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Objective To compare the accuracy of liquid based cytology using the computerised ThinPrep Imager with that of manually read conventional cytology.Design Prospective study.Setting Pathology laboratory in Sydney, Australia.Participants 55 164 split sample pairs (liquid based sample collected after conventional sample from one collection) from consecutive samples of women choosing both types of cytology and whose specimens were examined between August 2004 and June 2005.Main outcome measures Primary outcome was accuracy of slides for detecting squamous lesions. Secondary outcomes were rate of unsatisfactory slides, distribution of squamous cytological classifications, and accuracy of detecting glandular lesions.Results Fewer unsatisfactory slides were found for imager read cytology than for conventional cytology (1.8% v 3.1%; P<0.001). More slides were classified as abnormal by imager read cytology (7.4% v 6.0% overall and 2.8% v 2.2% for cervical intraepithelial neoplasia of grade 1 or higher). Among 550 patients in whom imager read cytology was cervical intraepithelial neoplasia grade 1 or higher and conventional cytology was less severe than grade 1, 133 of 380 biopsy samples taken were high grade histology. Among 294 patients in whom imager read cytology was less severe than cervical intraepithelial neoplasia grade 1 and conventional cytology was grade 1 or higher, 62 of 210 biopsy samples taken were high grade histology. Imager read cytology therefore detected 71 more cases of high grade histology than did conventional cytology, resulting from 170 more biopsies. Similar results were found when one pathologist reread the slides, masked to cytology results.Conclusion The ThinPrep Imager detects 1.29 more cases of histological high grade squamous disease per 1000 women screened than conventional cytology, with cervical intraepithelial neoplasia grade 1 as the threshold for referral to colposcopy. More imager read slides than conventional slides were satisfactory for examination and more contained low grade cytological abnormalities. INTRODUCTIONAlthough manual checking of conventional cervical smears has been used for decades to screen for cervical cancer and precancerous cells, liquid based cytology is replacing conventional cytology in many countries. The potential advantages of liquid based cytology are adjunctive testing, including testing for human papillomavirus; faster reading times; and cost saving of automation. Evidence is insufficient, however, to confirm that liquid based cytology is more accurate than conventional cytology, 1 which continues to be widely used.Conventional cytology involves the transference of cervical material from a collection instrument on to a glass slide whereas liquid based cytology (for example, the ThinPrep Liquid-based Cytology Preparation system, Cytyc, Marlborough, MA) involves rinsing the collection instrument in liquid to produce a suspension, which is processed in a laboratory to produce a monolayer of cells. The ThinPrep Imager (Cytyc) system, a computerised sy...

Objective To determine women's preferences for and reported experience with medical test decision-making.Design Computer-assisted telephone survey.Setting and participants Six hundred and fifty-two women resident in households randomly selected from the New South Wales electronic white pages.Main outcome measures Reported and preferred test and treatment (for comparison) decision-making, satisfaction with and anxiety about information on false results and side-effects; and effect of anxiety on desire for such information.Results Overall most women preferred to share test (94.6%) and treatment (91.2%) decision-making equally with their doctor, or to take a more active role, with only 5.4-8.9% reporting they wanted the doctor to make these decisions on their behalf. This pattern was consistent across all age groups. In general, women reported experiencing a decision-making role that was consistent with their preference. Women who had a usual doctor were more likely to report experiencing an active role in decision-making. More women reported receiving as much information as they wanted about the benefits of tests and treatment than about the side-effects of tests and treatment. Most women wanted information about the possibility of false test results (91.5%) and test side-effects (95.6%), but many reported the doctor never provided this information (false results ¼ 40.0% and side-effects ¼ 31.3%). A substantial proportion said this information would make them anxious (false results ¼ 56.6% and sideeffects ¼ 43.1%), but reported they wanted the information anyway (false results ¼ 77.6% and side-effects ¼ 88.1%).Conclusions Women prefer an active role in test and treatment decision-making. Many women reported receiving inadequate information. If so, this may jeopardize informed decision-making.

We aimed to compare the times cytologists spend reviewing cervical cytology slides processed by the ThinPrep Imager (TPI) with times they spend examining conventional cytology (CC) slides. We also aimed to examine the effect of cytologists' experience on reading times. Using a cross-sectional analytical design, we analyzed routine laboratory data, collected retrospectively over 7 months, for 41 cytologists, including paired data for 20 who read both TPI and CC slides. For the 20 cytologists who read both types of cytology, the mean reading rate was 13.3 slides per hour for TPI slides and 6.1 slides per hour for CC slides. The mean within-reader difference between TPI and CC rates was 7.2 slides per hour (P < 0.001). For CC reading, mean times did not differ between those who were additionally trained to read TPI slides and those who only read CC. Slower readers had greater increases in speed when using the TPI compared with CC reading than did faster readers (P < 0.001). More experienced cytologists tended to read CC slides more quickly than did those less experienced, but experience did not affect TPI reading times or within-reader differences in reading times between cytology types. The TPI significantly reduced reading times compared with CC. This reduction was greater amongst slower readers, and was unrelated to experience.

This paper deals with the question of how the general public should be addressed when offering hearing screening. Postal-based questionnaires in the United Kingdom, Germany, and The Netherlands were sent to users of hearing devices, those that are in the process of obtaining one, or those that have indicated that they have special interest in hearing. Results of the survey indicated that respondents were enthusiastic about the idea of being able to carry out hearing self-screening tests via the internet, telephone, or questionnaires. A questionnaire as a method to screen on hearing was generally preferred above using the internet, which was preferred over using the telephone for the test. About 27% of the respondents indicated to use exclusively one method. Most respondents indicated that either method provided would be of interest (41%), 17% indicated not to be interested in conducting screening tests using the internet.