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Context.-The Food and Drug Administration has recently approved several devices that use computerized image analysis to rescreen Papanicolaou (Pap) smears that have already been examined by cytotechnologists. Physicians and laboratories must decide whether the utility of these devices justifies the cost. Objective.-To determine the effectiveness and cost of PAPNET-assisted rescreening in identifying cervical abnormalities not identified by manual rescreening. Design.-PAPNET-assisted rescreening of 5478 Pap smears obtained in 1994 and 1995 previously identified as "within normal limits" or "benign changes" on both initial and random screening. Patients.-Female service members and dependents aged 12 to 88 years. Setting.-Air Force clinics in the United States and Japan. Intervention.-Rescreening of Pap smears by PAPNET, followed by reevaluation of abnormal smears by the consensus panel, consisting of 3 cytotechnologists and 3 pathologists. Main Outcome Measures.-Proportion of Pap smears initially screened as normal identified as abnormal by both PAPNET and consensus panel; costs of rescreening. Results.-PAPNET screening identified 1614 (29%) slides requiring additional microscopic review. On further review, 448 (8% of total) had possibly abnormal cells. Ultimately, 11 of these cases were reviewed by the consensus panel for potentially atypical cells. Of these 11 cases, 5 were reclassified as atypical squamous cells of undetermined significance (ASCUS) and 1 as atypical glandular cells of undetermined significance (AGUS). No additional squamous intraepithelial neoplasia (SIL) was identified in these smears; the patient with a diagnosis of AGUS on rescreening was diagnosed as having a low-grade SIL (LSIL) on follow-up. Costs

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Squamous cell carcinoma of the uterine cervix typically has a curable precancerous phase of 5 to 10 years, during which the Papanicolaou (Pap) test can often detect characteristic cytologic features. The records of 126,024 Pap tests from January 1994 through June 1999 were reviewed. The distribution of cervical dysplasia was unequally distributed between age and military relationship groups, with younger women and active duty women being at increased relative risk for squamous intraepithelial lesions.

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Human papillomavirus is a common genital tract infection believed to be a causative agent of uterine cervical dysplasia. In a minority of cases, dysplasia progresses to squamous cell carcinoma. We reviewed the cervical smear reports for all female recruits who reported for training at Navy Recruit Training Center, Orlando, in calendar year 1993. During this period, 8,029 female recruits reported for training. We found that 24 recruits (0.30%) had a finding of high-grade squamous intra-epithelial lesion (HSIL); 203 (2.5%) had a finding of low-grade squamous intraepithelial lesion (LSIL); 377 (4.7%) had abnormalities other than HSIL or LSIL; and 7,425 (92%) had no abnormalities. These prevalence rates are lower than those reported for other populations.