Comparative Study of Cervical Pap Smears Using Conventional Cytology and Low-Cost Liquid-Based Cytology Techniques in a Tertiary Care Center

Introduction Cervical cancer remains a major public health problem, particularly in low- and middle-income countries where effective screening is essential for early detection. Although the conventional Papanicolaou (Pap) smear is widely used, its diagnostic accuracy may be affected by obscuring factors such as blood, mucus, and inflammation. Low-cost liquid-based cytology (LBC) using EziPREP has been introduced to improve smear quality while remaining affordable. Objectives To evaluate and compare the specimen adequacy, cytomorphological features, and diagnostic performance of conventional Pap smear and low-cost liquid-based cytology (EziPREP). Methodology This cross-sectional study included 200 women attending the gynecology outpatient department of a tertiary care hospital between January and February 2024. Cervical samples from each participant were processed by both conventional Pap smear and EziPREP liquid-based cytology. Smears were evaluated for specimen adequacy, cytomorphological characteristics, endocervical cell representation, background obscuring factors, epithelial cell abnormalities, and infective organisms. Results The study population had a mean age of 42.2 years (range: 23–78 years). EziPREP demonstrated significantly better endocervical cell representation than conventional Pap smear (57.39% vs. 44.32%; p = 0.0473). Conventional smears showed significantly higher inflammatory, hemorrhagic, and mucoid backgrounds, whereas EziPREP produced cleaner smears with improved cellular preservation and reduced cell overlap. Both techniques showed comparable performance in detecting epithelial cell abnormalities and infective organisms, with no statistically significant difference in diagnostic categorization. Conclusion Low-cost liquid-based cytology (EziPREP) provides superior specimen quality and improved cytomorphological assessment compared with conventional Pap smear while maintaining comparable detection of epithelial cell abnormalities and infective organisms. Its improved smear quality and affordability make it a practical option for routine cervical cancer screening, particularly in resource-limited settings.