Computer‐assisted primary screening of cervical smears using the PAPNET method: comparison with conventional screening and evaluation of the role of the cytologist

Abstract

The PAPNET method is an interactive computer-assisted screening procedure. The diagnostician selects the abnormal video tiles out of the 128 and decides which smears need additional light microscopy. The original diagnoses of 1494 archival smears were compared with the PAPNET analysis of the same smears. The general trend observed was that the PAPNET-assisted diagnoses were of a higher grade than those assigned by the primary screener, thus less cases were signed out as negative. In addition, the PAPNET method was used for primary screening of 2971 randomly selected smears, whilst in the same period 5797 smears were conventionally screened. Using the PAPNET method, significantly fewer smears were signed out as negative. Seventy-three percent of the cases were diagnosed on the basis of the information provided by the 128 video tiles, 11% had to be screened completely by the light microscope, and the remaining cases needed additional light microscopy of a part of the smear. As a result, PAPNET-assisted screening was approximately two times faster. The great advantage of the method is that it is much less tiring for the eyes than conventional screening, making fatigue-related errors less likely, and if a smear contains only a few abnormal cells, these are easier to find.

Telecytology:Diagnostic Accuracy in Cervical-Vaginal Smears

“…This false-negative rate is higher than reported by Koss and associates," Slagel and coworkers, 14 and others. 10 The discrepancy between our and other's data may be due to differences in study design, but needs further investigation.…”

PAPNET for Cervical Cytology Screening

“…To facilitate, abnormal cells are displayed side by side on the video screen so that they can be compared and interpreted more easily. 17 To improve diagnosis, such systems can be used to generate large databases for teaching and testing medical professionals, thus enhancing the exchange of knowledge worldwide. Automation can also bring a higher level of objectivity, 16 and in remote areas it can bring the benefits of expert diagnosis.…”

Assessing the Costs and Benefits of Alternative Rescreening Strategies

“…In published studies, the PAPNET system had a 27% selection rate, with an estimated increase in sensitivity of 9.9%. 11 Without including the cost of image review by the cytotechnologist in the analysis or the costs of the additional management and labor that would be required to organize, ship and receive back a laboratory's entire output of "negative" slides, the PAPNET method results in about four times the cost of additional abnormal cases discovered as compared to 100% manual rescreening, yet the number of missed abnormals that the PAPNET system can be expected to help detect is less than the number from 100% manual rescreening.…”