Conventional PAP Smear or Liquid-Based Cytology, The Better Screening Tool for Cervical Cancer: a Comparative Study at a Tertiary Care Center in North-East India

PurposeIndia accounts for one-fourth of world's total cervical cancer deaths. According to the recently released National Cancer Registry Programme 2020 report, age-adjusted incidence rate (AAR) of cervical cancer was highest in the North Eastern region followed by Bengaluru 17.7 and then Barshi (Rural) 15.3. Papumpare district in Arunachal Pradesh (North-East India) had the highest AAR of 27.7. The prime purpose of the study is to compare conventional PAP smear with liquid-based cytology, on the basis of parameters like slide quality, detection of dysplasia in cervical cancer, and the scope for routine usage of liquid-based cytology in government healthcare facilities in India.MethodsBoth PAP smear and liquid-based cytology samples were taken from 100 randomly selected patients belonging to age group 21-65 yrs.', who were sexually active, after taking relevant history and per speculum examination. Both the samples were then reported according to the Bethesda Classification of cervical cytology.Results and ConclusionsOut of 100 patients screened most of them belonged to the age group of 30-45 yrs. Dysplasia (HSIL + LSIL + ASCUS) was more commonly seen in perimenopausal age group belonging to lower middle class. Out of the 15 patients with dysplasia, ten patients had coitarche at or below 20 yrs. 46% of patients with dysplasia had three previous pregnancies and had lower abdominal pain as the most common complaint. 100% of the patients with dysplasia had unhealthy cervix. Percentage of inadequate slides were 21% in PAP smear compared to 10% in LBC. Dysplasia was seen in 13% in PAP smear compared to 15% in LBC. Slide cellularity was more in LBC (88%) compared to PAP smear (77%). It was concluded that LBC is a better screening tool when compared to conventional PAP smear in terms of better slide quality and option to do HPV testing in the same sitting. However, excessive cost of a single LBC kit makes it challenging to be used in routine screening.