title: Effects of transitioning from conventional methods to liquid-based methods on unsatisfactory Papanicolaou tests: results from a multicenter US study.
abstract: BACKGROUND
  Papanicolaou (Pap) testing has transitioned from conventional preparations (CPs) to liquid-based preparations (LBPs) because of the perceived superiority of LBPs. Many studies conclude that LBPs reduce unsatisfactory Pap tests; however, some believe that the evidence substantiating this claim is weak. The authors studied the effect of the transition from CPs to LBPs on the proportion of unsatisfactory Pap tests in 4 health care systems in the United States participating in the National Institutes of Health-funded Screening Effectiveness and Research in Community-Based Healthcare (SEARCH) project.
  
  
  METHODS
  The study cohort consisted of 548,174 women ages 21 to 65 years who had 1443,725 total Pap tests between 2000 and 2010. Segmented regression analysis was used to estimate the effect of adopting LBPs on the proportion of unsatisfactory Pap tests after adjusting for age.
  
  
  RESULTS
  Three sites that implemented SurePath LBP experienced significant reductions in unsatisfactory Pap tests (estimated effect: site 1, -2.46%; 95% confidence interval [CI], -1.47%, -3.45%; site 2, -1.78%; 95% CI, -1.54%, -2.02%; site 3, -8.25%; 95% CI, -7.33%, -9.17%). The fourth site that implemented ThinPrep LBP did not experience a reduction in unsatisfactory Pap tests. The relative risk of an unsatisfactory Pap test in women aged ≥ 50 years increased after the transition to LBPs (SurePath: relative risk, 2.1; 95% CI, 1.9-2.2; ThinPrep: relative risk, 1.7; 95% CI, 1.5-2.0).
  
  
  CONCLUSIONS
  The observed changes in the proportion of unsatisfactory Pap tests varied across the participating sites and depended on the type of LBP technology, the age of women, and the rates before the implementation of this technology.
authors: Meyers Primary Care Institute, a joint endeavor of the University of Massachusetts Medical School, Fallon Community Health Plan, and Reliant Medical Group, Worcester, Massachusetts; Department of Pathology, University of Massachusetts Medical School, Worcester, Massachusetts.
authors: Christopher L
authors: CL
authors: Owens
authors: Dan
authors: D
authors: Peterson
authors: Aruna
authors: A
authors: Kamineni
authors: Diana S M
authors: DS
authors: Buist
authors: Sheila
authors: S
authors: Weinmann
authors: Tyler R
authors: TR
authors: Ross
authors: Andrew E
authors: AE
authors: Williams
authors: Azadeh
authors: A
authors: Stark
authors: Kenneth F
authors: KF
authors: Adams
authors: Terry S
authors: TS
authors: Field
mesh_terms: D000328:Adult; D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000175:diagnosis* / Q000453:epidemiology; D003581:Cytodiagnosis; D055088:Early Detection of Cancer / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008403:Mass Screening; D008875:Middle Aged; D060787:Neoplasm Grading; D065006:Papanicolaou Test; D011379:Prognosis; D014481:United States / Q000453:epidemiology; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis* / Q000453:epidemiology; D014626:Vaginal Smears; D055815:Young Adult; D002578:Uterine Cervical Dysplasia / Q000175:diagnosis* / Q000453:epidemiology
keywords: Papanicolaou test; SurePath; ThinPrep; conventional; liquid based; unsatisfactory
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