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Adequacy Criteria and Cytomorphological Changes in Liqui-Prep TM versus Conventional Cervical Cytology

* Associate Professor, Department of Obstetrics and Gynecology
** Associate Professor, Department of Pathology
± Student, Faculty of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
+Corresponding Author: N Afshar Moghaddam , Department of Pathology, Faculty of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran, Tel.: +98(311) 6691565, E-mail: [email protected].
Shiraz E-Medical Journal. 11(4): 173-182.
Article Type: Research Article;


Background: The subject of adequacy in cervical smears has an essential role in the prevention
of cervical cancer deaths. The predicament of establishing exactly what constitutes an
adequate sample has received increasing attention in recent years. In this study, we tried to
compare specimen adequacy and cytomorphological changes between conventional cervical
and liquid based cytology “ Liqui-PREP TM”.

Materials and Methods: A total of 170 asymptomatic women who undergo annual screening,
were examined in cytopathology and gynecology departments (Al-Zahra Hospital of Isfahan
University, Iran) during August 2008 to December 2008. Among which 153 cases, 93 cases:
pre-menopause and 60 cases: post menopause women were subsequently selected. The
conventional smears (CS) and Liquid-Based slides (LBS) using Liqui-PREP TM technique taken
from each patient were evaluated carefully by a professional cytopathologist. The number of
endocervical and transional zone's cells per slide, covering diagnostic squamous cells (%) and
degenerated cells per high power microscopic field (HPF) were also counted. Other cytomorphological
changes evaluated for postmenopausal women were included: number of eosinophilic
pyknotic cells and spindled cells, basophilic globules (per HPF) and the presences of
basophilic filaments (+/-).SPSS software was used for data analysis using indices of frequency
percent, mean, and standard deviation for descriptive analysis

Results: Mean of the patients' age was 42.28 which ranged from 20 to 67 years. The numbers
of satisfactory cases with CS were 30 (31.9%) compared to 58 (62.4%) with the LBC
(P<0.0001). Data for menopausal women included respectively: 11 (18.30%) and 39 (65%)
and the P<0.0001. A significant difference was observed two methods in the number of
degenerated cells and the amount of slide coverage by squamous cells in both age groups
(P=0.0001) but bet the quantitative amount of endocervical cells was more in CS method
rather than LBC method (P=0.0001). Other morphologic changes (variations) assessed in
Shiraz E Medical Journal, Vol. 11, No. 4, October 2010
menopause age group included:eosinophilic pyknotic cells, basophilic globules, spindled cells,
and basophilic filaments which demonstrated a significant difference between two methods.
The basophilic filaments were evaluated qualitatively as positive and negative. In CS 13
cases (21.7%) were negative and 47 ones (78.3%) were positive for filaments. All 13 negative
cases in CS method were negative in LBC method also. But out of the 47 positive cases
in LBC method, 13 cases (21.7%) were positive and 47 cases (78.7%) were negative (P
value = 0.0001).

Conclusion: 1. Liquid-PREP TM is a straight-forward cytological procedure, relying on classic
cell handling procedures. 2. Cellular material is encapsulated in a matrix material that assures
quantitative, robust adherence to the slide. 3. The number of cells transferred to the
slide is controlled by the cytologist. 4. Liquid-PREP TM is not expensive

Keywords: Convensional cervical smear, Liquid based cytology, Liquid-PREP TM, Adequacy


Authors wish to express their gratitude to all women who participated in this study. We would also like to thank Mr. Chehrei