Liquid Based Cytology Cervical Cancer Screening Program—Georgian Experience

: Objective: The study aimed to evaluate liquid based cytology as a tool for cervical cancer screening in Georgia. Materials and Methods: 1293 cervical cytology samples have been analyzed in Georgia. The samples had been collected and processed by the usage of materials and equipment provided by Hologic. Prepared smears were post-fixed in 96% ethanol and stained accordingly with Papanicolau protocol. The Bethesda 2001 system terminology was employed for reporting and diagnoses of cervical smears. Results: The negative for intraepithelial lesion or malignancy (NILM) category was equal to 1156 cases (89.40%). Other categories in decreasing order were atypical squamous cells of undetermined significance (ASCUS) with 104 cases (8.04%), low grade squamous intraepithelial lesion (L-SIL) with 8 cases (0.62%), high grade squamous intraepithelial lesion (H-SIL) with 1 case (0.08%), atypical squamous cells, cannot exclude high grade intraepithelial lesion (ASC-H) with 21 cases (1.63%) and atypical glandular cells of undetermined significance (AGUS) with 3 cases (0.23%). Cellularity was lower in liquid based cytology (LBC) as compared with conventional smears (CS). Also, nuclear overlap


Introduction
Cervical cancer is the severe health care problem. According with global statistics, cervical cancer is on the second place by the frequency and on the third by mortality among the cancers of reproductive system [1][2][3]. 527,000 newly diagnosed cases of cervical cancer and 265,000 deaths due to this health care problem were recorded in 2012 by World Health Organization. Most part (85%) of cervical cancer incidence and mortality occurred in developing countries [2], those are characterized by the absence or ineffective and irregular screening programs [2,3]. The cytological screening is the main screening approach for cervical cancer [2,3]. The Papanicolau stained conventional smear can be used for cervical cancer screening purposes, but some authors [2] complained on low diagnostical sensitivity because of false positive and false negative results. The amount of false-negatives varies from 2% to 50% [1,[4][5][6][7][8][9][10][11][12]. In a meta-analysis study [13] the sensitivity of cervical cancer screening performed by application of conventional smear was declared as 58% (range 11%-99%), with a specificity of 68% (range 14%-97%). LBC is characterized by the improved sensitivity and specificity in comparison with conventional smear. The method is ensuring the better fixation and excellent preservation of nuclear details. Atypical cells are obvious, they aren't obscured by another cells or background. Furthermore, LBC method is characterized by the low rate of unsatisfactory samples. The application of LBC for cervical cancer screening in countries with middle and low income is limited due to the financial restrictions, conventional smear is still the basic method of cervical cancer screening in developing world [18][19][20][21].
As it was the case that LBC method by usage of ThinPrep was introduced in Georgia, the aims of this study were to evaluate the feasibility of ThinPrep as a methodology in terms of ease of installation, procedure, interpretation and cost.

Materials and Method
One thousand two hundred ninety three cervical cytology samples have been analyzed in Georgia. These were 18-65 years old non-vaccinated for human papillomavirus (HPV), gynecologically asymptomatic females. The median age of screened group was 37 years. Specific inclusion criteria has not been used for patients recruitment. Informed consent has been obtained for all cytology smears. All smears were taken by usage of the ThinPrep reagents (Hologic). The cervical smear was obtained by rover cervical brushes and washed in sampling solution ThinPrep (Hologic). One

Results
One thousand two hundred ninety three cases were analyzed in our study. All cases were the cellular monolayer, nuclei overlap has not been seen. 1156 cases (89.40%) were reported as the negative for intraepithelial lesion or malignancy (NILM), atypical epithelial cells were seen in 134 (10.37%) cases, and glandular cell atypia was reported in 3 (0.23%) cases (Table 1) Table 2.

Discussion
The article presents a result of LBC based cervical cancer screening pilot study in Georgia. One thousand two hundred ninety three cases were analyzed in this study. 2. Sample processing, review and reporting should be proper and standardized.
3. Reporting terminology should be standard and understandable for the clinician.
Regarding terminology it should be emphasized, that the most informative and adequate is the Bethesda 2001 System (TBS) [22]. This is a comprehensive way to report cytologic peculiarities of the cervix by a simple diagnostic terms and the possibility to incorporate a descriptive diagnosis and evaluation of specimen adequacy [18][19][20][21].