Cytomorphological spectrum on conventional pap smear and liquid-based cytology in unhealthy cervices with special reference to HPV DNA: An observational study in a tertiary care hospital

Background: Cervical cancer remains a major public health problem despite being largely preventable through effective screening. Persistent infection with high-risk human papillomavirus (HPV) plays a pivotal role in cervical carcinogenesis. Conventional Papanicolaou (Pap) smear and Liquid-Based Cytology (LBC) are commonly used screening modalities, particularly in women with unhealthy cervices. LBC has been proposed to overcome limitations associated with conventional cytology and allows ancillary testing, such as HPV DNA analysis, from the same sample. Objectives: To compare the cytomorphological findings of conventional Pap smear and Liquid-Based Cytology in women with unhealthy cervices and to assess the utility of HPV DNA testing in cases with epithelial cell abnormalities. Materials and Methods: This observational study was conducted over a period of 1.5 years in the Department of Pathology in collaboration with the Department of Obstetrics and Gynaecology at a tertiary care hospital. A total of 74 women with clinically unhealthy cervices were included. Cervical samples were collected and processed using both conventional Pap smear and LBC techniques. Cytological findings were reported according to the Bethesda system, and HPV DNA testing was performed in cases showing epithelial cell abnormalities. Results: Epithelial cell abnormalities were detected in 34.8% of cases by Pap smear and 39.2% by LBC. LBC demonstrated superior sample adequacy, improved visualization of cytomorphological features, higher detection of ASC-H, LSIL, and HSIL, and a significantly cleaner background compared to conventional Pap smears. Both methods detected an equal number of neoplastic lesions. HPV DNA positivity was observed in four cases, though HPV genotyping could not be performed. The difference in detection rates between the two methods was not statistically significant. Conclusion: Liquid-Based Cytology showed marginally higher detection of epithelial abnormalities with better sample adequacy, cleaner background, and preserved cellular architecture compared to conventional Pap smear. The additional advantage of HPV co-testing from residual samples makes LBC a valuable and efficient screening tool for the evaluation of unhealthy cervices in tertiary care settings.