Background: This study was designed to compare the efficacy of two important screening modalities liquid-based cytology and conventional PAP smear. Both are cytological screening methods for cervical cancer. Materials and methods: A prospective split-sample cervical cytological study was performed in 220 women attending Gynaecology Out patient Department at Mata Gujri Memorial Medical College, MG University, Kishanganj, Bihar over a period of 2 years (September 2021–September 2023). Results: In a study of 220 conventional smears, 5.45% were unsatisfactory, while the majority (80%) were inflammatory. Among the 220 liquid-based cytology (LBC) smears, there were no unsatisfactory samples, and inflammatory smears were slightly less prevalent (78.18%). Dysplastic smears underwent human papillomavirus (HPV) testing, with 62.5% testing positive. Squamous intraepithelial lesions were more common in women over 40 and those with symptoms of vaginal discharge or an unhealthy cervix. Dysplastic lesions were more frequent in women who married early, had higher parity, or shorter intervals between deliveries. Neoplastic changes were associated with smoking and oral contraceptive pills (OCP) use. One human immunodeficiency virus (HIV) positive woman had carcinoma in situ. Conclusion: The most common finding in cervical smear cytology was inflammation, followed by normal cytology. Liquid-based cytology showed a higher case pick-up rate (ASCUS, LSIL, CIS) and allowed for HPV detection, providing an advantage in screening. Most patients with neoplastic changes were HPV-positive. Overall, LBC was more sensitive and specific than conventional PAP smear (CPS), with increased detection rates of ASCUS, LSIL, and CIS due to obtaining more satisfactory smears and offering HPV detection.