Automation-assisted and liquid-based cytology for cervical cancer screening: MSAC Application 1122 Assessment report

In Australia, cervical cytology is conventionally undertaken using the Pap smear test. This involves the collection of cells from the uterine cervix. Cells are collected from the cervix using a small cytobrush/broom or spatula and smeared onto a glass slide for examination under the microscope by a cytologist. Cytological abnormalities are classified using the Australian Modified Bethesda System (AMBS) as high-grade squamous intraepithelial lesions (HSIL), possible HSIL (pHSIL), low-grade squamous intraepithelial lesions
(LSIL) or possible LSIL (pLSIL).

Liquid-based cytology (LBC) involves collection of cervical cells in a similar way as for conventional Pap, but the head of the brush, broom or spatula is rinsed into a vial of liquid to produce a cell suspension. The cell sample is treated to remove other material, such as blood and mucus, so that a thin layer of cervical cells can be placed on a slide for microscopic examination. Automated cytology refers to the use of a computer imager to scan slides prepared using LBC or conventional techniques. The Two systems of
automated LBC slide reading are marketed in Australia, the ThinPrep® Imager [Cytyc Pty Ltd] and the FocalPoint Imaging System [Becton Dickinson Pty Ltd]. These systems are
used to direct cytologists to the areas on the slide most likely to contain abnormal cells.

This report considers evidence published since the previous reviews of liquid-based and automation-assisted cervical cancer screening (Medical Services Advisory Committee
2002b; Medical Services Advisory Committee 2003).