Evolution of Papanicolaou Staining in Cervical Cytology: From Conventional Smears to Liquid-Based and Digital Cytopathology - A Narrative Review

Tenggrik R Marak; Gonya Gadi; Sushma Devi Gurung; R. Lalbiakdika; Hage Kanya

doi:10.69968/ijisem.2026v5i3737-753

Authors

Tenggrik R Marak MMLS Student, Department of Medical Laboratory Science, Regional Institute of Paramedical and Nursing Sciences, Aizawl, Mizoram – 796017
Gonya Gadi MMLS Student, Department of Medical Laboratory Science, Regional Institute of Paramedical and Nursing Sciences, Aizawl, Mizoram – 796017
Sushma Devi Gurung MMLS Student, Department of Medical Laboratory Science, Regional Institute of Paramedical and Nursing Sciences, Aizawl, Mizoram – 796017
R. Lalbiakdika MMLS Student, Department of Medical Laboratory Science, Regional Institute of Paramedical and Nursing Sciences, Aizawl, Mizoram – 796017
Hage Kanya MMLS Student, Department of Medical Laboratory Science, Regional Institute of Paramedical and Nursing Sciences, Aizawl, Mizoram – 796017

DOI:

https://doi.org/10.69968/ijisem.2026v5i3737-753

Keywords:

Papanicolaou Test, Uterine Cervical Neoplasms, Cytodiagnosis, Artificial Intelligence, Digital Pathology

Abstract

Background: Papanicolaou staining remains central to cervical cytology, but its laboratory context has expanded from conventional smears to liquid-based preparation, automated screening, digital cytopathology, molecular testing, and artificial intelligence.

Objective of the review: To critically synthesize the evolution of Papanicolaou staining and cervical cytology, with emphasis on staining principles, conventional and liquid-based methods, quality assurance, automation, digital imaging, HPV-based triage, artificial intelligence, workflow, and implementation challenges.

Key findings: Conventional smears are inexpensive and information-rich but remain vulnerable to sampling, fixation, transfer, and screening variability. Liquid-based cytology improves preparation standardization and facilitates residual-sample molecular testing, although diagnostic advantage is setting- and platform-dependent. Automation can improve reproducibility and throughput, whereas digital cytopathology enables remote review and computational analysis but introduces scanning, storage, validation, and governance requirements. Artificial intelligence may support prioritization, quality control, and classification, but dataset shift, external validation, and human oversight remain critical.

Conclusion: The evolution of Pap cytology is cumulative rather than substitutive. Effective cervical screening depends on validated workflows, specimen quality, laboratory quality systems, appropriate infrastructure, equitable access, and integration of cytology with HPV testing and human-supervised digital decision support.

References

[1] Bray F, Laversanne M, Sung H, Ferlay J, Siegel RL, Soerjomataram I, Jemal A. Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA: A Cancer Journal for Clinicians. 2024;74(3):229-263. doi:10.3322/caac.21834

[2] Singh D, Vignat J, Lorenzoni V, Eslahi M, Ginsburg O, Lauby-Secretan B, Arbyn M, Basu P, Bray F, Vaccarella S. Global estimates of incidence and mortality of cervical cancer in 2020: A baseline analysis of the WHO Global Cervical Cancer Elimination Initiative. The Lancet Global Health. 2023;11(2):e197-e206. doi:10.1016/S2214-109X(22)00501-0

[3] Bhatla N, Singhal S. Primary HPV screening for cervical cancer. Best Practice & Research Clinical Obstetrics & Gynaecology. 2020;65:98-108. doi:10.1016/j.bpobgyn.2020.02.008

[4] Bhatla N, et al. Screening and management of preinvasive lesions of the cervix: Good clinical practice recommendations from FOGSI. Journal of Obstetrics and Gynaecology Research. 2020;46(2):201-214. doi:10.1111/jog.14168

[5] Rajaram S, Gupta B. Screening for cervical cancer: Choices and dilemmas. Indian Journal of Medical Research. 2021;154(2):210-220. doi:10.4103/ijmr.IJMR_857_20

[6] Saraiya M, et al. Computable guidelines and clinical decision support for cervical cancer screening and management to improve outcomes and health equity. Journal of Women’s Health. 2022;31(4):462-468. doi:10.1089/jwh.2022.0100

[7] Papanicolaou GN, Traut HF. The diagnostic value of vaginal smears in carcinoma of the uterus. American Journal of Obstetrics and Gynecology. 1941;42(2):193-206. doi:10.1016/S0002-9378(16)40621-6

[8] Chantziantoniou N, et al. Inception and development of the Papanicolaou stain method. Acta Cytologica. 2017;61(4-5):266-280. doi:10.1159/000457827

[9] Thakur M, Guttikonda VR. Modified ultrafast Papanicolaou staining technique: A comparative study. Journal of Cytology. 2017;34(3):149-153. doi:10.4103/JOC.JOC_23_16

[10] Shinde PB, Pandit AA. Application of modified ultrafast Papanicolaou stain in cytology of various organs. Diagnostic Cytopathology. 2006;34(2):135-139. doi:10.1002/dc.20360

[11] Maruta J, et al. Quick aspiration cytology for thyroid nodules by modified Ultrafast Papanicolaou staining. Diagnostic Cytopathology. 2003;28(1):45-48. doi:10.1002/dc.19999

[12] Kamal MM, et al. Ultrafast Papanicolaou stain modified for developing countries: Efficacy and pitfalls. Acta Cytologica. 2011;55(2):205-212. doi:10.1159/000320909

[13] Sinkar P, Arakeri SU. Utility of modified ultrafast Papanicolaou stain in cytological diagnosis. Journal of Clinical and Diagnostic Research. 2017;11(3):EC28-EC31. doi:10.7860/JCDR/2017/20882.9532

[14] Pangarkar MA. The Bethesda System for reporting cervical cytology. CytoJournal. 2022;19:28. doi:10.25259/CMAS_03_07_2021

[15] Wang T, et al. Updates in cervical cancer screening guidelines, The Bethesda System for Reporting Cervical Cytology, and clinical management recommendations. Journal of Clinical and Translational Pathology. 2023;3(2):75-83. doi:10.14218/JCTP.2023.00004

[16] Koyanagi T, et al. Cervical cancer screening efficacy using SurePath, ThinPrep and conventional cytology: A large data set analysis from the Japan Cancer Society. Cytopathology. 2024;35(6):770-775. doi:10.1111/cyt.13431

[17] Ucak R, et al. Analysis of the differences between Bethesda groups according to conventional smear and liquid-based cytology methods in cervicovaginal cytology: A single-center experience with 165,915 cases. Acta Cytologica. 2024;68(1):54-59. doi:10.1159/000536663

[18] Andola SK, et al. Should liquid-based cytology be preferred than conventional Pap smear: A comparative analysis. Journal of Obstetrics and Gynaecology of India. 2024;74(4):311-318. doi:10.1007/s13224-023-01828-x

[19] Maheshwari Y, et al. Comparative analysis of conventional cytology and liquid-based cytology in the detection of carcinoma cervix and its precursor lesions. Journal of Cytology. 2023;40(3):114-118. doi:10.4103/joc.joc_29_23

[20] Patel N, et al. A comparison of conventional Pap smear and liquid-based cytology for cervical cancer screening. Gynecology and Minimally Invasive Therapy. 2023;12(2):77-82. doi:10.4103/gmit.gmit_118_22

[21] Liang LA, et al. Cervical cancer screening: Comparison of conventional Pap smear test, liquid-based cytology, and human papillomavirus testing as stand-alone or cotesting strategies. Cancer Epidemiology, Biomarkers & Prevention. 2021;30(3):474-484. doi:10.1158/1055-9965.EPI-20-1003

[22] Dasgupta S. The efficiency of cervical Pap and comparison of conventional Pap smear and liquid-based cytology: A review. Cureus. 2023;15(11):e48343. doi:10.7759/cureus.48343

[23] Tambvekar SE, Balsarkar G. Modernizing cervical cytology screening with liquid-based methods at community-level hospitals: A much-needed breakthrough for India. Journal of Obstetrics and Gynaecology of India. 2024;74(4):371-377. doi:10.1007/s13224-024-02051-y

[24] Miguel R, Gregorio B, Santos C, Andriotti C, Valle L, Saieg M. Validation of cytopathology specimens for digital pathology. Cytopathology. 2023;34(4):302-307. doi:10.1111/cyt.13234

[25] Antonini P, et al. Relevance of the College of American Pathologists guideline for validating whole slide imaging for diagnostic purposes to cytopathology. Cytopathology. 2023;34(1):5-14. doi:10.1111/cyt.13178

[26] Marletta S, et al. Delphi expert consensus for whole slide imaging in thyroid cytopathology. Cytopathology. 2023;34(6):581-589. doi:10.1111/cyt.13279

[27] Jain E, et al. Whole slide imaging technology and its applications: Current and emerging perspectives. International Journal of Surgical Pathology. 2024;32(3):433-448. doi:10.1177/10668969231185089

[28] Eccher A, Girolami I. Current state of whole slide imaging use in cytopathology: Pros and pitfalls. Cytopathology. 2020;31(5):372-378. doi:10.1111/cyt.12806

[29] Kim D, et al. Digital cytology part 1: Digital cytology implementation for practice: A concept paper with review and recommendations from the American Society of Cytopathology Digital Cytology Task Force. Journal of the American Society of Cytopathology. 2024;13(2):86-96. doi:10.1016/j.jasc.2023.11.006

[30] Eloy C, et al. How many more slides to go until we fully adopt digital cytology?. Cytopathology. 2024;35(4):442-443. doi:10.1111/cyt.13388

[31] Allahqoli L, et al. Diagnosis of cervical cancer and pre-cancerous lesions by artificial intelligence: A systematic review. Diagnostics. 2022;12(11):2771. doi:10.3390/diagnostics12112771

[32] Sambyal D, Sarwar A. Recent developments in cervical cancer diagnosis using deep learning on whole slide images: An overview of models, techniques, challenges and future directions. Micron. 2023;173:103520. doi:10.1016/j.micron.2023.103520

[33] Liu L, et al. Performance of artificial intelligence for diagnosing cervical intraepithelial neoplasia and cervical cancer: A systematic review and meta-analysis. eClinicalMedicine. 2025;80:102992. doi:10.1016/j.eclinm.2024.102992

[34] Guo P, et al. Ensemble deep learning for cervix image selection toward improving reliability in automated cervical precancer screening. Diagnostics. 2020;10(7):451. doi:10.3390/diagnostics10070451

[35] Gao W, et al. Cervical cell image classification-based knowledge distillation. Biomimetics. 2022;7(4):195. doi:10.3390/biomimetics7040195

[36] Fu L, et al. Deep learning based cervical screening by cross-modal integration of colposcopy, cytology, and HPV test. International Journal of Medical Informatics. 2022;159:104675. doi:10.1016/j.ijmedinf.2021.104675

[37] Mathivanan SK, et al. Enhancing cervical cancer detection and robust classification through a fusion of deep learning models. Scientific Reports. 2024;14(1):10812. doi:10.1038/s41598-024-61063-w

[38] Alsubai S, Alqahtani A, Sha M, Almadhor A, Abbas S, Mughal H, Gregus M. Privacy preserved cervical cancer detection using convolutional neural networks applied to Pap smear images. Computational and Mathematical Methods in Medicine. 2023;2023:9676206. doi:10.1155/2023/9676206

[39] Rivera Rolon MDM, et al. Implementing 100% quality control in a cervical cytology workflow using whole slide images and artificial intelligence provided by the Techcyte SureView System. Cancer Cytopathology. 2025;133(6):e70019. doi:10.1002/cncy.70019

[40] Yang Y, et al. Integration of AI-assisted in digital cervical cytology training: A comparative study. Cytopathology. 2025;36(2):156-164. doi:10.1111/cyt.13461

[41] Kyrgiou M, et al. Cervical screening: ESGO-EFC position paper. British Journal of Cancer. 2020;123(4):510-517. doi:10.1038/s41416-020-0920-9

[42] Gilham C, Sargent A, Peto J. Triaging women with human papillomavirus infection and normal cytology or low-grade dyskaryosis: Evidence from 10-year follow up of the ARTISTIC trial cohort. BJOG. 2020;127(1):58-68. doi:10.1111/1471-0528.15957

[43] Cuzick J, et al. Combined use of cytology, p16 immunostaining and genotyping for triage of women positive for high-risk human papillomavirus at primary screening. International Journal of Cancer. 2020;147(7):1864-1873. doi:10.1002/ijc.32973

[44] Hu Y, et al. Evaluation of p16/Ki-67 dual-stained cytology in triaging HPV-positive women during cervical cancer screening. Cancer Epidemiology, Biomarkers & Prevention. 2020;29(6):1246-1252. doi:10.1158/1055-9965.EPI-19-1180

[45] Han Q, et al. p16/Ki-67 dual-stained cytology used for triage in cervical cancer opportunistic screening. Chinese Journal of Cancer Research. 2020;32(2):208-217. doi:10.21147/j.issn.1000-9604.2020.02.08

[46] Stanczuk G, et al. Clinical performance of triage strategies for Hr-HPV-positive women: A longitudinal evaluation of cytology, p16/Ki-67 dual stain cytology, and HPV16/18 genotyping. Cancer Epidemiology, Biomarkers & Prevention. 2022;31(7):1492-1498. doi:10.1158/1055-9965.EPI-21-1425

[47] Goulart RA, et al. Extended HPV genotyping and dual stain for the triage of primary HPV screen-positive cases: Practical guidance for the cytopathology laboratory. Cancer Cytopathology. 2025;133(4):e70006. doi:10.1002/cncy.70006

[48] Song F, et al. The effectiveness of HPV16 and HPV18 genotyping and cytology with different thresholds for the triage of human papillomavirus-based screening on self-collected samples. PLOS ONE. 2020;15(6):e0234518. doi:10.1371/journal.pone.0234518

[49] Chatzistamatiou K, et al. Comparison of different strategies for the triage to colposcopy of women tested high-risk HPV positive on self-collected cervicovaginal samples. Gynecologic Oncology. 2021;162(3):560-568. doi:10.1016/j.ygyno.2021.06.020

[50] Andersen K, et al. Targeted next generation sequencing for human papillomavirus genotyping in cervical liquid-based cytology samples. Cancers. 2022;14(3):652. doi:10.3390/cancers14030652

[51] Yu L, et al. Significance of triple detection of p16/Ki-67 dual-staining, liquid-based cytology and HR HPV testing in screening of cervical cancer: A retrospective study. Frontiers in Oncology. 2022;12:915418. doi:10.3389/fonc.2022.915418

[52] Zhao F, et al. The application of liquid-based cytological detection for p16, cytologic evaluation and high-risk human papillomavirus testing in cervical cancer screening: A clinical evaluation. International Journal of Women’s Health. 2022;14:965-973. doi:10.2147/IJWH.S365236

[53] Fu Y, et al. Head-to-head comparison of DH3 HPV test and HC2 assay for detection of high-risk HPV infection in residual cytology samples. Microbiology Spectrum. 2022;10(1):e0157021. doi:10.1128/spectrum.01570-21

[54] Ramírez-Palacios P, et al. Benefit of double-reading cytology smears as a triage strategy among high-risk human papillomavirus-positive women in Mexico. Cancer Cytopathology. 2020;128(10):715-724. doi:10.1002/cncy.22303

[55] Pimple SA, Mishra GA, Deodhar KK. Evidence based appropriate triage strategies for implementing high risk HPV as primary technology in cervical cancer screening. Minerva Ginecologica. 2020;72(2):96-105. doi:10.23736/S0026-4784.20.04511-6

[56] Vassilakos P, et al. A cross-sectional study exploring triage strategies for HPV-positive women in Cameroon. International Journal of Gynecological Cancer. 2021;31(6):808-816. doi:10.1136/ijgc-2020-002302

[57] Confortini M. Is the use of the atypical squamous cells of undetermined significance category still necessary in cytological triage?. Cytopathology. 2021;32(2):281-282. doi:10.1111/cyt.12927

[58] Chong Y, et al. Diagnostic proficiency test using digital cytopathology and comparative assessment of whole slide images of cytologic samples for quality assurance program in Korea. Journal of Pathology and Translational Medicine. 2023;57(5):251-264. doi:10.4132/jptm.2023.07.17

[59] Siebers AG, et al. Comparison of liquid-based cytology with conventional cytology for detection of cervical cancer precursors: A randomized controlled trial. JAMA. 2009;302(16):1757-1764. doi:10.1001/jama.2009.1569

[60] Abulafia O, et al. Performance of ThinPrep liquid-based cervical cytology in comparison with conventionally prepared Papanicolaou smears: A quantitative survey. Gynecologic Oncology. 2003;90(1):137-144. doi:10.1016/S0090-8258(03)00176-8

[61] Kim D, et al. Digital cytology part 2: Artificial intelligence in cytology: A concept paper with review and recommendations from the American Society of Cytopathology Digital Cytology Task Force. Journal of the American Society of Cytopathology. 2024;13(2):97-110. doi:10.1016/j.jasc.2023.11.005

[62] Vikraman SM, et al. Cervical cancer elimination in Indian context: Moving from barriers to facilitators. Cancer. 2022;128(23):4041-4046. doi:10.1002/cncr.34486

[63] Oommen AM, et al. Strategies and implementation outcomes of HPV-based cervical screening studies to prevent cervical cancer in India: A systematic review. Journal of Cancer Policy. 2024;42:100513. doi:10.1016/j.jcpo.2024.100513

[64] Borkotoky K, et al. Learning from the Indian National Family Health Survey to assess population based oral, cervix and breast cancer screening in low-and-middle income countries. The Lancet Regional Health - Southeast Asia. 2024;30:100483. doi:10.1016/j.lansea.2024.100483

[65] Gupta S, et al. Challenges and opportunities to making Indian women cervical cancer free. Indian Journal of Medical Research. 2023;158(5-6):470-475. doi:10.4103/ijmr.ijmr_1052_23

[66] Khan A, et al. CervixFormer: A multi-scale Swin transformer-based cervical Pap-smear WSI classification framework. Computer Methods and Programs in Biomedicine. 2023;240:107718. doi:10.1016/j.cmpb.2023.107718

[67] Shastri SS, et al. Secondary prevention of cervical cancer: ASCO resource-stratified guideline update. JCO Global Oncology. 2022;8:e2200217. doi:10.1200/GO.22.00217

[68] Nayar R, Wilbur DC. The Bethesda System for Reporting Cervical Cytology: A historical perspective. Acta Cytologica. 2017;61(4-5):359-372. doi:10.1159/000477556

[69] Fontaine D, et al. Unsatisfactory rates vary between cervical cytology samples prepared using ThinPrep and SurePath platforms: A review and meta-analysis. BMJ Open. 2012;2(2):e000847. doi:10.1136/bmjopen-2012-000847

[70] Tantitamit T, et al. Cost-effectiveness of primary HPV screening strategies and triage with cytology or dual stain for cervical cancer. Cancer Control. 2020;27(1):1073274820922540. doi:10.1177/1073274820922540

[71] Fontham ETH, Wolf AMD, Church TR, et al. Cervical cancer screening for individuals at average risk: 2020 guideline update from the American Cancer Society. CA Cancer J Clin. 2020;70(5):321-346. doi:10.3322/caac.21628

[72] Perkins RB, Guido RS, Castle PE, et al. 2019 ASCCP Risk-Based Management Consensus Guidelines for Abnormal Cervical Cancer Screening Tests and Cancer Precursors. J Low Genit Tract Dis. 2020;24(2):102-131. doi:10.1097/LGT.0000000000000525

[73] Cheung LC, Egemen D, Chen X, et al. 2019 ASCCP Risk-Based Management Consensus Guidelines: Methods for Risk Estimation, Recommended Management, and Validation. J Low Genit Tract Dis. 2020;24(2):90-101. doi:10.1097/LGT.0000000000000528

[74] Egemen D, Cheung LC, Chen X, et al. Risk Estimates Supporting the 2019 ASCCP Risk-Based Management Consensus Guidelines. J Low Genit Tract Dis. 2020;24(2):132-143. doi:10.1097/LGT.0000000000000529

[75] Nayar R, Chhieng DC, Crothers B, et al. Moving forward: The 2019 ASCCP Risk-Based Management Consensus Guidelines for Abnormal Cervical Cancer Screening Tests and Cancer Precursors and implications for laboratories. J Am Soc Cytopathol. 2020;9(4):291-303. doi:10.1016/j.jasc.2020.05.002

[76] Brisson M, Kim JJ, Canfell K, et al. Impact of HPV vaccination and cervical screening on cervical cancer elimination: a comparative modelling analysis in 78 low-income and lower-middle-income countries. Lancet. 2020;395(10224):575-590. doi:10.1016/S0140-6736(20)30068-4

[77] Canfell K, Kim JJ, Brisson M, et al. Mortality impact of achieving WHO cervical cancer elimination targets: a comparative modelling analysis in 78 low-income and lower-middle-income countries. Lancet. 2020;395(10224):591-603. doi:10.1016/S0140-6736(20)30157-4

[78] Sung H, Ferlay J, Siegel RL, et al. Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. CA Cancer J Clin. 2021;71(3):209-249. doi:10.3322/caac.21660

[79] Bao H, Bi H, Zhang X, et al. Artificial intelligence-assisted cytology for detection of cervical intraepithelial neoplasia or invasive cancer: A multicenter, clinical-based, observational study. Gynecol Oncol. 2020;159(1):171-178. doi:10.1016/j.ygyno.2020.07.099

[80] Tesfahunei HA, Ghebreyesus MS, Assefa DG, et al. Human papillomavirus self-sampling versus standard clinician-sampling for cervical cancer screening in sub-Saharan Africa: a systematic review and meta-analysis of randomized controlled trials. Infect Agents Cancer. 2021;16:43. doi:10.1186/s13027-021-00380-5

[81] Di Gennaro G, Licata F, Trovato A, Bianco A. Does self-sampling for human papilloma virus testing have the potential to increase cervical cancer screening? An updated meta-analysis of observational studies and randomized clinical trials. Front Public Health. 2022;10:1003461. doi:10.3389/fpubh.2022.1003461

[82] Nishimura H, Yeh PT, Oguntade H, Kennedy CE, Narasimhan M. HPV self-sampling for cervical cancer screening: a systematic review of values and preferences. BMJ Glob Health. 2021;6(5):e003743. doi:10.1136/bmjgh-2020-003743

[83] Camara H, Zhang Y, Lafferty L, et al. Self-collection for HPV-based cervical screening: a qualitative evidence meta-synthesis. BMC Public Health. 2021;21:1503. doi:10.1186/s12889-021-11554-6

[84] Clarke MA, Wentzensen N, Perkins RB, et al. Recommendations for Use of p16/Ki67 Dual Stain for Management of Individuals Testing Positive for Human Papillomavirus. J Low Genit Tract Dis. 2024;28(2):124-130. doi:10.1097/LGT.0000000000000802

[85] Grosserueschkamp F, Jutte H, Gerwert K, Tannapfel A. Advances in Digital Pathology: From Artificial Intelligence to Label-Free Imaging. Visc Med. 2021;37(6):482-490. doi:10.1159/000518494

[86] Klein C, Zeng Q, Arbaretaz F, et al. Artificial intelligence for solid tumour diagnosis in digital pathology. Br J Pharmacol. 2021;178(21):4291-4315. doi:10.1111/bph.15633

[87] Sobhani F, Robinson R, Hamidinekoo A, et al. Artificial intelligence and digital pathology: Opportunities and implications for immuno-oncology. Biochim Biophys Acta Rev Cancer. 2021;1875(2):188520. doi:10.1016/j.bbcan.2021.188520

[88] Forsch S, Klauschen F, Hufnagl P, Roth W. Artificial Intelligence in Pathology. Dtsch Arztebl Int. 2021;118(12):194-204. doi:10.3238/arztebl.m2021.0011

[89] Evans AJ, Brown RW, Bui MM, et al. Validating Whole Slide Imaging Systems for Diagnostic Purposes in Pathology. Arch Pathol Lab Med. 2022;146(4):440-450. doi:10.5858/arpa.2020-0723-CP

[90] Girolami I, Pantanowitz L, Marletta S, et al. Diagnostic concordance between whole slide imaging and conventional light microscopy in cytopathology: A systematic review. Cancer Cytopathol. 2020;128(1):17-28. doi:10.1002/cncy.22195

[91] Matias AV, Amorim JGA, Macarini LAB, et al. What is the state of the art of computer vision-assisted cytology? A systematic literature review. Comput Med Imaging Graph. 2021;91:101934. doi:10.1016/j.compmedimag.2021.101934

[92] Chantziantoniou N. BestCyte primary screening of 500 ThinPrep Pap Test thin-layers: interobserver diagnostic concordance and digital cytology assessment. J Pathol Inform. 2023;14:100182. doi:10.1016/j.jpi.2022.100182

[93] Hosseini MS, Brawley-Hayes JAZ, Zhang Y, Chan L, Plataniotis KN, Damaskinos S. Focus Quality Assessment of High-Throughput Whole Slide Imaging in Digital Pathology. IEEE Trans Med Imaging. 2020;39(1):62-74. doi:10.1109/TMI.2019.2919722

[94] Ikenberg H, Lieder S, Ahr A, Wilhelm M, Schon C, Xhaja A. Comparison of the Hologic Genius Digital Diagnostics System with the ThinPrep Imaging System: a retrospective assessment. Cancer Cytopathol. 2023;131(7):424-432. doi:10.1002/cncy.22695

[95] Vargas-Cardona HD, Rodriguez-Lopez M, Arrivillaga M, et al. Artificial intelligence for cervical cancer screening: Scoping review, 2009-2022. Int J Gynaecol Obstet. 2024;165(2):566-578. doi:10.1002/ijgo.15179

[96] Chatterjee PB, Hingway SR, Hiwale KM. Evolution of Pathological Techniques for the Screening of Cervical Cancer: A Comprehensive Review. Cureus. 2024;16(5):e60769. doi:10.7759/cureus.60769

[97] Maruyama S, Sakabe N, Ito C, Shimoyama Y, Sato S, Ikeda K. Effect of Specimen Processing Technique on Cell Detection and Classification by Artificial Intelligence. Am J Clin Pathol. 2023;159(5):448-454. doi:10.1093/ajcp/aqac178

[98] Xu M, Cao C, Wu P, et al. Advances in cervical cancer: current insights and future directions. Cancer Commun (Lond). 2025;45(2):77-109. doi:10.1002/cac2.12629

[99] Bonde JH, Sandri MT, Gary DS, Andrews JC. Clinical Utility of Human Papillomavirus Genotyping in Cervical Cancer Screening: A Systematic Review. J Low Genit Tract Dis. 2020;24(1):1-13. doi:10.1097/LGT.0000000000000494

[100] Damkjaer M, Laursen JB, Petersen LK, et al. Endocervical sampling in women with suspected cervical neoplasia: a systematic review and meta-analysis of diagnostic test accuracy studies. Am J Obstet Gynecol. 2022;227(6):839-848.e4. doi:10.1016/j.ajog.2022.07.036