4. Hrvatski kongres kliniËke citologije 4th Croatian Congress ... - Penta

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4. Hrvatski kongres kliniËke citologije / 1. Hrvatski simpozij analitiËke citologije / 2. Hrvatski simpozij citotehnologije 68 Klinička citologija - Plenarna i pozvana predavanja BENEFITS OF LIQUID BASED CYTOLOGY OVER CONVENTIONAL PAP TEST: PRESENT AND FUTURE. Verhest A Institute Jules Bordet, Brussels - Belgium Objective:The intention of this presentation is to provide insight into our everyday experience with the BD-SurePath TM liquid based technology that we used for cervical cancer screening since 1998. We will also focus on use of reflex HPV-DNA testing as an adjunct for external quality control and guided screening of cervical cytology specimens as a significant advance over routine manual screening . Methods:Conventional Pap screening has been credited with a 75 % reduction in cancer incidence and death rates in the last 50 years. Despite this, there was a growing evidence of a limited sensitivity of 77 % for detecting CIN 2 (when using LSIL as a threshold) with an individual Pap smear, a low positive predictive value (10-30%), a highly subjective interpretation leading to misclassification with unreducible false negative and positive rates. These factors limiting the performance of the Pap smear while increasing the complexity and costs of screening programmes, we replaced conventional smear in december 1997 by thin layer preparations made with BD-PrepStain TM automate from samples collected in BD-SurePath TM preservative fluid. Liquid based cytology (LBC) diagnoses were assessed on first screening sample with a second reading combined with HPV test to improve the ASCUS predictive value and offer an immediate evaluation of our personal performance and possible misinterpretation of the Bethesda TBS criteria. The LBC process is now widely used in the United States, many European countries and elsewhere. The slides facilitated the screening by skilled human observers or triggered an impetus for automated screening. In order to determine if use of the BD FocalPoint GS Imaging System (BD Diagnostics-TriPath) is more effective than manual screening, a large clinical trial has been recently performed. (1) A 2-armed, masked trial was run at 4 clinical sites. 12,313 slides were evaluated. The control arm (CA) consisted of routine manual screening and quality control (QC) rescreening. The experimental arm (EA) consisted of screening by the BD FocalPoint GS Imaging System. Results: With the adoption of LBC we have significantly reduced the number of unsatisfactory smears minimizing cellular preparation artifacts, decreased the ASCUS rate and improved the sensitivity and specificity of our SIL diagnoses. The use of HPV testing has ascertained our diagnoses in the necessary learning curve of our morphologic interpretation of abnormals. BD-SurePath TM increased comfort and skill level of the all staff. More evenly dispersed single-cell population between aggregates enhances the clarity of the smear, makes them easier to evaluate for atypia; its utilization demonstrated evident superiority over conventional Pap smear in terms of disease detection. Using computer-assisted imaging, all positive, discordant, and a subsampling of negative slides were adjudicated to a reference diagnosis. The results obtained in the two arms were compared to the reference diagnoses and sensitivity, specificity, and negative predictive value (NPV) were calculated for ASC-US+, LSIL+ and HSIL+ groups. (1). The FocalPoint LGS reading gives a higher detection sensitivity than the manual reading for HSIL+ and for LSIL+. (1-2) For ASC-US+,
Clinical Cytology - Plenary and Invited Lectures the sensitivities were not statistically different between the study arms in Tench’s Study (1) while Beccati (2) reports a more precise ASCUS diagnosis. Conclusions: The optimal preservation of the cells with BD-SurePath LBC is reducing collection, preparation and screening errors of conventional Pap smears. It facilitates comfort of screening by human observers. The lower rate of unsatisfactory smears and ASCUS/SIL ratio have contributed to an increased HSIL+ detection. Use of the BD FocalPoint GS Imaging System significantly improved the sensitivity for detection of the important categories of squamous intraepithelial lesion (SIL) and cancer with a much smaller decrement in specificity. (1) SurePath cytology, FocalPoint prescreening and HPV test can improve the efficacy of screening program in a low incidence/low endemicity setting. (2) The increased sensitivity compared to conventional smear with an increased specificity for a given sensitivity reduce recall rate and unnecessary colposcopies and biopsies avoiding overtreatment and emotional stress. 1. WD Tench, RD Luff, TM Molina, KP Abraham, C Kemper, WS Black-Schaffer, DC Wilbur. 2009. 35th EFCS Congress of Cytology Improved Sensitivity for Detection of Important Cervical Lesions in Liquid-Based Cytology using Computer-Assisted Imaging 2. MD Beccati, C Buriani, O Bulzoni, G Binotti, A Carantoni, C Cavicchi, A . Delazer, S Immovilli, I Maestri, I Nenci. 2009. 35th EFCS Congress of Cytology Efficacy of Cytology-Based Screening Program Optimized by Liquid Based Cytologywith Automated Pre-Screening and HPV Testing alainverhest@yahoo.com 69 4 th Croatian Congress of Clinical Cytology / 1 st Croatian Symposium of Analytical Cytology / 2 nd Croatian Symposium of Cytotechnology
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Final programme and abstract book
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