Sherman M E, Schiffman M, Herrero R, Kelly D, Bratti C, Mango L J, Alfaro M, Hutchinson M L, Mena F, Hildesheim A, Morales J, Greenberg M D, Balmaceda I, Lorincz A T
Department of Pathology, the Johns Hopkins Medical Institutions, Baltimore, Maryland, USA.
Cancer. 1998 Oct 25;84(5):273-80.
Automated cytology devices have utility in quality assurance applications, but the effectiveness of these devices in primary screening is unknown.
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.
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.
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.
自动化细胞学设备在质量保证应用中具有实用价值，但这些设备在初筛中的有效性尚不清楚。
从参与美国国立癌症研究所资助的一项基于人群的研究的7323名女性中获取登记涂片，先在哥斯达黎加进行人工筛查，然后在美国使用PAPNET系统（Neuromedical Systems公司，纽约州苏芬）进行独立评估，该系统是一种基于神经网络的半自动设备。对PAPNET图像异常的涂片进行显微镜复查，然后由一名美国细胞病理学家进行诊断。还对由细胞学采样器冲洗液制备的ThinPrep玻片（Cytyc公司，马萨诸塞州博克斯伯勒）和宫颈图像（国家检测实验室，密苏里州芬顿）进行了评估。任何细胞学诊断异常或宫颈图像阳性的女性均被转诊进行阴道镜检查，并在必要时进行活检和确定性治疗。
根据美国细胞技术人员对PAPNET图像的复查，7323份涂片中的1017份（13.9%）被选作人工筛查，结果选出492份（6.7%）可能异常的玻片转诊给美国病理学家。最终，312份涂片（占总数的4.3%）被诊断为含有意义不明确的鳞状细胞或更严重的异常（≥ASCUS），假设这导致66.5%最终诊断为鳞状上皮内病变或更严重异常（≥SIL）的女性以及86.0%≥高级别SIL的患者被转诊。在哥斯达黎加进行的传统显微镜筛查假设导致6.5%≥ASCUS的患者被转诊进行阴道镜检查，包括69.5%≥SIL的患者和79.8%≥高级别SIL的患者。
在本研究中，PAPNET辅助的细胞学筛查准确识别了来自高级别SIL或癌女性的涂片。PAPNET辅助筛查在常规实践中的临床成本效益有待未来研究确定。
