Manual method for liquid‐based cytology: A demonstration using 1,000 gynecological cytologies collected directly to vial and prepared by a smear‐slide technique

Abstract

We report on the formulation and use of an alcoholic-agar additive solution generally useful for rapid, inexpensive liquid-based cytology slide preparation. Gynecological cytology specimens were collected from 1,000 women. Two hundred fifty aliquots each of CytoRich, CytoRich Red (Tripath Imaging, Inc., Burlington, NC), Preservcyt (Cytyc Corp., Boxborough, MA), and DINA*TRANS (DINA*CYT Corp., Portland, OR) fixatives were used for this study. Fixed cell suspensions from 1,000 women, seen consecutively by a general obstetrics and gynecology practice, were vortex-mixed and transferred into a premeasured amount of alcoholic-agar in test tubes. Test tubes were conventionally centrifuged, cells were trapped in a spontaneously formed agar-gel, and the supernatant solutions were decanted. Vortex-mixing cell buttons caused a rapid gel-to-sol transition, affording viscous cell suspensions that were applied to slides, smeared, and stained using Papanicolaou stains. Slides showed unclumped, monolayered, uniform, random cell-spreads. All of the fixatives afforded crisp presentation of normal and abnormal cells. There was an about 3-fold increase in HSIL+ (0.7-1.8%) and LSIL diagnoses (1.3-4.4%), and a 45% reduction in ASCUS diagnoses (3.3-1.8%), as compared to our cytology laboratory's previous year's patients' statistics with a concurrent 0.2% unsatisfactory rate, due solely to inadequate sampling. This manual method makes liquid-based cytology inexpensive and does not require specialized preparative devices.

Manual Liquid Based Cytology in Primary Screening for Cervical Cancer - a Cost Effective Preposition for Scarce Resource Settings

“…Despite its success as a preventive screening tool for cervical cancer, CPS has its limitations (Deshou et al, 2009). False negatives in CPS may be related to inadequate sampling, inadequate transfer of the sample onto the glass slide or deficiencies in the microscopic assessment of the slide (Maksem et al, 2001). To overcome these problems, a new slide preparation method namely the Manual Liquid Based Cytology (MLBC)was introduced by(.…”

“…To overcome these problems, a new slide preparation method namely the Manual Liquid Based Cytology (MLBC)was introduced by(. Maksem et al, 2001) In the manual liquid based method, cells are uniformly dispersed by a membrane, from a suspension of cells in a polymer solution (Maksem et al, 2001;Kavatkar et al, 2008). As with most screening tests, the CPS suffers from imperfect sensitivity and specificity.…”

“…Comparison of unsatisfactory smear rates have varied with some investigators reporting increased rates for liquid based methods (Maksem et al, 2001;Baker et al, 2002, Alves et al, 2004 with some investigators reporting decreased (Park et al, 2001;Baker, 2002) and some, no significant change (Park et al, 2001;Baker, 2002). In our study the number of unsatisfactory smears by CPS was 9 as compared to MLBC which had one unsatisfactory smear with scant squamous cellularity as observed in many studies…”

“…There are studies (Maksem et al, 2001;Kavatkar et al, 2008) which have dealt with liquid based cytology and have found its diagnostic accuracy comparable with conventional Pap smears. MLBC method however is specific to the laboratory, available equipments, fixatives and polymer solutions, etc.…”

Accuracy of a low priced liquid‐based method for cervical cytology in 632 women referred for colposcopy after a positive Pap smear

“…One of these alternative monolayer slide preparation methods makes use of a cytocentrifuge and an alcoholic-agar solution, named 3MLBC. [5][6][7] Other known systems in Europe using the Hettich cytocentrifuge are CytoSCREEN 1 (Seroa, Monaco, France) and Turbitec 1 (Labonord, Templemars, France). In this quality control study, we determined the sensitivity and specificity of LBC with the Turbitec cytocentrifuge technique in a series of 632 women who recently had an abnormal cervical smear and were referred to our CIN outpatient clinic.…”