PAPNET-Assisted Rescreening of Cervical Smears

Abstract

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

The False-Negative Fraction: A Statistical Method to Measure the Efficacy of Cervical Smear Screening Laboratories

“…However, other laboratories haveachieved comparable results with traditional methods, usually at lower cost. 5 The FNF is a measureofPap smear screening efficacy that is gaining widespread mention in the laboratory science literature. When providers are deciding where to send Pap smears, it may be wise to consider whethera candidate laboratory has a FNF that is sufficiently low to indicate the practice of superior CVS screening.…”

CytoView

“…Such image analysis systems may eventually play a major role in screening and diagnosis of cervical cancer. 3 Other potential applications include teaching, training, diagnostic consultation and PT. 4 Our primary purpose here was to develop and assess the feasibility of using computerized image technology for PT and training in cervical cytology.…”

Cost Analysis of PAPNET-Assisted vs. Conventional Pap Smear Evaluation in Primary Screening of Cervical Smears

“…Several studies have assessed the effectiveness 1,3,4,9,14 or have explored the cost implications 5 and cost-effectiveness 6,[11][12][13]15 of the PAPNET system. These studies all referred to a situation where PAPNET was used as a rescreening instrument and used anecdotal information concerning resource implications.…”