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Costs and outcomes of PAPNET secondary screening technology for cervical cytologic evaluation. A community hospital's
G L Brotzman1, S Kretzchmar, D Ferguson
1Department of Family and Community Medicine, Medical College of Wisconsin, USA.
Objective:
To determine the effectiveness of and costs associated with semiautomated rescreening of Papanicolaou smears with negative findings at a community hospital.
Design:
A prospective study of 1200 Papanicolaou smear slides with negative findings using the PAPNET screening system (Neuromedical Systems, Incorporated, Suffern, NY).
Setting:
Community hospital laboratory.
Patients:
Patients with negative findings on Papanicolaou smears who agreed to have their smears reviewed using PAPNET.
Interventions:
None.
Main Outcome Measures:
Results of rescreening and resources involved in processing the PAPNET review.
Results:
Screening with PAPNET identified 8 patients with atypical squamous cells of undetermined significance (ASCUS) that were not diagnosed on initial screening, yielding a false-negative rate in our laboratory of 0.7% for ASCUS. No low- or high-grade squamous intraepithelial lesions were identified. Based on our laboratory processing 6000 Papanicolaou smears a year, at $19 per slide, it would cost our laboratory $102,600 for PAPNET review of all smears with negative findings. In contrast, the estimated cost to have another cytotechnologist review all such smears manually would cost $11,977. The rate of changed diagnoses in the PAPNET group was similar to the rate in our standard rescreening of 10% of all smears with negative findings. Mean turnaround time for a PAPNET screen was 13.9 days, compared with 3.9 days for manual review.
Conclusions:
For a laboratory with a low percentage of smears with abnormal findings, a quality cytotechnologist and pathologist, and required quality assurance standards in place, PAPNET may not improve appreciably the pick-up rate for missed cervical lesions, and may add significantly to the cost and turnaround time of cytologic evaluation of cervical smears.