Interobserver reproducibility with LiquiPrep™ liquid-based cervical cytology screening in a developing country

Abstract

Objective: A modified liquid-based techniques known as the "LiquiPrep™ (LP) system" requires neither expensive equipment nor complicated specimen preparation. The aim of this study was to assess the applicability of the LP for use in a developing country. Methods: Cervical cytology specimens were collected from 777 women, using the Cervex-Brush™. The brush was first smeared on a glass side for conventional Papanicolaou (CP) stain, and then immersed in preservation fluid for LP preparation. Cytologic interpretations were classified into four categories: 1) no atypical cells, 2) atypical squamous epithelial cells (ASC), 3) definite epithelial cell abnormality, and 4) unsatisfactory specimen. Interobserver variability was tested using weighted kappa statistics. Results: An LP specimen cost $9 per case compared to $3 per case for a conventional Pap smear. The time to learn the technique was only a few days. Forty six (5.92%) specimens by LP were unsatisfactory. The overall agreement between cytopathologists was 96.7% (weighted κ=0.62), with 95.6% (weighted κ=0.44) for the cases enrolled earlier, increasing to 97.9% (weighted κ=0.78) for the cases enrolled later. Conclusions: In summary, after a short learning curve, interobserver reproducibility of LP smear was near perfect. This feature of the LP, together with the relatively low cost and simple protocol, makes it quite suitable for cervical cytology screening in developing countries. Moreover, with this technique, some of each sample can be reserved for additional studies such as HPV detection and subtyping.