Liquid-based cervical cytology: A review of the literature with methods of evidence-based medicine

BACKGROUND. The objective of the current study was to evaluate the applicability of liquid-based cytology in the Netherlands population screening program for cervical cancer. METHODS. A special committee performed an evaluation of all the available literature. Two methods were investigated: the AutoCytePrep system (currently known as ShurePath-system; TriPath Imaging, Burlington, NC) and the ThinPrep system (Cytyc, Boxborough, MA) for the detection of squamous epithelial abnormalities. All literature up to May 2000 was evaluated. RESULTS. For the AutoCytePrep system, there were indications that the detection rate for atypical squamous cells of undetermined significance (ASCUS) or higher had lower sensitivity compared with conventional screening. No definitive statement could be made concerning the value of the AutoCytePrep system for the detection rate of low-grade squamous intraepithelial lesions (LSIL) or higher and high-grade squamous intraepithelial lesions (HSIL) or higher because of conflicting results. For the ThinPrep system, there were indications that the detection rate of ASCUS or higher had a higher detection rate compared with conventional screening, with slightly lower specificity. It is likely that the detection rate of LSIL or higher with the ThinPrep system had greater sensitivity compared with conventional screening with almost unchanged specificity. In addition, it is likely that the detection rate of HSIL or higher with the ThinPrep system had a higher detection rate and greater absolute sensitivity compared with conventional screening with almost unchanged relative and absolute specificity. CONCLUSIONS. Further research that complies with the standards stated in the current study will be necessary to evaluate the applicability of the AutoCytePrep method. Further evaluation of the costs and benefits of the ThinPrep method should be undertaken to decide definitively whether to implement this method in the Netherlands population screening program.

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