1. The ThinPrep ® PapTest ™ PAUL SULTANA MLS Thursday, 22 October 2015

2. Background The conventional smear has been the most successful screening test Screening every 3-5years has resulted in a 70% reduction in incidence

3. Why LBC (Liquid based cytology) has been introduced in the Malta Continuing improvement to the Cervical screening Programme Limitations of conventional cytology Modernisation of the technique Future benefits –Extra tests – HPV, chlamydia, Neiseria Gonorrhoea.

4. Limitations Of Conventional Smear (From UK studies)  False Negative Rate of up to 55% 1 Sampling and interpretive errors  Ambiguous reports of 6.4% 2 70% are truly negative 30% represent more severe abnormality  Inadequate specimens of 9.7% 2 1. Hutchinson et al., AJCP, Vol 101-2; 215-219, 2. DOH Statistical Bulletin 2000/2001

5. Sources Of False Negatives Sampling issues (70%) –cells not collected on the sampling device –cells collected, but not transferred to the slide Interpretive issues (30%) –abnormal cells present on slide but either not seen or misinterpreted

6. How LBC is different Easier method for smear takers Technology diminishes blood, mucus & polymorphs Thin layer preparation Smaller area of the slide to screen

7. Conventional smear

8. What we see under the microscope conventional smear

9. The prepared slide with the new ThinPrep

10. What we see under the microscope. Notice the clean back ground and how well the cells are dispersed rendering easier to interpretation.

11. NICE recommendation is based on: Systematic review of literature relating to efficacy of LBC undertaken as part of the HTA programme New evidence from the 3 pilot sites at Bristol, Norwich and Newcastle

13. Summary of Results www.nice.org.uk  “Robust evidence that LBC is a cost effective alternative to conventional Pap for the health service in the UK in terms of life years saved”  Evidence of a reduction in the number of unsatisfactory specimens  Productivity of laboratories increased  Smear takers and laboratory staff liked LBC  Expect LBC will reduce the number of false negatives and the incidence of invasive cancer

14. ThinPrep® Pap Test™ Extensively Evaluated > 100 published studies 23 distinct peer-reviewed journals Health Economic Studies –AHCPR –Hutchinson –ScHARR Three meta-analyses –Bernstein –Abulafia –Klinkhamer

15. Conventional vs. LBC in Scotland Conventional (%) LBC (%) Unsatisfactory13.61.9 Negative80.991.7 Borderline2.52.6 Mild2.02.3 Moderate0.60.8 Severe0.40.6 Others0.1 1 year conventional vs 1 year LBC

16. What is liquid based cytology? Collection of cellular material into a vial of preservative fluid

17. ThinPrep ® 2000 Processor

18. ThinPrep ® 3000 Processor

19. ThinPrep ® Process In the laboratory 1. Dispersion2. Cell Collection 3. Cell Transfer

20. ConventionalThinPrep ® The Difference is Obvious

21. The ThinPrep ® PapTest ™ PAUL SULTANA MLS Thursday, 22 October 2015