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Costs and Outcomes of PAPNET Secondary Screening Technology for Cervical Cytologic Evaluation
A Community Hospital's Experience
Gregory L. Brotzman, MD;
Susan Kretzchmar, MD;
David Ferguson, MD;
Mark Gottlieb, PhD;
Colleen Stowe, CT(ASCP)
Arch Fam Med. 1999;8:52-55.
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.
From the Department of Family and Community Medicine, Medical College of Wisconsin (Drs Brotzman and Gottlieb), and the Department of Clinical Pathology (Drs Kretzchmar and Ferguson) and Cytotechnology Laboratory (Ms Stowe), Columbia Hospital, Milwaukee, Wis.
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