Effectiveness of the ThinPrep Imaging System: Clinical experience in a low risk screening population

Papillo, Jacalyn L.; John, Timothy L. St.; Leiman, Gladwyn

doi:10.1002/dc.20779

Cited by 40 publications

(74 citation statements)

References 9 publications

(18 reference statements)

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Previous data in nonrandomized settings have shown better performance of CAS compared with manually read LBC [16][17][18]28,29 and CC. 15,17 In a large prospective Australian 1 Conventional cytology: total n cytologically positives: 93 (60 histologically confirmed, 33 imputed).…”

Section: Discussionmentioning

confidence: 99%

“…31 The proportion of 3% of specimens found insufficient for CAS analysis in our study was likely due to technical limitations of CAS, as reported by the manufacturer and in the literature. [16][17][18] Small bubbles which occur during preparation do not interfere with manual reading of LBC but are not acceptable for CAS, since the computer imager might read them as enlarged nuclei.…”

Section: Discussionmentioning

confidence: 99%

“…Recently, several studies have indicated the potential of a new computer-assisted technique (CAS) to improve the sensitivity of LBC without a loss in specificity. [15][16][17][18] Since 1971 in Germany, women have had legal and free access to an annual conventional cytologic smear starting at 20 years of age with no upper age limit. 19 Smears are taken and processed by gynecologists if the woman presents at the practice.…”

mentioning

confidence: 99%

See 2 more Smart Citations

A randomized trial comparing conventional cytology to liquid‐based cytology and computer assistance

Klug

Neis

Harlfinger³

et al. 2012

Intl Journal of Cancer

View full text Add to dashboard Cite

Liquid-based cytology (LBC) has replaced conventional cytology (CC) for cervical cancer screening in some countries. However, it remains unclear whether LBC is superior to CC. A randomized controlled trial was conducted between August 2007 and March 2009 in Germany to compare LBC, alone and in combination with computer-assisted imaging technology (CAS), to CC in the detection of histologically confirmed cervical intraepithelial neoplasia (CIN). The main outcome measures were detection rates, relative sensitivities, positive predictive values (PPVs) and relative PPVs comparing LBC without and with CAS to CC. Primary histological outcome was CIN2 or higher. Included were 20,627 women participating in opportunistic cervical cancer screening at 20 gynecologic practices. The practices were randomized weekly to use LBC (n 5 11,331) or CC (n 5 9,296). Patients with positive findings were invited to expert colposcopy. The relative sensitivity of LBC versus CC using the CIN21 cut-off was 2.74 (95% confidence interval [CI] 1.66-4.53). The relative sensitivity of LBC/CAS versus CC for CIN21 was 3.17 (95% CI 1. 94-5.19). The PPV of LBC and CC for CIN21 was 48% and 38%, respectively. The PPV ratio did not differ significantly from unity. Differences between LBC and CC were smaller in some sensitivity and subgroup analyses; however, relative sensitivity of LBC remained increased. LBC without and with CAS compared with CC under the field conditions of an opportunistic screening system had a significantly higher sensitivity for the detection of CIN without deterioration of PPVs. Additional use of CAS did not further improve sensitivity of LBC. V C 2012 Wiley Periodicals, Inc.Key words: randomized controlled trial, early detection of cancer, uterine cervical neoplasm, Papanicolaou smear, liquid-based cytology, computer-assisted imaging technology Additional Supporting Information may be found in the online version of this article. Stefanie J. Klug, Jochem K€ onig and Hans Ikenberg had full access to all the data of the study. They take responsibility for the integrity of the data and the accuracy of the data analysis. Hans Ikenberg, Stefanie J. Klug, Klaus J. Neis and Werner Harlfinger take responsibility for the study concept and design. Werner Harlfinger and Klaus J. Neis take responsibility for the acquisition of data. Stefanie J. Klug, Jochem K€ onig, Veronika Weyer and Hans Ikenberg take responsibility for the analysis and interpretation of data. Stefanie J. Klug and Hans Ikenberg take responsibility for the drafting of the manuscript. All are responsible for the critical revision of the manuscript for important intellectual content. Jochem K€ onig, Veronika Weyer and Stefanie J. Klug did the statistical analysis. Werner Harlfinger, Klaus J. Neis, Armin Malter and Hans Ikenberg obtained funding. Sibylle Spieth, Friederike Brinkmann-Smetanay and Friedrich Kommoss had the administrative, technical or material support. Study supervision is by Hans Ikenberg, Werner Harlfinger, Klaus J. Neis and Stefanie J. Klug. Stefanie J. Klu...

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

See 1 more Smart Citation

A randomized trial comparing conventional cytology to liquid‐based cytology and computer assistance

Klug

Neis

Harlfinger³

et al. 2012

Intl Journal of Cancer

View full text Add to dashboard Cite

show abstract

“…17 Papillo et al reported a 10%-30% increased productivity over manual screening, but provided no information on hourly or daily screening rates. 18 Lozano et al, conversely, found no appreciable differences in CT screening rates or productivity between manual screening and ThinPrep Imaging system: manual average 77 slides per day (range, 56-99) compared with ThinPrep Imaging system average 78 slides per day (range, 61-111). 16 At the very least, our data and those of the literature, where studies evaluated routine laboratory settings, suggest caution at allowing CTs to screen at rates above 100 slides per day, even with the ThinPrep Imaging system.…”

Section: Original Articlementioning

confidence: 94%

“…Our productivity and screening rates are similar to other ThinPrep Imaging system studies that were performed in independent laboratories under routine screening settings. [15][16][17][18] Davey et al reported a daily average screening rate of 93 slides using the ThinPrep Imaging system (range, 85.75 to 100.5). 15 Pacheco et al experienced a mean lab increase in productivity of 23.5% with the ThinPrep Imaging system over manual screening (11.7 slides vs 9.5 slides per hour).…”

Section: Original Articlementioning

confidence: 99%

Does the time of day or weekday affect screening accuracy?

Elsheikh

Kirkpatrick²,

Fischer³

et al. 2010

Cancer Cytopathology

View full text Add to dashboard Cite

BACKGROUND: Workload is extensively regulated in gynecologic cytology. However, sensitive monitors of excessive workload are not available. METHODS: We measured the variation in abnormal (atypical squamous cells [ASC], lowgrade squamous intraepithelial lesion [LSIL], and high-grade squamous intraepithelial lesion [HSIL]) rates for 4 cytotechnologists (CTs) among different days of the week and at different times during the day while they were performing primary screening with the ThinPrep Imaging System. RESULTS: Three of 4 CTs detected significantly less abnormal cases on 1 day of the week than another (1 Monday, 2 Friday). Two of those CTs detected significantly fewer total abnormal cases in the afternoon than in the morning; this was strongly correlated with increased speed in the afternoon and decreased detection of ASC cases. HPV þ rates for ASC cases dropped as the abnormal rate dropped. The third CT detected significantly fewer ASC cases in the morning; this was counterbalanced by an increase detection of LSIL cases, suggesting a shift in diagnostic threshold between the AM and PM. The difference in abnormal detection rates between morning and afternoon correlated with a false-negative fraction of 0.96. CONCLUSIONS: There are significant differences in detection rates of abnormal cases between days of the week and the morning and afternoon. Correlating abnormal rates and workload between the morning and afternoon may represent a sensitive way to detect excessive workload. Because individual CTs may have different responses to workload and no overall pattern emerged, data on their workload and performance need to be tracked individually. Cancer (Cancer Cytopathol) 2010;118:41-6.

show abstract

Implementation of the Thinprep imaging system in a tertiary military medical center

Duby

DiFurio

2009

Cancer Cytopathology

View full text Add to dashboard Cite

BACKGROUND: The ThinPrep Imaging System (TIS) was implemented at Brooke Army Medical Center (BAMC) in February 2006 and has been a crucial part of the ability of the Department of Pathology and Laboratory Services ability to improve efficiency and turnaround times for Papanicolaou (Pap) test reporting. The increased detection rate of squamous abnormalities, specifically high‐grade squamous intraepithelial lesions (HSIL), has been well documented by many studies. In addition, the TIS has increased productivity for many laboratories. The objective of this study was to evaluate the effects of implementing the TIS at BAMC, a tertiary military medical center. Specifically, the following were assessed: 1) whether the detection of squamous abnormalities was increased with the TIS, 2) how the rate of high‐risk human papillomavirus (HR‐HPV) detection in atypical squamous cells (ASC) of undetermined significance (ASC‐US) cases changed (or did not change) before and after implementation of the TIS, and 3) how the TIS influenced productivity. METHODS: All gynecologic cytology at BAMC has been collected and processed using the ThinPrep system since 2002. Before February 2006 and before implementation of the TIS, Pap tests were screened manually by the cytotechnologists. Detection rates of squamous abnormalities were compared between the period from February 2005 to December 2005 (manual screening) and the period from February 2006 to December 2006 (image‐assisted screening). Squamous abnormalities included ASC‐US; ASC, cannot rule out HSIL (ASC‐H); low‐grade squamous intraepithelial lesion (LSIL); HSIL; glandular abnormalities; and malignancies (squamous or glandular). In addition, the rates of HR‐HPV‐positive, HR‐HPV‐negative, and HR‐HPV‐quantity not sufficient were compared for the same periods. During both periods, testing for HR‐HPV was performed only on ASC‐US Pap tests. HR‐HPV was tested with Digene Hybrid Capture 2 methodology. Productivity was calculated as the change in average slides screened per hour before and after imager implementation. RESULTS: In total, 107,647 Pap tests were analyzed in the 2005 (54,438 Pap tests) and 2006 (53,209 Pap tests) timeframes. Increases in the detection of ASC‐H, atypical glandular cells (AGC), LSIL, and HSIL were statistically significant. The proportion of negative for intraepithelial lesion or malignancy (NILM) and unsatisfactory cases decreased significantly with implementation of the TIS. The ASC to squamous intraepithelial lesion (ASC:SIL) ratio decreased from 1.5 to 1.0 after TIS implementation. Decreases in the ASC‐US HR‐HPV‐positive proportion and increases in the ASC‐US HR‐HPV‐negative proportion after implementation of the TIS were statistically significant. In our laboratory, a 60% increase in productivity was noted with use of the TIS. CONCLUSIONS: Implementation of the TIS at BAMC significantly increased the detection of ASC‐H, AGC, LSIL, and HSIL but had no significant impact on the ASC‐US detection rate. Although the ASC‐US rate did not change, both the HR‐H...

show abstract

Effectiveness of the ThinPrep Imaging System: Clinical experience in a low risk screening population

Cited by 40 publications

References 9 publications

A randomized trial comparing conventional cytology to liquid‐based cytology and computer assistance

A randomized trial comparing conventional cytology to liquid‐based cytology and computer assistance

Does the time of day or weekday affect screening accuracy?

Implementation of the Thinprep imaging system in a tertiary military medical center

Contact Info

Product

Resources

About