Cervical screening programmes: can automation help? Evidence from systematic reviews, an economic analysis and a simulation modelling exercise applied to the UK

Willis, Brian H; Barton, Pelham; Pearmain, Philippa; Bryan, Stirling; Hyde, CJ

doi:10.3310/hta9130

Cited by 83 publications

(17 citation statements)

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“…Verification thus depends on the sum of the test results, not on the discordance between the index test and the CGS as in our example. In specific cases, verification in cervical cancer screening studies might only be performed on discordant results while concordant results are never verified [23]. This represents the most extreme form of discordant verification bias and has been described methodologically by Miller before [24].…”

Section: Discussionmentioning

confidence: 99%

Partial verification bias and incorporation bias affected accuracy estimates of diagnostic studies for biomarkers that were part of an existing composite gold standard

Karch

Koch

Zapf³

et al. 2016

Journal of Clinical Epidemiology

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Abstract:Objective: To investigate how choice of gold standard biases estimates of sensitivity and specificity in studies reassessing the diagnostic accuracy of biomarkers that are already part of a lifetime composite gold standard (CGS).Study design and Setting: We performed a simulation study based on the real-life example of the biomarker 'protein 14-3-3' used for diagnosing Creutzfeldt-Jakob disease. Three different types of gold standard were compared: perfect gold standard 'autopsy' (available in a small fraction only; prone to partial verification bias), lifetime CGS (including the biomarker under investigation; prone to incorporation bias) and 'best available' gold standard (autopsy if available, otherwise CGS).Results: Sensitivity was unbiased when comparing 14-3-3 with autopsy, but overestimated when using CGS or 'best available' gold standard. Specificity of 14-3-3 was underestimated in scenarios comparing 14-3-3 with autopsy (up to 24%). In contrast, overestimation (up to 20%) was observed for specificity compared with CGS; this could be reduced to 0-10% when using the 'best available' gold standard.Conclusion: Choice of gold standard affects considerably estimates of diagnostic accuracy. Using the 'best available' gold standard (autopsy where available, otherwise CGS) leads to valid estimates of specificity, whereas sensitivity is estimated best when tested against autopsy alone. Karch et al. 4 Keywords:Diagnostic validity, incorporation bias, partial verification bias, Creutzfeldt-Jakob disease, 14-3-3, autopsy Running title:Competing biases in diagnostic studies for already established biomarkers What is new:-We assessed for the first time how choice of gold standard biases estimates of diagnostic accuracy in the reassessment of biomarkers that are already part of a lifetime composite gold standard (CGS) and identified a new type of partial verification bias (which we call 'discordant partial verification bias').-We showed that, in studies reassessing the diagnostic accuracy of already established biomarkers, use of the 'best available' gold standard (autopsy where available, otherwise CGS) leads to valid estimates of specificity, whereas sensitivity is estimated best when tested against autopsy alone.-Future studies need to take our results into account and should follow our recommendations for study design in order to prevent over-as well as underestimation of diagnostic accuracy. Karch et al. 5

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Section: Discussionmentioning

confidence: 99%

Partial verification bias and incorporation bias affected accuracy estimates of diagnostic studies for biomarkers that were part of an existing composite gold standard

Karch

Koch

Zapf³

et al. 2016

Journal of Clinical Epidemiology

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“…Such cervical cytology can have a high specificity of 95-98% but a sensitivity of lower than 50% [36]. Other methods such as automated cytology and human papilloma virus (HPV) testing [37][38][39] have been introduced to reduce the false negative rates. An abnormal Pap smear is followed by colposcopic examination, biopsy and histological confirmation of the clinical diagnosis.…”

Section: Vibrational Spectroscopy For Cervical Cancer Pathology [34]mentioning

confidence: 99%

Vibrational Spectroscopy: Disease Diagnostics and Beyond

Byrne¹,

Ostrowska²,

Nawaz³

et al. 2013

Challenges and Advances in Computational Chemistry and Physics

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SummaryThis chapter outlines some developments in the applications of vibrational spectroscopy for disease diagnostics and demonstrates how the applications of the spectroscopic techniques can be extended to the analysis and evaluation of disease aetiology and the mechanisms of interaction with and the cellular and subcellular responses to, for example, chemotherapeutic agents and nanoparticles. The primary emphasis is on Raman spectroscopy, although some examples are based on infrared absorption spectroscopy. The studies presented are chosen to illustrate how a range of multivariate analytical techniques can be employed to maximize the potential benefits of the complex spectral information obtained from tissue or cells.

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“…Particular consideration was given to health technology assessments conducted in Australia [11], New Zealand [12], and various European states [13,14,15,16], including the recent MAVARIC report [17,18]. All Italian literature on the subject was also acquired [6,19,20,21,22,23,24,25].…”

Section: Methodsmentioning

confidence: 99%

Health Technology Assessment of Computer-Assisted Pap Test Screening in Italy

Palma

Moresco²,

Rossi³

2013

Acta Cytologica

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Objective: To assess the introduction of computer-assisted Pap test screening in cervical cancer screening. Various scenarios are considered: conventional and liquid-based cytology (LBC) slides, fully automatic instrumentation (Becton Dickinson FocalPoint™ Slide Profiler and Hologic ThinPrep® Imaging System), and semiautomatic scanner (Hologic Integrated Imager I-Squared). Methods: A working group was formed that included researchers from the largest centers already using instrumentation. A questionnaire on laboratory management and on social/ethical issues and annual workload was proposed. Prices for the technology were obtained directly from the producers; costs were calculated from observed and literature data. The scope of the report and final draft were submitted to a consulting committee of stakeholders. Results: The break-even point was found to be 49,000 cases/year, if conventional slides were used, while it was near the theoretical maximum capacity, 70,000 cases/year, with LBC slides. Efficiency increased with the volume of slides. Screening time decreased by two thirds for conventional slides and by less than half for LBC slides. Acceptance of the instrumentation by the users was good. Conclusions: Computer-assisted screening may increase productivity even if in most situations it will mean additional costs. Furthermore, primary screening with human papillomavirus tests will drastically reduce the need for Pap test reading.

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Cervical screening programmes: can automation help? Evidence from systematic reviews, an economic analysis and a simulation modelling exercise applied to the UK

Cited by 83 publications

References 0 publications

Partial verification bias and incorporation bias affected accuracy estimates of diagnostic studies for biomarkers that were part of an existing composite gold standard

Partial verification bias and incorporation bias affected accuracy estimates of diagnostic studies for biomarkers that were part of an existing composite gold standard

Vibrational Spectroscopy: Disease Diagnostics and Beyond

Health Technology Assessment of Computer-Assisted Pap Test Screening in Italy

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