Conventional preparation versus UPREP liquid based preparation in fine needle aspiration in a teaching hospital: A comparative study

INTRODUCTION: Cancer is the leading cause of death worldwide, accounting for 8.8 million deaths in 2015 alone. Globally, nearly 1 in 6 deaths is due to cancer. Approximately 70% of cancer deaths occur in low- and middle-income countries. The number of new cancer cases is expected to rise by about 70% over the next 2 decades with more than 60% of world’s total new annual cases occurring in Africa, Asia and Central and South America. These regions also account for 70% of the world‟s cancer deaths. The most common causes for death worldwide are cancers of Lung (1.69 million deaths), Liver (788000 deaths), Colorectal (774000 deaths), Stomach (754000 deaths), Breast (571000 deaths). AIMS AND OBJECTIVES: To compare FNAC smears made by conventional preparation and UPREP liquid based preparation. RESULT: In the present study comparison of cellularity, informative background, background debris, inflammatory cells, monolayer, cell architecture, cytoplasm and nucleus details of FNAC smears in both conventional and uprep group was done using chi-square test. p value less than 0.05 was considered as significant i.e, there is a difference in FNAC smears made by conventional preparation and UPREP liquid based preparation. In this study informative background, background debris, inflammatory cells, monolayer, cell architecture, cytoplasm and nucleus details of FNAC smears in both conventional and uprep groups were found to be significant (p<0.05). SUMMARY: UPREP liquid based cytology is a novel system of manual liquid based cytology. Automated LBC systems have been in use since the late 1900s. The advantages include improved sensitivity, specificity due to better fixation of cells, reduced air drying artefact, obscuring factors like blood, monolayer preparation, better cytomorphology of nucleus and cytoplasm. This has therefore resulted in a lower rate of unsatisfactory cytology samples. There was also added advantage, the residual material could be used for making further smears, special stains, immunocytochemistry. However, the initial high cost of setup have resulted in the development of manual LBC kits. This study encompassed 55 cases, in whom FNAC was done. Material from the first pass was used to prepare smear in the conventional smear method. Material from the second pass was prepared using UPREP LBC technique. Both slides were compared for cellularity, informative background, background debris, monolayer, cell architecture, nuclear and cytoplasmic details using a semi – quantitative scoring system. The results were analysed using chi-square test. Out of the 55 cases, 11 were fibroadenoma of breast and 14 were carcinoma breast, 8 were benign thyroid lesions, 10 were Hashimotos Thyroiditis, 6 were Follicular Lesions of Unknown Significance, 3 were Papillary Carcinoma Thyroid and two were found to be reactive lymphadenitis. The diagnosis in both groups did not change hence the diagnostic accuracy of UPREP LBC is similar to conventional smear. With respect to cellularity no significant difference was noted in both groups. Concerning informative background, UPREP LBC showed less diagnostic background material particularly in benign lesions of breast and thyroid. The absence of necrosis and blood aided in better visualization of cytoplasm and nuclear details particularly in malignant cases. In the current study, statistically significant differences was observed in CS preparations and UPREP LBC with regard to informative background, background debris, inflammatory cells, monolayer, cell architecture, cytoplasm and nucleus details (p<0.05). Manual liquid based preparations like UPREP LBC can be used as a low cost alternative to other expensive automated LBC systems. Use of both conventional smear and Liquid based cytology can improve the diagnostic yield in fine needle aspiration cytology. CONCLUSION: Fine needle aspiration is a safe and cost effective method for the diagnosis of palpable lesions at various anatomical sites. However, adequate preparation of smears determines the quality of FNA. Manual liquid based cytology like UPREP LBC is an accurate, less expensive alternative procedure to automated LBC with the advantage of providing monolayer, absence of obscuring blood or debris, better nuclear and cytoplasmic morphology. It is prudent to recognize certain distinct changes in LBC smears in order to avoid interpretative errors. Because of that, training before screening and interpreting LBC preparations is highly recommended. Manual LBC can be used as a adjunct with conventional preparation.