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Liquid-based cytology and conventional smears compared over two 12-month periods


A. R. W. Williams, Department of Pathology, Royal Infirmary of Edinburgh, Edinburgh, UK.
Tel.: +44 131 242 7120; Fax: +44 131 242 7146;


Background and objective:  Liquid based cytology (LBC) was introduced across the Scottish Cervical Screening Programme in 2003–2004. The objective of this study was to compare in a large cytopathology laboratory the results of cervical samples over two twelve-month periods, 2001–2002, when the great majority of smears were conventional, with 2003–2004, when all were LBC.

Methods:  The results of smears in both periods were analysed to give overall reporting profiles, and correlated with results of cervical biopsies. The numbers of patients referred for colposcopy were compared.

Results:  The percentage of unsatisfactory smears fell from 13.6% to 1.9%. Colposcopic referrals for repeated unsatisfactory smears fell from almost 25% to 0.5%. There was a decrease in overall smear numbers, but despite this there was an increase in the number of smears reported as showing dyskaryosis of any grade. There was an increase in positive predictive value for moderate dyskaryosis and above, from 79.5% to 86.1%. The outcome of biopsies from patients referred with mild dyskaryosis showed no decrease in accuracy of predicting a low grade histological lesion. Workload in the laboratory decreased, due to fewer smears received overall, more rapid primary screening times and fewer multi-slide cases. Primary screening backlogs all but disappeared, and reporting times greatly improved.

Conclusions:  Introduction of liquid based cytology led to improvements in unsatisfactory smear rates, with significant benefits to colposcopic referrals and laboratory turnaround times. Pick-up rates of dyskaryosis were maintained, and the positive predictive value of a dyskaryotic smear report was improved.