Comparison of the conventional cervical smear and liquid-based cytology: Results of a controlled, prospective study in the Abruzzo Region of Italy

Objective: To compare conventional cervical testing (CCT) and liquid-based cytology (LBC) within a randomized trial performed during 2001-2002 in the Abruzzo Region of Italy, including a cost-outcome comparative analysis. Study Design: Study subjects were recruited in the framework of a controlled, randomized study organized in the Abruzzo Region. Women aged 26-64 years were randomized to an active arm (LBC) or control arm (CCT). The participating laboratories had no previous experience with LBC. Results: The inadequacy rate was 4.3% in CCT and 1.3% in the LBC arm (p < 0.001). Atypical squamous cells of undetermined significance and atypical glands of undetermined sig nificance reports were more frequent at CCT vs. LBC. A small, insignificant excess of low grade squamous intraepithelial lesions or high grade squamous epithelial lesions+ reports was observed in the LBC arm. The cervical intraepithelial neoplasia 2+ (CIN2+) detection rate was not statistically different in the 2 arms (CCT = 0.54%, LBC = 0.66%, p = 0.28). In the overall series positive predictive value was slightly but not significantly higher in the LBC arm. LBC increased costs by 4.2% per both screened women and CIN2+ detected. Conclusion: The study reflects the introductory phase of LBC in labo ratories without prior LBC experience. In this setting LBC reduced the inadequacy rate and decreased reading and was at least as sensitive as and more specific than CCT. Utilization of LBC in organized screening programs will be based on local feasibility, considering that the high cost of LBC is only partially compensated for by other benefits, such as residual cellular material, available for molecular testing, including human papillomavirus testing. © The International Academy of Cytology.