Oct 28;302(16):1757–64.
Wright PK, Marshall J, Desai M. Comparison of SurePath® and ThinPrep® liquid-based cervical cytology using positive predictive value, atypical predictive value and total predictive value as performance indicators. Cytopathology. 2010 Dec;21(6):374–8.
Phaliwong P, Pariyawateekul P, Khuakoonratt N, Sirichai W, Bhamarapravatana K, Suwannarurk K. Cervical cancer detection between conventional and liquid based cervical cytology: a 6-year experience in Northern Bangkok Thailand. Asian Pac J Cancer Prev. 2018 May 26;19(5):1331–6.
Fremont-Smith M, Marino J, Griffin B, Spencer L, Bolick D. Comparison of the SurePath liquid-based Papanicolaou smear with the conventional Papanicolaou smear in a multisite direct-to-vial study. Cancer. 2004 Oct 25;102(5):269–79.
Hoda RS, Loukeris K, Abdul-Karim FW. Gynecologic cytology on conventional and liquid-based preparations: a comprehensive review of similarities and differences. Diagn Cytopathol. 2013 Mar;41(3):257–78.
Doyle B, O’Farrell C, Mahoney E, Turner L, Magee D, Gibbons D. Liquid-based cytology improves productivity in cervical cytology screening. Cytopathology. 2006 Apr;17(2):60–4.
Schledermann D, Ejersbo D, Hoelund B. Improvement of diagnostic accuracy and screening conditions with liquid-based cytology. Diagn Cytopathol. 2006 Nov;34(11):780–5.
Strander B, Andersson-Ellström A, Milsom I, Rådberg T, Ryd W. Liquid-based cytology versus conventional Papanicolaou smear in an organized screening program: a prospective randomized study. Cancer. 2007 Oct 25;111(5):285–91.
Bui CN, Choi E, Suh M, Jun JK, Jung KW, Lim MC, et al. Trend analysis of process quality indicators for the Korean National Cervical Cancer Screening Program from 2005 to 2013. J Gynecol Oncol. 2021 Jan;32(1):e14.
Bentz JS, Rowe LR, Gopez EV, Marshall CJ. The unsatisfactory ThinPrep Pap Test: missed opportunity for disease detection? Am J Clin Pathol. 2002 Mar;117(3):457–63.
Clark SB, Dawson AE. Invasive squamous-cell carcinoma in ThinPrep specimens: diagnostic clues in the cellular pattern. Diagn Cytopathol. 2002 Jan;26(1):1–4.
Kenyon S, Sweeney BJ, Happel J, Marchilli GE, Weinstein B, Schneider D. Comparison of BD Surepath and ThinPrep Pap systems in the processing of mucus-rich specimens. Cancer Cytopathol. 2010 Oct 25;118(5):244–9.
Zhao FH, Hu SY, Bian JJ, Liu B, Peck RB, Bao YP, et al. Comparison of ThinPrep and SurePath liquid-based cytology and subsequent human papillomavirus DNA testing in China. Cancer Cytopathol. 2011 Dec 25;119(6):387–94.
You do not currently have access to this content.