One of the merits of ThinPrep 1 (TP) liquid-based preparation in cervical cytology is the reduction of the unsatisfactory rate in comparison with conventional smears. 1-3 This is achieved by reducing the presence of obscuring hemorrhage, inflammation, lubricant, mucus and nonblood contaminant materials in the background, and by virtue of the rapid fixation that allows clear viewing of the cellular details. 1-3 However, certain technical problems, probably inherent within the TP technique, can lead to unexpected limitations with regards the final satisfactory rate, especially when handling bloody material from symptomatic women. 3 Hemorrhagic smears can lead to deceptively unsatisfactory material that on occasions can hide significant epithelial abnormalities. Attempts to overcome this drawback can be a beneficial and a relatively cost-effective measure. Reprocessing by glacial acetic acid (GAA) wash is one way to improve the satisfactory rate of TP Pap tests.We conducted a prospective study over a 2-year period to investigate the effectiveness of reprocessing of unsatisfactory TP Pap slides in improving the overall satisfactory rate. We also studied the ability of reprocessing to uncover significant epithelial abnormalities. We used the 2001 Bethesda System, which requires a minimum number of squamous cells of 5,000 for liquid-based cytology to be clearly visualized. 4 Therefore, TP Pap tests slides with squamous cells less than 5,000 cells or poorly visualized and obscured cells were considered unsatisfactory and they were reprocessed. The remaining, residual Pre-servCyt 1 vial contents were transferred into a centrifuge tube. The fluid was centrifuged at 3,000 rotations per minute for 5 minutes. The supernatant was decanted, leaving a pellet at the bottom. A volume of 27 ml of CytoLyt 1 solution and 3 ml of concentrated GAA were added to the tube, and the contents were resuspended by vigorous agitation and recentrifuged at 3,000 RPM for 5 minutes. A 5 ml of PreservCyt 1 solution was added to the pellet, homogenized, and then added to a new PreservCyt solution TP vial and the solution was homogenized by vigorous manual agitation. A new second TP Pap slide was prepared using ThinPrep 2000 machine with a new filter. The reprocessing took 45 minutes and together with 30 minutes for Pap stain, the total turnaround time was 75 minutes.The study covered 8,224 TP Pap tests. Of these, 336 (4.08%) cases showed unsatisfactory Pap tests. After reprocessing, 285 (84.8%) cases showed satisfactory second slides, while 51 (15.2%) cases remained unsatisfactory. The final unsatisfactory Pap tests were reduced to 51 (0.62%) with a reduction rate of 69.6% of the unsatisfactory Pap tests. Of the 285 postprocessing satisfactory cases, 31 (10.9%) cases showed additional significant epithelial abnormalities. Of these, 15 (58.06%) cases showed atypical squamous cells of undetermined significance (ASCUS), 5 (16.13%) showed low-grade squamous intraepithelial lesion (LSIL), 4 (12.9%) showed high-grade squamous intraepithelial lesion (HSIL...

This study illustrates the potential of lubricant, mucus, and foreign body contaminant materials to cause interpretation errors in TP cervical cytology. Although liquid-based preparation reduces the obscuring effect of these materials, the unusual appearance of some of these particles in TP cervical smears not only can mimic infectious microorganisms, but also squamous dyskaryosis. This can lead to serious interpretation errors for the inexperienced cytotechnologists and pathologists, which subsequently can have an effect on the women's management.

No abstract

The aim of this study was to compare the frequency of abnormal cervical cytology in women with infertility problems with that of fertile women by using ThinPrep® liquid-based Pap Tests™. A retrospective case-control study for over 2 years was conducted. The cases included all women with infertility problems who had Pap tests during their infertility treatment period. The cases were further subdivided into primary and secondary infertility groups. The control group included all women without infertility problems who had routine Pap tests in the same period. The age and demographic features were adjusted and matched for both groups. Statistical analysis included chi-square test and Fischer exact test. The infertility group (n = 490) showed significantly (P < 0.05) more abnormal cervical squamous epithelial abnormalities (48 positive cases, 9.8%) than the controls (n = 7,150, 216 positive cases, 3%). Women with secondary infertility had more epithelial abnormalities and more high-grade lesions than women with primary infertility. Women with infertility had statistically significant higher frequency of squamous intraepithelial lesions than women without infertility problems of similar age and demographic background. The data suggest that women with infertility might benefit from more frequent cervical cytology screening.

No abstract