LIQUID BASED CYTOLOGY for cervical..pptx

An overview of how to perform liquid based cytology

1. CERVICAL SMEAR FOR LIQUID BASED CYTOLOGY DR NUHU TERI JAMES MBBS, MSc., FWACS-(OBGYN)

2. Outline Introduction Advantage of LBC Conditions for pap smear Sampling devices Procedure Conclusion Video

3. Introduction Liquid ­based cytology (LBC) is a method which produce thin­ layer smears Entails the utilisation of collection fluid that fixes, and rinses the cells Designed to overcome the pitfalls of conventional Papanicolaou ( Pap) smears in cervical cancer screening The aim is improve the transfer of cells from the collection device to a microscope slide and ensure uniformity of the cell population in each sample

4. Advantages/Benefits of LBC Higher sensitivity compared to convention pap smear (76-95% vs 53-92%). Satisfactory smears, 99% Improved preservation of the cells in the specimen Interpretation accuracy Interference by artifacts such as air drying, cellular degeneration, etc , is eliminated Reduces obscuring inflammatory cells and blood Less incidence of repeat Pap tests Lower cost HPV testing can be performed on the same sample within 30 days of collection

5. Condition for cervical smear Best between 7th and 15th day of the menstrual cycle C an be taken at a different time of the cycle Do not take during menses Treat pre-existing infections Avoid vaginal sex for at least 48 hour (two days) prior to test Avoid using tampons, vaginal creams, birth control foams or jellies, lubricants or douches for at least 48 hours prior to test

6. Cervical broom/ Cervex brush

7. Combi-brush Tighter/small cervical os Do not use in pregnancy Do not use in women with IUCD Do not use in fragile cervix

8. Vial for thin prep

9. Vial for SurePath

10. Procedure Take a brief history Set trolley with all necessary equipment Confirm the expiry date on the vial Remove the plastic cover over the vial Speculum insertion: Lubricate with warm water. W ater-soluble carbomer -free lubricant can be used, but do not apply on the tip of the speculum Take STI specimens if required. Gently wipe away cervical discharge or mucous. Vigorous cleaning may scrap cervical cells.

11. Procedure.. Insert the broom into the endocervix so that the shorter bristles fully contact the ectocervix Rotate the cervix brush 5 times in a clockwise direction For combi-brush rotate twice

12. ThinPrep For ThinPrep : Rinse the broom by pushing it into the bottom of the vial 10 times, forcing the bristles apart. Then , swirl the broom vigorously to release more material. Inspect the brush for material, and if present, repeat the sweep and swirl Finally cover the vial/specimen container and send to the laboratory.

13. SurePath For SurePath : Insert the broom into the larger opening of the vial. Rotate the broom 90° to use the inner edge of the insert to pull off the broom into the vial Benefits: Lower rates of unsatisfactory slide Greater proportion of specimen is retained Adequate volume for HPV- test

14. Conclusion LBC is an improvement over the tradition pap smear with higher sensitivity and specificity Less likely to be affected by artefacts Proper cervical sampling method is important in ensuring reliable result

15. THANK YOU FOR YOUR UNDIVIDED ATTENTION

16. References Bavikar R, Patel N, Buch A, Kulkarni M. A Comparison of Conventional Pap smear and Liquid Based Cytology for Cervical Cancer Screening. Gynaecol Minim Invasive Ther 2024;13(1):77-82. Zhoa FH, et al. Comparison of ThinPrep and SurePath Liquid-Based Cytology and Subsequent Human Papillomavirus DNA Testing in China. Wiley Online Library 2011. doi 10.1002/cncy.20177. Rebolj M, Rask J, Ballegooijen M, Kirschner B, Rozemeijer K, Bonde J, et al. Cervical histology after routine ThinPrep or SurePath liquid-based cytology and computer-assisted reading in Denmark. British Journal of Cancer (2015) 113, 1259–1274 | doi : 10.1038/bjc.2015.339 Macharia E, Machuri L. A comparative analysis of conventional pap smear, liquid based cytology and colposcopy in Kenyatta National Hospital. Int J Reprod Contracept Obstet Gynecol 2014; 3:58-63. https://youtu.be/- WRQIAi-uCU?si=8TVckPM7fEgxyGfL