Controversial topics on liquid-based gynaecological cytology and roles of the HPV molecular diagnostics

Wai-Kuen NG

Senior Medical Officer, Division of Anatomical Pathology, Department of Pathology an Clinical Biochemistry, Queen Mary Hospital, The University of Hong Kong, Hong Kong SAR, China

Liquid-based cytology (LBC) and human papillomavirus (HPV) DNA testing are getting increasingly popular in cervical cancer screening nowadays. Though many studies have been published in the literature trying to analyse the pros and cons of these new technologies, the cost-effectiveness for routine use is still debatable. LBC is claimed to improve specimen adequacy, enhance detection of significant cervical diseases and shorten slide screening time. It has also been recommended in some developed countries with organised cervical screening programmes. Conflicting data based on recent controlled trials however exist. The main issue remains whether the higher cost of LBC is offset by its claimed benefits, provided that the accuracy is as good as or better than that of conventional Pap smears. Similar considerations also happen in HPV DNA testing which has been shown to be more sensitive but less specific than cervical cytology in detecting significant abnormalities. Thus, the role of HPV DNA testing as a primary screening tool is still controversial. HPV molecular diagnostics however do give some help in triage of women with low-grade cytological abnormalities, following up of patients after treatment of high-grade cervical intraepithelial neoplasia (CIN), as well as resolving some morphological mysteries such as "atypical repair" and transitional celll "metaplasia." On the other hand, alternative options, which address the issue of CIN prognostication from a different perspective, may have the potential to replace cytological examination and HPV DNA testing in the future.

Keywords: Liquid-based cytology; human papillomavirus; molecular diagnostics.

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