Authors' objectives:

This review aims to assess the available evidence on the effectiveness of liquid-based cervical cytology, a technique developed with the intent of improving the accuracy of Pap tests for cervical cancer screening.

Authors' recommendations: With regard to liquid-based cervical cytology (LBC), the ICSI Technology Assessment Committee finds: 1. LBC is an option to conventional Pap testing for cervical cancer screening. a. For the detection of pre-invasive cervical lesions, LBC is comparable to conventional Pap; there is no evidence of a change in the rate of cancer detection when liquid-based samples are analyzed (Conclusion Grade II). b. For minor grade lesions, there is evidence of a higher detection rate with LBC (Conclusion Grade II). As a result, LBC acts to normalize the rate of detection of atypical squamous cells of undetermined significance (ASCUS) so that pathologists can reach the 3%-5% ASCUS rate expected (Bethesda criteria) More accurate detection of ASCUS helps to better identify patients who need further testing. Interobserver validity is higher with LBC. 2. The implementation of a liquid-based collection system has no impact on the safety of the patient during the sample collection process. The impact of the new technology may be to objectify Pap smear diagnosis and potentially reduce the number of repeat visits (and associated costs) for additional Pap testing, HPV testing (since the residual material may be used), or more invasive procedures. 3. Of 11 studies cited in this report that presented test results as either satisfactory, satisfactory but limited by, or unsatisfactory, 8 found a higher rate of satisfactory samples with LBC. Between 75.6% and 97.7% of LBC preparations were satisfactory compared with 60.5% to 97.5% with conventional Pap preparations. 4. A recent metaanalysis of 15 studies reported a sensitivity of 80% for LBC and 72% for conventional Pap testing predominantly for the detection of low grade squamous intraepithelial lesions or more severe (LSIL+) by histology and/or independent pathology review of slides with a Pap test result of LSIL+ Specificity did not differ between conventional and LBC preparations.

Authors' methods: Review

Project Status: Completed

URL for project: http://www.icsi.org/index.asp

Year Published: 2003

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: United States

Organisation Name: Institute for Clinical Systems Improvement

Contact Address: 8009 34th Avenue South, Suite 1200, Bloomington, MN, USA. Tel: +1 952 814 7060; Fax: +1 952 858 9675

Contact Name: icsi.info@icsi.org

Contact Email: icsi.info@icsi.org

Copyright: Institute for Clinical Systems Improvement (ICSI)