Comparing SurePath, ThinPrep, and conventional cytology as primary test method: SurePath is associated with increased CIN II+ detection rates

Abstract

PurposeWithin the last decade, SurePath and ThinPrep [both liquid-based cytology (LBC) tests] have replaced conventional cytology (CC) as primary test method in cervical cancer screening programs of multiple countries. The aim of our study was to examine the effect in the Dutch screening program.MethodsAll primary smears taken within this program from 2000 to 2011 were analyzed using the nationwide registry of histo- and cytopathology (PALGA) with a follow-up until March 2013. The percentage of smears classified as borderline/mildly dyskaryotic (BMD) and >BMD as well as CIN and cervical cancer detection rates were compared between SurePath and ThinPrep versus CC by logistic regression analyses (adjusted for age, screen region, socioeconomic status, and calendar time).ResultsWe included 3,118,685 CC, 1,313,731 SurePath, and 1,584,587 ThinPrep smears. Using SurePath resulted in an increased rate of primary smears classified as >BMD [odds ratio (OR) = 1.12 (95% confidence interval (CI) 1.09–1.16)]. CIN I and II+ detection rates increased by 14 % [OR = 1.14 (95% CI 1.08–1.20)] and 8 % [OR = 1.08 (95% CI 1.05–1.12)]. Cervical cancer detection rates were unaffected. Implementing ThinPrep did not result in major alterations of the cytological classification of smears, and it did not affect CIN detection rates. While not significant, cervical cancer detection rates were lower [OR = 0.87 (95% CI 0.75–1.01)].ConclusionsThe impact of replacing CC by LBC as primary test method depends on the type of LBC test used. Only the use of SurePath was associated with increased CIN II+ detection, although it simultaneously increased the detection of CIN I.

Cervical cancer incidence after normal cytological sample in routine screening using SurePath, ThinPrep, and conventional cytology: population based study

“…Fontaine et al have shown that unsatisfactory rates are significantly lower when using SurePath instead of ThinPrep. 44 Although this was not shown in our previous study, 19 we then found similar results (an odds ratio of 0.74, 0.72 to 0.75) when comparing unsatisfactory rates between SurePath and ThinPrep.…”

“…19 As the use of SurePath resulted in decreased rates of cervical cancer after a normal screening sample, this indicates that at least part of the extra detected CIN lesions were progressive. As the use of ThinPrep seemed to result in increased cancer rates, this suggests that fewer of the detected CIN lesions were progressive.…”

Validation of a New Low-Cost, Methanol-Based Fixative for Cervical Cytology and Human Papillomavirus Detection

“…There are few studies comparing different methods of LBC. Published studies have shown better performance of SurePath® over Thinprep® in the detection of significant lesions [15, 16]. However, ours is the first study addressing the performance of a new and cheaper fixative, thereby making this method affordable and universal in the treatment of LBC for low-income countries.…”

Using novel biomarkers to triage young adult women with minor cervical lesions: a cost‐effectiveness analysis

“…Meta-analyses suggest that the diagnostic accuracy of cytology does not vary by collection method (i.e., conventional Pap smear versus liquid-based cytology), although liquid-based collection may result in fewer inadequate tests and is preferable because it allows reusing the sample for HPV testing (i.e., reflex testing) [35,37]. However, recent studies suggest that the sensitivity for detecting CIN2+ depends on the type of liquid-based cytology test [38,39]. In contrast to cytology, HPV DNA tests are automated and [40]), which detects presence or absence of HPV DNA.…”