Critical Analyses of the Introduction of Liquid-Based Cytology in a Public Health Service of the State of São Paulo, Brazil.
OBJECTIVE
The aim of this study was to compare the performance of the current conventional Pap smear with liquid-based cytology (LBC) preparations.


METHODS
Women routinely undergoing their cytopathological and histopathological examinations at Fundação Oncocentro de São Paulo (FOSP) were recruited for LBC. Conventional smears were analyzed from women from other areas of the State of São Paulo with similar sociodemographic characteristics.


RESULTS
A total of 218,594 cases were analyzed, consisting of 206,999 conventional smears and 11,595 LBC. Among the conventional smears, 3.0% were of unsatisfactory preparation; conversely, unsatisfactory LBC preparations accounted for 0.3%. The ASC-H (atypical squamous cells - cannot exclude high-grade squamous intraepithelial lesion) frequency did not demonstrate any differences between the two methods. In contrast, the incidence of ASC-US (atypical squamous cells of undetermined significance) was almost twice as frequent between LBC and conventional smears, at 2.9 versus 1.6%, respectively. An equal percentage of high-grade squamous intraepithelial lesions were observed for the two methods, but not for low-grade squamous intraepithelial lesions, which were more significantly observed in LBC preparations than in conventional smears (2.2 vs. 0.7%). The index of positivity was importantly enhanced from 3.0% (conventional smears) to 5.7% (LBC).


CONCLUSIONS
LBC performed better than conventional smears, and we are truly confident that LBC can improve public health strategies aimed at reducing cervical lesions through prevention programs.
Laboratx00F3;rio de Investigax00E7;x00E3;o Mx00E9;dica (LIM) 14, Faculdade de Medicina, Universidade de Sx00E3;o Paulo, Sx00E3;o Paulo, Brazil.
Adhemar
A
Longatto-Filho
José Eduardo
JE
Levi
Toni Ricardo
TR
Martins
Diane
D
Cohen
Lise
L
Cury
Luisa Lina
LL
Villa
José
J
Eluf-Neto
D000293:Adolescent; D000328:Adult; D000368:Aged; D065309:Atypical Squamous Cells of the Cervix / Q000473:pathology*; D001938:Brazil / Q000453:epidemiology; D016022:Case-Control Studies; D002584:Cervix Uteri / Q000473:pathology*; D002648:Child; D003584:Cytological Techniques / Q000379:methods*; D003937:Diagnosis, Differential; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D060787:Neoplasm Grading; D065006:Papanicolaou Test; D011379:Prognosis; D065310:Squamous Intraepithelial Lesions of the Cervix / Q000175:diagnosis* / Q000453:epidemiology / Q000517:prevention & control; D014481:United States; D014492:United States Public Health Service; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis* / Q000453:epidemiology / Q000517:prevention & control; D014626:Vaginal Smears; D055815:Young Adult; D002578:Uterine Cervical Dysplasia / Q000175:diagnosis* / Q000453:epidemiology / Q000517:prevention & control