title: Performance of a semiautomated Papanicolaou smear screening system: results of a population-based study conducted in Guanacaste, Costa Rica.
abstract: BACKGROUND
  Automated cytology devices have utility in quality assurance applications, but the effectiveness of these devices in primary screening is unknown.
  
  
  METHODS
  Enrollment smears obtained from 7323 women participating in a population-based study sponsored by the National Cancer Institute were screened manually in Costa Rica and then evaluated independently in the U.S. with the PAPNET system (Neuromedical Systems, Inc., Suffern, NY), a semiautomated, neural network-based device. Smears with abnormal PAPNET images were microscopically rescreened and then diagnosed by a U.S. cytopathologist. ThinPrep slides (Cytyc Corporation, Boxborough, MA), prepared from rinses of the cytologic sampler, and cervigrams (National Testing Laboratories, Fenton, MO) were also evaluated. Women with any abnormal cytologic diagnosis or a positive cervigram were referred for colposcopy with biopsy and definitive therapy if indicated.
  
  
  RESULTS
  Based on the U.S. cytotechnologist's review of the PAPNET images, 1017 (13.9%) of 7323 smears were selected for manual screening, resulting in the selection of 492 (6.7%) possibly abnormal slides for referral to the U.S. pathologist. Ultimately, 312 smears (4.3% of the total) were diagnosed as containing squamous cells of undetermined significance or a more severe abnormality (> or =ASCUS), resulting, hypothetically, in the referral of 66.5% of women with a final diagnosis of a squamous intraepithelial lesion or a more severe abnormality (> or =SIL) and 86.0% of patients with > or =high grade SIL. Conventional microscopic screening performed in Costa Rica resulted in the hypothetical referral of 6.5% of patients with > or =ASCUS for colposcopy, including 69.5% of patients with > or =SIL and 79.8% of those with > or =high grade SIL.
  
  
  CONCLUSIONS
  In this study, PAPNET-assisted cytologic screening accurately identified smears obtained from women with high grade SIL or carcinoma. Determination of the clinical cost-effectiveness of PAPNET-assisted screening in routine practice awaits future study.
authors.affiliation: Department of Pathology, the Johns Hopkins Medical Institutions, Baltimore, Maryland, USA.
authors.forename: M E
authors.initials: ME
authors.lastname: Sherman
authors.forename: M
authors.initials: M
authors.lastname: Schiffman
authors.forename: R
authors.initials: R
authors.lastname: Herrero
authors.forename: D
authors.initials: D
authors.lastname: Kelly
authors.forename: C
authors.initials: C
authors.lastname: Bratti
authors.forename: L J
authors.initials: LJ
authors.lastname: Mango
authors.forename: M
authors.initials: M
authors.lastname: Alfaro
authors.forename: M L
authors.initials: ML
authors.lastname: Hutchinson
authors.forename: F
authors.initials: F
authors.lastname: Mena
authors.forename: A
authors.initials: A
authors.lastname: Hildesheim
authors.forename: J
authors.initials: J
authors.lastname: Morales
authors.forename: M D
authors.initials: MD
authors.lastname: Greenberg
authors.forename: I
authors.initials: I
authors.lastname: Balmaceda
authors.forename: A T
authors.initials: AT
authors.lastname: Lorincz
mesh_terms: D015331:Cohort Studies; D003364:Costa Rica; D004279:DNA, Viral / Q000302:isolation & purification; D005260:Female; D006801:Humans; D008403:Mass Screening / Q000379:methods*; D016571:Neural Networks, Computer; D065006:Papanicolaou Test; D027383:Papillomaviridae / Q000302:isolation & purification; D011230:Precancerous Conditions / Q000473:pathology* / Q000821:virology; D011446:Prospective Studies; D012017:Referral and Consultation; D014481:United States; D002583:Uterine Cervical Neoplasms / Q000473:pathology* / Q000821:virology; D014626:Vaginal Smears / Q000295:instrumentation / Q000379:methods*
chemical_list: D004279:DNA, Viral